Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults.

BACKGROUND: Cognitive impairment and dementia are severe public health issues in aging populations, which can be exacerbated by insufficient or unhealthy dietary intake. Food (in)security status is linked to cognitive function among older adults, but the relationship is complex and can vary by sociodemographic characteristics. OBJECTIVE: This article aimed to investigate the association between food insecurity and cognitive function among United States older adults and explore potential variations by race and ethnicity groups. METHODS: We prospectively examined changes in cognitive function and incidence of cognitive impairment alongside the presence of self-reported food insecurity among older adults of different racial and ethnic groups. Data were from the 2012-2018 Health and Retirement Study (HRS) and the 2013 Health Care and Nutrition Study (HCNS), including N = 6,638 United States adults aged 50 years and older. Food insecurity was measured by a self-reported United States Household Food Security Survey Module, and cognitive function was assessed by the modified version of the Telephone Interview for Cognitive Status. RESULTS: Results showed that 17% of United States older adults reported food insecurity in the 2013 HCNS. Compared with food secure older adults, those reporting food insecurity experienced worsened cognitive functioning over time (B = -0.63, p < .001), and they were more likely to have onset of cognitive impairment (OR= 1.46, p < .001) in the 6-y observation. Compared with non-Hispanic White older adults, being non-Hispanic Black, non-Hispanic Other, or Hispanic was associated with 2.96, 2.09, or 1.26 odds (p < .001) of cognitive impairment (2012-2018), respectively. Older adults of racial and ethnic minority groups also had higher risks of experiencing the double burden of cognitive impairment alongside food insecurity compared with non-Hispanic White older adults. CONCLUSION: Findings underscore racial and ethnic structural disparities in food security and cognitive health in the United States aging population.

Biomarkers of Dietary Omega-6 Fatty Acids and Incident Cardiovascular Disease and Mortality.

BACKGROUND: Global dietary recommendations for and cardiovascular effects of linoleic acid, the major dietary omega-6 fatty acid, and its major metabolite, arachidonic acid, remain controversial. To address this uncertainty and inform international recommendations, we evaluated how in vivo circulating and tissue levels of linoleic acid (LA) and arachidonic acid (AA) relate to incident cardiovascular disease (CVD) across multiple international studies. METHODS: We performed harmonized, de novo, individual-level analyses in a global consortium of 30 prospective observational studies from 13 countries. Multivariable-adjusted associations of circulating and adipose tissue LA and AA biomarkers with incident total CVD and subtypes (coronary heart disease, ischemic stroke, cardiovascular mortality) were investigated according to a prespecified analytic plan. Levels of LA and AA, measured as the percentage of total fatty acids, were evaluated linearly according to their interquintile range (ie, the range between the midpoint of the first and fifth quintiles), and categorically by quintiles. Study-specific results were pooled using inverse-variance-weighted meta-analysis. Heterogeneity was explored by age, sex, race, diabetes mellitus, statin use, aspirin use, omega-3 levels, and fatty acid desaturase 1 genotype (when available). RESULTS: In 30 prospective studies with medians of follow-up ranging 2.5 to 31.9 years, 15 198 incident cardiovascular events occurred among 68 659 participants. Higher levels of LA were significantly associated with lower risks of total CVD, cardiovascular mortality, and ischemic stroke, with hazard ratios per interquintile range of 0.93 (95% CI, 0.88-0.99), 0.78 (0.70-0.85), and 0.88 (0.79-0.98), respectively, and nonsignificantly with lower coronary heart disease risk (0.94; 0.88-1.00). Relationships were similar for LA evaluated across quintiles. AA levels were not associated with higher risk of cardiovascular outcomes; in a comparison of extreme quintiles, higher levels were associated with lower risk of total CVD (0.92; 0.86-0.99). No consistent heterogeneity by population subgroups was identified in the observed relationships. CONCLUSIONS: In pooled global analyses, higher in vivo circulating and tissue levels of LA and possibly AA were associated with lower risk of major cardiovascular events. These results support a favorable role for LA in CVD prevention.

Nutrient Profiling Systems, Front of Pack Labeling, and Consumer Behavior.

PURPOSE OF REVIEW: Guiding consumers toward more healthful food choices may help address the high prevalence of poor dietary quality and diet-related diseases. The use of front-of-package labels (FOPL) on food items is expanding to provide focused nutritional information or representations, often based upon nutrient profiling systems. RECENT FINDINGS: FOPL provide a source of nutrition and health information that is readily understood by consumers, including those with limited literacy. There is evidence that FOPL can shift consumer behavior toward more nutritious and healthful choices. However, assessments of the effectiveness of FOPL have been restricted in scope and rely largely on simulation models rather than real-world environments. FOPL are a direct source of nutritional guidance at the point-of-purchase and provide an opportunity to convey critical information on ingredients that are associated with health promotion and/or increased risk of non-communicable diseases. However, limited evidence regarding the most effective forms of FOPL to achieve behavior change and challenges from the food industry impedes the establishment of standardized nutrient profiles and algorithms. Future opportunities for FOPL include the potential for integrating nutritional profiles with non-nutrient factors affecting health such as food processing and environmental sustainability.

Increased complication rates after hip and knee arthroplasty in patients with cirrhosis of the liver.

BACKGROUND: Risk stratification is critical in patients with cirrhosis undergoing THAs and TKAs, as they may be more likely to have serious medical and surgical complications. As opposed to the Child-Pugh scoring system, which has limited use for orthopaedic surgeons inexperienced in assessing ascites and hepatic encephalopathy, the Model for End-stage Liver Disease (MELD) is an easily calculated, validated scoring system for severity of liver disease based on common laboratory values; however, its usefulness for predicting complications after elective arthroplasty has not been studied. QUESTIONS/PURPOSES: The purposes of this study were to determine the differences between patients with cirrhosis and control subjects in (1) hospital length of stay, discharge disposition, and readmission within 90 days; (2) early postoperative (90 days) medical complications potentially related to liver disease; (3) surgical complications within 90 days and any time after the procedure; (4) mortality rates after THA and TKA; and in addition, (5) to use the MELD score as a predictor for risk of complications and mortality. METHODS: Institutional database query software used coding data identified 115 patients with liver cirrhosis before having THAs or TKAs from 2000 to 2012 and 115 control subjects without cirrhosis matched by age, sex, procedure, and year of surgery. Early postoperative and longer-term medical and surgical complications were compared. Regression analysis was used to determine a MELD score that predicted greater risk of complications. RESULTS: Compared with matched control subjects, patients with cirrhosis had prolonged length of stay and higher rates of discharge to nursing facilities, readmission in 90 days, and urinary tract infections (p < 0.01), renal failure (p = 0.03), blood transfusions (p < 0.01), gastrointestinal hemorrhage (p = 0.04), dislocations (p = 0.01), infections (p = 0.02), and revisions (p = 0.04) within 90 days. One-year (p = 0.01) and longer-term (p = 0.0002) mortality rates were greater in patients with cirrhosis. A MELD score of 10 or greater predicted a three times increased likelihood (odds ratio [OR]) of any complication (95% CI, 1.28-7.00; p = 0.01) and 4.1 times increased likelihood (OR) of death (95% CI, 1.42-11.86; p < 0.01). CONCLUSIONS: Patients with cirrhosis undergoing THAs and TKAs should be counseled regarding their increased risk of medical complications, surgical complications, and death. A MELD score of 10 or greater is associated with a high rate of complications, although this finding needs further validation because we were unable to control for all medical confounders. LEVEL OF EVIDENCE: Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

An Open-Access Data Platform: Global Nutrition and Health Atlas (GNHA).

The rapid development of nutrition science is embracing digital transformation to generate large amounts of data. Precision nutrition and "Big Data" place increasing demand for data repositories and visualization, which enhances the digital transformation. We defined the need for an integrated nutrition data platform as a web-based platform that can collect, store, track, analyze, monitor, and visually display key metrics in nutrition and health while allowing users to interact with visuals and download data provided in the platform. Interactive dashboards create new opportunities for scholars and practitioners to generate and test hypotheses. We present the development and implementation of the Global Nutrition and Health Atlas (GNHA; https://sites.tufts.edu/gnha/), an open-access online platform covering nutrition and health data with 26 themes and 500+ indicators from 190+ countries up to 30 y. We view GNHA as an interactive tool aiming to share information and perspectives and foster collaborations and innovations.

Food Compass is a nutrient profiling system using expanded characteristics for assessing healthfulness of foods.

Nutrient profiling systems (NPS) aim to discriminate the healthfulness of foods for front-of-package labelling, warning labels, taxation, company ratings and more. Existing NPS often assess relatively few nutrients and ingredients, use inconsistent criteria across food categories and have not incorporated the newest science. Here, we developed and validated an NPS, the Food Compass, to incorporate a broader range of food characteristics, attributes and uniform scoring principles. We scored 54 attributes across 9 health-relevant domains: nutrient ratios, vitamins, minerals, food ingredients, additives, processing, specific lipids, fibre and protein, and phytochemicals. The domain scores were summed into a final Food Compass Score (FCS) ranging from 1 (least healthy) to 100 (most healthy) for all foods and beverages. Content validity was confirmed by assessing nutrients, food ingredients and other characteristics of public health concern; face validity was confirmed by assessing the FCS for 8,032 foods and beverages reported in NHANES/FNDDS 2015-16; and convergent and discriminant validity was confirmed from comparisons with the NOVA food processing classification, the Health Star Rating and the Nutri-Score. The FCS differentiated food categories and food items well, with mean ± s.d. ranging from 17.1 ± 17.2 for savoury snacks and sweet desserts to 81.6 ± 16.0 for legumes, nuts and seeds. In many food categories, the FCS provided important discrimination of specific foods and beverages as compared with NOVA, the Health Star Rating or the Nutri-Score. On the basis of demonstrated content, convergent and discriminant validity, the Food Compass provides an NPS scoring a broader range of attributes and domains than previous systems with uniform and transparent principles. This publicly available tool will help guide consumer choice, research, food policy, industry reformulations and mission-focused investment decisions.

Systematic Review of Dietary Patterns and Sustainability in the United States.

Improving awareness and accessibility of healthy diets are key challenges for health professionals and policymakers alike. While the US government has been assessing and encouraging nutritious diets via the Dietary Guidelines for Americans (DGA) since 1980, the long-term sustainability, and thus availability, of those diets has received less attention. The 2015 Dietary Guidelines Advisory Committee (DGAC) examined the evidence on sustainable diets for the first time, but this topic was not included within the scope of work for the 2020 DGAC. The objective of this study was to systematically review the evidence on US dietary patterns and sustainability outcomes published from 2015 to 2019 replicating the 2015 DGAC methodology. The 22 studies meeting inclusion criteria reveal a rapid expansion of research on US dietary patterns and sustainability, including 8 studies comparing the sustainability of DGA-compliant dietary patterns with current US diets. Our results challenge prior findings that diets adhering to national dietary guidelines are more sustainable than current average diets and indicate that the Healthy US-style dietary pattern recommended by the DGA may lead to similar or increased greenhouse gas emissions, energy use, and water use compared with the current US diet. However, consistent with previous research, studies meeting inclusion criteria generally support the conclusion that, among healthy dietary patterns, those higher in plant-based foods and lower in animal-based foods would be beneficial for environmental sustainability. Additional research is needed to further evaluate ways to improve food system sustainability through both dietary shifts and agricultural practices in the United States.

Development of a rabbit pleural cancer model by using VX2 tumors.

Primary and secondary pleural cancer remains an important clinical problem, with research progress limited by the lack of a suitable moderate- to large-sized (3 to 4 kg) animal model of pleural cancer. Many potential pleura-based imaging and treatment modalities cannot be investigated sufficiently by using currently available small murine animal models because their pleural space is not comparable to that of humans and therefore does not allow for the use of standard thoracoscopic techniques. Here we describe the development of a reproducible model of pleural malignancy in moderate-sized immunocompetent rabbits. Under thoracoscopic guidance, 9-15 x 10(6) VX2 carcinoma cells were inoculated into the plural space of 3 to 4 kg New Zealand white rabbits that had undergone gentle pleural abrasion. Malignant tumor involvement developed on the visceral and parietal pleural surfaces in an average of 2 to 4 wk. This novel pleural tumor model induction method likely will facilitate a broad range of investigations of pleural cancer diagnostics and therapeutics.

Linking sustainability to the healthy eating patterns of the Dietary Guidelines for Americans: a modelling study.

BACKGROUND: Evidence-based nutrition policy is a key mechanism to promote planetary health. In the USA, the Dietary Guidelines for Americans are the foundation of nutrition policy and guide more than US$80 billion in federal spending. Recent attempts have been made to incorporate sustainability into the development of the Dietary Guidelines. However, the sustainability of the 2015-20 Dietary Guidelines remains unclear; research has not yet assessed the environmental impacts of the distinct healthy patterns recommended by the policy. METHODS: In this modelling study done at the University of New Hampshire (Durham, NH, USA), we analysed the healthy US-style (US), healthy Mediterranean-style (MED), and healthy vegetarian (VEG) patterns recommended in the 2015-20 Dietary Guidelines for Americans. Food groups and subgroups consisted of 321 commonly consumed foods, with group composition predetermined by the US Department of Agriculture. We compiled and used multiple datasets to assign environmental burdens to foods, focusing on six impact categories of policy importance: global warming potential, land use, water depletion, freshwater and marine eutrophication, and particulate matter or respiratory organics. We did life cycle impact assessments for each of the three diet patterns and compared the six impact categories between the patterns. We also analysed the proportion contribution of the food groups to each impact category in each of the diet patterns. FINDINGS: The US and MED patterns had similar impacts, except for freshwater eutrophication. Freshwater eutrophication was 31% lower in the US pattern than the MED pattern, primarily due to increased seafood in the MED pattern. All three patterns had similar water depletion impacts, with fruits and vegetables as major contributors. For five of the six impacts, the VEG pattern had 42-84% lower burdens than both the US and MED patterns. Reliance on plant-based protein and eggs in the VEG pattern versus emphasis on animal-based protein in the other patterns was a key driver of differences, as was a lower overall protein foods recommendation in the VEG pattern. INTERPRETATION: The recommended patterns in the Dietary Guidelines for Americans might have starkly different impacts on the environment and other dimensions of human health beyond nutrition. Given the scale of influence of the Dietary Guidelines for Americans on food systems, incorporating sustainability into their development has the potential to have great benefit in terms of long-term food security. FUNDING: None.

Yogurt: role in healthy and active aging.

Yogurt consumption has been associated with health benefits in different populations. Limited information, however, is available on nutritional and health attributes of yogurt in older adults. Yogurt is abundant in calcium, zinc, B vitamins, and probiotics; it is a good source of protein; and it may be supplemented with vitamin D and additional probiotics associated with positive health outcomes. Aging is accompanied by a wide array of nutritional deficiencies and health complications associated with under- and overnutrition, including musculoskeletal impairment, immunosenescence, cardiometabolic diseases, and cognitive impairment. Furthermore, yogurt is accessible and convenient to consume by the older population, which makes yogurt consumption a feasible approach to enhance older adults' nutritional status. A limited number of studies have specifically addressed the impact of yogurt on the nutritional and health status of older adults, and most are observational. However, those reported thus far and reviewed here are encouraging and suggest that yogurt could play a role in improving the nutritional status and health of older adults. In addition, these reports support further investigation into the role of yogurt in healthy and active aging.

Evaluation of tracheal imaging by optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) is a new technology capable of generating high resolution cross-sectional images of complex tissue in real time. Analogous to ultrasound, OCT measures backscattered light intensity using coherence interferometery to construct topographical images of complex tissue. Since OCT uses infrared light rather than acoustic waves, its spatial resolution is exceptionally high (2-10 microm). Recent advances in data acquisition, analysis, and processing enable real-time imaging, and make OCT a potentially valuable tool for pulmonary airway diagnostic applications, including assisting directed airway biopsies. OBJECTIVE: This study evaluates feasibility of OCT for delineating proximal airway microstructures in various animal as well as human tracheas. METHODS: Excised trachea samples from New Zealand white rabbits, Duroc pigs, and human trachea were imaged using a compact, 1,300-nm broad-band superluminescent-diode-based prototype fiber OCT device we constructed. The resulting structural OCT images were compared to conventional hematoxilin and eosin (HE) stained histological sections from the same samples. RESULTS: OCT was able to delineate microstructures such as the epithelium, mucosa, cartilage, and glands in all samples. CONCLUSION: These findings suggest that integration of OCT with flexible fiberoptic bronchoscopy could enhance pulmonary diagnostic medicine and detection of pathologic tissue changes in various respiratory diseases.

In vivo multiphoton fluorescence imaging: a novel approach to oral malignancy.

BACKGROUND AND OBJECTIVE: Current techniques for oral diagnosis require surgical biopsy of lesions, and may fail to detect early malignant change. Non-invasive, sensitive tools providing early detection of oral cancer and a better understanding of malignant change are needed. These studies evaluated in vivo multiphoton excited fluorescence (MPM) techniques to (1) map epithelial and subepithelial changes through out oral carcinogenesis and (2) serve as an effective diagnostic modality. STUDY DESIGN/MATERIALS AND METHODS: In the hamster model (n = 70), epithelial and subepithelial change was imaged in vivo throughout carcinogenesis. MPM- and histopathology-based diagnoses on a scale of 0 (healthy)-6 (squamous cell carcinoma [s.c.c.]) were scored by two pre-standardized investigators. RESULTS: Collagen matrix and fibers, cellular infiltrates, blood vessels, and microtumors were clearly visible. MPM agreed with the histopathology for 88.6% of diagnoses. CONCLUSIONS: In vivo MPM images provide (1) high resolution information on specific components of the carcinogenesis process (2) an excellent basis for oral diagnostics.