Differences in Nutrient Intake and Diet Quality Between Non-Hispanic Black and Non-Hispanic White Men in the United States

A review of dairy food intake for improving health among black adults in the US

The adult life stage encompasses a range of new experiences, opportunities, and responsibilities that impact health and well-being. During this life stage, health disparities continue to increase for Black Americans, with Black adults having a disproportionate burden of obesity, chronic diseases, comorbidities, and worse treatment outcomes compared to their White peers. While many of the underlying factors for these disparities can be linked to longstanding sociopolitical factors such as systemic racism, food insecurity, and poor access to healthcare, there are also several modifiable risk factors that are known to significantly impact health outcomes, such as improving diet quality, increasing physical activity, and not smoking. Of all the modifiable risk factors known to impact health, improving dietary habits is the factor most consistently associated with better outcomes for body weight and chronic disease. Of the major food groups recommended by the 2020-2025 Dietary Guidelines for Americans (DGA) for achieving healthier dietary patterns, dairy foods have a nutrient profile which matches most closely to what Black Americans are inadequately consuming (e.g., vitamin A, vitamin D, calcium, magnesium). However, Black adults tend to consume less than half the recommended daily servings of dairy foods, in part, due to issues with lactose intolerance, making higher intake of dairy foods an ideal target for improving diet quality and health in this population. This review examines the current body of evidence exploring the links between dairy intake, obesity, cardiometabolic disease risk, chronic kidney disease, and the most common types of cancer, with a special focus on health and disparities among Black adults. Overall, the evidence from most systematic reviews and/or meta-analyses published in the last decade on dairy intake and health outcomes has been conducted on White populations and largely excluded research on Black populations. The findings from this extensive body of research indicate that when teamed with an energy-restricted diet, meeting or exceeding the DGA recommended 3 daily servings of dairy foods is associated with better body weight and composition outcomes and lower rates of most common chronic diseases than lower intake (<2 servings per day). In addition to the number of daily servings consumed, the specific types (e.g., milk, yogurt, cheese) and subtypes (e.g., low-fat, fermented, fortified) consumed have also been shown to play major roles in how these foods impact health. For example, higher intake of fermented dairy foods (e.g., yogurt) and vitamin D fortified dairy products appear to have the most protective effects for reducing chronic disease risk. Along with lactose-free milk and cheese, yogurt is also generally low in lactose, making it an excellent option for individuals with lactose intolerance, who are trying to meet the DGA recommendations for dairy food intake.

Comprehensive assessment of chrononutrition behaviors among nationally representative adults: Insights from National Health and Nutrition Examination Survey (NHANES) data

BACKGROUND

Aligning the time of food intake, i.e., chrononutrition, with the body's circadian clock can have a significant impact on overall health, particularly cardiometabolic health. However, there is a lack of population-based information on various chrononutrition behaviors in the United States, where the prevalence of obesity is high.

OBJECTIVE

Our primary aim was to characterize chrononutrition behaviors and their 15-year trends among US adults. We also explored the temporal associations between trends in chrononutrition behaviors and trends in obesity.

DESIGN

We utilized data from 8 cycles (2003-2018) of the National Health and Nutrition Examination Survey (NHANES) on 34,470 adults (age >19 years). The clock time of food/beverage consumption was extracted from two 24-h food recalls. The following chrononutrition behaviors were defined: 1) The clock time of the first, last, and midpoint (when 50% of total daily energy was consumed) of food/beverage intake; 2) Eating window (the time elapsed between the first and last intake); 3) Late-night eating (food intake between 21:00-23:59); and 4) Eating frequency. Survey-weighted % or mean ± standard error (SE) was used to demonstrate chrononutrition behaviors and survey-weighted regression models were utilized to evaluate trends in chrononutrition behaviors, BMI, and obesity over a 15-year period.

RESULTS

Thirty five percent of US adults had long eating windows lasting 13 h or more, with 59% of individuals consuming calories after 9 PM. The patterns of food intake among American adults were skewed, with the highest proportion of their daily energy intake (36%) being consumed during dinner meals. Notable differences in chrononutrition behaviors observed among different population subgroups. Young adults and men had longer eating windows with a higher prevalence of late-night eating compared to their age- and sex-counterparts. Black individuals had shorter eating periods due to delayed breakfast, the highest proportion (68%) of late-night eating, and obtained a greater amount of energy intake from snacks compared to other racial/ethnic groups. Over the 15-year span, there were only minor changes in a few aspects of chrononutrition behaviors, including 2% reduction in the time of eating window, while most other meal timing behaviors remained unchanged. Trends in chrononutrition behaviors were disproportionately smaller than the trends in obesity rates.

CONCLUSIONS

US adults persistently consume higher amounts of daily energy intake later in the day. Despite calls for Americans to shift intake to earlier parts of the day, this study shows that there is little change in the overall population over the 15-year period reviewed.

Structural racism and geographic access to food retailers in the United States: A scoping review

This scoping review summarized findings and key measures from U.S.-based studies that 1) examined associations between geographic indicators of structural racism (e.g., redlining, racial segregation) and access to food retailers (e.g., supermarkets, convenience stores) or 2) documented disparities in access by neighborhood racial/ethnic composition. In 2022, relevant scientific literature was reviewed using Covidence software. Independent reviewers examined 13,069 citations; 163 citations advanced to the full-text review stage and 70 were selected for inclusion. Twenty-one studies (30%) linked one or more indicator of structural racism to food retailer access while 49 (70%) solely examined differences in access by neighborhood racial/ethnic composition. All studies featuring indicators of structural racism reported significant findings; however, indicators varied across studies making it difficult to make direct comparisons. Key indicators of structural racism in the food access literature included redlining (n = 3), gentrification (n = 3), and racial segregation (n = 4). Many U.S.-based studies have evaluated food retailer access by neighborhood racial/ethnic composition. Moving forward, studies should model indicators of structural racism and determine their influence on geographic access to large and small food retailers.

Differences in Nutrient Intake and Diet Quality among Non-Hispanic Black Adults by Place of Birth and Length of Time in the United States

Prior research suggests that migrating to the United States (US) can negatively affect the diets and health of immigrants. There is limited information on how relocating to the US affects the diets of Black-identifying immigrants. To address this gap, this study examined differences in nutrient intake and diet quality among non-Hispanic Black adults by place of birth and length of time in the US. Cross-sectional data from the National Health and Nutrition Examination Survey (2005-2016) were analyzed. Approximately 6508 non-Hispanic Black adults were categorized into three groups: foreign-born (FB) living in the US <10 years (n = 167), FB living in the US ≥ 10 years (n = 493), and US-born (n = 5848). Multivariable-adjusted logistic and linear regression models were evaluated to identify differences in nutrient intake and diet quality (as measured by the Healthy Eating Index (HEI) of 2015) across the three groups when controlling for socio-demographics. Compared to US-born adults, both FB groups had significantly higher HEI-2015 scores and higher odds of meeting dietary recommendations for several nutrients: saturated fat, sodium, and cholesterol. There were no differences in nutrient intake between the two FB groups; however, FB (<10 years) adults had better diet quality than FB (≥10 years) ones. Place of birth and length of time in the US were associated with dietary intake among non-Hispanic Black adults. More research is needed to improve understanding of dietary acculturation among Black-identifying immigrants in the US.

A qualitative study of ecological and motivational factors to inform weight management interventions for Black men in the rural South of the United States

RATIONALE AND OBJECTIVE

Black men in the rural South of the United States (US) are underrepresented in weight management behavioral trials. Qualitative research is needed to inform interventions that can reduce obesity and health disparities in this population. We explored how intrapersonal, social, and environmental factors affect motivation and weight-related behaviors and how to culturally adapt behavioral interventions for Black men in the rural South.

METHODS

We conducted individual telephone interviews with 23 Black men (mean age 50 ± 14 years) with overweight or obesity living in rural South Carolina communities in 2020 and 2021. Interviews were audio recorded, professionally transcribed, and coded by two men's health researchers who achieved an intercoder reliability of 70%. Content analysis using QSR NVivo 12 was used to generate themes using deductive and inductive approaches.

RESULTS

Physical health and health behaviors were perceived as key determinants of overall health. Family, friends, and other social contacts often provided positive social support that increased motivation but also hindered motivation by engaging in behaviors men were trying to avoid. Younger participants had stronger views of rural environments not supporting healthy lifestyles, which compounded personal challenges such as time constraints and lack of motivation. Comfort was discussed as a critical program consideration, and gender concordance among program participants and facilitators was perceived as promoting comfort. Participants noted preferences and benefits of in-person, group programs emphasizing physical activity, and younger participants more strongly endorsed programs that incorporated sports and competition.

CONCLUSIONS

Findings from this study provide important evidence to inform the development of weight management interventions for Black men in the rural US South. Based on these findings, an innovative, competitive "football-themed" weight management program promoting peer support and integrating competitive physical activities is being evaluated for younger Black men in the rural South.

Bad situation, treat yourself: a qualitative exploration of the factors influencing healthy eating habits during the COVID-19 pandemic

Purpose

To explore barriers and facilitators to healthy eating during the COVID-19 pandemic among adults enrolled in an internet-based weight loss program.

Methods

Adults in an internet-delivered weight loss program were recruited to participate. Participants completed online study surveys and a semi-structured interview via telephone between June 1, 2020 and June 22, 2020. The interview included questions to explore how the COVID-19 pandemic has influenced dietary behaviors. Constant comparative analysis was used to identify key themes.

Results

Participants (n = 30) were primarily female (83%) and white (87%), 54.6 ± 10.0 years old, and had a mean body mass index of 31.1 ± 4.5 kg/m². Barriers included snacking/ease of access to food, eating as a coping mechanism, and lack of routine/planning. Facilitators included calorie control, regular routine/scheduling, and self-monitoring. General themes with eating were a change in eating out frequency or modality, cooking more, and changes in alcohol consumption.

Conclusion

Eating habits among adults enrolled in a weight loss program changed during the COVID-19 pandemic. Future weight loss programs and public health recommendations should consider modifying recommendations to place increased emphasis on strategies to overcome barriers to healthy eating and promote facilitators that may help with healthy eating, particularly during unexpected circumstances or events.

Association Between Dietary and Serum Cholesterol and Cognitive Function Among the U.S. Elderly from NHANES 2011-2014

BACKGROUND

The association between dietary or serum cholesterol and cognitive performance in older adults has not been well-established.

OBJECTIVE

This study aimed to investigate the potential association between dietary or serum cholesterol and cognitive performance in the elderly population.

METHODS

A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 and 2013-2014. Diet and supplement cholesterol was estimated based on two non-consecutive 24-hour dietary recalls. Cognitive function was assessed using various statistical tests. Poor cognitive performance was defined as scores below the lowest quartile within age groups. Regression models were adjusted for demographic factors, and subgroup analyses were performed for non-Hispanic White (NHW) and non-Hispanic Black (NHB) individuals.

RESULTS

Among 759 participants aged 60 years and above, dietary cholesterol was only associated with dietary saturated fatty acids and serum high-density lipoprotein cholesterol. There was no evidence of an association between dietary cholesterol and cognitive function, except for NHB individuals, where dietary cholesterol showed a positive correlation with cognitive function. In the overall sample and NHW participants, there were consistent positive associations between serum total cholesterol and cognitive performance across statistical tests, while such associations were rare among NHB individuals. Although not statistically significant, NHB individuals had higher dietary/supplementary/total cholesterol intake compared with NHW individuals.

CONCLUSION

Within the normal range, increasing serum cholesterol may be a potential factor to prevent or relieve cognitive dysfunction. However, ethnic differences should be taken into account when considering the association between cholesterol and cognitive performance.

A Comparison of Dietary Patterns and Factors Influencing Food Choice among Ethnic Groups Living in One Locality: A Systematic Review

Globally, the number of minority ethnic groups in high-income countries is increasing. However, despite this demographic change, most national food consumption surveys are not representative of ethnically diverse populations. In consequence, many ethnic minorities' dietary intakes are underreported, meaning that accurate analysis of food intake and nutrient status among these groups is not possible. This systematic review aims to address these gaps and understand differences in dietary intakes and influencers of dietary habits of ethnic groups worldwide. A systematic search was conducted through three databases (Pubmed, Web of Science and Scopus) and manual searches, generating n = 56,647 results. A final search of these databases was completed on 13 September 2021, resulting in a total of 49 studies being included in this review. Overall, food group intakes-particularly fruit, vegetable and fish intake-and diet quality scores were seen to differ between ethnicities. Overall Black/African American groups were reported to be among the poorest consumers of fruit and vegetables, whilst Asian groups achieved high diet quality scores due to higher fish intakes and lower fat intakes compared to other groups. Limited data investigated how nutrient intakes, dietary and meal patterns compared between groups, meaning that not all aspects of dietary intake could be compared. Socioeconomic status and food availability appeared to be associated with food choice of ethnic groups, however, confounding factors should be considered more closely. Future work should focus on comparing nutrient intakes and meal patterns between ethnicities and investigate potential targeted interventions which may support adherence to food-based dietary guidelines by all ethnic groups.

Healthy Eating Index (HEI) Scores Differ by Race/Ethnicity But Not Hypertension Awareness Status Among US Adults with Hypertension: Findings from 2011-2018 National Health and Nutrition Examination Survey

BACKGROUND

Little is known about whether diet quality is associated with race/ethnicity as well as hypertension awareness status among adults with hypertension.

OBJECTIVE

The aim of this study was to examine associations between diet quality and race/ethnicity as well as hypertension awareness.

DESIGN

Analysis of the 2011-2018 National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey representative of the U.S.

POPULATION

PARTICIPANTS/SETTING

A total of 6,483 participants with hypertension who were at least 18 years old and had dietary recall data were included.

MAIN OUTCOME MEASURES

Diet quality was assessed by Healthy Eating Index (HEI)-2015.

STATISTICAL ANALYSIS PERFORMED

Weighted chi-square tests were employed to test associations between categorical variables. Weighted linear regression was used to model the HEI-2015 score by various covariates.

RESULTS

Among the 6,483 participants with hypertension included in this study, the average HEI-2015 total score was 54.0 out of the best possible score of 100. In unadjusted analysis, the HEI-2015 total score was significantly different by race/ethnicity (P<0.01), being 60.9 for Non-Hispanic Asian (NHA) participants, 54.4 for Hispanic, 53.8 for non-Hispanic White (NHW), and 52.7 for non-Hispanic Black (NHB) participants. The HEI-2015 component scores were statistically different by race/ethnicity for all the 13 components (all P<0.01). In adjusted analysis, race/ethnicity was significantly associated with the total HEI-2015 score (P<0.0001), but hypertension awareness status was not (P=0.99), after controlling for age, sex, BMI, marital status, educational level, income level and insurance status.

CONCLUSIONS

There were significant racial/ethnic differences in HEI-2015 scores among participants with hypertension. Hypertension awareness status was not associated with HEI-2015 scores. Further study is needed to identify reasons why there was an association between HEI-2015 scores and race/ethnicity, and a lack of association with hypertension awareness.

Towards a Water-Energy-Food (WEF) nexus index: A review of nutrient profile models as a fundamental pillar of food and nutrition security

The Water-Energy-Food (WEF) nexus approach should be promoted as a tool for sustainable management of resources through the interconnection of these three fundamental pillars. Particularly, food security must ensure healthy and balanced diets for everyone, but selecting individual indicators to assess all slants covered by this element is not an easy task. Hence, the objective of this paper is two-fold, to review nutrient profiling (NP) models that allow to categorize foods and evaluate diets based on their nutritional quality, and to choose the most appropriate model to be used within a WEF nexus index. To address this issue, a total of 159 documents were assessed, appraising the geographic distribution, and time evolution of the publications, as well as the characteristics and potential applications of the NP systems. The review concludes that the NRF9.3. model is the most liable option to be used in a WEF nexus index, presenting the best characteristics by means of the definition of scores and thresholds, and the use of an 'across-the-board' criteria and a reference quantity of 100 kcal, alongside offering higher ability to assess diets and foods than the other competitive model (HEI) through the evaluation of nutrients to encourage instead of foods. A secondary outcome of the review is the identification of the NP models as a useful tool to enable institutions with information to establish policies in the field of public health and facilitating the decision-making process according to the current healthy claims.

Disparities in Surgical Oncology: Management of Advanced Cancer

Significant variations in the patterns of care, incidence, and mortality rates of several common cancers have been noted. These disparities have been attributed to a complex interplay of factors, including genetic, environmental, and healthcare-related components. Within this review, primarily focusing on commonly occurring cancers (breast, lung, colorectal), we initially summarize the burden of these disparities with regard to incidence and screening patterns. We then explore the interaction between several proven genetic, epigenetic, and environmental influences that are known to contribute to these disparities.

Dietary intake and diet quality by weight category among a racially diverse sample of women in Birmingham, Alabama, USA

Diet is a modifiable contributor to health. The lack of adherence to recommended dietary guidelines may contribute to the disproportionate burden of obesity and other chronic conditions observed in the Deep South region of the United States. The objective of this cross-sectional study was to describe food group intake and diet quality by race and weight status of women in the Deep South. Study participants were eighty-nine healthy female volunteers (56 % black, 44 % white, mean age 39⋅7 ± 1⋅4 years) recruited from Birmingham, AL, USA. Body Mass Index (BMI) determined weight status (non-obese/obese). Healthy Eating Index-2010 (HEI-2010) calculated from dietary recalls assessed diet quality. Wilcoxon sum-rank test compared HEI-2010 scores by race and weight status. χ ² analysis compared the percentage of women who achieved maximum points for HEI-2010 index food components by subgroup. Caloric and macronutrient intake did not differ by race or weight status (mean kcal 1863⋅0 ± 62⋅0). Median Total HEI-2010 Score for the sample was 51⋅9 (IQR: 39⋅1-63⋅4). Although there was no statistical difference in diet quality by race, more whites achieved the maximum score for vegetable intake compared to blacks, while blacks reported higher total fruit intake. Non-obese women reported better diet quality (56⋅9 v. 46⋅1; P = 0⋅04) and eating more whole fruits, and more achieved the maximum score for protein from plant and seafood sources. In summary, differences in diet quality were observed by weight status, but not race among this sample. These results point to tailored dietary interventions for women in metropolitan areas of Alabama, USA.

Evaluation of Diet Quality Among American Adult Cancer Survivors: Results From 2005-2016 National Health and Nutrition Examination Survey

BACKGROUND

Diet quality among adult cancer survivors is low, and there is minimal information on the Healthy Eating Index (HEI)-2015 score, a measure of diet quality and adherence to the 2015-2020 Dietary Guidelines for Americans, in this population.

OBJECTIVE

This study aimed to examine HEI-2015 total and component scores and associated factors among adult cancer survivors. Also, this study examined which dietary components needed the most change to improve diet quality in this population.

DESIGN

The National Health and Nutrition Examination Survey (NHANES) is an ongoing nationally representative population-based cross-sectional study that is conducted annually.

PARTICIPANTS/SETTING

In all, 1971 adults with a self-reported cancer diagnosis in their lifetime (both individuals with cancer currently and those that are cancer-free) from NHANES 2005-2016 were included in this study.

MAIN OUTCOME MEASURES

HEI-2015 total and 13 component scores were calculated using the simple scoring algorithm method from the average of 2 24-hour recalls.

STATISTICAL ANALYSES

The associations of the HEI-2015 total score with sociodemographic, lifestyle, and health-related factors were analyzed using the least square means comparisons. A multivariable survey regression model was used to identify associations with the HEI-2015 total score after adjustment for potential confounders. The 13 component scores were also compared by participant characteristics to identify target food groups for subgroup-specific nutrition intervention.

RESULTS

The average HEI-2015 total score was 55.6 (95% confidence interval = 54.8-56.4). Factors associated with the HEI-2015 total score included age, race/ethnicity, education, smoking status, body mass index, and oral health status. Overall, poor adherence to the 2015-2020 Dietary Guidelines for Americans was found for most HEI-2015 components, with Whole Grains, Greens and Beans, Sodium, and Fatty Acids components having less than 50% of the maximum possible scores.

CONCLUSIONS

Results indicate poor diet quality among American adult cancer survivors, with significant disparities observed across sociodemographic and lifestyle factors, particularly education levels, body mass index, and smoking status. Nutrition interventions for cancer survivors should consider focusing on improving diet quality by increasing intakes of whole grains and greens and beans, lowering sodium consumption, and achieving a healthy balance of fatty acids (ie, a favorable ratio of unsaturated fats to saturated fats).