Geospatial Analysis of Food Deserts and Their Impact on Health Outcomes in Children with Cystic Fibrosis.

Food insecurity (FI) is defined as "the limited or uncertain access to adequate food." One root cause of FI is living in a food desert. FI rates among people with cystic fibrosis (CF) are higher than the general United States (US) population. There is limited data on the association between food deserts and CF health outcomes. We conducted a retrospective review of people with CF under 18 years of age at a single pediatric CF center from January to December 2019 using demographic information and CF health parameters. Using a Geographic Information System, we conducted a spatial overlay analysis at the census tract level using the 2015 Food Access Research Atlas to assess the association between food deserts and CF health outcomes. We used multivariate logistic regression analysis and adjusted for clinical covariates and demographic covariates, using the Child Opportunity Index (COI) to calculate odds ratios (OR) with confidence intervals (CI) for each health outcome. People with CF living in food deserts and the surrounding regions had lower body mass index/weight-for-length (OR 3.18, 95% CI: 1.01, 9.40, p ≤ 0.05 (food desert); OR 4.41, 95% CI: 1.60, 12.14, p ≤ 0.05 (600 ft buffer zone); OR 2.83, 95% CI: 1.18, 6.76, p ≤ 0.05 (1200 ft buffer zone)). Food deserts and their surrounding regions impact pediatric CF outcomes independent of COI. Providers should routinely screen for FI and proximity to food deserts. Interventions are essential to increase access to healthy and affordable food.

The Theory of Planned Behavior and the USDA Summer Food Service Program.

OBJECTIVE: Examine the impact of the Summer Food Service Program (SFSP) on the intentions to positively change fruit and vegetable consumption in a rural, low-income adolescent population using the Theory of Planned Behavior. DESIGN: Quantitative data collected via a pre-post intervention survey to determine predictors of positive nutrition behaviors and changes in self-reported fruit and vegetable consumption. SETTING: A mid-sized university. PARTICIPANTS: Fifty-seven high school students. Participants were primarily female (n = 36) and white (n = 56). INTERVENTION: Participants followed the standards of the SFSP for 5 weeks and were provided with mandatory and optional nutrition education sessions. MAIN OUTCOME MEASURE: Intentions to change nutrition behaviors. ANALYSIS: Multiple regression. RESULTS: Paired-sample t test showed a significant increase in knowledge from pretest (mean [M] = 11.18, SD = 1.68) to posttest (M = 12.91, SD = 1.76); t[56] = -8.09, P < 0.001; (t[56] = -8.09, P < 0.001) and in self-reported fruit and vegetable intake from pretest (M = 13.96, SD = 4.23) to posttest (M = 16.80, SD = 5.42); (t[56] = -3.20, P = 0.002). Regression demonstrated that all constructs of the Theory of Planned Behavior were significant (F[4, 52] = 14.56, P < 0.001 with an R2 of 0.53) for their effects on behavior intentions with perceived behavioral control being the most salient predictor. CONCLUSIONS AND IMPLICATIONS: Opportunities for shaping adolescent nutrient intake and eating behaviors during enrollment in the SFSP exist. Reinforcing positive attitudes, subjective norms, and perceived behavioral control may help to increase nutrition behavioral intentions and nutrition behaviors.

Adverse Events Associated With the Use of Sipuleucel-T Reported to the US Food and Drug Administration's Adverse Event Reporting System, 2010-2017.

Importance: Sipuleucel-T was the first therapeutic cancer vaccine approved by the US Food and Drug Administration (FDA) in 2010. Although almost a decade has passed since its approval for the treatment of asymptomatic or minimally symptomatic castration-resistant prostate cancer (CRPC), there remains a paucity of literature describing safety data in the postmarketing period. Objective: To describe the postmarketing safety experience for sipuleucel-T. Design, Setting, and Participants: In this case series study, US reports for sipuleucel-T submitted to the FDA's Adverse Event Reporting System were searched and reviewed between April 29, 2010, and December 31, 2017. This system is a spontaneous safety surveillance database for drug and therapeutic biologic products. The analysis of 3216 reports and select case reviews were undertaken between February and November 2018. Main Outcomes and Measures: Descriptive statistics were used to assess adverse event reports for sipuleucel-T. Empirical Bayes Geometric Means (EBGM) and their 90% confidence intervals (CIs) were computed to identify disproportionate (ie, at least twice the expected) reporting of sipuleucel-T-event pairs. Selected adverse events and death reports were individually reviewed. Results: In total, 3216 reports were identified for sipuleucel-T, of which 2014 (62.6%) were serious. For all included reports, the patients' median (interquartile range) age was 73 (67-79) years, and 3149 were specified to be males. Chills (n = 318), malaise (n = 196), pyrexia (n = 189), culture positive (n = 184), fatigue (n = 180), and nausea (n = 173) were among the most commonly reported adverse events. Infusion-related reactions (EBGM, 12.1; 90% CI, 9.4-15.3), infections, vascular events, and transient ischemic attacks (EBGM, 2.9; 90% CI, 2.2-3.9) were reported disproportionately. Among 249 deaths for which relevant dates were available, 128 (51.4%) were reported within 30 days of a sipuleucel-T infusion, of which 81.2% included a specified cause of death; of these 104 deaths, there were 37 neoplasms (35.6%), 25 cardiac disorders (24.0%), 18 nervous system disorders (17.3%), and 9 infections (8.7%). Conclusions and Relevance: Reported adverse events were generally consistent with the safety experience observed in prelicensure studies and described in the sipuleucel-T package insert. Off-label use among overtly symptomatic men with CRPC, reporting bias, or lack of product effectiveness may have influenced the reporting of deaths within 30 days of treatment initiation. With this overview of sipuleucel-T experience, the present study serves as a resource for health care professionals and patients as they weigh the risks and benefits of treatment in the context of all available therapeutic options for CRPC.

Effects of USDA quality grade and cooking on water-soluble precursors of beef flavor.

The objective of the current study was to determine the effects of three USDA quality grades and cooking on the water-soluble flavor precursors of beef Longissimus lumborum. Raw and cooked steaks from beef strip loins of USDA Prime (PR; n = 8), Low-Choice (LC; n = 8), and Standard (ST; n = 8) were analyzed for extractable free amino acids, reducing sugars, and other nitrogenous organic compounds (NOCs). Overall, two-way quality grade × cooking interactions were found for the contents of most water-soluble precursors (Pquality grade × cooking < 0.05), which were greater in raw LC and ST and were changed more in ST and LC steaks by cooking. The magnitude of those changes suggested that cystine, a dimer of cysteine, glucose, and glucose 6-phosphate might play more important roles in beef flavor development than previously thought.

From the USDA: Educating the Next Generation: Funding Opportunities in Food, Agricultural, Natural Resources, and Social Sciences Education.

The National Institute of Food and Agriculture within the U.S. Department of Agriculture provides leadership, capacity, and funds to support the continuing development of a safe and competitive agricultural system. Many of the agency's educational programs are led by the Division of Community and Education (DOCE). These programs span agricultural education, enhancing agricultural literacy through both formal and nonformal education. Here, we have highlighted funding opportunities within DOCE that enhance agricultural education and literacy by supporting the improvement of students' critical communication, leadership skills, and experiential learning opportunities. Some of these programs include opportunities for which students can apply, while others focus on faculty applications. Opportunities faculty can apply for may support student-recruitment and student-retention techniques, curriculum development, innovative teaching methods, and institutional capacity-building programs. Overall, these programs foster a diverse workforce in agricultural science that matches the increasing diversity of the country.

Comparison of flavonoid intake assessment methods.

BACKGROUND: Flavonoids are a diverse group of polyphenolic compounds found in high concentrations in many plant foods and beverages. High flavonoid intake has been associated with reduced risk of chronic disease. To date, population based studies have used the United States Department of Agriculture (USDA) food content database to determine habitual flavonoid intake. More recently, a new flavonoid food content database, Phenol-Explorer (PE), has been developed. However, the level of agreement between the two databases is yet to be explored. AIM: To compare the methods used to create each database, and to explore the level of agreement between the flavonoid intake estimates derived from USDA and PE data. DESIGN: The study population included 1063 randomly selected women aged over 75 years. Two separate intake estimates were determined using food composition data from the USDA and the PE databases. RESULTS: There were many similarities in methods used to create each database; however, there are several methodological differences that manifest themselves in differences in flavonoid intake estimates between the 2 databases. Despite differences in net estimates, there was a strong level of agreement between total-flavonoid, flavanol, flavanone and anthocyanidin intake estimates derived from each database. Intake estimates for flavanol monomers showed greater agreement than flavanol polymers. The level of agreement between the two databases was the weakest for the flavonol and flavone intake estimates. CONCLUSION: In this population, the application of USDA and PE source data yielded highly correlated intake estimates for total-flavonoids, flavanols, flavanones and anthocyanidins. For these sub-classes, the USDA and PE databases may be used interchangeably in epidemiological investigations. There was poorer correlation between intake estimates for flavonols and flavones due to differences in USDA and PE methodologies. Individual flavonoid compound groups that comprise flavonoid sub-classes had varying levels of agreement. As such, when determining the appropriate database to calculate flavonoid intake variables, it is important to consider methodologies underpinning database creation and which foods are important contributors to dietary intake in the population of interest.

Energy Contents of Frequently Ordered Restaurant Meals and Comparison with Human Energy Requirements and U.S. Department of Agriculture Database Information: A Multisite Randomized Study.

BACKGROUND: Excess energy intake from meals consumed away from home is implicated as a major contributor to obesity, and ∼50% of US restaurants are individual or small-chain (non-chain) establishments that do not provide nutrition information. OBJECTIVE: To measure the energy content of frequently ordered meals in non-chain restaurants in three US locations, and compare with the energy content of meals from large-chain restaurants, energy requirements, and food database information. DESIGN: A multisite random-sampling protocol was used to measure the energy contents of the most frequently ordered meals from the most popular cuisines in non-chain restaurants, together with equivalent meals from large-chain restaurants. SETTING: Meals were obtained from restaurants in San Francisco, CA; Boston, MA; and Little Rock, AR, between 2011 and 2014. MAIN OUTCOME MEASURES: Meal energy content determined by bomb calorimetry. STATISTICAL ANALYSIS PERFORMED: Regional and cuisine differences were assessed using a mixed model with restaurant nested within region×cuisine as the random factor. Paired t tests were used to evaluate differences between non-chain and chain meals, human energy requirements, and food database values. RESULTS: Meals from non-chain restaurants contained 1,205±465 kcal/meal, amounts that were not significantly different from equivalent meals from large-chain restaurants (+5.1%; P=0.41). There was a significant effect of cuisine on non-chain meal energy, and three of the four most popular cuisines (American, Italian, and Chinese) had the highest mean energy (1,495 kcal/meal). Ninety-two percent of meals exceeded typical energy requirements for a single eating occasion. CONCLUSIONS: Non-chain restaurants lacking nutrition information serve amounts of energy that are typically far in excess of human energy requirements for single eating occasions, and are equivalent to amounts served by the large-chain restaurants that have previously been criticized for providing excess energy. Restaurants in general, rather than specific categories of restaurant, expose patrons to excessive portions that induce overeating through established biological mechanisms.

Why Is Creating a Healthy Food Environment So Crucial to Making Improvements in Diet-Related NCDs?

Non-communicable diseases (NCDs) such as cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are the leading cause of death worldwide. To decrease the global burden of NCDs and strengthen national efforts to combat NCDs, the World Health Organization (WHO) released the Global Action Plan for the Prevention and Control of NCDs 2013-2020. This plan provides established procedures and several policy options for member countries and other partners. Although many countries recognize that prevention of NCDs is an important health priority, their governments currently face a challenge: How do they adopt a multi-sectoral approach to promoting a healthy lifestyle among their populations? For this, all sectors of the food system (primary production, food processing, distribution, marketing, retail, catering, and food service) need to coordinate with each other for future governance. Since regulatory policy intervention areas for diet-related NCDs are widespread throughout the global food system, for future perspectives, comprehensive and coordinated approaches are needed for policy development and implementation across all levels of governments and food sectors in order to ensure sustainable policy action.

Comparison of Various Databases for Estimation of Dietary Polyphenol Intake in the Population of Polish Adults.

The primary aim of the study was to estimate the consumption of polyphenols in a population of 6661 subjects aged between 20 and 74 years representing a cross-section of the Polish society, and the second objective was to compare the intakes of flavonoids calculated on the basis of the two commonly used databases. Daily food consumption data were collected in 2003-2005 using a single 24-hour dietary recall. Intake of total polyphenols was estimated using an online Phenol-Explorer database, and flavonoid intake was determined using following data sources: the United States Department of Agriculture (USDA) database combined of flavonoid and isoflavone databases, and the Phenol-Explorer database. Total polyphenol intake, which was calculated with the Phenol-Explorer database, was 989 mg/day with the major contributions of phenolic acids 556 mg/day and flavonoids 403.5 mg/day. The flavonoid intake calculated on the basis of the USDA databases was 525 mg/day. This study found that tea is the primary source of polyphenols and flavonoids for the studied population, including mainly flavanols, while coffee is the most important contributor of phenolic acids, mostly hydroxycinnamic acids. Our study also demonstrated that flavonoid intakes estimated according to various databases may substantially differ. Further work should be undertaken to expand polyphenol databases to better reflect their food contents.

Estimation of Flavonoid Intake in Older Australians: Secondary Data Analysis of the Blue Mountains Eye Study.

Flavonoids, consumed in plant-based foods, have been linked to risk reduction of cancers, cardiovascular, and neurodegenerative diseases. The paucity of information on dietary sources and quantities of flavonoid intake in older adults limits interpretation of epidemiological studies that link flavonoid intake with health outcomes in this population. It was our aim to describe total flavonoid intake, including flavonoid subclasses, in older Australians and to identify rich and commonly consumed sources of flavonoids in this age group. Twelve days of weighed food record dietary data from a subsample of the Blue Mountains Eye Study baseline cohort study of older Australians (n = 79) was analyzed using the US Department of Agriculture flavonoid database. Mean intake of flavonoids was estimated to be 683 mg/day (SD = 507) of which flavan-3-ols contributed 92%, followed by flavonols (4%), flavanones (3%), and flavones (<1%). Black tea was the major flavonoid source, providing 89% of total flavonoid intake. No differences in intake between genders were identified. Dietary intake of flavonoids and flavonoid subclasses in older Australians is similar to the one other estimation of intake in Australian older adults and confirms the types of foods that contribute to flavonoid intake among this sample of older Australians.

Prevalence of internal parasites in beef cows in the United States: Results of the National Animal Health Monitoring System's (NAHMS) beef study, 2007-2008.

During the United States Department of Agriculture (USDA) National Animal Health Monitoring System's (NAHMS) 2007-2008 beef study, 567 producers from 24 US States were offered the opportunity to collect fecal samples from weaned beef calves and have them evaluated for the presence of parasite eggs (Phase 1). Participating producers were provided with instructions and materials for sample collection. Up to 20 fresh fecal samples were collected from each of the 99 participating operations. Fresh fecal samples were submitted to one of 3 randomly assigned laboratories for evaluation. Upon arrival at the laboratories, all samples were processed for the enumeration of strongyle, Nematodirus, and Trichuris eggs using the modified Wisconsin technique. The presence or absence of coccidian oocysts and tapeworm eggs was also noted. In submissions where the strongyle eggs per gram exceeded 30, aliquots from 2 to 6 animals were pooled for DNA extraction. Extracted DNA was subjected to genus level polymerase chain reaction (PCR) identification for the presence of Ostertagia, Cooperia, Haemonchus, Oesophagostomum, and Trichostrongylus. In this study, 85.6% of the samples had strongyle type, Nematodirus, and Trichuris eggs. Among the samples evaluated, 91% had Cooperia, 79% Ostertagia, 53% Haemonchus, 38% Oesophagostomum, 18% Nematodirus, 7% Trichuris, and 3% Trichostrongylus. The prevalence of coccidia and tapeworm eggs was 59.9% and 13.7%, respectively.

Pendant l'étude de 2007­2008 chez les bovins effectuée par le Système national de surveillance des maladies animales (NAHMS) du Département de l'agriculture des États-Unis (USDA), 567 producteurs provenant de 24 états américains se sont vus offrir l'opportunité de prélever des échantillons de fèces de veaux sevrés et de les faire analyser pour la présence d'oeufs de parasite (Phase 1). On a fourni aux producteurs participants les instructions et le matériel pour le prélèvement d'échantillon. Jusqu'à 20 échantillons de fèces fraiches furent prélevés de chacune des 99 opérations participantes. Les échantillons de fèces fraiches furent soumis de manière aléatoire pour évaluation à l'un des trois laboratoires participants. Suite à l'arrivée au laboratoire, tous les échantillons étaient traités pour énumération des strongles, de Nematodirus, et d'oeufs de Trichuris en utilisant la technique de Wisconsin modifiée. La présence ou l'absence d'ookystes de coccidie et d'oeufs de vers plats furent également notées. Dans les échantillons soumis et dont le nombre d'oeufs de strongles par gramme dépassait 30, des aliquots de 2 à 6 animaux étaient regroupés pour extraction de l'ADN. L'ADN extrait était soumis à une réaction d'amplification en chaine par la polymérase (PCR) pour une identification au genre de la présence d'Ostertagia, de Cooperia, d'Haemonchus, d'Oesophagostomum, et de Trichostrongylus. Dans la présente étude, 85,6 % des échantillons avaient des strongles, du Nematodirus, et des oeufs de Trichuris. Parmi les échantillons évalués, 91 % avaient du Cooperia, 79 % de l'Ostertagia, 53 % de l'Haemoncus, 38 % de l'Oesophagostomum, 18 % du Nematodirus, 7 % du Trichuris, et 3 % du Trichostrongylus. Les prévalences de coccidies et d'oeufs de vers plats étaient respectivement de 59,9 % et 13,7 %.(Traduit par Docteur Serge Messier).

Differences in the nutritional content of baby and toddler foods with front-of-package nutrition claims issued by manufacturers v. governments/health organizations.

OBJECTIVE: Nutritional information panels are required on all packaged food products in the USA, yet are perceived as difficult to use by consumers. Nutritional symbols have been developed by various groups to assist consumers in making healthier food purchases. Different nutritional criteria are used depending on the authorizing body of these symbols. The present study assesses the nutrient profile of baby and toddler foods in light of their accompanying nutritional symbols. DESIGN: Kruskal-Wallis and χ 2 tests were used to assess differences in the nutritional content of products based on the presence and issuing body of nutritional symbols. SETTING: Nine grocery, drug and department stores in Philadelphia, PA, USA. SUBJECTS: Two hundred and forty packaged baby and toddler foods. RESULTS: Products whose nutritional symbol was issued by government/health professionals contained significantly more Ca (P = 0·002), fibre (P = 0·001), protein (P = 0·005), vitamin A (P = 0·011), vitamin C (P < 0·001) and Zn (P < 0·001) and less sugar (P = 0·004) per serving than products without a nutritional symbol and products whose nutritional symbol was issued by the manufacturer. CONCLUSIONS: Products with a nutritional symbol issued by government/health professionals were healthier than foods with nutritional symbols issued by the manufacturer directly and foods with no nutritional symbols.

Improved Overall Quality of Diets Reported by Expanded Food and Nutrition Education Program Participants in the Mountain Region.

OBJECTIVE: To evaluate the Expanded Food and Nutrition Education Program, a large US Department of Agriculture nutrition education program for low-income people, by comparing the overall quality and cost of diets when entering and exiting the program. METHODS: Secondary analysis of data collected in 2011 from female participants in the Mountain region. Dietary recalls were collected by paraprofessionals. Outcome measures were the differences between Healthy Eating Index-2005 scores and costs of diets at entry and exit. Significance was determined using the Wilcoxon signed-rank test. RESULTS: At entry the mean total Healthy Eating Index-2005 score was 49.1 (out of a possible 100) and at exit, 55.2 (P < .001) (n = 3,338). Eight of 12 component scores also improved significantly whereas the sodium score worsened. The estimated median cost of diets was 13% higher at exit compared with entry. CONCLUSIONS: Participants' overall diet quality improved and was accompanied by an increase in food cost.

Process of formulating USDA's Expanded Flavonoid Database for the Assessment of Dietary intakes: a new tool for epidemiological research.

The scientific community continues to be interested in potential links between flavonoid intakes and beneficial health effects associated with certain chronic diseases such as CVD, some cancers and type 2 diabetes. Three separate flavonoid databases (Flavonoids, Isoflavones and Proanthocyanidins) developed by the USDA Agricultural Research Service since 1999 with frequent updates have been used to estimate dietary flavonoid intakes, and investigate their health effects. However, each of these databases contains only a limited number of foods. The USDA has constructed a new Expanded Flavonoids Database for approximately 2900 commonly consumed foods, using analytical values from their existing flavonoid databases (Flavonoid Release 3.1 and Isoflavone Release 2.0) as the foundation to calculate values for all the twenty-nine flavonoid compounds included in these two databases. Thus, the new database provides full flavonoid profiles for twenty-nine predominant dietary flavonoid compounds for every food in the database. Original analytical values in Flavonoid Release 3.1 and Isoflavone Release 2.0 for corresponding foods were retained in the newly constructed database. Proanthocyanidins are not included in the expanded database. The process of formulating the new database includes various calculation techniques. This article describes the process of populating values for the twenty-nine flavonoid compounds for every food in the dataset, along with challenges encountered and resolutions suggested. The new expanded flavonoid database released on the Nutrient Data Laboratory's website would provide uniformity in estimations of flavonoid content in foods and will be a valuable tool for epidemiological studies to assess dietary intakes.

Use of song as an effective teaching strategy for nutrition education in older adults.

The objective of this study was to explore whether singing an educational song would be effective in improving older adults' knowledge about nutrition. We used a randomized controlled design to determine whether singing an educational song would result in increased nutrition knowledge in a low-income population of older adults compared to a control group of similar adults who did not sing the song. Eighteen congregate nutrition sites were randomly assigned to the treatment or control group. Analysis via independent samples t -test showed the knowledge gain mean scores for the treatment group were significantly ( P  < 0.05) greater than those of the control group. This study supports a unique new approach to increasing nutrition knowledge of older adults by using music.