Estimated economic burden of cancer associated with suboptimal diet in the United States.

PURPOSE: Suboptimal diet is a preventable cause of cancer. We aimed to estimate the economic burden of diet-associated cancer among US adults. METHODS: We used a Comparative Risk Assessment model to quantify the number of new cancer cases attributable to seven dietary factors among US adults ages 20 + years. A Markov cohort model estimated the 5-year medical costs for 15 diet-associated cancers diagnosed in 2015. We obtained dietary intake from 2013 to 2016 National Health and Nutrition Examination Survey, cancer incidence, and survival from 2008 to 2014 Surveillance, Epidemiology, and End Results (SEER) program, and medical costs from 2007 to 2013 linked SEER-Medicare data. RESULTS: The estimated 5-year medical costs of new diet-associated cancer cases diagnosed in 2015 were $7.44 (2018 US$). Colorectal cancer had the largest diet-related 5-year medical costs of $5.32B. Suboptimal consumption of whole grains ($2.76B), dairy ($1.82B), and high consumption of processed meats ($1.5B) accounted for the highest medical costs. Per-person medical costs attributable to suboptimal diet vary by gender, race, and age group. CONCLUSIONS: Suboptimal diet contributes substantially to the economic burden of diet-associated cancers among US adults. This study highlights the need to implement population-based strategies to improve diet and reduce cancer burden in the US.

Adults Meeting Fruit and Vegetable Intake Recommendations - United States, 2019.

The 2020-2025 Dietary Guidelines for Americans* advise incorporating more fruits and vegetables into U.S. residents' diets as part of healthy dietary patterns. Adults should consume 1.5-2 cup-equivalents of fruits and 2-3 cup-equivalents of vegetables daily.† A healthy diet supports healthy immune function (1) and helps to prevent obesity, type 2 diabetes, cardiovascular diseases, and some cancers (2); having some of these conditions can predispose persons to more severe illness and death from COVID-19 (3). CDC used the most recent 2019 Behavioral Risk Factor Surveillance system (BRFSS) data to estimate the percentage of states' adult population who met intake recommendations overall and by sociodemographic characteristics for 49 states and the District of Columbia (DC). Overall, 12.3% of adults met fruit recommendations, ranging from 8.4% in West Virginia to 16.1% in Connecticut, and 10.0% met vegetable recommendations, ranging from 5.6% in Kentucky to 16.0% in Vermont. The prevalence of meeting fruit intake recommendations was highest among Hispanic adults (16.4%) and lowest among males (10.1%); meeting vegetable intake recommendations was highest among adults aged ≥51 years (12.5%) and lowest among those living below or close to the poverty level (income to poverty ratio [IPR] <1.25) (6.8%). Additional policies§ and programs that will increase access to fruits and vegetables in places where U.S. residents live, learn, work, and play, might increase consumption and improve health.

Decisions to attend holiday gatherings during COVID-19 and engagement in key prevention strategies: United States, January 2021.

Gatherings where people are eating and drinking can increase the risk of getting and spreading SARS-CoV-2 among people who are not fully vaccinated; prevention strategies like wearing masks and physical distancing continue to be important for some groups. We conducted an online survey to characterise fall/winter 2020-2021 holiday gatherings, decisions to attend and prevention strategies employed during and before gatherings. We determined associations between practicing prevention strategies, demographics and COVID-19 experience. Among 502 respondents, one-third attended in person holiday gatherings; 73% wore masks and 84% practiced physical distancing, but less did so always (29% and 23%, respectively). Younger adults were 44% more likely to attend gatherings than adults ≥35 years. Younger adults (adjusted prevalence ratio (aPR) 1.53, 95% CI 1.19-1.97), persons who did not experience COVID-19 themselves or have relatives/close friends experience severe COVID-19 (aPR 1.56, 95% CI 1.18-2.07), and non-Hispanic White persons (aPR 1.57, 95% CI 1.13-2.18) were more likely to not always wear masks in public during the 2 weeks before gatherings. Public health messaging emphasizing consistent application of COVID-19 prevention strategies is important to slow the spread of COVID-19.

From Practice to Publication: The Promise of Writing Workshops.

Practitioners in health departments, university extension programs, and nonprofit organizations working in public health face varied challenges to publishing in the peer-reviewed literature. These practitioners may lack time, support, skills, and efficacy needed for manuscript submission, which keeps them from sharing their wisdom and experience-based evidence. This exclusion can contribute to literature gaps, a failure of evidence-based practice to inform future research, reduced ability to educate partners, and delays in advancing public health practice. Our article describes the writing workshops offered to Division of Nutrition, Physical Activity, and Obesity (DNPAO), Centers for Disease Control and Prevention (CDC) funded programs in 2021. This project consisted of three 60-minute introductory writing webinars open to all recipients, followed by a Writing for Publications workshop, an 8- to 9-week virtual learning/writing intensive for selected writing team applicants. The Society for Public Health Education staff, consultants, and CDC/DNPAO staff developed, refined, and presented the curriculum. The workshop for public health practitioner writing teams was offered to two cohorts and included extensive coaching and focused on potential submission to a Health Promotion Practice supplement, "Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field" (see Supplemental Material), which was supported by CDC/DNPAO. We describe the webinars, the workshop design, modifications, evaluation methods and results.

Percentage of Adolescents Meeting Federal Fruit and Vegetable Intake Recommendations - Youth Risk Behavior Surveillance System, United States, 2017.

According to the 2020-2025 Dietary Guidelines for Americans, persons should consume fruits and vegetables as part of a healthy eating pattern to reduce their risk for diet-related chronic diseases, such as cardiovascular disease, type 2 diabetes, some cancers, and obesity.* A healthy diet is important for healthy growth in adolescence, especially because adolescent health behaviors might continue into adulthood (1). The U.S. Department of Agriculture (USDA) recommends minimum daily intake of 1.5 cups of fruit and 2.5 cups of vegetables for females aged 14-18 years and 2 cups of fruit and 3 cups of vegetables for males aged 14-18 years.† Despite the benefits of fruit and vegetable consumption, few adolescents consume these recommended amounts (2-4). In 2013, only 8.5% of high school students met the recommendation for fruit consumption, and only 2.1% met the recommendation for vegetable consumption (2). To update the 2013 data, CDC analyzed data from the 2017 national and state Youth Risk Behavior Surveys (YRBSs) to describe the percentage of students who met intake recommendations, overall and by sex, school grade, and race/ethnicity. The median frequencies of fruit and vegetable consumption nationally were 0.9 and 1.1 times per day, respectively. Nationally, 7.1% of students met USDA intake recommendations for fruits (95% confidence interval [CI] = 4.0-10.3) and 2.0% for vegetables (upper 95% confidence limit = 7.9) using previously established scoring algorithms. State-specific estimates of the percentage of students meeting fruit intake recommendations ranged from 4.0% (Connecticut) to 9.3% (Louisiana), and the percentage meeting vegetable intake recommendations ranged from 0.6% (Kansas) to 3.7% (New Mexico). Additional efforts to expand the reach of existing school and community programs or to identify new effective strategies, such as social media approaches, might help address barriers and improve adolescent fruit and vegetable consumption.

Prevalence of Municipal-Level Policies Dedicated to Transportation That Consider Food Access.

INTRODUCTION: Local governments can address access to healthy food and transportation through policy and planning. This study is the first to examine municipal-level transportation supports for food access. METHODS: We used a nationally representative sample of US municipalities with 1,000 or more persons from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living (N = 2,029) to assess 3 outcomes: public transit availability, consideration of food access in transportation planning, and presence of demand-responsive transportation (DRT). We used χ2 tests to compare prevalences by municipal characteristics including population size, rurality, census region, median educational attainment, poverty prevalence, racial and ethnic population distribution, and low-income low-access to food (LILA) status. RESULTS: Among municipalities, 33.7% reported no public transit and 14.8% reported having DRT. Both public transit and DRT differed by population size (both P < .001) and census region (both P < .001) and were least commonly reported among municipalities with populations less than 2,500 (46.9% without public transit; 6.6% with DRT) and in the South (40.0% without public transit; 11.1% with DRT). Of those with public transit, 33.8% considered food access in transportation planning; this was more common with greater population size (55.9% among municipalities of ≥50,000 persons vs 16.8% among municipalities of <2,500 persons; P < .001), in the West (43.1% vs 26.8% in the Northeast, 33.7% in the Midwest, 32.2% in the South; P = .003), and municipalities with 20% or more of the population living below federal poverty guidelines (37.4% vs 32.2% among municipalities with less than 20% living in poverty; P = .07). CONCLUSION: Results suggest that opportunities exist to improve food access through transportation, especially in smaller and Southern communities, which may improve diet quality and reduce chronic disease.

Top Food Category Contributors to Sodium and Potassium Intake - United States, 2015-2016.

Most U.S. adults consume too much sodium and not enough potassium (1,2). For apparently healthy U.S. adults aged ≥19 years, guidelines recommend reducing sodium intake that exceeds 2,300 mg/day and consuming at least 3,400 mg/day of potassium for males and at least 2,600 mg/day for females* (1). Reducing population-level sodium intake can reduce blood pressure and prevent cardiovascular diseases, the leading causes of death in the United States (1,3). Adequate potassium intake might offset the hypertensive effects of excessive sodium intake (1). Data from the 2015-2016 What We Eat in America (WWEIA) dietary interview component of the National Health and Nutrition Examination Survey (NHANES)† were analyzed to identify top food categories contributing to sodium and potassium intake for U.S. residents aged ≥1 year. During 2015-2016, 40% of sodium consumed came from the top 10 food categories, which included prepared foods with sodium added (e.g., deli meat sandwiches and pizza). Approximately 43% of potassium consumed was from 10 food categories, which included foods naturally low in sodium (e.g., unflavored milk, fruit, vegetables) and prepared foods. These results can inform efforts to encourage consumption of foods naturally low in sodium, which might have the dual benefit of reducing sodium intake and increasing potassium intake, contributing to cardiovascular disease prevention.

Effect of a Fruit and Vegetable Prescription Program on Children's Fruit and Vegetable Consumption.

INTRODUCTION: Most children in families with low income do not meet dietary guidance on fruit and vegetable consumption. Fruit and vegetable prescription programs improve access to and affordability of health-supporting foods for adults, but their effect on dietary behavior among children is not known. The objective of this study was to describe the extent to which exposure to a fruit and vegetable prescription program was associated with changes in consumption among participants aged 2 to 18. METHODS: We used data from a modified National Cancer Institute screener to calculate fruit and vegetable intake among 883 children who were overweight or had obesity and participated in a 4- to 6-month fruit and vegetable prescription program at federally qualified health centers during 4 years (2012-2015). Secondary analyses in 2017 included paired t tests to compare change in fruit and vegetable consumption (cups/day) between first and last visits and multivariable linear regressions, including propensity dose-adjusted models, to model this change as a function of sociodemographic and program-specific covariates, such as number of clinical visits and value of prescription redemption. RESULTS: We found a dose propensity-adjusted increase of 0.32 cups (95% confidence interval, 0.19-0.45 cups) for each additional visit while holding constant the predicted number of visits and site. An equal portion of the change-score increase was attributed to vegetable consumption and fruit consumption (ß = 0.16 for each). CONCLUSION: Fruit and vegetable prescription programs in clinical settings may increase fruit and vegetable consumption among children in low-income households. Future research should use a comparison group and consider including qualitative analysis of site-specific barriers and facilitators to success.

The dietary impact of introducing new retailers of fruits and vegetables into a community: results from a systematic review.

OBJECTIVE: To investigate the potential dietary impact of the opening of new retailers of healthy foods. DESIGN: Systematic review of the peer-reviewed research literature. SETTING: References published before November 2015 were retrieved from MEDLINE, EMBASE and Web of Science databases using keyword searches. SUBJECTS: The outcome of the review was change in fruit and vegetable consumption among adults. RESULTS: Of 3514 references retrieved, ninety-two articles were reviewed in full text, and twenty-three articles representing fifteen studies were included. Studies used post-test only (n 4), repeated cross-sectional (n 4) and repeated measures designs (n 7) to evaluate the dietary impact of supermarket (n 7), farmers' market (n 4), produce stand (n 2) or mobile market (n 2) openings. Evidence of increased fruit and vegetable consumption was most consistent among adults who began shopping at the new retailer. Three of four repeated measures studies found modest, albeit not always statistically significant, increases in fruit and vegetable consumption (range 0·23-0·54 servings/d) at 6-12 months after baseline. Dietary change among residents of the broader community where the new retailer opened was less consistent. CONCLUSIONS: The methodological quality of studies, including research designs, sampling methods, follow-up intervals and outcome measures, ranged widely. Future research should align methodologically with previous work to facilitate meta-analytic synthesis of results. Opening a new retailer may result in modest short-term increases in fruit and vegetable consumption among adults who choose to shop there, but the potential longer-term dietary impact on customers and its impact on the broader community remain unclear.

Disparities in State-Specific Adult Fruit and Vegetable Consumption - United States, 2015.

The 2015-2020 Dietary Guidelines for Americans recommend that Americans consume more fruits and vegetables as part of an overall dietary pattern to reduce the risk for diet-related chronic diseases such as cardiovascular disease, type 2 diabetes, some cancers, and obesity (1). Adults should consume 1.5-2.0 cup equivalents of fruits and 2.0-3.0 cups of vegetables per day.* Overall, few adults in each state met intake recommendations according to 2013 Behavioral Risk Factor Surveillance System (BRFSS) data; however, sociodemographic characteristics known to be associated with fruit and vegetable consumption were not examined (2). CDC used data from the 2015 BRFSS to update the 2013 report and to estimate the percentage of each state's population meeting intake recommendations by age, sex, race/ethnicity, and income-to-poverty ratio (IPR) for the 50 states and District of Columbia (DC). Overall, 12.2% of adults met fruit recommendations ranging from 7.3% in West Virginia to 15.5% in DC, and 9.3% met vegetable recommendations, ranging from 5.8% in West Virginia to 12.0% in Alaska. Intake was low across all socioeconomic groups. Overall, the prevalence of meeting the fruit intake recommendation was highest among women (15.1%), adults aged 31-50 years (13.8%), and Hispanics (15.7%); the prevalence of meeting the vegetable intake recommendation was highest among women (10.9%), adults aged ≥51 years (10.9%), and persons in the highest income group (11.4%). Evidence-based strategies that address barriers to fruit and vegetable consumption such as cost or limited availability could improve consumption and help prevent diet-related chronic disease.

Clinical-Community Partnerships to Identify Patients With Food Insecurity and Address Food Needs.

INTRODUCTION: More than 42 million people in the United States are food insecure. Although some health care entities are addressing food insecurity among patients because of associations with disease risk and management, little is known about the components of these initiatives. METHODS: The Systematic Screening and Assessment Method was used to conduct a landscape assessment of US health care entity-based programs that screen patients for food insecurity and connect them with food resources. A network of food insecurity researchers, experts, and practitioners identified 57 programs, 22 of which met the inclusion criteria of being health care entities that 1) screen patients for food insecurity, 2) link patients to food resources, and 3) target patients including adults aged 50 years or older (a focus of this assessment). Data on key features of each program were abstracted from documentation and telephone interviews. RESULTS: Most programs (n = 13) focus on patients with chronic disease, and most (n = 12) partner with food banks. Common interventions include referrals to or a list of food resources (n = 19), case managers who navigate patients to resources (n = 15), assistance with federal benefit applications (n = 14), patient education and skill building (n = 13), and distribution of fruit and vegetable vouchers redeemable at farmers markets (n = 8). Most programs (n = 14) routinely screen all patients. CONCLUSION: The programs reviewed use various strategies to screen patients, including older adults, for food insecurity and to connect them to food resources. Research is needed on program effectiveness in improving patient outcomes. Such evidence can be used to inform the investments of potential stakeholders, including health care entities, community organizations, and insurers.

Baicalein, a component of Scutellaria baicalensis, induces apoptosis by Mcl-1 down-regulation in human pancreatic cancer cells.

Scutellaria baicalensis (SB) and SB-derived polyphenols possess anti-proliferative activities in several cancers, including pancreatic cancer (PaCa). However, the precise molecular mechanisms have not been fully defined. SB extract and SB-derived polyphenols (wogonin, baicalin, and baicalein) were used to determine their anti-proliferative mechanisms. Baicalein significantly inhibited the proliferation of PaCa cell lines in a dose-dependent manner, whereas wogonin and baicalin exhibited a much less robust effect. Treatment with baicalein induced apoptosis with release of cytochrome c from mitochondria, and activation of caspase-3 and -7 and PARP. The general caspase inhibitor zVAD-fmk reversed baicalein-induced apoptosis, indicating a caspase-dependent mechanism. Baicalein decreased expression of Mcl-1, an anti-apoptotic member of the Bcl-2 protein family, presumably through a transcriptional mechanism. Genetic knockdown of Mcl-1 resulted in marked induction of apoptosis. The effect of baicalein on apoptosis was significantly attenuated by Mcl-1 over-expression, suggesting a critical role of Mcl-1 in this process. Our results provide evidence that baicalein induces apoptosis in pancreatic cancer cells through down-regulation of the anti-apoptotic Mcl-1 protein.

A joint effect of new Western diet and retinoid X receptor α prostate-specific knockout with development of high-grade prostatic intraepithelial neoplasia in mice--a preliminary study.

BACKGROUND: The "New Western-style Diet" (NWD) characterized by high in fat and low in fiber, vitamin D, calcium, and methyl donors--are considered as a risk factor for prostate cancer. Previous studies have shown that premalignant lesions of human prostate have decreased expression of the Retinoid X Receptor alpha (RXRα). This study was to determine the effect of diet in RXRα knockout mice in developing high-grade prostate intraepithelial neoplasia (mPIN). METHODS: Male mice (n = 54) with or without the RXRα prostate null mutation were fed either NWD or AIN-76A control diet for 10 months; prostates were harvested at 11 months of age and examined for prostate mPIN. RESULTS: mPIN was seen in 79% of RXRα prostate null mice fed NWD (n = 19), 30.8% RXRα prostate null mice fed AIN-76A (n = 13), 42.9% RXRα wild-type mice fed NWD (n = 14), and 12.5% RXRα wild-type mice fed AIN-76A (n = 8). Unconditional Logistic analysis showed a significant joint effect of NWD and RXRα status in developing mPIN 26.3 (95% CI: 2.5-280), but interaction was not significant owing to the small sample size 1.6 (0.09-27.7, P = 0.7441). CONCLUSION: This study provides preliminary data to support a joint RXRα-diet effect in prostate carcinogenesis.

Foods and Beverages Available to Nurses in Hospital Cafeterias, Vending Machines, and Gift Shops.

PURPOSE: Hospitals are important workplaces for nurses with many perceived barriers to healthy eating, but objective assessments are lacking. This study evaluated the healthfulness of hospital consumer food environments. DESIGN: Cross-sectional observational; Setting: South Carolina; Subjects: Cafeterias, vending machines (VM), and gift shops (GS) in hospitals of varying size, urbanization, and region. MEASURES: Using the Hospital Nutrition Environment Scan (HNES), primary outcomes of interest included availability, access, prices, and location of healthy foods in relation to nursing units. ANALYSIS: Descriptive and inferential statistics by independent samples t-test, ANOVA, Mann-Whitney U, χ2, or Fisher's exact test as appropriate. RESULTS: Thirty-one hospitals were observed from December 2019 to February 2020. Average composite HNES score (n = 28) was 46.3 ± 14.9 (-45 to 173 range), indicating sub-optimal food environments. Cafeterias (n = 31) scored an average of 30.9 ± 10.5 (-33 to 86 range). Average VM (n = 31) and GS (n = 28) scores were 11.6 ± 6.0 (-6 to 55 range) and 2.9 ± 4.0 (-6 to 32 range), respectively. Small hospitals (≤100 beds) had lower average cafeteria score (22.4 ± 10.3) than extra-large hospitals (≥500 beds; 42 ± 5.2, P < .01). Small hospitals also had lower composite HNES scores (34.4 ± 17.1) compared to extra-large hospitals (61.0 ± 14.4, P = .02). Data regarding availability, access, prices, and location were also reported. CONCLUSION: Due to abundant availability of unhealthy foods and beverages, hospital consumer food environments scored low on observations using the HNES, highlighting the opportunity to improve the healthfulness of facility offerings.

Characteristics Associated With Self-Reported Worry Among Adults About Food Availability and Food Safety During the COVID-19 Pandemic-United States, June 2020 Survey Data.

PURPOSE: During a pandemic, persons might experience worry because of threats (real or perceived), or as part of stress-related reactions. We aimed to provide insight into Americans' worry about food during COVID-19. Design, Subjects, Measures: Online survey data from June 2020 (n = 4,053 U.S. adults; 62.7% response rate) was used to assess 2 outcomes: worry about food availability (FA); food safety (FS). Adults with missing information about FA and FS were excluded from analysis (final n = 3,652). ANALYSIS: We used descriptive statistics and multivariable logistic regression to examine characteristics associated with the outcomes and estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for associations between sociodemographic variables and outcomes. RESULTS: 58.3% of respondents reported worry about FA; 57.5% about FS, with higher odds of worry for FA and FS (versus referents) in lower income households (FA: aOR = 1.76 95%CI [1.30, 2.39]; FS: 1.84[1.35, 2.51]); unemployed (1.54[1.05, 2.28]; 1.90[1.26,2.81]); non-Hispanic Black (1.55[1.14,2.12]); 2.25[1.65,3.07]); Hispanic (1.39[1.06,1.82]; 1.94[1.46,2.56]). CONCLUSION: Findings highlight the importance of strategies to reduce consumer worry about FA and FS and negative food behaviors, and the need for continued access to hunger safety net programs, which could have positive effects on nutrition security.

A Pediatric Fruit and Vegetable Prescription Program Increases Food Security in Low-Income Households.

OBJECTIVE: To assess change in household food security associated with participation in a pediatric fruit/vegetable prescription program. METHODS: The researchers analyzed clinic-based, fruit/vegetable prescription program data for 578 low-income families, collected in 2013-2015, and calculated changes in food security (summative score; high/low/very low; and individual US Department of Agriculture measures). RESULTS: Of participating households, 72% increased their summative score over the course of the program. In adjusted regression models, participants had higher change scores with 5 or 6 clinical visits, compared with 1 or 2 visits (ß = .07; 95% confidence interval, 0.01-0.14), and college education of the primary caretaker, compared with less than college (ß = .05; 95% confidence interval, 0.01-0.09). Select clinic sites (but neither visit nor redemption proportions) significantly contributed to change score variance. All US Department of Agriculture measures saw significant increases. CONCLUSIONS AND IMPLICATIONS: Fruit/vegetable prescription programs may help providers address patients' food insecurity. Further research using experimental designs and implementation science could build the case to incorporate programs into practice.

Foods and Beverages Obtained at Worksites in the United States.

BACKGROUND: Nutrition interventions are a common component of worksite wellness programs and have been recognized as an effective strategy to change employee dietary behaviors. However, little is known about worksite food behaviors or the foods that are obtained at workplaces at the national level. OBJECTIVE: The aims were to examine the frequency of and the amount of money spent obtaining foods at work among employed US adults, to determine the foods most commonly obtained at work, and to assess the dietary quality of these foods. DESIGN: This is a cross-sectional analysis of data from the US Department of Agriculture Food Acquisition and Purchasing Survey, a nationally representative household survey conducted from April 2012 through January 2013 on food purchases and acquisitions during a 7-day study period. PARTICIPANTS: The study included 5,222 employed adult Americans. MAIN OUTCOME MEASURES: The study assessed the prevalence of obtaining any foods at work overall and according to sociodemographic subgroups, number of acquisitions and calories obtained, most commonly obtained foods and leading food sources of calories, and 2010 Healthy Eating Index (HEI) scores that represent dietary quality. STATISTICAL ANALYSES PERFORMED: Prevalence estimates of obtaining ≥1 foods at work were compared according to sociodemographic characteristic using χ2 tests. RESULTS: Nearly a quarter (23.4%) of working adults obtained foods at work during the week, and the foods they obtained averaged 1,292 kcal per person per week. The leading food types obtained included foods typically high in solid fat, added sugars, or sodium, such as pizza, regular soft drinks, cookies or brownies, cakes and pies, and candy. HEI scores suggest that work foods are high in empty calories, sodium, and refined grains and low in whole grains and fruit. CONCLUSIONS: Working adults commonly obtain foods at work, and the foods they obtain have limited dietary quality. Future research should examine the role worksites can play to help ensure access to and promote healthier options.

Ellagitannin-rich pomegranate extract inhibits angiogenesis in prostate cancer in vitro and in vivo.

Angiogenesis is critical to tumor growth and is stimulated by tissue hypoxia due to poor oxygen delivery. In turn, cellular hypoxia leads to angiogenesis via the induction of hypoxia-inducible factor-1alpha (HIF-1alpha) and vascular endothelial growth factor (VEGF) at a cellular level. Pomegranate juice and extracts, which are rich sources of ellagitannins, have been shown to have chemopreventive potential against prostate cancer, but there have been no studies on the effects of an ellagitannin-rich pomegranate extract on angiogenesis. Human prostate cancer cells (LNCaP) and human umbilical vein endothelial cells (HUVEC) were incubated with a pomegranate extract standardized to ellagitannin content (POMx), under normoxic and hypoxic conditions in vitro. Human prostate cancer cells (LAPC4) were injected subcutaneously into severe combined immunodeficient (SCID) mice and the effects of oral administration of POMx on tumor growth, microvessel density, and HIF-1alpha and VEGF expression were determined after 4 weeks of treatment. POMx inhibited the proliferation of LNCaP and HUVEC cells significantly under both normoxic and hypoxic conditions. HIF-1alpha and VEGF protein levels were also reduced by POMx under hypoxic conditions. POMx decreased prostate cancer xenograft size, tumor vessel density, VEGF peptide levels and HIF-1alpha expression after 4 weeks of treatment in SCID mice. These results demonstrate that an ellagitannin-rich pomegranate extract can inhibit tumor-associated angiogenesis as one of several potential mechanisms for slowing the growth of prostate cancer in chemopreventive applications. Further studies in humans are needed to confirm that angiogenesis can be inhibited by an ellagitannin-rich pomegranate extract administered orally as a dietary supplement.

Youth Access to School Salad Bars in the United States-2011 to 2014.

PURPOSE: To examine differences in students' access to school salad bars across sociodemographic groups and changes in availability over time. DESIGN: Nonexperimental. SETTING: Nationally representative 2011 and 2014 YouthStyles surveys. PARTICIPANTS: A total of 833 (2011) and 994 (2014) US youth aged 12 to 17 years. MEASURES: Youth-reported availability of school salad bars. ANALYSIS: Multivariable logistic regression models were used to assess differences in school salad bar availability by sociodemographics and changes in availability from 2011 to 2014. RESULTS: Youth-reported salad bar availability differed by age in 2011 and race/ethnicity in 2014, but not by sex, income, metropolitan residence, or region in either year. Salad bars were reported by 62% of youth in 2011 and 67% in 2014; the increase was not statistically significant ( P = .07). Significant increases from 2011 to 2014 were noted among youth aged 12 to 14 years (56%-69%; P < .01), youth of non-Hispanic other races (60%-85%; P < .01), and youth in the Midwest (58%-72%; P = .01). CONCLUSION: These results suggest that youth-reported access to school salad bars does not differ significantly across most sociodemographic groups. Although overall salad bar availability did not increase significantly from 2011 to 2014, some increases were observed among subgroups. Continued efforts to promote school salad bars through initiatives such as Let's Move Salad Bars to Schools could help increase access for the nearly one-third of US youth reporting no access.

Physician Characteristics Associated With Sugar-Sweetened Beverage Counseling Practices.

PURPOSE: Frequent sugar-sweetened beverage (SSB) consumption is associated with chronic disease. Although physician counseling can positively affect patient behavior, physicians' personal characteristics may influence counseling practices. We explored SSB-related topics physicians discuss when counseling overweight/obese patients and examined associations between physicians' SSB-related counseling practices and their personal and medical practice characteristics. DESIGN: Cross-sectional survey. SETTING: DocStyles survey, 2014. PARTICIPANTS: A total of 1510 practicing US physicians. MEASURES: Physician's SSB counseling on calories, added sugars, obesity/weight gain, health effects, consumption frequency, water substitution, and referral. ANALYSIS: Adjusted odds ratios (aORs) were calculated with multivariable logistic regression, adjusting for physician's personal and medical practice characteristics. RESULTS: Most physicians (98.5%) reported SSB-related counseling. The most reported topic was obesity/weight gain (81.4%); the least reported were added sugars (53.1%) and referral (35.0%). Physicians in adult-focused specialties had lower odds than pediatricians of counseling on several topics (aOR range: 0.26-0.64). Outpatient physicians had higher odds than inpatient physicians of counseling on consumption frequency and water substitution (aOR range: 1.60-2.01). Physicians consuming SSBs ≥1 time/day (15.7%) had lower odds than nonconsumers of counseling on most topics (aOR range: 0.58-0.68). CONCLUSION: Most physicians reported SSB-related counseling; obesity/weight gain was discussed most frequently. Counseling opportunities remain in other topic areas. Opportunities also exist to strengthen SSB counseling practices in adult-focused specialties, inpatient settings, and among physicians who consume SSBs daily.