Longitudinal study of the relationship between coffee consumption and type 2 diabetes in Chinese adult residents: Data from China Health and Nutrition Survey.

BACKGROUND: Increasing coffee intake was inversely associated with risk of type 2 diabetes in Western countries. However, in China where coffee consumption and diabetes population has been growing fast in recent years, studies on the impact of coffee intakes on the onset of type 2 diabetes are lacking. This study attempts to determine the associations between coffee consumption and type 2 diabetes in Chinese adults. METHODS: This longitudinal study analyzed 10447 adults who had participated in at least two rounds of the China Health and Nutrition Survey (CHNS), which is a survey database of multistage, random cluster process during 1993-2011. Coffee consumption and type 2 diabetes incidence were measured in the survey. Body mass index (BMI), age, sex, place of residence, waves, education level, smoking, drinking alcohol and tea drinking frequency were adjusted as covariate. We used longitudinal fixed effects regression models to assess changes within person. RESULTS: After adjusting confounding factors, lower risk of diabetes is observed among Chinese adults who drink coffee occasionally (Adjusted Odds Ratio (AOR) = 0.13, 95% CI = 0.05, 0.34) and drink almost every day (AOR = 0.61, 95% CI = 0.45, 0.83), compared with those who do not or hardly drink. In the subgroup analysis, among women aged 45-59 who drink coffee one to three times a week (AOR = 0.21, 95% CI = 0.08, 0.52) and men over 60 who drink coffee almost every day (AOR = 0.19, 95% CI = 0.07, 0.53), protective effects were found. For young men aged 19-29, drinking coffee almost every day showed a risk effect (AOR = 20.21, 95% CI = 5.96-68.57). CONCLUSIONS: Coffee drinking habit is an independent protective factor for adult on type 2 diabetes in China. And it varies among people with different ages and genders. The rapid growth of coffee consumption in China in recent years may help reduce the risk of type 2 diabetes, but at the same time, the risk of type 2 diabetes in adolescents needs attention.

Introduction to the SIMPLE Macro, a Tool to Increase the Accessibility of 24-Hour Dietary Recall Analysis and Modeling.

BACKGROUND: Information on long-term dietary intake is often required for research or program planning, but surveys routinely use short-term assessments such as 24-h recalls (24HRs). Methods to reduce the impact of within-person variation in 24HRs, such as the National Cancer Institute (NCI) method, typically require extensive training and skill. OBJECTIVES: We introduce the Simulating Intake of Micronutrients for Policy Learning and Engagement (SIMPLE) macro, a new tool to increase the accessibility of 24HR analysis. We explain the underlying theory behind the tool and provide examples of potential applications. METHODS: The SIMPLE macro connects the core NCI statistical code to estimate usual intake distributions and includes additional code to enable advanced analyses such as predictive modeling. The related SIMPLE-Iron macro applies the full probability method to estimate inadequate iron intake, and the SIMPLE-1D macro is used for descriptive or modeling analyses of data with a single 24HR per person. The macros and associated documentations are freely available. We analyzed data from the US National Health and Nutrition Examination Survey (NHANES) and the Cameroon National Micronutrient Survey to compare the SIMPLE macro to 1) the core NCI code using the Estimated Average Requirement cut point method, and 2) the IMAPP software for iron only, and to demonstrate the applications of the SIMPLE macro for estimating usual intake and predictive modeling. RESULTS: The SIMPLE macro generates identical results to the core NCI code. The SIMPLE-Iron macro also produces estimates of inadequate iron intake comparable to the IMAPP software. The examples demonstrate application of the SIMPLE macro to 1) descriptive analyses of nutrient intake from food and supplements (NHANES), and 2) analyses accounting for breast-milk nutrient intake and modeling fortification and supplementation programs (Cameroon). CONCLUSIONS: The SIMPLE macros may facilitate the analysis and modeling of dietary data to inform nutrition research, programs, and policy.

A cross-sectional study investigating the relationship between handgrip strength with multimorbidity in Korean adults: Findings from the Korea National Health and Nutrition Examination Survey VI-VII (2014-2017).

ABSTRACT: To date research investigating the associations between handgrip strength and multimorbidity when stratifying by age and sex is limited. Furthermore, this is the first study in a Korean population, and the first to include adults ≥ 19 years of age. Here we investigated the associations between handgrip strength and multimorbidity in Korean adults aged ≥ 19 years.In this cross-sectional study data from the Korean National Health and Nutrition Examination Survey were used. Multimorbidity was defined as having 2 or more chronic diseases. A total of 19,779 participants were eligible for the study (8730 male and 11,049 female). We grouped and analysed participants based on age and sex (men and women aged 19-49 years, men and women aged 50-80 years) and examined the associations between handgrip strength and multimorbidity using multivariate logistic regressions using stratification by age, sex and body mass index (BMI).Multivariate logistic regressions revealed a significant inverse association irrespective of sex, between relative handgrip strength and multimorbidity. Participants with the lowest handgrip strength had a significantly higher odds ratio (OR) of multimorbidity (men aged 19-49 years: 3.76 and aged 50 years to 80 years: 2.11; women aged 19 years to 49 years: 1.52 and aged 50-80 years: 2.15) when compared to those with highest handgrip strength after adjusting for confounding variables. The highest OR was observed in men aged 19 years to 49 years with a BMI ≥ 25 kg/m2.In the current study we observed a significant inverse relationship between handgrip strength and multimorbidity in males and females with 2 or more chronic diseases. Male participants with a low handgrip strength aged between 19 years to 49 years with a BMI ≥25 kg/m2 may be at greater risk of multimorbidity. This study highlights the need for further longitudinal studies to investigate the effects of increasing handgrip strength combined with weight loss, as an effective strategy to reduce the incidence of multimorbidity.

Association between Infant and Young Child Feeding (IYCF) Indicators and the Nutritional Status of Children (6-23 Months) in Northern Ghana.

Although recommended infant and young child feeding (IYCF) practices have been found to be protective against undernutrition in some settings, there is no finality yet due to inconsistencies in the literature. A cross-sectional survey of 581 mother-child pairs was conducted in northern Ghana in June 2018. The association between IYCF indicators and child undernutrition (stunting and wasting) were assessed. The descriptive analysis showed that 66.4% of the children (6-23 months) were introduced to complementary feeding in a timely manner, 69.4% met the minimum meal frequency, and 38.9% met the minimum acceptable diet daily. The prevalence of stunting, wasting, underweight and overweight was 33.2%, 14.1%, 27% and 2.6%, respectively. From the multivariable binary logistic regression, child gender, child age group and source of power for lighting the household were significantly associated with wasting. Intake of iron-rich foods, child age group, and maternal height were significantly associated with stunting after adjusting for confounders. The prevalence of the compliance with IYCF indicators was relatively high. None of the individual IYCF indicators showed significant association with undernutrition, except intake of iron-rich foods for stunting. Nutrition-specific interventions targeted at improving IYCF practices, dietary diversification and intake of nutrient-rich meals, should be adopted and scaled up to address undernutrition in northern Ghana.

[Access to grocery stores and nutrition/food intake observed in the National Health and Nutrition Survey: Focusing on the substitution-complementary relation].

Objective　This study aimed to identify the characteristics of nutrition and food intake among people who have limited access to grocery stores (hereinafter, "people with limited access").Method　Data from the 2011 National Health and Nutrition Survey and 2011 Comprehensive Survey of Living Conditions were compiled using a data-linkage method. These are the only surveys that contain data regarding people's access to grocery stores. Nutrition and food intake among people with limited access were examined using an econometric method targeting 1,051 women aged 65 years and older. The objective variables for the analysis were caloric intake (kcal) from energy-providing nutrients, namely, proteins, fats, and carbohydrates, and 17 items in different food groups (g/1,000 kcal). The analysis used the seemingly unrelated regressions model, a simultaneous equations model designed to address endogeneity through simultaneous determinations of objective variables. This model indicated, by way of coefficients, the influence of the factors (variables) that define caloric intake from each nutrient and food group. The substitution-complementary relation among the nutrients and among the food groups was expressed as a correlation matrix between error terms.Results　The characteristics of people with limited access were examined targeting women aged 65 years and older with respect to their access to grocery stores and intake of energy-providing nutrients. The results indicated that their caloric intake (kcal) of carbohydrates was significantly high, whereas their caloric intake (kcal) of fats was significantly low. Their caloric intake by food group (g/1,000 kcal) also confirmed similar results: their intake of grains was high, but that of fats was low. Thus, the results indicated a strong likelihood that people with limited access, even after accounting for the substitution-complementary relation, had a diet that was too high in carbohydrates.Conclusion　People with limited access tended to have a diet that was too high in carbohydrates. This tendency had a strong likelihood to be because of not simply the prices or their preferences but their food environment-that is, their limited access to grocery stores. The food environment prescribes people's diet, even when individuals' financial situations are taken into account. Therefore, the study indicated the necessity for chain store operators to cooperate with one another and with the government to create an environment that facilitates shopping-support services.

Adherence to Vitamin D Intake Guidelines in the United States.

BACKGROUND: The American Academy of Pediatrics (AAP) revised its infant vitamin D intake guidelines in 2008. We aimed to examine previously unexplored trends in meeting vitamin D intake guidelines among US infants since 2009 and whether there were differences across demographic subgroups. METHODS: We analyzed dietary recall data for infants 0 to 11 months in the 2009-2016 NHANES. We estimated the percentage meeting 2008 AAP vitamin D guidelines, defined as consuming ≥1 L of infant formula and/or receiving a vitamin D supplement of ≥400 IU. We used Poisson regressions to assess trends over time and differences across demographic subgroups. RESULTS: Overall, 27.1% (95% confidence interval [CI]: 24.3%-29.8%) of US infants in 2009-2016 met vitamin D intake guidelines, with nonbreastfeeding infants (31.1% [95% CI: 27.6%-34.5%]) more likely to meet guidelines than breastfeeding infants (20.5% [95% CI: 15.4%-25.5%]; P < .01). From 2009-2010 to 2015-2016, overall and for both breastfeeding and nonbreastfeeding infants, there were no significant changes over time in the percentage of infants who met the guidelines (P > .05). Among breastfeeding infants, those with a family income ≥400% of the federal poverty level, with a college graduate head of household, and with private insurance were more likely to meet guidelines. CONCLUSIONS: Among US infants, we observed no increase in meeting AAP vitamin D intake guidelines since 2009. Less than 40% of infants met guidelines in nearly all demographic subgroups. These findings suggest renewed consideration of how to best meet vitamin D intake guidelines.

Liver is widely eaten by preschool children in the Northern Cape province of South Africa: Implications for routine vitamin A supplementation.

Previous research has demonstrated a virtual absence of vitamin A deficiency and adequacy of vitamin A intake through consumption of liver in preschool children of a community in the Northern Cape province of South Africa where sheep farming is common, and liver, an exceptionally rich source of vitamin A, is frequently eaten. Only 60-75 g of liver per month is needed to meet the vitamin A requirement of preschool children. Because this may have implications for routine vitamin A supplementation, and because liver consumption for the rest of the province is unknown, the study aim was to establish the prevalence and frequency of liver intake in a provincial-wide survey. An unquantified liver-specific food frequency questionnaire, covering a period of 1 month, complemented by a 1-year recall, was administered to mothers of 2- to 5-year-old children (n = 2,864) attending primary health care facilities in all five districts and 26 subdistricts. A total of 86% of children were reported to eat liver, which was eaten in all districts by at least 80% of children. The overall median frequency of liver intake was 1.0 [25th, 75th percentiles: 0.5, 3.0] times per month and ranged from 1.0 [0.3, 2.0] to 2.0 [1.0, 4.0] for the various districts. Based on a previously reported portion size of 66 g, these results suggest vitamin A dietary adequacy in all districts and possibly also vitamin A intake exceeding the Tolerable Upper Intake Level in some children. Routine vitamin A supplementation in this province may not be necessary and should be reconsidered.

Nutritional status of Tajik children and women: Transition towards a double burden of malnutrition.

The double burden of malnutrition, an emerging concern in developing countries, can exist at various levels: individual, household, and population. Here, we explore the nutritional status of Tajik women (15-49 years) and children (5-59 months) focusing on overweight/obesity along with undernutrition (underweight, stunting, and micronutrient deficiencies). For this, nutritional markers (haemoglobin (Hb), transferrin receptor (TfR), serum ferritin (Sf), retinol binding protein (RBP), vitamin D, serum folate, and urinary iodine), height, and weight were assessed from 2,145 women and 2,149 children. Dietary intake, weaning, and breastfeeding habits were recorded using a 24-hr recall and a questionnaire. Overweight (24.5%) and obesity (13.0%) are increasing among Tajik women compared with previous national surveys (2003 and 2009). Prevalence of iron deficiency and anaemia was 38.0% and 25.8%, respectively; 64.5% of women were iodine deficient, 46.5% vitamin A deficient, and 20.5% had insufficient folate levels. Women in rural areas had significantly lower iron status and body mass index and higher iodine intake compared with urban areas; 20.9% of children were stunted, 2.8% wasted, 6.2% underweight, 52.4% iron deficient, and 25.8% anaemic; all more prominent in rural areas. Dietary diversity was higher among urban women. Intraindividual or household double burden was not seen. In summary, double burden of malnutrition constituted an increase in overweight among women, especially in urban areas, and persisting levels of undernutrition (stunting, iron, and vitamin A deficiency), predominately in rural areas. A holistic, innovative approach is needed to improve infant and young children feeding and advise mothers to maintain an adequate diet.

Food, water, energy, and macronutrient intake of non-breastfed infants and young children (0-3 years).

PURPOSE: The French Nutri-Bébé 2013 study aimed to assess the nutritional intake of infants and young children in comparison with the recommendations of the 2013 European Food Safety Authority (EFSA). METHODS: This cross-sectional study enrolled a random sample of families selected according to the Quota sampling method. A 3-day dietary record was conducted and supervised by two face-to-face interviews. All foods and beverages consumed were qualitatively and quantitatively reported in a diary, and their composition calculated using a food composition database. RESULTS: A total of 1035 non-breastfed children were included. Formula was abandoned early, amounting to approximately 50% of the total food intake at 7 months in 50% of infants and 22% at 1 year. A similar trend was observed for specific complementary foods. After 1 year, 50% of children consumed cow's milk, which was semi-skimmed in 88% of cases. Drinking water intake was low. Protein intake reached 1.4 times the average requirements before 3 months, 2 times at 8-9 months, and > 4 times at 30-35 months. Fat intake was below the EFSA adequate intake (AI) in > 90% of children. Alpha-linolenic acid intake was equal to or greater than the AI in all infants < 3 months, 85% of children at 6 months, 34% at 12-17 months, and 8% >24 months. Regardless of age, docosahexaenoic acid (DHA) intake was less than the AI. CONCLUSION: Strong discrepancies are observed between the actual and recommended intake in young, non-breastfed children namely, a high-protein intake, and a low fat intake, especially DHA.

Increased coffee, tea, or other sugar-sweetened beverage consumption in adolescents is associated with less satisfactory dietary quality, body fatness and serum uric acid profiles over the past 18 years in Taiwan.

BACKGROUND AND OBJECTIVES: Taiwan has a high density of convenience stores and beverage shops, which makes sugar-sweetened beverages (SSBs) very accessible to teenagers. This study examined the changes and the association between SSBs and biomarkers and nutrient intake, for teenagers over the course of 18 years using a national representative sample. METHODS AND STUDY DESIGN: This cross-sectional study used data from the Nutrition and Health Survey in Taiwan (NAHSIT). Complete data for teenagers aged 13 to 19 years including a 24-hour dietary recall, anthropometric and clinical measurements, and SSBs from two periods were analyzed (1993-1996: N=1820; 2010-2011: N=2513). SAS callable SUDAAN was used for statistical analysis, adjusting for the sampling scheme. Log transformation was used for non-normal variables before linear models were used. Coffee or tea and SSB (excluding tea or coffee) consumers were categorized as non-drinkers, low (below), or high (above) consumers based on median intake during 1993-1996. RESULTS: Intake of coffee or tea increased significantly in the 18 years of this study (p<0.01), whereas intake of SSBs (excluding coffee or tea) decreased significantly (p<0.05). Intake was significantly higher among second survey and those with high total energy intakes (p<0.01). For both coffee/tea and SSB, the high-intake groups had higher serum uric acid and intake of carbohydrates (p<0.05), lower intake of protein and phosphorus and lower dietary diversity score (p<0.05). CONCLUSIONS: Consumption of coffee or tea increased in adolescents during the 18 years. High intakes of SSB, coffee or tea was associated with high serum uric acid values and worse dietary quality.

Demographic, health behavior, and cardiometabolic risk factor profile in yoga and non-yoga participants: NHANES 1999-2006.

OBJECTIVE: To examine and compare the demographic, health behavior, and cardiometabolic risk factor characteristics of participants who report 1) participating in yoga, 2) not participating yoga, or 3) are inactive, using a nationally representative sample of U.S. adults. DESIGN: Study participants were from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) who self-reported participation in yoga (n = 74), no-yoga (n = 3,753) or were inactive (n = 1,285). Participants in the no-yoga group did engage in other types of physical activity, while the inactive group reported no activity during the survey period. RESULTS: Yoga participants were primarily female (80.7%), college educated (51.9%), mostly non-smokers (46.9%), and reported moderate alcohol consumption (72.1%). Yoga participants were found to be significantly less likely to have an elevated waist circumference (OR = 0.40, p < 0.01; OR = 0.30, p < 0.01), and a low HDL (OR = 0.43, p = 0.03; OR = 0.34, p < 0.05) compared to both non-yoga participants and inactive individuals, respectively. Yoga participants were 61% less likely to have elevated blood glucose compared to non-yoga participants (OR = 0.39, p < 0.05). Compared to inactive individuals, yoga participants were 52% (OR = 0.48, p < 0.05) and 66% (OR = 0.34, p < 0.05) less likely have an elevated body mass index and have elevated triglyceride levels, respectively. CONCLUSIONS: Given the emergence of yoga as a common form of physical activity, it is imperative to understand the characteristics of those who participate in yoga to further understand its relationship with cardiovascular risk. This study was one of the first to use nationally-representative data and objectively measured cardiometabolic variables. Key Words: complementary medicine, epidemiology, survey, population, physical activity, cardiovascular disease.

KDOQI US Commentary on the 2017 ACC/AHA Hypertension Guideline.

Hypertension is a modifiable risk factor for cardiovascular morbidity and mortality and reduction of elevated blood pressure (BP) remains an important intervention for slowing kidney disease progression. Over the past decade, the most appropriate BP target for initiation and titration of BP-lowering medications has been an area of intense research and debate within the clinical community. In 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) in conjunction with several other professional societies released new hypertension guidelines based on data from a systematic review of clinical trials and observational data. While many of the recommendations in the ACC/AHA hypertension guideline are relevant to nephrology practice, BP targets and management strategies for patients receiving dialysis are not discussed. This Kidney Disease Outcomes Quality Initiative (KDOQI) commentary focuses largely on recommendations from the ACC/AHA hypertension guidelines that are pertinent to individuals at risk of chronic kidney disease or with non-dialysis-dependent chronic kidney disease. This KDOQI commentary also includes a brief discussion of the consensus statement regarding hypertension diagnosis and management for adults receiving maintenance dialysis published by the European Renal and Cardiovascular Medicine Working Group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension. Overall, we support the vast majority of the ACC/AHA recommendations and highlight select areas in which best diagnosis and treatment options remain controversial.

Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study.

BACKGROUND: Economic incentives through health insurance may promote healthier behaviors. Little is known about health and economic impacts of incentivizing diet, a leading risk factor for diabetes and cardiovascular disease (CVD), through Medicare and Medicaid. METHODS AND FINDINGS: A validated microsimulation model (CVD-PREDICT) estimated CVD and diabetes cases prevented, quality-adjusted life years (QALYs), health-related costs (formal healthcare, informal healthcare, and lost-productivity costs), and incremental cost-effectiveness ratios (ICERs) of two policy scenarios for adults within Medicare and Medicaid, compared to a base case of no new intervention: (1) 30% subsidy on fruits and vegetables ("F&V incentive") and (2) 30% subsidy on broader healthful foods including F&V, whole grains, nuts/seeds, seafood, and plant oils ("healthy food incentive"). Inputs included national demographic and dietary data from the National Health and Nutrition Examination Survey (NHANES) 2009-2014, policy effects and diet-disease effects from meta-analyses, and policy and health-related costs from established sources. Overall, 82 million adults (35-80 years old) were on Medicare and/or Medicaid. The mean (SD) age was 68.1 (11.4) years, 56.2% were female, and 25.5% were non-whites. Health and cost impacts were simulated over the lifetime of current Medicare and Medicaid participants (average simulated years = 18.3 years). The F&V incentive was estimated to prevent 1.93 million CVD events, gain 4.64 million QALYs, and save $39.7 billion in formal healthcare costs. For the healthy food incentive, corresponding gains were 3.28 million CVD and 0.12 million diabetes cases prevented, 8.40 million QALYs gained, and $100.2 billion in formal healthcare costs saved, respectively. From a healthcare perspective, both scenarios were cost-effective at 5 years and beyond, with lifetime ICERs of $18,184/QALY (F&V incentive) and $13,194/QALY (healthy food incentive). From a societal perspective including informal healthcare costs and lost productivity, respective ICERs were $14,576/QALY and $9,497/QALY. Results were robust in probabilistic sensitivity analyses and a range of one-way sensitivity and subgroup analyses, including by different durations of the intervention (5, 10, and 20 years and lifetime), food subsidy levels (20%, 50%), insurance groups (Medicare, Medicaid, and dual-eligible), and beneficiary characteristics within each insurance group (age, race/ethnicity, education, income, and Supplemental Nutrition Assistant Program [SNAP] status). Simulation studies such as this one provide quantitative estimates of benefits and uncertainty but cannot directly prove health and economic impacts. CONCLUSIONS: Economic incentives for healthier foods through Medicare and Medicaid could generate substantial health gains and be highly cost-effective.

Is selenium intake associated with the presence of depressive symptoms among US adults? Findings from National Health and Nutrition Examination Survey (NHANES) 2011-2014.

OBJECTIVES: This study aimed to examine the cross-sectional association between dietary and serum selenium measures and depressive symptoms among a nationally representative sample of US adults. METHODS: Dietary selenium intake and serum selenium concentration were evaluated on 7725 adult participants from National Health and Nutrition Examination Survey (NHANES) 2011-2014. Participants' selenium intake, assessed by 24-h recall, was classified based on the recommended dietary allowance (dietary selenium intake ≥ 55 µg/d) and estimated average requirement (dietary selenium intake ≥ 45 µg/d) criteria. Serum selenium and depressive symptoms were assessed using inductively coupled plasma mass spectrometry and a patient health questionnaire or use of an antidepressant, respectively. Univariate and multivariate logistic regression, accounting for the complex survey design of NHANES, were employed to estimate the cross-sectional association between measures of selenium and the presence of depressive symptoms. RESULTS: The median selenium concentration was 193.9 µg/L (interquartile range = 179.3-209.3). Approximately 8% of the participants met the case definition for depressive symptoms. Based on the recommended dietary allowance of selenium, participants not meeting the recommended dietary intake, compared with those meeting the requirement, had higher odds of depressive symptoms (odds ratio [OR] = 1.57, 95% confidence interval [CI]: 1.03-2.38). When analyzing by quintile of dietary selenium intakes, compared with the first quintile, participants in higher quintiles had significantly lower odds of depressive symptoms. However, based on quintiles of serum selenium and using the first quintile as referent category, except for quintile 3, results indicated a higher but not significant association (quintile 2 [OR = 1.08, 95% CI: 0.73-1.61], quintile 4 [OR = 1.17, 95% CI: 0.89-1.55], and quintile 5 [OR = 1.14, 95% CI: 0.83-1.58]). Power analysis indicated sufficient power. Notably, study participants had a very high serum selenium concentration. The findings, although not significant, between serum selenium concentrations and depressive symptoms had a U-shaped association, supported by the current literature. CONCLUSIONS: Our study supports an inverse association between participants recommended dietary intake of selenium and depressive symptoms. Although results were not statistically significant for the association by quartile of serum selenium concentrations and depressive symptoms, a U-shaped association was identified.

Food and Beverage Intake From 12 to 23 Months by WIC Status.

: media-1vid110.1542/5984243449001PEDS-VA_2018-2274Video Abstract BACKGROUND: In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) revised its food packages to align with updated nutrition science. Understanding how these revisions may impact current consumption patterns could be important. METHODS: Dietary data from the 2011-2014 NHANES were used to estimate the percentage of children who were aged 12 to 23 months consuming selected food and beverage categories on any given day by age and WIC status (children who were on WIC, those who were eligible for but not receiving WIC benefits, and those who were not eligible for WIC). RESULTS: Consumption of food and beverage categories differed by WIC status. On a given day, a lower percentage of children who were eligible for but did not receive WIC benefits consumed vegetables (excluding white potatoes; 42.3%) and grains (76.5%) compared with children who were participating in WIC (vegetables [excluding white potatoes]: 60.4%; grains: 85.5%) and those who were not eligible for WIC benefits (vegetables [excluding white potatoes]: 58.1%; grains: 87.2%; P < .05). A lower percentage of both children who were eligible for but not receiving WIC benefits and those who were participating in WIC consumed fruits (57.6% and 70.6%, respectively) and snacks (45.9% and 48.5%, respectively) than those who were not eligible for WIC (fruits: 86.4%; snacks: 69.1%; P < .05). A lower percentage of children who were receiving WIC consumed dairy than children who were not eligible for WIC (91.7% and 97.2%, respectively; P < .05). A higher percentage of those who were receiving WIC consumed 100% juice (70.6%) than children who were eligible for but not receiving WIC (51.6%) and children who were not eligible for WIC (50.8%; P < .05). CONCLUSIONS: Improving early WIC participation and retention could positively impact some diet-related disparities among young children who are eligible for WIC.

Development of a nutritional documentation tool: a Delphi study.

In daily clinical practice, the smooth, timely and comprehensive transfer of information between care settings is important and reflects a cornerstone of high-quality patient care. The integration of nutritional information in the medical information transfer is currently not included in an evidence-based approach. It was, therefore, the aim of this study to develop a nutritional documentation tool (NDoc) on the basis of evidence and test it for its usability in daily clinical practice. Based on the results of a literature review, the authors collected core content using a modified Delphi survey from experts across Europe and included the information collected in a structured, NDoc. The subsequently developed tool included thirty items and was tested for its usability on a daily basis among primary care physicians and clinical physicians. The new NDoc can be introduced for use in any computer-based hospital information system regionally and adapted for worldwide use.

A health facility based case-control study on determinants of low birth weight in Dassie town, Northeast Ethiopia: the role of nutritional factors.

BACKGROUND: Low birth weight remains a major public health problem affecting developing countries. Evidence shows that low birth weight has long lasting negative health consequences through its contribution to stunting, mental impairment and non-communicable chronic diseases in later life. Thus, it is worth investigating the role of nutritional factors as determinants of low birth weight to suggest nutritional interventions to curb its negative health outcomes. This study aimed to investigate the determinants of low birth weight with main focus on the role of nutritional factors in Ethiopia. METHODS: A facility-based case-control study was conducted from 3 February to 29 April, 2017. The data were collected using structured, pretested interviewer-administered questionnaire in all public health facilities of Dessie Town. Anthropometric measurements were made following standard procedures for both mothers and their newborns. Consecutive live births of < 2500 g and two succeeding normal weight babies were selected as cases and controls, respectively. Data were entered in to Epi-data software version 3.1, and exported to SPSS version 21, and analyzed using frequency, mean and percentage. Factors with p < 0.25 during bivariate analyses were entered into a multivariable logistic regression model to determine significant determinants of LBW. Statistical significance was considered at p < 0.05. Results were reported with odds ratio and 95% CI. RESULTS: Mean ± SD of birth weight (g) was 2138 ± 207 for cases and 3145 ± 415 for controls. After adjusting for potential confounders using multivariable logistic regression analysis, the absence of iron and folate supplementation, receiving no nutritional counseling and consuming no additional meal, maternal undernutrition, maternal anemia and inadequate dietary diversity during the current pregnancy were found to be significant determinants of low birth weight in our study. CONCLUSION: Lack of nutritional counseling, absence of additional meal intake and iron and folate supplementation during pregnancy, and maternal undernutrition, maternal anemia and inadequate maternal dietary diversity were significant determinants of low birth weight. The importance of nutritional counseling, improving iron and folate supplementation during pregnancy, and nutritional status of pregnant women need to be strengthened to reduce the incidence of LBW in Ethiopia. In addition, behavioral change communications targeting pregnant women to improve women dietary diversity and their extra meal intake practice need to be enhanced in Ethiopia.

A Clinician's Guide for Trending Cardiovascular Nutrition Controversies: Part II.

The potential cardiovascular (CV) benefits of many trending foods and dietary patterns are still incompletely understood, and scientific inquiry continues to evolve. In the meantime, however, a number of controversial dietary patterns, foods, and nutrients have received significant media attention and are mired by "hype." This second review addresses some of the more recent popular foods and dietary patterns that are recommended for CV health to provide clinicians with current information for patient discussions in the clinical setting. Specifically, this paper delves into dairy products, added sugars, legumes, coffee, tea, alcoholic beverages, energy drinks, mushrooms, fermented foods, seaweed, plant and marine-derived omega-3-fatty acids, and vitamin B12.

A Survey Instrument to Assess Intake of Dietary Supplements, Related Products, and Caffeine in High-Use Populations.

Substantial data on the use of dietary supplements by the general adult population are available, but many population subgroups have not been extensively studied. Because military service members and young people consume large amounts of dietary supplements, including for enhancement of physical performance, weight control, and bodybuilding, which can be dangerous, we developed a comprehensive questionnaire to characterize patterns of supplement use in these and other populations. The questionnaire has been used to study >7000 military service members and 1000 college students. This supplement article presents a detailed description of the questionnaire, which contains comprehensive questions on demographic characteristics, exercise habits, attitudes with regard to dietary supplements, and amount of money spent on supplements. Intakes of specific dietary supplements and caffeine, frequency of use, and reasons for use are assessed. The questionnaire was designed for studying dietary supplement and caffeine intake patterns with the use of paper-and-pencil administration to military populations and was modified for use with college students and for computer and Web administration. It is available online at https://go.usa.gov/xn9FP and in the Supplemental File for this publication. It can be used to study other populations if minor modifications are made. The online version of the questionnairewill be updated periodically as newversions become available. In conclusion, a validated, detailed, noncopyrighted questionnaire designed to assess the use of dietary supplements, energy drinks (and related products), and caffeine is available for use in diverse populations. The format of the questionnaire is adaptable to computer administration and scoring, and it can be customized for specific subpopulations, locations, and product categories including updates that reflect changes in the availability of supplements or availability of new products.

Underuse of Effective Cardiac Medications Among Women, Middle-Aged Adults, and Racial/Ethnic Minorities With Coronary Artery Disease (from the National Health and Nutrition Examination Survey 2005 to 2014).

Given the proven effectiveness of several cardiac medications for patients with coronary artery disease (CAD), we examined the national use of 4 classes of effective medications, overall and by age, sex, and race/ethnicity in 2005 to 2014. We used data from the National Health and Nutrition Examination Survey, including a self-reported diagnosis of CAD and independently verified medication use. Weighting procedures extrapolated our data to the adult US population with CAD. Analyses included 1,789 US adults aged ≥45 years with a history of CAD. The average age of this population was 68 years; 40% were women and 79% were non-Hispanic whites. In 2005 to 2014, 53.2% (standard error [SE] = 1.5) reported use of angiotensin-converting enzyme inhibitor/angiotensin receptor blockers, 58.5% (SE = 1.5) ß blockers, and 67.2% (SE = 1.4) statins. Two of these medications were used by 64.1% (SE = 1.5) of the study population and all 3 by 29.1% (SE = 1.3). In 2011 to 2014, 68.5% (SE = 2.4) of American adults with a history of CAD reported use of aspirin. The use of statins increased from 63.1% in 2005/2006 to 76.8% in 2013/2014. Adults aged 45 to 64 years old, women, and racial/ethnic minorities had lower use of effective cardiac medications compared with older adults, men, and non-Hispanic whites. In conclusion, the use of statins, but not other medications, has increased over the past 10 years among American adults with previously diagnosed CAD. Continued targeted efforts are needed to increase the receipt of effective cardiac medications among all US adults with CAD, especially those aged 45 to 64 years, women, and racial/ethnic minorities.