Nutritional quality of snacks and beverages sold through vending machines in a large Hispanic-serving urban college campus in the United States: A cross-sectional study.

Students from nutritionally-vulnerable neighborhoods face dietary challenges through built environment of college vending machines. In this cross-sectional study, snacks and beverages sold in vending machines for a 4-week period in a Bronx-based Hispanic-serving college were recorded. Nutritional information was recorded from nutrition labels. Proportion of low- and high-sodium foods, "smart snacks" with a limit of 200 kcal and 200 mg of sodium, and foods with added sugar were recorded. Snacks had significantly higher calories and sodium per serving (227 kcal, 208 mg) than beverages (132 kcal, 90 mg) (t-test, p < 0.001). Almost a third of the snacks (32%) qualified as "smart snacks" for calories and 62% qualified as "smart snacks" for sodium. Beverages contained less than half the number of ingredients as snacks. About 53% of beverages and almost 60% of snacks listed sugar among the first five ingredients. Results underscore the need for colleges to promote less-processed entities with less added sugar.

An analysis of nutrient facts labels of pediatric multi-vitamin and mineral supplements: Is there a risk of overexposure?

BACKGROUND: Voluntary and mandatory fortification of pediatric foods, along with widespread consumption of dietary supplements have resulted in an increased proportion of children with excessive micronutrient intake. AIM: This study aimed to analyze the proportion of pediatric dietary supplements that exceed the Recommended Dietary Allowance (RDA) and Tolerable Upper Limit for the individual micronutrients. We further identified the proportion of supplements with large amounts of micronutrients that were marketed through child-friendly and parent-geared promotional language and graphics on the packaging. METHODS: The nutrient facts label on pediatric supplement packages sold by three large retail pharmacy chains was analyzed for micronutrient content. Labels were examined for the presence of trademarked or generic cartoon characters and parent-geared health promotional statements. RESULTS: More than a third and almost a fifth of the samples contained vitamin A and niacin respectively in amounts equivalent to or above the established tolerable upper limit for one- to three-year-old children. A major proportion of these supplements had child-friendly and parent-targeted promotional language on the package. CONCLUSION: The potential for pediatric supplements as a source for excessive micronutrient consumption underscores the need for parents and health care professionals to use nutrition labels as a valuable tool to prevent micronutrient toxicity.

Discussing health while seeking community: A descriptive study of celiac disease on TikTok.

Background: For individuals suffering from chronic disease, more than being an information source for health information, social media serves as a dynamic forum for shared goals, emotional and practical support through the sharing of lived experiences. Aim: This study envisaged a content analysis of the 100 most widely-viewed English language videos related to celiac disease posted on TikTok. Methods: TikTok was searched using the hashtag #celiacdisease. This search term was chosen as it represented the broadest summation of the desired topic with the most views (80 million) of any related hashtag. The first 100 English language videos were selected. The video content was analyzed against predetermined descriptive categories, deductively derived content related to facts about celiac disease from a reliable source, and inductive content categories derived during the coding process. Results: The 100 videos included in this study received a total of 44,056,600 likes. The average number of likes across all videos was 440,566 with a standard deviation of 656,642.06. Two of the three categories were present in a majority (>50) of the videos. They were practical information on diet therapy management (n = 63) and challenges in managing celiac disease (n = 73). In both instances, videos featuring this content also garnered a majority of the likes, 74.18% and 82.9% respectively. Independent one-tailed t-tests (α = .05) returned significant results for the diagnosis-related information (p = .0390) and practical information in diet therapy management (p = .0358) categories. On average, videos that included diagnosis-related information received more likes than those that did not: 672,983.33 vs. 340,958.57. Similarly, the average number of likes was significantly higher for videos that included practical information on diet therapy management (518,715.87) vs. those that did not (307,500). Conclusions: This study further confirms the growing trend of people using social media to discuss health issues in a way that is free and easily accessible among communities with shared experiences. The long-term effects of using personal narratives as credible sources of behavioral change for health, medical, or professional resources can be further investigated.

Lost in print: difficulty in reading online information pertaining to phenylketonuria.

Phenylketonuria (PKU) is the most prevalent inborn error of amino acid metabolism, necessitating patients to strictly restrict dietary phenylalanine. As this can be a confusing and concerning diagnosis, patients and loved ones will likely be drawn to learn more. A critical factor for citizens to harness the health-related digital information is to ensure that it is easy to read. This study assessed the readability of 100 digital articles related to PKU and explored the effect of the source of online information on the readability of these articles. For each article, 5 readability tests were conducted using on-line readability software. From the 100 assessed websites, 34% were commercially sourced. Of the remaining 66 sites, 40% had.org and 17% had.gov extensions. All 5 tests confirm that a large majority of the sample was written at an unacceptable reading level. In fact, over two-thirds of the sample received a readability score within the difficult range for three of the tests, while the remaining two deemed 49% and 45% of the sample as difficult to read, respectively. Commercially sourced websites were deemed to be more difficult to read than the other sites with respect to the two of the five measures. Despite the large amount of PKU information online, most of it may be incomprehensible to the average person and thus miss the mark in helping patients and caregivers manage their condition. Opportunities exist for authors of digital health promotional information to effectively achieve their goal by using comprehensible, easy-to-read language.

Direct-to-consumer genetic testing in the news: a descriptive analysis.

Direct-to-consumer genetic testing (DTC GT) diagnostic tools do not entail referral through a healthcare provider and are used by consumers to screen for genetic health risk, pharmacogenomics, and predisposition to certain diseases and to learn more about ancestry. The purpose of this study was to describe the content of DTC DNA online news articles - specifically to characterize how rising concerns related to consumer privacy, medical advancements, and bioethics are covered in online news as access to these testing kits continues to grow. One hundred news articles identified on Google News using the search term "direct to consumer DNA testing" were coded for pre-determined content categories. Only 34.0% of news articles were created by healthcare professionals. Only 10.0% of online news articles mentioned testing confidentiality and privacy protection. Articles that mentioned > 5 commercial DTC DNA products more often discussed how DTC DNA testing provides personalized information about health and link to family disease risk and other traits (85.7% vs. 61.1%, p = 0.02), can lead to the location of family members or ancestors (78.6% vs. 55.63%, p = 0.03), and that the testing results housed in DNA databases can be utilized by law enforcement to track suspects or their relatives (32.1% vs. 9.7%, p = 0.01). Articles that mentioned ≤ 5 commercial DTC DNA products failed to mention that there exists a potential for data breaches (75.0% vs. 53.6%, p = 0.04). Online news articles should adequately inform consumers regarding the benefits and risks of DTC GT tests to facilitate informed decision-making.

The landscape of online news regarding genetically modified foods: A cross-sectional study.

BACKGROUND: There has been substantial debate surrounding the use of genetically modified foods (GMFs). AIM: The purpose of this study was to describe the content of news articles covering GMFs. METHODS: A search was completed on Google News using the key words "genetically modified foods" and the resulting 100 English-language news articles were analyzed for content. RESULTS: Only 26% of the articles analyzed were from professional or government sources. Among all content categories, definition or explanation of GMFs with a featured product as an example had the highest coverage, being addressed in 74% of the sample. Identification of GMFs from food labels (p = .001), was significantly associated with the source of the article (p > .05). CONCLUSIONS: Opportunities exist for scientists, educators, and health experts to present evidence-based and science-based information, with a balanced emphasis on the risks and benefits of GMFs to help consumers to make well-informed choices.

What do popular YouTube videos say about genetically modified foods? A content analysis.

Purpose: YouTube is one of the most popular media sharing platforms that facilitates both professionals and lay people to participate in dissemination of knowledge and opinions. Its wide-reaching impact allows both top-down and bottom-up flow of information between experts and lay audience. With a vast proportion of Americans obtaining health-related information digitally, the purpose of this study was to describe the content of 100 most viewed YouTube videos in the English language, specific to genetically modified foods (GMFs). Methods: Using the search terms "genetically modified foods" the URLs and metadata for 100 English YouTube videos with the highest viewership were curated. Each video was viewed, and dichotomously coded for the absence or presence of ten content categories. Descriptive statistics, percentages of categorical variables and independent one-tailed t-tests (α=.05) were conducted to assess the statistical effect of the absence or presence of these categories on the number of views and likes garnered by the videos. Results: Cumulatively, the 100 videos observed received 65,536,885 views and 1,328,605 likes. Only 7% of the videos were created by professionally credentialed individuals or organizations. More than 90% of the sampled videos described GMFs with an example, 50% mentioned their role in alleviating hunger, and 65% mentioned ecological concerns attributed to GMFs. Conclusions: Our results underscore the need for health professionals to increase their digital presence on online media sharing platforms such as YouTube, and capitalize on its pervasiveness as potential conduits of accurate scientific information to equip consumers make evidence-based, informed decision regarding GMFs.

Preeclampsia information on the internet: An application of five readability tests.

The purpose of this study was to determine the readability level of information on 100 unique websites with information on preeclampsia. Five different readability measures were used to measure each website's readability via an online readability calculator. All five readability measures determined that a vast majority of the sites sampled were written at unacceptable levels (89%+). Independent one-tailed t-tests (α = 0.05) determined that there was no statistical difference in the readability scores of.com vs the other websites on any of the 5 readability assessments. We recommend that efforts be made to simplify language in accordance with plain language recommendations for health information in the United States.

Online news coverage of infant formula shortage in the United States: A content analysis.

This study aimed to describe the content of internet news specific to the 2022 infant formula shortage in the United States. First hundred English news articles on Google News were coded for content categories to reflect recommendations for affected families by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Chi-square test of independence (α = 0.05) determined if content categories was statistically affected by whether the news article was professionally authored or an internet news article. Only 17% of the articles were professionally authored. Hardships to parents was the predominant theme (73% of news articles); 53% mentioned challenges for infants needing hypoallergenic or specialized formulas; 52% addressed food safety. Coverage of feeding guidelines, challenges for specialized formula requirements, introduction to solid foods, re-lactation, breastfeeding support, and food safety were not significantly impacted by whether the article was professionally authored or not (p > .05). Results point to the need for health professionals to increase their online presence as a vital source of accurate information during a public health crisis.

The Effect of Pulse Pressure on All-Cause and Cardiovascular-Specific Mortality Risks in US Adults.

OBJECTIVES: To examine the effect of pulse pressure on all-cause and cardiovascular-specific mortality risks and whether this effect varies with sex and race/ethnicity among adults who participated in the third National Health and Nutrition Examination Survey and were followed to December 31, 2006. DESIGN: Cohort/Longitudinal. SETTING: United States. MAIN OUTCOME MEASURE: All-cause and cardiovascular-specific mortality. METHODS: Hazard rates and 95% confidence intervals (CI) for all-cause and cardiovascular-specific mortality associated with the pulse pressure quartiles (Q) were estimated through Cox proportional regression before and after controlling for selected characteristics. RESULTS: Relative to adults with pulse pressure in the first quartile, death rate for all-cause mortality was 29% (95% CL: 1.03, 1.62) and 54% (95% CI: 1.22, 1.95) higher in adults with pulse pressures in Q3 and Q4, respectively, after adjustment for all study covariates. These associations were further observed in Whites and Mexican Americans only. For cardiovascular-specific mortality, the adjusted death rates for Q3 and Q4 were 57% (95% CI: 1.00, 2.44) and 76% (95% Cl: 1.16, 2.67). CONCLUSIONS: Our findings suggest that pulse pressure could be associated with all-cause and CVD-specific mortality risk among US adults.

An examination of product packaging marketing strategies used to promote pediatric multivitamins.

The purpose of this study was to describe the nature of marketing strategies for multivitamin and multimineral (MVM) supplement packaging and to assess the extent to which these supplements are marketed as food products. A cross-sectional study of children's supplement packaging was conducted. Descriptive statistics identified common marketing practices. Websites of the three largest retail chain pharmacies in the United States and MVM manufacturers were accessed. The study's sample consisted of packaging for 52 children's MVM supplements. Child-targeted marketing included reference to trademarked characters on 42.3% of MVM packaging (n = 22). More than 80% of the sample (n = 42) listed fruity flavors and almost all packaging included descriptive words related to the MVMs' shape and/or flavor (88.5%, n = 46). Nearly one-fifth of the packaging (n = 10) pictured a food item. With respect to parent-targeted promotional language, almost 83% of the supplement packages (n = 43) included text on the support of bodily structure/function. More than half of the sample (53.8%, n = 28) had promotional language related to dietary practice (e.g. organic, gluten-free). Pediatricians can play a role in ensuring that parents are aware of (1) possible risks associated with MVM overconsumption, and (2) the importance of deriving vitamins and minerals from a balanced diet. Given the high number of exposures to pediatric MVMs among youth and established influence of food marketing on shaping children's perceptions and behaviors, further research is necessary to determine the extent to which children's MVMs are marketed as a food product and perceived as such by children.

The effect of body mass index on adequacy of serum 25-hydroxyvitamin D levels in US adults: the National Health and Nutrition Examination Survey 2001 to 2006.

PURPOSE: To investigate the relationship between body mass index (BMI) and vitamin D adequacy among US adults. METHODS: We used data for US adults aged 18 years or older (n = 12,927) who participated in the 2001 to 2006 United States National Health and Nutrition Examination Survey. Log-binomial regression was used to estimate the strength of association between BMI categories and the prevalence of serum 25-hydroxyvitamin D [25(OH)D] greater than or equal to 20 ng/mL before and after controlling for selected characteristics. An interaction term between race or ethnicity and BMI categories was tested. RESULTS: Among US adults, 67.2% had serum 25(OH)D greater than or equal to 20 ng/mL, a cut point suggested by the Office of Dietary Supplements for adequate bone and general health. Overweight and obese adults were 8% (95% confidence interval, 0.89-0.95) and 26% (95% confidence interval, 0.71-0.78), respectively, less likely to have serum 25(OH)D greater than or equal to 20 ng/mL than their normal weight counterparts after controlling for age, gender, race/ethnicity, nativity and marital status, as well as education and income. No heterogeneity of the association between BMI categories and the prevalence of 25(OH)D greater than or equal to 20 ng/mL was observed by race or ethnicity. CONCLUSIONS: The low prevalence of 25(OH)D greater than equal to 20 ng/mL among overweight and obese adults in the US population underscores the need to comparatively assess vitamin D intakes across different BMIs.

A comparative study of the sodium content and calories from sugar in toddler foods sold in low- and high-income New York City supermarkets.

Information from the nutrition facts labels of toddler foods marketed in low- and high-income New York City zip codes were analyzed for sodium content, the proportion of sugar-derived calories, and presence of sugar and/or high-fructose corn syrup as an added sweetener in the list of ingredients. Among the 272 toddler foods analyzed, more than a quarter were high in sodium, over one-third derived at least 20% their calories from sugar, and more than 41% of the foods had sugar and/or high-fructose corn syrup listed among the first five ingredients. The proportion of foods with such nutritional characteristics did not significantly differ between the low- and high-income neighborhood supermarkets. Median sodium content was highest among "side dishes" and "meals." The proportion of calories derived from sugar was found to be highest among "snacks and yogurt blends" in both low- and high-income neighborhoods and "breakfast foods and cereals" in low-income neighborhoods. When compared to high-income neighborhoods, more than three times the proportion of total calories in "breakfast foods and cereals" sold in low-income neighborhoods were derived from sugar. Since taste preferences established during childhood can have long-lasting influence on dietary habits, it is imperative to limit the promotion of toddler foods that are high in sodium and sugar as well as educate parents to make nutritionally sound decisions at the point of purchase.

Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death.

OBJECTIVES: We examined the association of body mass index with all-cause and cardiovascular disease (CVD)-specific mortality risks among US adults and calculated the rate advancement period by which death is advanced among the exposed groups. METHODS: We used data from the Third National Health and Nutrition Examination Survey (1988-1994) linked to the National Death Index mortality file with follow-up to 2006 (n = 16 868). We used Cox proportional hazards regression to estimate the rate of dying and rate advancement period for all-cause and CVD-specific mortality for overweight and obese adults relative to their normal-weight counterparts. RESULTS: Compared with normal-weight adults, obese adults had at least 20% significantly higher rate of dying of all-cause or CVD. These rates advanced death by 3.7 years (grades II and III obesity) for all-cause mortality and between 1.6 (grade I obesity) and 5.0 years (grade III obesity) for CVD-specific mortality. The burden of obesity was greatest among adults aged 45 to 64 years for all-cause and CVD-specific mortality and among women for all-cause mortality. CONCLUSIONS: These findings highlight the impact of the obesity epidemic on mortality risk and premature deaths among US adults.

The effect of body mass index on optimal vitamin D status in U.S. adults: the National Health and Nutrition Examination Survey 2001-2006.

OBJECTIVES: To investigate the relationship between body mass index (BMI) and optimal vitamin D status in U.S. adults. METHODS: Data on 12,927 adults 18 years and older participating in National Health and Nutrition Examination Surveys 2001-2006 were used. Serum levels of 25-hydroxy vitamin D 30 ng/mL or greater was used as a measure of vitamin D sufficiency. Log-binomial regression was used to estimate the strength of the association between BMI categories and the prevalence of vitamin D sufficiency before and after adjusting for selected characteristics. RESULTS: After adjustment, overweight and obese individuals were 24% and 55%, respectively, less likely to have a 25-hydroxy vitamin D level of 30 ng/mL or greater compared with their normal-weight counterparts. CONCLUSIONS: Our findings call attention to the importance of identifying individuals at risk for vitamin D insufficiency and its potential adverse health outcomes because the latter may increase health disparities in the U.S. population. If vitamin D insufficiency is implicated for chronic diseases such as cardiovascular diseases and diabetes, a vitamin D supplementation regimen would need to be readdressed, especially for segments of the U.S. population with greater BMIs.

An analysis of Bronx-based online grocery store circulars for nutritional content of food and beverage products.

With the rising rates of diabetes and obesity in New York City's poorest communities, efforts to assist low-income residents in spending money to promote nutritious food consumption have increased. The objective of this study was to assess the extent to which Bronx-based grocery stores offered nutritious foods on sale through their weekly circulars. Over a 2-month period, we analyzed 2,311 food and beverage products placed on the first page of online circulars for fifteen Bronx-based grocery stores. For each circular, we recorded the number of starchy and non-starchy fruits and vegetables; for each product, total fiber and carbohydrate content per serving (in grams), whether the product was processed, and sale price were recorded. Total sugar content (in grams) was recorded for all sugar-sweetened beverages. Over 84 % of the products were processed, and almost 40 % had at least one carbohydrate choice (15 g) per food serving. Only 16.5 % of the products were fresh fruits and green leafy vegetables, and 1.4 % had fiber content of 5 or more grams per serving. Requiring the purchase of multiples of unhealthy products to receive the sale price was also noted. Almost three-quarters of the sugar-sweetened beverages were advertised with promotional sales compared to over half of the fresh fruits and only one-third of fresh vegetables. We identified no other studies that address nutritional content of foods found in grocery store circulars. More research is necessary to determine if purchasing nutritious products at grocery stores in low-income neighborhoods is influenced by sale prices.

A comparison of the nutritional quality of food products advertised in grocery store circulars of high- versus low-income New York City zip codes.

Grocery stores can be an important resource for health and nutrition with the variety and economic value of foods offered. Weekly circulars are a means of promoting foods at a sale price. To date, little is known about the extent that nutritious foods are advertised and prominently placed in circulars. This study's aim was to compare the nutritional quality of products advertised on the front page of online circulars from grocery stores in high- versus low-income neighborhoods in New York City (NYC). Circulars from grocery stores in the five highest and five lowest median household income NYC zip codes were analyzed. Nutrition information for food products was collected over a two-month period with a total of 805 products coded. The study found no significant difference between the nutritional quality of products advertised on the front page of online circulars from grocery stores in high- versus low-income neighborhoods in New York City (NYC). In both groups, almost two-thirds of the products advertised were processed, one-quarter were high in carbohydrates, and few to no products were low-sodium, high-fiber, or reduced-, low- or zero fat. Through innovative partnerships with health professionals, grocery stores are increasingly implementing in-store and online health promotion strategies. Weekly circulars can be used as a means to regularly advertise and prominently place more healthful and seasonal foods at an affordable price, particularly for populations at higher risk for nutrition-related chronic disease.

Food advertisements in two popular U.S. parenting magazines: results of a five-year analysis.

Obesity rates among American youth have prompted an examination of food advertisements geared towards children. Research indicates children's high exposure to these advertisements and their influence on food preferences. Less is known about the presence of these advertisements in parenting magazines. This study's objective was to examine prevalence of food advertisements in popular parenting magazines and identify products by USDA food category. We analyzed 116 issues of two popular U.S. parenting magazines across five years. All food and beverage advertisements for USDA Food Category were coded. Breakfast cereals were coded for nutritional quality. The coding took place at varied libraries in New Jersey, in the United States. A total of 19,879 food and beverage products were analyzed. One-third of advertisements (32.5%) were for baked goods, snacks, and sweets -- products generally low in nutrient density. Two-thirds of the breakfast cereals were low in nutritional quality (64.6%). Beverages comprised 11% of the advertisements, fruit juices the highest proportion. Less than 3% of advertisements were for fruits and vegetables combined. No significant food product trends were evident across the five-year period. Food advertisements identified in parenting magazines were generally low in nutritional value. Additional research is necessary to determine the influence of food advertisements on parents' purchasing habits.