"Many people have no idea": a qualitative analysis of healthcare barriers among Yazidi refugees in the Midwestern United States.

BACKGROUND: The COVID-19 pandemic has shed new light on inequities in healthcare access faced by immigrant and refugee communities. To address ongoing disparities, there is an urgent need for ecological approaches to better understand the barriers that hinder and resources that facilitate access to healthcare. This study investigates barriers to healthcare system access faced by Yazidi refugees in the Midwestern United States. METHODS: Informed by the Interpretative Phenomenological Approach, three focus group meetings with a community advisory board were conducted between September 2019 and January 2020. The nine-member focus group included social workers, healthcare providers, and members of the Yazidi community. Meeting recordings were transcribed into English, coded for themes, and validated. RESULTS: We describe themes related to specific barriers to healthcare access; analyze the influence of relational dynamics in the focus group; explore experiential themes related to healthcare access in the Yazidi community, and finally interpret our findings through a social-ecological lens. CONCLUSION: Community agencies, healthcare organizations, policymakers, and other stakeholders must work together to develop strategies to reduce systemic barriers to equitable care. Community representation in priority-setting and decision-making is essential to ensure relevance, acceptability, and utilization of developed strategies.

Cancer incidence and survival trends among infants in the United States from 1975 to 2014.

BACKGROUND: Cancer among infants (<1 year old) has unique epidemiologic, clinical, and genetic characteristics compared with cancer in older children. Nonetheless, data on secular trends in infant cancer incidence and survival in the United States is sparse. METHODS: Population-based data from nine areas of the Surveillance Epidemiology and End Results (SEER) were used to estimate the incidence, average annual percentage change (APC) for trends, and survival of malignant neoplasm among infants from 1975 to 2014. Data were stratified by gender, race, registry, and cancer type. RESULTS: There were 3437 new infant cancer cases with an overall incidence of 23.6/100 000. Neuroblastoma was the most common infant malignancy (6.5/100 000), followed by leukemia (3.8/100 000), and brain and central nervous system tumors (3.3/100 000). The incidence rate increased significantly from 1975 to 2014 (APC 0.68; 95% CI 0.30-1.06; P < .05). Variations in overall incidence rates were uneven across SEER registry geographic areas, with the lowest rates among both males and females in New Mexico. Relative to other racial distribution, infant cancer rates were highest among Whites. The relative survival rates improved over time for all tumors except for renal, sarcomas, and germ cells and were not significantly different by gender or race. CONCLUSIONS: Cancer incidence among infants increased over time largely driven by leukemia, germ cell, and sarcoma mainly among male infants. The overall survival for infant cancer has improved over the past 40 years, especially since 1990 for hepatic tumors, lymphoma, and leukemia. Further research is needed to explore the potential impacts of genetic, environmental, and perinatal factors for possible explanations for these increased cancer incidence trends.

Association of magnesium intake and vitamin D status with cognitive function in older adults: an analysis of US National Health and Nutrition Examination Survey (NHANES) 2011 to 2014.

PURPOSE: Reduced cognitive function associated with aging has gained increasing attention as the US population ages. Magnesium plays a critical role in vitamin D biosynthesis and metabolism; and deficiencies in magnesium and vitamin D show associations with poor cognition. However, no study has examined their interaction. This study aimed to evaluate the associations of magnesium intake and serum 25-hydroxyvitamin D (25(OH)D) concentrations, indicating vitamin D status, with cognition, and interaction between these nutrients in older adults. METHODS: Based on the National Health and Nutrition Survey (NHANES) 2011-2014, the study included 2466 participants aged ≥ 60 years who completed the Digit Symbol Substitution Test (DSST) and had data available on serum 25(OH)D and magnesium intake. Cognitive impairment was defined as a DSST score lower than the lowest quartile. Serum 25(OH)D concentrations were measured by HPLC-tandem mass spectrometry. RESULTS: Higher total magnesium intake was independently associated with higher DSST scores (highest quartile vs lowest: ß = 4.34, 95% CI 1.14-7.54). The association of total magnesium intake with high DSST score was primarily observed among women, non-Hispanic whites, physically active participants and those with sufficient vitamin D status, although the interactions were not significant. The odds of cognitive impairment was reduced with increasing intake of total magnesium (p trend < 0.01) and higher level of serum 25(OH)D (p trend = 0.05). CONCLUSIONS: Findings suggest that high magnesium intake alone may improve cognitive function in older adults, and the association may be stronger among subjects with sufficient vitamin D status. Further studies are needed to confirm these findings.

Association of serum levels of antioxidant micronutrients with mortality in US adults: National Health and Nutrition Examination Survey 1999-2002.

OBJECTIVE: To examine associations between serum antioxidant levels and mortality (all-cause, cancer and CVD) among US adults. DESIGN: We examined the risk of death from all-cause and cause-specific mortality associated with serum antioxidant (vitamin E and carotenoids) and vitamin A levels using Cox regression models to estimate hazards ratios (HR) and 95 % CI. SETTING: The National Health and Nutrition Examination Survey (NHANES) 1999-2002 was followed up through 31 December 2015. PARTICIPANTS: The NHANES 1999-2002 cohort included 8758 participants aged ≥ 20 years. Serum carotenoid levels were only assessed for the 1999-2000 cycle. Therefore, sample size for each assessed antioxidant ranged from 4633 to 8758. RESULTS: Serum vitamin E level was positively associated with all-cause mortality (HR = 1·22, 95 % CI 1·04, 1·43, highest v. lowest quartile). No other antioxidants were associated with mortality in overall analysis. In race/ethnicity-specific analyses, high vitamin E and α-tocopherol levels were associated with increased risk of all-cause mortality among non-Hispanic Whites. Among non-Hispanic Blacks, serum α-tocopherol level was associated with decreased risk of cancer mortality (HR = 0·30, 95 % CI 0·12, 0·75, third v. first quartile) and total carotenoid levels with reduced risk of CVD mortality (HR = 0·26; 95 % CI 0·07, 0·97, second v. lowest quartile). Hispanics with high ß-carotene levels had reduced risk of CVD mortality. CONCLUSIONS: Serum antioxidant levels may be related to mortality; these associations may differ by race/ethnicity and appeared to be non-linear for all-cause and cause-specific mortality. Further studies are needed to confirm our results.

Dietary Red and Processed Meat Intake and Markers of Adiposity and Inflammation: The Multiethnic Cohort Study.

OBJECTIVE: The potential influence of dietary factors on inflammation is important for cancer prevention. Utilizing data from control participants (312 men, 911 women) in 2 nested case-control studies of cancer within the Multiethnic Cohort, we examined the associations of red and processed meat intake with serum levels of leptin, adiponectin, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and interleukin (IL)-6 and the mediator effect of body mass index (BMI) on the above associations (if present). METHODS: Multivariable linear models were applied to assess the association between red and processed meat intake at cohort entry and serum biomarker levels measured 9.1 years later after adjusting for covariates and to determine the mediator effect of BMI. RESULTS: Overall red and processed meat intake was positively associated with serum leptin levels in men (ß = 0.180, p = 0.0004) and women (ß = 0.167, p < 0.0001). In women, higher red and processed meat consumption was significantly associated with higher CRP (ß = 0.069, p = 0.03) and lower adiponectin levels (ß = -0.082, p = 0.005). In mediation analyses with red and processed meat intake and BMI as predictors, the associations of red and processed meat with biomarkers decreased substantially (as indicated by percentage change in effect: leptin in men, 13.4%; leptin in women, 13.7%; adiponectin in women, -4.7%; CRP in women, 7.4%) and were no longer significant (p > 0.05), whereas BMI remained significantly associated with serum leptin (men: ß = 3.209, p < 0.0001; women: ß = 2.891, p < 0.0001), adiponectin (women: ß = -1.085, p < 0.0001), and CRP (women: ß = 1.581, p < 0.0001). CONCLUSION: The current data suggest that the amount of excess body weight or the degree of adiposity may mediate the relations between dietary red and processed meat intake and serum biomarkers associated with obesity and inflammation.

Parents' barriers and strategies to promote healthy eating among school-age children.

The home environment is considered one of the most important settings in regards to the development of healthy eating habits among children. The primary purpose of this study was to explore parents' barriers and strategies in promoting healthy eating in the home. The secondary objective was to determine whether the barriers and strategies parents had were different between healthy weight and overweight/obese school-age children. Semi-structured individual interviews with 14 parents of healthy weight and 11 parents of overweight/obese children (6-12 years) were conducted in family homes from August 2014 to March 2015. Transcripts were recorded and codes and themes were verified by the research team and one qualitative expert. Themes emerging from both parents of healthy weight and overweight/obese children were: 1) Parents are busy and strapped for time; 2) Cost is a barrier in providing healthy food, but parents are resourceful; 3) Children ask for junk food regularly, but parents have strategies to manage; 4) Picky eaters are a challenge but parents know they have to overcome this barrier; and 5) Early exposure to unhealthy eating influences children's food choices but strategies can help. However, parents of overweight/obese children felt a lack of support from their spouses/partners for healthy eating in the home, which was not expressed among parents of healthy weight children. Additionally, barriers and strategies were similar among parents of children from different age groups [6-9 years vs. 10-12 years (pre-adolescents)]. Our results suggest while parents faced some challenges in promoting healthy eating in the home, they utilized several strategies to overcome these barriers, which are valuable for direct intervention to improve home food environment and manage children's weight.

Relationships between nutrition-related knowledge, self-efficacy, and behavior for fifth grade students attending Title I and non-Title I schools.

The Social Cognitive Theory (SCT) is a widely used theory for nutrition education programming. Better understanding the relationships between knowledge, self-efficacy, and behavior among children of various income levels can help to form and improve nutrition programs, particularly for socioeconomically disadvantaged youth. The purpose of this study was to determine the relationships between knowledge, self-efficacy, and behavior among fifth grade students attending Title I (≥40% of students receiving free or reduced school meals) and non-Title I schools (<40% of students receiving free or reduced school meals). A validated survey was completed by 55 fifth grade students from Title I and 122 from non-Title I schools. Differences in knowledge, self-efficacy, and behavior scores between groups were assessed using t test and adjusted for variations between participating schools. Regression analysis was used to determine the relationships between knowledge, self-efficacy, and behavior. In adjusted models, the Title I group had significantly lower scores on several knowledge items and summary knowledge (P = 0.04). The Title I group had significantly lower scores on several behavior variables including intakes of fruits (P = 0.02), vegetables (P = 0.0005), whole grains (P = 0.0003), and lean protein (P = 0.047), physical activity (P = 0.002) and summary behavior (P = 0.001). However the Title I group scored higher on self-efficacy for meal planning (P = 0.04) and choosing healthy snacks (P = 0.036). Both self-efficacy (ß = 0.70, P < 0.0001) and knowledge (ß = 0.35, P = 0.002) strongly predicted behavior; however, only self-efficacy remained significant in the Title I group (self-efficacy, ß = 0.82, P = 0.0003; knowledge, ß = 0.11, P = 0.59). Results demonstrate disparities in nutrition knowledge and behavior outcomes between students surveyed from Title I and non-Title I schools, suggesting more resources may be necessary for lower income populations. Findings suggest that future nutrition interventions should focus on facilitating the improvement of children's self-efficacy.

Development and validation of a social cognitive theory-based survey for elementary nutrition education program.

BACKGROUND: The Social Cognitive Theory (SCT) is a widely used model for developing elementary nutrition education programs; however, few instruments are available to assess the impact of such programs on the main constructs of the SCT. The purposes of this study were: 1) to develop and validate a SCT-based survey instrument that focuses on knowledge, behavior, and self-efficacy for fifth grade students; 2) to assess the relationships between knowledge, behavior, and self-efficacy; and 3) to assess knowledge, behavior, and self-efficacy for healthy eating among the fifth grade students. METHODS: A 40-item instrument was developed and validated using content validity and tested among 98 fifth grade students for internal consistency reliability. Relationships between knowledge, behavior, and self-efficacy were assessed using Pearson Correlation Coefficients. Differences in behavior and knowledge scores between children with high and low self-efficacy were examined using t-test. RESULTS: Cronbach's alphas for self-efficacy (0.70) and behavior (0.71) subscales of the survey were acceptable, although lower for knowledge (0.56). Summary scores for self-efficacy and behaviors were positively correlated (r = 0.40, P = 0.0001); however, summary knowledge scores were not associated with self-efficacy (r = 0.02, P = 0.88) or behavior scores (r = 0.14, P = 0.23). Participants with high self-efficacy also had significantly higher scores on consuming fruits (P = 0.0009) and dairy products (P = 0.009), eating breakfast (P = 0.008), helping plan family meals (P = 0.0006) and total behaviors for healthy-eating (P = 0.001) compared to those with low self-efficacy. In addition, approximately two thirds of the fifth grade students reported that they did not eat any fruits or vegetables or ate them only once on a typical day. CONCLUSIONS: The developed instrument is a reliable and useful tool to assess SCT-based elementary nutrition education programs, particularly for self-efficacy and behavior. Our results also indicated that strategic interventions are necessary to improve dietary behaviors regarding fruit and vegetable consumptions among elementary school students.

Serum coenzyme Q10, α-tocopherol, γ-tocopherol, and C-reactive protein levels and body mass index in adolescent and premenopausal females.

OBJECTIVE: Lipid-soluble antioxidants are associated with a lower incidence for many chronic diseases of aging, possibly by preventing damage from chronic inflammation. In the current study, we compared serum levels of coenzyme Q10 (CoQ10), α-tocopherol, γ-tocopherol, and C-reactive protein (CRP) between adolescent girls and premenopausal women to assess changes from childhood to midlife. METHODS: Baseline serum CoQ10, α-tocopherol, γ-tocopherol, and CRP levels were measured in 207 girls (13-19 years) and 183 premenopausal women (34-47 years) using standard methods and the 2 age groups were compared by t test. The influence of age, body mass index (BMI), and race/ethnicity and interaction effects on serum values were assessed using analysis of covariance. Pearson correlation coefficients were used to assess associations between pairs of lipid micronutrients. RESULTS: Overall, adolescent girls had significantly lower mean serum CoQ10, α-tocopherol, γ-tocopherol, and CRP levels relative to premenopausal women (CoQ10: 376 vs 544 ng/mL, p < 0.0001; α-tocopherol: 6.9 vs 13.5 µg/mL, p < 0.0001; γ-tocopherol: 1.3 vs 1.7 µg/mL, p < 0.0001; CRP: 1.29 vs 2.13 mg/L, p < 0.0001). The differences in CoQ10 and tocopherols remained significant after adjustment for BMI and race/ethnicity. CoQ10 was significantly and positively correlated to α- and γ-tocopherol, and BMI was positively associated with CRP and γ-tocopherol in both groups. CONCLUSIONS: Lower serum CoQ10, α-tocopherol, γ-tocopherol, and CRP levels in adolescent girls compared to women suggests that adolescents may have a reduced need for antioxidants possibly due to their lower BMI and inflammatory status as indicated by CRP.

Incidence of Postpartum Depression Decreases After Initial Expansion of Military Maternity Leave.

INTRODUCTION: Postpartum depression impacts 1 in 8 women in the United States. Research has indicated maternity leave duration, and compensation can have an impact on postpartum depression symptoms. The U.S. military increased their maternity leave provision from 6 to 12 weeks in 2016. The aim of this study was to expand upon current literature on the role of maternity leave on postpartum depression by analyzing objective data from 2011 to 2019 utilizing military health records. METHODS: All deliveries to active duty women in the Military Health System from 2011 to 2019 were considered for analysis. A total of 60,746 women met inclusion criteria. Active duty women were stratified by year of delivery to identify if they had 6 weeks (2011-2015) or 12 weeks (2016-2019) of maternity leave. International Classification of Disease (ICD)-9 and ICD-10 codes were used for the identification of postpartum depression diagnosis. Logistic regression models were used to assess the association between maternity leave provision and postpartum depression diagnosis adjusting for covariates. RESULTS: Overall, 4.8% of the women were diagnosed with postpartum depression. Active duty women who were allotted 12 weeks (2016-2019) of maternity leave had higher odds of postpartum depression diagnosis than those allotted 6 weeks (2011-2015) (12 weeks vs. 6 weeks of leave: odds ratio [OR] = 1.29; 95% confidence interval [CI] = 1.20-1.39, P < 0.0001). However, there was a 50% reduction in odds of postpartum depression during 2016-2017 (the 2 years following the 12-week leave implementation) in comparison to 2011-2015 (OR = 0.50; 95% CI = 0.43-0.57, P < 0.0001). The trends were similar across military branches. Additionally, between 2011 and 2019, the lowest rates of postpartum depression were observed during 2016-2017, but the rates significantly increased starting 2018. Overall, women with lower military ranks had higher postpartum depression rates than those with higher ranks. CONCLUSIONS: Our results indicate increasing paid maternity leave in the military from 6 to 12 weeks did initially lower the odds of postpartum depression diagnosis among active duty women from immediately after policy implementation (2016) and prior to the release of the Veterans Affairs and Department of Defense Clinical Practice Guidelines on Pregnancy Management (2018). Later, increased odds of depression (2018-2019) are likely due to increased depression screening protocols at the Military Treatment Facilities in the perinatal period.

Overall and Sex-Specific Associations of Serum Lipid-Soluble Micronutrients with Metabolic Dysfunction-Associated Steatotic Liver Disease among Adults in the United States.

This study examined overall and sex-specific associations of serum lipid-soluble micronutrients including α- and γ-tocopherols, 25-hydroxy-vitamin D (25(OH)D), retinol, and six major carotenoids with metabolic dysfunction-associated steatotic lever disease (MASLD) using the 2017-2018 National Health and Nutrition Examination Survey. This analysis included 3956 adults (1991 men, 1965 women) aged ≥ 20 years. Steatotic liver disease was determined through transient elastography examination. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for MASLD associated with micronutrients were estimated using logistic regressions. Higher serum α-tocopherol (highest vs. lowest quartile: OR = 1.53, 95% CI = 1.05-2.22, p = 0.03) and γ-tocopherol (highest vs. lowest quartile: OR = 4.15, 95% CI = 3.00-5.74, p < 0.0001) levels were associated with increased odds of MASLD. Higher serum 25(OH)D levels were associated with reduced odds of MASLD (highest vs. lowest quartile: OR = 0.41, 95% CI = 0.27-0.61, p = 0.0001). Inverse associations with the condition were also observed for carotenoids (α-carotene, ß-carotene, α-cryptoxanthin, ß-cryptoxanthin, combined lutein and zeaxanthin, and lycopene) in the serum (Ps < 0.05). The results were comparable between men and women, except for those on α-tocopherol, for which a positive association was only observed for men (p = 0.01). Our results suggest potential protective associations of serum 25(OH)D and carotenoids with MASLD. The positive associations between tocopherols and MASLD may reflect pathophysiological conditions associated with the condition.

Extending Air Force Physical Fitness Postpartum Dwell Time Improves Maternal Physical Readiness.

INTRODUCTION: Research suggests women are more likely to fail their military physical fitness assessment in the immediate postpartum period than in the prenatal period. In 2015, the United States Air Force physical fitness postpartum testing dwell time increased from 6 months to 12 months postpartum. The primary aim of this study was to assess if Air Force active duty women's physical readiness, as indicated by individual physical fitness test results, was impacted by this change. The secondary aim was to determine the postpartum duration for active duty Air Force women to return to their prenatal anthropometric measurements. METHODS: All active duty Air Force women who gave birth from 2011-2019 in the military medical system were considered for analysis. A total of 6,726 women meeting inclusion criteria were grouped to 6 month testers (delivery between 2011-February 2015) and 12 month testers (delivery between March 2015 and 2019). Logistic regression and general linear models were used to assess the associations and predictability of the various fitness and anthropometric components of the physical fitness testing requirements (6 vs. 12 month testers), controlling for covariates (age, military rank, marital status, and ethnicity). RESULTS: Those testing at 12 months had decreased odds (odds ratio = 0.40, 95% CI = 0.32-0.49, P < .0001) of failing their initial postpartum fitness test than those testing at 6 months. The prevalence of test failure at the first exam postpartum was 10.4% among 6 month testers and 4% among 12 month testers. Women who tested at 6 months retained relatively more weight (2.7 ± 5.0 kg, 4.2% increase), body mass index (1.0 ± 2.1 kg/m2, 4.5% increase), and abdominal circumference (2.4 ± 4.9 cm, 3.5% increase) than their counterparts testing at 12 months (1.8 ± 5.4 kg, 2.8% increase; 0.7 ± 2.2 kg/m2, 3.0% increase; and 1.8 ± 5.0 cm, 2.7% increase; respectively) (P < .0001). When comparing those with prenatal fitness status of "excellent," "pass," or "fail," no group attained prenatal weight status in the 24 months monitored. Average weight and abdominal circumference retention for all groups at 24 months postpartum were 2.8 kg and 1.3 cm, respectively. Among initial postpartum fitness testing failures, the component most failed was sit-ups (34.5%), followed by the 1.5-mile run (29.8%). Six month testers were more likely, across all prenatal fitness categories ("fail," "pass" and "excellent") to fail postpartum fitness testing compared to 12 month testers (26.1%, 17.7%, and 5.6% vs.19.4%, 7.3% and 2%, respectively). CONCLUSIONS: The decision of the Air Force to increase the minimal required time between childbirth and postpartum physical fitness testing for women has positively impacted fitness test failure rates and anthropometric measure changes. Additional policy should be implemented to support postpartum holistic health interventions.

Increasing Maternity Leave and Decreasing Attrition Rates of U.S. Active Duty Women in the Prenatal and Immediate Postpartum Period.

INTRODUCTION: The USA currently does not have a national parental leave policy. In 2016, the Secretary of Defense increased the allotted maternity leave for active duty U.S. military members from 6 to 12 weeks. The purpose of this study was to understand the potential impact of this change on attrition rates of active duty women in the Army, Air Force, Navy, and Marines from their initial prenatal visit through the first year postpartum. METHODS: All active duty women who had a confirmed pregnancy in the electronic health record from 2011 to 2019 were included for consideration in the study. A total of 67,281 women met the inclusion criteria. These women were followed from their initial documented prenatal visit for 21 months (9 months gestation and 12 months postpartum) for removal from the Defense Eligibility and Enrollment Reporting System signaling attrition from service presumably related to pregnancy or childbirth. Logistic regression models were used to assess the association between maternity leave policy and attrition adjusting for covariates. RESULTS: Overall, women who were allotted 6 weeks of maternity leave were associated with higher attrition relative to women provided 12 weeks of maternity leave (odds ratio = 1.36; 95% CI, 1.31-1.42; P < .0001), representing a 22% decrease in attrition rates of women given 12 weeks vs. 6 weeks of leave. This impact of attrition rate was the greatest among members who were of lower rank (6 weeks vs. 12 weeks of leave: junior enlisted (E1-E3), 29.2% vs. 22.0%, P < .0001 and non-commissioned officer (E4-E6), 24.3% vs. 19.4%, P < .0001) and who served in the Army (28.0% vs. 21.2%, P < .0001) and Navy (20.0% and 14.9%, P < .0001). CONCLUSIONS: Family-friendly health policy appears to have the intended outcome of retaining talent in the military workforce. The impact of health policy on this population can provide a glimpse into the influence of similar policies should they be implemented nationwide.

Association of Habitual Intake of Probiotic Supplements and Yogurt with Characteristics of the Gut Microbiome in the Multiethnic Cohort Adiposity Phenotype Study.

Consumption of probiotics and/or yogurt could be a solution for restoring the balance of the gut microbiota. This study examined associations of regular intake of probiotic supplements or yogurt with the gut microbiota among a diverse population of older adults (N=1,861; 60-72 years). Fecal microbial composition was obtained from 16S rRNA gene sequencing (V1-V3 region). General Linear Models were used to estimate the associations of probiotic supplement or yogurt intake with microbiome measures adjusting for covariates. Compared to non-yogurt consumers (N=1,023), regular yogurt consumers (≥once/week, N=818) had greater Streptococcus (ß=0.29, P=0.0003) and lower Odoribacter (ß=-0.33, P<0.0001) abundance. The directions of the above associations were consistent across the five ethnic groups but stronger among Japanese Americans (Streptococcus: ß=0.56, P=0.0009; Odoribacter: ß=-0.62, P=0.0005). Regular intake of probiotic supplements (N=175) was not associated with microbial characteristics (i.e., alpha diversity and the abundance of 152 bacteria genera). Streptococcus is one of the predominant bacteria genera in yogurt products, which may explain the positive association between yogurt consumption and Streptococcus abundance. Our analyses suggest that changes in Odoribacter were independent of changes in Streptococcus abundance. Future studies may investigate whether these microbial genera and their sub-level species mediate potential pathways between yogurt consumption and health.

Effects of vitamin D3 and calcium supplementation on serum levels of tocopherols, retinol, and specific vitamin D metabolites.

γ-Tocopherol (γT) protects against DNA-damaging effects of nitrogen oxides, yet its physiologic regulation in vivo is unknown. Observational studies indicate inverse associations of 25[OH]-vitamin D with γT and leptin. To determine whether vitamin D(3) supplementation alters levels of lipid-soluble micronutrients, serum samples (N = 85 subjects) from a randomized, double-blind, placebo-controlled clinical trial of vitamin D(3) (800 IU) and calcium (2 g), alone and in combination, were analyzed for lipid micronutrients and specific vitamin D metabolites at baseline and after 6 mo of supplementation. Serum 25[OH]-vitamin D(3) levels increased 55% (P < 0.0001) and 48% (P = 0.0005), whereas 25[OH]-vitamin D(2) levels were lower by 48% (P = 0.26) and 21% (P = 0.36) in the vitamin D(3) and vitamin D(3) plus calcium groups, respectively. At baseline, γT levels were inversely associated with 25[OH]D (r = -0.31, P = 0.004). With vitamin D(3) plus calcium treatment, serum α-tocopherol decreased 14% (P = 0.04), whereas similar changes in γT (19% lower, P = 0.14) were observed. No significant effects were observed for D(3) supplementation on leptin or retinol levels. These results are consistent with the hypothesis that vitamin D(3) ± calcium affects serum tocopherol and 25[OH]D(2) levels; however, studies using larger, more homogeneous populations are warranted.

Leptin, adiponectin, and obesity among Caucasian and Asian women.

Ethnic differences in adipose tissue distribution may contribute to different chronic disease risks across ethnic groups, and adipokines may mediate the risk. In a cross-sectional study, we examined ethnic differences in adipokines and inflammatory markers as related to body mass index (BMI) among 183 premenopausal women with Caucasian and Asian ancestry. General linear models were used to estimate adjusted mean levels of leptin, adiponectin, interleukin-6, and C-reactive protein (CRP). Asian women had significantly lower serum levels of leptin, adiponectin, and CRP than Caucasian participants (P≤.01) across all levels of BMI. Among overweight and obese women, Asians showed a stronger association of CRP with leptin (ß=1.34 versus ß=0.64) and with adiponectin (ß=-0.95 versus ß=-0.75) than Caucasians. Compared to Caucasians of similar BMI, Asians may experience a higher chronic disease risk due to lower levels of adiponectin despite their lower levels of leptin.

Effect of a Workplace Weight-Loss Program for Overweight and Obese Healthcare Workers.

PURPOSE: Examining the effect of a workplace weight-loss program on weight loss, and physical, behavioral and mental well-being among overweight/obese healthcare workers. DESIGN: Quasi experimental design. SETTING: Single healthcare setting. PARTICIPANTS: Forty-one (48.0 ± 11.2 years) day-time shift healthcare employees with body mass index [BMI] >29 kg/m2. INTERVENTION: Sixteen-week program with weekly group meetings/activities and individual appointments with nutrition/health experts. MEASURES: Objective (weight, BMI, blood pressure) and self-reported measures were collected at baseline, conclusion of the intervention and 3 to 6 months post-intervention. ANALYSIS: Repeated measure analysis accounting for confounders. RESULTS: Participants had an average of 13 pounds (5.6%) weight loss (224.2 ± 6.4 vs. 211.6 ± 6.4 lbs.; P < 0.0001) upon program completion with significant decreases in BMI (37.7 ± 1.0 vs. 35.1 ± 1.0 kg/m2; P < 0.0001). Extreme obesity (BMI≥40 kg/m2) rate was reduced from 36.6% to 17.1% (P < 0.0001). There were decreases in diastolic blood pressure (76.0 ± 1.4 vs. 68.7 ± 1.5 mmHg; P = 0.001) and self-reported blood glucose (119.9 ± 4.4 vs. 105.5 ± 4.6 mg/dL; P = 0.03). Participants had improvements in weekly physical activity (25% change; P = 0.01), nutrition behavior (33% change, P < 0.0001), sleep quality (23% change, P = 0.005), and depression (72% change, P < 0.0001). Twenty-seven participants had post-intervention follow-up data. On average participants regained 8 pounds, which was less than the initial weight loss (16 lbs., N = 27). CONCLUSION: The results suggest the program may benefit healthcare employees. Further emphasis should be placed on post-intervention weight management to prevent weight regain.

Associations of Dietary Lipid-Soluble Micronutrients with Hepatic Steatosis among Adults in the United States.

Lipid-soluble micronutrients may be beneficial to non-alcoholic fatty liver disease due to their important roles in metabolism and maintaining tissue functions. Utilizing 2017-2018 National Health and Nutrition Examination Survey, this study examined the potential overall and race/ethnicity-specific (black, Hispanic and white) associations of dietary lipid-soluble micronutrients (α-tocopherol, retinol, vitamin D, ß-carotene and total carotenoids) with hepatic steatosis. The analysis included 4376 adults (1037 blacks, 981 Hispanics, 1549 whites) aged ≥20 years who completed the transient elastography examination with dietary data available. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using logistic regressions. The age-adjusted prevalence of steatosis was 20.9% for blacks, 34.0% for Hispanics and 28.7% for whites. Overall, dietary α-tocopherol was inversely associated with steatosis (highest vs. lowest quartile: OR = 0.51, 95%CI = 0.35-0.74, Ptrend = 0.0003). The associations remained significant among blacks (highest vs. lowest tertile: OR = 0.45, 95%CI = 0.26-0.77, Ptrend = 0.002) and whites (highest vs. lowest tertile: OR = 0.56, 95%CI = 0.33-0.94, Ptrend = 0.02). Higher α-tocopherol intake was associated with lower odds of steatosis among all (Ptrend = 0.016) and black participants (Ptrend = 0.003) classified as never/rare/occasional alcohol drinkers. There was a trend suggesting higher ß-carotene intake with lower odds of steatosis (Ptrend = 0.01). Our results suggest potential protective effects of dietary vitamin E as α-tocopherol on steatosis particularly among blacks.

Associations of quality of life with physical activity, fruit and vegetable consumption, and physical inactivity in a free living, multiethnic population in Hawaii: a longitudinal study.

INTRODUCTION: High intake of fruit and vegetables and being physically active are associated with reduced risk of chronic diseases. In the current study, we examined the associations of physical activity, fruit and vegetable consumption, and TV/video watching (indicator for physical inactivity) with perceived quality of life (QOL) in a sample of free living adults. METHODS: A cohort (N = 139) from a random, multi-ethnic sample of 700 adults living in Hawaii was evaluated at 3-month intervals for the first year and 6-month intervals for the second year. QOL was assessed from self-reports of mental or physical health at the end of the study. RESULTS: Overall, the cohort participants appeared to maintain relatively constant levels of physical activity, fruit and vegetable intake, and TV/video watching. Physical activity was positively related to mental health (p-values < 0.05), but not physical health, at all time points regardless of participants' fruit and vegetable consumption and hours of TV/video watching. Neither mental nor physical health was associated with fruit and vegetable intake or TV/video watching. CONCLUSION: Our study supports that physical activity is positively associated with mental health. Fruit and vegetable consumption and TV/video watching may be too specific to represent an individual's overall nutritional status and physical inactivity, respectively.

Association of Home Food Availability with Prediabetes and Diabetes among Adults in the United States.

This study examined associations of home food availabilities with prediabetes and diabetes among 8929 adults (20-70 years) participating in 2007-2010 National Health and Nutrition Examination Surveys. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression. Relative to non-diabetic participants (individuals without diabetes or prediabetes), prediabetes participants were associated with lower availabilities of green vegetables (OR = 0.82; 95% CI = 0.73-0.91; p = 0.0006) and fat-free/low-fat milk (OR = 0.80, 95% CI = 0.65-0.89; p = 0.001) and higher sugary drink availability (OR = 1.24, 95% CI = 1.04-1.48; p = 0.02), adjusting for age, sex, and ethnicity (Model 1). The associations remained significant for vegetables (p = 0.005) and fat-free/low-fat milk (p = 0.02) adjusting for additional confounders (body mass index, education, Model 2). Adjusting for dietary components did not change the above results (in model 2) significantly. Participants with high healthy food availability scores had approximately 31% reduction (p = 0.003) in odds of prediabetes compared to those with low scores in Model 1. No associations were detected for diabetes except for fat-free/low-fat milk availability, for which an inverse association was observed in Model 1 (OR = 0.80, 95% CI = 0.65-0.99; p = 0.04). The results show prediabetes participants had lower availability of healthy foods and higher availability of unhealthy foods, suggesting the need to improve healthy food availability at home for this population.