A Qualitative Study to Understand Stakeholders' Views About the Fruits & Veggies (FNV) Social Marketing Campaign to Promote Fruit and Vegetable Consumption in the United States.

BACKGROUND: In 2015, the Partnership for a Healthier America (PHA) piloted a branded social marketing communications initiative called the FNV (Fruits & Veggies) Campaign to promote the sale and consumption of fruits and vegetables among mom and teen target audiences in 2 California and Virginia pilot markets. After the first year, FNV was expanded to multiple markets across the United States through diverse partnerships. Factors, resources, and strategies that contribute to the effectiveness and sustainability of the campaign need to be identified. OBJECTIVE: The purpose of this qualitative study was to explore diverse stakeholders' views and expectations about the FNV Campaign design, reach, effectiveness, and impact and prospects for expansion, scale-up, and sustainability. DESIGN: Semistructured interviews were conducted between July and October 2016 with stakeholders to elicit their perspectives and expectations of the FNV Campaign. PARTICIPANTS/SETTING: A purposive sample of diverse stakeholders (n = 22) affiliated with national, state, and local industry and government and nongovernmental organizations. ANALYSIS: Data were recorded, transcribed, input into NVivo 11 software (QSR International. Melbourne, Australia), coded and organized thematically using a conceptual framework that examined campaign design, reach, effectiveness, adoption, implementation, expansion, scaling up, and sustainability. RESULTS: Opportunities, challenges, and expectations of stakeholders were reported for the FNV Campaign related to engaging future partners from different levels of community, government, and industry; conducting and disseminating findings from multifaceted evaluations; ensuring campaign effectiveness; and developing and improving campaign elements for target audiences and partner adoption. Conducting formative research, partner, and audience engagement, implementation, and evaluation are essential to the ensure effectiveness and sustainability of the FNV Campaign. CONCLUSIONS: Insights from this study can inform the strategic use of social marketing campaign elements to facilitate the effectiveness and sustainability of the FNV Campaign as it expands and is scaled up across markets nationwide.

Evaluation of integrated marketing communication strategies used for the Fruits & Veggies Campaign in California and Virginia.

In 2015, the Partnership for a Healthier America launched the branded Fruits & Veggies (FNV) Campaign to promote fruit and vegetable sales and intake to moms and teens in two California and Virginia pilot markets. The FNV Campaign used a novel, creative approach to promote fruits and vegetables through integrated marketing communication (IMC) strategies. Findings from a mixed-methods process evaluation conducted between 2016 and 2017 were used to explore congruence between stakeholders' expectations of IMC strategy potential and FNV brand awareness and reach among target audiences. Awareness and recall of IMC strategies were assessed through a cross-sectional survey of target audience respondents (n = 1604) from the pilot markets. Qualitative data regarding IMC strategy potential and influential factors were gathered from stakeholder interviews (n = 22). Approximately 19.6% (n = 315) of respondents were aware of the FNV Campaign. Stakeholders' perspectives regarding IMC potential aligned with findings that the proportion of aware respondents was significantly (p = 0.008) higher among teens (22%) than moms (17%). Qualitative results also converged with higher proportions of survey respondents recalling brand exposure through social media (46%) and retail settings (30%) than community activities (18%), word of mouth (17.5%), and traditional media advertisements (9.5%). IMC recall did not differ between mom and teen respondents except for significantly (p = 0.02) higher word of mouth recall among teen respondents. Findings support using selected IMC strategies and future involvement of diverse stakeholders. Evaluation results can inform future research and practice to improve IMC strategy reach and influence as the FNV Campaign expands to new markets nationwide.

State Regulations Promoting Infant Physical Activity in Early Care and Education.

BACKGROUND: State policies have the potential to improve early care and education (ECE) settings, but little is known about the extent to which states are updating their licensing and administrative regulations, especially in response to national calls to action. In 2013, we assessed state regulations promoting infant physical activity in ECE and compared them with national recommendations. To assess change over time, we conducted this review again in 2018. METHODS: We reviewed regulations for all US states for child care centers (centers) and family child care homes (homes) and compared them with three national recommendations: (1) provide daily tummy time; (2) use cribs, car seats, and high chairs for their primary purpose; and (3) limit the use of restrictive equipment (e.g., strollers). We performed exact McNemar's tests to compare the number of states meeting recommendations from 2013 to 2018 to evaluate whether states had made changes over this period. RESULTS: From 2013 to 2018, we observed significant improvement in one recommendation for homes-to use cribs, car seats, and high chairs for their primary purpose (odds ratio 11.0; 95% CI 1.6-47.3; p = 0.006). We did not observe any other significant difference between 2013 and 2018 regulations. CONCLUSIONS: Despite increased awareness of the importance of early-life physical activity, we observed only modest improvement in the number of states meeting infant physical activity recommendations over the past 5 years. In practice, ECE programs may be promoting infant physical activity, but may not be required to do so through state regulations.

The Slow Down Program: A mixed methods pilot study of a mindfulness-based stress management and nutrition education program for mothers.

OBJECTIVE: Stress levels have been associated with a broad range of adverse health outcomes, particularly for mothers and subsequently, their children. Mindfulness-based stress management is a tool that has effectively been utilized in several disciplines and has potential applications to eating behaviors. This paper describes the effects of an exploratory mindfulness-based stress management and nutrition education program, the Slow Down Program, on mothers' perceived stress, eating behavior, and self-efficacy. DESIGN & SETTING: This study used a mixed methods quasi-experimental design. Nineteen mothers with young children (five or younger) participated in the study. The SDP consisted of four consecutive weekly 1.5 h sessions focused on experiential learning and facilitated discussion. MAIN OUTCOME MEASURES: Quantitative data were collected pre- and post-intervention and included: the Perceived Stress Scale; Mindfulness Self-Efficacy Scale; and the Three-Factor Eating Questionnaire Revised-18. Qualitative data included a focus group post-intervention and an individual interview 4-6 weeks post-intervention. RESULTS: The SDP showed significant improvements in participants' perceived stress (p = .04), uncontrolled eating (p < 0.01), cognitive restraint (p < 0.01), and mindfulness self-efficacy (p < 0.01). Qualitatively, participants also reported changes in self-efficacy and eating behaviors - specifically improvements in mindful eating, and sensory and satiety awareness. CONCLUSIONS: The results of this pilot study demonstrate that nutrition programs incorporated with mindfulness strategies may offer positive, short-term impacts on stress reduction and eating behaviors. Additional studies are warranted across a variety of populations with more rigorous study designs to assess long-term effects.

Validation of a Rapid Method to Assess Habitual Beverage Intake Patterns.

The Healthy Beverage Index (HBI) is an emerging approach to assess beverage pattern quality. HBI total scores range from 0 to 100, with higher scores indicating greater adherence to proposed beverage recommendations. However, assessing patterns is resource-intensive due to the need for extensive dietary data, typically 24-h dietary records or recalls. The BEVQ-15, a beverage intake questionnaire, may be used as an alternative method to rapidly measure HBI scores. The objective of this cross-sectional investigation is to assess the comparative validity of the HBI-Q, a method to rapidly assess HBI scores via the BEVQ-15, as compared to the traditional method of deriving HBI scores via dietary recalls/records. Between 2012 and 2016, a cross-sectional sample of adults in southwest Virginia completed three 24-h dietary recalls (30-60 min administration and analysis time per recall) and the BEVQ-15 (3-4 min administration time). HBI scores were generated by both methods, and compared via paired-samples t-tests, correlations, and Bland-Altman analysis. Among 404 adults (mean age = 40 years), total mean HBI scores were 63.7 from the HBI-Q and 67.3 from the recalls (mean difference = 3.6 out of 100; r = 0.63; both p ≤ 0.001). Agreement between the two methods for total HBI scores via Bland-Altman plots was 92%. Using the HBI-Q to rapidly assess HBI scores in adults will increase the utility of the HBI by decreasing the time and resources required, thus allowing researchers and practitioners to provide targeted feedback for improvement.

Modeling the Effect of Replacing Sugar-Sweetened Beverage Consumption with Water on Energy Intake, HBI Score, and Obesity Prevalence.

Sugar-sweetened beverages (SSB) contribute to excessive weight gain through added energy intake. Replacing SSB with water is one strategy that has shown promise in helping lower excessive energy intake. Using nationally representative data from US adults (n = 19,718) from NHANES 2007-2012 we examine the impact of replacing SSB with water on Healthy Beverage Index (HBI) scores and obesity prevalence. Replacing an 8-ounce serving of SSB with water lowered the percent of energy from beverages from 17% to 11% (among those consuming 1 serving SSB/day). Reductions in the percent energy from beverages were observed across all SSB consumption groups (1-2 servings/day and >2 servings/day). Among adults there was a 9% to 21% improvement in HBI score when one serving of water replaced one serving of SSB. Using previously published randomized controlled trials (RCT) and meta-analyses of measured weight loss we also predicted a reduction in the prevalence of obesity (observed: 35.2%; predicted 33.5%-34.9%, p < 0.05) and increase in the prevalence of normal weight (observed: 29.7%; high weight loss: 31.3%, p < 0.05). Our findings provide further epidemiologic evidence that water in the place of SSB can be used as a strategy to limit energy intake and help individuals meet beverage intake recommendations.

The Healthy Beverage Index Is Associated with Reduced Cardiometabolic Risk in US Adults: A Preliminary Analysis.

BACKGROUND AND OBJECTIVE: Beverage recommendations exist, but few evaluate overall beverage intake quality. Our objective was to develop a scoring algorithm for assessing beverage intake quality among US adults (aged ≥19 years), and to examine the association between overall beverage quality and cardiometabolic risk. DESIGN: We developed a scoring algorithm, similar to the Healthy Eating Index-2010, using recommendations for total beverage energy, meeting fluid requirements, and consuming within recommended limits for beverage subgroups (eg, low-fat milk, fruit juice). Multiple scoring systems were evaluated. The final scoring system, which consisted of 10 components, was applied to the average of 2 days of 24-hour dietary intake data for adults (aged ≥19 years) from the National Health and Nutrition Examination Survey (NHANES), 2005-2010. STATISTICAL ANALYSES PERFORMED: Poisson regression models stratified by sex and body mass index multivariables were used to examine the cross-sectional association between the Healthy Beverage Index (HBI) score and cardiometabolic outcomes. RESULTS: The 10-item index had a mean±standard deviation score of 63±16 from a possible 100 points. Each 10-point higher HBI score was associated with lower odds ratios for hypertension (men and women); high fasting insulin level, high fasting glucose level, and high low-density lipoprotein cholesterol level (women and overweight/obese men), low high-density lipoprotein cholesterol level (women), and high C-reactive protein level (men). CONCLUSIONS: We found positive associations between higher HBI scores and more favorable lipid profiles; hypertension risk; and, among men, C-reactive protein levels. These preliminary results suggest that the HBI could be a valuable tool to evaluate overall beverage intake quality in adults. More research is needed to understand whether improvements in beverage quality and, thus, HBI score, are associated with beneficial changes in health.

A comparison of fruits, vegetables, sugar-sweetened beverages, and desserts in the packed lunches of elementary school children.

BACKGROUND: An estimated 40% of children bring a packed lunch to school. These lunches are not required to meet nutrition standards. The aim of this study was to compare differences in the nutritional quality of elementary packed lunches by the presence or absence of sugar-sweetened beverages (SSB), desserts, and fruits and vegetables (FVs). METHODS: Observational data for prekindergarten and kindergarten packed lunches were collected from three schools in rural Virginia for 5 consecutive school days and analyzed for macro- and micronutrients and by the presence or absence of food and beverage items. RESULTS: Of the 561 packed lunch observations collected, 41.7% contained no FV, 41.2% contained an SSB, and 61.1% contained a dessert. The nutrient profile of packed lunches with at least one fruit or vegetable had significantly higher levels of carbohydrate, fiber, sugar, vitamin A, and vitamin C. Packed lunches containing an SSB had significantly higher levels of sugar and vitamin C and significantly lower levels of protein, fiber, vitamin A, calcium, and iron. Packed lunches containing a dessert had significantly higher levels of energy, carbohydrate, fat, saturated fat, sodium, sugar, vitamin C, and iron and significantly lower levels of vitamin A. CONCLUSIONS: Additional research is needed to fully understand parent and child motivations for packing lunches and the decision processes that influence the inclusion of food items. The development of packed lunch interventions, encouragement of National School Lunch Program participation, or enactment of school policies to increase the nutritional value of packed lunches is warranted.

Combined measure of neighborhood food and physical activity environments and weight-related outcomes: The CARDIA study.

Engagement in healthy lifestyle behaviors likely reflects access to a diverse and synergistic set of food and physical activity resources, yet most research examines discrete characteristics. We characterized neighborhoods with respect to their composition of features, and quantified associations with diet, physical activity (PA), body mass index (BMI), and insulin resistance (IR) in a longitudinal biracial cohort (n=4143; aged 25-37; 1992-2006). We used latent class analysis to derive population-density-specific (

Beverage consumption in Brazil: results from the first National Dietary Survey.

OBJECTIVE: To provide an overview of beverage consumption patterns using the first nationally representative survey of dietary intake in Brazil. DESIGN: Beverage consumption data were obtained by 1 d food records in an individual dietary survey. SETTING: Nationwide cross-sectional survey, 2008-2009. SUBJECTS: Nationally representative sample of individuals aged ≥10 years (n 34 003). RESULTS: Beverages contributed 17.1 % of total energy consumption. Caloric coffee beverages provided the greatest level of energy overall (464 kJ (111 kcal)/d). Individuals aged 10-18 years (243 kJ (58 kcal)/d) and 19-39 years (230 kJ (55 kcal)/d) consumed a higher proportion of energy from sugar-sweetened soft drinks than individuals over this age (142 kJ (34 kcal)/d for those aged 40-59 years and 79 kJ (19 kcal)/d for those aged ≥60 years). CONCLUSIONS: Overall, the contribution of beverages, particularly sugary beverages, to total energy consumption in Brazil represents an important public health challenge and is comparable with those from other countries.

Adult consumers of cranberry juice cocktail have lower C-reactive protein levels compared with nonconsumers.

Flavonoids are important bioactive plant constituents found in abundance in berries, including cranberries. Cranberry beverages have been shown to beneficially impact urinary and cardiovascular health in clinical and observational studies, but their association with anthropometric outcomes is unknown. We examined the association between cranberry juice cocktail (CJC) consumption with flavonoid intake, and cardiometabolic and anthropometric outcomes among adults in the US data for adults (≥19 years, n = 10334) were drawn from cross-sectional National Health and Nutrition Examination Survey combined 2005-2008 survey. We hypothesized that CJC consumers will have lower anthropometric measures and healthier cardiometabolic profiles, including lower cholesterol and C-reactive protein (CRP). A CJC consumer (n = 330) was defined as anyone consuming CJC for 2 nonconsecutive 24-hour dietary recalls. We used multivariate linear regression models to examine differences in anthropometric and cardiometabolic outcomes comparing CJC consumers to nonconsumers controlling for important confounders. Consumers drank an average 404 mL (14 fl oz) of CJC for 2 days and did not have higher total energy intakes compared with nonconsumers (mean [SD], 2259 [79] vs 2112 [24], respectively). In fully adjusted models, adult CJC consumers had significantly lower levels of CRP (mean [SD], -0.13 [0.05]; P = .015), results that were strengthened after further adjustment for body mass index (mean [SD], -0.98 [0.04]; P = .027). Trends toward lower weights and lower levels of cholesterol did not reach statistical significance. Intake of cranberry polyphenols may play a role in promoting anti-inflammatory markers among CJC consumers, specifically lowering CRP levels.

Nutritional comparison of packed and school lunches in pre-kindergarten and kindergarten children following the implementation of the 2012-2013 National School Lunch Program standards.

OBJECTIVE: Approximately 40% of children bring a packed lunch to school. Little is known about the quality of these lunches. This study examined the nutritional quality of packed lunches compared with school lunches for pre-kindergarten and kindergarten children after the implementation of 2012-2013 National School Lunch Program standards. METHODS: The researchers collected observational data for packed and school lunches from 3 schools in rural Virginia for 5 consecutive school days and analyzed them for macro and micro nutrients. RESULTS: Of the 1,314 observations collected; 42.8% were packed lunches (n = 562) and 57.2% were school lunches (n = 752). Energy, fat, saturated fat, sugar, vitamin C, and iron were significantly higher whereas protein, sodium, fiber, vitamin A, and calcium were significantly lower for packed lunches than school lunches. CONCLUSIONS AND IMPLICATIONS: Packed lunches were of less nutritional quality than school lunches. Additional research is needed to explore factors related to choosing packed over school lunches.

Regulations to promote healthy sleep practices in child care.

OBJECTIVES: The purpose of this study was to assess state licensing and administrative regulations promoting healthy sleep practices in child care and to compare these regulations to national recommendations. METHODS: We reviewed regulations related to healthy sleep practices for all states and territories for both child care centers (centers) and family child care homes (homes). We compared regulations with Institute of Medicine recommendations to promote sleep in child care, including (1) create environments that ensure restful sleep; (2) encourage sleep-promoting behaviors and practices; (3) encourage practices that promote child self-regulation of sleep; and (4) seek consultation yearly from a sleep expert. We used Cochran-Mantel-Haenszel trend tests to assess associations between geographic region and number of regulations consistent with the recommendations. RESULTS: The mean number of regulations for states was 0.9 for centers and 0.8 for homes out of a possible 4.0. For centers, no state had regulations for all 4 recommendations; 11 states had regulations for 2 of the 4 recommendations. For homes, 9 states had regulations for 2 of the recommendations. States in the Northeast had the greatest mean number of regulations for centers (1.2) and homes (1.1), and states in the South had the fewest (0.7 and 0.7, respectively); these geographic differences were significant for centers (P = .03) but not homes (P = .14). CONCLUSIONS: More states in the Northeast had regulations consistent with the Institute of Medicine sleep recommendations, but overall few states had regulations consistent with the recommendations.

A review of state regulations to promote infant physical activity in child care.

BACKGROUND: The purpose of this study was to review state regulations promoting increased physical activity and decreased sedentary behaviors in infants in child care and to assess consistency with recent Institute of Medicine (IOM) recommendations. METHODS: We compared existing state and territory licensing and administrative regulations to recent IOM recommendations to promote physical activity and decrease sedentary time in very young children attending out-of-home child care (both child care centers and family child care homes). Three independent reviewers searched two sources (a publicly available website and WestlawNext™) and compared regulations with five IOM recommendations: 1) providing daily opportunities for infants to move, 2) engaging with infants on the ground, 3) providing daily tummy time for infants less than six months of age, 4) using cribs, car seats and high chairs for their primary purpose, and 5) limiting the use of restrictive equipment for holding infants while they are awake. We used Pearson chi-square tests to assess associations between geographic region, year of last update, and number of state regulations consistent with the IOM recommendations. RESULTS: The mean (SD) number of regulations for states was 1.9 (1.3) for centers and 1.6 (1.2) for homes out of a possible 5.0. Two states had regulations for all five recommendations, Arizona for centers and Virginia for homes. Six states and territories had zero regulations for child care centers and seven states and territories had zero regulations for family child care homes. There were no significant associations between geographic region and number of regulations consistent with IOM recommendations. CONCLUSIONS: Out-of-home child care settings are important targets for optimal early child health interventions. While most states had some regulations related to the promotion of physical activity among infants, few states had regulations for more than three of the five IOM recommendations. Enhancing state regulations in child care facilities could aid in early childhood obesity prevention efforts.

States lack physical activity policies in child care that are consistent with national recommendations.

BACKGROUND: Child care facilities' policies can importantly impact health behaviors of toddlers and preschoolers. Our aim was to assess state regulations promoting physical activity (PA) in child care and compare regulations to national recommendations. METHODS: We reviewed licensing and administrative regulations related to promoting PA for all states and territories for child care centers (centers) and family child care homes (homes). Three reviewers searched two sources (a publically available website and WestlawNext) and compared regulations with 15 Institute of Medicine recommendations. We used Pearson's and Spearman's correlations to assess associations between geographic region, year of last update, and number of regulations consistent with the recommendations. RESULTS: The average number and range of regulations in centers and homes was 4.1 (standard deviation [SD], 1.4; range, 0-8) and 3.8 (SD, 1.5; range, 0-7), respectively. Nearly all states had regulations consistent with providing an outdoor (centers, 98%; homes, 95%) and indoor (centers, 94%, homes, 92%) environment "with a variety of portable play equipment and adequate space." No state had regulations for staff joining children, avoiding punishment for being physically active, yearly consultation from a PA expert, or providing training/education on PA for providers. CONCLUSIONS: There is room for improvement in child care regulations around PA for young children; PA promotion should be included with future updates to regulations.

Snacking is prevalent in Mexico.

BACKGROUND: Snacking has increased globally, but little is known about how Mexicans consume foods outside meals. OBJECTIVE: The aim of this study was to examine the prevalence and patterns of snacking behavior among Mexicans. METHODS: We used data from children and adults (aged ≥ 2 y; n = 9937) from the Mexican National Nutrition Survey 1999 and the Mexican National Health and Nutrition Survey (NHNS) 2012 to examine the prevalence of snacking as well as amount (kcal) and contribution of snacks to total energy intake per day. Snacking was defined as eating outside of the 3 main meals. We calculated per capita (among the total population) and per consumer ("snackers") estimates of the number of snacks per day, kilocalories per snack, kilocalories per day from snacks, and the percentage of energy from snacks. Top foods consumed during snack occasions were also examined for the NHNS 2012. All results were weighted to account for survey design and to be nationally representative. RESULTS: In 2012, an estimated 73% of the population consumed snacks on a given day, with estimates ranging from 70% among ≥ 59 y olds to 77% among 2-11 y olds. An average of 1.6 snacks/d were consumed by the population. This value was slightly higher (2.1 snacks/d) among snackers. Snacks provided an average of 343 kcal/d per snacker (17% of total energy/d). Fruit was the most commonly consumed snack food by all ages except for 12-18 y olds. Salty snacks, sweet snacks, sugar-sweetened beverages, and milk were frequently in the top 5 categories across age groups. Differences were observed between age groups. CONCLUSIONS: Snacking is prevalent in the Mexican population. Many, but not all, of the foods consumed during snack occasions are foods considered "foods to limit" in the United States.

A modified Mediterranean diet score is associated with a lower risk of incident metabolic syndrome over 25 years among young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study.

The Mediterranean diet has been reported to be inversely associated with incident metabolic syndrome (MetSyn) among older adults; however, this association has not been studied in young African American and white adults. The objective of the present study was to evaluate the association of a modified Mediterranean diet (mMedDiet) score with the 25-year incidence of the MetSyn in 4713 African American and white adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. A diet history questionnaire was used to assess dietary intake at baseline, year 7 and year 20 and a mMedDiet score was created. Cardiovascular risk factors were measured at multiple examinations over 25 years. The MetSyn was defined according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria. Cox proportional-hazards regression analysis was use to evaluate associations for incident MetSyn across the mMedDiet score categories adjusting for demographic characteristics, lifestyle factors and BMI. Higher mMedDiet scores represented adherence to a dietary pattern rich in fruit, vegetables, whole grains, nuts and fish, but poor in red and processed meat and snack foods. The incidence of MetSyn components (abdominal obesity, elevated TAG concentrations and low HDL-cholesterol concentrations) was lower in those with higher mMedDiet scores than in those with lower scores. Furthermore, the incidence of the MetSyn was lower across the five mMedDiet score categories; the hazard ratios and 95 % CI from category 1 to category 5 were 1·0; 0·94 (0·76, 1·15); 0·84 (0·68, 1·04); 0·73 (0·58, 0·92); and 0·72 (0·54, 0·96), respectively (P trend= 0·005). These findings suggest that the risk of developing the MetSyn is lower when consuming a diet rich in fruit, vegetables, whole grains, nuts and fish.

Sociodemographic differences in fast food price sensitivity.

IMPORTANCE: Fiscal food policies (eg, taxation) are increasingly proposed to improve population-level health, but their impact on health disparities is unknown. OBJECTIVE: To estimate subgroup-specific effects of fast food price changes on fast food consumption and cardiometabolic outcomes. DESIGN, SETTING, AND PARTICIPANTS: Twenty-year follow-up (5 examinations) in a biracial US prospective cohort: Coronary Artery Risk Development in Young Adults (CARDIA) (1985/1986-2005/2006, baseline N = 5115). Participants were aged 18 to 30 years at baseline; design indicated equal recruitment by race (black vs white), educational attainment, age, and sex. Community-level price data from the Council for Community and Economic Research were temporally and geographically linked to study participants' home address at each examination. MAIN OUTCOMES AND MEASURES: Participant-reported number of fast food eating occasions per week, body mass index (BMI), and homeostasis model assessment insulin resistance (HOMA-IR) from fasting glucose and insulin concentrations. Covariates included individual-level and community-level social and demographic factors. RESULTS: In repeated measures regression analysis, multivariable-adjusted associations between fast food price and consumption were nonlinear (quadratic, P < .001), with significant inverse estimated effects on consumption at higher prices; estimates varied according to race (interaction P = .04), income (P = .07), and education (P = .03). At the 10th percentile of price ($1.25/serving), blacks and whites had mean fast food consumption frequency of 2.20 (95% CI, 2.07-2.33) and 1.55 (1.45-1.65) times/wk, respectively, whereas at the 90th percentile of price ($1.53/serving), respective mean consumption estimates were 1.86 (1.75-1.97) and 1.50 (1.41-1.59) times/wk. We observed differential price effects on HOMA-IR (inverse for lower educational status only [interaction P = .005] and at middle income only [interaction P = .02]) and BMI (inverse for blacks, less education, and middle income; positive for whites, more education, and high income [all interaction P < .001]). CONCLUSIONS AND RELEVANCE: We found greater fast food price sensitivity on fast food consumption and insulin resistance among sociodemographic groups that have a disproportionate burden of chronic disease. Our findings have implications for fiscal policy, particularly with respect to possible effects of fast food taxes among populations with diet-related health disparities.

Sources of excessive saturated fat, trans fat and sugar consumption in Brazil: an analysis of the first Brazilian nationwide individual dietary survey.

OBJECTIVE: To examine the patterns of consumption of foods high in solid fats and added sugars (SoFAS) in Brazil. DESIGN: Cross-sectional study; individual dietary intake survey. Food intake was assessed by means of two non-consecutive food records. Foods providing >9·1% of energy from saturated fat, or >1·3% of energy from trans fat, or >13% of energy from added sugars per 100 g were classified as high in SoFAS. SETTING: Brazilian nationwide survey, 2008-2009. SUBJECTS: Individuals aged ≥10 years old. RESULTS: Mean daily energy intake was 8037 kJ (1921 kcal), 52% of energy came from SoFAS foods. Contribution of SoFAS foods to total energy intake was higher among women (52%) and adolescents (54%). Participants in rural areas (43%) and in the lowest quartile of per capita family income (43%) reported the smallest contribution of SoFAS foods to total energy intake. SoFAS foods were large contributors to total saturated fat (87%), trans fat (89%), added sugar (98%) and total sugar (96%) consumption. The SoFAS food groups that contributed most to total energy intake were meats and beverages. Top SoFAS foods contributing to saturated fat and trans fat intakes were meats and fats and oils. Most of the added and total sugar in the diet was supplied by SoFAS beverages and sweets and desserts. CONCLUSIONS: SoFAS foods play an important role in the Brazilian diet. The study identifies options for improving the Brazilian diet and reducing nutrition-related non-communicable chronic diseases, but also points out some limitations of the nutrient-based criteria.

The association of fast food consumption with poor dietary outcomes and obesity among children: is it the fast food or the remainder of the diet?

BACKGROUND: Although fast food consumption has been linked to adverse health outcomes, the relative contribution of fast food itself compared with the rest of the diet to these associations remains unclear. OBJECTIVE: Our objective was to compare the independent associations with overweight/obesity or dietary outcomes for fast food consumption compared with dietary pattern for the remainder of intake. DESIGN: This cross-sectional analysis studied 4466 US children aged 2-18 y from NHANES 2007-2010. Cluster analysis identified 2 dietary patterns for the non-fast food remainder of intake: Western (50.3%) and Prudent. Multivariable-adjusted linear and logistic regression models examined the association between fast food consumption and dietary pattern for the remainder of intake and estimated their independent associations with overweight/obesity and dietary outcomes. RESULTS: Half of US children consumed fast food: 39.5% low-consumers (≤30% of energy from fast food) and 10.5% high-consumers (>30% of energy). Consuming a Western dietary pattern for the remainder of intake was more likely among fast food low-consumers (OR: 1.51; 95% CI: 1.24, 1.85) and high-consumers (OR: 2.21; 95% CI: 1.60, 3.05) than among nonconsumers. The remainder of diet was independently associated with overweight/obesity (ß: 5.9; 95% CI: 1.3, 10.5), whereas fast food consumption was not, and the remainder of diet had stronger associations with poor total intake than did fast food consumption. CONCLUSIONS: Outside the fast food restaurant, fast food consumers ate Western diets, which might have stronger associations with overweight/obesity and poor dietary outcomes than fast food consumption itself. Our findings support the need for prospective studies and randomized trials to confirm these hypotheses.