Using 30-day modified rankin scale score to predict 90-day score in patients with intracranial hemorrhage: Derivation and validation of prediction model.

Whether 30-day modified Rankin Scale (mRS) scores can predict 90-day scores is unclear. This study derived and validated a model to predict ordinal 90-day mRS score in an intracerebral hemorrhage (ICH) population using 30-day mRS values and routinely available baseline variables. Adults enrolled in the Antihypertensive Treatment of Acute Cerebral Hemorrhage-2 (ATACH-2) trial between May 2011 and September 2015 with acute ICH, who were alive at 30 days and had mRS scores reported at both 30 and 90 days were included in this post-hoc analysis. A proportional odds regression model for predicting ordinal 90-day mRS scores was developed and internally validated using bootstrapping. Variables in the model included: mRS score at 30 days, age (years), hematoma volume (cm3), hematoma location (deep [basal ganglia, thalamus], lobar, or infratentorial), presence of intraventricular hemorrhage (IVH), baseline Glasgow Coma Scale (GCS) score, and National Institutes of Health Stroke Scale (NIHSS) score at randomization. We assessed model fit, calibration, discrimination, and agreement (ordinal, dichotomized functional independence), and EuroQol-5D ([EQ-5D] utility weighted) between predicted and observed 90-day mRS. A total of 898/1000 participants were included. Following bootstrap internal validation, our model (calibration slope = 0.967) had an optimism-corrected c-index of 0.884 (95% CI = 0.873-0.896) and R2 = 0.712 for 90-day mRS score. The weighted ĸ for agreement between observed and predicted ordinal 90-day mRS score was 0.811 (95% CI = 0.787-0.834). Agreement between observed and predicted functional independence (mRS score of 0-2) at 90 days was 74.3% (95% CI = 69.9-78.7%). The mean ± SD absolute difference between predicted and observed EQ-5D-weighted mRS score was negligible (0.005 ± 0.145). This tool allows practitioners and researchers to utilize clinically available information along with the mRS score 30 days after ICH to reliably predict the mRS score at 90 days.

Agreement between 30-day and 90-day modified Rankin Scale score and utility-weighted modified Rankin Scale score in acute intracerebral hemorrhage: An analysis of ATACH-2 trial data.

The relationship between 30- and 90-day modified Rankin Scale (mRS) scores in intracerebral hemorrhage (ICH) patients was evaluated. This post hoc cohort analysis of the ATACH-2 trial included patients with acute ICH who were alive at 30 days and who had mRS scores reported at 30 and 90 days. The mRS score was then converted to a utility (EuroQol-5 Dimension-3 Level [EQ-5D-3L])-weighted mRS score. After adjustment of 30-day mRS score for key covariates using multivariable ordinal regression, the relationship between 30-day and observed 90-day functional outcome was assessed via absolute difference in the utility-weighted version. Of the 1000 trial subjects, 898 met inclusion criteria. This low-moderate severity ICH cohort had a median baseline GCS score of 15 and median hematoma volume of 9.7 mL. Observed 30-day mRS had the largest association with observed 90-day values (χ2 = 302.9, p < 0.0001). Patients generally either maintained the same mRS scores between 30 and 90 days (48 %) or experienced a 1-point (32 %) or 2-point (10 %) improvement by 90 days. The mean ± standard deviation (SD) EQ-5D-3L at 90 days was 0.67 ± 0.26. Following adjustment, the mean absolute difference between predicted and observed utility-weighted 90-day mRS scores was 0.006 ± 0.13 points and less than the estimated minimal clinically important difference of 0.13 points. The difference in average utility-weighted mRS scores at 30 and 90 days was not clinically relevant, suggesting 30-day score may be a reasonable proxy for 90-day values in patients with ICH when 90-day values are not available.

Definition of factor Xa inhibitor-related, life-threatening gastrointestinal bleeding and guidance on when to use reversal therapy: A Delphi panel.

Objective: To define and contextualize life-threatening gastrointestinal (GI) bleeding in the setting of factor Xa (FXa) inhibitor therapy and to derive a consensus-based, clinically oriented approach to the administration of FXa inhibitor reversal therapy. Methods: We convened an expert panel of clinicians representing specialties in emergency medicine, gastroenterology, vascular medicine, and trauma surgery. Consensus was reached among the clinician panelists using the Delphi technique, which consisted of 2 survey questionnaires followed by virtual, real-time consensus-building exercises. Results: Hypovolemia and hemodynamic instability were considered the most important clinical signs of FXa inhibitor-related, life-threatening GI bleeds. Clinician panelists agreed that potentially life-threatening GI bleeding should be determined on the basis of hemodynamic instability, signs of shock, individual patient characteristics, and clinical judgment. Last, the panel agreed that all patients with life-threatening, FXa inhibitor-associated GI bleeding should be considered for FXa inhibitor reversal therapy; the decision to reverse FXa inhibition should be individualized, weighing the risks and benefits of reversal; and when reversal is elected, therapy should be administered within 1 h after initial emergency department evaluation, when possible. Conclusions: Consensus-based definitions of life-threatening GI bleeding and approaches to FXa inhibitor reversal centered on hemodynamic instability, signs of shock, individual patient characteristics, and clinical judgment. The results from this Delphi panel may inform clinical decision-making for the treatment of patients experiencing GI bleeding associated with FXa inhibitor use in the emergency department setting.

Lower mortality with andexanet alfa vs 4-factor prothrombin complex concentrate for factor Xa inhibitor-related major bleeding in a U.S. hospital-based observational study.

Background: Well-designed studies with sufficient sample size comparing andexanet alfa vs 4-factor prothrombin complex concentrate (4F-PCC) in routine clinical practice to evaluate clinical outcomes are limited. Objectives: To compare in-hospital mortality in patients hospitalized with rivaroxaban- or apixaban-related major bleeding who were treated with andexanet alfa or 4F-PCC. Methods: An observational cohort study (ClinicalTrials.gov identifier: NCT05548777) was conducted using electronic health records between May 2018 and September 2022 from 354 U.S. hospitals. Inclusion criteria were age ≥18 years, inpatient admission with diagnosis code D68.32 (bleeding due to extrinsic anticoagulation), a record of use of the factor Xa inhibitors rivaroxaban or apixaban, andexanet alfa or 4F-PCC treatment during index hospitalization, and a documented discharge disposition. Multivariable logistic regression on in-hospital mortality with andexanet alfa vs 4F-PCC was performed. The robustness of the results was assessed via a supportive propensity score-weighted logistic regression. Results: The analysis included 4395 patients (andexanet alfa, n = 2122; 4F-PCC, n = 2273). There were 1328 patients with intracranial hemorrhage (ICH), 2567 with gastrointestinal (GI) bleeds, and 500 with critical compartment or other bleed types. In the multivariable analysis, odds of in-hospital mortality were 50% lower for andexanet alfa vs 4F-PCC (odds ratio [OR], 0.50; 95% CI, 0.39-0.65; P < .01) and were consistent for both ICH (OR, 0.55; [0.39-0.76]; P < .01) and GI bleeds (OR, 0.49 [0.29-0.81]; P = .01). Similar results were obtained from the supporting propensity score-weighted logistic regression analyses. Conclusion: In this large observational study, treatment with andexanet alfa in patients hospitalized with rivaroxaban- or apixaban-related major bleeds was associated with 50% lower odds of in-hospital mortality than 4F-PCC. The magnitude of the risk reduction was similar in ICH and GI bleeds.

Clinical and health care resource use burden of hospitalizations for oral factor Xa inhibitor-associated major bleeding: A real-world analysis of Medicare beneficiaries.

Objective: To characterize the burden of illness associated with oral factor Xa (FXa) inhibitor-related bleeding in the US Medicare population. Methods: This retrospective cohort study used the full 20% Medicare random sample claims database to identify patients who experienced their first hospitalization for an FXa inhibitor-related major bleed between October 2013 and September 2017. Bleeding types were classified as intracranial hemorrhage (ICH), gastrointestinal (GI), and other. Associations between risk factors and outcomes (in-hospital and 30-day mortality, 30-day readmission, and discharge to a location other than home) adjusted for patient demographic characteristics, baseline clinical conditions, index event characteristics, treatment with hemostatic/factor replacement agents or transfusion (ie, usual care prereversal agent availability), multicompartment ICH and neurosurgical procedures (ICH cohort), and endoscopy (GI cohort) were assessed using multivariable regression and reported as crude incidences and adjusted odds ratios (ORs) stratified by bleed type. Results: Of the 11,593 patients identified, 2737 (23.6%) had ICH, 8169 (70.5%) had GI bleeds, and 687 (5.9%) had other bleeds. The incidences of in-hospital mortality, 30-day mortality, need for postdischarge out-of-home care, and 30-day readmission were 15.7%, 29.1%, 78.3%, and 20.3% in the single-compartment ICH cohort, respectively; and 1.7%, 6.8%, 41.3%, and 18.8% in the GI bleeds cohort, respectively. Increased odds of both in-hospital mortality and 30-day mortality were significantly associated with: multicompartment ICH (reference, single compartment ICH; OR = 3.35 [95% confidence interval (CI): 2.41-4.66]; 2.18 [95% CI: 1.63-2.91]), loss of consciousness during index hospitalization (yes vs no; OR = 2.03 [95% CI: 1.38-2.97]; 1.49 [95% CI: 1.11-2.02]), receiving usual care (yes vs no; OR = 1.55 [95% CI: 1.22-1.98]; 1.33 [95% CI: 1.09-1.63]) during index hospitalization, and increasing number of Elixhauser comorbidities at baseline (OR = 1.07 [95% CI: 1.03-1.10]; 1.09 [95% CI: 1.06-1.12]) in the ICH cohort; intensive care unit admission (yes vs no; OR = 1.88 [95% CI: 1.32-2.67]; 1.51 [95% CI: 1.26-1.81]), increasing number of Elixhauser comorbidities at baseline (OR = 1.12 [95% CI: 1.07-1.18]; 1.15 [1.12-1.18]), and increasing age on index date (OR = 1.04 [95% CI: 1.02-1.07]; 1.05 [95% CI: 1.04-1.07]) in the GI bleeds cohort. Conclusions: In this large sample of Medicare patients, FXa inhibitor-related major bleeding was associated with substantial burden in terms of adverse clinical outcomes and health care resource use. Incidence of ICH was lower than GI bleeds; however, burden of illness was notably higher with ICH.

Real-world clinical outcomes among US Veterans with oral factor xa inhibitor-related major bleeding treated with andexanet alfa or 4-factor prothrombin complex concentrate.

Oral factor Xa (FXa) inhibitors significantly reduce incidence of stroke and thromboembolic events in patients with atrial fibrillation or venous thromboembolism. Due to various factors and the lack of a randomized controlled trial comparing andexanet alfa to usual care, non-specific replacement agents including 4 F-PCC are still used off-label for FXa inhibitor bleed management. Clinical and mortality data were extracted from the inpatient medical data and Veteran Affairs (VA) vital status files over the time of March 2014 through December 2020. Propensity score-weighted models were used for this retrospective cohort study using data from the Veterans Affairs Informatics and Computing Infrastructure (VINCI). The study included 255 patients (85-andexanet alfa and 170-4 F-PCC) exposed to an oral factor Xa inhibitor and hospitalized with an acute major, gastrointestinal (GI), intracranial (ICH) or other bleed. In-hospital mortality was significantly lower in the andexanet alfa cohort compared to the 4 F-PCC cohort (10.6% vs. 25.3%, p = 0.01). Propensity score-weighted Cox models reveal a 69% lower hazard of in-hospital mortality for those treated with andexanet alfa (HR 0.31, 95% CI 0.14-0.71) compared to those treated with 4 F-PCC. Additionally, those treated with andexanet alfa had a lower 30-day mortality rate and lower 30-day hazard of mortality in the weighted Cox model (20.0% vs. 32.4%, p = 0.039; HR 0.54, 95% CI 0.30-0.98) compared to those treated with 4 F-PCC. Among 255 US veterans with major bleeding in the presence of an oral factor Xa inhibitor, treatment with andexanet alfa was associated with lower in-hospital and 30-day mortality than treatment with 4 F-PCC.

Derivation and validation of a composite scoring system (SAVED2) for prediction of unfavorable modified Rankin scale score following intracerebral hemorrhage.

Objective: To develop a composite score for predicting functional outcome post-intracerebral hemorrhage (ICeH) using proxy measures that can be assessed retrospectively. Methods: Data from the observational ERICH study were used to derive a composite score (SAVED2) to predict an unfavorable 90-day modified Rankin scale (mRS) score. Independent predictors of unfavorable mRS were identified via multivariable logistic regression and assigned score weights based on effect size. Area under the curve (AUC) was used to measure the score's discriminative ability. External validation was performed in the randomized ATACH-2 trial. Results: There were 2,449 patients from ERICH with valid mRS data who survived to hospital discharge. Predictors associated with unfavorable 90-day mRS score and their corresponding point values were: age ≥70 years (odds ratio [OR], 3.8; 1-point); prior stroke (OR, 2.8; 1-point); need for ventilation (OR, 2.7; 1-point); extended hospital stay (OR, 2.7; 1-point); and non-home discharge location (OR, 5.3; 2-points). Incidence of unfavorable 90-day mRS increased with higher SAVED2 scores (P < 0.001); AUC in ERICH was 0.82 (95% CI, 0.80-0.84). External validation in ATACH-2 (n = 904) found an AUC of 0.74 (95% CI, 0.70-0.77). Conclusions: Using data collected at hospital discharge, the SAVED2 score predicted unfavorable mRS in patients with ICeH.

Andexanet alfa versus four-factor prothrombin complex concentrate for the reversal of apixaban- or rivaroxaban-associated intracranial hemorrhage: a propensity score-overlap weighted analysis.

BACKGROUND: Andexanet alfa is approved (FDA "accelerated approval"; EMA "conditional approval") as the first specific reversal agent for factor Xa (FXa) inhibitor-associated uncontrolled or life-threatening bleeding. Four-factor prothrombin complex concentrates (4F-PCC) are commonly used as an off-label, non-specific, factor replacement approach to manage FXa inhibitor-associated life-threatening bleeding. We evaluated the effectiveness and safety of andexanet alfa versus 4F-PCC for management of apixaban- or rivaroxaban-associated intracranial hemorrhage (ICH). METHODS: This two-cohort comparison study included andexanet alfa patients enrolled at US hospitals from 4/2015 to 3/2020 in the prospective, single-arm ANNEXA-4 study and a synthetic control arm of 4F-PCC patients admitted within a US healthcare system from 12/2016 to 8/2020. Adults with radiographically confirmed ICH who took their last dose of apixaban or rivaroxaban < 24 h prior to the bleed were included. Patients with a Glasgow Coma Scale (GCS) score < 7, hematoma volume > 60 mL, or planned surgery within 12 h were excluded. Outcomes were hemostatic effectiveness from index to repeat scan, mortality within 30 days, and thrombotic events within five days. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated using propensity score-overlap weighted logistic regression. RESULTS: The study included 107 andexanet alfa (96.6% low dose) and 95 4F-PCC patients (79.3% receiving a 25 unit/kg dose). After propensity score-overlap weighting, mean age was 79 years, GCS was 14, time from initial scan to reversal initiation was 2.3 h, and time from reversal to repeat scan was 12.2 h in both arms. Atrial fibrillation was present in 86% of patients. Most ICHs were single compartment (78%), trauma-related (61%), and involved the intracerebral and/or intraventricular space(s) (53%). ICH size was ≥ 10 mL in volume (intracerebral and/or ventricular) or ≥ 10 mm in thickness (subdural or subarachnoid) in 22% of patients and infratentorial in 15%. Andexanet alfa was associated with greater odds of achieving hemostatic effectiveness (85.8% vs. 68.1%; OR 2.73; 95% CI 1.16-6.42) and decreased odds of mortality (7.9% vs. 19.6%; OR 0.36; 95% CI 0.13-0.98) versus 4F-PCC. Two thrombotic events occurred with andexanet alfa and none with 4F-PCC. CONCLUSIONS: In this indirect comparison of patients with an apixaban- or rivaroxaban-associated ICH, andexanet alfa was associated with better hemostatic effectiveness and improved survival compared to 4F-PCC. Trial registration NCT02329327; registration date: December 31, 2014.

Hematoma Expansion and Clinical Outcomes in Patients With Factor-Xa Inhibitor-Related Atraumatic Intracerebral Hemorrhage Treated Within the ANNEXA-4 Trial Versus Real-World Usual Care.

BACKGROUND AND PURPOSE: It is unestablished whether andexanet alfa, compared with guideline-based usual care including prothrombin complex concentrates, is associated with reduced hematoma expansion (HE) and mortality in patients with factor-Xa inhibitor-related intracerebral hemorrhage (ICH). We compared the occurrence of HE and clinical outcomes in patients treated either with andexanet alfa or with usual care during the acute phase of factor-Xa inhibitor-related ICH. METHODS: Data were extracted from the multicenter, prospective, single-arm ANNEXA-4 trial (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) and a multicenter observational cohort study, RETRACE-II (German-Wide Multicenter Analysis of Oral Anticoagulant-Associated Intracerebral Hemorrhage - Part Two). HE was based on computed tomography scans performed within 36 hours from baseline imaging. Inverse probability of treatment weighting was performed to adjust for baseline comorbidities and ICH severity. Patients presenting with atraumatic ICH while receiving apixaban or rivaroxaban within 18 hours of admission were included. Patients with secondary ICH or not fulfilling the inclusion criteria for the ANNEXA-4 trial were excluded. We compared ANNEXA-4 patients, who received andexanet alfa for hemostatic treatment, with RETRACE-II patients who were treated with usual care, primarily administration of prothrombin complex concentrates. Primary outcome was rate of HE defined as relative increase of ≥35%. Secondary outcomes comprised mean absolute change in hematoma volume, as well as in-hospital mortality and functional outcome. RESULTS: Overall, 182 patients with factor-Xa inhibitor-related ICH (85 receiving andexanet alfa versus 97 receiving usual care) were selected for analysis. There were no relevant differences regarding demographic or clinical characteristics between both groups. HE occurred in 11 of 80 (14%) andexanet alfa patients compared with 21 of 67 (36%) usual care patients (adjusted relative risk, 0.40 [95% CI, 0.20-0.78]; P=0.005), with a reduction in mean overall hematoma volume change of 7 mL. There were no statistically significant differences among in-hospital mortality or functional outcomes. Sensitivity analysis including only usual care patients receiving prothrombin complex concentrates demonstrated consistent results. CONCLUSIONS: As compared with usual care, andexanet alfa was associated with a lower rate of HE in atraumatic factor-Xa inhibitor-related ICH, however, without translating into significantly improved clinical outcomes. A comparative trial is needed to confirm the benefit on limiting HE and to explore clinical outcomes across patient subgroups and by time to treatment. Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT02329327 and NCT03093233.

Intuitive Eating is Associated With Higher Fruit and Vegetable Intake Among Adults.

OBJECTIVE: Assess how intuitive eating relates to dietary intake. METHODS: Survey data were collected in Project Eating and Activity in Teens and Young Adults, the fourth wave of a longitudinal cohort study (weighted n = 1,830, 49% women; mean age = 31 years). Intuitive eating was assessed using a 7-item scale adapted from the Intuitive Eating Scale and Intuitive Eating Scale-2. Dietary intake was measured via a semiquantitative food frequency questionnaire. Mean servings were stratified by gender and intuitive eating quartiles and adjusted for sociodemographic characteristics and caloric intake. RESULTS: Women and men in the top intuitive eating quartile consumed 0.6-0.3 servings more fruit and 0.4-0.6 servings more vegetables daily, respectively, compared with the bottom quartile, whereas men in the top quartile also consumed 0.6 servings fewer whole grains (all P < 0.05) than the bottom quartile. CONCLUSIONS AND IMPLICATIONS: Intuitive eating shows promise as a healthier alternative to practices such as dieting.

Major bleed costs of atrial fibrillation patients treated with factor Xa inhibitor anticoagulants.

OBJECTIVE: To examine the healthcare economic burden of atrial fibrillation (AF) patients treated with factor Xa inhibitor (FXaI) anticoagulants who were hospitalized in the US with a major bleed (MB). METHODS: Adult AF patients treated with FXaIs and hospitalized with an MB were selected from MarketScan databases (1 January 2015-30 April 2018). Patients were grouped into cohorts based on type of MB: intracranial hemorrhage (ICH), gastrointestinal (GI), other types of MB. Healthcare costs in 2019 USD were evaluated for index hospitalizations and during a variable follow-up period in unadjusted and adjusted analyses. RESULTS: Of the overall AF patient population treated with FXaIs and hospitalized with an MB (n = 7,577), 9.9% had ICH (mean age: 77.9 years; 58% male), 55.9% had GI (mean age: 76.8 years; 52% male), and 34.2% had other types of MB (mean age: 74.4 years; 61% male). Mean index hospitalization costs for ICH, GI, and other type of MB were $54,163, $26,901, and $36,645, respectively; from adjusted analyses, patients with ICH vs. GI spent 1.6 more days in the hospital; mean cost was $15,630 higher. Patients with other types of MB vs. GI spent 0.6 more days in the hospital; mean cost was $5,859 higher. Index hospitalization cost in addition to total all-cause healthcare costs incurred in the follow-up period were $34,522 higher per ICH patient and $11,584 higher per other type of MB patient vs. a GI MB patient. LIMITATIONS: Since this study was a retrospective observational study using a claims database analysis, a causal relationship between treatment with FXaIs and MB events cannot be established. CONCLUSIONS: Although all of the evaluated MB types were associated with high hospitalization costs, ICH was associated with the most substantial short- and long-term healthcare economic burden.

Young adult nutrition and weight correlates of picky eating during childhood.

OBJECTIVE: To identify whether picky eating during childhood is associated with dietary intake, weight status and disordered eating behaviour during young adulthood. DESIGN: A population-based study using data from young adults who responded online or by mail to the third wave of the Project EAT (Eating and Activity in Teens and Young Adults) study in 2008-2009. Participants retrospectively reported the extent to which they were a picky eater in childhood, sociodemographic characteristics, disordered eating behaviours, usual dietary intake, and weight and height. SETTING: Participants were initially recruited in the Minneapolis/St. Paul metropolitan area of Minnesota, USA, in 1998-1999. PARTICIPANTS: The analytic sample included 2275 young adults (55 % female, 48 % non-Hispanic White, mean age 25·3 (sd 1·6) years). RESULTS: Young adults who reported picky eating in childhood were found to currently have lower intakes of fruit, vegetables and whole grains, and more frequent intakes of snack foods, sugar-sweetened beverages and foods from fast-food restaurants. No associations were observed between picky eating in childhood and young adults' weight status, use of weight-control strategies or report of binge eating. CONCLUSIONS: While young adults who report picky eating during childhood are not at higher risk for disordered eating, those who were picky eaters tend to have less healthy dietary intake. Food preferences and dietary habits established by picky eaters during childhood may persist into adulthood.

Cumulative Encouragement to Diet From Adolescence to Adulthood: Longitudinal Associations With Health, Psychosocial Well-Being, and Romantic Relationships.

PURPOSE: The aim of the study was to identify whether parent encouragement to diet as an adolescent predicts subsequent encouragement to diet from significant others/romantic partners as an adult and examine longitudinal associations between cumulative encouragement to diet from close relationships (i.e., parent and significant other) and later weight, weight-related, and psychosocial well-being outcomes in adulthood. METHODS: Data from Project EAT I-IV, a 15-year longitudinal population-based study of socioeconomically and racially/ethnically diverse adolescents followed into adulthood (n = 1,116; mean age = 31.1 years; 61% female), were used for this study. Surveys and anthropometric measures were completed at school by adolescents in 1998-1999, and follow-up mailed and online surveys were completed at approximately 5-year intervals between 2003 and 2016. RESULTS: Adolescents who experienced encouragement to diet from their parents were more likely to have a significant other as an adult who also encouraged them to diet. In addition, there was a significant (p < .05) cumulative effect of encouragement to diet, such that experiencing more encouragement to diet from both a parent(s) and significant other was associated with higher weight status, more unhealthy weight-control behaviors (e.g., dieting, binge eating, and unhealthy weight control behaviors), and lower psychosocial well-being (e.g., lower body satisfaction and self-esteem and higher depressive symptoms) as a young adult. CONCLUSIONS: Encouragement to diet tracked from one close relationship to another and had a cumulative effect on adult weight, weight-related, and psychosocial well-being outcomes. Future interventions, clinical work, and research should be aware of these patterns and cumulative effects of encouragement to diet to target key relationships to reduce these harmful interpersonal patterns.

Longitudinal trajectories and prevalence of meeting dietary guidelines during the transition from adolescence to young adulthood.

BACKGROUND: Establishing healthy dietary habits during adolescence and young adulthood is critical for long-term health. OBJECTIVES: This study assessed the prevalence of meeting US Dietary Guidelines and trajectories in dietary intake for 4 MyPlate food groups during the transition from adolescence to young adulthood. METHODS: Three waves of surveys and food frequency questionnaires were collected as part of Project EAT (Eating and Activity in Teens and Young Adults), a 15-y longitudinal study. Adolescents (n = 1177, 57% female, mean ± SD age 15.0 ± 1.5 y) were recruited in 1998-1999 in Minneapolis-St Paul, Minnesota public schools and were resurveyed twice in young adulthood at mean ± SD ages 25.3 ± 1.5 and 31.1 ± 1.5 y. The prevalence of meeting guidelines for each MyPlate food group was calculated at each time point. Mean daily servings were compared over 5 y in young adulthood through the use of paired t tests. Adjusted least-squares means were calculated to compare dietary intake in young adulthood across quartiles of adolescent intake. RESULTS: Adolescents had the highest prevalence of meeting dietary guidelines for fruit (37% for females and 30% for males) and dairy (53% for females and 61% for males); young adults >30 y had the highest prevalence of meeting dietary guidelines for vegetables (19% for females and 8% for males) and whole grains (23% for females and 17% for males). From the mid-twenties to early thirties, vegetable intake increased, whereas dairy intake decreased. Dietary intake generally tracked over time with individuals in the lower quartiles of intake at adolescence generally continuing to have low intake in young adulthood. CONCLUSIONS: Although the prevalence of meeting dietary guidelines for whole grains and vegetables, and daily servings of vegetables increased with age, improving intake of whole fruit, whole grains, dairy, and vegetables remains key during the transition from adolescence to young adulthood.

Life Events and Longitudinal Effects on Physical Activity: Adolescence to Adulthood.

INTRODUCTION: Common life events, such as getting married or gaining employment, may be opportunities to intervene on health behaviors like physical activity. The purpose of this study was to determine the changes in moderate-to-vigorous physical activity (MVPA) associated with several common life events from adolescence to young adulthood. METHODS: Participants in Project EAT (ages 11 to 18 yr at baseline and 25 to 36 yr at wave 4) were surveyed at four timepoints from 1998 to 2016. Questions included marital status, employment status, postsecondary education completion and enrollment, and living situation between each wave. Linear regression was used to model the effect of each life event on change in self-reported MVPA. Post hoc mediation analysis was conducted to examine whether having a child mediated the effect of getting married on the change in MVPA. RESULTS: Average MVPA declined from 6.5 h·wk at baseline to 4.3 h·wk at wave 4. Having a child was associated with a significant decrease in MVPA between waves 2 and 3 and between waves 3 and 4. Getting married and leaving parents' home were associated with significant decreases in MVPA between waves 3 and 4. Having a child both mediated and moderated the effect of getting married on MVPA. CONCLUSIONS: This study provides evidence that MVPA declines both after getting married and after having a child and that these effects are not independent. Interventions to maintain or increase MVPA could profitably target couples planning to get married or have a child.

Eating, Activity, and Weight-related Problems From Adolescence to Adulthood.

INTRODUCTION: Determining the population-based scope and stability of eating, activity, and weight-related problems is critical to inform interventions. This study examines: (1) the prevalence of eating, activity, and weight-related problems likely to influence health; and (2) the trajectories for having at least one of these problems during the transition from adolescence to adulthood. METHODS: Project EAT I-IV (Eating and Activity in Teens and Young Adults) collected longitudinal survey data from 858 females and 597 males at four waves, approximately every 5 years, from 1998 to 2016, during the transition from adolescence to adulthood. Analyses were conducted in 2017-2018. Measures included high fast-food intake (≥3 times/week), low physical activity (<150 minutes/week), unhealthy weight control, body dissatisfaction, and obesity status. RESULTS: Among females, the prevalence of having at least one eating, activity, or weight-related problems was 78.1% at Wave 1 (adolescence) and 82.3% at Wave 4 (adulthood); in males, the prevalence was 60.1% at Wave 1 and 69.2% at Wave 4. Of all outcomes assessed, unhealthy weight control behaviors had the highest prevalence in both genders. The stability of having at least one problem was high; 60.2% of females and 34.1% of males had at least one problematic outcome at all four waves. CONCLUSIONS: The majority of young people have some type of eating, activity, or weight-related problem at all stages from adolescence to adulthood. Findings indicate a need for wide-reaching interventions that address a broad spectrum of eating, activity, and weight-related problems prior to and throughout this developmental period.

Who Values Gluten-Free? Dietary Intake, Behaviors, and Sociodemographic Characteristics of Young Adults Who Value Gluten-Free Food.

BACKGROUND: Over the past decade, consumer demand for gluten-free products has increased, but little is known about the public health impact of and factors correlated with valuing gluten-free food. OBJECTIVE: Describe the sociodemographic and behavioral characteristics of young adults valuing gluten-free as an important food attribute, and compare their dietary intake with other young adults. DESIGN: Cross-sectional analysis of survey data collected in 2015 to 2016 as part of the fourth wave of the Project EAT (Eating and Activity in Teens and Young Adults) cohort study. PARTICIPANTS/SETTING: Population-based sample of 1,819 young adults (25 to 36 years) (57% women, 69% white), initially recruited in Minneapolis-St Paul, MN, public middle and senior high schools. MEASURES: Valuing gluten-free food, weight goals and weight control behaviors, food production values, eating behaviors, physical activity, and dietary intake. STATISTICAL ANALYSES PERFORMED: Logistic regression models were used to investigate associations with potential correlates of valuing gluten-free food. For dietary intake, adjusted mean estimates were calculated for those who did and those who did not value gluten-free foods. RESULTS: Approximately 13% of young adults valued gluten-free food, a characteristic most strongly related to valuing food production practices (eg, organic, locally grown); factors such as Nutrition Facts use and having a weight goal were also related to gluten-free food values. Valuing gluten-free food was related to engagement in both healthy behaviors (eg, eating breakfast daily, eating more fruits and vegetables) and unhealthy behaviors (eg, using diet pills to control weight). CONCLUSIONS AND RELEVANCE: Young adults valuing gluten-free food generally engaged in healthier behaviors and had better dietary intake; of concern, they were also more likely to engage in unhealthy weight control behaviors. Valuing gluten-free food may be part of a cluster of behaviors representing an interest in making healthier food choices but may also be a marker for unhealthy weight preoccupation and behaviors.

Nutrition Facts Panels: Who Uses Them, What Do They Use, and How Does Use Relate to Dietary Intake?

BACKGROUND: Nutrition labels are a low-cost tool with the potential to encourage healthy eating habits. OBJECTIVE: To investigate correlates of frequent Nutrition Facts label use, describe the types of label information most often used, and measure how label use relates to dietary intake in young adults. DESIGN: Cross-sectional population-based study of young adults participating in Project Eating and Activity in Teens and Young Adults-IV. PARTICIPANTS/SETTING: Surveys and food frequency questionnaires were completed during 2015-2016 by young adults (N=1,817; weighted sample=49% women) aged 25 to 36 years. MAIN OUTCOME MEASURES: Nutrition Facts label use, frequency of using specific information on labels, and dietary intake. STATISTICAL ANALYSES PERFORMED: Relative risks and adjusted means were used to examine how demographic, behavior, and weight-related factors were associated with Nutrition Facts panel use, and how label use related to dietary outcomes. Associations with P values <0.05 were considered statistically significant. RESULTS: Approximately one-third (31.4%) of participants used Nutrition Facts labels "frequently." Use was significantly higher for women; for participants with high education and income; among those who prepared food regularly; among those who were physically active; among those with a weight status classified as overweight; and among those who were trying to lose, gain, or maintain weight. Label components used most often included sugars (74.1%), total calories (72.9%), serving size (67.9%), and the ingredient list (65.8%). Nutrition Facts label users consumed significantly more fruits, vegetables, and whole grains and fewer sugar-sweetened beverages, compared with nonusers. Nutrition Facts label users ate significantly more frequently at sit-down restaurants but less frequently at fast-food restaurants compared with nonusers. CONCLUSIONS: Although Nutrition Facts label use was associated with markers of better dietary quality in a population-based sample of young adults, only one-third of participants used labels frequently. Methods to improve label use should be studied, particularly through leveraging weight- or health-related goals (eg, interest in making healthier food choices), and meeting consumer preferences concerning label content.