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1.
PLoS Med ; 17(9): e1003245, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32898152

RESUMO

BACKGROUND: Beverages, especially sugar-sweetened beverages (SSBs), have been increasingly subject to policies aimed at reducing their consumption as part of measures to tackle obesity. However, precision targeting of policies is difficult as information on what types of consumers they might affect, and to what degree, is missing. We fill this gap by creating a typology of beverage consumers in Great Britain (GB) based on observed beverage purchasing behaviour to determine what distinct types of beverage consumers exist, and what their socio-demographic (household) characteristics, dietary behaviours, and weight status are. METHODS AND FINDINGS: We used cross-sectional latent class analysis to characterise patterns of beverage purchases. We used data from the 2016 GB Kantar Fast-Moving Consumer Goods (FMCG) panel, a large representative household purchase panel of food and beverages brought home, and restricted our analyses to consumers who purchase beverages regularly (i.e., >52 l per household member annually) (n = 8,675). Six categories of beverages were used to classify households into latent classes: SSBs; diet beverages; fruit juices and milk-based beverages; beer and cider; wine; and bottled water. Multinomial logistic regression and linear regression were used to relate class membership to household characteristics, self-reported weight status, and other dietary behaviours, derived from GB Kantar FMCG. Seven latent classes were identified, characterised primarily by higher purchases of 1 or 2 categories of beverages: 'SSB' (18% of the sample; median SSB volume = 49.4 l/household member/year; median diet beverage volume = 38.0 l), 'Diet' (16%; median diet beverage volume = 94.4 l), 'Fruit & Milk' (6%; median fruit juice/milk-based beverage volume = 30.0 l), 'Beer & Cider' (7%; median beer and cider volume = 36.3 l; median diet beverage volume = 55.6 l), 'Wine' (18%; median wine volume = 25.5 l; median diet beverage volume = 34.3 l), 'Water' (4%; median water volume = 46.9 l), and 'Diverse' (30%; diversity of purchases, including median SSB volume = 22.4 l). Income was positively associated with being classified in the Diverse class, whereas low social grade was more likely for households in the classes SSB, Diet, and Beer & Cider. Obesity (BMI > 30 kg/m2) was more prevalent in the class Diet (41.2%, 95% CI 37.7%-44.7%) despite households obtaining little energy from beverages in that class (17.9 kcal/household member/day, 95% CI 16.2-19.7). Overweight/obesity (BMI > 25 kg/m2) was above average in the class SSB (66.8%, 95% CI 63.7%-69.9%). When looking at all groceries, households from the class SSB had higher total energy purchases (1,943.6 kcal/household member/day, 95% CI 1,901.7-1,985.6), a smaller proportion of energy from fruits and vegetables (6.0%, 95% CI 5.8%-6.3%), and a greater proportion of energy from less healthy food and beverages (54.6%, 95% CI 54.0%-55.1%) than other classes. A greater proportion of energy from sweet snacks was observed for households in the classes SSB (18.5%, 95% CI 18.1%-19.0%) and Diet (18.8%, 95% CI 18.3%-19.3%). The main limitation of our analyses, in common with other studies, is that our data do not include information on food and beverage purchases that are consumed outside the home. CONCLUSIONS: Amongst households that regularly purchase beverages, those that mainly purchased high volumes of SSBs or diet beverages were at greater risk of obesity and tended to purchase less healthy foods, including a high proportion of energy from sweet snacks. These households might additionally benefit from policies targeting unhealthy foods, such as sweet snacks, as a way of reducing excess energy intake.


Assuntos
Bebidas/economia , Comércio/tendências , Comportamento do Consumidor/economia , Adulto , Animais , Bebidas Adoçadas Artificialmente , Cerveja , Peso Corporal , Comportamento do Consumidor/estatística & dados numéricos , Estudos Transversais , Água Potável , Características da Família , Feminino , Sucos de Frutas e Vegetais , Humanos , Renda , Análise de Classes Latentes , Masculino , Leite , Inquéritos Nutricionais , Obesidade/psicologia , Reino Unido , Vinho
2.
BMC Public Health ; 20(1): 1475, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993606

RESUMO

BACKGROUND: In Japan, a high-sodium diet is the most important dietary risk factor and is known to cause a range of health problems. This study aimed to forecast Japan's disability-adjusted life year (DALYs) for chronic diseases that would be associated with high-sodium diet in different future scenarios of salt intake. We modelled DALY forecast and alternative future scenarios of salt intake for cardiovascular diseases (CVDs), chronic kidney diseases (CKDs), and stomach cancer (SC) from 2017 to 2040. METHODS: We developed a three-component model of disease-specific DALYs: a component on the changes in major behavioural and metabolic risk predictors including salt intake; a component on the income per person, educational attainment, and total fertility rate under 25 years; and an autoregressive integrated moving average model to capture the unexplained component correlated over time. Data on risk predictors were obtained from Japan's National Health and Nutrition Surveys and from the Global Burden of Disease Study 2017. To generate a reference forecast of disease-specific DALY rates for 2017-2040, we modelled the three diseases using the data for 1990-2016. Additionally, we generated better, moderate, and worse scenarios to evaluate the impact of change in salt intake on the DALY rate for the diseases. RESULTS: In our reference forecast, the DALY rates across all ages were predicted to be stable for CVDs, continuously increasing for CKDs, and continuously decreasing for SC. Meanwhile, the age group-specific DALY rates for these three diseases were forecasted to decrease, with some exceptions. Except for the ≥70 age group, there were remarkable differences in DALY rates between scenarios, with the best scenario having the lowest DALY rates in 2040 for SC. This represents a wide scope of future trajectories by 2040 with a potential for tremendous decrease in SC burden. CONCLUSIONS: The gap between scenarios provides some quantification of the range of policy impacts on future trajectories of salt intake. Even though we do not yet know the policy mix used to achieve these scenarios, the result that there can be differences between scenarios means that policies today can have a significant impact on the future DALYs.


Assuntos
Doença Crônica/tendências , Pessoas com Deficiência/estatística & dados numéricos , Promoção da Saúde/organização & administração , Anos de Vida Ajustados por Qualidade de Vida , Cloreto de Sódio na Dieta/efeitos adversos , Adulto , Doenças Cardiovasculares/epidemiologia , Dieta/estatística & dados numéricos , Previsões , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Cloreto de Sódio na Dieta/administração & dosagem
3.
Environ Health ; 19(1): 94, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32867766

RESUMO

BACKGROUND: Various risk factors influence obesity differently, and environmental endocrine disruption may increase the occurrence of obesity. However, most of the previous studies have considered only a unitary exposure or a set of similar exposures instead of mixed exposures, which entail complicated interactions. We utilized three statistical models to evaluate the correlations between mixed chemicals to analyze the association between 9 different chemical exposures and obesity in children and adolescents. METHODS: We fitted the generalized linear regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) to analyze the association between the mixed exposures and obesity in the participants aged 6-19 in the National Health and Nutrition Examination Survey (NHANES) 2005-2010. RESULTS: In the multivariable logistic regression model, 2,5-dichlorophenol (2,5-DCP) (OR (95% CI): 1.25 (1.11, 1.40)), monoethyl phthalate (MEP) (OR (95% CI): 1.28 (1.04, 1.58)), and mono-isobutyl phthalate (MiBP) (OR (95% CI): 1.42 (1.07, 1.89)) were found to be positively associated with obesity, while methylparaben (MeP) (OR (95% CI): 0.80 (0.68, 0.94)) was negatively associated with obesity. In the multivariable linear regression, MEP was found to be positively associated with the body mass index (BMI) z-score (ß (95% CI): 0.12 (0.02, 0.21)). In the WQS regression model, the WQS index had a significant association (OR (95% CI): 1.48 (1.16, 1.89)) with the outcome in the obesity model, in which 2,5-DCP (weighted 0.41), bisphenol A (BPA) (weighted 0.17) and MEP (weighted 0.14) all had relatively high weights. In the BKMR model, despite no statistically significant difference in the overall association between the chemical mixtures and the outcome (obesity or BMI z-score), there was nonetheless an increasing trend. 2,5-DCP and MEP were found to be positively associated with the outcome (obesity or BMI z-score), while fixing other chemicals at their median concentrations. CONCLUSION: Comparing the three statistical models, we found that 2,5-DCP and MEP may play an important role in obesity. Considering the advantages and disadvantages of the three statistical models, our study confirms the necessity to combine different statistical models on obesity when dealing with mixed exposures.


Assuntos
Exposição Ambiental/efeitos adversos , Monitoramento Ambiental/métodos , Poluentes Ambientais/efeitos adversos , Obesidade Pediátrica/epidemiologia , Adolescente , Teorema de Bayes , Criança , Feminino , Humanos , Modelos Lineares , Masculino , Modelos Estatísticos , Inquéritos Nutricionais , Obesidade Pediátrica/induzido quimicamente , Prevalência , Estados Unidos/epidemiologia
4.
Health Rep ; 31(9): 13-26, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32935961

RESUMO

BACKGROUND: Adults spend a large proportion of their day at work. Physical activity (PA) and sedentary behaviour (SB) have been shown to vary considerably between occupations. The objective of this study is to describe occupational differences in accelerometer-measured and self-reported PA and SB for Canadian full-time workers. DATA AND METHODS: Using combined data from three cycles of the nationally representative Canadian Health Measures Survey (N = 4,080), three activity groups (high, intermediate, low) were created based on a composite ranking of accelerometer-derived steps, proportion of time spent sedentary (SED%) and moderate-to-vigorous intensity physical activity (MVPA) in bouts of ⋝10 minutes (MVPAbouted). Differences between groups were assessed for accelerometer-derived and self-reported PA and SB, and sociodemographic and clinical characteristics. RESULTS: On average, Canadians employed in full-time work were sedentary for 68.9% of their day (95% confidence interval [CI]: 68.3% to 69.6%), took 8,984 steps per day (95% CI: 8,719 to 9,249) and accumulated 79.5 minutes per week of MVPAbouted (95% CI: 71.1 to 87.9). Among Canadians employed in full-time work, 18.5% met the Canadian Physical Activity Guidelines. The high-activity group took significantly more steps and had a lower SED%, but spent a higher proportion of time in light-intensity PA compared with the intermediate- and low-activity groups. No differences were observed for MVPA. The low-activity group reported more recreational and active travel-related PA and leisure reading, while those in the high-activity group reported more work and domestic PA and leisure screen time. DISCUSSION: The majority of full-time working adults are not getting adequate MVPA and spend most of their day sedentary, regardless of occupation. Findings support workplace policies to improve MVPA levels among Canadian workers and to promote awareness for the potential benefit of occupation-specific messaging around PA and SB.


Assuntos
Inquéritos Nutricionais , Comportamento Sedentário , Adulto , Canadá , Exercício Físico , Humanos , Viagem , Doença Relacionada a Viagens
5.
J Am Dent Assoc ; 151(10): 782-789, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32979957

RESUMO

BACKGROUND: The authors' aim was to examine the association between sugar-sweetened beverage (SSB) consumption and the prevalence and severity of the caries experience in children and adults in the United States. METHODS: The authors analyzed data obtained from 14,192 people aged 2 through 74 years, who participated in the National Health and Nutrition Examination Survey from 2011 through 2014. Using descriptive analyses, the authors assessed the distributions of sociodemographic characteristics overall and via SSB intake. The authors used multivariable logistic regression to estimate the association of untreated and severe untreated caries with SSB consumption in all age groups. RESULTS: Across all ages, male participants were more likely than female participants to consume SSBs, and consumption was higher in non-Hispanic black and Hispanic populations. Relative to those who did not consume SSBs, people aged 20 through 44 years who consumed SSBs had significantly higher odds of having untreated caries (adjusted odds ratio [AOR], 1.27; 95% confidence interval [CI], 1.04 to 1.55) and severe untreated caries (AOR, 1.36; 95% CI, 1.15 to 1.60). Adolescents aged 9 through 19 years had significantly higher odds of having untreated caries (AOR, 1.37; 95% CI, 1.05 to 1.80), and middle-aged adults (45-64 years) had significantly higher odds of severe untreated caries (AOR, 1.46; 95% CI, 1.10 to 1.92) relative to those who did not consume SSBs. CONCLUSIONS: Consumption of SSBs was associated with increased caries experience among young children and increased risk of developing untreated caries in all age groups of children and adults. Continued efforts by policy makers, public health leaders, and clinicians to reduce consumption of SSBs across the life span are paramount.


Assuntos
Cárie Dentária , Inquéritos Nutricionais , Adolescente , Adulto , Afro-Americanos , Idoso , Bebidas/efeitos adversos , Bebidas/análise , Criança , Pré-Escolar , Estudos Transversais , Cárie Dentária/epidemiologia , Cárie Dentária/etiologia , Sacarose na Dieta/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bebidas Adoçadas com Açúcar , Estados Unidos/epidemiologia , Adulto Jovem
6.
Medicine (Baltimore) ; 99(31): e21159, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756093

RESUMO

Being overweight and obese is a serious public health issues in China. However, the effects of substance use and mental factors on weight changes remain unclear. In this study, we aimed to investigate the association among self-perceived stress, history of smoking and drinking, and weight status by using data from the China Health and Nutrition Survey in 2015.A total of 8028 adults were selected from China Health and Nutrition Survey in 2015. The self-reported data primarily included sociodemographic data, self-perceived stress scores, and history of smoking and drinking. Physical measurements including height and weight were logged to calculate body mass index. Multivariate and multinomial regression models were used to estimate effects of substance and perceived stress on weight status.The prevalence of underweight and overweight/obese people were 4.52% and 51.51% in Chinese adults, respectively. Adults with high perceived stress were negatively associated with being overweight and obese (OR = 0.80, 95% CI = 0.66-0.97 in the middle level and OR = 0.69, 95%CI = 0.55-0.88 in the high level). Adults with history of smoking had low risk of being overweight/obese (OR = 0.71, 95% CI = 0.62-0.82). Adults with history of drinking had high risk of overweight/obese (OR = 1.22, 95% CI = 1.06-1.40). In addition, the association between drinking and overweight/obese was affected by different levels of perceived stress (OR = 1.15, 95%CI = 0.83-1.59 in low-stress group and OR = 1.42, 95%CI = 1.04-1.94 in high-stress group).The effects of self-perceived stress and history of smoking as well as drinking on weight status were significant in this study. The government and healthcare policymakers should strengthen early psychological factor and behavioral intervention to decrease the prevalence of abnormal-weight status.


Assuntos
Consumo de Bebidas Alcoólicas , Obesidade/epidemiologia , Fumar , Estresse Psicológico , Adulto , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/etiologia , Obesidade/psicologia , Prevalência , Fatores Socioeconômicos
8.
Environ Pollut ; 265(Pt A): 114763, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32806428

RESUMO

Ubiquitous exposure to endocrine disruptive chemicals (EDC) among women of reproductive age is alarming. Exposure to EDCs could be contributing to infertility. We determined the association between common EDCs and self-reported infertility among U.S. women, 18-45 years of age using the National Health and Nutrition Examination Surveys (NHANES) for periods 2013-2014 and 2015-2016. A cross-sectional study on reproductive age women was conducted. Available important sociodemographic variables, and urinary concentrations of parabens (methyl paraben [MP], ethyl paraben [EP], propyl paraben [PP], and butyl paraben [BP]), Benzophenone-3 (BP-3), Bisphenol-A (BPA), and triclosan (TCS) were obtained from the NHANES databases. Clustering among EDCs were obtained using variable cluster analysis. Relative risk regression models were used to estimate associations of individual and combined EDCs with self-reported infertility after applying appropriate survey weights to account for the complex survey design as well as to compensate for the four-year cycle. Results were summarized using prevalence ratio (PR) with 95% confidence interval (CI). Of total 789 individuals included in the study, 14% (95%CI: 11%-18%) had infertility. MP and PP were detected in 99% of urine samples, BP in 46%, EP and BP-3 in 96%, BPA in 94% and TCS in 73%. Self-reported infertility was significantly associated with combined score of BP-3, BPA and TCS (PR = 1.13, p = 0.007), and above detection level of EP (PR = 1.57, p = 0.025) even after adjusting for potential confounders. Our results suggested the EP and mixtures of benzophenones, TCS, and BPA were associated with infertility among the U.S. women. However, because of the limitations inherent to the cross-sectional study design, prospective cohort studies are warranted to confirm these findings.


Assuntos
Infertilidade Feminina , Triclosan , Adolescente , Adulto , Benzofenonas , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos Nutricionais , Parabenos , Estudos Prospectivos , Adulto Jovem
9.
Nutrients ; 12(8)2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32751721

RESUMO

AIM: to describe physical activity and ultra-processed foods consumption, their changes and sociodemographic predictors among adolescents from countries in Europe (Italy and Spain) and Latin America (Brazil, Chile, and Colombia) during the SARS-CoV-2-pandemic period. METHODS: Cross-sectional study via web survey. International Physical Activity Questionnaire (IPAQ) and weekly ultra-processed food consumption data were used. To compare the frequencies of physical activity status with sociodemographic variables, a multinomial logistic and a multiple logistic regression for habitual ultra-processed foods was performed. In final models, p < 0.05 was considered significant. RESULTS: Sample of 726 adolescents, mostly females (59.6%) aged 16-19 years old (54.3%). Adolescents from Latin America presented odds ratio (OR) 2.98 (CI 95% 1.80-4.94) of being inactive and those whose mothers had higher level of education were less active during lockdown [OR 0.40 (CI 95% 0.20-0.84)]. The habitual ultra-processed consumption was also high during this period in all countries, and more prevalent in Latin America. CONCLUSION: A higher prevalence of inactivity was observed in this population, but reductions of physical activity and habitual ultra-processed consumption during the pandemic were more pronounced in Latin America. Our findings reinforce the importance of promoting a healthy lifestyle, i.e., exercise and diet, during periods of social isolation.


Assuntos
Infecções por Coronavirus , Dieta , Exercício Físico , Fast Foods , Comportamento Alimentar , Pandemias , Pneumonia Viral , Comportamento Sedentário , Adolescente , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , Ingestão de Energia , Europa (Continente) , Feminino , Estilo de Vida Saudável , Humanos , Modelos Logísticos , Masculino , Inquéritos Nutricionais , Obesidade/etiologia , Razão de Chances , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Isolamento Social , América do Sul , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-32751821

RESUMO

The tendency of misperceiving one's body image was found to be higher among those at normal body mass index (BMI). Thus, the present study aims to provide basic data to seek solutions for ideal physical activities and right body image perception by comparing health-related behaviors of women at normal BMI. Among the 39,225 respondents from the Korea National Health and Nutrition Examination Survey (KNHNES) conducted from 2013 to 2017, 10,798 adult women with World Health Organization (WHO) BMI Classifications of 18.5 ≤ BMI < 25 (Asia-Pacific) were considered, from which pregnant and breast-feeding women and women whose body image perception was not identified were excluded, leading to a total of 9288 women. Data were analyzed utilizing SAS ver. 9.4 for frequency analysis, cross tabulation, GLM (generalized linear model), and logistic regression analysis with complex samples design, in conformity with the guidelines of the KNHNES. The results showed that approximately most (87.6%) of adult Korean women misperceived their body image. Misperception of body image was related to inappropriate health-related behaviors such as smoking, insufficient sleeping, and excessive body weight management; those who had underestimated their body image (≤64 odds ratio (OR) (0.718 (confidence interval (C.I.) 0.594-0.866))) carried out fewer health-related behaviors, while women aged 65 or above engaged in more health-related behaviors when they perceived themselves as obese (OR 1.683 (C.I. 1.260-2.248; overestimation)). To sum up, it was found that lack of health management, inappropriate body weight control, and health-related behaviors are related to body image misperception compared with real BMI. As such, it is necessary to have educational programs to encourage building proper perception of one's body image and body weight, and to carry out health-related behaviors.


Assuntos
Imagem Corporal/psicologia , Peso Corporal/etnologia , Comportamentos Relacionados com a Saúde/etnologia , Adulto , Idoso , Ásia , Grupo com Ancestrais do Continente Asiático , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Inquéritos Nutricionais , República da Coreia
11.
PLoS One ; 15(8): e0237983, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822397

RESUMO

OBJECTIVES: Although smoking is known to have a negative impact in patients with metabolic syndrome (MetS), only a few studies have examined the association between electronic cigarette (e-cig) use and MetS. METHODS: Among 22,948 participants in the 6th Korea National Health and Nutrition Examination Survey, 14,738 (13,459 [91.3%] never, 954 [6.5%] ever, and 325 [2.2%] current e-cig users) were selected. The relationship between e-cig exposure and MetS (based on the National Cholesterol Education Program Adult Treatment Panel [NCEP-ATP] III criteria) was evaluated using a multivariable logistic regression analysis. An unweighted analysis was performed to evaluate this association without a sampling weight. A subgroup analysis was performed among active smokers to compare dual users with never e-cig users. RESULTS: Among current e-cig users, 85.0% were dual users, 12.7% were former cigarette users, and 2.2% were only e-cig users. After adjustment for covariates, abdominal obesity and hypertriglyceridemia were significantly associated with current e-cig exposure (odds ratio [OR]: 1.88, 95% confidence interval [CI]: 1.41-2.50 and OR: 1.32, 95% CI: 1.00-1.74 respectively [compared with the never e-cig users group]). Compared with never e-cig users, current e-cig users showed an OR of 1.27 (95% CI: 0.96-1.70, Ptrend = 0.01) for MetS. In the unweighted analysis, the OR for MetS in current e-cig users was 1.40 (95% CI: 1.08-1.81, Ptrend <0.01). Compared with never e-cig users, dual users showed a higher OR for abdominal obesity (OR: 1.71, 95% CI: 1.25-2.34, Ptrend <0.001). CONCLUSIONS: Current e-cig exposure was associated with an increased risk of MetS. Dual use of e-cigs and cigarettes was associated with abdominal obesity. Further longitudinal studies and better assessment of e-cig use and type are needed to clarify this relationship.


Assuntos
Síndrome Metabólica/patologia , Vaping , Adulto , HDL-Colesterol/sangue , Fumar Cigarros , Feminino , Humanos , Hipertrigliceridemia/epidemiologia , Hipertrigliceridemia/patologia , Modelos Logísticos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/epidemiologia , Obesidade/patologia , Razão de Chances , República da Coreia/epidemiologia , Triglicerídeos/sangue
12.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32859735

RESUMO

OBJECTIVES: Food insecurity has been associated with obesity, but previous studies are inconsistent and few included infants. We examined associations between household food security and infant adiposity and assessed the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) as effect modifiers. We hypothesized that infants from food-insecure households would have greater adiposity, with attenuation by WIC and SNAP. METHODS: We repeatedly measured 666 infants from the southeastern United States in 2013-2017. We categorized households as high, marginal, low, or very low using the US Household Food Security Survey Module. Outcomes were BMI z score, subscapular and triceps skinfold-for-age z score, the sum of subscapular and triceps skinfolds, the ratio of subscapular and triceps skinfolds, and BMI z score ≥1 (at risk for overweight). We used covariate-adjusted repeated-measures linear and logistic regressions. RESULTS: Of infants, 68.6% were Black and 60.5% had household incomes <$20 000. Interactions between food security and WIC and/or SNAP were not significant. Compared with infants from high food security households, infants from very low food security households had higher BMI z scores (0.18 U; 95% confidence interval [CI] 0.01 to 0.35), higher subscapular skinfold-for-age z scores (0.31 U; 95% CI 0.04 to 0.59), a higher sum of subscapular and triceps skinfolds (0.53 mm; 95% CI 0.002 to 1.07), and greater odds of being at risk for overweight (odds ratio 1.55; 95% CI 1.14 to 2.10). Infants from low food security households had greater odds of being at risk for overweight (odds ratio 1.72; 95% CI 1.17 to 2.10). CONCLUSIONS: In larger and longer studies, researchers should examine food security and adiposity in young children.


Assuntos
Adiposidade/fisiologia , Características da Família , Abastecimento de Alimentos/economia , Inquéritos Nutricionais/economia , Obesidade Pediátrica/economia , Obesidade Pediátrica/epidemiologia , Adulto , Estudos de Coortes , Feminino , Assistência Alimentar/economia , Assistência Alimentar/tendências , Humanos , Lactente , Masculino , Inquéritos Nutricionais/tendências , Obesidade Pediátrica/diagnóstico , Sudeste dos Estados Unidos/epidemiologia
13.
PLoS One ; 15(7): e0236738, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735599

RESUMO

Ultra-processed food consumption has been associated with several health outcomes such as obesity, hypertension, cardiovascular disease and cancer. The deleterious nutrient profile of these products, and the presence of food additives, neoformed contaminants and contact materials such as phthalates and bisphenol may be some of the potential pathways through which ultra-processed food influences disease outcomes. The aim of this study was to examine the association between dietary contribution of ultra-processed foods and urinary biomarker concentrations of parent compounds or their metabolites including Di(2-ethylhexyl) phthalate (ΣDEHP), Di-isononyl phthalate (ΣDiNP), Monocarboxynonyl phthalate (mCNP), Mono (3-carboxypropyl) phthalate (mCPP), Monobenzyl phthalate (mBzP), Bisphenol A (BPA), Bisphenol F (BPF) and Bisphenol S (BPS), in the US. Participants from the cross-sectional 2009-2016 National Health and Nutrition Examination Survey, aged 6+ years, with urinary measures and with one 24-hour dietary recall were included in the study. Ultra-processed foods were identified based on the NOVA classification system, a four-group food classification based on the extent and purpose of industrial food processing. Linear regression was used to compare average urinary creatinine-standardized concentrations across quintiles of energy contribution of ultra-processed foods. Models incorporated survey sample weights and were adjusted for different sociodemographic and life-style variables. Adjusted geometric means of ΣDiNP, mCNP, mCPP, mBzP and BPF increased monotonically from the lowest to the highest quintile of ultra-processed food consumption. As both phthalates/bisphenol and ultra-processed foods have been previously associated with insulin resistance, diabetes, general/abdominal obesity and hypertension, our results suggest the possibility of contact materials in ultra-processed foods as one link between ultra-processed food and these health outcomes. Future studies could confirm findings and further explore these mechanisms of action.


Assuntos
Dieta , Fast Foods , Fenóis/urina , Ácidos Ftálicos/urina , Adolescente , Adulto , Compostos Benzidrílicos/urina , Criança , Estudos Transversais , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Estrogênios não Esteroides/urina , Fast Foods/efeitos adversos , Fast Foods/estatística & dados numéricos , Feminino , Aditivos Alimentares/efeitos adversos , Manipulação de Alimentos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Saúde Pública/estatística & dados numéricos , Sulfonas/urina , Adulto Jovem
14.
PLoS Med ; 17(8): e1003256, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32853224

RESUMO

BACKGROUND: Ultra-processed food (UPF) consumption has increased drastically worldwide and already represents 50%-60% of total daily energy intake in several high-income countries. In the meantime, the prevalence of overweight and obesity has risen continuously during the last century. The objective of this study was to investigate the associations between UPF consumption and the risk of overweight and obesity, as well as change in body mass index (BMI), in a large French cohort. METHODS AND FINDINGS: A total of 110,260 adult participants (≥18 years old, mean baseline age = 43.1 [SD 14.6] years; 78.2% women) from the French prospective population-based NutriNet-Santé cohort (2009-2019) were included. Dietary intakes were collected at baseline using repeated and validated 24-hour dietary records linked to a food composition database that included >3,500 different food items, each categorized according to their degree of processing by the NOVA classification. Associations between the proportion of UPF in the diet and BMI change during follow-up were assessed using linear mixed models. Associations with risk of overweight and obesity were assessed using Cox proportional hazard models. After adjusting for age, sex, educational level, marital status, physical activity, smoking status, alcohol intake, number of 24-hour dietary records, and energy intake, we observed a positive association between UPF intake and gain in BMI (ß Time × UPF = 0.02 for an absolute increment of 10 in the percentage of UPF in the diet, P < 0.001). UPF intake was associated with a higher risk of overweight (n = 7,063 overweight participants; hazard ratio (HR) for an absolute increase of 10% of UPFs in the diet = 1.11, 95% CI: 1.08-1.14; P < 0.001) and obesity (n = 3,066 incident obese participants; HR10% = 1.09 (1.05-1.13); P < 0.001). These results remained statistically significant after adjustment for the nutritional quality of the diet and energy intake. Study limitations include possible selection bias, potential residual confounding due to the observational design, and a possible item misclassification according to the level of processing. Nonetheless, robustness was tested and verified using a large panel of sensitivity analyses. CONCLUSIONS: In this large observational prospective study, higher consumption of UPF was associated with gain in BMI and higher risks of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting UPF consumption. TRIAL REGISTRATION: ClinicalTrials.gov NCT03335644 (https://clinicaltrials.gov/ct2/show/NCT03335644).


Assuntos
Índice de Massa Corporal , Ingestão de Energia/fisiologia , Fast Foods/efeitos adversos , Inquéritos Nutricionais/tendências , Valor Nutritivo/fisiologia , Sobrepeso/epidemiologia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Sobrepeso/diagnóstico , Estudos Prospectivos , Fatores de Risco
15.
PLoS One ; 15(8): e0237149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764774

RESUMO

PURPOSE: To investigate the association between daily sunlight exposure duration and diabetic retinopathy in Korean adults with diabetes. METHODS: This study used data from the 2008-2011 Korea National Health and Nutrition Examination Survey. Overall, 1,089 patients with diabetes aged >40 years were included. The duration of daily sunlight exposure was assessed via health interviews. Comprehensive ophthalmic evaluations, including standard retinal fundus photography after pupil dilation, were conducted. Diabetic retinopathy was graded using the modified Airlie House Classification. Multivariate logistic regression analysis was performed to analyze the association between daily sunlight exposure duration and the diagnosis of diabetic retinopathy and non-proliferative diabetic retinopathy. RESULTS: The risk of diabetic retinopathy was 2.66 times higher in the group with ≥5 h of daily sunlight exposure than in the group with less exposure after adjusting for risk factors such as duration of diabetes, serum hemoglobin A1c level, hypertension, and dyslipidemia (P = 0.023). Furthermore, the risk of non-proliferative diabetic retinopathy was 3.13 times higher in the group with ≥5 h of daily sunlight exposure than in the group with less exposure (P = 0.009). In patients with diabetes for <10 years, the risks of diabetic retinopathy and non-proliferative diabetic retinopathy were 4.26 and 4.82 times higher in the group with ≥5 h of daily sunlight exposure than the group with less exposure, respectively (P < 0.05). CONCLUSIONS: This study revealed that sunlight exposure for ≥5 h a day was significantly associated with an increased risk of diabetic retinopathy and non-proliferative diabetic retinopathy in Korean patients with diabetes. The risks were significantly higher in patients with diabetes for <10 years. Therefore, reducing daily sunlight exposure could be an early preventive strategy against diabetic retinopathy in people with diabetes.


Assuntos
Retinopatia Diabética/epidemiologia , Luz Solar/efeitos adversos , Idoso , Estudos Transversais , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/etiologia , Retinopatia Diabética/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais/estatística & dados numéricos , Estresse Oxidativo/efeitos da radiação , Fotografação , Fotoperíodo , Prevalência , República da Coreia/epidemiologia , Retina/diagnóstico por imagem , Retina/efeitos da radiação , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
16.
Am Heart J ; 228: 44-46, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32771699

RESUMO

Recent results from the ISCHEMIA trial highlight the importance of medical management for patients with stable ischemic heart disease. We determine the prevalence of angina in the United States, as well as the use of first-line goal directed therapy by US patients with angina. We used individual patient level data from the National Health and Nutrition Examination Survey (NHANES), 2007-2016. Using the complex survey weights, we create projections for the US population with angina as well as those using ß-blockers, antiplatelet agents, or statins-3 first-line medications for patients with angina. Among adults ≥40 years old, 4,469,934 US adults are estimated to have physician-diagnosed angina. Of the patients with angina, 2,757,171 (61.7%) were on ß-blockers, 2,984,902 (66.8%) were on statins, and 2,433,088 (54.4%) were on any antiplatelet medication; 1,457,983 patients were on all 3 medications, for an overall proportion of 32.6% of angina patients taking all three first-line medications in the United States. While the prevalence of angina in the US is high, the use of goal-directed medical therapy remains low. Strategies to improve the use of medications for preventing secondary events are urgently needed.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Angina Estável , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Prevenção Secundária , Adulto , Angina Estável/tratamento farmacológico , Angina Estável/epidemiologia , Uso de Medicamentos/normas , Uso de Medicamentos/estatística & dados numéricos , Feminino , Mau Uso de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Inquéritos Nutricionais/estatística & dados numéricos , Prevalência , Prevenção Secundária/métodos , Prevenção Secundária/normas , Estados Unidos/epidemiologia
17.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32778539

RESUMO

BACKGROUND: The optimal approach to screening and diagnosis of prediabetes and diabetes in youth is uncertain. METHODS: We conducted a cross-sectional analysis of 14 119 youth aged 10 to 19 years in the 1999-2016 NHANES. First, we examined the performance of American Diabetes Association risk-based screening criteria. Second, we evaluated the performance of current clinical definitions of prediabetes and diabetes based on hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), either HbA1c or FPG, or both HbA1c and FPG (confirmatory definition) to identify youth at high cardiometabolic risk. RESULTS: Overall, 25.5% of US youth (10.6 million in 2016) were eligible for screening. Sensitivity and specificity of the screening criteria for detecting any hyperglycemia were low for both HbA1c ≥5.7% (sensitivity = 55.5%, specificity = 76.3%) and FPG ≥100 mg/dL (sensitivity = 35.8%, specificity = 77.1%). Confirmed undiagnosed diabetes (HbA1c ≥6.5% and FPG ≥126 mg/dL) was rare, <0.5% of youth. Most (>85%) cases of diabetes were diagnosed. Associations with cardiometabolic risk were consistently stronger and more specific for HbA1c-defined hyperglycemia (specificity = 98.6%; sensitivity = 4.0%) than FPG-defined hyperglycemia (specificity = 90.1%; sensitivity = 19.4%). CONCLUSIONS: One-quarter of US youth are eligible for screening for diabetes and prediabetes; however, few will test positive, especially for diabetes. Most cases of diabetes in US youth are diagnosed. Regardless of screening eligibility, we found that HbA1c is a specific and useful nonfasting test to identify high-risk youth who could benefit from lifestyle interventions to prevent diabetes and cardiovascular risk in adulthood.


Assuntos
Glicemia/análise , Diabetes Mellitus/diagnóstico , Jejum/sangue , Hemoglobina A Glicada/análise , Estado Pré-Diabético/diagnóstico , Adolescente , Criança , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/etnologia , Programas de Rastreamento/estatística & dados numéricos , Síndrome Metabólica/diagnóstico , Inquéritos Nutricionais , Obesidade Pediátrica/epidemiologia , Guias de Prática Clínica como Assunto , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/etnologia , Prevalência , Sensibilidade e Especificidade , Estados Unidos/epidemiologia , Adulto Jovem
18.
BMC Public Health ; 20(1): 1155, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32787863

RESUMO

BACKGROUND: Nearly 40 million American adults report past year food insecurity. This is concerning, as food insecurity is associated with chronic disease morbidity and premature mortality. Women disproportionately experience food insecurity, and sexual minority women (i.e., lesbian, bisexual, and heterosexual women reporting same-sex behavior; SMW) may be at greater risk for experiencing food insecurity disparities. The purpose of this study was to investigate patterns and prevalence of food insecurity and food assistance use in sexual minority and exclusively heterosexual women using population-level health surveillance data. METHODS: Using pooled 2004-2014 National Health and Nutrition Examination Survey data (N = 7379), we estimated weighted point prevalence of past 12-month food insecurity, severe food insecurity, Supplemental Nutrition Assistance Program (SNAP) use, and emergency food assistance use. We then used Poisson regression with robust variance to estimate prevalence ratios comparing SMW to exclusively heterosexual women on all outcomes. Women were classified by sexual identity and lifetime same-sex behavior as lesbian (n = 88), bisexual (n = 251), heterosexual and reporting same-sex behavior (heterosexual WSW; n = 366), or exclusively heterosexual women (referent; n = 6674). RESULTS: Between 20.6-27.3% of lesbian, bisexual, and heterosexual WSW reported past 12-month food insecurity (versus 13.1% of exclusively heterosexual women). All SMW reported greater prevalence of past 12-month food insecurity and severe food insecurity than exclusively heterosexual women: prevalence ratios (PR) ranged from 1.34 (95% confidence interval [CI], 1.05-1.70) to 1.84 (95% CI, 1.13-3.01). No differences were found in SNAP participation by sexual orientation, but more lesbians and heterosexual WSW reported using emergency food assistance in the past 12-months (PR = 1.89; 95% CI, 1.29-2.79 and PR = 1.43; 95% CI, 1.03-2.00 respectively). CONCLUSIONS: All SMW reported higher prevalence of food insecurity than exclusively heterosexual women. Lesbians and heterosexual WSW were also more likely to rely on emergency food assistance. This is problematic as SNAP use may reduce food insecurity over time, but emergency food resources (e.g., food pantries) do not. More evidence is needed to understand the multilevel factors driving food insecurity in this population to develop policy and community-based efforts to increase SNAP participation and decrease food insecurity.


Assuntos
Assistência Alimentar/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estados Unidos , Adulto Jovem
19.
JAMA ; 324(4): 359-368, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32721008

RESUMO

Importance: The Healthy, Hunger-Free Kids Act of 2010, implemented nationwide in 2012, was intended to improve the nutritional quality of meals served in the National School Lunch Program (NSLP). Objective: To assess whether there was an association between the Healthy, Hunger-Free Kids Act of 2010 and dietary quality of lunch for students participating in the NSLP, stratified by income. Design, Setting, Participants: Serial cross-sectional study design, using National Health and Nutrition Examination Survey (NHANES) data from 2007-2008, 2009-2010, 2013-2014, and 2015-2016, of students who were surveyed in the NHANES and were attending schools participating in the NSLP. Individuals who were aged 5 to 18 years, in kindergarten through 12th grade, enrolled in a school that served school lunch, and had a reliable weekday dietary recall were included. Exposures: The Healthy, Hunger-Free Kids Act of 2010 (prepolicy period: 2007-2010; postpolicy period: 2013-2016), with participation in the NSLP estimated based on an algorithm. Main Outcomes and Measures: The primary outcome was dietary quality of intake for lunch, measured by the Healthy Eating Index-2010 (HEI-2010) score (range, 0-100; 0 indicates a diet with no adherence to the 2010 Dietary Guidelines for Americans and 100 indicates a diet with complete adherence to the guidelines). Results: Among 6389 students included in the surveys (mean age, 11.7 [95% CI, 11.6-11.9] years; 3145 [50%] female students; 1880 [56%] were non-Hispanic white), 32% were low-income, 12% were low-middle-income, and 56% were middle-high-income students. A total of 2472 (39%) were participants in the NSLP. Among low-income students, the adjusted mean prepolicy HEI-2010 score was 42.7 and the postpolicy score was 54.6 among NSLP participants and the adjusted mean prepolicy score was 34.8 and postpolicy score was 34.1 among NSLP nonparticipants (difference in differences, 12.6 [95% CI, 8.9-16.3]). Among low-middle-income students, the adjusted mean prepolicy HEI-2010 score was 40.4 and postpolicy score was 54.8 among NSLP participants and the adjusted mean prepolicy score was 34.2 and postpolicy score was 36.1 among NSLP nonparticipants (difference in differences, 12.4 [95% CI, 4.9-19.9]). Among middle-high-income students, the adjusted mean HEI-2010 prepolicy score was 42.7 and postpolicy score 55.5 for NSLP participants and the adjusted mean prepolicy score was 38.9 and prepolicy score was 43.6 for NSLP nonparticipants (difference in differences, 8.1 [95% CI, 4.2-12.0]). Conclusions and Relevance: In a serial cross-sectional study of students, the Healthy, Hunger-Free Kids Act of 2010 was associated with better changes in dietary quality for lunch among presumed low-income, low-middle-income, and middle-high-income participants in the NSLP compared with nonparticipants.


Assuntos
Dieta/normas , Assistência Alimentar/legislação & jurisprudência , Almoço , Valor Nutritivo , Instituições Acadêmicas , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Serviços de Alimentação/legislação & jurisprudência , Serviços de Alimentação/normas , Humanos , Renda , Masculino , Política Nutricional/legislação & jurisprudência , Inquéritos Nutricionais , Estados Unidos
20.
Wei Sheng Yan Jiu ; 49(3): 345-356, 2020 May.
Artigo em Chinês | MEDLINE | ID: mdl-32693882

RESUMO

OBJECTIVE: To analyze the changes in the awareness of nutritional knowledge in Chinese adults during 2004-2015. METHODS: The present study used data from "China Health and Nutrition Health" and selected those participated in surveys conducted in 2004-2015, with completed data of demographic characteristics and nutritional knowledge measurement and aged 18 years and above as subjects. We analyzed the awareness rates of Chinese Dietary Guidelines and various nutritional knowledges in adults from different provinces and adults of 9 provinces by characteristics, and evaluated the changes during 2004-2015. RESULTS: There were 9615, 9702, 9999, 12 990 and 15 958 subjects in waves of 2004, 2006, 2009, 2011 and 2015, respectively. Awareness of dietary guidelines in adults from 9 provinces significantly increased during 2004-2015(P<0. 0001), and the rate was 21. 1% in 2015, 2. 9 times as high as that in 2004. The awareness rates of all seven correct nutritional knowledges also displayed an increased trend during survey periods(P<0. 0001), and there was a considerable rise in 2006. Awareness on staple foods was lower in each wave, especially in 2004(0. 9%). The changes in the awareness of all five wrong nutritional knowledges were inconsistent during 2004-2015, in which the awareness on sugar, high fat foods and physical activity showed a decreased trend(P<0. 0001), and the awareness rate of physical activity was lower. Overall awareness of nutritional knowledges in adults tended to increase during 2004-2015(P<0. 0001), however, that in each wave was very low, and just 4. 0% in 2015. Awareness of dietary guidelines in adults from 3 municipalities in 2015 was higher than that in 2011(P<0. 0001), but the differences were opposite for most of nutritional knowledges. Moreover, awareness of dietary guidelines of 3 municipalities(Beijing, Shanghai and Chongqing)in 2011 and 2015 was higher than corresponding rate in 9 provinces or newly recruited 3 provinces. There were similar changes in the awareness of dietary guidelines and nutritional knowledges in adults from 9 provinces by age, gender, education level, residence area and location during 2004-2015 to that in total population, and there were differences in the awareness of nutritional knowledge by demographic characteristics in some survey waves. CONCLUSION: The awareness of dietary guidelines and overall awareness of nutritional knowledges were lower in Chinese adults, especially for the items on staple foods, meat and physical activity.


Assuntos
Dieta , Política Nutricional , Adolescente , Adulto , Pequim , China , Cidades , Humanos , Inquéritos Nutricionais
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