bluuebunny/crossref_metadata_2025 huggingface dataset:
Poor Child Feeding Practices and Malnutrition in Bihar, India
Authors: Young Melissa Fox , Mehta Rukshan , Larson Leila , Kekre Priya , Verma Pankaj , Girard Amy Webb , Ramakrishnan Usha , Chaudhuri Indrajit , Srikantiah Sridhar , Martorell Reynaldo
Published: November 2023

Child malnutrition in Bihar is a public health problem. An improved understanding of the current situation and key determinants is needed to inform policies and programs. We used data that were collected as part of the cross‐sectional baseline survey of an ongoing multiple micronutrient powder program evaluation in West Champaran, Bihar to evaluate child feeding practices and malnutrition among children ages 6–18 months (n=4360). Data were analyzed using SAS; descriptive analyses were used to report socio‐demographic characteristics of the population. Multivariate logistic models were developed to identify determinants of anemia and stunting including key socio‐demographic (child age, sex, parity, early age at marriage (<18 yrs), maternal education, religion, socioeconomic status (SES, from a composite wealth index), household hunger (as measured by the household hunger scale) and child feeding practices (preleacteal feeds, currently breastfeeding, dietary diversity and minimum acceptable diet). The baseline sample was 50% female and the average child was 11 months old. 78% of the households were Hindu and 21% Muslim; 33% were scheduled caste/tribe, 51% were other backward castes and 16% other. 60% of mothers and 36% of fathers were illiterate. 36% of the mothers were married before 18 years. Overall, breastfeeding rates were reported to be high with 99% ever breast fed and 95% currently breastfeeding. However, 61% of infants were given prelacteal feeds. Only 39% of families reported initiating complementary feeding at 6 months, 5% earlier and the majority (56%) reported late initiation of foods. Quality of complementary feeding was a major barrier. Only 20% of households reported adequate dietary diversity and 15% achieved the minimal acceptable diet. Rates of malnutrition were alarming in this population. 72% of children were anemic, 33% stunted, 27% wasted and 42% underweight. Key determinants (odds ratio; 95%CI) for child anemia included: child age (1.04; 1.01–1.07), female sex (0.74; 0.62–0.87), and household hunger (1.4; 1.03–1.96). Key determinants for child stunting included: child age (1.14; 1.11–1.17), female sex (0.74; 0.63–0.87), SES lowest vs highest tertile (1.75; 1.40–2.19), SES mid vs highest tertile (1.56; 1.26–1.94). Overall in Bihar there are high rates of child malnutrition and poor complementary feeding practices. Gender, household hunger and income are key underlying factors contributing to anemia and stunting in children.

Support or Funding Information

Funding support provided by a BMGF grant through a subcontract with CARE‐India
Thinness and Time to Pregnancy among Rural Bangladeshi Adolescents
Authors: Hur Jinhee , West Keith P. , Shamim Abu Ahmed , Rashid Mahbubur , Labrique Alain B. , Wu Lee S‐F. , Mehra Sucheta , Klemm Rolf D. W. , Christian Parul
Published: November 2023

Few studies have examined the relationship between maternal nutritional status and fecundability. We assessed the temporal association between preconceptional mid‐upper arm circumference (MUAC), measured in adolescence (12–19 years) with low MUAC reflecting thinness, and time to pregnancy (TTP) among rural, newlywed, largely non‐contracepting (< 10.5%) women (n 5374) in northwestern Bangladesh. Women were recruited into a pregnancy surveillance system from 2001–2002 to participate in an antenatal vitamin A or beta‐carotene supplementation trial (West et al. JAMA 2011) and visited at home every 5 wks to ascertain a 1‐month history of menstruation. Amenorrheic women received a urine test to confirm pregnancy. Surveillance continued until pregnancy or for up to 312 weeks. Mean ± SD age and MUAC at surveillance enrollment were 15.3 ± 1.9 y and 22.5 ± 1.9 cm. Age at pregnancy ascertainment was 16.8 ± 1.9 y. Compared to those with a MUAC > 21.5 cm, adolescents with a smaller MUAC (≤ 21.5 cm) had a longer TTP (10 wks in median survival time, overall P < 0.001) and 5% lower cumulative incidence of first pregnancy (P < 0.001), evident at each age, but especially so among youngest newlyweds (12 to 13 y). In a Cox proportional hazards model, thinner women (MUAC < 21.5 cm) were 12% less likely to become pregnant than those better nourished, adjusting for age, year and season of enrollment, and family planning practice (HR 0.88, 95% CI 0.82–0.93, P < 0.001). Undernourished adolescent girls may experience a longer time to pregnancy than those of better nutritional status.

Support or Funding Information

Supported by the Bill and Melinda Gates Foundation (GH614) and USAID, Washington DC.
Assessment of the Nutritional Adequacy of Complementary Foods and Infant and Young Child Feeding Practices in Sodo Zurea District, Wolayita, Southern Ethiopia
Authors: Moges Debebe , Abebe Yewelsew , Gibson Rosalind S.
Published: November 2023

Childhood malnutrition in Ethiopia remains very prevalent and inadequate complementary food intakes and improper feeding practices remain a common problem in Ethiopian infants and young children. The objective of this study was to assess the nutritional adequacy of complementary foods and of infant and young child feeding practices in Sodo Zurea District of Wolayita Zone, Southern Ethiopia. A cross‐sectional survey design was employed to collect data from 180 mothers, selected by a stratified two‐stage cluster sampling method, who had breastfed children aged 6–23 months. Socio‐demographic status, anthropometry, breastfeeding, and the adequacy of complementary foods were determined, and complementary feeding practices and behaviors assessed by direct in‐home observations. Only 21% of infants and young children were exclusively breastfed up to 6 months of age. Prevalence of stunting was 16.7% for infants aged 6–8 months, 33.3% for infants aged 9–11 months and 50% for children 12–24 months. Energy and nutrient intakes from complementary foods were also calculated from one day in‐home weighed records. The dietary diversity score of the study participants showed that only 3.3% had dietary diversity scores greater than three food groups. Very few children (3.3%) were fed minimum acceptable diets according to the WHO recommended infant and young child feeding guidelines, and responsive feeding was not practiced. Median energy intakes and densities of micronutrients from complementary foods (except for protein) were below the WHO recommendations. In conclusion, there is a need to focus on nutrition education interventions that address the WHO guiding principles for infant and young child feeding practices in this area.

Support or Funding Information

Supported by Canadian International Food Security Research Fund (CIFSRF) project through the International Development Research Center (IDRC).
Broadband Connections Within The Cell: How Mitochondria Talk To The Endomembrane
Authors: Kornman Benoit
Published: November 2023

Although chromosome partitioning during mitosis is well studied, the molecular mechanisms that allow proper segregation of cytoplasmic organelles in human cells are poorly understood. I will present a mechanism by which mitochondria are transported towards the daughter cell periphery at the end of mitosis. This mechanism involves the mitochondrial protein Miro and the mitotic cytoskeletal protein Cenp‐F.

Support or Funding Information

This work is supported by the European Research Council, the Swiss National Research Foundation and the ETH Zurich.
A Developmental Evaluation of PumpMed: A Web Application Designed to Promote Pumping in a Neonatal Intensive Care Unit
Authors: Bower Katie , Burnette Tara , Kortsmit Tim , Wright Courtney , Kavanagh Katie
Published: November 2023

PumpMed was developed in response to formative qualitative interviews (phase 1). Themes from these interviews shaped the development of the PumpMed prototype, with the goal of designing an intervention that meets the unique needs facing mothers of preterm infants. The primary focus of PumpMed is to provide an interactive platform where mothers can receive timely encouragement from breastfeeding specialists and have the ability to log pumping sessions electronically. Self‐monitoring is often the first approach when targeting maintenance or modification of specific behaviors. The targeted behavior for this intervention will be increased and continued pumping to establish and maintain the breast milk supply. The purpose of conducting a developmental evaluation is to assess any issues prior to implementation of the pilot intervention. Through a developmental evaluation we have been able to include changes and improvements suggested by potential users. This has assisted in helping us to better identify useful data from the target population. Participants are being recruited from phase 1 of the study (qualitative phase) and through local and state breastfeeding coalitions. English‐speaking mothers of preterm infants, who have since been discharged from the hospital, have access to the Internet (with a valid e‐mail address), are ≥18 years of age, and have any experience pumping for their preterm infant (mothers do not have to be currently pumping) are eligible to participate. At the time of study completion, the infant can be no more than two years of age. To date, 12 mothers have been enrolled in the study and completed a usability and acceptability questionnaire, which includes the Systems Usability Scale (SUS), a validated assessment tool, as well as open‐ended questions to solicit additional feedback. Recruitment will continue until approximately 20 mothers provide feedback. Preliminary results indicate that PumpMed scores are above average in usability on the SUS. In addition, the evaluation has also served to test out the application during development, leading to changes that improve the ease of use of PumpMed. Sample feedback, provided by mothers who have assessed the usability and acceptability of PumpMed confirms for us that we are meeting the target population's needs and will be used to direct continued development.

Support or Funding Information

UTK Office of Research SARIF Summer Assistantship
The High Cost of Healthy Snacks in Corner Stores
Authors: DeWeese Robin , Ohri‐Vachaspati Punam
Published: November 2023

Introduction

Energy‐dense, nutrient‐poor foods tend to be more expensive than healthy foods such as fruits and vegetables (FV). The purpose of this study was to compare the prices of unhealthy (chips) and healthy (cut‐up/single‐serve FV) snacks that students are likely to purchase from a corner store.

Methods

Store audits were conducted in 325 New Jersey corner stores. Auditors purchased a snack‐sized bag of chips and a snack‐sized FV from each store. One hundred‐twenty stores that sold both healthy and unhealthy snacks were included in the analysis. Chip prices were compared to FV prices overall and by store sales volume and block group characteristics. Chip and FV prices were also analyzed separately according to store sales volume and block group characteristics.

Results

In the overall sample, chips cost significantly more than FV did ($.60±.46 vs $.47±.17; p < .05). In subgroup analysis the directionality in price differences were consistent across all types of stores and neighborhoods. Differences were significant for corner stores with the lowest sales volumes ($.63±.41 vs $.45±.14; p < .05), for stores in block groups with a low proportion of vacant housing units ($.73±.63 vs $.51±.19; p < .05), and for stores in block groups with a medium proportion of unemployed residents ($.57±.26 vs $.45±.17; p < .05). The difference between the cost of FV and chips was higher in stores with lower sales volumes (18 cents) compared to the difference in prices in stores with higher sales volumes (5 cents), and these differences were marginally significant (p = .07).

Conclusions

Reducing the prices of healthy snacks may be an important first step in changing children's purchasing behaviors. This strategy may be most effective in the smallest corner stores.

Support or Funding Information

This research was funded by a National Institute of Food and Agriculture predoctoral dissertation fellowship (20146701122279) and by a grant from the National Institute of Child Health and Human Development (1R01HD071583‐01A1)
Between Meal Snacks And Food Habits In Brazilian Preschool Children: National Representative Sample Survey
Authors: Nogueira‐de‐Almeida Carlos Alberto , Del'Arco Ana Paula Wolf Tasca , Previdelli Ágatha Nogueira , Tosatti Abykeyla Melisse , Fisberg Mauro
Published: November 2023

Objective

To describe the eating habits of Brazilian preschool children related to the ingestion of between meal snacks and their nutritional contribution.

Methods

Secondary analysis of a structured questionnaire answered during three days, by the mothers of 1,391 children from 4 to 6 years old from a representative sample of all regions of the country, on the food consumed in between meal snacks and their quantities.

Results

98.20% of Brazilian children performed between meal snacks, that, on average, consisted of 2,9 food groups. Qualitatively, the compositions of the between meal snacks in the morning and afternoon were similar, mostly containing the same food groups: fruits in general, cookies and yoghurts in general. The afternoon between meal snack had more calories and different foods and also foods with higher added sugars content (candy, ice cream and chocolates). The added sugar consumption, considering together the amount consumed in the morning and the afternoon, already approached the limits recommended for the whole diet by WHO.

Conclusion

The composition of the between meals is very important, since they include opportunities to fill the nutritional requirements of this age group, which are in growth and development period, whom need adequate nutritional support. The Brazilian preschool children have the habit of performing the between meal snacks, but the quality of these meals need to be better, regarding, specially, the great content of added sugar.

Support or Funding Information

The study was funded and supported by Danone Brasil
Barriers and motivations in providing fruit and vegetables in the home: perceptions of parents of overweight/obese preschoolers and school‐aged children
Authors: Nepper Martha J , Chai Weiwen
Published: November 2023

Background

Given the importance of parental influences on children's fruit and vegetable intakes and limited research conducted on parental views of providing fruit and vegetables to their children in the home, the objective of the study was to explore and compare parental perceptions of barriers and motivations in providing fruits and vegetables in the home environment between overweight/obese preschoolers (3–5 years) and overweight/obese school‐aged children (6–12 years).

Methods

A total of 13 parents of overweight/obese (>85th%) preschoolers and 14 parents of overweight/obese (>85th%) school‐aged children, recruited from Early Head Start and Head Start programs (preschoolers) and family‐based weight management programs (school‐aged children) participated in the qualitative study with focus group interviews from February 2015 to September 2015. Qualitative codes and themes regarding parental views were developed using content analysis, and were verified by the research team and qualitative experts.

Results

There were similarities and a few differences between parents of preschoolers and school‐aged children in barriers and motivations in providing fruits and vegetables in the home. Common barriers between both groups of parents were children less accepting of vegetables, the high price of fruits and vegetables, possible wasting of fruits and vegetables if not eaten before spoiling, and that if fruits and vegetables were not “ready to go”, they were less likely to be eaten. Parents of overweight/obese school‐aged children were more concerned regarding their child's weight and that extended family members (such as grandparents) were viewed as more of a negative influence compared to parents of overweight/obese preschoolers.

Conclusions and Implications

These findings suggest that parents of both overweight/obese preschoolers and school‐aged children face similar yet different barriers and motivations which need to be addressed when developing intervention strategies for weight management.

Support or Funding Information

This research was supported by the Ann A. Hertzler Research Grant from Academy of Nutrition and Dietetics Foundation.
E‐MECHANIC Exercise Interventions Eliminate the Unexpected Association between Weight Gain and a Healthy Food Environment
Authors: Myers Candice Alicia , Broyles Stephanie T. , Church Timothy S. , Martin Corby K.
Published: November 2023

Objective

To examine if the relationship between change in BMI and weight during the E‐MECHANIC study were moderated by the neighborhood food environment among participants assigned to exercise versus no‐exercise groups.

Methods

This study used data from the Examination of Mechanisms (E‐Mechanic) of Exercise‐Induced Weight Compensation randomized control trial, which randomized 198 overweight and obesity adults (21–65 years old; 74% female; 34% African American) to a no‐exercise control or one of two exercise groups for 6 months. BMI and weight were measured at baseline, 4 weeks, and the end of the study. Neighborhood food environment was measured as healthy food availability using the Nutrition Environment Measures Survey‐Stores (NEMS) tool, which quantified the availability, quality, and price of food within neighborhood food stores. Neighborhoods were categorized as low, medium, or high (tertiles) on healthy food availability. Change in BMI and weight from baseline were regressed against neighborhood healthy food availability in a multilevel repeated‐measures model, controlling for age, sex, race, and socioeconomic status.

Results

Change in BMI and weight in the no‐exercise group were moderated by living in a neighborhood with high healthy food availability. Specifically, participants who did not receive either of the exercise interventions and resided in neighborhoods with high healthy food availability saw significant increases in BMI (LS‐means: 0.33±0.13, p=0.01) and weight (LS‐means: 0.90±0.36, p=0.01) during the study. However, those participants assigned to either of the exercise interventions did not demonstrate a significant moderating effect of the neighborhood food environment on change in BMI and weight.

Conclusions

High healthy food availability was associated with increased BMI and weight for no‐exercise participants. This unexpected finding could indicate that greater availability of healthy foods may also mean greater access to food, both healthy and unhealthy, in general. We also note that we do not account for actual dietary patterns or consumption or other aspects of the neighborhood environment that may be important for health behaviors. The failure of neighborhood food environment to moderate response to the exercise interventions indicates that health promotion programs that incorporate physical activity and exercise are one potential way to limit the negative effects of neighborhood food environment on body mass.

Support or Funding Information

1 F32 HL123242; R01 HL102166; 1 U54 GM104940
High Density Lipoprotein Cholesterol to Total Cholesterol Ratio is Associated with Index of Central Obesity in a Young Multi‐Ethnic Group Living in South Florida
Authors: Huffman Fatma G , Ajabshir Sahar , Li Tan , Exebio Joel , Zarini Gustavo
Published: November 2023

Objective

The aim of this study was to assess the relationship between High Density Lipoprotein (HDL) Cholesterol to Total Cholesterol (TC) ratio (HDLC/TC) and index of central obesity [waist‐to‐height ratio (WHtR)] in a young multiethnic group living in South Florida.

Methods

This cross‐sectional study included 76 young adults, males (n=39) and females (n=37), ages 18–36 years recruited from Florida International University campus. Participants were asked to step behind a screened area, remove their shoes and heavy clothing and step on a scale with height rod to measure their body weight and height. Participants’ waist circumference was measured with a non‐flexible tape measure. HDLC, TC and serum 25‐hydroxyvitamin D were measured by ELISA method. Diastolic blood pressure (DBP) was measured by an automated monitor. Alcohol consumption and cigarettes smoking were calculated from a demographic questionnaire. A multi‐linear regression model was run, adjusting for age, gender, serum 25hydroxyvitamin D, DBP, alcohol consumption and smoking cigarettes.

Results

HDLC/TC was negatively associated with WHtR (P=0.012). This association remained significant after controlling for covariates (B=−0.146, P=0.001). The model explained 66% of the variation in HDLC/TC.

Conclusion

The results of this study suggest that higher WHtR may be associated with lower HDLC/TC levels. Interventions are needed to confirm these results.

Support or Funding Information

Funding source: Funding for this research was provided through a grant from NIH/NIDDK.
Improving the Nutritional Impact of the Supplemental Nutrition Assistance Program: Perspectives from the Participants
Authors: Leung Cindy W , Musicus Aviva , Willett Walter C , Rimm Eric B
Published: November 2023

The Supplemental Nutrition Assistance Program (SNAP) is the largest federal food assistance program in the United States designed to provide supplemental support to alleviate food insecurity and improve dietary intake. Currently 1 in 7 Americans or 47.6 million people receive governmental support to purchase any kind of food as long as it is not alcohol, nutritional supplements, heated food or food served to eat on location. In recent years, policymakers, public health nutritionists and anti‐hunger advocates have been engaged in an ongoing discussion about how to modify SNAP policies to maximize its nutritional impact for its beneficiaries. However, SNAP participants and low‐income nonparticipants have been missing from this conversation, despite their key stakeholder interests. This online study surveyed 387 individuals from Amazon Mechanical Turk, of whom 118 were SNAP beneficiaries and 269 food‐insufficient but not enrolled in SNAP (nonparticipants), on their perspectives of proposed strategies to improve the nutritional impact of SNAP. The majority of all respondents (70%) believed the current benefit level was insufficient to afford a healthy diet. Most SNAP participants (76%) and nonparticipants (81%) supported pairing monetary incentives for fruits and vegetables with restrictions for sugary beverages to be purchased with SNAP benefits. Participants were asked to choose from two hypothetical scenarios: 1) a SNAP program that combined healthy incentives and restrictions for sugary bevera0ges (i.e. SNAP+), or 2) SNAP in its current form. From the whole sample, 67% of SNAP participants and 83% of nonparticipants chose SNAP+. Of those who initially chose SNAP in its current form, 68% of SNAP participants and 64% of nonparticipants would choose SNAP+ if paired with a 50% increase in benefit level. These results show overwhelming support from program participants and food‐insufficient nonparticipants for SNAP policies that both facilitate the purchase of healthful foods and limit the purchase of unhealthful foods, specifically sugary beverages. These policies deserve to be studied in pilot projects and may help to alleviate diet‐related health disparities in this vulnerable population.

Support or Funding Information

This study was supported by the National Institutes of Health (grant K99 HD084758 to C.W. Leung).
Childhood Obesity and the Gut Microbiome: What are the Dietary Drivers?
Authors: Herman Dena R , Pham Ann‐Marie R , Lopez Ulises , Flores Gilberto E
Published: November 2023

Background

Much work has addressed the role that gut flora has in obesity, and several studies have found associations between the gut microbiome and weight gain in adults. However, quantitative linkages between diet and gut microbiome composition are lacking, particularly in post‐weaned, pre‐pubescent children.

Objectives

To understand the relationship between the gut microbiome and childhood obesity and the role of nutritional factors.

Methods

Data were collected from children, ages 2–9 years at an early childhood center in Los Angeles, CA. Study participants (n=95) provided 3 fecal samples and 3, quantitative, 24‐hour dietary recalls of foods consumed prior to fecal sampling. Microbial communities were characterized using Illumina amplicon sequencing of variable region 4 of the 16S rRNA gene. Dietary data were disaggregated and converted to macro‐ and micronutrients using the ASA24. For each individual, dietary and microbiome data were averaged across the three sampling days.

Results

In this ethnically diverse, community‐based population (52.7% Hispanic, 12.2% Asian/Pacific Islander, 1.5% African‐American, 17.6% other), 29% were overweight or obese. Older children had more diverse microbiomes (Shannon Diversity, rho=0.335; p=0.0009) but diversity did not level off by age 3 y, as has been previously reported. Spearman Rank correlations for dietary variables with bacterial families for 1–3 year olds showed positive correlations for Ruminococcacea and very dark green vegetables (rho−0.347) and negative correlations for percent total fat (rho=0.409); and negative correlations for Prevotellaceae and total dairy intake and yogurt (rho=−0.330 and −0.317 respectively). For 4–8 year olds, Bacteroidaceae were negatively associated with all animal proteins, soy, tomato, and all vegetables (rho=−0.277; −0.295; −0.367; −0.360 respectively); negative correlations with Ruminococcacea for red meat, potatoes and sugar (rho=−0.349; −0.304; −0.283 respectively) and positive correlations for fish high in omega‐3s; negative correlations with Prevotellaceae for processed meats and whole grains (rho=−0.310 and −0.407) and a positive correlation with red meats (rho=0.295). All values were significant at p<0.05.

Conclusion

Age‐specific differences in diet can be used to predict features of the microbiome with differential bacterial families responding to different dietary features. Understanding these subtle changes in the gut microbiome may help identify appropriate interventions to improve obesity‐related health outcomes.

Support or Funding Information

Funding for this research was provided in part through the NIH NIGMS BUILD Diversity Fund, 1RL5M0009603.
HEALTH PROMOTION PROGRAM AMONG MEXICAN MINISTRY OF HEALTH EMPLOYEES
Authors: Ortiz Ana Francis Guzman , Chairez‐Jimenez Carolina , Paz Sara Moreno , Torres Serna Aldo A. , Daniela Serrano L.
Published: November 2023

BACKGROUND

According to last Mexican nutritional survey (ENSANUT) in 2012, the cases of chronic diseases such as Obesity and overweight, shown a risky increase in the last decade. 73% of adult woman and 69.4% in adult men live with those conditions. There are few information to this date about Health studies on federal employees.

OBJECTIVES

To boost changes in nutritional lifestyle among federal employees and their families in order to create a platform that impact the rest of the population.

METHODS

A longitudinal study of 2200 federal employees of the Mexican National Ministry of Health from July 2015 to October 2015. They realize physical evaluations integrated by 26 modules where they register a functional capacity main result. After the results where deliver, they had to follow a nutritional plan and an exercise routine. The second evaluation will set 3 months later. And among the evaluations they were invited to participate in workshops and sport activities. The exclusion factor was the level of blood pressure.

RESULTS

Of the study participants, 83.46% reported having a very low or low physical condition. This percentage could be associated with the high number of obesity cases in the general population. 12.53% of the participants have healthy condition and finally 3.65% reported an outstanding condition similar to professional athletes. The body mass index (BMI) reported was of 22.02% obesity, 44.38% overweight, 25.9% normal weight and 7.85% reported lower weight. This results are slightly different than the national results in the Mexican nutritional survey.

CONCLUSION

The results shown in the first evaluation demonstrate that the nutritional campaigns are not enough and that the federal employees are no excusable of suffering this condition, Obesity need a structured program to fight it in addition of regular evaluations to reverse the situation.

Support or Funding Information

Thanks to “Movimiento es Salud” Foundation, for their relevant role applying the functional capacity evaluations, and all their support for this project.
Implementing Health Coaching in Primary Care: Results from a Pilot Study
Authors: Mann Jeffrey Matthew , Locke Amy , Segar Michelle , Orizondo Carissa , McKenna Jessica , Moore Heather , Judge Jessyca , Djuric Zora
Published: November 2023

Health coaching is potentially a cost‐effective method by which individuals can obtain assistance in achieving and maintaining healthy lifestyles in primary care. In health coaching, the counselor partners with the patient, helping patients discover their own strengths, challenges, and solutions. Currently, there is little research on health coaching with regard to integration within a primary care setting. The aim of this study is to determine whether medical assistants can assist primary care providers in achieving a healthier lifestyle for their patients. We recruited and trained two medical assistants in basic health coaching techniques using self‐determination theory. The program consists of 12 weeks of telephone coaching with in‐person visits at the beginning and end of the program. The focus areas for health coaching are improvement in diet, physical activity, and sleep habits. Thus far, 65 subjects have enrolled in the study. All of the subjects who volunteered for the study were either overweight or obese, and 75% or more of enrolled subjects selected improving diet or physical activity as their primary goal. Thus far 28 subjects have completed 12 weeks of study participation. Mean fruit intakes increased from 1.6 to 2.0 servings per day (p=0.21), and mean vegetable intakes increased from 2.4 to 3.5 servings per day (p=0.03). Physical activity increased by a mean of 110 minutes/week and the percentage of subjects meeting the Centers for Disease Control recommendations for being physically active increased from 44% to 62% (p=0.05). Mean BMI decreased from 34.5 to 33.1 kg/m2 (p=0.09). Encouraging changes also were seen in the motivation of the subjects for health behavior change. Intrinsic motivation for eating a healthy diet and being physically active each increased after 12 weeks of coaching. Issues with implementation that were resolved included involving physicians in referrals, incorporating coaching notes into the medical record, and scheduling coaching calls amongst other medical assistant duties. Study evaluations indicated that subjects were pleased with the program. Of the 28 subjects who have completed 12 weeks of study, 27 agreed or mostly agreed that all family medicine practices should offer health coaching for their patients, and 27 of 28 intended to keep working on their health coaching goals. These pilot results indicate that the role medical assistants have in a primary care setting can be expanded to include health coaching for preventive health behaviors.

Support or Funding Information

Funding from the Patient‐Centered Medical Homes initiative in the Department of Family Medicine is acknowledged.
The Prevalence of Adult Obesity in Africa
Authors: Einstein George P , Obidi O F , Tulp Orien L , Oyesile T C
Published: November 2023

Background

Adult obesity, a major risk factor for premature mortality from cardiovascular diseases and diabetes is on the rise in many African countries

Objectives

To investigate the incidence of adult obesity and its associated risk factors in Africa over a twenty–year period. (1992–2012).

Methods

A literature search was performed using Pubmedcentral, google scholar and other sources. The quality of studies was assessed with the use of meta‐analysis. For each study, a Mantel–Haenzel, adjusted relative risks with 95% confidence intervals (CI) were performed for possible confounding factors. For each study, a multivariate logistic regression analysis of the adjusted odds ratio was performed to identify the risk factors on the incidence and prevalence of obesity.

Separate meta–analyses were performed on results from studies grouped with similar characteristics.

Findings

Five research studies were selected and utilized for the meta–analysis. Quality of individual studies rages from 0.51–0.78 (median, 0.62). Meta‐analysis based on the prevalence of obesity gave pooled odds ratios 2.97 (95% CI; 2.35–3.68). In the multivariate logistic regression, gender, educational attainment and socio–economic status were found to be independent predictors for obesity.

Conclusion

The findings suggests an apparently high prevalence of obesity in African adults which requires urgent attention.

Support or Funding Information

Supported by Institutional Resources of USAT, the Einstein Institute, and the University of Lagos
Validation of a Food Frequency Questionnaire to Assess Nutrient Intake for Diabetes Intervention Trial
Authors: Al Abdrabalnabi Ahmed , Segovia‐Siapco Gina , Heim Lauren , Sabaté Joan , Wien Michelle
Published: November 2023

Background

Type 2 diabetes is an important global health issue. Since individuals with type 2 diabetes (T2D) are taught to use food exchanges when measuring their macronutrient intake, food frequency questionnaires (FFQ) using this familiar method is critical in the dietary intake assessment of this group.

Aim

To evaluate the ability of a FFQ developed for participants of a diabetes intervention trial in estimating nutrient intake against multiple unannounced 24‐hr recalls.

Methods

Patients with type 2 diabetes (T2D) (n= 43; 25 females and 18 males), with mean age of 61.6 (SD 13.1) years and a mean BMI of 29.0 (SD 21.0), participated in a randomized, prospective 24‐week parallel‐group clinical intervention trial. Dietary intake was assessed using 6 unannounced 24‐hr recalls (24HDR) composed of 4 weekdays and 2 weekend days, and a self‐administered semi‐quantitative FFQ with 72 hard‐coded items that was developed for the study. Portion sizes in the FFQ were based on the 2014 American Diabetes Association and the Academy of Nutrition and Dietetics, Choose Your Foods food lists. Wilcoxon signed ranks test, correlation analyses with energy adjustment and deattenuation, and cross‐classification were used to evaluate the agreement between the FFQ and multiple 24HDR on intake of 25 nutrients.

Results

Compared to the 24HDR, the FFQ has significantly underestimated most of the nutrients except for total sugar, animal protein, arachiodonic acid, EPA, dietary fiber, calcium, and potassium. Deattenuated energy‐adjusted correlations ranged between 0.62 (calcium) and 0.07 (iron), with weak correlations (r<0.35) for 9 nutrients, moderate correlations (0.35≤r<0.50) for 5 nutrients and strong correlations (r≥0.50) for 10 nutrients. In the cross‐classification analyses, agreement within 1 quartile ranged from 66% (energy and sodium) to 91% (animal and vegetable proteins) while gross misclassifications ranged from 0% (vegetable protein) to 11% (sodium).

Conclusion

The FFQ has a tendency to underestimate absolute intake of most nutrients; however, it has good ranking ability. Underreporting tendency in this group of mostly overweight/obese subjects is similar to findings in other studies. The FFQ developed for the intervention trial can be considered a reasonably valid tool in assessing intake of most nutrients.
Pattern of consumption of sugar‐sweetened drinks among elementary schoolchildren attending public schools in Amatitlán, Guatemala
Authors: Díaz‐Jereda Liza Alejandra , Oliva Raquel Campos , Solomons Noel W.
Published: November 2023

Background

Although the consumption of sweetened drinks contributes to the energy requirements of children, high consumption of sugary drinks have been linked to the risk of chronic, non‐communicable diseases.

Objective

To describe the sources, volumes and costs of sugar‐sweetened beverages in a convenience sample of school‐aged children from public schools in a suburban setting in the greater metropolitan Guatemala City area.

Methods

We recruited a total of 150 schoolchildren, 67 boys and 83 girls, from grades 1 to 6 in 4 elementary schools in the municipality of Amatitlán, 27 km south of Guatemala City. They were given crayons and a pre‐formatted work booklet, along with instructions to make a pictorial record of each meal and snack over the following 24 h. Upon returning the booklets, participants were interviewed concerning the portion size of all items consumed. A full analysis of 24‐h energy intake from all sources was compiled. With a focus on liquid items, they were classified into subgroups, and the packaging and nutrition labeling on each sugary drink reported was consulted to determine energy content and sales price.

Results

Median 1‐day consumption of all liquids was 1628 mL, providing 479 kcal of energy, with 390 mL as non‐caloric drinking water. Caloric density varied widely according to beverage group. The mean contribution of sweetened drinks was 428±237 kcal, representing 20.2% of the total daily energy intake. There were no significant differences in the pattern of drinks consumption between boys and girls. The most common beverage packaging was plastic bottles and Tetra Pak® cartons. The unit price by retail presentation ranged from Q.0.40 to 21.00. ($0.05 to 2.76 USD).

Conclusions

Pictorial recording of diet is a promising approach for child nutrition. Carbonated soda beverages were not the major sweetened drink in this sample, but the calories from all sugar‐containing drinks constitute a fifth of the reported energy for the single‐day records.
The Automated Self‐Administered 24‐Hour (ASA24) is Now Mobile and Can Collect Both 24‐Hour Recalls and Food Records
Authors: Subar Amy F. , Mittl Beth , Zimmerman Thea P. , Kirkpatrick Sharon I. , Schap TusaRebecca E. , Miller Amy , Wilson Magdalena M. , Kaefer Christie , Potischman Nancy
Published: November 2023

ASA24 is a fully automated, web‐based, self‐administered 24‐hour dietary recall that provides a complete system for probing, coding, and calculating nutrient and food group intakes. The system is based on the U.S. Department of Agriculture's interviewer‐administered Automated Multiple‐Pass Method, the recall method used in the National Health and Nutrition Examination Survey (NHANES). It has been available to extramural investigators, clinicians, and educators at no cost since 2009. From 2009 until October 2015, more than 1,800 studies registered to use ASA24 and more than 204,000 recalls were completed. Modified versions are available for use with children and Canadian participants, and an Australian version is under development. All U.S. versions can be completed in English or Spanish, and the Canadian version will soon be available in French.

By early 2016, the National Cancer Institute (NCI) and Westat will release a new mobile version of ASA24 that will be accessible using smart phones and tablets in addition to laptops and desktops. With this new version, researchers will be able to collect food records as well as 24‐hour recalls. The user interface has been modernized to reflect current best practices for web‐users, and includes new features for searching and filtering to find foods consumed, identifying favorites, and obtaining context‐specific help. Supplements are now reported using a more intuitive approach similar to the way in which foods and beverages are reported. The following databases have been updated: the list of foods and beverages provided to respondents, based on NHANES 2011–12; nutrients in foods/beverages, based on the Food and Nutrient Database for Dietary Studies 2011–12; food groups, based on the Food Patterns Equivalents Database 2011–12; the list of supplements and nutrient database associated with supplements, based on the NHANES Dietary Supplement Database 2011–12. The updated version will allow for expanded usage of ASA24, enabling the collection of high‐quality dietary intake data in a range of settings and study types. The NCI and other Institutes and Centers at the National Institutes of Health are committed to providing a low‐cost means for investigators to obtain high‐quality 24‐hour dietary recalls, and now, food records, in surveillance, epidemiologic, intervention, and clinical research.

Support or Funding Information

National Cancer Institute
Applications of the Healthy Eating Index‐2005 and ‐2010 between 2008 and 2015
Authors: Schap TusaRebecca , Kuczynski Kevin , Koegel Kristin , Hiza Hazel , Krebs‐Smith Susan , Reedy Jill , Subar Amy , Wilson Magdelina , Rihane Colette
Published: November 2023

The Healthy Eating Index (HEI) is a measure of diet quality that is based on key recommendations of the Dietary Guidelines for Americans. Starting with the 2005 version, it has used a universal set of standards, which allows it to be applied to any set of foods and therefore have applications in a variety of research settings. We conducted a literature review to describe and assess the various research applications of the HEI‐2005 and HEI‐2010 from 2008 to 2015.

There have been over 130 papers published using HEI‐2005 since its release in 2008. Over 65 papers have been published that used HEI‐2010, which was released in 2013. The number and scope of publications continued to grow each year; nearly 90 papers were published in 2015 alone. A majority of studies that used the HEI examined either the prospective or cross sectional association between overall diet quality and health outcomes. Examples of health outcomes studied included cancer, cardiovascular disease, type 2 diabetes, dental health, and ocular health. Additionally, the HEI was used to assess the impact of nutrition interventions on diet quality, to examine associations between single foods and overall diet quality, and to investigate the association between diet quality and biomarkers. Both versions of the HEI were used to examine diet quality of specific subgroups of the population such as children and adolescents, older adults, and specific race‐ethnic populations. A smaller number of studies examined the diet quality of a particular set of foods in the food environment, for example, foods provided in distribution programs or available in the US food supply.

This literature review demonstrates the importance of the concept of diet quality as represented by the HEI to assess adherence to guidelines and investigate the relationship between diet quality and health outcomes across a variety of research settings. A better understanding of the current applications of HEI will inform future development of resources for researchers and policymakers.
Association of Total Antioxidant Capacity with Mortality of U.S. Adults in Follow‐up Study of NHANES 1988–1994 and 1999–2004
Authors: Kim Kijoon , Vance Terrence M. , Chen Ming‐Hui , Chun Ock K.
Published: November 2023

Antioxidant rich diets have been shown to reduce risk of chronic disease and mortality. However, studies on the association of total antioxidant intake and mortality using representative sample of the US population are limited. The aim of this study was to assess the relationship between dietary total antioxidant capacity (TAC) and all‐cause and disease specific mortality among US adults in NHANES 1988–1994 and 1999–2004. A total of 23,589 US adults aged 30 years and older participated in this study. TAC was calculated from one‐day 24‐h diet recall data at baseline and all‐cause, cancer and cardiovascular disease (CVD) mortality was through December 31, 2011. During a mean follow‐up of 13 years, 7,157 deaths occurred. Age‐standardized mortality rates per 100,000 population by all‐cause, cancer and CVD were 2164, 461 and 650, respectively. Under cause‐specific Cox proportional hazards models for sample survey data, inverse associations and dose‐response relationship were observed between TAC and all‐cause mortality (highest quartile (Q4) vs. Q1 ref. HR 0.75; 95% CI 0.68–0.82), cancer mortality (Q4 vs. Q1 ref. HR 0.68; 95% CI 0.55–0.84) and CVD mortality (Q4 vs. Q1 ref. HR 0.83; 95% CI 0.69–0.99) after adjusting for age, gender and total energy intake. The inverse association and dose‐response relationship still remained between TAC and all‐cause mortality (Q4 vs. Q1 ref. HR 0.88; 95% CI 0.79–0.98) and CVD mortality (Q4 vs. Q1 ref. HR 0.78; 95% CI 0.63–0.96) when further adjusted for relevant covariates. These findings support that greater consumption of antioxidants was beneficial to reducing risk of death from all‐cause and CVD.

Support or Funding Information

This study was supported by Allen Foundation Research Grant.
Carbohydrates but not Fats Trigger Coronary Heart Disease Risk: Findings from the Malaysia Lipid Study (MLS)
Authors: Chuah Khun Aik , Yeak Zu Wei , Balasubramanian Gaiyal , Se Chee Hee , Ng See Hoe , Sahathevan Sharmela , Chinna Karuthan , Sundram Kalyana , Karupaiah Tilakavati
Published: November 2023

Background

Coronary heart disease (CHD) has traditionally being linked to fat consumption, particularly saturated fat (SFA) but findings from recent meta‐analyses and large population studies challenge the association of CHD with increased SFA intake.

Objective

This study aims to characterize cardiometabolic risk profile in an urban Malaysian population of 577 healthy adults comprising the 3 main ethnic groups of Malays, Chinese and Indians.

Method

Data included dietary macronutrient and fatty acid intake patterns, physical activity, body composition and cardiometabolic markers inclusive of lipid and lipoprotein profiles, lipoprotein particle size.

Result

Total energy intake was 1825±413 kcal/day for the MLS population and similar between ethnic groups (P=0.205). Indian subjects consumed the most carbohydrate (256.0±58.1 g/day) followed by Malays (248.4±58.5 g/day) and Chinese (237.7±55.5 g/day) but only intake comparisons between Indian and Chinese was significant (P=0.01). In contrast, Chinese were consuming more protein and fat (68.7±20.3 and 79.5±20.5 g/day) compared to Malays (62.4±16.9 and 61.8±18.3g/day) and Indians (57.9±17.1 and 60.3±19.3 g/day) (both P<0.001). Despite higher fat and protein intakes, Chinese were found to have significantly lower TC:HDL‐C ratio, TG:HDL‐C ratio, total LDL and small LDL particle concentrations compared to Malays and Indians (P<0.05). Chinese were also found to have significantly higher total HDL, large LDL particle concentrations and larger particle size for LDL and HDL compared to Malays and Indians (P<0.05). For the overall population, higher total energy intake was associated with increased TC:HDL‐C (β=0.0003, P<0.01), TG:HDL‐C (β=0.0002, P<0.01), small LDL concentration (β=0.082, P<0.01), but also associated with decreased LDL (β=−0.0002, P<0.01) and HDL particle sizes (β= −0.0002, P<0.01), even after adjusted for confounding factors, such as age, body mass index and physical activity. Similar trends were also observed for carbohydrate intake with increased carbohydrate intake was associated with increased TC:HDL‐C (β=0.0017, P<0.01), TG:HDL‐C (β=0.0016, P<0.01), small LDL concentration (β=0.537, P<0.01) but negatively associated with LDL (β= −0.0016, P<0.01) and HDL (β= −0.0012, P<0.01) particle sizes. These trends were not observed when total fat or SFA intake were increased (P>0.05).

Conclusion

Carbohydrate but not fat intake in an urban Malaysian population significantly associated with negative impacts on CHD risk evaluated against more advanced biochemical markers.

Support or Funding Information

This project is funded by Malaysian Palm Oil Council (MPOC), NN‐047‐2012.