Two-year outcomes of Faith in Action/Fe en Acción: a randomized controlled trial of physical activity promotion in Latinas.

BACKGROUND: Latina women are less likely to report engaging in leisure-time physical activity (PA) than non-Latina white women. This study evaluated the 24-month impact of a faith-based PA intervention targeting Latinas. METHODS: The study is a cluster randomized controlled trial of a PA intervention or cancer screening comparison condition, with churches as the randomization unit. A total of 436 Latinas (aged 18-65 years) from 16 churches who engaged in low levels of self-report and accelerometer-based PA were enrolled. The experimental condition was a 24-month PA intervention, with in-person classes, social support, and environmental changes, led by community health workers (i.e., promotoras). At baseline, 12-, and 24 months, we assessed changes in accelerometer-based and self-reported moderate to vigorous physical activity (MVPA; primary outcomes). Secondary outcomes were light intensity activity, sedentary time, body mass index (BMI), and waist circumference. RESULTS: After adjusting for sociodemographic factors, a mixed effects analysis found significant increases in self-reported leisure time MVPA (p < 0.005) and marginal increases in accelerometer-assessed MVPA (p < 0.08) 24 months post-baseline in the intervention compared to the attention-control condition. Data showed significant associations between PA class attendance and engaging in MVPA as assessed by self-report and accelerometry. No significant changes were found for light activity, sedentary time, BMI, or waist circumference. CONCLUSIONS: Participants who attended the PA classes at least once a month engaged in significantly higher MVPA compared to those who did not. Maximizing engagement and maintenance strategies to enhance PA maintenance could contribute to important long-term health benefits. TRIAL REGISTRATION: NCT01776632 , Registered March 18, 2011.

Associations among affect, diet, and activity and binge-eating severity using ecological momentary assessment in a non-clinical sample of middle-aged fathers.

PURPOSE: Knowledge of within-day factors associated with binge-eating severity among middle-aged fathers is limited. The purpose of the current report was to examine within-day associations of affect, diet, and activity in relation to binge-eating severity using ecological momentary assessment (EMA) in men. METHODS: Twenty-three middle-aged fathers completed 8 days of EMA and wore accelerometers to objectively assess activity. Generalized estimating equations assessed relationships among affect, diet, and activity and binge-eating severity. RESULTS: When positive affect was above average, men reported greater binge-eating severity in the next 2 h. Oppositely, when negative affect was above average, men reported less binge-eating severity in the next 2 h. At times when men reported consumption of sweets and fast food, they reported higher binge-eating severity during the same 2-h window. Men with greater average levels of light activity reported less overall binge-eating severity. CONCLUSIONS: Findings show that affect, unhealthy food intake, and light activity could be targeted among middle-aged fathers to reduce binge-eating severity and prevent eating disorders. LEVEL OF EVIDENCE: Level III: Evidence obtained from cohort or case-control analytic studies.

SARS-CoV-2 acquisition and immune pathogenesis among school-aged learners in four diverse schools.

BACKGROUND: Understanding SARS-CoV-2 infection in children is necessary to reopen schools safely. METHODS: We measured SARS-CoV-2 infection in 320 learners [10.5 ± 2.1 (sd); 7-17 y.o.] at four diverse schools with either remote or on-site learning. Schools A and B served low-income Hispanic learners; school C served many special-needs learners, and all provided predominantly remote instruction. School D served middle- and upper-income learners, with predominantly on-site instruction. Testing occurred in the fall (2020), and 6-8 weeks later during the fall-winter surge (notable for a tenfold increase in COVID-19 cases). Immune responses and mitigation fidelity were also measured. RESULTS: We found SARS-CoV-2 infections in 17 learners only during the surge. School A (97% remote learners) had the highest infection (10/70, 14.3%, p < 0.01) and IgG positivity rates (13/66, 19.7%). School D (93% on-site learners) had the lowest infection and IgG positivity rates (1/63, 1.6%). Mitigation compliance [physical distancing (mean 87.4%) and face-covering (91.3%)] was remarkably high at all schools. Documented SARS-CoV-2-infected learners had neutralizing antibodies (94.7%), robust IFN-γ + T cell responses, and reduced monocytes. CONCLUSIONS: Schools can implement successful mitigation strategies across a wide range of student diversity. Despite asymptomatic to mild SARS-CoV-2 infection, children generate robust humoral and cellular immune responses. IMPACT: Successful COVID-19 mitigation was implemented across a diverse range of schools. School-associated SARS-CoV-2 infections reflect regional rates rather than remote or on-site learning. Seropositive school-aged children with asymptomatic to mild SARS-CoV-2 infections generate robust humoral and cellular immunity.

Investigating the momentary association between maternal support and children's fruit and vegetable consumption using ecological momentary assessment.

Despite compelling evidence that fruit and vegetable (F/V) consumption can reduce the risk of obesity and chronic disease, most children fail to meet the daily recommendations for dietary consumption. Theoretical models and empirical findings suggest that parents play a key role in guiding children's overall dietary behaviors. To extend previous findings, the current study utilized ecological momentary assessment (EMA) on smartphones to assess the within-subject and between-subject effects of maternal support (i.e., encouragement, preparation) of F/V on their child's F/V consumption. Mother-child dyads (n = 191) completed six semi-annual 7-day waves of EMA surveys. EMA assessed mothers' past 2-h support for F/V and children's F/V consumption. At the within-subject level, greater maternal encouragement for F/Vs (OR = 2.41) and maternal preparation of F/Vs (OR = 1.43) than usual were associated with increased odds of their child eating F/V during the same 2-h window. At the between-subject level, greater maternal preparation of F/V (OR = 5.99), compared to other mothers, was associated with increased odds of their child eating F/V. Children with lower BMI (vs. higher BMI) were more likely to consume F/Vs when their mothers encouraged them to eat F/V (OR = 0.74). These findings suggest that maternal support may have a strong and immediate effect on children's F/V consumption. Theoretical models on behavior change should consider how explanatory factors, such as parental support, may vary at the momentary level. Boosting maternal support at the momentary level may be a critical component of future mobile-based interventions to address childhood obesity.

The Association of Maternal Perceived Stress With Changes in Their Children's Healthy Eating Index (HEI-2010) Scores Over Time.

BACKGROUND: Few studies have examined the role of maternal stress in relation to their children's dietary quality and its trajectory over time. PURPOSE: The objective of this longitudinal study was to examine the effect of baseline maternal stress on the change in their 8- to 12-year-old children's dietary quality over 1 year. METHODS: Mother-child dyads (N = 189) from the greater Los Angeles area participating in the Mothers' and their Children's Health (MATCH) study in 2014-2016 completed assessments at baseline, 6 months, and 12 months. At baseline, mothers (mean age = 41.0 years, standard deviation [SD] = 6.1) completed the 10-item Cohen's Perceived Stress Scale (PSS). At each time point, children (51% female, mean age = 9.6 years, SD = 0.9) completed up to two 24-hr dietary recalls. Dietary data were used to calculate each child's Healthy Eating Index 2010 (HEI-2010) score at each time point. Multilevel models examined the effect of time on the patterns of change in children's HEI-2010 scores over 1 year and the cross-level interaction between baseline maternal PSS score and time on the change in children's HEI-2010 scores. RESULTS: On average, there was no significant linear change in child HEI-2010 across 1 year (b = -0.410, p = .586). Controlling for covariates, the rate of change in HEI-2010 differed depending on mother's baseline PSS (i.e., significant cross-level interaction effect) (b = -0.235, p = .035). CONCLUSIONS: Our results showed that higher-than-average maternal stress at baseline was associated with greater decline in children's dietary quality over 1 year. Family-based dietary interventions that incorporate maternal stress reduction could have positive effects on children's dietary quality.

Within-Subject Effects of Stress on Weight-Related Parenting Practices in Mothers: An Ecological Momentary Assessment Study.

BACKGROUND: Stress may compromise parenting practices related to children's dietary intake, physical activity, and sedentary behavior. PURPOSE: The current study used Ecological Momentary Assessment (EMA) to examine microtemporal sequences underlying maternal stress and subsequent weight-related parenting practices. METHODS: Mothers (n = 199) of children aged 8-12 years participated in two separate 7-day waves of EMA with up to eight randomly prompted surveys per day during children's nonschool time. EMA items assessed stress and weight-related parenting practices. RESULTS: When mothers reported experiencing greater stress than usual, they subsequently engaged in less physical activity parenting (e.g., encouraging physical activity; p < .05) and more sedentary screen behavior parenting (e.g., limiting TV/video games; p < .05) over the next 2 hr. CONCLUSIONS: Addressing within-day variations in maternal stress may be an important component of parent-focused child obesity prevention interventions.

Within-Subject Associations of Maternal Physical Activity Parenting Practices on Children's Objectively Measured Moderate-to-Vigorous Physical Activity.

OBJECTIVE: Longitudinal within-subject (WS) associations of mothers' momentary assessed physical activity (PA) parenting practices were examined with children's objectively measured PA during the same 2-hr time frame. METHOD: Mother-child dyads (n = 189) completed five ecological momentary assessment (EMA) measurement bursts over 3 years. During each 7-day burst, mothers EMA-reported their past 2 hr PA parenting practices (i.e., encouraging their child to be physically active, taking their child someplace to be physically active), and children (Mage=9.6 years, SD = 0.9) wore an accelerometer to measure moderate-to-vigorous PA (MVPA). Two-part multilevel models were used, with zero portions representing not meeting MVPA and positive portions representing any MVPA, controlling for demographic covariates. Cross-level interaction terms of child sex and age with parenting were created to test moderation effects. RESULTS: When mothers reported taking their child to be physically active, children were more likely to get some MVPA (b = -0.56, p < .001). When mothers reported taking their child to be physically active more, children had higher levels of MVPA (b = 0.24, p < .001). When mothers reported encouraging their child to be physically active, children were less likely to get any MVPA (b = 0.27, p < .05). However, when mothers reported encouraging their child to be physically active more, children had higher levels of MVPA (b = 0.29, p < .001). These effects were not moderated by child sex or age. CONCLUSIONS: WS variations of mothers' support for PA across the day were associated with changes in children's MVPA. Future research should consider promoting mothers' provision of support for increasing children's PA.

Dual Versus Single Parental Households and Differences in Maternal Mental Health and Child's Overweight/Obesity.

Objectives Mothers report higher levels of psychological stress than fathers. s. Psychological stress is posited to influence parenting practices that could increase children's obesity risk. However, previous studies have not investigated several aspects of maternal mental health and the moderating role of household structure on children's obesity risk. The objective was to investigate associations of maternal mental health with child obesity risk, and whether these associations differed by household structure (single-parent vs. dual parent/multigenerational). Methods Mothers and their 8-12 year old children (N = 175 dyads) completed baseline questionnaires on mothers' mental health and child anthropometrics. Separate logistic regressions assessed associations of standardized maternal mental health indicators with the odds of child overweight/obesity, controlling for child age, and women's BMI, age, education, employment status, and annual income. Household structure was investigated as a moderator of these relationships.Results There were no statistically significant relationships between maternal mental health characteristics and odds of child overweight/obesity. Among single mothers only, greater anxiety was associated with higher risk of child overweight/obesity [OR (95% CI) = 3.67 (1.27-10.62); p = 0.0163]; and greater life satisfaction was marginally associated with lower risk of child overweight/obesity [OR (95% CI) = 0.44 (0.19-1.01); p = 0.0522]. Mothers' life satisfaction may lower risk for their children's overweight/obesity, whereas higher anxiety may increase this risk, particularly among children living in single-mother households. Conclusions for Practice Future interventions could increase resources for single mothers to buffer the effects of stress and lower pediatric obesity risk.

Parenting styles, food-related parenting practices, and children's healthy eating: A mediation analysis to examine relationships between parenting and child diet.

Parents exert a strong influence on their children's diet. While authoritative parenting style is linked to healthier weight and dietary outcomes in children, and authoritarian and permissive parenting styles with unhealthy eating, little is known about the mechanisms that mediate these relationships. Feeding styles are often examined in relation to child diet, but they do not consider the social and physical environmental contexts in which dietary behaviors occur. Therefore, this study examined whether parenting styles (authoritative, authoritarian, and permissive) were associated with three specific food-related parenting practices - mealtime structural practices (e.g., eating meals as a family), parent modeling of healthy food, and household food rules and whether these parenting practices mediated the association between parenting styles and children's diet. Participants were 174 mother-child dyads. Mothers (68% married, 58% college graduates, Mage = 41 years [SD = 6.2]) reported on their parenting practices using validated scales and parenting style using the Parenting Styles and Dimensions Questionnaire. Children (52% female, Mage = 10 years [SD = 0.9]) completed two telephone-based 24-hour dietary recalls. Dietary outcomes included the Healthy Eating Index (HEI)-2010 score, and fruit and vegetables and added sugar intake. Using PROCESS, multiple mediation cross-sectional analyses with parallel mediators using 10,000 bootstraps were performed. Significant indirect effects were observed with mealtime structure and the relationships between authoritative parenting and HEI-2010 score (b = 0.045, p < .05, CI = [0.006, 0.126]), authoritarian parenting and HEI-2010 score (b = -0.055, p < .05, CI = [-0.167, -0.001]), and permissive parenting and HEI-2010 score (b = -0.093, p < .05, CI = [-0.265, -0.008]). Child diet quality is affected by mealtime structural practices. Further examination of the features by which mealtime structural practices serve as a mechanism for parents to support healthy eating among their children may improve children's diet quality.

Promoting healthier children's meals at quick-service and full-service restaurants: Results from a pilot and feasibility study.

High-calorie restaurant foods contribute to childhood overweight. Increased consumer demand for healthier kids' meals may motivate the restaurant industry to provide additional healthy options. This study pilot-tested a combination of four strategies (toy incentive, placemats, server prompts, signage) designed to increase demand for healthier kids' meals, which were defined as those eligible for the National Restaurant Association's Kids LiveWell program. Relative sales of healthier kids' meals were examined before (n = 3473 total kids' meal orders) and during Month 1 (n = 3546 total kids' meal orders) and Month 2 of implementation (n = 3645 total kids' meal orders) of an 8-week intervention in two locations each of a quick-service (QSR) and full-service (FSR) restaurant chain. Convenience samples of children (n = 27) and their parents (n = 28) were surveyed regarding parent and child perceptions of intervention components. Findings regarding the effectiveness and feasibility of the intervention were mixed. At the FSRs, the relative percentage of monthly sales from healthier kids' meals increased from 5.0% of kids' meal orders at baseline to 8.3% during Month 1, ending at 6.4% during Month 2. At the QSRs, the relative percentage of monthly sales from healthier kids' entrees decreased from 27.5% at baseline to 25.2% during Month 1, ending at 25.9% during Month 2. Implementation quality tracking showed that consistent implementation of intervention components was a challenge; parent- and child-reported awareness of intervention components supported this finding. Future directions are discussed, aiming to build upon these findings and maximize the feasibility, effectiveness, and sustainability of efforts to promote healthier eating in restaurants.

Mixed Messages: Ambiguous Penalty Information in Modified Restaurant Menu Items.

Restaurant menu items from six national or regional brands were modified to reduce fat, saturated fat, sodium and total calories. Twenty-four items were tested with a current recipe, and two modifications (small and moderate reductions) for 72 total products. Approximately 100 consumers tested each product for acceptability as well as for desired levels of tastes/flavor, amounts of key ingredients and texture/consistency using just-about-right (JAR) scales. Penalty analysis was conducted to assess the effects of non-JAR ratings on acceptability scores. Situations arose where JAR ratings and penalty analyses could yield different recommendations, including large groups with low penalties and small groups with high penalties. Opposing groups with moderate to high penalties on opposite sides of the same JAR scale were also seen. Strategies for dealing with these observances are discussed.

Weight-Inclusive Podcasts Improved Intuitive Eating, Body Appreciation, and Anti-Fat Attitudes Among Nutrition Students.

OBJECTIVE: Assess the impact of a weight-inclusive podcast (WIP) intervention on body appreciation, intuitive eating (IE), anti-fat attitudes, and weight and health attitudes in university students enrolled in an upper-division nutrition course. METHODS: Quasi-experimental design: Intervention participants listened to 8 weekly WIP episodes (n = 16); the comparison group listened to 8 weekly general nutrition podcasts (n = 29). Intuitive eating, body appreciation, anti-fat attitudes, and general weight and health attitudes were measured preintervention and postintervention. RESULTS: Two-way, repeated measures analysis of variance revealed significant interaction effects of time × group, with participants in the WIP group experiencing significantly greater improvements in body appreciation (P = 0.03) and IE (P = 0.02) and greater reductions in anti-fat attitude scores (P = 0.006) than the comparison group. CONCLUSIONS AND IMPLICATIONS: Podcasts may be a cost-effective tool to improve body appreciation and IE and reduce anti-fat attitudes in future nutrition professionals. Future research would benefit from recruiting prehealth professionals across different majors.

Impostor phenomenon in registered dietitians: an exploratory survey.

BACKGROUND: Impostor phenomenon, also referred to as imposter syndrome or impostorism, was initially identified among high achieving women who felt undeserving of their successes because they felt they were earned through luck or chance, rather than skill or experience. It's prevalence has been identified in many health professions; however, there are no known studies of Registered Dietitians' (RDs) perceptions of impostor phenomenon. This study assesses the following among RDs: [1] prevalence of impostor phenomenon and differences in impostor phenomenon levels, if any, based on [2] highest educational level achieved and [3] years of experience as an RD. METHODS: A cross-sectional survey was sent electronically to 5,000 RDs credentialed by the Commission on Dietetic Registration in the United States. Respondents' agreement with 20 impostor phenomenon statements from the Clance Impostor Phenomenon Scale were measured. The sum score from the scale was used to classify levels of impostor phenomenon. Descriptive statistics and chi square analyses for comparison were evaluated. RESULTS: Of the 445 (9%) who began the survey, 266 (5%) completed it and were included in analyses. Over 76% of 266 individuals reported at least moderate impostorism (score of 40 or fewer points out of 100). No difference was seen based on educational level (p = .898); however, those with less than five years' experience reported higher impostor phenomenon (p < .05). Among those with five to 39 years' experience, over 40% reported moderate impostorism. CONCLUSION: Impostor phenomenon is prevalent among RDs. Moderate impostorism was pervasive among all those with less than 40 years' experience and could potentially negatively impact these respondents. Future research could explore ways to reduce impostor phenomenon in RDs.

Motivational and self-regulatory processes associated with weight-related parenting behaviors.

Background: Parents play an influential role on their child's eating and physical activity. How maternal personality and individual differences, such as motivation and self-regulation, are associated with their weight-related parenting has yet to be studied. The current study examined relationships of mothers' motivational and self-regulatory characteristics with weight-related parenting practices. Methods: Mothers (N = 149, MAge = 42.78 years, 49% Hispanic/Latino) of school-aged children (ages 10-14 years, 55.7% female) completed questionnaires assessing behavioral inhibition system/behavioral activation system (BIS/BAS), self-control, and weight-related parenting practices (i.e., role modeling, food restriction, rule enforcement, limiting, discipline, pressure to eat). Structural equation modeling examined associations of BIS, BAS, and self-control with parenting practices. Results: Among mothers, higher avoidance motivation was associated with difficulty with rule enforcement. Higher approach motivation was associated with less limiting of unhealthy food and sedentary behavior. Higher self-control predicted more role modeling and less difficulty with rule enforcement. Conclusion: Findings support associations of maternal motivational and self-regulatory processes with weight-related parenting behaviors. Results may inform tailored strategies based on individual differences for family-based interventions for parenting.

Development and Rasch Analysis of the 18-Item Health Resilience Profile (HRP).

Existing resilience measures have psychometric shortcomings, and there is no current gold-standard resilience measure. Previous work indicates adults enrolled in a health coaching program may benefit from a resilience measure that is tailored and contextualized to this sample. This two-part study aimed to develop and evaluate a resilience instrument focused on health behavior change in adults in a health coaching program. Two studies were conducted to (1) create a resilience instrument (Health Resilience Profile; HRP) specific to adults attempting health behavior change (n = 427; female = 83.8%; age = 44.5 ± 11.9 years) and to (2) optimize the instrument performance using Rasch analysis (n = 493; female = 62.1%; age = 49.8 ± 12.5 years). Study 1 identified two issues: (1) four unacceptable misfit items and (2) inappropriate rating scale functioning. Study 2 evaluated an improved instrument based on the outcome of study 1 resulting in one more misfit item, and unidimensionality was supported. The new four-category rating scale functioned well. The item-person map indicated that item difficulty distribution was well matched to participants' resilience level, and items were free from measurement error. Finally, items did not show differential item functioning across age, sex, alcohol use, and obesity status. The 18-item HRP is optimized for adults in a health coaching program.

Parent awareness of young children's physical activity.

OBJECTIVE: Parents who overestimate their child's physical activity (PA) level may not encourage their children to increase their PA. We assessed parental awareness of child PA, and investigated potential correlates of overestimation. METHOD: Child PA (accelerometer) and parent-classified child PA ['active' ≥ 60 min/day vs. 'inactive' <60 min/day moderate and vigorous PA (MVPA)] were measured over 7 days [n=329, 44% male, 39% Latino; mean (SD) 9.1 (0.7)years] in an obesity prevention study in San Diego (Project MOVE). Agreement between date-matched objective MVPA and parent-classified child PA was assessed; % days parental overestimation was the outcome variable. Associations between parental overestimation and potential correlates were investigated using three-level mixed-effects linear regression. RESULTS: Children met the PA guidelines on 43% of days. Parents overestimated their children's PA on 75% of days when children were inactive. Most parents (80%) overestimated their child's PA on ≥ 1 measurement day. Parental support for child PA (transport, encouragement and participation with child) (p<0.01) was positively associated with higher overestimation. Parents of girls showed more overestimation than parents of boys (p=0.04). CONCLUSION: Most parents incorrectly classified their child as active when their child was inactive. Strategies addressing parental overestimation may be important in PA promotion.

Blue Zones-Based Worksite Nutrition Intervention: Positive Impact on Employee Wellbeing.

"Blue Zones" are geographical regions where people live to be non-agenarians and centenarians with significantly better rates of mental wellness when compared to the average American. It was discovered that these areas have nine unique evidenced-based lifestyle principles, with one of their main principles being the consumption of a plant-based diet. With this in mind, we performed a worksite intervention with the objective of understanding the relationships among Blue Zones knowledge, a plant-based lifestyle, and improvements in overall mental wellness during the COVID-19 pandemic. During spring 2021, we recruited 52 employees from a public, mid-sized university in the southwestern United States to participate in an 8-week virtual intervention that included weekly topic presentations, cooking demonstrations, and Blue Zones education. Participants were also assigned to weekly wellness counseling groups integrating Motivational Interviewing based principles that included additional, relevant conversation topics and support. The final sample (n = 52 participants) had a mean age of 45.6 ± 10.6 years. Participants were predominantly women (84.6%) and nearly half were married (44.2%). The majority attended graduate school (59.6%) and identified as White (84.6%). Paired-samples t-tests indicated significant improvements in all mental wellness outcomes and Healthy Eating Index-2015 (HEI-2015) scores over time (p's < 0.001 to 0.02). Multiple linear regression models revealed that Blue Zones knowledge (ß = -0.037, p = 0.010) significantly negatively predicted Patient Health Questionnaire-9 (PHQ-9) scores at 8-weeks. Additionally, multiple linear regression models indicated small group attendance (ß = -1.51, p = 0.003) and Blue Zones knowledge (ß = -0.81, p = 0.012) significantly negatively predicted sleep scores at 8-weeks. When HEI-2015 total scores were also included at baseline and 8-weeks (post-intervention), Blue Zones knowledge (ß = -0.031, p = 0.049) was a borderline significant predictor of PHQ-9 at 8-weeks. Additionally, small group sessions (ß = -1.52 p = 0.005) were a significant predictor of sleep at 8-weeks. The intervention illustrated that virtual intervention strategies can improve nutrition and mental wellness for future advancement in life quality and wellbeing.

Nutrition availability for those incarcerated in jail: Implications for mental health.

PURPOSE: Using a seven-day cycle menu and commissary items at a rural county jail, this study aims to describe provisions of micronutrients known to be associated with mental health disorders and if they meet dietary guidelines. DESIGN/METHODOLOGY/APPROACH: The nutritional content of a seven-day cycle menu and four available commissary food packs were evaluated using NutritionCalc® Plus software (McGraw-Hill Education version 5.0.19) and compared to Dietary Reference Intakes (DRI). FINDINGS: Menu mean values of Vitamin B6, Vitamin B12, Vitamin C and zinc met DRI recommendations. However, Vitamin D (for men and women), magnesium (for men only) and omega-3s (for men only) did not meet the DRI recommendations. ORIGINALITY/VALUE: As deficits of Vitamin D, magnesium and omega-3s are known to exacerbate bipolar disorder, anxiety and depression, small changes to food would increase the offerings and potential intake of nutrients that may improve mental health.

Nutritional adequacy of meals and commissary items provided to individuals incarcerated in a southwest, rural county jail in the United States.

BACKGROUND: Poor diet may contribute to deleterious chronic health among individuals incarcerated. Yet, limited research has evaluated the nutritional content of menus and commissary items provided in jails. Thus, this study assessed the macronutrient distribution, caloric composition, and diet quality of the seven-day cycle menu and commissary items provided in a southwest, rural county jail in the United States. METHODS: Daily and mean availability of calories and macronutrients for the seven-day cycle menu and commissary items were estimated using NutritionCalc Plus®. Diet quality (i.e., Healthy Eating Index-2015 [HEI-2015]) was assessed. Macronutrients and calories were compared to the Acceptable Macronutrient Distribution Range (AMDR) and the 2020-2025 Dietary Guidelines for Americans (DGA). Protein and carbohydrate were compared to the Dietary Reference Intake (DRI). HEI-2015 was compared to the average U.S. diet. RESULTS: Daily caloric provisions exceeded DGA recommendations. Daily available (16.2%-25.2% kcal/day) and mean protein met the AMDR recommendations, yet exceeded the DRI. Mean protein with commissary packs exceeded the AMDR recommendations and DRI. Daily available carbohydrate met AMDR recommendations for all but two days of the seven-day cycle menu, which exceeded recommendations (52.5%-66.4% kcal/day). Mean carbohydrate met the AMDR recommendations and exceeded the DRI, and with the commissary packs, exceeded the AMDR recommendations and DRI. Daily available total fat for the seven-day cycle menu (79.5-146.7 g), mean total fat alone and with the commissary packs exceeded AMDR recommendations. Daily available saturated fat for the seven-day cycle menu (16.7-47.7 g) exceeded AMDR recommendations for all but one day of the seven-day cycle menu, while mean saturated fat alone and with the commissary packs exceeded AMDR recommendations. Daily available added sugars for the seven-day cycle menu (8.4-14.2 g), mean added sugars alone and with the commissary packs all met AMDR recommendations. HEI-2015 scores for the seven-day cycle menu ranged from 49.3-74.5 (mean = 62.2, SD = 9.4), and increased with the commissary packs. CONCLUSIONS: Exceeding caloric and saturated fat recommendations may contribute to weight gain, regardless of high diet quality. Increasing nutrient-dense foods available in jail may reduce chronic disease among incarcerated populations.