Performance of a short percentage energy from fat tool in measuring change in dietary intervention studies

Affective disorders, weight change, and patient engagement in a rural behavioral weight loss trial

BACKGROUND

Adults in rural areas have a higher prevalence of obesity and some mental health conditions. The degree to which mental health influences weight loss among rural residents remains unclear. This study evaluated changes in body weight, physical activity, diet, and program engagement outcomes in a cohort of participants with vs. without an affective disorder in a behavioral weight loss trial.

METHODS

A sample of 1407 adults with obesity were recruited from rural U.S. primary care practices to participate in a weight loss trial. In this secondary analysis, participants were stratified by those with vs. without an affective disorder at baseline. Mixed models were used to estimate changes in outcomes over 24 months.

RESULTS

One-third of participants (n = 468) had an affective disorder. After covariate adjustment, both groups experienced significant weight loss over 24 months, but weight loss was significantly less among those with an affective disorder at all follow-up times (all p's < 0.001; 24-month weight loss -2.7 ± 0.4 vs. -4.8 ± 0.3 kg). Compared to those without an affective disorder, participants with an affective disorder also had significantly less improvement in physical activity and fruit/vegetable consumption, lower attendance at weight loss sessions, and less engagement in setting weight loss goals and strategies.

CONCLUSION

Participants with an affective disorder lost less body weight and less improvement in lifestyle measures over 24 months. These trends paralleled reduced engagement in critical intervention activities such as weight loss session attendance. Future interventions should consider additional methods to minimize disengagement in adults with underlying affective disorders.

Dietary Intake Among Church-Affiliated African Americans: The Role of Intentions and Beliefs

Diabetes and heart disease disproportionately burden African Americans, who tend to have worse nutritional intake than Whites. Many Black churches are influential institutions in the Black community, with potential to assist with promotion of healthy eating behaviors. The purpose of the current study was to use the Theory of Planned Behavior (TPB) to examine intention to eat a healthy diet and dietary behaviors among church-affiliated African Americans. It was hypothesized that TPB constructs would positively predict intention to eat a healthy diet and that intention to eat a healthy diet would be a predictor of fat and fruit and vegetable intake. It was also hypothesized that control beliefs would predict reduced fat intake and increased fruit and vegetable intake. Path analyses indicated behavioral, normative, and control beliefs were predictive of intention to eat a healthy diet. Intention to eat healthy was a significant predictor of dietary intake behaviors. These findings provide support for the use of the TPB in examining diet among church-affiliated African Americans. This study represents an opportunity to inform dietary interventions for the African American faith community.

Child Body Fat and Body Mass Index: Which Determinants are Most Important?

The purpose of this study was to examine child and parent determinants of children's body fat percentage (BF%) along with their body mass index percentile (BMIp). Children's BF% and BMIp auger lifelong health risks when elevated, and one in five children are affected. Participants (N = 135) included 62% female children; 50.7% Caucasian, 31.7% Hispanic, and 8.5% African American. Children were aged 9-15 years (2% underweight, 47.9% normal weight, 19.7% overweight, and 24.6% obese). Parent BMI average was 30.67 (1.4% underweight, 20.4% normal weight, 23.9% overweight, 40% obese, and 7% extreme obesity); 77.5% of the participating parents were mothers. Following multiple imputations, path analyses were conducted of child and parent determinants of children's BF% and BMIp. Children's BF% and BMIp were related to parents' concern about overweight and children's perception of that concern. For children of overweight or obese parents, who are at highest risk for obesity, assessing the parents' concern is the highest priority.

Health behavior among working adults: Workload and exhaustion are associated with nutrition and physical activity behaviors that lead to weight gain

The purpose of this study was to evaluate the relationship between workload, exhaustion, and key health behaviors for weight loss-nutrition and physical activity. Structural equation modeling was used to estimate the path coefficients in a sample of 953 employed adults. The results show that workload and exhaustion were positively related to emotional eating, uncontrolled eating, and percent of calories from fat. In addition, exhaustion was negatively related to physical activity levels. Workload and exhaustion are associated with nutrition and physical activity behaviors that promote weight gain and should be considered in weight management interventions for working adults.

Sex Differences in Lifestyle Behaviors among U.S. College Freshmen

Within lifestyle behavior research, the sex of populations causes differences in behaviors and outcomes of studies. This cross-sectional study investigated lifestyle behavior patterns in college students, examining sex differences in four areas: Nutrition, physical activity, sleep, and stress. Data from over 1100 college freshmen across 8 United States universities were used for this cross-sectional analysis. Self-reported data assessed fruit and vegetable intake, fat percent intake, physical activity, perceived stress, and sleep quality. Statistical analysis included Pearson chi-squared and Mann–Whitney’s U tests for scores by sex. Likewise, healthy cut-offs were used to determine frequency of participants within range of the five tools. Males reported higher intake of both fruits and vegetables, and percent energy from fat than females. Males also reported higher physical activity levels, lower stress levels, and poorer sleep quality than females. Of the five self-reported tools, males were found to have a larger frequency of participants with healthy ranges than females. In a large college freshmen sample, sex was found to be related to general lifestyle behaviors which strengthen results reported in the previous literature. These findings shed light on the need for lifestyle behavior interventions among at-risk college students to enhance their behaviors to healthy levels.

Increasing Dietary Fiber Intake Is Associated with a Distinct Esophageal Microbiome

Introduction

There is increasing evidence that the microbiome contributes to esophageal disease. Diet, especially fiber and fat intake, is a known potent modifier of the colonic microbiome, but its impact on the esophageal microbiome is not well described. We hypothesized that dietary fiber and fat intake would be associated with a distinct esophageal microbiome.

Methods

We collected esophageal samples from 47 ambulatory patients scheduled to undergo endoscopy who completed a validated food frequency questionnaire quantifying dietary fiber and fat intake. Using 16S high-throughput sequencing, we determined composition of the esophageal microbiome and predicted functional capacity of microbiota based on fiber and fat intake.

Results

Among all samples, the most abundant phyla were Firmicutes (54.0%), Proteobacteria (19.0%), Bacteroidetes (17.0%), Actinobacteria (5.2%), and Fusobacteria (4.3%). Increasing fiber intake was significantly associated with increasing relative abundance of Firmicutes (p = 0.04) and decreasing relative abundance of Gram-negative bacteria overall (p = 0.03). Low fiber intake was associated with increased relative abundance of several Gram-negative bacteria, including Prevotella, Neisseria, and Eikenella. Several predicted metabolic pathways differed between highest and lowest quartile of fiber intake. Fat intake was associated with altered relative abundance of few taxa, with no alterations at the phylum level and no changes in microbiome functional composition.

Conclusions

Dietary fiber, but not fat, intake was associated with a distinct esophageal microbiome. Diet should be considered an important modifier of the esophageal microbiome in future studies. Studies are also needed to elucidate how the effects of dietary fiber on the esophageal microbiome may contribute to esophageal disease.

Effect of Intensity and Program Delivery on the Translation of Diabetes Prevention Program to Worksites: A Randomized Controlled Trial of Fuel Your Life

OBJECTIVE

The aim of this study was to evaluate the effectiveness of the Fuel Your Life program, an adaptation of the Diabetes Prevention Program (DPP), utilizing implementation strategies commonly used in worksite programs-telephone coaching, small group coaching, and self-study.

METHODS

The primary outcomes of body mass index and weight were examined in a randomized control trial conducted with city/county employees.

RESULTS

Although the majority of participants in all three groups lost some weight, the phone group lost significantly more weight (4.9 lb), followed by the small groups (3.4 lb) and the self-study (2.7 lb). Of the total participants, 28.3% of the phone group, 20.6% of the small group, and 15.7% of the self-study group lost 5% or more of their body weight.

CONCLUSIONS

Fuel Your Life (DPP) can be effectively disseminated using different implementation strategies that are tailored to the workplace.

Association between diet quality and measures of body adiposity using the Rate Your Plate survey in patients presenting for coronary angiography

BACKGROUND

Diet is a modifiable risk factor for cardiovascular disease; however, dietary patterns are historically difficult to capture in the clinical setting. Healthcare providers need assessment tools that can quickly summarize dietary patterns. Research should evaluate the effectiveness of these tools, such as Rate Your Plate (RYP), in the clinical setting.

HYPOTHESIS

RYP diet quality scores are associated with measures of body adiposity in patients referred for coronary angiography.

METHODS

Patients without a history of coronary revascularization (n = 400) were prospectively approached at a tertiary medical center in New York City prior to coronary angiography. Height, weight, and waist circumference (WC) were measured; body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. Participants completed a 24-question RYP diet survey. An overall score was computed, and participants were divided into high (≥58) and low (≤57) diet quality groups.

RESULTS

Participants in the high diet quality group (n = 98) had significantly lower measures of body adiposity than did those in the low diet quality group (n = 302): BMI (P < 0.001), WC (P = 0.001), WHtR (P = 0.001). There were small but significant inverse correlations between diet score and BMI, WC, and WHtR (P < 0.001). These associations remained significant after adjustment for demographics, tobacco use, and socioeconomic factors.

CONCLUSIONS

Higher diet quality scores are associated with lower measures of body adiposity. RYP is a potential instrument to capture diet quality in a high-volume clinical setting. Further research should evaluate the utility of RYP in cardiovascular risk-factor control.

FUEL Your Life: A Translation of the Diabetes Prevention Program to Worksites

Purpose.

To evaluate the effectiveness of FUEL Your Life, a translation of the Diabetes Prevention Program for worksites.

Design.

A randomized control group design was conducted in five worksites of a large transportation company. Measures were collected pretest, posttest (6 months), and follow-up (12 months).

Setting.

Railroad maintenance facilities of Union Pacific Railroad.

Subjects.

Participants consisted of 362 workers (227 treatment, 135 control).

Intervention.

FUEL Your Life was translated from the Diabetes Prevention Program to better fit within the context of the worksite. The primary difference was the use of peer health coaches to provide social support and reinforcement and an occupational nurse to provide lesson content (six sessions of 10 minutes) to participants instead of the lifestyle coaches employed by the Diabetes Prevention Program, resulting in a less structured meeting schedule.

Measures.

The primary outcomes were weight and body mass index (BMI), with secondary outcomes including eating behaviors, physical activity, and social support.

Analysis.

Latent growth modeling was used to measure changes in the outcomes over time.

Results.

Participants in the intervention group maintained weight/BMI (–.1 pounds/–.1 BMI), whereas the control participants gained weight/BMI (+2.6 pounds/+.3 BMI), resulting in a statistically significant difference between groups. Fifty-five percent of intervention participants lost some weight, whereas only 35% of the control group lost weight.

Conclusions.

FUEL Your Life, a low intensity intervention, was not effective for promoting weight loss, but was effective for helping workers maintain weight over a 12-month period.

Racial Differences in Obesity-Related Risk Factors Between 2-Year-Old Children Born of Overweight Mothers

OBJECTIVE

Investigate racial differences in a range of obesity-related socio-behavioral risk factors in children born of obese mothers.

METHODS

142 Black and 151 White 2-year-old children and their parents were surveyed on their physical activity environment, food environment, parental role modeling, eating behaviors, feeding practices, child physical activity, dietary intake, and eating behaviors; body mass index (BMI) for parents and children (BMI z-score) were calculated.

RESULTS

In bivariate analyses, Black families reported significantly more risk factors for early-childhood obesity than White families, including greater availability of soda, more television viewing, and poorer dietary intake. In multivariate analyses adjusting for maternal and socioeconomic factors, the differences between Black and White families on factors including television watching and dietary intake remained significant.

CONCLUSION

These data show a greater number of risk factors for obesity among Black children and their families compared with White children even after adjustment for maternal BMI and socioeconomic status.

Relative validation of fruit and vegetable intake and fat intake among overweight and obese African-American women

OBJECTIVE

To compare commonly used dietary screeners for fat intake and fruit and vegetable intake with 24 h dietary recalls among low-income, overweight and obese African-American women.

DESIGN

Three telephone interviews were completed; measures included two 24 h dietary recalls (a weekday and weekend day) using the Nutrition Data System for Research software, the Behavioral Risk Factor Surveillance System's (BRFSS) Fruit and Vegetable Consumption Module and the National Cancer Institute's (NCI) Percentage Energy from Fat Screener.

SETTING

Participants were recruited from three federally qualified health centres in south-west Georgia, USA.

SUBJECTS

Participants (n 260) were African-American women ranging in age from 35 to 65 years. About half were unemployed (49.6%) and 58.7% had a high-school education or less. Most were obese (88.5%), with 39.6% reporting a BMI ≥ 40.0 kg/m(2).

RESULTS

Mean fruit and vegetable intake reported from the 24 h dietary recall was 2.66 servings/d compared with 2.79 servings/d with the BRFSS measure. The deattenuated Pearson correlation was 0.22, with notable variation by weight status, education level and age. Mean percentage of energy from fat was 35.5% as reported from the 24 h dietary recall, compared with 33.0% as measured by the NCI fat screener. The deattenuated Pearson correlation was 0.38, also with notable variation by weight status, education level and age.

CONCLUSIONS

Validity of brief dietary intake measures may vary by demographic characteristics of the sample. Additional measurement work may be needed to accurately measure dietary intake in obese African-American women.

Dash of faith: a faith-based participatory research pilot study

The Dash of Faith pilot used a community-based participatory research approach to design an experiential dietary intervention based on two African-American churches, one intervention and one comparison. Congregation members identified components that were incorporated into 12 weekly and 4 monthly sessions, with a goal of increasing fruit and vegetable and lowering fat intake. At 2 months, a marginally significant (p = 0.07) increase in fruit and vegetable consumption was observed in the intervention group but was not maintained at study conclusion. We propose that these mixed findings may be attributable, in part, to bias introduced by the participatory nature of the design.

Reducing cardiovascular disease risk in mid-life and older African Americans: a church-based longitudinal intervention project at baseline

INTRODUCTION

African Americans (AAs) experience higher age-adjusted morbidity and mortality than Whites for cardiovascular disease (CVD). Church-based health programs can reduce risk factors for CVD, including elevated blood pressure [BP], excess body weight, sedentary lifestyle and diet. Yet few studies have incorporated older adults and longitudinal designs.

PURPOSES

The aims of this study are to: a) describe a theory-driven longitudinal intervention study to reduce CVD risk in mid-life and older AAs; b) compare selected dietary (fruit and vegetable servings/day, fat consumption), physical activity (PA) and clinical variables (BMI, girth circumferences, systolic and diastolic BP, LDL, HDL, total cholesterol [CHOL] and HDL/CHOL) between treatment and comparison churches at baseline; c) identify selected background characteristics (life satisfaction, social support, age, gender, educational level, marital status, living arrangement and medication use) at baseline that may confound results; and d) share the lessons learned.

METHODS

This study incorporated a longitudinal pre/post with comparison group quasi-experimental design. Community-based participatory research (CBPR) was used to discover ideas for the study, identify community advisors, recruit churches (three treatment, three comparison) in two-counties in North Florida, and randomly select 221 mid-life and older AAs (45+) (n=104 in clinical subsample), stratifying for age and gender. Data were collected through self-report questionnaires and clinical assessments.

RESULTS AND CONCLUSIONS

Dietary, PA and clinical results were similar to the literature. Treatment and comparison groups were similar in background characteristics and health behaviors but differed in selected clinical factors. For the total sample, relationships were noted for most of the background characteristics. Lessons learned focused on community relationships and participant recruitment.

HPV prevalence at enrollment and baseline results from the Carolina Women's Care Study, a longitudinal study of HPV persistence in women of college age

Background

Cervical cancer, a rare outcome of high-risk human papillomavirus (HPV) infection, disproportionately affects African American women, who are about twice more likely than European American women to die of the disease. Most cervical HPV infections clear in about one year. However, in some women HPV persists, posing a greater risk for cervical dysplasia and cancer. The Carolina Women’s Care Study (CWCS) was conducted to explore the biological, genetic, and lifestyle determinants of persistent HPV infection in college-aged European American and African American women. This paper presents the initial results of the CWCS, based upon data obtained at enrollment.

Methods

Freshman female students attending the University of South Carolina were enrolled in the CWCS and followed until graduation with biannual visits, including two Papanicolaou tests, cervical mucus collection, and a questionnaire assessing lifestyle factors. We recruited 467 women, 293 of whom completed four or more visits for a total of 2274 visits.

Results and conclusion

CWCS participants were 70% European American, 24% African American, 3% Latina/Hispanic, and 3% Asian. At enrollment, 32% tested positive for any HPV. HPV16 infection was the most common (18% of infections). Together, HPV16, 66, 51, 52, and 18 accounted for 58% of all HPV infections. Sixty-four percent of all HPV-positive samples contained more than one HPV type, with an average of 2.2 HPV types per HPV-positive participant. We found differences between African American and European American women in the prevalence of HPV infection (38.1% African American, 30.7% European American) and abnormal Papanicolaou test results (9.8% African-American, 5.8% European American). While these differences did not reach statistical significance at enrollment, as the longitudinal data of this cohort are analyzed, the sample size will allow us to confirm these results and compare the natural history of HPV infection in college-aged African American and European American women.

The development of a tracking tool to improve health behaviors in African American adults

Although African Americans (AAs) have high risk for cardiovascular disease, few individual tailored interventions are available to improve healthy lifestyles in this population. The purpose of this study was to develop and pilot-test a tracking tool for AA adults to examine the extent to which participants initiated health goals and were ready for change, improved health behaviors (increased fruit/vegetables and physical activity, decreased fat), and perceived the tool was useful in tracking and improving health behaviors. AA adults (n=11, 40 years or older) were recruited and completed for one week the Health Check Report Card (HCRC), a tracking tool that measures types of food eaten and physical activity using a pre-determined point system. Findings showed that the participants at post-test significantly increased fruit/vegetable consumption. The HCRC was perceived as helpful in tracking health behaviors. This study suggests that the HCRC may be a tool to explore in improving health behaviors of AAs.

Authoritative feeding behaviors to reduce child BMI through online interventions

PURPOSE.: The purpose of the study was to examine the feasibility and initial efficacies of parent- and/or child-focused online interventions and variables correlated with child body mass index percentile change. DESIGN AND METHODS.: A feasibility and cluster randomized controlled pilot study was used. RESULTS.: Recruitment was more effective at parent-teacher conferences compared with when materials were sent home with fifth- to eighth-grade culturally diverse students. Retention was 90% for students and 62-74% for parents. Authoritative parent feeding behaviors were associated with lower child body mass index. A larger study is warranted. PRACTICE IMPLICATIONS.: Online approaches may provide a feasible option for childhood obesity prevention and amelioration.

Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors

OBJECTIVE

To evaluate associations between psychosocial and social-environmental variables and diabetes self-management, and diabetes control.

RESEARCH DESIGN AND METHODS

Baseline data from a type 2 diabetes self-management randomized trial with 463 adults having elevated BMI (M = 34.8 kg/m(2)) were used to investigate relations among demographic, psychosocial, and social-environmental variables; dietary, exercise, and medication-taking behaviors; and biologic outcomes.

RESULTS

Self-efficacy, problem solving, and social-environmental support were independently associated with diet and exercise, increasing the variance accounted for by 23 and 19%, respectively. Only diet contributed to explained variance in BMI (beta = -0.17, P = 0.0003) and self-rated health status (beta = 0.25, P < 0.0001); and only medication-taking behaviors contributed to lipid ratio (total-to-HDL) (beta = -0.20, P = 0.0001) and A1C (beta = -0.21, P < 0.0001).

CONCLUSIONS

Interventions should focus on enhancing self-efficacy, problem solving, and social-environmental support to improve self-management of diabetes.

Baseline design elements and sample characteristics for seven sites participating in the Nutrition Working Group of the Behavior Change Consortium

The purpose of this article is to describe the baseline design elements and sample characteristics of the Behavior Change Consortium (BCC) Dietary Measurement studies for each of the 7 sites that comprised the BCC Nutrition Working Group (NWG). This article summarizes the project designs, including descriptions of diverse study populations, primary assessment methods, and study outcomes. Common measures used across sites included the National Cancer Institute (NCI) Fruit and Vegetable Screener, NCI Percentage Energy from Fat Screener, 24-h dietary recalls, and a single- or 2-item fruit and vegetable measure. Data on sociodemographic characteristics, body weight and height, smoking status, and serum carotenoids were also collected. Study design information such as assessment time points, as well as baseline sample characteristics, is also described. This paper provides the overall framework and descriptive information and serves as the reference for the BCC NWG special supplement.

Evaluation of a short dietary assessment instrument for percentage energy from fat in an intervention study

The need for an inexpensive measure of dietary intake in intervention studies led to evaluation of the National Cancer Institute (NCI) Percentage Energy from Fat short instrument (PFat) in a subgroup of the Behavioral Change Consortium (BCC) intervention sites. The PFat's performance was evaluated using multiple nonconsecutive 24-h dietary recalls (24HR) as a reference instrument among participants at baseline in 4 demographically diverse intervention sites of the BCC. Mean estimates of percentage energy from fat for 24HR and PFat were within 2.1 percentage points of each other in all but 2 site/gender comparisons. 24HR and PFat estimates were not significantly different (P < 0.05) among men for 2 of 3 sites, and among women for 2 of 4 sites. Deattenuated Pearson correlation coefficients for the PFat and true intake (as estimated from the 24HR using a measurement error model) were significantly different from 0 (P < 0.05) for men and women in all sites, ranging from 0.52 to 0.77 among men and 0.36 to 0.59 among women. Besides gender and site, no other factors examined (age, education, smoking status, and BMI) consistently moderated validity estimates. If accurate assessment of diet at baseline (and presumably at follow-up) is essential, a more detailed instrument such as multiple 24HR may be warranted. The question of whether the PFat adequately measures change in diet is addressed in another article in this supplement.

Social desirability trait influences on self-reported dietary measures among diverse participants in a multicenter multiple risk factor trial

Data collected at 4 Behavioral Change Consortium sites were used to assess social desirability bias in self-reports derived from a dietary fat screener (PFat), a dietary fruit and vegetable screener (FVS), and a 1-item question on fruit and vegetable intake. Comparisons were made with mean intakes derived from up to 3 24-h recall interviews at baseline and follow-up (at 12 mo in 3 sites, 6 mo in the fourth). A social-desirability-related underestimate in fat intake on the PFat relative to the 24HR (percentage energy as fat) was evident in women [baseline b = -0.56 (P = 0.005); follow-up b = -0.62 (P < 0.001)]. There was an overestimate in FVS-derived fruit and vegetable consumption (servings/week) in men enrolled in any intervention at follow-up (b = 0.39, P = 0.05) vs. baseline (b = 0.04, P = 0.75). The 1-item fruit and vegetable question was associated with an overestimate at baseline in men according to SD score (b = 0.14, P = 0.02), especially men with less than college education (b = 0.23, P = 0.01). Women with less than college education expressed a similar bias at follow-up (b = 0.13, P = 0.02). Differences in the magnitude of bias according to gender, type of instrument used, and randomization condition are comparable to what has been seen for other instruments and have important implications for both measuring change in studies of diet and health outcomes and for developing methods to control for such biases.