Dietary Outcomes of a Multilevel, Multicomponent, Cluster Randomized Obesity Intervention in 6 Native American Communities in the Upper Midwest and Southwest United States.

Background: Impacts of colonization on dietary intake have led to high rates of obesity and noncommunicable diseases among Native American adults. Multilevel, multicomponent (MLMC) interventions may improve dietary intake. Objectives: To assess the impact of a MLMC obesity intervention, OPREVENT2 (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans 2; clinicaltrials.gov NCT02803853), on dietary intake in Native American adults in Intervention versus Comparison communities. Methods: A cluster-randomized controlled trial was performed among participants in 6 communities randomized to Intervention (n = 3 and Comparison (n = 3). Adults aged 18 to 75 were recruited from tribal communities in the Southwest and upper Midwest United States from September 2016 to May 2017 (n = 601). This analysis included participants who completed baseline and follow-up surveys (82% retention), reported dietary intake between 500 and 7000 kcal/d, and had no missing data for outcomes of interest (n = 446). The intervention was implemented from May 2017, to November 2018. OPREVENT2 integrated individual, environmental, social, and structural factors and was implemented in food stores, worksites, schools, and community media outlets in Intervention communities. Activities included taste tests, cooking demonstrations, and stocking healthier items in food stores and were reinforced by a social m)edia campaign, posters, brochures, and booklets focused on nutrition. Individual-level dietary intake among participating Native American adults was assessed via modified Block food-frequency questionnaire at preintervention and postintervention. Multilevel mixed-effects linear regression, with clustering at the community level, was performed. Results: Between-group effects were significant (P < 0.05) for intake of carbohydrates (-23 g/d), total fat (-9 g/d), saturated fats (-3 g/d), and monounsaturated fats (-4 g/d), with greater decreases in Intervention communities. Between-group effect for total sugar (-12 g/d in Intervention communities) was not statistically significant. Conclusions: This MLMC intervention was associated with significantly improved carbohydrate, total fat, and saturated fat intake among Native American adults. These changes are important for improving health within this population.

Cardiometabolic risk among rural Native American adults in a large multilevel multicomponent intervention trial.

This cross-sectional analysis of the baseline evaluation sample of the Obesity Prevention and Evaluation of InterVention Effectiveness in Native Americans 2 (OPREVENT2) study included 601 Native American adults ages 18-75 living in rural reservation communities in the Midwest and Southwest United States. Participants completed a self-report questionnaire for individual and family history of hypertension, heart disease, diabetes and obestiy. Body mass index (BMI), percent body fat, and blood pressure were measured by trained research staff. About 60% of respondents had a BMI >30 kg/m2. Approximately 80% had a waist-to-hip ratio and percent body fat classified as high risk, and nearly 64% had a high-risk blood pressure measurement. Although a large proportion of participants reported a family history of chronic disease and had measurements that indicated elevated risk, relatively few had a self-reported diagnosis of any chronic disease. Future studies should examine potential connections between healthcare access and discordance in self-reported versus measured disease risks and diagnoses.

Next-generation sequencing: insights to advance clinical investigations of the microbiome.

Next-generation sequencing (NGS) technology has advanced our understanding of the human microbiome by allowing for the discovery and characterization of unculturable microbes with prediction of their function. Key NGS methods include 16S rRNA gene sequencing, shotgun metagenomic sequencing, and RNA sequencing. The choice of which NGS methodology to pursue for a given purpose is often unclear for clinicians and researchers. In this Review, we describe the fundamentals of NGS, with a focus on 16S rRNA and shotgun metagenomic sequencing. We also discuss pros and cons of each methodology as well as important concepts in data variability, study design, and clinical metadata collection. We further present examples of how NGS studies of the human microbiome have advanced our understanding of human disease pathophysiology across diverse clinical contexts, including the development of diagnostics and therapeutics. Finally, we share insights as to how NGS might further be integrated into and advance microbiome research and clinical care in the coming years.

Low Healthy Diet Self-Efficacy and Intentions Associated with High Sweet Snacks and Sugar Sweetened Beverages Consumption among African American Adolescents Recruited from Low-Income Neighborhoods in Baltimore.

Psychosocial factors may influence consumption patterns of sweet snacks and sugar sweetened beverages (SSB), which are potential risk factors for obesity among African American (AA) adolescents. We used multivariable linear and logistic regression models to examine cross-sectional associations among psychosocial factors, sweet snacks and SSB consumption, and BMI z-scores in 437 AA adolescents aged 9-14 years living in low-income neighborhoods in Baltimore City, U.S.A. Mean caloric intake from sugar was 130.64 ± 88.37 kcal. Higher sweet snacks consumption was significantly associated with lower self-efficacy (adjusted Odds Ratio (aOR) = 0.81; 95% CI = 0.71 to 0.93) and lower food intentions scores (0.43; 0.30 to 0.61). Higher SSB consumption was associated with lower outcome expectancies (aOR = 0.98; 95% CI = 0.96-0.99), lower self-efficacy (0.98; 0.96 to 0.99), and lower food intentions (0.91; 0.87 to 0.95). No significant association was found between SSB and sweet snacks consumption and weight status. Psychosocial factors may play a role in sugar consumption behaviors among AA adolescents in low-income neighborhoods. Further studies are needed to improve our understanding of causal mechanisms of this association.

Exposure to a Multilevel, Multicomponent Obesity Prevention Intervention (OPREVENT2) in Rural Native American Communities: Variability and Association with Change in Diet Quality.

The OPREVENT2 obesity prevention trial was a multilevel multicomponent (MLMC) intervention implemented in rural Native American communities in the Midwest and Southwest U.S. Intervention components were delivered through local food stores, worksites, schools, community action coalitions, and by social and community media. Due to the complex nature of MLMC intervention trials, it is useful to assess participants' exposure to each component of the intervention in order to assess impact. In this paper, we present a detailed methodology for evaluating participant exposure to MLMC intervention, and we explore how exposure to the OPREVENT2 trial impacted participant diet quality. There were no significant differences in total exposure score by age group, sex, or geographic region, but exposure to sub-components of the intervention differed significantly by age group, sex, and geographical region. Participants with the highest overall exposure scores showed significantly more improvement in diet quality from baseline to follow up compared to those who were least exposed to the intervention. Improved diet quality was also significantly positively associated with several exposure sub-components. While evaluating exposure to an entire MLMC intervention is complex and imperfect, it can provide useful insight into an intervention's impact on key outcome measures, and it can help identify which components of the intervention were most effective.

B'more Healthy Corner Stores for Moms and Kids: Identifying Optimal Behavioral Economic Strategies to Increase WIC Redemptions in Small Urban Corner Stores.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) redemption rates have been declining in many low-income urban settings, potentially related to aspects of the food environment. B'more Healthy Corner Stores for Moms and Kids was a feasibility trial in Baltimore City that aimed to test multiple behavioral economic (BE) strategies in 10 corner stores (intervention = eight stores, comparison = two stores), to evaluate their influence on the stocking and redemptions of WIC foods. Tested strategies included in-person storeowner training, point of purchase promotion, product placement, and grouping of products in a display. All four strategies were feasible and implemented with high reach, dose delivered, and fidelity. Additionally, text messaging was found to be an acceptable form of intervention reinforcement for storeowners. Analyses to assess change in stocking of WIC foods, total sales of WIC foods, and sales of WIC foods to WIC clients, revealed consistent positive changes after implementation of the store owner training strategy, while changes after the implementation of other strategies were mixed. Furthermore, WIC food sales to WIC clients significantly increased after the simultaneous implementation of two strategies, compared to one (p > 0.05). Results suggest that store owner training was the most influential strategy and that the implementation of more BE strategies does not necessarily lead to proportional increases in stocking and sales. Selected BE strategies appear to be an effective way of increasing stocking and sales of WIC foods in small urban food stores.