Simulated reductions in consumption of sugar-sweetened beverages improves diet quality in Lower Mississippi Delta adults

[Quality of diet is associated with water intake among residents in São Paulo, Brazil]

The scope of the study was to evaluate the probability of the adequacy of water intake among residents of São Paulo, and to investigate if the quality of diet differs according to the adequacy of water intake. Data were extracted from the Health Survey of São Paulo, a cross-sectional, population-based study. Water intake (drinking water beverages and food) was evaluated using two 24-hours dietary recalls and a supplementary dietary intake questionnaire. Adequacy and classification of water intake was assessed using the corresponding Adequate Intake for sex and age of the individual. Dietary quality was evaluated using the revised Brazilian Healthy Eating Index (BHEI). The associations were tested using the Theil-Sen median test and logistic regression models. A low probability of adequate water intake was observed, and this decreased with advancing age. Except among the elderly, among whom no association was observed, a positive association between water intake and the BHEI was observed, and for the total and integral fruit components, which was maintained after confusion adjustments. Among adults, it was observed that those who ingested less water had even lower scores for saturated fats. The residents of São Paulo have low water intake, and the quality of diet is worse among those who drink less water.

[Diet quality and associated factors among the elderly: a population-based study in Campinas, São Paulo State, Brazil]

The aim of this study was to assess the quality of diet among the elderly and associations with socio-demographic variables, health-related behaviors, and diseases. A population-based cross-sectional study was conducted in a representative sample of 1,509 elderly participants in a health survey in Campinas, São Paulo State, Brazil. Food quality was assessed using the Revised Diet Quality Index (DQI-R). Mean index scores were estimated and a multiple regression model was employed for the adjusted analyses. The highest diet quality scores were associated with age 80 years or older, Evangelical religion, diabetes mellitus, and physical activity, while the lowest scores were associated with home environments shared with three or more people, smoking, and consumption of soft drinks and alcoholic beverages. The findings emphasize a general need for diet quality improvements in the elderly, specifically in subgroups with unhealthy behaviors, who should be targeted with comprehensive strategies.

Gender differences in the relationship between risk of hypertension and fruit intake

OBJECTIVE

To investigate the relationship between hypertension and fruit intake in an Asian population.

METHOD

This study was based on the data from 2007, 2008 and 2009 Korea National Health and Nutrition Examination Survey. In the final analysis, a total of 9791 subjects (men=3819, women=5972) were included. Daily energy and nutrient intakes were assessed using 24-h recall. The odds ratios (ORs) for hypertension were assessed by using logistic regression and multivariable models.

RESULTS

A total of 10.6% of individuals were classified as having hypertension. Compared with the lowest quintile of fruit intake, the fifth quintile showed the lowest likelihood of hypertension (OR 0.73; 95% confidence interval [CI], 0.61-0.88) after adjusting for age and gender. For women, the likelihood of hypertension in the 2nd, 3rd, 4th and 5th quintiles of fruit intake decreased to 0.67 (95% CI, 0.34-1.30), 0.76 (0.56-1.05), 0.90 (0.67-1.22) and 0.54 (0.38-0.77), respectively, after adjusting for confounding factors (P value for trend=0.0011). An inverse association of fruit intake and hypertension was shown only in non-obese women. For men and obese women, there was no relationship between fruit intake and hypertension.

CONCLUSION

Dietary fruit recommendation for hypertension should be taken into account together with ethnic background, gender as well as the presence of obesity in individuals.

Simple changes within dietary subgroups can rapidly improve the nutrient adequacy of the diet of French adults

Identifying the dietary changes with the greatest potential for improving diet quality is critical to designing efficient nutrition communication campaigns. Our objective was to simulate the effects of different types of dietary substitutions to improve diet quality at the individual level. Starting from the observed diets of 1330 adults participating in the national French Nutrition and Health Survey (Etude Nationale Nutrition Santé), we simulated the effects of 3 different types of food and beverage substitutions with graded implementation difficulty for the consumer in a stepwise dietary counseling model based on the improvement in the PANDiet index, which measures diet quality in terms of nutrient adequacy. In scenario 1, substitutions of a food or beverage for its "lighter" version resulted in a modest improvement in the PANDiet score (Δ = +3.3 ± 0.1) and a decrease in energy intake (Δ = -114 ± 2 kcal/d). In scenario 2, substitutions of a food or beverage within the same food subgroup resulted in a marked improvement in the PANDiet score (Δ = +26.4 ± 0.2) with no significant change in energy intake. In this second scenario, the improvement in nutrient adequacy was due to substitutions in many subgroups, with no single subgroup contributing >8% to the increase in the PANDiet score. In scenario 3, substitutions of a food or beverage within the same food group resulted in the greatest improvement in the PANDiet score (Δ = +31.8 ± 0.2) but with an increase in energy intake (Δ = +204 ± 9 kcal/d). In this third scenario, the improvement in nutrient adequacy was largely due to substitutions of fish for meat and processed meat (∼30% of the increase in the PANDiet score). This study shows that a strategy based on simple substitutions within food subgroups is effective in rapidly improving the nutritional adequacy of the diet of French adults and could be used in public health nutrition actions.

Using the RE-AIM Framework in formative evaluation and program planning for a nutrition intervention in the Lower Mississippi Delta

OBJECTIVE

Identification of prominent themes to be considered when planning a nutrition intervention using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.

DESIGN

Qualitative formative research.

SETTING

Women's social and civic organizations in the Lower Mississippi Delta.

PARTICIPANTS

Thirty-seven (5 white and 32 black) women with a college degree or higher.

PHENOMENON OF INTEREST

Impact of dietary and contextual factors related to the Lower Mississippi Delta culture on intervention planning.

ANALYSIS

Case analysis strategy using question-by-question coding.

RESULTS

Major themes that emerged were "healthy eating focus" and "promoting a healthy lifestyle" when recruiting organizations (Reach); "positive health changes" as a result of the intervention (Effectiveness); "logistics: time commitment, location, and schedule" to initiate a program (Adoption); "expense of healthy foods" and "cooking and meal planning" as barriers to participation (Implementation); and "resources and training" and "motivation" as necessary for program continuation (Maintenance). The "health of the Delta" theme was found across all dimensions, which reflected participants' compassion for their community.

CONCLUSIONS AND IMPLICATIONS

Results were used to develop an implementation plan promoting optimal reach, effectiveness, adoption, implementation, and maintenance of a nutrition intervention. This research emphasizes the benefits of formative research using a systematic process at organizational and individual levels.

Changes in both global diet quality and physical activity level synergistically reduce visceral adiposity in men with features of metabolic syndrome

With regard to the beneficial impact of lifestyle interventions on weight and abdominal obesity management, our objective was to identify which components of a lifestyle-intervention program [physical activity (PA), energy and macronutrient intake, diet quality] had an influence on visceral adipose tissue (VAT) loss. The present lifestyle intervention targeted a daily energy deficit (500 kcal), coupled with a PA program (160 min/wk). From the 144 participants initially recruited, 93 viscerally obese men (age: 49 ± 1 y; waist circumference: 108 ± 9 cm; plasma triglyceride concentration: 2.46 ± 0.09 mmol/L) who completed a 3-d dietary journal both at baseline and after 1 y of intervention and a daily PA journal for 1 y were considered in the present analyses. Body composition and fat distribution were assessed by using dual-energy X-ray absorptiometry and computed tomography. After 1 y, abdominally obese men significantly improved their diet quality, as assessed by the Dietary Approaches to Stop Hypertension (DASH)-derived diet quality (DQ) score (P < 0.0001). Improved DQ and higher levels of PA were both independently and significantly associated with reductions in body weight, fat mass, VAT, and thigh muscle fat content, beyond reported energy intake or diet macronutrient composition. When stratified according to the level of PA and DQ [PA- (low PA), DQ- (low DQ), PA+ (high PA), DQ+ (high DQ)], the PA+/DQ+ group showed reductions in VAT that were 20% greater than in the PA-/DQ+ group, 28% greater than in the PA+/DQ- group, and 50% (P < 0.05) greater than in the PA-/DQ- group. Our results highlight the strong contribution of DQ beyond macronutrient and energy content to changes in body composition and suggest that synergistic changes in both DQ and PA levels optimally reduce VAT in men with features of metabolic syndrome.

Dietary sodium intake and prevalence of overweight in adults

OBJECTIVE

There has been no convincing evidence for a direct relation between sodium intake and being overweight. Therefore, we investigated the independent relationship between overweight and sodium intake in human subjects.

METHODS

Of those aged 19 to 64 years who participated in the 4th Korea National Health and Nutrition Examination Survey, a total of 5955 participants (54% female) were included. Subjects were excluded if they reported unrealistic daily total energy intakes or intentional dietary changes, were pregnant, or were diagnosed with hypertension, diabetes, renal failure, liver cirrhosis, or thyroid disease. Overweight was defined as having a body mass index of 25 kg/m(2) or higher. Sodium intake was calculated from 24-h recall and categorized into quintiles. Multivariate logistic regression was used to test the relationship between sodium intake and being overweight.

RESULTS

Compared to men in the lowest quintile, men in the 4th and 5th quintiles had an increased risk of being overweight with odds ratios (ORs) of 1.37 (95% confidence interval [CI], 1.02-1.82) and 1.67 (95% CI, 1.23-2.27) respectively, after adjusting for confounding factors including soft drink and energy intake. The P value for trend of ORs in each quintile for men was 0.0033. In women, compared to the lowest quintile, the highest quintile had an OR of 1.31(95% CI, 0.96-1.79) and showed a marginally significant trend towards increasing risk of being overweight (P value=.058).

CONCLUSIONS

Our findings suggest an independent relationship between high sodium intake and an increased risk of being overweight in adults.

Simulated reductions in consumption of sugar-sweetened beverages improves diet quality in Lower Mississippi Delta adults

BACKGROUND

Although the effects of replacing sugar-sweetened beverages (SSBs) with water on energy intake and body weight have been reported, little is known about how these replacements affect diet quality.

OBJECTIVE

To simulate the effects of replacing SSBs with tap water on diet quality and total energy intake of Lower Mississippi Delta (LMD) adults.

DESIGN

Retrospective analysis of cross-sectional dietary intake data using a representative sample of LMD adults (n=1,689). Diet quality was measured using the Healthy Eating Index-2005 (HEI-2005) scores that were computed using the population ratio method. The effects of substituting SSBs with water on diet quality were simulated by replacing the targeted items' nutrient profile with tap water's profile.

RESULTS

Simulating the replacement of SSBs with tap water at 25, 50, and 100% levels resulted in 1-, 2.3-, and 3.8-point increases, respectively, in the HEI-2005 total score. Based on a mean daily intake of 2,011 kcal, 100% substitution of SSBs with tap water would result in 11% reduction in energy intake.

CONCLUSIONS

Replacing SSBs with water could substantially improve the diet quality of the LMD adult population and potentially lead to significant weight loss overtime. Prioritizing intervention efforts to focus on the replacement of SSBs with energy-free drinks may be the most efficacious approach for conveying potentially substantial health benefits in this and similar disadvantaged populations.