Dietary Intake and Quality among Stroke Survivors: NHANES 1999-2018.

BACKGROUND: Nutrition is an important modifiable risk factor for prevention and treatment of stroke. However, examination of nutrient intake and diet quality in stroke survivors is limited. OBJECTIVES: The aim of the study was to estimate usual nutrient intake and diet quality in US adults with and without a history of self-reported stroke. METHODS: Using US National Health and Nutrition Examination Survey (NHANES) 1999-2018, we analyzed demographics, health history, and dietary intake data in 1626 individuals with a history of stroke matched for age, gender, and survey cycle to respective controls (n=1621) with no history of stroke. A minimum of one 24-h dietary recall was used to assess dietary intake. Diet quality was determined using Healthy Eating Index 2015 (HEI-2015) scores. Adult food security was assessed based on responses to the US Department of Agriculture Household Food Security Survey Module. Physical and mental limitations were assessed from responses to the NHANES Physical Functioning Questionnaire. Estimates were reported as mean (standard error). RESULTS: In comparison to controls, stroke survivors were more likely to be food insecure, experience poverty, and report physical and mental limitations (P < .001, all comparisons). Stroke survivors were more likely to report excessive (% > acceptable macronutrient distribution range) intake for total fat (50.9 [2.7]% vs. 40.4 [2.2]%, P < .001) and inadequate intake (% < estimated average requirement) for calcium (54.6 [1.8]% vs. 43.5 [2.4]%, P = .001) and magnesium (66 [1.8] vs. 53.6 [1.8]%, P < .001). In addition, stroke survivors reported lower HEI-2015 total scores than controls (49.8 vs. 51.9, P < .001). Finally, HEI-2015 total scores were lower in stroke survivors who were food insecure and those with a lower income-to-poverty ratio (< 185%) (P = .001). CONCLUSIONS: Dietary intake in stroke survivors was nutritionally poor, with suboptimal nutrient intake and lower overall diet quality compared with age- and gender-matched controls. Furthermore, poverty and food insecurity were more prevalent in stroke survivors and associated with worse diet quality.

Usual dietary fibre intake according to diabetes status in USA adults - NHANES 2013-2018.

It is unknown if fibre intake differs across diabetes status in USA adults and is associated with glycaemic outcomes. This cross-sectional analysis utilised National Health and Nutrition Examination Survey cycles 2013-2018 data to estimate usual total dietary fibre intake in USA adults and across diabetes status (no diabetes, prediabetes and type II diabetes (T2D)). Associations among dietary fibre intake and glycaemic outcomes were also reported across groups. Adults (≥ 19 years) with at least one dietary recall were included. Diabetes status was determined from self-report data and measured HbA1c. Independent samples t tests were used to compare mean (se) intake across sub-populations. 14 640 adults (51·3 % female) with 26·4 % and 17·4 % classified as having prediabetes and T2D, respectively. Adults with T2D reported greater mean (se) dietary fibre intake compared with no T2D for females (9·5 (0·13) v. 8·7 (0·11) g/1000 kcal/d and males (8·5 (0·12) v. 7·7 (0·11) g/1000 kcal/d; P < 0·01)). However, only 4·2 (0·50)% and 8·1 (0·90)% of males and females with T2D, respectively, met the adequate intake for fibre. Fibre intake was associated with lower insulin (ß = -0·80, P < 0·01), serum glucose (ß = -1·35, P < 0·01) and Homeostatic Model Assessment for Insulin Resistance (ß = -0·22, P < 0·01) in adults without diabetes, and no relationships in adults with prediabetes or T2D were found. Although dietary fibre intake was highest among adults with T2D, intake was suboptimal across all groups. In adults without diabetes, dietary fibre intake was associated with improved glycaemic outcomes and insulin resistance; however, these associations were attenuated by anthropometric and lifestyle covariates.

Usual Dietary Intake of Resistant Starch in US Adults from NHANES 2015-2016.

BACKGROUND: Resistant starch (RS) confers many health benefits, mostly due to nonenzymatic human digestion and gut microbiota fermentation capacity. The usual intake of naturally occurring dietary RS in US adults is unclear. OBJECTIVES: This study estimated usual daily RS intake in grams per 1000 kcal in US adults by sex, age, and ethnic group, as well as the most frequent food category contributing to RS intake using data from the NHANES 2015-2016. METHODS: RS content of foods consumed was matched with Food and Nutrient Database for Dietary Studies food codes. The National Cancer Institute method was used to estimate adults' usual RS intake from 2 24-h dietary recalls. Day 1 RS contribution from food groups to overall RS intake was ranked for the total sample, across age-sex categories, and across ethnic groups. RESULTS: In total, 5139 US adults (48.4% male) had a mean daily usual intake of RS of 1.9 ± 0.0 g/(1000 kcal⋅d). Males and females had a similar intake of RS [2.0 ± 0.0 g compared with 1.9 ± 0.0 g/(1000 kcal⋅d)] with no differences between sexes within the same age category. When comparing ethnic groups within each age category, the non-Hispanic white males and females had significantly lower RS intake than all other ethnic groups [range: 1.7-1.8 compared with 2.1-2.3 g RS/(1000 kcal⋅d), respectively], with no differences among the other ethnic groups. French fries and other fried white potatoes, rice, and beans, peas, and legumes were the most frequently consumed food categories contributing to RS intake in all adults. CONCLUSIONS: US adults should improve the intake of natural RS food sources. Increasing RS intake will improve gastrointestinal health as a prebiotic and potentially increase insulin sensitivity with adequate consumption (e.g., ∼15 g/d).

Fiber Intake Predicts Weight Loss and Dietary Adherence in Adults Consuming Calorie-Restricted Diets: The POUNDS Lost (Preventing Overweight Using Novel Dietary Strategies) Study.

BACKGROUND: The effects of dietary composition on weight loss are incompletely understood. In addition to energy intake, fiber intake, energy density, macronutrient composition, and demographic characteristics have all been suggested to contribute to weight loss. OBJECTIVE: The primary aim of this analysis was to assess the role of dietary fiber as a predictor of weight loss in participants who consumed calorie-restricted diets (-750 kcal/d from estimated energy needs) for 6 mo, using data from the POUNDS Lost (Preventing Overweight Using Novel Dietary Strategies) Study-a randomized trial that examined the effects of calorie-restricted diets varying in macronutrient composition on weight loss in adults. METHODS: Data were randomly partitioned to a training data set (70%) in which the effects of fiber and other weight-loss predictors were identified using adjusted Least Absolute Shrinkage and Selection Operator and model averaging. The retained predictors were then fit on the testing data set to assess predictive performance. RESULTS: Three hundred and forty-five participants (53.9% female) provided dietary records at baseline and 6 mo. Mean ± SD age and BMI for the full sample was 52.5 ± 8.7 y and 32.6 ± 3.9 kg/m2, respectively. Mean ± SD (99% CI) weight change at 6 mo for the full sample was -7.27 ± 5.6 kg (-8.05, -6.48 kg). The final, best fit model (R2 = 0.41) included fiber, energy density, fat, age, adherence, baseline weight, race, and changes from baseline in carbohydrate, fiber, PUFA, and MUFA intake, but the most influential predictor was fiber intake ($\hat{\beta }$ = -0.37; P < 0.0001). In addition, fiber was strongly associated with adherence to the macronutrient prescriptions (P < 0.0001). Interactions between race and adherence, age, baseline weight, carbohydrate, energy density, and MUFAs were also retained in the final model. CONCLUSION: Dietary fiber intake, independently of macronutrient and caloric intake, promotes weight loss and dietary adherence in adults with overweight or obesity consuming a calorie-restricted diet. This trial was registered at clinicaltrials.gov as NCT00072995.

Serum Cholesterol Differences Between Statin Users Who Take Dietary Supplements and Those Who Do Not: NHANES 2013-2018.

Background: Cardiovascular disease (CVD) is the leading cause of mortality in the United States and statins are the most commonly prescribed medication. It is important to understand the potential impact supplements may have when taken in combination with statins on serum lipid outcomes. Objectives: To evaluate the differences in the concentrations of cholesterol, triacylglycerol (TAG), and HbA1c between adults who use statins alone and those who combine statins and dietary supplements. Methods: A cross-sectional analysis using data from US adults aged ≥20 years who participated in the NHANES (2013-2018). The serum concentrations of lipids and the HbA1c levels were compared using independent sample t-tests. All analyses were adjusted for the complex survey design and used appropriate sample weights. Results: Of 16,327 participants included in this analysis, 13% reported the use of statins alone, and 8.8% used statins and dietary supplements. Statin users who used dietary supplements tended to be women (50.5%), aged 65.8 ± 0.4 years, and were more likely to be White (77.4%). Participants who used statins in combination with dietary supplements were less likely to have higher levels of total cholesterol (5.1% ± 1.4% vs. 15.6% ± 2.7%, P < 0.001), HbA1c (6.0% ± 0.1% vs. 6.3% ± 0.1%, P < 0.05), and HDL cholesterol (50 ± 1.3 vs. 47 ± 0.8 mg/dL, P < 0.05) than those who used statins alone. No significant differences were identified between the two groups for LDL cholesterol and TAG concentrations. Conclusions: Statin users who coingested dietary supplements were less likely to have high levels of total cholesterol and HbA1c and greater HDL levels than statin users who did not take dietary supplements. Dietary intake, lifestyle choices, and other confounders may have influenced the observed outcome differences for those who took dietary supplements with statins and those who did not.

Association of Tree Nut Consumption with Cardiovascular Disease and Cardiometabolic Risk Factors and Health Outcomes in US Adults: NHANES 2011-2018.

Background: Tree nuts are nutrient dense, and their consumption has been associated with improvements in health outcomes. Objective: To estimate the usual tree nut intake and examine the association between tree nut consumption and cardiometabolic (CM) health outcomes in a nationally representative sample of US adults. Methods: Cross-sectional data were analyzed from a sample of 18,150 adults aged ≥ 20y who provided at least one reliable 24-h dietary recall and had complete data for the variables of interest in the NHANES 2011-2018. Tree nut consumers were defined as those consuming ≥ » ounce/d (7.09 g). The National Cancer Institute Method was used to estimate the usual tree nut intake among consumers. Measurement error calibrated regression models were used to assess the association between tree nut consumption and each health outcome of interest. Results: Approximately 8% of all participants (n = 1238) consumed tree nuts and had a mean ± SE usual intake of 39.5 ± 1.8 g/d. Tree nut consumers were less likely to have obesity (31% vs. 40%, P < 0.001) and low high-density lipoprotein cholesterol (22% vs. 30%, P < 0.001) compared with nonconsumers. Moreover, tree nut consumers had a lower mean waist circumference (WC) (97.1 ± 0.7 vs. 100.5 ± 0.3 cm, P < 0.001) and apolipoprotein B (87.5 ± 1.2 vs. 91.8 ± 0.5 mg/dL, P = 0.004) than nonconsumers. After adjusting models for demographics and lifestyle covariates, the difference in WC between average intake (33.7 g/d) and low threshold intake (7.09/g) of tree nuts was -1.42 ± 0.58 cm (P = 0.005). Conclusions: Most US adults do not consume tree nuts, yet modest consumption was associated with decreased prevalence of cardiovascular disease and CM risk factors and improvement for some health outcome measures.

College Campus Food Pantry Program Evaluation: What Barriers Do Students Face to Access On-Campus Food Pantries?

The purpose of this study was to explore barriers Texas Woman's University (TWU) students face in accessing on-campus food pantries. This cross-sectional, survey-based study was conducted in Fall 2021. Students' use of the food pantries and barriers to utilization, including qualitative questions, were evaluated using descriptive statistics and thematic analyses. Students (n = 529) completed the survey. Despite a high prevalence of food insecurity (49.2%), most students reported never using the pantries (89.8%). Almost half of the students were unaware that these pantries existed on campus (47.8%). More than one in four students believed there were barriers to accessing the pantries, with time tissues, lack of transportation, limited food pantry hours of operation, and social stigma most commonly cited as major barriers to access. Food insecurity remains an urgent problem at TWU since the prevalence has remained high since 2019 despite the institutions' efforts to reduce it. One of those resources has not been utilized as expected, which might impede improvements in food security among students. TWU on-campus food pantries can use these findings to address major barriers by offering after-hours access through the libraries or campus police, partnering with public transportation, and normalizing accessing food assistance.

Implementation of a food scholarship program improves nutrient intake and dietary quality of college students.

Objective: To determine the impact of a new food scholarship program on nutrient intake and dietary quality. Participants: College students (n = 49), female (78%), single (76%), average age 28 years, and white (49%). Methods: Fruits, vegetables, dairy, meat products and nonperishable foods were distributed twice a month. A one-group pretest post-test intervention compared baseline and 10 weeks data. Food security was measured and three-day food records assessed nutrient intake, Health Eating Index (HEI)-2015 (total and component) scores, and food group servings. Paired t-test at baseline and 10 weeks were performed (SPSS v25) (p < 0.05). Results: Prevalence of food insecurity did not change (baseline 53%, 10 weeks 47%). Protein, (p = 0.001), niacin (p = 0.002), magnesium (p = 0.034), phosphorous (p = 0.039), potassium (p = 0.019), and vegetable servings (p = 0.034) intake increased. Total HEI-2015 scores remained unchanged but HEI-2015 vegetable scores increased (p = 0.023). Conclusion: Increased intake of some nutrients and vegetable servings were achieved with the food scholarship program.

Influence of COVID-19 Pandemic Restrictions on College Students' Dietary Quality and Experience of the Food Environment.

The COVID-19 pandemic restrictions sent college students online and off campus, potentially reducing access to healthy food. The objective of this cross-sectional, internet-based study was to use qualitative and quantitative survey methods to evaluate whether COVID-19 pandemic restrictions in Texas, USA affected college students' ability to buy food, how/what they shopped for, how they prepared food, what they ate, how they felt about eating, and overall dietary quality (assessed using Healthy Eating Index [HEI] scores). Survey responses from 502 students (87.5% female; 59.6% nonwhite, mean age 27.5 ± 0.4 years, >50% graduate students) were analyzed. The qualitative analysis of open-ended questions revealed 110 codes, 17 subthemes, and six themes. Almost all students experienced changes in at least one area, the most common being changes in shopping habits. Participants with low or very low food security had lower HEI scores compared to food secure students (p = 0.047). Black students were more likely to report changes in their ability to buy food (p = 0.035). The COVID-19 restrictions varied in their impact on students' ability to access sufficient healthy food, with some students severely affected. Thus, universities should establish procedures for responding to emergencies, including identifying at-risk students and mobilizing emergency funds and/or food assistance.

Prevalence and Social Determinants of Food Insecurity among College Students during the COVID-19 Pandemic.

The coronavirus disease (COVID-19) pandemic has increased unemployment and food insecurity in the United States (US). Prior to the pandemic, college students exhibited higher rates of food insecurity than nonstudent households. The objectives of this study were to assess the prevalence and determinants of food insecurity among college students during the COVID-19 pandemic. We administered an online survey to 651 students on three diverse campuses at a state-funded university in Texas, US, in May 2020. Food security was assessed using a multistep approach that included the 2-item Food Sufficiency Screener and 6-Item USDA Food Security Survey Module (FSSM). Overall, 34.5% of respondents were classified as food insecure within the last 30 days. The strongest predictors of food insecurity were change in current living arrangement (OR = 2.70, 95% CI: 2.47, 2.95), being furloughed (OR = 3.22, 95% CI: 2.86, 3.64), laid off (OR = 4.07, 95% CI: 3.55, 4.66), or losing part-time work (OR = 5.73, 95% CI: 5.09, 6.46) due to the COVID-19 pandemic. These findings highlight the high prevalence of food insecurity among college students during the COVID-19 pandemic, with students who experienced housing insecurity and/or loss of income due to the pandemic being impacted the most.

Pretreatment Fasting Glucose and Insulin as Determinants of Weight Loss on Diets Varying in Macronutrients and Dietary Fibers-The POUNDS LOST Study.

Efforts to identify a preferable diet for weight management based on macronutrient composition have largely failed, but recent evidence suggests that satiety effects of carbohydrates may depend on the individual's insulin-mediated cellular glucose uptake. Therefore, using data from the POUNDS LOST trial, pre-treatment fasting plasma glucose (FPG), fasting insulin (FI), and homeostatic model assessment of insulin resistance (HOMA-IR) were studied as prognostic markers of long-term weight loss in four diets differing in carbohydrate, fat, and protein content, while assessing the role of dietary fiber intake. Subjects with FPG <100 mg/dL lost 2.6 (95% CI 0.9;4.4, p = 0.003) kg more on the low-fat/high-protein (n = 132) compared to the low-fat/average-protein diet (n = 136). Subjects with HOMA-IR ≥4 lost 3.6 (95% CI 0.2;7.1, p = 0.038) kg more body weight on the high-fat/high-protein (n = 35) compared to high-fat/average-protein diet (n = 33). Regardless of the randomized diet, subjects with prediabetes and FI below the median lost 5.6 kg (95% CI 0.6;10.6, p = 0.030) more when consuming ≥35 g (n = 15) compared to <35 g dietary fiber/10 MJ (n = 16). Overall, subjects with normal glycemia lost most on the low-fat/high-protein diet, subjects with high HOMA-IR lost most on the high-fat/high protein diet, and subjects with prediabetes and low FI had particular benefit from dietary fiber in the diet.

Comparison of dietary habits and plans for dietary changes in black and white women seeking bariatric surgery.

BACKGROUND: Achieving weight loss after bariatric surgery depends on the individual's ability to sustain lifestyle changes involving dietary modifications. Presurgical dietary assessment is critical to evaluate usual dietary habits and identify the need for intervention before surgery. OBJECTIVES: The objective of this study was to identify usual dietary habits of black and white women seeking bariatric surgery and to examine potential differences between these ethnic groups. An additional aim was to describe participants' plans to change dietary behaviors after surgery. SETTING: This study examined data from an observational study sponsored by a benefits management group in Louisiana. METHODS: In this cross-sectional study, a presurgical dietary assessment interview questionnaire collected information on dietary habits. Participants (n = 200) were adult women being screened for bariatric surgery; 54% were white, and 46% were black. Descriptive statistics were calculated and differences between groups were tested using 2-way analysis of the variance. RESULTS: Participants reported consuming fast food 2.9 ± 2.6 times per week, fried foods 2.1 ± 1.8 times per week, and desserts 3.4 ± 3.2 times per week. Blacks reported more frequent consumption of fast food (P<.01), sugar-sweetened sodas (P<.05), and sugar-sweetened tea (P<.01) compared with whites. Plans for changing dietary behaviors after surgery were similar between ethnic groups. CONCLUSIONS: Findings indicated that frequent consumption of fast foods, fried foods, desserts, and sugar-sweetened beverages was common among women seeking bariatric surgery. Blacks tended to consume these foods and beverages more often than whites. Current dietary habits and future plans to change dietary behaviors should be addressed before surgery for success. Follow-up studies investigating the assessment instrument's ability to predict dietary adherence and weight loss after surgery are warranted.