Characteristics Associated With Purchasing Sugar-Sweetened Beverages and Bottled Water Among US Households, 2015.

BACKGROUND: Frequent intake of sugar-sweetened beverages (SSBs) among US adults is a public health concern because it has been associated with increased risks for adverse health outcomes such as obesity, type 2 diabetes, and cardiovascular disease. In contrast, drinking plain water (such as tap, bottled, or unsweetened sparkling water) instead of drinking SSBs might provide health benefits by improving diet quality and helping prevent chronic diseases. However, there is limited information on estimated expenditures on SSBs or bottled water among US households. OBJECTIVE: This study examined differences in SSB and bottled water purchasing according to household and geographic area characteristics and estimated costs spent on purchasing SSB and bottled water from retail stores among a nationally representative sample of US households. DESIGN: This study is a secondary analysis of the 2015 Circana (formerly Information Resources Inc) Consumer Network Panel data, which were merged with the US Department of Agriculture nutrition data using the US Department of Agriculture Purchase-to-Plate Crosswalk-2015 dataset (the latest available version of the Purchase-to-Plate Crosswalk at the time the study began), and the Child Opportunity Index 2.0 data. PARTICIPANTS/SETTINGS: A total of 63,610 households, representative of the contiguous US population, consistently provided food and beverage purchase scanner data from retail stores throughout 2015. EXPLANATORY VARIABLES: The included demographic and socioeconomic variables were household head's age, marital status, highest education level, race and ethnicity of the primary shopper in the household, family income relative to the federal poverty level, and presence of children in the household. In addition, descriptors of households' residential areas were included, such as the county-level poverty prevalence, urbanization, census region, and census tract level Child Opportunity Index. MAIN OUTCOME MEASURES: Annual per capita spending on SSB and bottled water and daily per capita SSB calories purchased. STATISTICAL ANALYSIS: Unadjusted and multivariable adjusted mean values of the main outcome measures were compared by household demographic, socioeconomic, and geographic characteristics using linear regression analysis including Circana's household projection factors. RESULTS: Nearly all households reported purchasing SSBs at least once during 2015 and spent on average $47 (interquartile range = $20) per person per year on SSBs, which corresponded to 211 kcal (interquartile range = 125 kcal) of SSBs per person per day. About seven in 10 households reported purchasing bottled water at least once during 2015 and spent $11 (interquartile range = $5) per person on bottled water per year. Both annual per capita SSB and bottled water spending, and daily per capita SSB calories purchased was highest for households whose heads were between 40 and 59 years of age, had low household income, or lived in poor counties, or counties with a low Child Opportunity Index. Annual per capita spending was also higher for households with never married/widowed/divorced head, or at least 1 non-Hispanic Black head, and households without children, or those living in the South. Daily per capita SSB calorie purchases were highest for households where at least 1 head had less than a high school degree, households with at least 1 Hispanic or married head, and households with children or those living in the Midwest. CONCLUSIONS: These findings suggest that households that had lower socioeconomic status had higher annual per capita spending on SSBs and bottled water and higher daily per capita total SSB calories purchased than households with higher socioeconomic status.

Association Between County-Level Food Retail and Socioeconomic Environment and Nutritional Quality of Household Food Purchases, 2015.

BACKGROUND: About 40 million Americans do not have easy access to affordable nutritious foods. Healthier foods are less likely to be available to those living in rural and/or lower-income communities. OBJECTIVE: The objective of this study was to analyze the association between nutritional quality of household food purchases and county-level food retail environment; county-level demographic, health, and socioeconomic indicators; and household composition, demographic characteristics, and socioeconomic characteristics. DESIGN: This study is a secondary analysis of the 2015 Information Resources Inc Consumer Network panel; Purchase-to-Plate Crosswalk, which links US Department of Agriculture nutrition databases to Information Resources Inc scanner data; County Health Rankings; and the Food Environment Atlas data. PARTICIPANTS AND SETTINGS: A total of 63,285 households, representative of the contiguous US population, consistently provided food purchase scanner data from retail stores throughout 2015. MAIN OUTCOME MEASURES: Nutritional quality of retail food purchases was assessed using the Healthy Eating Index 2015 (HEI-2015). STATISTICAL ANALYSIS: Multivariate linear regression analysis was used to simultaneously test the relationship between the main outcome and household-level demographic and socioeconomic characteristics as well as the county-level demographic, health, socioeconomic, and retail food environment. RESULTS: Household heads who had higher education and households with higher incomes purchased food of better nutritional quality (ie, higher HEI-2015 scores). Also, the association between retail food purchase HEI-2015 scores and the food environment was weak. Higher density of convenience stores was associated with lower retail food purchase nutritional quality for higher-income households and households living in urban counties, whereas low-income households in counties with higher specialty (including ethnic) store density purchased higher nutritional quality food. Both in the full sample and when stratified by household income or county rural vs urban status, no association was found between grocery store, supercenters, fast-food outlets, and full-service restaurant densities and retail food purchase HEI-2015 scores. HEI-2015 scores were negatively correlated with the county average number of mental health days for higher income and urban households. CONCLUSIONS: The study findings suggest that availability of healthier food alone may not improve healthfulness of retail food purchases. Future studies examining the influence of demand-side factors/interventions, such as habits, cultural preferences, nutrition education, and cost/affordability, on household purchasing patterns could provide complementary evidence to inform effective intervention strategies.

Adherence to Federal Dietary Recommendations for Total Fruit Consumption and the Intake of Underconsumed Nutrients: Findings from the National Health and Nutrition Examination Survey, 2015 to 2018.

BACKGROUND: A persistent gap exists between U.S. consumers' actual fruit consumption and Federal dietary recommendations for fruit. Individuals who most deviate from recommendations may be at a greater risk of underconsuming some nutrients. OBJECTIVE: We investigated how widely total fruit consumption varies across adult consumers and whether those who most deviate from recommendations also consume less vitamins A and C, calcium, magnesium, and potassium. The 2020 Dietary Guidelines Advisory Committee has identified each of these nutrients as being underconsumed by the U.S. population in general. METHODS: Data used were from the NHANES, 2015 to 2016 and 2017 to 2018 cycles. For 9832 adults (age >18), we compared their total fruit consumption to recommendations for their age and sex. We also calculated 2015 Healthy Eating Index (HEI-2015) scores. Component scores for Total Fruit and Whole Fruit were subtracted from the total HEI-2015 scores to measure adherence with dietary recommendations outside the fruit group. Two-way and 3-way contingency tables were then used to measure the association between adherence to fruit recommendations and the intake of underconsumed nutrients before and after controlling for adherence to other food group recommendations, respectively. RESULTS: About two-thirds of adults eat less than half the recommended amount of fruit on any given day. Those who routinely unconsume fruit may be at a greater risk of underconsuming potassium and vitamin C. Calcium, magnesium, and vitamin A consumption do not show a consistent relationship with fruit intake relative to recommendations after controlling for diet quality outside the fruit group. CONCLUSIONS: There is much variation across the U.S. population in fruit consumption relative to recommendations. The present study suggests that individuals who deviate the most are at a particularly increased risk of underconsuming vitamin C and potassium.

Association between the Nutritional Quality of Household At-Home Food Purchases and Chronic Diseases and Risk Factors in the United States, 2015.

Lower diet quality is a leading preventable risk factor for obesity and chronic diseases. This study assesses differences in the nutritional quality of at-home food purchases, using the Healthy Eating Index (HEI)-2015 and its components, among households with and without a member reporting type 2 diabetes (T2D), cardiovascular disease (CVD), obesity, and/or smoking. We use the 2015 IRI Consumer Network nationally representative household food purchase scanner data, combined with the IRI MedProfiler and the USDA's Purchase-to-Plate Crosswalk datasets. For each/multiple condition(s), the difference in mean HEI score adjusted for covariates is tested for equivalence with the respective score against households without any member with the condition(s). The HEI score is higher for households without a member with reported T2D (2.4% higher), CVD (3.2%), obesity (3.3%), none of the three conditions (6.1%, vs. all three conditions), and smoking (10.5%) than for those with a member with the respective condition. Households with a member with T2D score better on the added sugar component than those with no member reporting T2D. We found that the average food purchase quality is lower than the recommended levels, especially for households with at least one member reporting a chronic condition(s).

The more that households prioritise healthy eating, the better they can afford to consume a sufficient quantity and variety of fruits and vegetables.

OBJECTIVE: To examine the variety of fruits and vegetables lower income households in the USA can buy while meeting Federal dietary recommendations at different levels of expenditure. DESIGN: Simulation techniques were used to create 3000 market baskets of fruits and vegetables. All baskets contained enough food for a four-person household to meet dietary recommendations for fruits and vegetables over 1 week. Each basket's retail value was estimated along with the ability of a representative household to afford each basket with different levels of expenditure. SETTING: We used data from the US Department of Agriculture's (USDA) Fruit and Vegetable Prices data product which reports a US household's costs to buy each of 157 different fruit and vegetable products per edible cup equivalent. PARTICIPANTS: We consider the situation facing a lower income household that receives maximum benefits through the Supplemental Nutrition Assistance Program (SNAP). These benefits are enough for the household to obtain a nutritious and palatable diet without spending any of its own money on food if it approximately follows USDA's Thrifty Food Plan. RESULTS: Households receiving maximum SNAP benefits can buy a sufficient variety and quantity of fruits and vegetables if they allocate about 40 % of those benefits to these two food groups. However, if households spend less than that amount, the variety of products they can buy while still satisfying recommendations drops off quickly. CONCLUSION: Households that move fruits and vegetables to the centre of their budgets can better afford to meet Federal dietary guidelines.

The inverse relationship between food price and energy density: is it spurious?

OBJECTIVE: An important debate in the literature is whether or not higher energy-dense foods are cheaper than less energy-dense foods. The present communication develops and applies an easy statistical test to determine if the relationship between food price and energy density is an artifact of how the data units are constructed (i.e. is it 'spurious' or 'real'?). DESIGN: After matching data on 4430 different foods from the National Health and Nutrition Examination Survey with corresponding prices from the Center for Nutrition Policy and Promotion's Food Prices Database, we use a simple regression model to test if the relationship between food price and energy density is 'real' or 'spurious'. SETTING: USA. SUBJECTS: Total sample size is 4430 observations of consumed foods from 4578 participants from the non-institutionalized US adult population (aged 19 years and over). RESULTS: Over all 4430 foods, the null hypothesis of a spurious inverse relationship between food price per energy density and energy density is not rejected. When the analysis is broken down by twenty-five food groups, there are only two cases where the inverse relationship is not spurious. In fact, the majority of non-spurious relationships between food price and energy density are positive, not negative. CONCLUSIONS: One of the main arguments put forth regarding the poor diet quality of low-income households is that high energy-dense food is cheaper than lower energy-dense food. We find almost no statistical support for higher energy-dense food being cheaper than low energy-dense food. While economics certainly plays a role in explaining low nutritional quality, more sophisticated economic arguments are required and discussed.

Food costs, diet quality and energy balance in the United States.

The high obesity rates and poor diet quality in the United States, particularly among low income populations, are often attributed to low income, low food access, and high food prices of healthy foods. This paper discusses these associations and questions some of the metrics used to measure food prices. The paper argues that 1. On average, Americans consume diets that need improvement and there is only a very limited relationship between income and diet quality; 2. The way the food price is measured makes a difference in the perception of how expensive healthy and less healthy food is; 3. The way Americans allocate their food budgets between healthy and less healthy foods is not in line with healthy diets; and 4. At any food spending level there are households that purchase healthy (and unhealthy) diets, including budgets at or below the maximum allotment for the Supplemental Nutrition Assistance Program (SNAP) which provides a means for low-income households to purchase food. Our key finding is that healthy foods and diets are affordable, but policy makers, nutrition educators, researchers and the media need to focus on promoting this message, and providing additional guidance on making the changes for Americans to switch to a healthy and affordable diet.

Can low-income Americans afford to satisfy MyPyramid fruit and vegetable guidelines?

OBJECTIVE: To estimate the costs of satisfying MyPyramid fruit and vegetable guidelines, with a focus on whether low-income households can bear these costs. DESIGN: Descriptive analysis of the 2008 National Consumer Panel with information on the food purchases of 64,440 households across the contiguous United States was used to analyze the cost of fruits and vegetables. Costs per MyPyramid cup-equivalents were calculated by accounting for cooking yields and the portion of a food item's retail weight that is inedible. VARIABLES MEASURED: Costs per cup-equivalent for less expensive fruits and vegetables by MyPyramid subgroup including whole and cut fruit, fruit juice, dark green vegetables, orange vegetables, starchy vegetables, other vegetables, and legumes. RESULTS: In 2008, a variety of fruits and vegetables was available for an average cost of $0.40 to $0.50 per cup-equivalent. MyPyramid fruit and vegetable recommendations could be satisfied at this cost level. CONCLUSIONS AND IMPLICATIONS: Low-income Americans facing national average food prices can satisfy MyPyramid fruit and vegetable guidelines with a budget equal to the Thrifty Food Plan allocation to fruits and vegetables. However, many low-income households spend too much money on food that is low in fruit and vegetable content. Some money should be reallocated to fruits and vegetables.

Movement of trichloroethene in a discontinuous permafrost zone.

At a site with discontinuous permafrost in Fairbanks, Alaska, releases of trichloroethene (TCE), an industrial solvent, have caused contamination of the groundwater. The objective of this study was to investigate the relationship between the migration pathway of the TCE groundwater plume and the distribution of the discontinuous permafrost at the site. The TCE plume configuration is substantially different than what regional hydrology trends would predict. Using GIS, we conducted a geostatistical analysis of field data collected during soil-boring installations and groundwater monitoring well sampling. With the analysis results, we constructed maps of the permafrost-table elevation (top of permafrost) and of the groundwater gradients and TCE concentrations from multiyear groundwater sampling events. The plume concentrations and groundwater gradients were overlain on the permafrost map to correlate permafrost locations with groundwater movement and the spatial distribution of TCE moving with groundwater. Correlation of the overlay maps revealed converging and diverging groundwater flow in response to the permafrost-table distribution, the absence of groundwater contamination in areas with a high permafrost-table elevation, and channeling of contaminants and water between areas of permafrost. In addition, we measured groundwater elevations in nested wells to quantify vertical gradients affecting TCE migration. At one set of nested wells down gradient from an area of permafrost we measured an upward vertical gradient indicating recharge of groundwater from the subpermafrost region of the aquifer causing dilution of the plume. The study indicates that the variable distribution of the permafrost is affecting the way groundwater and TCE move through the aquifer. Consequently, changes to the permafrost configuration due to thawing would likely affect both groundwater movement and TCE migration, and areas that were contaminant-free may become susceptible to contamination.

Food consumed away from home can be a part of a healthy and affordable diet.

The benefit calculation of the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program, is based primarily on results of the Thrifty Food Plan (TFP) developed by the USDA. By using a nonlinear mathematical programming approach, the TFP provides a dietary pattern recommendation that deviates the least from low-income consumers' consumption pattern, meets dietary guidelines, and is economical. The TFP stipulates that all foods should be purchased at stores and prepared at home [food at home (FAH)] and excludes an important part of current consumers' diet, food away from home (FAFH). Our purpose was to evaluate the feasibility and nutritional impact of adding a FAFH dimension into the TFP model framework. Measures of energy density, nutrients and food group composition, and the overall diet quality measured by the Healthy Eating Index 2005 were calculated and compared across the TFP, the TFP with FAFH, and low-income consumers' diet pattern. Our results indicated that considering moderate FAFH in the TFP yielded similar nutrient and food group composition as the original TFP while greatly increasing the practicality and adaptability of the recommended dietary pattern. These findings may be used by nutrition educators to develop healthful FAFH choices for individuals receiving SNAP benefits.

Development of food group composites and nutrient profiles for the MyPyramid Food Guidance System.

OBJECTIVE: To identify food selections in each MyPyramid food group or subgroup reflective of typical consumption patterns by Americans, and the nutrient intake that can be expected from consuming a specified amount of these foods from each group, in a low-fat and no-added-sugars form. DESIGN: An analytical process to identify food consumption choices within each food group and subgroup using national food consumption surveys, and to identify the expected nutrient content of each group using food composition databases. VARIABLES MEASURED: Relative consumption of foods within each food group; nutrient content for each food group and subgroup (energy plus 27 nutrients). ANALYSIS: Disaggregated foods from consumption surveys into component ingredients. Combined similar ingredients into "item clusters" and determined relative consumption of each. Calculated a consumption-weighted nutrient profile for each food group. RESULTS: Consumption-weighted food intake selections and nutrient profiles were developed for all MyPyramid food groups and subgroups. CONCLUSIONS AND IMPLICATIONS: This analytical process derived food group and subgroup composites which estimate typical food choices within each MyPyramid food group. These were used to assess the adequacy of the MyPyramid food intake patterns as they were being iteratively developed.

Food source makes a difference in diet quality.

OBJECTIVE: To examine the relationship between diet quality and source of food among U.S. adults. DESIGN: Cross-sectional sample of adults who participated in the 1994-1996 Continuing Survey of Food Intakes by Individuals divided into clusters based on their food source. SETTING: In-person interviews conducted nationwide. PARTICIPANTS: A national sample of 9407 adults over 18 years of age. METHOD: Data gathered from the interviews consisted of two 24-hour dietary recalls; self-reported demographic characteristics; body mass index (BMI); and health behaviors such as physical activity, smoking, and alcohol consumption. MAIN OUTCOME MEASURES: The United States Department of Agriculture (USDA) Healthy Eating Index (HEI) score and the percentage of total grams of food consumed from each source. ANALYSIS: Multivariate linear regression evaluated the association between food source pattern determined by cluster analysis, and HEI scores, while controlling for demographic characteristics, BMI, and health behaviors. RESULTS: Ten primary food source patterns were identified from the clusters. The food source clusters were statistically significant in predicting HEI score and were stronger predictors than most demographic and health behaviors included. IMPLICATIONS FOR RESEARCH AND PRACTICE: The success of cluster analysis in identifying food source patterns and associating them with diet quality suggests that identifying an individual's food source pattern may be more predictive of diet quality than demographic characteristics, and other health behaviors.

Simple measures of dietary variety are associated with improved dietary quality.

The objective of this study was to identify a measure of dietary variety that was associated with improved dietary quality and easily understood by consumers. Dietary quality was measured by nutrient adequacy and intakes of added sugars, saturated fat, cholesterol, and sodium. We developed four definitions of dietary variety: (a) a count of basic commodities consumed; (b) a count of food codes reported; (c) a count of five Food Guide Pyramid (FGP) food groups consumed; and (d) a count of 22 FGP subgroups consumed. The analysis sample included 4,964 men and 4,797 women aged 19 years and older who participated in the Continuing Survey of Food Intakes by Individuals 1994-96. For each day of dietary data, we examined associations of each type of dietary variety with several measures of dietary quality using Spearman's correlations and multivariate linear regression models. After adjusting for energy intake and the number of FGP food group servings, all types of dietary variety were positively associated with mean nutrient adequacy across 15 nutrients, but associations were strongest for commodity-based variety and for 22 FGP subgroup consumption variety. Likewise, all variety measures were inversely associated with intakes of added sugars and saturated fat, with commodity-based variety and 22 FGP subgroup variety the strongest. We conclude that variety measured using 22 FGP subgroups is preferable because it is a good predictor of dietary quality, is relatively simple to calculate, and is easy to explain to consumers.

Dietary variety increases the probability of nutrient adequacy among adults.

Despite guidance to consume a variety of foods, the role of dietary variety in ensuring nutrient adequacy is unclear. The aim of this study was to determine whether a commodity-based measure of dietary variety was associated with the probability of nutrient adequacy after adjusting for energy and food group intakes. Subjects were 4969 men and 4800 women >/= 19 y old who participated in the Continuing Survey of Food Intakes for Individuals 1994-1996. Using 24-h recall data, the mean probability of adequacy across 15 nutrients was calculated using the Dietary Reference Intakes. Dietary variety was defined using a commodity-based method similar to that used for the Healthy Eating Index (HEI). Associations were examined in gender-specific multivariate regression models. Energy intake was a strong predictor of the mean probability of adequacy in models controlled for age, BMI, education level, and ethnicity (model R(2) = 0.60 and 0.54 for men and women, respectively). Adding the number of servings from each of the 5 Food Guide Pyramid (FGP) groups to the models significantly improved the model fit (R(2) = 0.69 and 0.66 for men and women). Adding dietary variety again significantly improved the model fit for both men and women (R(2) = 0.73 and 0.70, respectively). Variety counts within the dairy and grain groups were most strongly associated with improved nutrient adequacy. Dietary variety as defined by the HEI contributes an additional component of dietary quality that is not captured by FGP servings or energy intake.

Influence of age and tic disorders on obsessive-compulsive disorder in a pediatric sample.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a heterogeneous disorder with emerging data suggesting that age of onset and/or the presence of tics may define clinically important subgroups. OBJECTIVE: This study set out to evaluate the impact of age and tic disorders on the symptom profile in a pediatric sample of patients with OCD ascertained from a specialty clinic. METHODS: Eighty children with OCD (50 boys, 30 girls) were assessed for symptom type, severity, age of onset, presence of a tic disorder, and functional status. Each child's most impairing obsessions and compulsions were identified and compared by age category (above and below the age of 11 years) and according to the presence or absence of a tic disorder. RESULTS: The mean age of the sample was 11.1 +/- 3.19 years (range 4-18 years). The most common obsessions reported were contamination and worries about harm. Common compulsions included washing and rituals to prevent harm. The only significant differences across age groups were the percentage of religious worries and slightly higher severity of obsessions in the adolescent age group (p < 0.05). The presence of tics was associated with increased frequency of repetitive behavior unrelated to harm avoidance (p < 0.05). Children without a history of tics were more likely to describe incidents of contamination, washing, and repetitive request for reassurance (p < 0.05 for each). CONCLUSION: In this convenient sample of clinically ascertained children, there were few phenotypic differences in children above or below the age of 11 years. Differences in the distribution of OCD symptoms according to the presence or absence of tics, which has been documented in adult samples, were evident in this sample.

An approach to dialysis for ethylene glycol intoxication.

Eleven cases of ethylene glycol ingestion were retrospectively analyzed for presentation, treatment, and outcome. Patients were grouped according to the time it took to receive medical attention, and whether or not they received I continuous hemodialysis (CHD) versus intermittent hemodialysis (IHD). Six patients presented within 12 h of exposure (Group 1), whereas 5 patients presented later (Group 2; range 48-120 h). Comparisons were made for age, ethylene glycol level, anion gap, osmolar gap, pH, admission creatinine level, time from ingestion to presentation, total time spent on hemodialysis, number of dialysis treatments, recovery time, recovery creatinine, hospital length of stay, and status. Significant differences were observed for ethylene glycol level, osmolar gap, and presentation time. Ten of the 11 patients received single pass hemodialysis, and 5 of these received I CHD. Of the 5 patients who received CHD versus the 5 patients who received IHD, none developed complications (p=0.004). Patients who presented within 10 h of exposure had fewer complications than those who presented > 12 h after exposure Timely CHD is superior to IHD in treating ethylene glycol intoxication. An adeQuate time course of hemodialysis can be approximated using the ethylene gycol index, and may eliminate reliance on ethylene glycol levels in determining adequate endpoints of dialysis in treating poisoned patients.