Nutrition-related Health Outcomes Research Articles

Stressful Life Changes Affect Nutrition-Related Health Outcomes Among US Army Soldiers (P18-070-19)

ObjectivesThis prospective cohort study aimed to determine if experiencing stressful life changes were associated with an earlier onset of adverse nutrition-related health outcomes among US Army Soldiers. An additional aim was to determine which stressful life changes were most associated with these outcomes and if there were gender differences in the magnitude of the associations. MethodsStressful life changes were changes in marital status, combat deployment or returning from deployment, relocation, adding a child, change in rank, change in occupation, or development of a physical limitation to duty. Nutrition-related health outcomes were hyperlipidemia diagnosis, substantial weight gain, or weight-related separation from the Army. Using longitudinal data from the Stanford Military Data Repository representing all active-duty Soldiers who were age 17–62 between 2011 and 2014 (n = 827,126), event history analysis was used to model the association of stressful life changes with nutrition-related outcomes. ResultsMarriage was found to raise the odds of substantial weight gain three months later by 1.24 times (95% CI: 1.16, 1.32) for men and 1.68 times (95% CI: 1.51, 1.89) for women. Developing a physical duty limitation raised the odds of hyperlipidemia two months later by 1.42 times (95% CI: 1.15, 0.75) for men and 1.83 times (95% CI: 1.01, 3.32) for women and the odds of substantial weight gain two months later by 3.16 times (95% CI: 2.89, 3.44) in men and 1.69 times (95% CI: 1.36, 2.08) in women. ConclusionsDifferences in the magnitude of associations show stressful life changes affect male and female Soldiers differently. Identifying times after stressful life changes when the risk of developing an undesirable health outcome is highest offers new possibilities for proactively addressing health. Findings could guide the timing of interventions to mitigate the effects of stress on health in military and civilian populations. Funding SourcesNone. Disclaimer: Authors’ views do not reflect official DoD or Army policy.

Reporting Accuracy of Energy Intake Among Exclusively Formula-Fed Infants (P11-097-19)

ObjectivesAssessment of diet is important for understanding nutrition-related health outcomes. Like all methods, diet assessment is subject to error. Error, and in turn reporting accuracy, have been studied extensively in the adult literature but to a lesser extent in the pediatric literature. In the present study, we utilized data on energy intake (EI) and total energy expenditure (TEE) in a racially diverse and contemporary cohort of healthy exclusively formula-fed newborns to determine EI reporting accuracy. MethodsIn 0.75-month-old term infants (n = 113; 62% black), we measured TEE using the doubly labeled water method and EI using the 3-day weighed bottle method with diet records. Mothers were provided with pre-weighed bottles from which to feed their infants and bottles were weighed by study staff upon return; diet records were analyzed using Nutrient Data Software for Research. Since energy is needed for growth, the estimated energy requirement (EER) was calculated using TEE + energy cost of tissue deposition (175 kcal/d). EI was defined as the mean energy intake over the 3-day period and reporting accuracy was defined as the ratio of EI: EER, which should be equivalent to 1.0 in healthy infants. The cutoff range for implausible reporters was: greater than or less than 1.0 –2*the square root of the average within subject coefficient of variation for EI (12.5%)/100 and TEE (8.2%)/100. EI: EER ratios within the cutoff range (i.e., 0.778-1.222) were categorized as plausible reports, and those below or above the cutoff categorized as non-plausible under-reports and over-reports of EI. ResultsThe mean EI: EER was 1.037, with a minimum and maximum of 0.360 and 1.907, respectively. Approximately half (49%) of the ratios were deemed plausible, whereas the remainder were implausible under reports (24%) or over reports (27%). Among plausible reports, the mean EI: EER ratio was 0.990 with a minimum and maximum of 0.778 and 1.217, respectively. ConclusionsDespite using the weighed bottle method, only half of the EI reports were plausible. Future research needs to optimize the weighed bottle method to improve accuracy among newly parturient mothers, and consider the accuracy of reported EI when evaluating the impact of early diet on health outcomes. Funding SourcesNIH Grants HD072307 and HD094908.

The Effectiveness of App-Based Mobile Interventions on Nutrition Behaviors and Nutrition-Related Health Outcomes: A Systematic Review and Meta-Analysis

Background: App-based mobile nutrition interventions offer a promising approach for fighting obesity and nutrition-related diseases in a broad spectrum of the population, but reliable estimates of their effectiveness in changing nutrition behaviors and achieving nutrition-related health outcomes are scarce. We conducted a systematic review and meta-analysis to assess the effectiveness and characteristics of interventions such as behavior change techniques (BCTs) on nutrition behaviors, obesity indices, and clinical metabolic parameters. Methods. We searched seven databases (MEDLINE, PubMed, PsycINFO, PsycIndex, PsycArticle, SPORTDiscus, and Web of Science) for intervention studies using a smartphone application to promote changes in nutrition behaviors and nutrition-related health outcomes between 2006 and June 2017, including all intervention study designs and populations. Data was extracted following a predefined hierarchy. Independent researchers then reviewed the search results to identify pre-specified outcomes and key characteristics. We assessed the studies' risk of bias in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, and the certainty of evidence using the CONSORT 2010 checklist. Outcomes were changes in nutrition behaviors (primary) and consequent nutrition-related health outcomes (secondary). We estimated pooled effect sizes using meta-analysis with random effects, and conducted separate meta-regressions to identify meaningful moderators. Findings: Forty-one of the 10 132 interventions identified in the meta-analysis met our selection criteria, comprising 6 348 participants and 373 outcomes from 27 RCTs with sample sizes ranging from 10 to 833 participants. In terms of efficacy, a beneficial effect of app-based mobile interventions was identified for both nutrition behaviors (g = 0·19, CI = 0·06 - 0·32, p = ·004) and nutrition-related health outcomes (g = 0·24, CI = 0·06 - 0·43, p = ·009), including positive effects on obesity indices (g = 0·47, CI = 0·06 - 0·87, p = ·024), blood pressure (g = 0·22, CI = 0·01 - 0·42, p = ·043), and blood fats (g = 0·16, CI = 0·03 - 0·28, p = ·018). Most interventions comprised of four BCTs, namely 'Goals & Planning', 'Feedback & Monitoring', 'Shaping Knowledge', and 'Social Support'. Moderating effects including RCT vs. non-RCT, the type of app, and sample and intervention characteristics were not statistically significant. Interpretation. Focused app-based mobile interventions are effective in changing nutrition behaviors and nutrition-related health outcomes, which highlights their potential for fighting the obesity epidemic in a broad spectrum of the population. These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of mobile interventions. Funding: Federal Ministry of Education and Research and the German Research Foundation (SmartAct, 74 BMBF Grant 01EL1820A; RiskDynamics, DFG Grant FOR 2374). Competing financial interests: The authors declare no competing financial interests.

The Effectiveness of App-Based Mobile Interventions on Nutrition Behaviors and Nutrition-Related Health Outcomes: A Systematic Review and Meta-Analysis

The Effectiveness of App-Based Mobile Interventions on Nutrition Behaviors and Nutrition-Related Health Outcomes: A Systematic Review and Meta-Analysis

Review of Health Literacy and Nutrition-Related Research in the Middle East

Aim: In the Middle East where nutrition-related diseases continue to be on the rise, health literacy related research may provide meaningful insight to patient-provider communication, nutrition and general health behavior, to improve health outcomes. Yet, little is known about health literacy in the region. We provide insight into the current research on health literacy and nutrition-related outcomes in the region. Methods: English-language articles were identified using relevant keywords to search PubMed, Medline, Web of Science, and ProQuest Middle East & African. Inclusion criteria were quantitative and qualitative studies of any design focused on health literacy and nutrition-related health outcomes in the Middle East. We identified 22 unduplicated articles that met inclusion criteria.Results: To date, only three studies employ a validated health literacy measure to examine the relationship between health literacy and nutrition-related disease outcomes (e.g., diabetes, overweight, and obesity). However, the research findings from the three studies cannot be generalized to larger populations within each country. Participants were patients who regularly visited health care facilities. The limited samples may bias conclusions regarding health literacy and the influence on nutrition-related disease outcomes.Conclusions: Research is needed to understand health literacy and health literacy needs in Middle East countries, which are known for their racial and ethnic, and socio-economic diversity. Researchers can take advantage of the multitude of health literacy tools which have been validated and are readily available for use in diverse populations. Established health literacy measures provide greater benefit than developing brand new assessments when important information is urgently needed to address nutrition-related health outcomes.

Food and nutrition programs for Aboriginal and Torres Strait Islander Australians: an overview of systematic reviews.

Objective To provide an overview of previous reviews of programs that aimed to improve nutritional status or diet-related health outcomes for Aboriginal and Torres Strait Islander peoples, in order to determine what programs are effective and why. Methods A systematic search of databases and relevant websites was undertaken to identify reviews of nutrition interventions for Aboriginal and Torres Strait Islander Australians. Pairs of reviewers undertook study selection and data extraction and performed quality assessment using a validated tool. Results Twelve papers reporting 11 reviews were identified. Two reviews were rated high quality, three were rated medium and six were rated low quality. The reviews demonstrated that a positive effect on nutrition and chronic disease indicators can be a result of: 1) incorporating nutrition and breastfeeding advice into maternal and child health care services; and 2) multifaceted community nutrition programs. The evidence suggests that the most important factor determining the success of Aboriginal and Torres Strait Islander food and nutrition programs is community involvement in (and, ideally, control of) program development and implementation. Conclusions Community-directed food and nutrition programs, especially those with multiple components that address the underlying causes of nutrition issues, can be effective in improving nutrition-related outcomes. What is known about the topic? More effective action is urgently required in order to reduce the unacceptable health inequalities between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Food insecurity and nutrition-related chronic conditions are responsible for a large proportion of the ill health experienced by Australia's First Peoples. What does this paper add? This narrative overview of 11 reviews published between 2005 and 2015 provides a synthesis of the current evidence for improving Aboriginal and Torres Strait Islander nutrition across the lifespan. The findings suggest that community-based and community-controlled programs, especially those with multiple components that address the underlying causes of nutrition issues, have the greatest potential to improve nutrition-related health outcomes. What are the implications for practitioners? Food and nutrition programs that are initiated and designed by local Aboriginal and Torres Strait Islander people are most likely to be effective. Nutrition and breastfeeding education and advice should be consistently incorporated into maternal and child healthcare services. Nutrition issues should be addressed through multifaceted approaches that address improving individual knowledge and skills, as well as strategies that increase access to nutritious food and provide a healthy food environment.

Consumers' Response to an On-Shelf Nutrition Labelling System in Supermarkets: Evidence to Inform Policy and Practice.

Providing a nutrition rating system on the front of food packages or on retail shelf tags has been proposed as a policy strategy for supporting healthier food choices. Guiding Stars is an on-shelf nutrition labelling system that scores foods in a supermarket based on nutritional quality; scores are then translated into ratings of 0 to 3 stars. It is consistent with evidence-informed recommendations for well-designed labels, except for not labelling 0-star products. The largest supermarket retailer in Canada rolled out the Guiding Stars system in supermarkets across Ontario, Canada. The aim of our study was to examine the extent to which consumers respond to an on-shelf nutrition labelling system in supermarkets to inform current and future nutrition labelling policies and practices. Capitalizing on a natural experiment, we conducted a quasi-experimental study across 3 supermarket banners (or "chains") in Ontario, one of which implemented the Guiding Stars system in 2012. We used aggregated supermarket transaction data to test the effect of Guiding Stars on the nutritional quality of food purchases in intervention supermarkets relative to control supermarkets. We also conducted exit surveys among 783 randomly selected shoppers from intervention and control supermarkets to assess consumer awareness, understanding, trust, and self-reported use of the labelling system. Relative to control supermarkets, shoppers in intervention supermarkets made small but significant shifts toward purchasing foods with higher nutritional ratings; however, shifts varied in direction and magnitude across food categories. These shifts translated into foods being purchased with slightly less trans fat and sugar and more fiber and omega-3 fatty acids. We also found increases in the number of products per transaction, price per product purchased, and total revenues. Results of the exit surveys indicate a modest proportion of consumers were aware of, understood, and trusted Guiding Stars in intervention supermarkets, and a small proportion of consumers reported using this system when making purchasing decisions. However, 47% of shoppers exposed to Guiding Stars were confused when asked to interpret the meaning of a 0-star product that does not display a rating on the shelf tag. This study demonstrates support for policies promoting on-shelf nutrition labels designed according to evidence-informed principles, but policymakers should move forward with caution when investing in such systems until research has confirmed optimal label design, clarified the mechanisms through which dietary intake is improved, and assessed associations with nutrition-related health outcomes.

Best (but oft-forgotten) practices: mediation analysis ,

This contribution in the "Best (but Oft-Forgotten) Practices" series considers mediation analysis. A mediator (sometimes referred to as an intermediate variable, surrogate endpoint, or intermediate endpoint) is a third variable that explains how or why ≥2 other variables relate in a putative causal pathway. The current article discusses mediation analysis with the ultimate intention of helping nutrition researchers to clarify the rationale for examining mediation, avoid common pitfalls when using the model, and conduct well-informed analyses that can contribute to improving causal inference in evaluations of underlying mechanisms of effects on nutrition-related behavioral and health outcomes. We give specific attention to underevaluated limitations inherent in common approaches to mediation. In addition, we discuss how to conduct a power analysis for mediation models and offer an applied example to demonstrate mediation analysis. Finally, we provide an example write-up of mediation analysis results as a model for applied researchers.

A Historical Review of Changes in Nutrition Standards of USDA Child Meal Programs Relative to Research Findings on the Nutritional Adequacy of Program Meals and the Diet and Nutritional Health of Participants: Implications for Future Research and the Summer Food Service Program.

Background: The USDA child meal programs (CMPs) (National School Lunch Program (NSLP), School Breakfast Program (SBP), and Summer Food Service Program (SFSP) were established in 1946 (NSLP) and 1975 (SBP and SFSP) to improve the diet and nutritional health of US children. There is concern that participation in these programs may in fact be a contributor to the current childhood obesity epidemic. Objective: The purpose of this study was to determine if the CMPs are meeting their intended goal by reviewing the historical changes to nutrition standards of the CMPs in correspondence with the literature that examines the nutritional adequacy of meals served as part of these programs, as well as the dietary intakes and nutritional status of participants. Methods: Public Law and the Federal Register were reviewed and websites and online databases were systematically searched. Results: NSLP and SBP first underwent updates to the nutrition standards in 1994 and subsequently 2010, whereas SFSP last underwent modifications in 2000. The majority of data, all collected prior to 2010, demonstrate that meals served as part of the NSLP and SBP are not meeting nutrition standards. In addition, the dietary intakes of NSLP and SBP participants are high in calories, fat, saturated fat, and sodium, and low in fiber. Studies examining the weight status and other nutrition-related health outcomes of NSLP and SBP participants have produced mixed results. In contrast, no studies published in the peer-reviewed literature have been conducted examining the nutritional adequacy of SFSP meals or the dietary intakes or nutritional health of SFSP participants. There are public reports available on the nutritionally adequacy of SFSP meals, however, they are severely outdated (1988 and 2003). Due to this dearth of information, a case study on a sample SFSP menu from summer 2015 was conducted; results showed that the meals are high in carbohydrate and protein content and insufficient in vegetable servings. Conclusions: There is critical need for policy change that would enable updates to the SFSP nutrition standards to match those of the NSLP and SBP. In addition, strategies are needed to facilitate development of CMP menus that meet current nutrition standards. Finally, rigorously designed studies are needed to understand the direct impact of CMP participation on child diet and health, particularly the SFSP for which there is limited published data.

The scale of the evidence base on the health effects of conventional yogurt consumption: findings of a scoping review.

Background: The health effects of conventional yogurt have been investigated for over a century; however, few systematic reviews have been conducted to assess the extent of the health benefits of yogurt.Objective: The aim of this scoping review was to assess the volume of available evidence on the health effects of conventional yogurt.Methods: The review was guided by a protocol agreed a priori and informed by an extensive literature search conducted in November 2013. Randomized controlled trials were selected and categorized according to the eligibility criteria established in the protocol.Results: 213 studies were identified as relevant to the scoping question. The number of eligible studies identified for each outcome were: bone health (14 studies), weight management and nutrition related health outcomes (81 studies), metabolic health (6 studies); cardiovascular health (57 studies); gastrointestinal health (24 studies); cancer (39 studies); diabetes (13 studies), Parkinson's disease risk (3 studies), all-cause mortality (3 studies), skin complaints (3 studies), respiratory complaints (3 studies), joint pain/function (2 studies); the remaining 8 studies reported a variety of other outcomes. For studies of a similar design and which assessed the same outcomes in similar population groups, we report the potential for the combining of data across studies in systematic reviews.Conclusions: This scoping review has revealed the extensive evidence base for many outcomes which could be the focus of systematic reviews exploring the health effects of conventional yogurt consumption.

Statistical Modeling Approaches with Taste Functioning and Central Adiposity in Women: Implications for Mining the New National Health and Nutrition Examination Survey (NHANES) Taste and Smell Protocol

For the first time, taste functioning is assessed in NHANES 2013‐2014 with measures that capture genetic and environmentally‐mediated variation in taste, previously shown to associate with diet behaviors and adiposity. Mining an existing database of 407 ostensibly healthy women (35±17 years), we utilized structural equation modeling to test paths of association between self‐reported risk factors for taste alteration (otitis media, head trauma, tonsillectomy), NHANES taste measures (intensities of concentrated NaCl and quinine on the tongue tip and whole mouth) and central adiposity. Thirty‐nine% were overweight/obese; 21% had elevated waist circumference (WC). Diminished taste intensity on the tongue‐tip, measured directly or as ratio to whole mouth intensity, was explained by taste risk factors and associated with greater WC. Greater WC also was explained directly by age, lower papillae density (another marker of taste variation) and taste risk factors. Additionally, tongue tip‐whole mouth ratio partially mediated (indirect effect, β=‐0.03, p <0.05) the association between head trauma and WC. The model showed good fit indices, explaining 15.7% variance in WC. The model excluding papillae density showed similar results. In summary, NHANES taste measures can have relevance to nutrition‐related health outcomes with paths of association between risk factors for taste alteration, taste functioning and adiposity. Our findings provide a framework for analyzing NHANES taste data to study associations between taste, dietary behaviors and health (Supported by NIDCD).

Patients' preferences for nutrition‐related health outcomes in liver disease: a preliminary study using an electronic questionnaire

Patients with liver disease frequently have nutritional problems but intervening to improve these is challenging. Healthcare interventions that respond to patients' needs are associated with better health outcomes but no studies investigating patients' preferences for nutrition-related outcomes in liver disease have been published. The present study aimed to identify nutrition-related health outcomes that are important to patients with liver disease. An electronic questionnaire was devised and reviewed by patients and dietitians with relevant experience. It comprised a Likert scale and open questions focussing on six domains considered pertinent to patients with liver disease. An invitation to participate was posted on the website of a national liver charity and sent to liver patient support groups. Fifty-one patients participated (22 men and 29 women). Responses indicated a wide range of preferred nutrition-related outcomes, with those identified as very important most frequently focussing on gaining knowledge about which foods to eat more or less of, as well as on understanding why nutrition is important in liver disease. Women tended to score outcomes as more important than did men. Participants who considered themselves overweight scored outcomes on body size and shape as more important than those with other nutritional problems. Additional outcomes were identified and included an increased knowledge of healthy eating, interactions between medication and food, and supplementation. The present study identified a wide range of nutrition-related outcomes that were important to this small sample of patients with liver disease and these may be useful to guide the direction of future nutrition-related management.

A Theoretically Based Behavioral Nutrition Intervention for Community Elders at High Risk: The B-NICE Randomized Controlled Clinical Trial

We conducted a study designed to evaluate the efficacy and feasibility of a multilevel self-management intervention to improve nutritional intake in a group of older adults receiving Medicare home health services who were at especially high risk for experiencing undernutrition. The Behavioral Nutrition Intervention for Community Elders (B-NICE) trial used a prospective randomized controlled design to determine whether individually tailored counseling focused on social and behavioral aspects of eating resulted in increased caloric intake and improved nutrition-related health outcomes in a high-risk population of older adults. The study was guided by the theoretical approaches of the Ecological Model and Social Cognitive Theory. The development and implementation of the B-NICE protocol, including the theoretical framework, methodology, specific elements of the behavioral intervention, and assurances of the treatment fidelity, as well as the health policy implications of the trial results, are presented in this article.

Nutrition-related health effects of organic foods: a systematic review

There is uncertainty over the nutrition-related benefits to health of consuming organic foods. We sought to assess the strength of evidence that nutrition-related health benefits could be attributed to the consumption of foods produced under organic farming methods. We systematically searched PubMed, ISI Web of Science, CAB Abstracts, and Embase between 1 January 1958 and 15 September 2008 (and updated until 10 March 2010); contacted subject experts; and hand-searched bibliographies. We included peer-reviewed articles with English abstracts if they reported a comparison of health outcomes that resulted from consumption of or exposure to organic compared with conventionally produced foodstuffs. From a total of 98,727 articles, we identified 12 relevant studies. A variety of different study designs were used; there were 8 reports (67%) of human studies, including 6 clinical trials, 1 cohort study, and 1 cross-sectional study, and 4 reports (33%) of studies in animals or human cell lines or serum. The results of the largest study suggested an association of reported consumption of strictly organic dairy products with a reduced risk of eczema in infants, but the majority of the remaining studies showed no evidence of differences in nutrition-related health outcomes that result from exposure to organic or conventionally produced foodstuffs. Given the paucity of available data, the heterogeneity of study designs used, exposures tested, and health outcomes investigated, no quantitative meta-analysis was justified. From a systematic review of the currently available published literature, evidence is lacking for nutrition-related health effects that result from the consumption of organically produced foodstuffs.

Diet quality – what is it and does it matter?

Measures of diet quality have evolved with a number of scoring indices currently in use. They are increasingly being used to examine epidemiological associations between dietary intake and nutrition-related health outcomes. The present review aims to describe current diet quality tools and their applications, and to examine the relationship between diet quality and morbidity and mortality. A search was conducted of MEDLINE, Cochrane, EMBASE, CINAHL and ProQuest electronic databases. Inclusion criteria were: English language; published from 2004 on; conducted in adult populations; longitudinal/cohort/case-control or cross-sectional study; included a theoretically defined measure of diet quality. A total of twenty-five indices of overall diet quality and/or variety were found, with components ranging from nutrients only to adherence to recommended food group servings, to variety within healthful food groups. The majority of studies reviewed had methodological weaknesses but demonstrated that higher dietary quality was consistently inversely related to all-cause mortality, with a protective effect of moderate magnitude. The associations were stronger for men and for all-cause and CVD mortality. The limitations of both the indices and the studies that use them need to be considered when interpreting and comparing results. However, diet quality indices do appear to be able to quantify risk of some health outcomes, including biomarkers of disease and risk of CVD, some cancers and mortality. Further research is needed to improve the validity of these tools and to adapt them for use in clinical dietetic practice.

Birthplace Is Associated with More Adverse Dietary Profiles for US-Born Than for Foreign-Born Latino Adults

Our objective was to examine the association between ethnicity and birthplace and the percent of energy from selected food groups among Hispanics, the largest growing segment of the US population. We used data from NHANES 1999–2004, collected from Mexican (n = 3375) and other Hispanic (n = 622) adults (18 y and older), classified as foreign born (FB) or US born (USB). Using University of North Carolina’s food-grouping system, we created 24 nutrient- and behavioral-based food groups. We examined percent consuming and per-consumer estimates using logistic and linear regression models, respectively. Predicted mean energy was estimated using marginal effect models. All models were controlled for gender, age, income, and education and were weighted to account for sampling design. FB Hispanics obtained more energy from food groups such as legumes, fruits, and low-fat/high-fiber breads, with differences accounted for by a greater percent consuming these foods rather than higher energy intake among consumers. Conversely, FB Hispanics consumed a lower percentage of energy from foods such as non-Mexican fast food and snacks and desserts. Speaking Spanish also was associated with greater consumption of legumes, rice, fruits, soups, and potatoes. Variation in diet may in part account for the difference in nutrition-related adverse health outcomes observed among USB Hispanics, particularly Mexicans. Targeted dietary interventions are needed to reduce health disparities associated with dietary intake.

Food Security and Health Security: Explaining the Levels of Nutritional Status in Pakistan

Food security and health security: Explaining the levels of nutritional status in Pakistan , Food security and health security: Explaining the levels of nutritional status in Pakistan , مرکز فناوری اطلاعات و اطلاع رسانی کشاورزی