Nutritional Status of Allogeneic Hematopoietic Stem Cell Transplant Recipients and Post-transplant Outcomes.

This study investigated the relationship between nutritional status of hematopoietic stem cell transplant (HSCT) recipients pre-/post-transplant and outcomes post-transplant. A secondary data analysis was conducted of 18 patients 2-weeks pre-transplant and 3 weeks post-transplant. Nutrients/food servings analyzed from 24-dietary recalls were scored for diet quality, antioxidant status, and energy adequacy (≥75% of recommended targets). Patient outcomes included frequency/severity of gastrointestinal (GI) symptoms, mucositis, % weight change, acute graft vs. host disease (aGVHD), length of stay (LOS), hospital readmission, intensive care unit (ICU) admission, and plasma albumin and cytokine levels. Pre-transplant, patients consumed more calories, total and saturated fat (% kcals) and less carbohydrate (% kcals) vs. post-transplant. Higher vs. lower pre-transplant diet quality was related to positive weight change (p <. 05), and greater interleukin-10 (p <. 05). Energy inadequacy pre-transplant was related to more aGVHD post-transplant (p < 0.05). Post-transplant, higher diet quality was related to greater plasma albumin (p <. 05), shorter LOS (p <. 05), no ICU admissions (p <. 01), and more GI symptoms (p <. 05); higher antioxidant status was related to greater albumin (p <. 05); and energy adequacy was related to shorter LOS (p <. 05). Optimizing dietary quality, antioxidant status and energy adequacy pre-/post -transport are important considerations to improve patient outcomes after HSCT.

Design and rationale for the supermarket and web-based intervention targeting nutrition (SuperWIN) for cardiovascular risk reduction trial.

PURPOSE: The prevalence of chronic diseases is increasing largely due to suboptimal dietary habits. It is not known whether individualized, supermarket-based, nutrition education delivered by registered dietitians, utilizing the advantages of the in-store and online environments, and electronically collected purchasing data, can increase dietary quality. METHODS AND RESULTS: The supermarket and web-based intervention targeting nutrition (SuperWIN) for cardiovascular risk reduction trial is a randomized, controlled dietary intervention study. Adults identified from a primary care network with 1 or more risk factors were randomized at their preferred store to: (1) standard of care plus individualized, point- of-purchase nutrition education; (2) standard of care plus individualized, point- of-purchase nutrition education enhanced with online shopping technologies and training; or (3) standard of care alone. Educational sessions within each store's clinic and aisles, emphasized the dietary approaches to stop hypertension (DASH) diet. The primary assessment was an intention-to-treat comparison on the effects of the dietary interventions on mean change in DASH score (90-point range) from baseline to 3 months (post-intervention). Additional outcomes included blood pressure, lipids, weight, purchasing behavior, food literacy, and intervention feedback. Between April 2019 to February 2021, 267 participants were randomized (20 excluded due to coronavirus disease pandemic). Median age was 58 years, 69% were female, 64% had a college degree, 53% worked full-time, 64% were obese, 73% were treated with blood pressure and 42% with cholesterol medications, and most had low-to-moderate diet quality. CONCLUSION: The SuperWIN trial was designed to provide a rigorous evaluation of the efficacy of 2 novel, comprehensive, supermarket-based dietary intervention programs.

Weight status and health behaviors of adolescents and young adults with sickle cell disease: The emerging risk for obesity.

Historically, youth with sickle cell disease (SCD) were at risk for being underweight, but recent data suggests this population is replicating obesity trends of youth in the United States. The current observational study assessed the weight status and health behaviors of 44 adolescents and young adults with SCD via a self-report survey and chart review. Using height and weight data closest to survey completion date, 27% of participants were either overweight or obese. With respect to obesogenic risk behaviors, 77% ate fast food 1-3 times per week, 25% had no fruits/vegetables with any of their meals, 11% drank no water, and 57% watched 4 or more hours of television per day. Though more research is needed, this preliminary study adds to the SCD literature suggesting an emerging shift toward obesity in this population. As such, adolescents with SCD may benefit from interventions to decrease obesity risk factors as being overweight or obese has the potential to worsen SCD-related symptoms and complications.

Differences in adolescent activity and dietary behaviors across home, school, and other locations warrant location-specific intervention approaches.

BACKGROUND: Investigation of physical activity and dietary behaviors across locations can inform "setting-specific" health behavior interventions and improve understanding of contextual vulnerabilities to poor health. This study examined how physical activity, sedentary time, and dietary behaviors differed across home, school, and other locations in young adolescents. METHODS: Participants were adolescents aged 12-16 years from the Baltimore-Washington, DC and the Seattle areas from a larger cross-sectional study. Participants (n = 472) wore an accelerometer and Global Positioning Systems (GPS) tracker (Mean days = 5.12, SD = 1.62) to collect location-based physical activity and sedentary data. Participants (n = 789) completed 24-h dietary recalls to assess dietary behaviors and eating locations. Spatial analyses were performed to classify daily physical activity, sedentary time patterns, and dietary behaviors by location, categorized as home, school, and "other" locations. RESULTS: Adolescents were least physically active at home (2.5 min/hour of wear time) and school (2.9 min/hour of wear time) compared to "other" locations (5.9 min/hour of wear time). Participants spent a slightly greater proportion of wear time in sedentary time when at school (41 min/hour of wear time) than at home (39 min/hour of wear time), and time in bouts lasting ≥30 min (10 min/hour of wear time) and mean sedentary bout duration (5 min) were highest at school. About 61% of daily energy intake occurred at home, 25% at school, and 14% at "other" locations. Proportionately to energy intake, daily added sugar intake (5 g/100 kcal), fruits and vegetables (0.16 servings/100 kcal), high calorie beverages (0.09 beverages/100 kcal), whole grains (0.04 servings/100 kcal), grams of fiber (0.65 g/100 kcal), and calories of fat (33 kcal/100 kcal) and saturated fat (12 kcal/100 kcal) consumed were nutritionally least favorable at "other" locations. Daily sweet and savory snacks consumed was highest at school (0.14 snacks/100 kcal). CONCLUSIONS: Adolescents' health behaviors differed based on the location/environment they were in. Although dietary behaviors were generally more favorable in the home and school locations, physical activity was generally low and sedentary time was higher in these locations. Health behavior interventions that address the multiple locations in which adolescents spend time and use location-specific behavior change strategies should be explored to optimize health behaviors in each location.

Healthy hearts in pediatric heart transplant patients with an exercise and diet intervention via live video conferencing-Design and rationale.

BACKGROUND: Pediatric heart transplant (PedHtx) patients have increased cardiovascular risk profiles that affect their long-term outcomes and quality of life. We designed a 12- to 16-week diet and exercise intervention delivered via live video conferencing to improve cardiovascular health. Our methodology and baseline assessment of the first 13 enrolled patients are reported. METHODS: Inclusion criteria are as follows: (a) 8-19 years old; (b) heart transplant >12 months; (c) ability to fast overnight; (d) cardiac clearance by cardiologist; and (e) presence of an adult at home during exercise sessions for patients <14 years old. Exclusion criteria are as follows: (a) acute illness; (b) latex allergy; (c) transplant rejection <3 months ago; and (d) multi-organ transplantation. The intervention consists of one diet and three exercise sessions weekly via live video conferencing. Study visits are conducted at baseline, intervention completion, and end of maintenance period. RESULTS: A total of 13 participants (15.2 [2.3] years) have been enrolled. Median percent-predicted VO2 max was 56.8 [20.7]% (10 patients <70%). Ten patients had abnormal endothelial function (reactive hyperemia index <1.9; 1.4 [0.325]) and 11 patients had stiff arteries (pulse wave velocity ≧5.5 m/s for 15-19 years, ≧4.5 m/s for 8-14 years; 5.6 [0.7] m/s). Patients had suboptimal diets (saturated fat: 22.7 [23.8] g/d, sodium: 2771 [1557] mg/d) and were sedentary at a median of 67.5 [13.8]% of their time. CONCLUSIONS: Baseline assessment confirms that PedHtx patients have abnormal cardiac, vascular, and functional health indices, poor dietary habits, and are sedentary. These results support the rationale to test the feasibility and impact of a non-pharmacologic lifestyle intervention in this patient population.

Sociodemographic associations of longitudinal adiposity in youth with type 1 diabetes.

Excess adiposity is common in youth with type 1 diabetes, yet little is known about the sociodemographic factors that predict longitudinal trajectories of body fat. We analyzed data from 363 females and 379 males with type 1 diabetes over ~9 years of follow-up (mean baseline age 12.8 ± 2.3 years in females, 13.2 ± 2.4 years in males). Estimated body fat percentage (eBFP) was calculated with validated sex- and race/ethnicity-specific equations. Group-based modeling identified three eBFP trajectories for each sex. All female trajectories showed gradual increases, while male trajectories showed gradual decreases (<5% in eBFP) that plateaued around 7 years of diabetes duration. Female trajectories showed differences in baseline eBFP: Group F1 (38.0%), mean eBFP 27.8 ± 3.0%: Group F2 (47.9%), mean eBFP 33.9 ± 3.0%: and Group F3 (14.1%), mean eBFP 41.7 ± 4.1%. Male trajectories also showed differences in baseline eBFP: Group M1 (57.2%), mean eBFP 22.0 ± 3.0%: Group M2 (30.9%), mean eBFP 33.9 ± 3.0%: and Group M3 (12.9%), mean eBFP 36.1 ± 3.7%. In multinomial models, adjusted for clinical factors (eg, insulin regimen, insulin dose, and hemoglobin A1c), females who reported a single-parent household (adjusted odds ratio [aOR] = 3.34, 95% confidence interval [CI]: 1.49, 7.47), parental education of less than a college degree (aOR = 3.79, 95% CI: 1.60, 9.60), and a lack of private health insurance (aOR = 3.74, 95% CI: 1.45, 9.60), and a household income of less than $75 000 per year (aOR = 3.13, 95% CI: 1.27, 7.70) were approximately three to four times more likely to be in the highest eBFP trajectory group relative to the lowest eBFP trajectory group. Males who reported a household income of <$75 000/year were almost twice as likely to be in the Group M3 than the Group M1 in the unadjusted model only (aOR = 1.79, 95% CI: 0.91, 4.01 vs unadjusted OR: 2.48, 95% CI: 1.22, 5.06). Lower socioeconomic status may be associated with excess body fat throughout adolescence in type 1 diabetes, particularly among females.

Live Video Diet and Exercise Intervention in Overweight and Obese Youth: Adherence and Cardiovascular Health.

OBJECTIVE: To evaluate adherence of overweight and obese adolescents to a live video lifestyle intervention. The impact on vascular and functional health was also assessed. STUDY DESIGN: Twenty adolescents 14.5 ± 2.1 years of age with body mass index z-score 1.94 ± 0.43 were enrolled. The 12-week intervention included 3-times-weekly videoconference sessions with a trainer and weekly diet consultations. Adherence was evaluated by completion rate and percentage of sessions attended. Vascular health indices and traditional cardiovascular risk factors were obtained at baseline and study end. RESULTS: Seventeen participants (85%) completed the intervention. The participants attended 93 ± 11% of scheduled sessions. Reasons for absences included illness/injury (23%), school activities (21%), holidays (18%), forgetting the appointment (8%), Internet connectivity issues (7%), and family emergency (7%). Significant changes were observed in waist-hip ratio (0.87 ± 0.08 vs 0.84 ± 0.08, P = .03), total (159 ± 27 vs 147 ± 23 mg/dL, P = .004) and low-density lipoprotein cholesterol levels (91 ± 20 vs 81 ± 18 mg/dL, P = .004), volume of inspired oxygen per heartbeat at peak exercise (69 ± 16 vs 72 ± 15%, P = .01), and functional movement score (13 ± 2 vs 17 ± 1, P < .001). Participants with abnormal vascular function at baseline showed improvement in endothelial function and arterial stiffness indices (P = .01 and P = .04, respectively). CONCLUSIONS: A 12-week live video intervention promotes adherence among overweight and obese adolescents and shows promise for improving vascular and functional health. Integrating telehealth into preventive care has the potential to improve cardiovascular health in the youth at risk.

Plasma nutrient biomarkers are associated with waist-to-height ratio in youth with type 1 diabetes.

BACKGROUND: Plasma fatty acids (FAs) and micronutrients have been associated with central obesity in adults; however, previous studies of these associations in adults have yielded mixed results. In addition, no comparable research has been conducted among youth with type 1 diabetes (T1D). OBJECTIVE: We investigated the cross-sectional and longitudinal associations between plasma nutrient biomarkers and waist-to-height ratio (WHtR) in youth with T1D. METHODS: These analyses included 1324 youth aged 3-20 y at T1D diagnosis with a baseline visit in the SEARCH (Search for Diabetes in Youth) Study and a subset of 1178 of these youth with a follow-up visit an average of 23 mo (range: 16-40 mo) after their baseline visit. Plasma phospholipid FAs and vitamins were measured, and estimated desaturase activities were calculated at baseline. Anthropometric measurements and diabetes-related assessments were collected at each visit. Multiple linear regression was used to examine the association between plasma nutrient biomarkers and WHtR. RESULTS: In cross-sectional analysis, plasma palmitic acid (P = 0.004), dihomo-γ-linolenic acid (DGLA; P = 0.017) and Δ6 desaturase (D6D; P = 0.006) were positively correlated with WHtR after adjustment of confounders. Oleic acid (OA; P = 0.002), linoleic acid (LA; P = 0.015), Δ9 desaturase 18 (D9D-18; P = 0.027), and vitamin D (P < 0.0001) were negatively correlated with WHtR after adjustment. Weight status was an effect modifier (P < 0.05). In normal-weight youth, vitamin D (P = 0.003) was negatively associated with WHtR. In obese youth, stearic acid (P = 0.037), DGLA (P < 0.0001), and D6D (P < 0.0001) were positively associated and OA (P = 0.0008), D9D-18 (P = 0.0006), and vitamin D (P < 0.0001) were negatively associated with WHtR. In longitudinal analysis, baseline linoleic acid (P = 0.018), n-6:n-3 (ω-3:ω-6) FA ratio (P = 0.029), vitamin D (P = 0.003), and vitamin E (P < 0.0001) were negatively correlated with WHtR at follow-up only in obese participants. CONCLUSIONS: In T1D youth, plasma FAs and vitamins are associated with WHtR and are modified by weight status. These associations are particularly marked in obese youth.

Sugar-sweetened beverage intake and cardiovascular risk factor profile in youth with type 1 diabetes: application of measurement error methodology in the SEARCH Nutrition Ancillary Study.

The SEARCH Nutrition Ancillary Study aims to investigate the role of dietary intake on the development of long-term complications of type 1 diabetes in youth, and capitalise on measurement error (ME) adjustment methodology. Using the National Cancer Institute (NCI) method for episodically consumed foods, we evaluated the relationship between sugar-sweetened beverage (SSB) intake and cardiovascular risk factor profile, with the application of ME adjustment methodology. The calibration sample included 166 youth with two FFQ and three 24 h dietary recall data within 1 month. The full sample included 2286 youth with type 1 diabetes. SSB intake was significantly associated with higher TAG, total and LDL-cholesterol concentrations, after adjusting for energy, age, diabetes duration, race/ethnicity, sex and education. The estimated effect size was larger (model coefficients increased approximately 3-fold) after the application of the NCI method than without adjustment for ME. Compared with individuals consuming one serving of SSB every 2 weeks, those who consumed one serving of SSB every 2 d had 3.7 mg/dl (0.04 mmol/l) higher TAG concentrations and 4.0 mg/dl (0.10 mmol/l) higher total cholesterol and LDL-cholesterol concentrations, after adjusting for ME and covariates. SSB intake was not associated with measures of adiposity and blood pressure. Our findings suggest that SSB intake is significantly related to increased lipid levels in youth with type 1 diabetes, and that estimates of the effect size of SSB on lipid levels are severely attenuated in the presence of ME. Future studies in youth with diabetes should consider a design that will allow for the adjustment for ME when studying the influence of diet on health status.

Relative validity and reliability of an FFQ in youth with type 1 diabetes.

OBJECTIVE: To evaluate the relative validity and reliability of the SEARCH FFQ that was modified from the Block Kids Questionnaire. DESIGN: Study participants completed the eighty-five-item FFQ twice plus three 24 h dietary recalls within one month. We estimated correlations between frequencies obtained from participants with the true usual intake for food groups and nutrients, using a two-part model for episodically consumed foods and measurement error adjustment. SETTING: The multi-centre SEARCH for Diabetes in Youth Nutrition Ancillary Study. SUBJECTS: A subgroup of 172 participants aged 10-24 years with type 1 diabetes. RESULTS: The mean correlations, adjusted for measurement error, of food groups and nutrients between the FFQ and true usual intake were 0·41 and 0·38, respectively, with 57 % of food groups and 70 % of nutrients exhibiting correlations >0·35. Correlations were high for low-fat dairy (0·80), sugar-sweetened beverages (0·54), cholesterol (0·59) and saturated fat (0·51), while correlations were poor for high-fibre bread and cereal (0·16) and folate (0·11). Reliability of FFQ intake based on two FFQ administrations was also reasonable, with 54 % of Pearson correlation coefficients ≥0·5. Reliability was high for low-fat dairy (0·7), vegetables (0·6), carbohydrates, fibre, folate and vitamin C (all 0·5), but less than desirable for low-fat poultry and high-fibre bread, cereal, rice and pasta (0·2-0·3). CONCLUSIONS: While there is some room for improvement, our findings suggest that the SEARCH FFQ performs quite well for the assessment of many nutrients and food groups in a sample of youth with type 1 diabetes.

Dietary patterns in adults from an Adriatic Island of Croatia and their associations with metabolic syndrome and its components.

Adriatic islanders have a high prevalence of metabolic syndrome (MetS) although they have traditionally practiced an active lifestyle and adhered to a Mediterranean diet. We performed a cross-sectional study to identify dietary patterns in a sample of 1442 adults from the island of Hvar, and determined whether MetS and its components: waist-circumference, serum triglycerides, fasting plasma glucose, HDL-cholesterol, and blood pressure, were related to an altered pattern of the traditional Mediterranean diet. Dietary intake was assessed by a food frequency questionnaire. MetS was defined using the International Diabetes Federation criteria. Our study showed that dietary patterns in this population have diversified from the traditional diet. Principal component analysis identified three major patterns. The meat, alcohol, and fish pattern (MAFp), sweets, grains, and fats pattern (SGFp), and an olive-oil, vegetables, and fruits pattern (OVFp) explained 30.6% of total dietary variance. The MAFp associated significantly with MetS (p = 0.027) and high plasma glucose (p = 0.006).

Efficacy of supermarket and web-based interventions for improving dietary quality: a randomized, controlled trial.

Dietary interventions may best be delivered at supermarkets, which offer convenience, accessibility, full food inventories and, increasingly, in-store registered dietitians, online shopping and delivery services. In collaboration with a large retail supermarket chain, we conducted a multisite supermarket and web-based intervention targeting nutrition trial (no. NCT03895580), randomizing participants (n = 247 (139 women and 108 men)) 2:2:1 to two levels of dietary education (Strategy 1 and Strategy 2) or an enhanced control group that included educational components beyond the routine standard of care. Both Strategies 1 and 2 included individualized, in-person, dietitian-led, purchasing data-guided interventions. Strategy 2 also included online tools for shopping, home delivery, selection of healthier purchases, meal planning and healthy recipes. The primary endpoint was change in dietary approaches to stop hypertension (DASH) score (a measure of adherence to the DASH diet) from baseline to 3 months. The primary endpoint was met because, at 3 months, the DASH score increased by 4.7 more for the combined Strategy 1 and Strategy 2 groups than for the control group (95% confidence interval (CI) (0.9, 8.5), P = 0.02). In a prespecified hierarchical test, at 3 months, DASH score increased by 3.8 more for the Strategy 2 group than for the Strategy 1 group (95% CI (0.8, 6.)9, P = 0.01). This trial demonstrates the efficacy of data-guided, supermarket-based, dietary interventions and modern online shopping tools in improving dietary quality in a free-living, community-based population. The trial also demonstrates the opportunity for academic investigators to collaborate with retailers to design and rigorously test comprehensive healthcare interventions.

Neighbourhood socio-economic environment predicts adiposity and obesity risk in children under two.

BACKGROUND: Neighbourhood socio-economic environment (SEE) is associated with obesity in older children and adults, but little is known about this relationship in younger children. Breastfeeding is an important preventative of adiposity in childhood, but its relationship with neighbourhood SEE is unknown. AIMS: We assessed differences in adiposity and obesity in children before age two by neighbourhood SEE, controlling for family socio-demographics and breastfeeding duration. MATERIALS AND METHODS: Family socio-demographics, child body mass index z scores (BMIz), and breastfeeding duration were collected at periodic study visits from participants in PREVAIL (n = 245), a birth cohort in Cincinnati, OH. Addresses were assigned a Deprivation Index score, a validated measure of SEE, and dichotomized into highest SEE (least deprived quartile of scores) and not highest SEE (remaining quartiles). Longitudinal and Poisson models assessed differences in BMIz by SEE over the second year of life and obesity risk at age two, respectively (highest SEE, reference), while attenuation of obesity risk by breastfeeding duration was tested in mediation models. RESULTS: Residing outside of the highest SEE neighbourhoods was associated with an increased BMIz of 0.04 (95%CI 0.02, 0.06) per month of life and increased obesity risk at age two (aRR: 3.7, 95%CI 1.2, 16.2), controlling for family socio-demographics. Breastfeeding duration attenuated >9% of the obesity risk attributable to SEE (mediated RR: 3.4, 95%CI 1.1, 14.8). DISCUSSION: In the PREVAIL Cohort, residing outside of the highest SEE neighbourhoods predicted a significant increase in BMIz and obesity risk in children before age two, a relationship that was partially mediated by breastfeeding duration. CONCLUSION: Breastfeeding support may play an important role in reducing obesity rates in children in lower SEE neighbourhoods.

Comparison of neighborhood deprivation index and food desert status as environmental predictors of early childhood obesity.

Nearly 14% of American children aged 2-5 have obesity, with higher rates in children from lower-income and Black families. While evidence connects neighborhood socioeconomic environment (SEE) and obesity in adults and adolescents, little is known of this relationship in young children. We compared measures of SEE and family-level socio-demographic factors as predictors of obesity at age two. METHODS: Family-level data from the PREVAIL Cohort, a CDC-funded birth cohort in Cincinnati, Ohio, were collected prenatally from the mothers. Residential addresses were geocoded and assigned validated measures of census tract-level SEE, including USDA food desert indicators and the Deprivation Index. Family-level and ecological SEE were compared as predictors of obesity (BMIz ≥1.65) at age two in terms of proportional differences, relative risk, and model fit statistics. RESULTS: Residing outside of Deprivation Index High SEE neighborhoods was significantly associated with higher proportion (20.0% vs 5.9%; χ2 = 4.36, p = 0.037) and increased risk of obesity in univariable (RR = 3.4, 95%CI: 1.26-13.86) and multivariable models (RR = 3.5, 95%CI: 1.06-11.71). There were no differences in proportion or risk of obesity by USDA food desert indicators or family-level factors. Models using categorical Deprivation Index performed better than the family-level and the USDA food desert variables in terms of model fit. CONCLUSION: In the PREVAIL Cohort, only category of Deprivation Index was a significant predictor of obesity in two-year-old children. Future studies are needed to evaluate the Deprivation Index as a generalizable tool to identify neighborhoods at higher risk for obesity.

Physical Activity, Sedentary Time, and Diet as Mediators of the Association Between TV Time and BMI in Youth.

PURPOSE: This study examined dietary indicators, sedentary time, and physical activity as potential mediators of the association between TV time and BMIz in youth. DESIGN: Cross-sectional study in 2 independent samples of youth. SETTING: Data collection occurred by mail and telephone for adolescents and either at home or in medical settings for children. SAMPLE: 928 youth ages 12-16 and 756 youth ages 6-12 and a parent. MEASURES: TV time, snacking/eating while watching TV, and a 3-day dietary recall were assessed via child/parent report. Physical activity and sedentary time were assessed by accelerometer wear. ANALYSIS: Direct and indirect associations (through 8 diet and activity variables) of TV time with BMIz were tested in boys and girls in each sample. RESULTS: TV time had a positive association with BMIz in 6-12 year old boys and girls. Direct associations emerged between TV time and the diet/activity variables, and between diet/activity variables and BMIz. Snacking/eating while watching TV had a significant positive association with BMIz in younger boys and mediated the association between TV time and BMIz (ß = .06, p = .019; 25% attenuation). CONCLUSIONS: Snacking/eating while watching TV may be a possible reason TV time is consistently associated with obesity in youth. Targeting reductions in TV time and associated snacking could improve health impacts.

Dietary Approaches to Stop Hypertension Dietary Intervention Improves Blood Pressure and Vascular Health in Youth With Elevated Blood Pressure.

This randomized control trial assessed the post-intervention and 18-month follow-up effects of a 6-month dietary approaches to stop hypertension (DASH)-focused behavioral nutrition intervention, initiated in clinic with subsequent telephone and mail contact, on blood pressure (BP) and endothelial function in adolescents with elevated BP. Adolescents (n=159) 11 to 18 years of age with newly diagnosed elevated BP or stage 1 hypertension treated at a hospital-based clinic were randomized. DASH participants received a take-home manual plus 2 face-to-face counseling sessions at baseline and 3 months with a dietitian regarding the DASH diet, 6 monthly mailings, and 8 weekly and then 7 biweekly telephone calls focused on behavioral strategies to promote DASH adherence. Routine care participants received nutrition counseling with a dietitian consistent with pediatric guidelines established by the National High Blood Pressure Education Program. Outcomes, measured pre- and post-intervention and at 18-months follow-up, included change in BP, change in brachial artery flow-mediated dilation, and change in DASH score based on 3-day diet recalls. Adolescents in DASH versus routine care had a greater improvement in systolic BP (-2.7 mm Hg, P= 0.03, -0.3 z-score, P=0.03), flow-mediated dilation (2.5%, P=0.05), and DASH score (13.3 points, P<0.0001) from baseline to post-treatment and a greater improvement in flow-mediated dilation (3.1%, P=0.03) and DASH score (7.4 points, P=0.01) to 18 months. The DASH intervention proved more effective than routine care in initial systolic BP improvement and longer term improvement in endothelial function and diet quality in adolescents with elevated BP and hypertension. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00585832.

Examining the consumer restaurant environment and dietary intake in children.

Within the away-from-home food environment there is a need to account for individual exposure (e.g., frequency of visitation) to that environment. The present study examined the consumer environment in both proximal and visited restaurants and their association with childrens' diet quality and anthropometrics. A cross-sectional analysis used baseline data from the Neighborhood Impact on Kids (NIK) study (2007-2009). Participants were 6-12-year-olds living in King County, WA and San Diego County, CA. This analysis (conducted 2019-2020) examined relationships between nearby restaurant count, Nutrition Environment Measures Survey in Restaurants (NEMS-R) within the child's block group, and weighted NEMS-R scores based on the restaurant where the child ate most frequently in relation to child energy intake, Healthy Eating Index (HEI-2010) total score and anthropometrics. Children's HEI-2010 scores were associated with NEMS-R scores within block groups, with children in the lowest NEMS-R tertile having significantly higher HEI scores than participants in the middle tertile. Weighted NEMS-R scores were significantly associated with waist circumference, with children in the highest NEMS-R tertile having a lower waist circumference than children in the lowest tertile. Nearby restaurant count was not associated with children's diet quality or anthropometrics. Our findings suggest the relationship between nutrition environment and child diet and anthropometrics varied depending on how nutrition environment was defined. However, findings may be limited by the low frequency of eating out reported in this sample. Food environment measures that account for individual-level behavior are needed to better understand the influence of food environments on diet and anthropometrics.

An Approach for Examining the Impact of Food Group-Based Sources of Nutrients on Outcomes with Application to PUFAs and LDL in Youth with Type 1 Diabetes.

Traditionally, nutritional epidemiologists have utilized single nutrient or dietary pattern approaches to examine diet-health relationships. However, the former ignores that nutrients are consumed from foods within dietary patterns, and, conversely, dietary patterns may provide little information on mechanisms of action. Substitution provides a framework for estimating diet-health relationships while holding some nutrient intakes constant. We examined substitution effects of polyunsaturated fatty acids (PUFAs) in the SEARCH Nutrition Ancillary Study in the context of food group source. PUFAs were calculated from fatty acids 18:3, 20:5, and 22:6 (n-3), and 18:2 and 20:4 (n-6) from a food frequency questionnaire, quantified by food group. Models were adjusted for other fat intake, carbohydrates, protein, age, race, gender, and diabetes duration. Participants (n = 1441) were 14 years old on average, 51% female, with type 1 diabetes for 3.6 years. Mean intake of PUFAs was 14.9 g/day, and the highest PUFA sources were nonsolid fats, nuts, grains, red/processed meats, sweets/desserts, and high-fat chicken. PUFAs from nuts were inversely associated with low-density lipoprotein cholesterol (LDL) (p = 0.03) and PUFAs from high-fat chicken were positively associated with LDL (p < 0.01). Substituting nuts for chicken was associated with -7.4 mg/dL in LDL. These findings illustrate the importance of considering food group-based sources of nutrients when examining diet-health relationships.

Association between diet quality indices and arterial stiffness in youth with type 1 diabetes: SEARCH for Diabetes in Youth Nutrition Ancillary Study.

AIMS: We studied the association of three distinct diet quality indices and two measures of arterial stiffness in youth and young adults (YYA) aged 10 to 30 with T1D. METHODS: Cross-sectional (n = 1421) and longitudinal (n = 520) analyses were conducted in T1D YYA participating in the SEARCH for Diabetes in Youth Study. The diet quality indices included the Dietary Approaches to Stop Hypertension (DASH) index, the Healthy Eating Index 2015 (HEI-2015), and a modified Mediterranean Diet Quality Index (mKIDMED). Arterial stiffness was measured with pulse wave velocity (PWV) and augmentation index (AIx) obtained using a SphygmoCor-Vx device and tonometer. RESULTS: Average diet quality was moderate to poor, with mean scores of 41 (DASH, range 0-80), 55 (HEI-2015, range 0-100), 3.7 (mKIDMED, range - 3-12). None of the diet quality scores was associated with the central PWV or Aix, independent of demographic, clinical and lifestyle factors, body mass index and HbA1c. Longitudinal data yielded consistent findings with cross-sectional results. CONCLUSIONS: This study suggests that diet quality may not function as an independent risk factor for arterial stiffening in YYA with T1D. These findings do not diminish the importance of consuming a quality diet for the management of diabetes, as demonstrated in previous work.

Healthy Hearts via Live Videoconferencing: An Exercise and Diet Intervention in Pediatric Heart Transplant Recipients.

Background Pediatric heart transplant recipients have high-risk cardiovascular profiles that can affect their long-term outcomes; however, promoting exercise and healthy diet has not been a major focus in the field. The objective of this study was to test the feasibility and impact of a supervised exercise and diet intervention delivered via live videoconferencing in this population. Methods and Results Patients 8 to 19 years of age at least 1 year post heart transplantation were enrolled. The 12- to 16-week intervention phase included live video-supervised exercise (×3/week) and nutrition (×1/week) sessions. The 12- to 16-week maintenance phase included ×1/week live video-supervised exercise and nutrition sessions and ×2/week self-directed exercise sessions. Cardiac, vascular, nutritional, and functional health indices were obtained at baseline, after intervention, and after maintenance. Fourteen patients (median age, 15.2; interquartile range, 14.3-16.7 years) at a median of 3.3 (interquartile range, 1.5-9.7) years after heart transplant completed the intervention. Patients attended 89.6±11% of exercise and 88.4±10% of nutrition sessions during the intervention and 93.4±11% of exercise and 92.3±11% of nutrition sessions during maintenance. After intervention, body mass index percentile (median, -27%; P=0.02), endothelial function (median, +0.29; P=0.04), maximum oxygen consumption (median, +2 mL/kg per minute; P=0.002). Functional Movement Screening total score (median, +2.5; P=0.002) and daily consumption of saturated fat (median, -6 g; P=0.02) improved significantly. After maintenance, improvements in maximum oxygen consumption (median, +3.2 mL/kg per minute; P=0.02) and Functional Movement Screening total score (median, +5; P=0.002) were sustained. Conclusions In pediatric heart transplant recipients, a live video-supervised exercise and diet intervention is feasible. Our results demonstrate excellent adherence with significant improvements in cardiovascular and functional health. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02519946.