Potential Protective Mechanisms of S-equol, a Metabolite of Soy Isoflavone by the Gut Microbiome, on Cognitive Decline and Dementia.

S-equol, a metabolite of soy isoflavone daidzein transformed by the gut microbiome, is the most biologically potent among all soy isoflavones and their metabolites. Soy isoflavones are phytoestrogens and exert their actions through estrogen receptor-ß. Epidemiological studies in East Asia, where soy isoflavones are regularly consumed, show that dietary isoflavone intake is inversely associated with cognitive decline and dementia; however, randomized controlled trials of soy isoflavones in Western countries did not generally show their cognitive benefit. The discrepant results may be attributed to S-equol production capability; after consuming soy isoflavones, 40-70% of East Asians produce S-equol, whereas 20-30% of Westerners do. Recent observational and clinical studies in Japan show that S-equol but not soy isoflavones is inversely associated with multiple vascular pathologies, contributing to cognitive impairment and dementia, including arterial stiffness and white matter lesion volume. S-equol has better permeability to the blood-brain barrier than soy isoflavones, although their affinity to estrogen receptor-ß is similar. S-equol is also the most potent antioxidant among all known soy isoflavones. Although S-equol is available as a dietary supplement, no long-term trials in humans have examined the effect of S-equol supplementation on arterial stiffness, cerebrovascular disease, cognitive decline, or dementia.

Associations Between Subjective Social Status and Health Behaviors Among College Students.

OBJECTIVE: Examine the associations between subjective social status (SSS), diet, and health outcomes in college students. METHODS: Cross-sectional study of 841 students enrolled at a large Midwestern university. Subjective social status within the US, as well as within the university, was measured using the MacArthur Scale of SSS. Outcomes included dietary intake (assessed using the Dietary Screening Questionnaire), body mass index, sleep, physical activity, alcohol use, and vaping behavior. Generalized linear models adjusting for students' sociodemographic characteristics were used to assess associations between SSS and outcomes of interest. RESULTS: Higher SSS-US was associated with 4%, 3%, and 1% higher intake of fruits, whole grains, and fiber, respectively (P < 0.05). Higher SSS-US and SSS-university rankings were both significantly associated with lower body mass index and better sleep duration (P < 0.05). Higher SSS-university rankings were also associated with more days of physical activity and alcohol consumption (P < 0.05). CONCLUSIONS AND IMPLICATIONS: In this exploratory study, higher SSS, apart from alcohol intake, was associated with more favorable health outcomes. More research is needed to consider additional psychological and biological mediators and dynamic aspects of SSS, examine potential interactions between SSS and racial and ethnic identities, and explore potential mechanisms underlying the observed associations.

Policy, Systems, and Environmental Changes in Child Nutrition Programs: A Systematic Literature Review.

The National School Lunch Program (NSLP) provides healthy food to millions of children annually. To promote increased lunch consumption, policy, systems, and environmental (PSE) change strategies are being implemented in child nutrition programs. An evaluation of the current evidence supporting PSE interventions in school nutrition programs is needed to facilitate evidence-based practices across the nation for programs. This systematic review aims to determine the quality and breadth of available evidence of the effectiveness of PSE strategies on the consumption and waste of fruits, vegetables, milk, and water in the NSLP. The inclusion criteria required studies to occur in a United States K-12 school setting, data collection after 2012, report consumption and waste findings for fruit, vegetable, milk, or water, and be an original research article. Articles included in the review are restricted to positive or neutral quality. Thirty studies are included, policy level (n = 4), systems level (n = 8), environmental level (n = 10), and multi-category (n = 8). Results from positively rated policy-level studies suggest that recess before lunch may increase milk consumption, whereas removing flavored milk may decrease consumption. System-level studies of offering vegetables first in isolation of other meal components and offering spiced vegetables compared with traditional preparations may increase vegetable consumption, and locally procuring produce may increase fruit and vegetable consumption. Environmental-level studies such as water promotion strategies such as placing cups near drinking fountains may increase water consumption. Improving the convenience, attractiveness, and palatability of fruits and vegetables may increase consumption. Future PSE research in child nutrition programs should incorporate implementation aides and metrics into their study designs to allow a better understanding of how to sustain interventions from the perspective of school nutrition professionals.

Call for Cultural and Language-Concordant Diabetes Care, Nutrition Education, and Self-Management for South Asian Individuals Living in the US.

Ethnic South Asian Americans have the highest relative risk of type 2 diabetes mellitus in the US. Culturally tailored and language-concordant diabetes care and nutrition interventions can potentially promote South Asian diabetes management and disease progression. From our perspective, the extent of their use and evaluation in the US settings remains limited. This Perspective characterizes and evaluates the necessity and outcomes of culturally and linguistically adapted lifestyle interventions targeted toward type 2 diabetes mellitus indicators among South Asian individuals in the US. Suggestions for how this education could be modified include emphasizing the cultural and linguistic knowledge and self-awareness of diabetes educators and the sociological and historical factors that influence the cultural and linguistic orientation of diabetes care professionals and their clients. Such strategies could ensure better diabetes education and self-management among South Asian individuals.

A healthy plant-based diet is favorably associated with cardiometabolic risk factors among participants of South Asian ancestry.

BACKGROUND: Plant-based diets are recommended for chronic disease prevention, yet there has been little focus on plant-based diet quality among participants of South Asian ancestry who consume a predominantly plant-based diet. OBJECTIVES: We evaluated cross-sectional and prospective associations between plant-based diet quality and cardiometabolic risks among participants of South Asian ancestry who are living in the United States. METHODS: We included 891 participants of South Asian ancestry who completed the baseline visit in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. The prospective analysis included 735 participants who completed exam 2 (∼5 years after baseline). The plant-based diet quality was assessed using 3 indices: an overall plant-based diet index (PDI) that summarizes the consumption of plant foods, a healthy PDI (hPDI) that measures consumption of healthy plant foods, and an unhealthy PDI (uPDI) that reflects consumption of less healthy plant foods. RESULTS: At baseline, the PDI score was inversely associated with fasting glucose. We observed inverse associations between PDI and hPDI scores and HOMA-IR, LDL cholesterol, weight, and BMI (all P values < 0.05). Higher scores on the hPDI, but not PDI, were associated with lower glycated hemoglobin, higher adiponectin, a smaller visceral fat area, and a smaller pericardial fat volume. Each 5-unit higher hPDI score was associated with lower likelihoods of fatty liver (OR: 0.76; 95% CI: 0.64, 0.90) and obesity (OR: 0.88; 95% CI: 0.80, 0.97). There were no associations between uPDI scores and cardiometabolic risks. Prospectively, after covariate adjustment for baseline values, each 5-unit higher hPDI score was associated with an 18% lower risk of incident type 2 diabetes (OR: 0.82; 95% CI: 0.67, 1.00). CONCLUSIONS: A higher intake of healthful plant-based foods was associated with a favorable cardiometabolic risk profile. Dietary recommendations to lower chronic disease risks among participants of South Asian ancestry should focus on the quality of plant-based foods.

Population attributable risk for colorectal and breast cancer in England, Wales, Scotland, Northern Ireland, and the United Kingdom.

Background: The population attributable risk (PAR) is a statistic commonly used for quantifying preventability of cancer. We report here PAR estimates for the United Kingdom (UK) along with its constituent countries for up-to-date risk factor-attributable colorectal cancer (CRC) and breast cancer (BC), focusing on diet and nutrition related factors and tobacco (CRC) using representative national surveys. Methods: The PAR was calculated using established, modifiable risk factors by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR): physical activity, body mass index (BMI), alcoholic drinks, red meat, processed meat, dietary fiber, dietary calcium, as well as cigarette smoking for CRC, and physical activity, BMI, alcoholic drinks, and fruits and vegetable consumption for BC. National prevalence estimates and relative risks (RRs) for CRC and BC were obtained from meta-analyses or large pooled analyses. Results: Based on eight dietary and lifestyle risk factors, the estimates for attributable cases of CRC for males and females, respectively, were as follows: England: 67% and 60%; Scotland: 68% and 59%, Wales: 66% and 61%; Northern Ireland: 67% and 61%; and UK: 67% and 60%. Excluding smoking, the PAR for the UK was 61% for men and 52% for women. Based on four dietary and lifestyle risk factors, the estimates for BC were as follows: England: 26%, Scotland: 27%; Wales: 25%; Northern Ireland: 26%; and UK: 27%. Conclusion: Up to 67% for CRC and 27% of BC were attributable to modifiable dietary and lifestyle factors in the UK. Moderate differences in PAR are observed between countries due to different prevalence of exposure to risk factors.

A number of lifestyle factors, such as smoking tobacco, heavy alcohol, physical inactivity, excess body weight, and poor diet can cause cancer. Estimating the future preventable burden of cancers through modifications to these behaviors is critical. Population attributable risk has been extensively used in the literature for quantifying the preventable burden of cancer. Based on some dietary and lifestyle risk factors, we report here United Kingdom (UK) cancer preventability estimates along with its constituent countries on the number of risk factor-attributable colorectal cancer and breast cancer.

Neighborhood Built Environment Measures and Association with Physical Activity and Sedentary Time in 9-14-Year-Old Children in Saskatoon, Canada.

This study assessed whether perceptual and researcher-rated measures of neighborhood-built environments (BEs) predict device-based multiple activity-related outcomes, specifically: moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and sedentary time (ST), in children. Eight hundred and sixteen children aged 9-14 years from Saskatoon, Canada, were surveyed on their perceptions of BE, and their PA outcomes were objectively monitored for one week at three different time frames over a one-year period, September 2014 to August 2015. The researcher-rated BE measures were collected by trained researchers using multiple BE audit tools: neighborhood active living potential (NALP) and Irvine Minnesota inventory (IMI), 2009-2010. A multilevel modeling approach was taken to understand BE influences of children's PA outcomes. Children's perceived availability of parks and sidewalks predicted a higher accumulation of MVPA and a lower accumulation of ST. Children's report of the absence of neighborhood social disorder (e.g., threats from scary dogs/people) predicted a higher LPA, while reported concern about crime predicted a lower MVPA. Researcher-rated neighborhood activity friendliness predicted a lower ST, however, researcher-rated safety from crime predicted a higher ST. Perceived BE characteristic were stronger predictors of children's PA outcomes compared to researcher-rated BE factors.

Prevalence and Pattern of Smoking among Bus Drivers of Dhaka, Bangladesh.

BACKGROUND: Smoking is an increasingly prevalent habit in Bangladesh, particularly among men with low socioeconomic status. AIM: The aim of this study was determining the prevalence and pattern of smoking among bus drivers of Dhaka city, Bangladesh. METHODS: A cross-sectional study was carried out from 15 to 26 March 2013 among four hundred bus drivers of Dhaka city, Bangladesh aged between 18 and 50 determining the prevalence, pattern, and socioeconomic determinants of smoking. Data were input into a pre-designed access database with data management and analysis using standard statistical tools (SPSS-15) to assess significance through cross-tabulation. RESULTS: The overall prevalence of smoking among bus drivers was 93%, and 20% of their daily income was spent on smoking. Though most (32.3%) of the drivers started smoking before involving in driving profession, but excessive smoking had been promoted by occupational and environmental stress experiencing hectic work schedule. Individuals with no education were three times (odds ratio (OR) 2.8; 95% CI 1.2-6.13) more likely to be smoker. Smoking was detected among 53.2% of smokers aged 26 or above (χ (2) = 8.30, P < 0.05), and they showed significantly high prevalence. The reasons behind smoking were almost exclusively habit (38.1%), peer influence (26.8%), and thinking of stress relief (25.3%). Smoking can also worsen poverty among users and their families because most of the drivers reported chest pain (34.4%), heart disease (25.8%), and other health complications caused by smoking depriving families of much-needed income and imposing additional costs of health care. CONCLUSION: Interventions and preventions by policy makers, public health experts, and other stakeholders should be introduced considering high prevalence of smoking among Bangladeshi bus drivers with detrimental health sequel.

A 24-hour dietary recall for assessing the intake pattern of choline among Bangladeshi pregnant women at their third trimester of pregnancy.

Maternal choline intake during the third trimester of human pregnancy can modify systemic and local epigenetic marks in fetal-derived tissues, promoting better pregnancy outcomes, increased immunity, as well as improved mental and physical work capacity with proper memory and cognitive development. 103 pregnant women presenting to the antenatal care of Azimpur Maternity Hospital of Dhaka, Bangladesh in their third trimester of pregnancy were randomly selected for this cross sectional study exploring dietary intake patterns of choline. A dietary recall form was administered to estimate frequency and amount of food consumption of foods for the previous 24 hours. Most women reported diets that delivered less than the recommended choline intake (mean ± SD; 189.5 ± 98.2) providing only 42.72% of total RDA value. The results of this study may indicate that dietary choline among pregnant, Bangladeshi women may not be adequate to meet the needs of both, the mother and fetus. Further studies are warranted to determine clinical implications.

Prevalence of obesity among Bangladeshi pregnant women at their first trimester of pregnancy.

BACKGROUND: Paradoxically, the escalating global epidemic of maternal obesity coexists with malnutrion in many areas of Bangladesh. This proves a major challenge to obstetric practice from preconception to postpartum due to related comorbid conditions including: maternal death or severe morbidity, gestational diabetes and hypertension, increased risk of early and recurrent miscarriage, pre-eclampsia, thromboembolism, post-caesarean wound infection, postpartum haemorrhage, and low breastfeeding rates. A dramatic increase in birth defects and other pregnancy-induced disorders related to maternal obesity has added millions of dollars to health care costs leading great economical loss to the country. OBJECTIVE: The study was designed to determine the prevalence of obesity among Bangladeshi pregnant women in their 1st trimester of pregnancy. STUDY DESIGN: 426 pregnant women presenting to the antenatal care until of Azimpur maternity hospital of Dhaka, Bangladesh were randomly selected for this cross sectional study to determine their weight status using body mass index (BMI, kg/m2). RESULT: 90 (21.2%) pregnant women were reported as obese with pregnancy BMI of >30 kg/m2. 171 (40.1%) and 140 (32.8%) pregnant women were reported as overweight and healthy with pregnancy BMI of 25-29.9 kg/m2 and 18.5-24.9 kg/ m2, respectively. Statistical analysis revealed obesity and overweight status were found to be significantly associated with age; women aged 31 or above were more likely to be obese (OR=2.5; 95% CI 1.53-3.96) and overweight (OR=3.3; 95% CI 2.15-4.99). CONCLUSION: This study provides evidence of increasing trends in obesity among Bangladeshi pregnant women, which poses possible health risks both for mother and child. The findings of this study may act as baseline data for monitoring the effectiveness of national programs for the prevention and control of maternal obesity.