Disparities in eating disorder symptoms and mental healthcare engagement prior to and following the onset of the COVID-19 pandemic: Findings from a national study of US college students.

OBJECTIVE: Early COVID-19 eating disorders (EDs) research used regionally restricted samples with little sociodemographic diversity. The present study aimed to address these research gaps by examining whether pandemic-related changes in ED symptoms and mental healthcare prevalence differed for historically marginalized groups within a national sample of US college students. METHOD: Participants included 242,906 US college students (Mage  = 23.45, SD = 7.04; MBMI  = 25.28, SD = 5.91) who completed the repeated cross-sectional multi-institute Healthy Minds Study between January 2019 and May 2021. Moderated logistic regressions examined whether pandemic-related changes in individuals' likelihoods of exhibiting current probable ED, reporting lifetime ED diagnoses, and-among individuals with current probable ED-mental healthcare engagement differed for diverse gender, sexual, and racial/ethnic identity groups, and by body mass index (BMI) and financial stress. RESULTS: There were increases of 5% and 12% in individuals' likelihoods of exhibiting current probable ED and symptomatic individuals' mental healthcare engagement, respectively, pre- to post-COVID-19 onset, but no pandemic-related changes in lifetime ED diagnosis prevalence. There were also important variations in these time-trends for different marginalized groups. For example, individuals identifying as genderqueer/gender nonconforming and lesbian exhibited increasing ED symptoms pre- to post-COVID-19 onset, and individuals with current probable ED and higher BMIs were increasingly likely to receive mental healthcare. Associations between financial stress, and the ED and mental healthcare outcomes did not change over time. DISCUSSION: These findings provide insight into groups of US college students that experienced disproportionate ED burden during the pandemic at the population level, and directions for research and interventions that warrant consideration.

Ultra-processed Foods and Cardiometabolic Health Outcomes: from Evidence to Practice.

PURPOSE OF REVIEW: Poor diet quality is the leading risk factor related to the overall cardiometabolic disease burden in the USA and globally. We review the current evidence linking ultra-processed foods and cardiometabolic health risk and provide recommendations for action at the clinical and public health levels. RECENT FINDINGS: A growing body of evidence conducted in a variety of study populations supports an association between ultra-processed food intake and increased risk of metabolic syndrome, hypertension, type 2 diabetes, overweight and obesity trajectories, and cardiovascular disease. The strongest evidence is observed in relation to weight gain and obesity among adults, as this association is supported by high-quality epidemiological and experimental evidence. Accumulating epidemiologic evidence and putative biological mechanisms link ultra-processed foods to cardiometabolic health outcomes. The high intake of ultra-processed foods in all population groups and its associated risks make ultra-processed foods an ideal target for intensive health promotion messaging and interventions.

Changes in the prevalence and sociodemographic correlates of eating disorder symptoms from 2013 to 2020 among a large national sample of U.S. young adults: A repeated cross-sectional study.

OBJECTIVE: The present study aimed to: (1) identify recent temporal changes in the prevalence of different cognitive and behavioral eating disorder (ED) symptoms, current probable EDs, lifetime ED diagnoses, and mental healthcare use among college students across the United States; (2) determine whether established disparities in ED prevalence and receiving mental healthcare have widened or narrowed over time for marginalized groups within this population. METHOD: Participants included a large national sample of U.S. college students (N = 286,720) who completed the repeated cross-sectional Healthy Minds Study from 2013 to 2020. Descriptive statistics and polynomial regressions quantified time-trends in participants' ED symptoms and past 12-month mental healthcare. Moderated regressions examined temporal changes in ED symptoms and mental healthcare based on sociodemographic characteristics. RESULTS: Individuals' engagement in different cognitive and behavioral ED symptoms, and likelihoods of exhibiting current probable EDs, reporting lifetime ED diagnoses, and (for individuals with current probable EDs) receiving therapy or counseling in the past 12-months exhibited nonlinear increases from 2013 to 2020. Further, the prevalence of current and lifetime ED symptoms and (for symptomatic individuals) past 12-month mental healthcare differed over time for individuals with different BMIs and gender, sexual, and racial/ethnic identities (but not ages). In particular, individuals with higher BMIs and those who identified as male, bisexual, and gay, lesbian, or queer exhibited increasing ED pathology over time. DISCUSSION: These findings provide important information on groups of U.S. college students that have experienced increasing burden of ED symptoms and may help guide ED prevention, treatment, and research priorities. PUBLIC SIGNIFICANCE: Recent temporal changes in the prevalence of eating disorder (ED) symptoms and mental healthcare were examined in a national sample of U.S. young adults. Non-linear increases in ED symptoms and mental healthcare were identified among U.S. young adults overall from 2013 to 2020. U.S. young adults with higher BMIs, males, bisexual, and gay, lesbian, or queer individuals exhibited increasing ED burden over time.

Dietary Patterns, Ceramide Ratios, and Risk of All-Cause and Cause-Specific Mortality: The Framingham Offspring Study.

BACKGROUND: Prior evidence suggests that diet modifies the association of blood ceramides with the risk of incident cardiovascular disease (CVD). It remains unknown if diet quality modifies the association of very long-chain-to-long-chain ceramide ratios with mortality in the community. OBJECTIVES: Our objectives were to determine how healthy dietary patterns associate with blood ceramide concentrations and to examine if healthy dietary patterns modify associations of ceramide ratios (C22:0/C16:0 and C24:0/C16:0) with all-cause and cause-specific mortality. METHODS: We examined 2157 participants of the Framingham Offspring Study (mean age = 66 y, 55% women). Blood ceramides were quantified using a validated assay. We evaluated prospective associations of the Dietary Guidelines Adherence Index (DGAI) and Mediterranean-style Diet Score (MDS) with incidence of all-cause and cause-specific mortality using Cox proportional hazards models. Cross-sectional associations of the DGAI and MDS with ceramides were evaluated using multivariable linear regression models. RESULTS: The C22:0/C16:0 and C24:0/C16:0 ceramide ratios were inversely associated with all-cause, CVD, and cancer mortality; multivariable-adjusted HRs (95% CIs) were 0.73 (0.67, 0.80) and 0.70 (0.63, 0.77) for all-cause mortality, 0.74 (0.60, 0.90) and 0.69 (0.55, 0.86) for CVD mortality, and 0.75 (0.65, 0.87) and 0.75 (0.64, 0.88) for cancer mortality, respectively. Inverse associations of the C22:0/C16:0 and C24:0/C16:0 ceramide ratios with cancer mortality were attenuated among individuals with a higher diet quality (DGAI or MDS above the median, all P-interaction ≤0.1). The DGAI and MDS had distinct associations with ceramide ratios (DGAI: lower C22:0/C16:0 across quartiles; MDS: higher C24:0/C16:0 across quartiles; all P-trend ≤0.01). CONCLUSION: In our community-based sample, ceramide ratios (C22:0/C16:0 and C24:0/C16:0) were associated with a lower risk of all-cause and cause-specific mortality. Further, we observed that a higher overall diet quality attenuates the association between blood ceramide ratios and cancer mortality and that dietary patterns have distinct relations with ceramide ratios.

The association among diet, dietary fiber, and bowel preparation at colonoscopy.

BACKGROUND AND AIMS: Pre-colonoscopy dietary restrictions vary widely and lack evidence-based guidance. We investigated whether fiber and various other foods/macronutrients consumed during the 3 days before colonoscopy are associated with bowel preparation quality. METHODS: This was a prospective observational study among patients scheduled for outpatient colonoscopy. Patients received instructions including split-dose polyethylene glycol, avoidance of vegetables/beans 2 days before colonoscopy, and a clear liquid diet the day before colonoscopy. Two 24-hour dietary recall interviews and 1 patient-recorded food log measured dietary intake on the 3 days before colonoscopy. The Nutrition Data System for Research was used to estimate dietary exposures. Our primary outcome was the quality of bowel preparation measured by the Boston Bowel Preparation Scale (BBPS). RESULTS: We enrolled 201 patients from November 2015 to September 2016 with complete data for 168. The mean age was 59 years (standard deviation, 7 years), and 90% of colonoscopies were conducted for screening/surveillance. Only 17% and 77% of patients complied with diet restrictions 2 and 1 day(s) before colonoscopy, respectively. We found no association between foods consumed 2 and 3 days before colonoscopy and BBPS scores. However, BPPS was positively associated with intake of gelatin, and inversely associated with intake of red meat, poultry, and vegetables on the day before colonoscopy. CONCLUSIONS: Our findings support recent guidelines encouraging unrestricted diets >1 day before colonoscopy if using a split-dose bowel regimen. Furthermore, we found no evidence to restrict dietary fiber 1 day before colonoscopy. We also found evidence to promote consumption of gelatin and avoidance of red meat, poultry, and vegetables 1 day before colonoscopy.

Eating disorders in collegiate female athletes: factors that assist recovery.

The purpose of this study was to identify factors that assist female athletes' recovery from eating disorders. Forty-seven female collegiate athletes who experienced eating disorders responded to an open-ended question regarding factors that most helped their recovery. The most common factors were the desire to be healthy enough to perform in sport, support from others, and shifts in values/beliefs. A unique finding was that the desire to be healthy enough to perform in sport most frequently facilitated recovery. This knowledge can help treatment providers to foster athletes' motivation to recover and distinguishes athletes as a unique treatment population from non-athletes.

Behavioral approaches to nutrition and eating patterns for managing type 2 diabetes: A review.

Nutritional interventions are a key component of type 2 diabetes management; making health-supporting changes in eating patterns can improve postprandial glycemic excursions and lower HbA1c to reduce diabetes-related morbidity and mortality. Research around implementing calorie-restricted and/or low-carbohydrate diets is plentiful, though the ability to sustain physiologic and behavioral changes for longer than 12 months is a concern. An understanding of intervention goals and adherence is needed to apply this research to patient care and translate expectations to real-world living contexts. Diverse dietary patterns including a Mediterranean eating pattern, vegetarian or plant-based eating pattern, or others that emphasize high-quality carbohydrates (e.g., whole grains), vegetables, whole fruits, legumes, and fish can support achievement of glycemic targets. Counseling strategies like motivational interviewing can be used to build eating competence. These approaches prioritize collaborative decision-making with the goal of increasing patient empowerment and self-efficacy. Strategies for incorporating these tools and frameworks in a clinical setting are highlighted. Providing ongoing diabetes and nutrition education, paired with appropriate support to address the challenges in implementing and sustaining behavior changes, is warranted. Further, social determinants of health including environmental context, education, socioeconomic status, access to healthcare, and experiences of systemic stigma (e.g., racism or weight bias) can interfere with individuals' diabetes self-care and nutrition behaviors. Providing medical nutrition therapy and tailoring nutrition interventions to individual needs and circumstances can be an important way physicians, dietitians, and diabetes providers can support individuals with type 2 diabetes.

Women's perceptions of weight stigma and experiences of weight-neutral treatment for binge eating disorder: A qualitative study.

Background: The detrimental effects of weight stigma are a growing concern as a contributor to negative physical and mental health outcomes, disparities in care, and healthcare avoidance. Research exploring the impact of weight-neutral healthcare is limited but suggests weight-neutral interventions are associated with positive psychological and behavioral outcomes. Little is known about patients' lived experiences receiving weight-neutral healthcare. Methods: We conducted semi-structured interviews between Feb 5, 2019 and Feb 25, 2020 with 21 women (90% non-Hispanic white, mean age 49 ± 14.8 years) who had type 2 diabetes or prediabetes and high body weight (mean body mass index 43.8 ± 8.4, range: 30.2-63.9) and previously attended a specialized treatment program for binge eating disorder. We recruited individuals with type 2 diabetes or prediabetes who completed of >2 weeks of a specialized binge eating disorder treatment program with the ability to participate in an English-spoken interview and did not have cognitive impairment or severe psychopathology that would limit recall or engagement in the interview. Interviews were analysed using thematic analysis and Nvivo software. The main outcome we studied was patients' lived experience in healthcare settings and in a weight-neutral eating disorder treatment program. Findings: Participants reported experiencing weight stigma in healthcare encounters and believed this decreased the quality of care they received. While participants frequently attempted to lose weight, they experienced embarrassment, internalized a sense of failure, and felt blamed for their weight and health conditions. In describing experiences within a weight-neutral paradigm, participants reported that helpful elements included consistency in the eating pattern (emphasizing adequate, varied, and nourishing intake), sufficient and specific education, and comprehensive support. Reported impacts included decreased binge episodes, experiencing less shame, and increased resiliency following treatment. Some participants experienced the weight-neutral treatment recommendations and the absence of the pursuit of weight loss as challenging. Interpretation: Weight-neutral treatment may improve psychological and behavioral outcomes regarding binge eating, and longitudinal, quantitative research is warranted. These findings are useful to decrease weight stigma in provider-patient interactions. Funding: The Dudley Allen Sargent Research Fund, Boston University.

Nutritional counseling in athletes: a systematic review.

Many studies report poor adherence to sports nutrition guidelines, but there is a lack of research on the effectiveness of nutrition education and behavior change interventions in athletes. Some studies among athletes demonstrate that nutrition education (NE), often wrongly confused with nutritional counseling (NC), alone is insufficient to result in behavior change. For this reason, a clear distinction between NC and NE is of paramount importance, both in terms of definition and application. NE is considered a formal process to improve a client's knowledge about food and physical activity. NC is a supportive process delivered by a qualified professional who guides the client(s) to set priorities, establish goals, and create individualized action plans to facilitate behavior change. NC and NE can be delivered both to individuals and groups. To our knowledge, the efficacy of NC provided to athletes has not been comprehensively reviewed. The aim of this study was to investigate the current evidence on the use and efficacy of nutritional counseling within athletes. A systematic literature review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. The search was carried out in: PubMed, Scopus, Web of Science, Science Direct, Cochrane Library between November 2022 and February 2023. Inclusion criteria: recreational and elite athletes; all ages; all genders; NC strategies. The risk of bias was assessed using the RoB 2.0 Cochrane tool. The quality of evidence checking was tested with the Mixed Methods Appraisal Tool system. From 2,438 records identified, 10 studies were included in this review, with athletes representing different levels of competition and type of sports. The most commonly applied behavior change theory was Cognitive Behavioral Theory. NC was delivered mainly by nutrition experts. The duration of the intervention ranged from 3 weeks to 5 years. Regarding the quality of the studies, the majority of articles reached more than 3 stars and lack of adequate randomization was the domain contributing to high risk of bias. NC interventions induced positive changes in nutrition knowledge and dietary intake consequently supporting individual performance. There is evidence of a positive behavioral impact when applying NC to athletes, with positive effects of NC also in athletes with eating disorders. Additional studies of sufficient rigor (i.e., randomized controlled trials) are needed to demonstrate the benefits of NC in athletes. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022374502.

Managing type 2 diabetes or prediabetes and binge eating disorder: a qualitative study of patients' perceptions and lived experiences.

BACKGROUND: The overlap in prevalence between type 2 diabetes and binge eating disorder is substantial, with adverse physical and mental health consequences. Little is known about patients' efforts at managing these two conditions simultaneously. The research objective was to explore patients' experiences managing co-existing type 2 diabetes or prediabetes and binge eating disorder. METHODS: This is a qualitative descriptive study using semi-structured interviews. Participants included 21 women with type 2 diabetes or prediabetes (90% non-Hispanic White; mean age 49 ± 14.8 years, mean BMI 43.8 ± 8.4; 48% with type 2 diabetes and mean HbA1c was 8.4%). Interviews were analyzed using thematic analysis and NVivo software. RESULTS: Qualitative analysis revealed that participants reported binge episodes frequently started in childhood or adolescence and went undiagnosed for decades; notably, they recalled that diabetes diagnosis preceded the binge eating disorder diagnosis. They also described trying to lose weight throughout their lives and how feelings of deprivation, shame, and failure exacerbated binge eating. Participants further reported how binge eating made diabetes self-care and outcomes worse. Finally, participants observed that when binge eating disorder treatment and diabetes management were synergistically integrated, they experienced improvements in both binge eating and glycemic outcomes. This integration included reframing negative thoughts surrounding binge eating disorder and diabetes self-management and increasing their understanding of how the two disorders were inter-related. CONCLUSION: Findings highlight the importance of increasing healthcare providers' awareness of and screening for binge eating disorder in the treatment of diabetes and inform specific integrated interventions that address both diagnoses. From this study where we interviewed 21 women with binge eating disorder (BED) and type 2 diabetes/prediabetes, we learned how binge eating impacted diabetes management and how diabetes impacted BED. Most participants reported receiving the diabetes diagnosis before being diagnosed with BED despite the earlier onset of binge eating, pointing to the need for BED screening. Participants described trying to lose weight throughout their lives and reported feelings of failure and shame, which made binge eating worse. Binge eating made diabetes management harder, but when diabetes and BED treatment were aligned, participants experienced improvements in binge symptoms and diabetes outcomes.

Cross-sectional association of dietary patterns with insulin-resistant phenotypes among adults without diabetes in the Framingham Offspring Study.

Cluster analysis is a valuable tool for exploring the health consequences of consuming different dietary patterns. We used this approach to examine the cross-sectional relationship between dietary patterns and insulin-resistant phenotypes, including waist circumference, BMI, fasting insulin, 2 h post-challenge insulin, insulin sensitivity index (ISI0,120), HDL-cholesterol, TAG and blood pressure, using data from the fifth examination cycle of the Framingham Offspring Study. Among 2875 participants without diabetes, we identified four dietary patterns based on the predominant sources of energy: 'Fruits, Reduced Fat Dairy and Whole Grains', 'Refined Grains and Sweets', 'Beer' and 'Soda'. After adjusting for multiple comparisons and potential confounders, compared with the 'Fruits, Reduced Fat Dairy and Whole Grains' pattern, the 'Refined Grains and Sweets' pattern had significantly higher mean waist circumference (92.4 v. 90.5 cm; P = 0.008) and BMI (27.3 v. 26.6 kg/m2; P = 0.02); the 'Soda' pattern had significantly higher mean fasting insulin concentration (31.3 v. 28.0 microU/ml; P < or = 0.001); the 'Beer' pattern had significantly higher mean HDL-cholesterol concentration (1.46 v. 1.31 mmol/l; P < 0.001). No associations were observed between dietary patterns and ISI0,120, TAG, and systolic or diastolic blood pressure. Our findings suggest that consumption of a diet rich in fruits, vegetables, whole grains and reduced-fat dairy protects against insulin-resistant phenotypes and displacing these healthy choices with refined grains, high-fat dairy, sweet baked foods, candy and sugar-sweetened soda may promote insulin-resistant phenotypes.

Diet and physical activity patterns of school-aged children.

Childhood provides an opportunity for establishing healthful lifestyle habits, yet little is known about diet and physical activity patterns of elementary school-aged children. A cohort of 35 boys and girls in grades 3 through 5 (mean age=9.5 years) was studied during the course of the 2004-2005 school year, providing seasonal assessments of diet and physical activity. Objectively measured data included height, weight, and pedometer step counts. Subjective data included seasonal 3-day diet diaries, a food frequency questionnaire, and a physical activity questionnaire. Participants were white, well-nourished, and within the healthy range for body mass index for age. Only three students (9%) were overweight and another three were "at risk" for overweight. Food intake patterns fell far below MyPyramid guidelines for average daily servings of fruits and vegetables. High intakes of saturated fat (average of 12% of calories) and sodium were noted, along with inadequate fiber intakes. Snacks, desserts, and entrees that contributed most to calorie and saturated fat intake were identified. Self-reported physical activity appears in line with recommendations, but step counts fall short, particularly for girls and during winter months. These findings identify targets for behavioral and environmental interventions to reduce childhood obesity risks. Additional research involving more diverse populations is warranted.

Clinical observations from nutrition services in college athletics.

College athletes are vulnerable to nutritional risks because of the rigorous demands of their sport, and because of the realities of college lifestyles. Athletes often adopt rigid training diets that predispose them to undernutrition, fatigue, and injury. Disordered eating, a common concern for college-aged women, affects a substantial number of female collegiate athletes, and is a growing concern for their male counterparts. Few resources exist to promote nutritional well-being among college athletes, particularly for individuals who suffer from eating pathology that is subclinical and often perceived as benign. This article presents evidence of the need for nutrition services for college athletes and describes nutritional risks that affect individuals across a variety of athletic teams. A multidisciplinary treatment model is depicted, featuring a nutrition practice at the core of a sports medicine wellness program in Division I college athletics. Observations from this practice document a substantial burden of subclinical eating disorders and elucidate characteristics of high-risk individuals. The Female Athlete Screening Tool is advocated as a useful tool for identifying eating pathology and triggering timely interventions. These insights from clinical practice identify opportunities and behavioral targets for intervention, and promote an effective model for health promotion in college athletics.

Feasibility and Acceptability of Dietary Intake Assessment Via 24-Hour Recall and Food Frequency Questionnaire among Women with Low Socioeconomic Status.

BACKGROUND: Comprehensive evaluation of dietary interventions depends on effective and efficient measurement to quantify behavior change. To date, little is known regarding which self-reported measure of dietary intake is most feasible and acceptable for use in evaluation of the effectiveness of diet intervention studies among underserved populations. OBJECTIVE: This research focused on evaluating feasibility and acceptability of two self-report measures of diet. DESIGN: Cross-sectional. PARTICIPANTS/SETTING: Two interviewer-administered 24-hour recalls and a 110-item food frequency questionnaire (FFQ) were administered to both English- and Spanish-speaking participants (n=36) by native English- and Spanish-speaking research assistants. On completion of both dietary assessments, participants were interviewed regarding their preference of measure. MAIN OUTCOME MEASURES: Feasibility for completion of the dietary assessment measures was determined for contacts and retention. Acceptability of the measures was determined through responses to open- and closed-ended questions. RESULTS: During the 5-month trial, 36 participants were enrolled; 29 completed both intake measures, and 26 completed both measures and the interview. Participants were mainly Hispanic/Latina (72%), with a mean age of 37.0 (±7.6) years. Feasibility targets were met for contacts (1.9, 1.6, 1.8 contact attempts to complete each diet assessment measure with a target of ≤2) and for retention with 89% and 91% completing two 24-hour recalls and the FFQ, respectively. Participants indicated both diet assessment methods were generally acceptable; both positive and negative comments were received for use of the FFQ. CONCLUSION: Dietary assessment with the use of 24-hour recalls or an FFQ can be feasible and acceptable among women with low socioeconomic status, although care should be taken to address cultural appropriateness in the selection of the measurement method.

Long-term yogurt consumption and risk of incident hypertension in adults.

OBJECTIVE: To evaluate the relation between yogurt consumption as well as cheese, milk, and total dairy, and high blood pressure (HBP) in two Nurses' Health Study cohorts (NHS, n = 69 298), NHS II (n = 84 368) and the Health Professionals Follow-Up Study (HPFS, n = 30 512). METHODS: NHS, NHS II, and HPFS participants were followed for incident HBP for up to 30, 20, and 24 years, respectively. Hazard ratios were calculated using time-dependent multivariate-adjusted Cox proportional hazards models. Pooled risk estimates were derived from fixed effects meta-analyses. RESULTS: Participants consuming at least five servings per week (vs. <1 serving per month) of yogurt in NHS, NHS II, and HPFS had 19% (95% CI 0.75-0.87), 17% (95% CI 0.77-0.90), and 6% (95% CI 0.83-1.07) lower HBP risks, respectively. In pooled analyses of these cohorts, higher yogurt consumption was linked with 16% (95% CI 0.80-0.88) lower HBP risk; higher total dairy (3 to <6 vs. <0.5 servings/day), milk (2 to <6/day vs. <4/week) and cheese (1 to 4/day vs. <1/week) were associated with 16% (95% CI 0.81-0.87), 12% (95% CI 0.86-0.90), and 6% (95% CI 0.90-0.97) lower HBP risks, respectively. After controlling for BMI as a possible causal intermediate, total dairy, yogurt, milk, and cheese were associated with 13, 10, 8, and 8% lower HBP risks, respectively. The combination of higher yogurt intake and higher DASH ('Dietary Approaches to Stop Hypertension') diet scores was associated with 30% (95% CI 0.66-0.75) lower HBP risk compared with lower levels of both factors. CONCLUSION: Higher total dairy intake, especially in the form of yogurt, was associated with lower risk of incident HBP in middle-aged and older adult men and women.

Regular Yogurt Intake and Risk of Cardiovascular Disease Among Hypertensive Adults.

BACKGROUND: High blood pressure (HBP) is a major cardiovascular disease (CVD) risk factor. Clinical trials including Dietary Approaches to Stop Hypertension (DASH) have demonstrated beneficial effects of dairy consumption on risks of HBP and CVD. Yogurt, a fermented dairy product, may independently be related to CVD risk. OBJECTIVE: To evaluate the association between yogurt consumption and CVD risk among hypertensive individuals in 2 large cohorts and to determine whether the association differs among those whose eating pattern more closely resembles the DASH diet. METHODS: Overall, 55,898 female Nurses' Health Study (NHS) and 18,232 male Health Professionals Follow-Up Study (HPFS) participants with prevalent HBP were included. Cumulative average estimates of yogurt intake from validated food frequency questionnaires were related to verified self-reported CVD outcomes using Cox proportional hazards models. Hazard ratios and 95% confidence intervals (CI) were adjusted for CVD risk factors, medications, and diet covariates. RESULTS: Yogurt intake was inversely associated with CVD risk (myocardial infarction and stroke) among hypertensive participants (P <0.01 in both cohorts). Among participants consuming ≥2 servings/week of yogurt, NHS women had a 17% (95% CI: 0.74-0.92) lower risk while HPFS men experienced a 21% (95% CI: 0.66-0.96) lower CVD risk compared to those who consumed <1 serving/month. Regular yogurt consumers with higher DASH diet scores had 16% (95% CI: 0.73-0.96) and 30% (95% CI: 0.57-0.85) CVD risk reductions in the 2 cohorts, respectively. CONCLUSION: Hypertensive men and women who consumed ≥2 servings/week of yogurt, especially in the context of a healthy diet, were at lower risk for developing CVD.

A Tale of Two Runners: A Case Report of Athletes' Experiences with Eating Disorders in College.

Athletes are at higher risk than the general population for eating disorders, and risk is heightened for athletes in thin-build sports, including track. Collegiate athletes are particularly vulnerable to disordered eating when the transition from home to the college environment adds to the stress of performance pressures and the high demands of the sport environment. Male and female athletes who develop eating disorders share some common characteristics, yet their experiences can be quite different, in part as a consequence of their sex and how eating disorders develop, and are recognized, acknowledged, and treated, within the culture of sports. This case report describes the experiences of two track athletes, one male and one female, who were recruited to the same Division 1 collegiate track program. Both were elite athletes, freshmen in the same year, experiencing the same urban college environment, and experiencing an eating disorder characterized by restrictive eating, significant weight loss, injury, and compromised performance in sport. Both received treatment from a multidisciplinary team of professionals. Both athletes achieved weight restoration, recovery from the disorder, and success in their sport. In spite of the similarities, striking differences were apparent in clinical presentation, predisposing features, onset of symptoms, entry points to treatment, interventions received, and clinical courses through treatment that depict sex differences in how eating disorders present in athletes and are addressed in the sport environment. Findings endorse the need for research and inform prevention strategies, risk assessment, and intervention approaches for nutrition and sports medicine professionals and collegiate athletic departments.

Compliance with expert population-based dietary guidelines and lower odds of carotid atherosclerosis in women: the Framingham Nutrition Studies.

BACKGROUND: Carotid stenosis, an indicator of subclinical atherosclerosis, predicts future coronary artery disease (CAD) and stroke and provides a noninvasive method to identify candidates for primary prevention. The relation between diet and stenosis is relatively unexplored, particularly in women. OBJECTIVE: We evaluated in women the association between nutrient intakes that were consistent with expert population-based dietary guidelines and carotid stenosis. DESIGN: We used prospective logistic regression analyses to evaluate relations between baseline nutrient intake and the presence of carotid stenosis at 4-y follow-up in 1123 women from the Framingham Offspring-Spouse study, after control for multiple CAD risk factors. We also developed multivariate models that were stratified by compliance with expert population-based dietary guidelines and smoking status. RESULTS: Baseline nutrient and risk factor profiles differed by women's compliance and smoking status. Dietary noncompliance and smoking were each associated with odds for stenosis that were 2.5-fold those of dietary compliance and nonsmoking. Odds were highest for dietary noncompliance in combination with smoking (odds ratio: 3.49; 95% CI: 1.67, 7.27). CONCLUSIONS: Nutrient intake consistent with current expert population-based dietary guidelines and smoking abstinence are associated with lower odds of carotid atherosclerosis in women. Unique dietary and risk factor profiles of at-risk women suggest areas for targeted primary CAD prevention.

Unique dietary patterns and chronic disease risk profiles of adult men: the Framingham nutrition studies.

OBJECTIVE: To identify the dietary patterns of adult men and examine their relationships with nutrient intake and chronic disease risk over long-term follow-up. DESIGN/SUBJECTS: Baseline 145-item food frequency questionnaires from 1,666 Framingham Offspring-Spouse cohort men were used to identify comprehensive dietary patterns. Independent 3-day dietary records at baseline and 8 years later provided estimates of subjects' nutrient intake by dietary pattern. Chronic disease risk factor status was compared at baseline and 16-year follow-up across all male dietary patterns. STATISTICAL ANALYSES: Cluster analysis was applied to food frequency data to identify non-overlapping male dietary patterns. Analysis of covariance and logistic regression were used to compare nutrient intake, summary nutritional risk scores, and chronic disease risk status at baseline and follow-up by male dietary pattern. RESULTS: Five distinct and comprehensive dietary patterns of Framingham Offspring-Spouse men were identified and ordered according to overall nutritional risk: Transition to Heart Healthy, Higher Starch, Average Male, Lower Variety, and Empty Calories. Nutritional risk was high and varied by dietary pattern; key nutrient contrasts were stable over 8-year follow-up. Chronic disease risk also varied by dietary pattern and specific subgroup differences persisted over 16 years, notably rates of overweight/obesity and smoking. CONCLUSIONS: Quantitative cluster analysis applied to food frequency questionnaire data identified five distinct, comprehensive, and stable dietary patterns of adult Framingham Offspring-Spouse cohort men. The close associations between the dietary patterns, nutritional risk, and chronic disease profiles of men emphasize the importance of targeted preventive nutrition interventions to promote health in the male population.