Atrial secondary tricuspid regurgitation: pathophysiology, definition, diagnosis, and treatment.

Atrial secondary tricuspid regurgitation (A-STR) is a distinct phenotype of secondary tricuspid regurgitation with predominant dilation of the right atrium and normal right and left ventricular function. Atrial secondary tricuspid regurgitation occurs most commonly in elderly women with atrial fibrillation and in heart failure with preserved ejection fraction in sinus rhythm. In A-STR, the main mechanism of leaflet malcoaptation is related to the presence of a significant dilation of the tricuspid annulus secondary to right atrial enlargement. In addition, there is an insufficient adaptive growth of tricuspid valve leaflets that become unable to cover the enlarged annular area. As opposed to the ventricular phenotype, in A-STR, the tricuspid valve leaflet tethering is typically trivial. The A-STR phenotype accounts for 10%-15% of clinically relevant tricuspid regurgitation and has better outcomes compared with the more prevalent ventricular phenotype. Recent data suggest that patients with A-STR may benefit from more aggressive rhythm control and timely valve interventions. However, little is mentioned in current guidelines on how to identify, evaluate, and manage these patients due to the lack of consistent evidence and variable definitions of this entity in recent investigations. This interdisciplinary expert opinion document focusing on A-STR is intended to help physicians understand this complex and rapidly evolving topic by reviewing its distinct pathophysiology, diagnosis, and multi-modality imaging characteristics. It first defines A-STR by proposing specific quantitative criteria for defining the atrial phenotype and for discriminating it from the ventricular phenotype, in order to facilitate standardization and consistency in research.

Dietary Sugar and Anthropometrics among Young Children in the Guelph Family Health Study: Longitudinal Associations.

Purpose: Our understanding of the influence of sugar intake on anthropometrics among young children is limited. Most existing research is cross-sectional and has focused on sugar-sweetened beverages. The study objective was to investigate longitudinal associations between young children's total, free, and added sugar intake from all food sources at baseline with anthropometric measures at baseline and 18 months.Methods: The Guelph Family Health Study (GFHS) is an ongoing randomized controlled trial and a family-based health promotion study. Food records and anthropometric data were collected at baseline (n = 109, 55 males; 3.7 ± 1.1 y, mean ± SD) and 18 months (n = 109, 55 males; 5.1 ± 1.1 y) of the GFHS pilots. Associations between sugar intakes and anthropometrics were estimated using linear regression models with generalized estimating equations adjusted for age, sex, household income, and intervention status.Results: Total sugar intake was inversely associated with body weight at 18 months (P = 0.01). There was no effect of time on any other associations between total, free, and added sugar intakes and anthropometrics.Conclusions: Early life dietary sugar intakes may not relate to anthropometric measures in the short term. Further investigation into potential associations between dietary sugar intakes and anthropometric variables over longer time periods is warranted.

Anatomic suitability for transapical transcatheter mitral valve implantation using a tether-based device.

BACKGROUND: Transcatheter mitral valve implantation (TMVI) is a novel therapeutic option for treating symptomatic mitral valve disease. Evaluating patient anatomical suitability is a critical step in the TMVI screening process, but currently requires specialized software and computerized device models. AIMS: This analysis sought to assess the effectiveness of simple and standardized multislice computed tomography (MSCT) anatomic measurements for their ability to discriminate between patients who passed anatomical screening for Tendyne™ TMVI. METHODS: Subjects screened for the Tendyne Expanded Clinical Study from January 2016 through September 2019 were included. Core laboratory screening measurements included mitral annular (MA) dimensions at end-systole and end-diastole, simulated device implantation, and neo-left ventricular outflow tract (LVOT) area. Additionally, nine standard measurements of patient anatomy were assessed for their predictive value of patients passing the anatomic screening process. RESULTS: Out of 496 subjects screened for eligibility, 257 subjects met clinical eligibility criteria with MA dimensions within the manufacturer's suggested range: 153 (59.5%) underwent TMVI while 104 (40.5%) were excluded from the study for other anatomic reasons (76% due to risk of LVOT obstruction). CT-derived left ventricular end-systole diameter (LVESD) had the highest discriminatory power for predicting TMVI anatomical suitability (area under the curve of 0.908, p < 0.0001). The mitral inter-commissural (IC) dimension was best predictive of annular dimensions being within range, with dimensions <30 or >50 mm resulting in a negative predictive value of 94.4%. CONCLUSIONS: MSCT-derived mitral IC dimension and LVESD easily performed measures that are effective predictors of anatomical suitability or screen failure for this tether-based TMVI device.

Long-Term Trends in Psychiatric Emergency Services Delivered by the Boston Emergency Services Team.

Rising psychiatric emergency department (ED) presentations pose significant financial and administrative burdens to hospitals. Alternative psychiatric emergency services programs have the potential to alleviate this strain by diverting non-emergent mental health issues from EDs. This study explores one such program, the Boston Emergency Services Team (BEST), a multi-channel psychiatric emergency services provider intended for the publicly insured and uninsured population. BEST provides evaluation and treatment for psychiatric crises through specialized psychiatric EDs, a 24/7 hotline, psychiatric urgent care centers, and mobile crisis units. This retrospective review examines the sociodemographic and clinical characteristics of 225,198 BEST encounters (2005-2016). Of note, the proportion of encounters taking place in ED settings decreased significantly from 70 to 58% across the study period. Findings suggest that multi-focal, psychiatric emergency programs like BEST have the potential to reduce the burden of emergency mental health presentations and improve patient diversion to appropriate psychiatric care.

Breakfast Quality of Preschool-aged Canadian Children.

Purpose: To investigate the breakfast quality of preschool-aged children through a comparison of their energy and nutrient intakes at breakfast to published benchmarks for a balanced breakfast.Methods: Dietary data were collected for 163 children aged 3-5 years enrolled in the Guelph Family Health Study using one parent-reported online 24-hour recall and analyzed for energy and nutrient intakes. Breakfast quality was assessed by tallying the frequency of participants whose nutrient and energy intakes at their breakfast meal met the recommendations for a balanced breakfast established by the International Breakfast Research Initiative (IRBI).Results: Almost all participants (98%) consumed breakfast, and most participants (82.5%) met the energy IRBI recommendation. However, the majority of participants did not meet the IRBI recommendations for breakfast intakes of most macronutrients and micronutrients. In particular, fewer than 25% of participants met the IRBI recommendations for breakfast intakes of dietary fibre, niacin, folate, vitamin C, calcium, potassium and zinc.Conclusions: Almost all preschool-aged children in this study consumed breakfast, but the nutritional quality of their breakfast did not meet recommendations for most nutrients. These results can inform nutrition education and intervention programs for children that aim to improve the nutritional quality of breakfast.

Transcatheter Mitral Valve Replacement After Surgical Repair or Replacement: Comprehensive Midterm Evaluation of Valve-in-Valve and Valve-in-Ring Implantation From the VIVID Registry.

BACKGROUND: Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining midterm outcomes after mitral ViV and ViR. METHODS: Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mm Hg and significant residual mitral regurgitation (MR) as ≥ moderate. RESULTS: A total of 1079 patients (857 ViV, 222 ViR; mean age 73.5±12.5 years; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days (interquartile range, 76-996); median echocardiographic follow-up for patients that survived 1 year was 772.5 days (interquartile range, 510-1211.75). Four-year Kaplan-Meier survival rate was 62.5% in ViV versus 49.5% for ViR (P<0.001). Mean gradient across the mitral valve postprocedure was 5.7±2.8 mm Hg (≥5 mm Hg; 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (P=0.09). Significant residual MR was more common in ViR patients (16.6% versus 3.1%; P<0.001) and was associated with lower survival at 4 years (35.1% versus 61.6%; P=0.02). The rates of Mitral Valve Academic Research Consortium-defined device success were low for both procedures (39.4% total; 32.0% ViR versus 41.3% ViV; P=0.01), mostly related to having postprocedural mean gradient ≥5 mm Hg. Correlates for residual MS were smaller true internal diameter, younger age, and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (subhazard ratio, 4.67; 95% CI, 1.74-12.56; P=0.002) and significant residual MR (subhazard ratio, 7.88; 95% CI, 2.88-21.53; P<0.001) were both independently associated with repeat mitral valve replacement. CONCLUSIONS: Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve postprocedural hemodynamics in mitral ViV and ViR should be further explored.

Neither soyfoods nor isoflavones warrant classification as endocrine disruptors: a technical review of the observational and clinical data.

Soybeans are a rich source of isoflavones, which are classified as phytoestrogens. Despite numerous proposed benefits, isoflavones are often classified as endocrine disruptors, based primarily on animal studies. However, there are ample human data regarding the health effects of isoflavones. We conducted a technical review, systematically searching Medline, EMBASE, and the Cochrane Library (from inception through January 2021). We included clinical studies, observational studies, and systematic reviews and meta-analyses (SRMA) that examined the relationship between soy and/or isoflavone intake and endocrine-related endpoints. 417 reports (229 observational studies, 157 clinical studies and 32 SRMAs) met our eligibility criteria. The available evidence indicates that isoflavone intake does not adversely affect thyroid function. Adverse effects are also not seen on breast or endometrial tissue or estrogen levels in women, or testosterone or estrogen levels, or sperm or semen parameters in men. Although menstrual cycle length may be slightly increased, ovulation is not prevented. Limited insight could be gained about possible impacts of in utero isoflavone exposure, but the existing data are reassuring. Adverse effects of isoflavone intake were not identified in children, but limited research has been conducted. After extensive review, the evidence does not support classifying isoflavones as endocrine disruptors.

Effect of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement on All-Cause Mortality in Patients With Aortic Stenosis: A Randomized Clinical Trial.

Importance: Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear. Objective: To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk. Design, Setting, and Participants: In this randomized clinical trial conducted at 34 UK centers, 913 patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk due to age or comorbidity were enrolled between April 2014 and April 2018 and followed up through April 2019. Interventions: TAVI using any valve with a CE mark (indicating conformity of the valve with all legal and safety requirements for sale throughout the European Economic Area) and any access route (n = 458) or surgical aortic valve replacement (surgery; n = 455). Main Outcomes and Measures: The primary outcome was all-cause mortality at 1 year. The primary hypothesis was that TAVI was noninferior to surgery, with a noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI for the absolute between-group difference in mortality. There were 36 secondary outcomes (30 reported herein), including duration of hospital stay, major bleeding events, vascular complications, conduction disturbance requiring pacemaker implantation, and aortic regurgitation. Results: Among 913 patients randomized (median age, 81 years [IQR, 78 to 84 years]; 424 [46%] were female; median Society of Thoracic Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%) completed follow-up and were included in the noninferiority analysis. At 1 year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%) in the surgery group, with an adjusted absolute risk difference of -2.0% (1-sided 97.5% CI, -∞ to 1.2%; P < .001 for noninferiority). Of 30 prespecified secondary outcomes reported herein, 24 showed no significant difference at 1 year. TAVI was associated with significantly shorter postprocedural hospitalization (median of 3 days [IQR, 2 to 5 days] vs 8 days [IQR, 6 to 13 days] in the surgery group). At 1 year, there were significantly fewer major bleeding events after TAVI compared with surgery (7.2% vs 20.2%, respectively; adjusted hazard ratio [HR], 0.33 [95% CI, 0.24 to 0.45]) but significantly more vascular complications (10.3% vs 2.4%; adjusted HR, 4.42 [95% CI, 2.54 to 7.71]), conduction disturbances requiring pacemaker implantation (14.2% vs 7.3%; adjusted HR, 2.05 [95% CI, 1.43 to 2.94]), and mild (38.3% vs 11.7%) or moderate (2.3% vs 0.6%) aortic regurgitation (adjusted odds ratio for mild, moderate, or severe [no instance of severe reported] aortic regurgitation combined vs none, 4.89 [95% CI, 3.08 to 7.75]). Conclusions and Relevance: Among patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk, TAVI was noninferior to surgery with respect to all-cause mortality at 1 year. Trial Registration: isrctn.com Identifier: ISRCTN57819173.

"If he doesn't buy in, it's a waste of time": Perspectives from diverse parents and adolescents on engaging children in ADHD treatment.

Engaging children and adolescents in ADHD care is critical for future independent disease management. However, there is a lack of evidence guiding health professionals and parents on how best to engage their children and adolescents in ADHD care. We recruited 41 diverse parents of children and adolescents with ADHD and 11 adolescents with ADHD from an urban, safety-net hospital to participate in in-depth, semi-structured qualitative interviews and then analyzed this data using thematic analysis. Children's level of illness insight about ADHD and self-esteem emerged as two major contributors to engagement of children and adolescents in ADHD care, and their intersection created four styles of engagement: proactive (high insight, high self-esteem), anxious (high insight, low self-esteem), apathetic (low insight, high self-esteem), and resistant (low insight, low self-esteem). This framework can help health professionals engage children and adolescents in care for ADHD and guide development of interventions to improve engagement in care.

Cheese Intake is Inversely Associated with LDL Cholesterol in Young Children.

Purpose: To determine if intake (servings/day) of total dairy and/or dairy subtypes (milk, cheese, and yogurt) were associated with biomarkers related to dyslipidemia, insulin sensitivity and inflammation in a sample of cardio-metabolically healthy young children from the Guelph Family Health Study at the University of Guelph, Guelph, Ontario, Canada.Methods: Baseline data from 42 children (aged 2.0-6.2 years) from 33 families who provided a dietary assessment and a fasted blood sample were included in this cross-sectional analysis. Linear and logistic regressions using generalized estimating equations were used for analysis and models were adjusted for age, gender, and household income.Results: In total, 42 children (3.74 ± 1.23 years old; mean (± SD)) consumed median (25th percentile, 75th percentile) servings/day of 1.70 (1.16, 2.81) for total dairy, 0.74 (0.50, 1.70) for milk, 0.63 (0.00, 1.16) for cheese, and 0.00 (0.00, 0.38) for yogurt. Cheese intake was significantly inversely associated with LDL cholesterol (-0.16 (95% CI: -0.29, -0.03) mmol/L per serving; P = 0.02)). No other associations between dairy intake and biomarkers were significant.Conclusions: Cheese intake was inversely associated with LDL cholesterol in this preliminary study of cardio-metabolically healthy young children, thereby warranting further research on dairy intake and cardiometabolic risk factors.

Canned Beans Decrease Serum Total and LDL Cholesterol in Adults with Elevated LDL Cholesterol in a 4-wk Multicenter, Randomized, Crossover Study.

BACKGROUND: Practical risk reduction strategies are needed to address cardiovascular disease. Beans can decrease LDL cholesterol; however, research into different daily amounts and varieties is warranted. OBJECTIVES: To examine the effects of canned beans (daily rotation of black, navy, pinto, dark red kidney, white kidney) in 1-cup (1CB, 180 g) and ½-cup (½CB, 90 g) daily amounts compared with a 1-cup white rice (WR) control on serum lipid and glycemic biomarkers in adults with elevated LDL cholesterol. METHODS: Adults [n = 73, mean ± SD age: 48.1 ± 14.2 y; BMI (in kg/m2): 25.9 ± 4.22; fasting serum LDL cholesterol: 3.0-5.0 mmol/L] consumed 1CB, ½CB, and WR for 4-wk treatment periods separated by ≥4-wk washouts in a multicenter, randomized, crossover study. Fasting serum LDL cholesterol (primary outcome) and other lipids and glycemic biomarkers (secondary outcomes) were measured on study days 1 and 29 of each treatment period with study day 29 values compared using repeated-measures ANCOVA, including study day 1 values as covariates. RESULTS: Treatment completion was n = 66 for 1CB, n = 68 for ½CB, and n = 64 for WR. Total cholesterol on study day 29 was lower for 1CB (P = 0.04) but not ½CB (P = 0.77) compared with WR (-5.46%, -2.74%, -0.65% changes from study day 1, respectively) and did not differ between 1CB and ½CB (P = 0.17). LDL cholesterol on study day 29 was also lower for 1CB (P = 0.002) but not ½CB (P = 0.30) compared with WR (-8.08%, -3.84%, +0.49% changes from study day 1, respectively) and did not differ between 1CB and ½CB (P = 0.11). Other lipids and glycemic biomarkers did not differ among treatments. CONCLUSIONS: Consumption of 1 cup (180 g) of canned beans of multiple varieties decreased total and LDL cholesterol in adults with elevated LDL cholesterol, supporting a practical strategy for cardiovascular disease risk reduction. This trial was registered at clinicaltrials.gov as NCT03830970.

Consequences of population structure for sex allocation and sexual conflict.

Both sex allocation and sexual conflict can be modulated by spatial structure. However, how the interplay between the type of dispersal and the scale of competition simultaneously affects these traits in sub-divided populations is rarely considered. We investigated sex allocation and sexual conflict evolution in meta-populations of the spider mite Tetranychus urticae evolving under budding (pairing females from the same patch) or random (pairing females from different patches) dispersal and either local (fixed sampling from each subpopulation) or global (sampling as a function of subpopulation productivity) competition. Females evolving under budding dispersal produced less female-biased offspring sex ratios than those from the random dispersal selection regimes, contradicting theoretical predictions. In contrast, the scale of competition did not strongly affect sex allocation. Offspring sex ratio and female fecundity were unaffected by the number of mates, but female fecundity was highest when their mates evolved under budding dispersal, suggesting these males inflict less harm than those evolving under random dispersal. This work highlights that population structure can impact the evolution of sex allocation and sexual conflict. Moreover, selection on either trait may reciprocally affect the evolution of the other, for example via effects on fecundity.

Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves.

AIMS: Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV. METHODS AND RESULTS: A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; median STS-PROM score 7.3% (4.2-12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) ≤ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02-1.13)], age [HR 1.21 (95% CI 1.01-1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11-1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis-patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31-14.39)], device malposition [SHR 3.75 (95% CI 1.36-10.35)], EBEV [SHR 3.34 (95% CI 1.26-8.85)], and age [SHR 0.59 (95% CI 0.44-0.78)]. CONCLUSIONS: The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.

Diet Quality of Canadian Preschool Children: Associations with Socio-demographic Characteristics.

Purpose: To examine associations between preschoolers' diet quality and parent and child socio-demographic variables.Methods: Cross-sectional analysis with 117 preschoolers. Parents reported socio-demographics and their children's diet using 3-day food records. Diet quality was assessed using the Healthy Eating Index (HEI) 2015. Linear regression models were used to analyze associations between socio-demographics and HEI scores.Results: A total of 86% of children had an HEI-2015 score in the "needs improvement" category (51-80 out of a maximum of 100). Children's overall HEI-2015 score was inversely associated with children's age (ß = -0.19, 95% CI -0.37, -0.02). Parental education was positively associated with children's overall HEI score (ß = 9.58, 95% CI 3.81, 15.35) and with scores for total fruit (ß = 1.00, 95% CI 0.39, 1.76), vegetables (ß = 1.11, 95% CI 0.03, 2.18), total protein (ß = 1.06, 95% CI 0.28, 1.84), and seafood/plant protein (ß = 1.67, 95% CI 0.43, 2.89) components. Children who identified as Caucasian (ß = 4.29, 95% CI 2.46, 6.14), had a Caucasian parent (ß = 3.01, 95% CI 0.78, 5.25), or parents who were born in Canada (ß = 2.32, 95% CI 0.53, 4.11) had higher scores for dairy.Conclusion: Our results suggest that preschoolers' diet quality needs improvement and that children's diet quality varies by children's age and parental education level.

Transcatheter aortic valve implantation 10 years after valve-in-valve transcatheter aortic valve implantation for failing aortic valve homograft root replacement.

Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is an established therapy for a degenerated surgical bioprosthesis. TAVI-in-TAVI following ViV-TAVI has not been previously performed. We report a high-risk patient presenting with severe left ventricular failure secondary to undiagnosed critical aortic stenosis due to degeneration of the implanted transcatheter heart valve more than a decade after initial ViV-TAVI for a failing stentless aortic valve homograft. Successful TAVI-in-TAVI reversed the clinical and echocardiographic changes of decompensated heart failure with no evidence of coronary obstruction.

Association between diet quality and food waste in Canadian families: a cross-sectional study.

BACKGROUND: Higher diet quality has been associated with greater amounts of food waste among adults in the United States. This study aims to build on previous work by examining the association between diet quality and food waste, as assessed using detailed waste audits, among a sample of Canadian families. METHODS: This cross-sectional study used data from 85 Canadian families with young children. Parent and children diet quality was assessed using the Healthy Eating Index-2015 (HEI-2015), calculated from 3-day food records. Household food waste was measured using detailed waste audits conducted over multiple weeks and these data were used to calculate daily per capita food waste. Linear regression was used to explore the association between parent and child HEI-2015 scores and daily per capita total avoidable and unavoidable food waste, as well as daily per capita avoidable and unavoidable food waste in the following categories: 1) fruits and vegetables, 2) milk, cheese and eggs, 3) meat and fish, 4) breads and cereals, 5) fats and sugars. RESULTS: Parent HEI-2015 scores ranged from 37 to 92 (out of 100) and 81% of parents' diets scored in the "Needs Improvement (51-80)" category. Parent and child diet quality scores were significantly correlated (r = 0.61; P < 0.0001) and 82% of children's diets scored in the "Needs Improvement" category. On average, households produced 107 g of avoidable food waste and 52 g of unavoidable food waste per person per day. Fruits and vegetables were the highest contributor for both avoidable and unavoidable food waste. Both parent and child HEI-2015 scores were not significantly associated with total daily per capita avoidable or unavoidable food waste. However, parent HEI-2015 scores were positively associated with daily per capita avoidable fruit and vegetable waste (Unstandardized ß = 1.05; 95%CI: 0.11, 1.99; P = 0.03) and daily per capita unavoidable fruit and vegetable waste (Unstandardized ß = 0.60; 95%CI: 0.03, 1.17; P = 0.04), after adjusting for household income. CONCLUSION: This is the first study to explore the association between diet quality and food waste using detailed waste audits. Future research should explore effective strategies towards improving diet quality while simultaneously reducing food waste, especially of fruits and vegetables.

Frequency of fruit juice consumption and association with nutrient intakes among Canadians.

BACKGROUND: In Canada, studies on consumption of 100% fruit juice and nutrient intakes are limited. AIM: This study aimed to evaluate nutrient intakes and adequacy of intake by frequency of fruit juice consumption. METHODS: Individuals ≥1 year (n = 34,351) participating in the Canadian Community Health Survey, 2004 with a 24-hour dietary recall and reported usual frequency of fruit juice consumption (assumed to be 100% juice) were categorized by frequency of consumption as <0.5, ≥0.5 to <1.5, or ≥1.5 times/day. RESULTS: More frequent consumption of fruit juice (≥0.5 times/day) was associated with higher intakes of total fruits and vegetables, whole fruits, energy, total sugars, vitamin C and potassium. More frequent consumption of fruit juice was associated with improved intake adequacy of vitamin C for adults. CONCLUSIONS: Fruit juice consumption contributes to increased intakes of vitamin C and potassium as well as energy and total sugars, thus presenting a trade-off for consumers to balance.

Associations between Family Meal Context and Diet Quality among Preschool-Aged Children in the Guelph Family Health Study.

Purpose: To explore the associations between family meal context and overall diet quality of Canadian preschool-aged children. Methods: Cross-sectional analysis of 95 preschool-aged children from 72 families. Measures about health behaviours and the family meal environment were drawn from selected questionnaire items. Three-day food records for children were assessed using the Healthy Eating Index 2010 (HEI-2010). Linear regression was used to explore the associations between the family meal variables and children's HEI-2010 scores. Results: In analyses adjusted for child age, sex, and household income, child involvement in meal preparation (ß = 4.34; 95% CI: 0.56-8.12) and time spent preparing the evening meal (ß = 3.77; 95% CI: 0.42-7.12) were associated with higher HEI-2010 scores. Serving fast food (ß = -2.90; 95% CI: -4.79 to -1.02) and using screen-based devices during meals (ß = -3.80; 95% CI: -7.38 to -0.21) were associated with lower HEI-2010 scores. Family meal frequency and serving prepared foods, sugar-sweetened beverages, and vegetables at meals were not significantly associated with preschoolers' diet quality. Conclusions: The context in which family meals take place influences child diet quality. Taking the time to include children in family meal preparation may benefit children's dietary intake.

Dairy and Plant-Based Dairy Alternatives Purchasing Habits of Guelph-Based Families with Preschool-Aged Children.

Purpose: To investigate dairy and plant-based dairy alternatives (DPBDA) purchasing habits, including comparisons among locations of purchase and among subtypes of DPBDA, of families with preschool-aged children.Methods: Expenditures on food and DPBDA were calculated using grocery and food receipts collected for 3 weeks from 51 households in and around Guelph, Ontario, Canada. DPBDA were coded by subtypes (alternatives, cheese/yogurt, cow's milk, cream, and ice cream/other) and by locations of purchase, which were coded as big-box, discount, high-end, local/other, and midrange stores. Logistic regression using generalized estimating equations was used to investigate odds of purchasing DPBDA by location of purchase. All models included family income and number of children as potential confounders.Results: Ninety-eight percent of families purchased cheese/yogurt, 92% purchased cow's milk, and 35% of families purchased plant-based dairy alternatives. Families were more likely to purchase DPBDA from big-box stores than discount, midrange, or local/other stores (P < 0.01) and were more likely to purchase cheese/yogurt than dairy alternatives, cream, or ice cream/other subtypes (P < 0.01). Odds of purchasing were not different between cheese/yogurt and cow's milk.Conclusion: Families' DPBDA purchasing habits differ by purchase location and subtype. Further research is warranted to understand the factors affecting these purchasing habits.

Food Type and Lentil Variety Affect Satiety Responses but Not Food Intake in Healthy Adults When Lentils Are Substituted for Commonly Consumed Carbohydrates.

BACKGROUND: Lentils have potential to increase satiety and may contribute to a body weight management strategy; however, the effects on satiety of replacing common food ingredients with lentils within food products remain largely unknown. OBJECTIVE: The aim of this study was to determine the effects of replacing wheat and rice with 2 lentil varieties within muffins and chilies on satiety, test-meal food intake, and 24-h energy intake. METHODS: Healthy adults consumed muffins or chilies in which wheat or rice was substituted with green (61.8 g) or red (54 g) lentils in 2 randomized crossover studies (muffin study: n = 24, mean ± SE age: 25.4 ± 0.9 y, BMI (in kg/m2): 23.2 ± 0.5; chili study: n = 24, age: 25.7 ± 1.0 y, BMI: 23.2 ± 0.5), with ≥1-wk washout periods between study visits and studies. Subjective appetite sensations measured over 180 min were summarized with total area under the curve (AUC), food intake was measured at an ad libitum test meal, and 24-h energy intake was measured using weighed food records. Treatment effects were compared within each study using repeated-measures ANCOVA (subjective appetite sensations) and ANOVA (food intake, 24-h energy intake). RESULTS: Green, but not red, lentil chili significantly increased fullness AUC (17.5%, P = 0.02) and decreased desire to eat AUC (20.1%, P = 0.02) and prospective food consumption AUC (16.7%, P = 0.04) compared with rice chili, with no significant differences between chili treatments for test-meal food intake or 24-h energy intake. Muffin treatments did not significantly differ for any outcomes. CONCLUSIONS: Replacing rice with green, but not red lentils within chili increases satiety but does not decrease food intake, whereas replacing wheat with lentils within muffins does not increase satiety or decrease food intake in healthy adults. Further study of the role of lentil replacement in food products in body weight management is warranted. This trial was registered at clinicaltrials.gov as NCT03128684.