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Adewumi O, Fijabi O. Higher Diet Quality Observed in Pregnant Women Compared to Women Living with and without Children in the US: NHANES 2011-2016. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2024; 43:430-436. [PMID: 38252077 DOI: 10.1080/27697061.2024.2302049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/01/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Women of reproductive age are a critical part of the population because their dietary habits and nutritional status impact the nutritional trajectory of future generations. Various studies have assessed the diet quality among women of reproductive age, but few studies have compared the diet quality of these women across the different life stages. OBJECTIVE To compare the diet quality among pregnant women, women living with children and women living without children in the United States of America (USA) using the Healthy Eating Index (HEI). METHODS This cross-sectional study was a secondary data analysis of the National Health and Nutrition Survey (NHANES), 2011-2016. Study participants comprised a total of 7120 women, ages 20-44 years in one of three life stage categories, pregnant women, women living in households with and without children less than 18 years. The HEI 2015 was used to assess the overall diet quality score as well as 13 dietary component scores-whole fruit, total fruit, greens and beans, whole grains, total vegetables, total protein foods, fatty acids, seafood and plant proteins, dairy, saturated fat, sodium, refined grains, and added sugars. The differences in HEI scores by life stage was assessed using linear regression models, adjusting for marital status, age, race and ethnicity, poverty index ratio, and educational status. RESULTS The mean overall HEI score of participants was 52.0 out of 100 points. The overall HEI scores of pregnant women was significantly higher than women living with and without children respectively (β = 4.6 ± 1.42, p = 0.002; β = 3.7 ± 1.34, p = 0.009). Also, pregnant women had significantly higher scores for whole fruit (β = 0.99 ± 0.18, p < 0.001; β = 0.98 ± 0.17, p < 0.001), dairy (β = 0.63 ± 0.27, p = 0.02; β = 0.68 ± 0.29, p = 0.02) and whole grains (β = 1.05 ± 0.40, p = 0.01; β = 0.97 ± 0.39, p = 0.02) than women living with and without children respectively. On the other hand, women living without children had significantly higher scores for total vegetables (β = 0.18 ± 2.04, p = 0.002), refined grains (β = 0.22 ± 0.10, p = 0.03) and added sugars (β = 0.35 ± 0.16, p = 0.04) than women living with children. CONCLUSION Pregnant women had the highest diet quality while women living in households with children had the lowest diet quality among the studied population.
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Affiliation(s)
- Opeyemi Adewumi
- Department of Human Nutrition and Hospitality Management, University of Alabama, Tuscaloosa, Alabama, USA
| | - Oluwatobi Fijabi
- Biological Sciences Department, University of Alabama, Tuscaloosa, Alabama, USA
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Stojic S, Eriks-Hoogland I, Gamba M, Valido E, Minder B, Chatelan A, Karagounis LG, Ballesteros M, Díaz C, Brach M, Stoyanov J, Diviani N, Rubinelli S, Perret C, Glisic M. Mapping of Dietary Interventions Beneficial in the Prevention of Secondary Health Conditions in Spinal Cord Injured Population: A Systematic Review. J Nutr Health Aging 2023; 27:524-541. [PMID: 37498100 DOI: 10.1007/s12603-023-1937-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/06/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Individuals with spinal cord injury are at risk of secondary health conditions (SHC) that develop as a consequence of autonomic dysfunction, prolonged oxidative stress and inflammation, and physical inactivity coupled with inadequate energy and nutritional intake. SHC can be debilitating and even life-threatening, and its prevention remains one of the major challenges in the continuum of medical care of aging SCI population. An unhealthy diet is a major driver of inflammation, oxidative stress, and unfavourable metabolic status and may be a practical preventive target to tackle increased SHC risk post-injury. AIMS To provide a catalogue of dietary interventions beneficial in prevention of SHC among individuals with SCI by conducting a systematic review of the literature on dietary interventions and dietary supplementation in promoting health and well-being after the injury. In addition, we aimed to provide a summary of observational studies exploring the association between habitual diet (macro- and micronutrients intake and dietary patterns) and health patterns following the injury. METHOD This review was registered at PROSPERO (University of York) with registration number CRD42022373773. Four medical databases (EMBASE.com, MEDLINE [Ovid], Cochrane CENTRAL, and Web of Science Core Collection) and Google Scholar were searched from inception until 11th July 2022. Studies were included if they were clinical trials or observational studies conducted in adult individuals with SCI and provided information of interest. Based on strength of the study design and risk of bias assessment (using the NIH tool), we classified studies from Level 1 (most reliable studies) to Level 4 (least reliable studies). RESULTS Of 12,313 unique citations, 47 articles (based on 43 original studies) comprising 32 interventional (22 RCTs, 3 NRCT, and 7 pre-post studies) and 11 observational studies (2 cohort studies, 2 case-control, 1 post-intervention follow-up study, and 6 cross-sectional studies) were included in the present systematic review. Twenty studies (46.5%) were classified as Level 1 or 2, indicating high/moderate methodological quality. Based on those studies, dietary strategies including high protein diet, intermittent fasting, balanced diet in combination with physical conditioning and electrical stimulation, and dietary supplementation including alpha-lipoic acid, creatine, vitamin D, and cranberry-derived supplements and probiotics were mapped as the most promising in prevention of SHC among individuals with SCI. CONCLUSIONS To develop timely and effective preventive strategies targeting major SHC (e.g., cardiometabolic diseases, urinary tract infections) in SCI, further research is warranted to confirm the effectiveness of dietary strategies/interventions identified through the current systematic review of the literature.
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Affiliation(s)
- S Stojic
- PD. Dr Marija Glisic, Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland, and
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Sneij A, Farkas GJ, Carino Mason MR, Gater DR. Nutrition Education to Reduce Metabolic Dysfunction for Spinal Cord Injury: A Module-Based Nutrition Education Guide for Healthcare Providers and Consumers. J Pers Med 2022; 12:2029. [PMID: 36556250 PMCID: PMC9786330 DOI: 10.3390/jpm12122029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/31/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
Spinal cord injury (SCI) results in a high prevalence of neurogenic obesity and metabolic dysfunction. The increased risk for neurogenic obesity and metabolic dysfunction is mainly due to the loss of energy balance because of significantly reduced energy expenditure following SCI. Consequently, excessive energy intake (positive energy balance) leads to adipose tissue accumulation at a rapid rate, resulting in neurogenic obesity, systemic inflammation, and metabolic dysfunction. The purpose of this article is to review the existing literature on nutrition, dietary intake, and nutrition education in persons with SCI as it relates to metabolic dysfunction. The review will highlight the poor dietary intakes of persons with SCI according to authoritative guidelines and the need for nutrition education for health care professionals and consumers. Nutrition education topics are presented in a module-based format with supporting literature. The authors emphasize the role of a diet consisting of low-energy, nutrient-dense, anti-inflammatory foods consistent with the Dietary Guidelines for Americans' MyPlate to effectively achieve energy balance and reduce the risk for neurogenic obesity and metabolic dysfunction in individuals with SCI.
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Affiliation(s)
- Alicia Sneij
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, P.O. Box 016960 (C-206), Miami, FL 33101, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33101, USA
| | - Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, P.O. Box 016960 (C-206), Miami, FL 33101, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33101, USA
| | - Marisa Renee Carino Mason
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, P.O. Box 016960 (C-206), Miami, FL 33101, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, P.O. Box 016960 (C-206), Miami, FL 33101, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33101, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- South Florida Spinal Cord Injury Model System, University of Miami Miller School of Medicine, Miami, FL 33101, USA
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Li J, Gower B, McLain A, Yarar‐Fisher C. Effects of a low-carbohydrate/high-protein diet on metabolic health in individuals with chronic spinal cord injury: An exploratory analysis of results from a randomized controlled trial. Physiol Rep 2022; 10:e15501. [PMID: 36411989 PMCID: PMC9812250 DOI: 10.14814/phy2.15501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023] Open
Abstract
We explored the impact of a low-carbohydrate/high-protein diet (LC/HP, ~30% energy from protein, 40% energy from carbohydrate) on indices of metabolic function and body composition in individuals with chronic spinal cord injury (SCI). Adults with SCI (≥3 years post-injury, C4-L2, AIS A-D) and insulin resistance or pre-diabetes were randomly assigned to an 8-week iso-caloric LC/HP diet group (n = 11) or control group (n = 14). All LC/HP meals were delivered weekly to participants' homes, and participants in the control group consumed their habitual diet. Each participant underwent an oral glucose tolerance test (OGTT) to assess glucose tolerance, insulin, area under the curve (AUC) for glucose and insulin, Matsuda Index, glucose-stimulated insulin secretion (GSIS), disposition index, and hepatic insulin extraction (HIE). Fasting blood lipid and inflammation were assessed, and body composition was estimated using dual-energy x-ray absorptiometry. A linear mixed model was used to evaluate the main effect of diet, time, and their interaction. Compared to the control group, participants in the LC/HP group had reduced total body fat mass (LC/HP: -5.9%, Control: 0.7%), visceral fat mass (LC/HP: -16.2%, Control: 5.2%), total- (LC/HP: -20.1, Control: 3.7 mg/dl), and LDL-cholesterol (LC/HP: -13.9, Control: 3.1 mg/dl) (pdiet*time < 0.05 for all). Regardless of group, AUCinsulin and peak insulin during the OGTT decreased, and HIE increased over time (ptime < 0.05). A trend for diet*time interaction was observed for glucoseOGTT120min (LC/HP: -20.7, Control: 3.0 mg/dl, pdiet*time = 0.09) and peak C-peptide (LC/HP: -2.1, Control: 0.0 ng/ml, pdiet*time = 0.07). HDL-cholesterol, lean body mass, Matsuda Index, fasting glucose, insulin, insulinOGTT120min , AUCglucose , pancreatic beta cell function (GSIS, disposition index), and inflammation (C-reactive protein, IL-6, IL-8, IL-10, TNF-α) did not change over time. In conclusion, our results suggest that individuals with SCI and insulin resistance may adopt an LC/HP diet to improve body composition and lipid profiles. Its impact on glucose metabolism and inflammation remains inconclusive and warrants future investigations.
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Affiliation(s)
- Jia Li
- Departments of Physical Medicine and RehabilitationThe University of Alabama at BirminghamBirminghamAlabamaUSA
| | - Barbara Gower
- Department of Nutrition SciencesUAB School of Health ProfessionsBirminghamAlabamaUSA
| | - Amie McLain
- Departments of Physical Medicine and RehabilitationThe University of Alabama at BirminghamBirminghamAlabamaUSA
| | - Ceren Yarar‐Fisher
- Departments of Physical Medicine and RehabilitationThe University of Alabama at BirminghamBirminghamAlabamaUSA
- Departments of Physical Medicine and Rehabilitation and NeuroscienceThe Ohio State UniversityColumbusOhioUSA
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Effects of a Low-carbohydrate/High-protein Diet on Gut Microbiome Composition in Insulin Resistant Individuals with Chronic Spinal Cord Injury: Preliminary Results from a Randomized Controlled Trial. Arch Phys Med Rehabil 2022; 103:1269-1278. [DOI: 10.1016/j.apmr.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/18/2022]
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Farkas GJ, Gordon PS, Trewick N, Gorgey AS, Dolbow DR, Tiozzo E, Berg AS, Gater DR. Comparison of Various Indices in Identifying Insulin Resistance and Diabetes in Chronic Spinal Cord Injury. J Clin Med 2021; 10:5591. [PMID: 34884295 PMCID: PMC8658352 DOI: 10.3390/jcm10235591] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of this screening and diagnostic study was to examine the accord among indices of glucose metabolism, including the Homeostatic Model Assessment for Insulin Resistance (HOMA), HOMA2, Matsuda Index, Quantitative Insulin-sensitivity Check Index (QUICKI), hemoglobin A1C (HbA1C), and fasting plasma glucose (FPG) against intravenous glucose tolerance test-measured insulin sensitivity (Si) in individuals with chronic motor complete SCI. Persons with chronic (≥12-months post-injury) SCI (n = 29; 79% men; age 42.2 ± 11.4; body mass index 28.6 ± 6.4 kg/m2; C4-T10) were included. Measures were compared using adjusted R2 from linear regression models with Akaike information criterion (AIC, a measure of error). QUICKI had the greatest agreement with Si (adjusted R2 = 0.463, AIC = 91.1, p = 0.0001), followed by HOMA (adjusted R2 = 0.378, AIC = 95.4, p = 0.0008), HOMA2 (adjusted R2 = 0.256, AIC = 99.7, p = 0.0030), and the Matsuda Index (adjusted R2 = 0.356, AIC = 95.5, p = 0.0004). FPG (adjusted R2 = 0.056, AIC = 107.5, p = 0.1799) and HbA1C (adjusted R2 = 0.1, AIC = 106.1, p = 0.0975) had poor agreement with Si. While HbA1C and FPG are commonly used for evaluating disorders of glucose metabolism, QUICKI demonstrates the best accord with Si compared to the other measures.
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Affiliation(s)
- Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (E.T.); (D.R.G.)
| | - Phillip S. Gordon
- Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, NJ 08820, USA;
| | - Nareka Trewick
- University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, USA;
| | - David R. Dolbow
- Department of Physical Therapy, William Carey University, Hattiesburg, MI 39401, USA;
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MI 39401, USA
| | - Eduard Tiozzo
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (E.T.); (D.R.G.)
| | - Arthur S. Berg
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA;
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (E.T.); (D.R.G.)
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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