Access With Education Improves Fruit and Vegetable Intake in Preschool Children.

OBJECTIVE: To compare effects of interventions aimed at increasing fruit and vegetable (FV) intake in children. DESIGN: Pre-post comparison and intervention study with randomly grouped classrooms. SETTING: Head Start classrooms. PARTICIPANTS: Two hundred nine Head Start children. INTERVENTIONS: Treatment A (n = 61) and treatment B (n = 82) children received high-carotenoid FVs for 8 weeks. Treatment B children also received weekly FV education, and their caregivers received FV information and recipes. The comparison group (n = 66) received neither FVs nor education. MAIN OUTCOME MEASURE: Carotenoid values in Raman units. ANALYSIS: Multilevel mixed models, ANCOVA, and post hoc analysis were used. RESULTS: Multilevel mixed models with the group as fixed effect and classrooms within group as a random effect; ANCOVA showed that the only significant variable affecting the score was the group main effect. The intraclass correlation coefficient was 0.037; the Raman unit scores of treatment B were significantly higher than those of treatment A (P = .02) or comparison group (P < .001). However, there was no significant difference between treatment A and comparison (P = .10; Cohen D = .71). CONCLUSIONS AND IMPLICATIONS: The results suggested that providing education where FVs are offered may help increase consumption. Measurement of carotenoids in family members who received FVs plus education, as well as replication of this model in different locations and ages of children should be investigated in future research.

Statin users have an elevated risk of dysglycemia and new-onset-diabetes.

OBJECTIVE: Statins are one of the most widely prescribed medications in the United States; however, there is a concern that they are associated with new-onset-diabetes (NOD) development. We sought to understand the risk of dysglycemia and NOD for a cohort of individuals that reflect real-world physician prescribing patterns. METHODS: A retrospective cohort study was conducted among individuals with indications for statin use (n = 7064). To examine elevated glycosylated hemoglobin (>6.0%), logistic regression with inverse probability weighting was used to create balance between incident statin users and nonusers. To evaluate the risk of NOD development, Cox PH models with time varying statin use compared NOD diagnoses among statin users and nonusers. RESULTS: A higher prevalence of elevated HbA1c (PD = 0.065; 95% CI: 0.002, 0.129, P = 0.045) occurred among nondiabetic incident users of statins. Additionally, statin users had a higher risk of developing NOD (AHR = 2.20; 95% CI: 1.35, 3.58, P = 0.002). Those taking statins for 2 years or longer (AHR = 3.33; 95% CI: 1.84, 6.01, P < 0.001) were at the greatest risk of developing NOD; no differences were observed by statin class or intensity of dose. CONCLUSION: As lifestyle programs like the Diabetes Prevention Program are promoted in primary care settings, we hope physicians will integrate and insurers support healthy lifestyle strategies as part of the optimal management of individuals at risk for both NOD and cardiovascular disease. The relationships between statin use and glycemic control should be evaluated in large cohort studies, medical record databases, and mechanistic investigations to inform clinical judgment and treatment.

An Evaluation of Reach for a Work Site Implementation of the National Diabetes Prevention Program Focusing on Diet and Exercise.

PURPOSE: Our objective is to evaluate the "reach" component of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework by comparing prediabetics who were and were not interested in enrolling in a free work site diabetes prevention program (DPP) during the first year of the program. Reach is defined as the proportion of eligible participants who enroll in a health program. DESIGN: A cross-sectional study design was used. SETTING: The setting was a large health system in the Midwest. PARTICIPANTS: Prediabetic health plan enrollees and spouses (N = 2158). MEASURES: An online health survey, annual voluntary biometric screenings delivered by a trained health-care professional using standardized protocols via point-of-care testing, and records from the DPP office were the sources of data for this study. ANALYSIS: Health behaviors and biometric screening results were simultaneously compared using multivariable logistic regression. RESULTS: The study population was 63% female, 79% white, and 16% black, and the mean age was 50.2 years (SD = 10.2). The reach of this program was 10%. Prediabetics were more likely to express interest in the DPP, if they were female (adjusted odds ratio [AOR]: 2.4; 95% confidence interval [95% CI]: 1.55-3.72; P < .001), black (AOR = 2.23; 95% CI: 1.43-3.47; P < .001), older in age (AOR: 1.08; 95% CI: 0.99-1.17; P = .05), or had a high-risk waist circumference (AOR = 1.44; 95% CI: 0.98-2.13; P = .07), lower self-efficacy to make healthy changes (AOR = 0.48; 95% CI: 0.26-0.91; P = .03), and 5 or more doctor visits in the last year (AOR = 2.13; 95% CI: 0.99-4.57; P = .05), after controlling for other covariates. CONCLUSION: Current recruitment and implementation strategies are reaching only a small group of individuals who are not representative of the larger prediabetic population. These findings inform future engagement strategies, and we recommend that public health practitioners evaluate reach to ensure that health promotion programs are of high value.

Energy Contribution of Beverages in US Children by Age, Weight, and Consumer Status.

BACKGROUND: Messaging to reduce unhealthy beverage intake is often targeted to overweight and obese children; however, there is little evidence to show that healthy weight children have healthier beverage intake patterns. Further, data on consumers only may further elucidate beverage intake patterns. PURPOSE: The aim of this study was to update the current body of literature describing beverage intake in children by weight category, with the addition of consumer-only data. METHODS: Day one 24-hour recalls from the National Health and Nutrition Examination Survey 2005-2010 were analyzed to assess beverage intake of children 2-18 years old and differences by weight category. Beverages were coded as water, milk, 100% juice, coffee/tea, fruit drinks, soda, or low-calorie/diet drinks. RESULTS: On average, 18.7% of total daily calories for 2- to 18-year-old children came from beverages; 60% of total daily calories from added sugar came from beverages. Mean calories from beverages were 359, 358, and 386 kcal for normal weight, overweight, and obese children, respectively. Across all weight categories, there were clinically significant differences between overall means and means for consumers only. There were overlapping confidence intervals for intake of calories from soda and fruit drinks consumed by 2- to 5-year-olds and 12- to 18-year-olds, suggesting nonsignificant differences in intake across weight categories for these age groups. CONCLUSIONS: Messaging around beverage intake may be beneficial for children of all weights, particularly for those known to consume sugar-sweetened beverages. The per-consumer estimates may represent a better measure of intakes in future examinations of 24-hour recall data.

Improving patrons' meal selections through the use of point-of-selection nutrition labels.

OBJECTIVES: We examined changes in meal selection by patrons of university food-service operations when nutrition labels were provided at the point of selection. METHODS: We used a quasi-experimental, single-group, interrupted time-series design to examine daily sales before, during, and after provision of point-of-selection nutrition labels. Piecewise linear regression was employed to examine changes in the average energy content of entrées and a paired t test was used to detect differences in sales across the periods. RESULTS: The average energy content of entrées purchased by patrons dropped immediately when nutrition labels were made available at point of selection and increased gradually when nutrition information was removed. There was no significant change in number of entrées sold or in revenues between the 2 periods. CONCLUSIONS: Use of nutrition labels reduced the average energy content of entrées purchased without reducing overall sales. These results provide support for strengthening the nutrition labeling policy in food-service operations.