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Objective How does diet quality (DQ) moderate associations between serious childhood stress exposures and adult depression? Methods We analyzed a cohort of Californian women at midlife (N=382; age 36-42). Serious childhood stress was defined as high perceived stress during childhood or adverse childhood experiences (ACEs) of physical abuse, sexual abuse, and/or household substance abuse. Women were dichotomized by current depression risk (high/low). The Healthy Eating Index (HEI)-2015 and Alternate Healthy Eating Index (AHEI)-2010 measured current DQ from 3-day food records. Interactions between childhood stress exposures and DQ indices were tested one-by-one in multivariable Poisson regression models. Results Depression risks associated with endorsing all 3 ACEs differed by HEI and AHEI scores, as did risks associated with endorsing high perceived stress, physical abuse, and sexual abuse by AHEI. Where DQ moderated stress-depression associations, predicted prevalences of high depression risk did not vary with DQ among women endorsing the particular childhood stressors. However, among non-endorsing women, predicted high depression risk prevalences were significantly lower with higher DQ compared to in their stress-exposed counterparts - e.g. at the 90th AHEI percentile, depression prevalences were ∼20% among 'non-childhood-stressed' women versus 48.8% (high perceived stress, sexual abuse), 52.0% (physical abuse), and 73.0% (3 ACEs) in 'childhood-stressed' women. Conclusions Higher current DQ, particularly as aligned with chronic disease prevention guidelines, predicts lower depression risk in women with low childhood adversity. DQ did not buffer depression risk in women with high childhood stress. Further research is warranted to examine persistent pathways of depression risk and diet's role within.

Policy Points This article describes a strategic combination of research, advocacy, corporate campaigns, communications, grassroots mobilization, legislation, regulatory actions, and litigation against companies and government to secure a national policy to remove artificial trans fat from the US food system. Sharing lessons we learned can help inform policymakers, academics, policy practitioners, and students across disciplines. Some of our lessons are that system change means that all consumers benefit without the need for individual behavior change; research can both identify opportunities to improve health and support policy adoption; policy efforts can serve as public education campaigns; policy campaigns can drive marketplace changes; and engaging forward-thinking companies can diffuse opposition to passing a policy. Context For many decades, partially hydrogenated vegetable oil (PHO), the primary source of artificial trans fat in the American diet, was used widely in processed and restaurant foods. In the early 1990s, studies linked the consumption of artificial trans fat with heart disease. This article details how research and advocacy led to eliminating artificial trans fat from the US food supply. Methods We synthesized published studies of the health impact of trans fat, the legislative history of state and local trans fat bills, the Food and Drug Administration's (FDA) regulatory docket on trans fat labeling and its declaration that PHOs are no longer Generally Recognized as Safe (GRAS), and our own files, which included strategy documents, notes from meetings with the FDA staff, correspondence between advocates and the FDA, fact sheets, press releases, news clips, and other materials. Findings This history of trans fat provides insights into policy strategy and advocacy best practices that resulted in the removal of trans fat from food in the United States, preventing an estimated 50,000 premature deaths a year. The lessons we learned are that system change benefits all consumers without the need for individual behavior change; research can both identify opportunities to improve health through policy and support policy adoption; policy campaigns can serve as public education campaigns; policy can drive changes to products and the marketplace; and engaging forward-thinking companies can help diffuse opposition to passing a policy. Securing this policy required the persistence of scientists and health advocates in first discovering the risks and then using the science to secure policies to mitigate the identified harm. Conclusions An understanding of the tactics used to help attain the targeted policies and how challenges were addressed (such as through communications, leveraging an expanding research base and expert reports, showing that a national policy was feasible through voluntary corporate changes and state and local policy, and litigation against companies and government agencies) may provide a model for scientists, students, advocates, and policymakers. We hope this account will inform efforts to address other public health challenges, such as the current threats of excessive exposure to sodium and added sugars, which persist in the US food system.

Objective:Household food insecurity is associated with CVD risk factors in low-income adults, but research on these associations among adolescents is inconsistent. This study investigates whether household and child food insecurity is associated with CVD risk factors in lower-income adolescents.Design:Cross-sectional. Multivariable linear regression assessed the association between household and child food security and CVD risk factors. Household and child food security was measured using the US Food Security Survey Module. The analyses were adjusted for adolescent’s age, sex, race/ethnicity, smoking status, physical activity and sedentary time, as well as household income and the head-of-household’s education and marital status.Setting:The USA.Participants:The sample was comprised of 2876 adolescents, aged 12–17 years, with household incomes at or below 300 % federal poverty line from the National Health and Nutrition Examination Survey cycles 2007–2016.Results:The weighted prevalence of household food insecurity in the analytic sample was 33·4 %, and the weighted prevalence of child food insecurity was 17·4 %. After multivariable adjustment, there were no significant associations between household and child food insecurity and BMI-for-age Z-score, systolic and diastolic blood pressure, HDL-cholesterol, total cholesterol, fasting TAG, fasting LDL-cholesterol and fasting plasma glucose.Conclusions:Despite observed associations in adults, household food insecurity was not associated with CVD risk factors in a national sample of lower-income adolescents. Child food insecurity was also not associated with CVD risk factors. More research should be conducted to confirm these associations.

Purpose: To understand associations between food insecurity and depression, anxiety, and stress during the COVID-19 pandemic among low-income adults in the United States. Methods: During March 19-24, 2020, we fielded a national, web-based survey (53% response rate) among low-income adults (

BackgroundHealth-related warning labels may reduce the intake of sugar-sweetened beverages (SSBs), but the effectiveness of such labels in real-world settings is not well established.ObjectivesWe investigated the influence of warning labels on SSB intake among college students at a large public Midwestern university.MethodsWe conducted a quasi-experimental intervention study among 840 undergraduate students recruited from 3 dining halls on 1 university campus. One dining hall was selected as the intervention (I) site, whereas the other dining halls served as control (C) sites. In January 2019, warning labels were posted on SSB dispensers at the I site. All students reported their beverage intake using a modified beverage frequency questionnaire 2 mo before and 2 mo after the warning label implementation. Generalized linear models examined the influence of the warning labels on SSB consumption at the I site compared with the C sites, adjusting for students' sociodemographic characteristics.ResultsIn the sample, 68% were aged 17-18 y old at baseline, and 51% identified as female. From baseline to follow-up, there was a 19% decrease in SSB intake at the I site, compared with a 5% decrease at the C sites (P=0.049 comparing I with C). This difference was driven by significant decreases in the intakes of fruit-flavored drinks, sweetened teas, and flavored milk at the I site compared with the C sites. Although not an SSB, 100% fruit juce consumption decreased 21% at the I site, compared with a 1% increase at the C sites (P=0.01 comparing I with C). No significant differences were observed in the intakes of soda, energy drinks, sweetened coffees, and nonsugary drinks at the I site compared with the C sites.ConclusionsWarning labels were effective in reducing SSB intake among college students, particularly for fruit-flavored drinks, sweetened teas, and flavored milk.This trial was registered at clinicaltrials.gov as NCT04435145.

OBJECTIVE: Financial stress has adverse consequences for health. However, the association between individual and cumulative associations of multiple financial stressors and serious psychological distress (SPD) is unclear. METHODS: Using data from the 2017 National Health Interview Survey, we examined cross-sectional associations between perceived financial worries, healthcare insecurity, food insecurity, and SPD among 23,317 USA adults. Associations were examined using logistic regression. RESULTS: Among USA adults in 2017, the overall prevalence of SPD was 3.6%. Among those with SPD, 85.5% were financially worried, 50.3% were food insecure, and 51.2% were healthcare insecure. Financial worries (OR: 4.27; CI: 3.31, 5.52), food insecurity (OR: 2.34; CI: 1.92, 2.85), and healthcare insecurity (OR: 2.26; CI: 1.85, 2.76) were each associated with higher odds of SPD. A dose-response association was found between the number of stressors and SPD. CONCLUSION: Each financial stressor was adversely associated with SPD both individually and cumulatively, indicating the adverse effects of the accumulation of these stressors. Additional studies are needed to understand the longitudinal effects of multiple financial stressors on mental health outcomes.

AIMS: The purpose of this study was to examine whether pandemic exposure impacted unmet social and diabetes needs, self-care behaviors, and diabetes outcomes in a sample with diabetes and poor glycemic control. METHODS: This was a cross-sectional analysis of participants with diabetes and poor glycemic control in an ongoing trial (n = 353). We compared the prevalence of unmet needs, self-care behaviors, and diabetes outcomes in successive cohorts of enrollees surveyed pre-pandemic (prior to March 11, 2020, n = 182), in the early stages of the pandemic (May-September, 2020, n = 75), and later (September 2020-January 2021, n = 96) stratified by income and gender. Adjusted multivariable regression models were used to examine trends. RESULTS: More participants with low income reported food insecurity (70% vs. 83%, p < 0.05) and needs related to access to blood glucose supplies (19% vs. 67%, p < 0.05) during the pandemic compared to pre-pandemic levels. In adjusted models among people with low incomes, the odds of housing insecurity increased among participants during the early pandemic months compared with participants pre-pandemic (OR 20.2 [95% CI 2.8-145.2], p < 0.01). A1c levels were better among participants later in the pandemic than those pre-pandemic (s = -1.1 [95% CI -1.8 to -0.4], p < 0.01), but systolic blood pressure control was substantially worse (s = 11.5 [95% CI 4.2-18.8, p < 0.001). CONCLUSION: Adults with low-incomes and diabetes were most impacted by the pandemic. A1c may not fully capture challenges that people with diabetes are facing to manage their condition; systolic blood pressures may have worsened and problems with self-care may forebode longer-term challenges in diabetes control.

Objective In youth, a preoccupation with weight and the desire to be thinner, or drive for thinness, might persist into adulthood and predict reward-based compulsive eating and greater weight status. Methods A total of 623 women were enrolled from a prospective cohort study starting at 10 years old and assessed up to 20 years later. Drive for thinness was measured five times during adolescence. In adulthood (mean age = 39.5), drive for thinness, reward-based eating drive, and BMI were measured. Results Structural equation modeling found cumulative adolescent drive for thinness predicted higher scores for both adult drive for thinness and reward-based eating drive. Youth drive for thinness was not directly associated with adult BMI but rather indirectly through adult drive for thinness. Reward-based eating drive was not associated with adult BMI. Conclusions Drive for thinness during the critical developmental years may exert long-term effects on adulthood eating behaviors tied to greater weight gain, potentially reflecting an important early target of intervention.

Background Shorter leukocyte telomere length (LTL) is associated with increased risk of a number of metabolic diseases including insulin resistance and the development of type 2 diabetes mellitus. Shorter LTL is also associated with stress reactivity suggestive of a possible role for LTL to predict response to behavioral interventions. However, few studies have evaluated how interventions, such as weight loss or dietary changes, are associated with LTL changes or whether LTL can predict behavioral responses to interventions. Objectives We evaluated metabolic changes in relation to LTL changes and LTL at baseline in a cohort of at-risk adults in response to a 10-mo workplace-based sugar-sweetened beverage (SSB) intervention. Methods At baseline, metabolic health and LTL measurements were assessed through standard blood draws on 212 participants. Multivariable linear regression models were used to assess changes in anthropometrics, SSB consumption, and 13 blood-based metabolic risk factors, in relation to LTL at baseline and changes in LTL. Results Longer LTL at baseline was associated with decreases in SSB consumption over the 6-mo follow-up period (B = −29.67; P = 0.04). Slower LTL attrition rates were associated with decreases in waist circumference (B = −0.27; P = 0.03), HDL cholesterol (B = −0.20; P = 0.05), and apoA1 (B = −0.09; P = 0.01). Conclusions Longer LTL at baseline predicted a favorable overall response to a behavioral intervention: decreases in SSB consumption. Abdominal adiposity losses paralleled slower declines in LTL suggestive of overall health benefits, but we found differences in the relations between metabolic changes and LTL at baseline compared with LTL attrition rates. Longer LTL may be a proxy marker of a positive behavioral response. This trial was registered at clinicaltrials.gov as NCT02585336., Longer leukocyte telomere length at baseline may be a predictor of positive behavioral response to a sugar-sweetened beverage reduction intervention in adults.

Background Food insecurity is believed to influence the quality and quantity of foods consumed; however, studies examining food insecurity and diet quality have been inconclusive and few studies have explored variability in these associations by sex and race/ethnicity. Objective This study examined associations between food insecurity and diet quality, and variations by sex and race/ethnicity. Design Cross-sectional analysis of data from the 2011-2014 National Health and Nutrition Examination Surveys. Participants The study population was composed of 4,393 adults (aged 20 to 65 years) with family incomes ≤300% of the federal poverty level with complete data on household food security and dietary intake via two 24-hour dietary recalls. Main outcome measures Diet quality was assessed using the Healthy Eating Index-2015. Statistical analyses performed Associations between food insecurity and Healthy Eating Index-2015 total and component scores were examined using linear regression models and generalized linear models. Models adjusted for sociodemographic and health covariates. Results Compared with food-secure adults, food-insecure adults reported a 2.22-unit lower Healthy Eating Index-2015 score (95% CI –3.35 to –1.08). This association was most pronounced among non-Hispanic whites and adults of Asian or other races/ethnicities. There were no associations among non-Hispanic black or Hispanic adults, and no differences by sex. Among non-Hispanic whites, food insecurity was associated with lower scores for total protein foods, seafood and plant proteins, and added sugar. Among Asians, food insecurity was associated with lower scores for whole fruit. Conclusions Food insecurity was associated with lower diet quality primarily among non-Hispanic whites; Asians; and other adults, a group composed of American Indian or Alaska Natives, Native Hawaiian or Other Pacific Islanders, and multiracial adults. Further research is needed to better understand the nature of this association among understudied racial/ethnic groups.

BACKGROUND: Food insecurity, a social and economic condition of inadequate food resources, is known to affect cognitive development in children. However, research is sparse among adult populations, particularly older adults who may be more susceptible to accelerated cognitive decline. OBJECTIVE: The aim of this study was to examine the associations between food insecurity and cognitive functioning among older adults. METHODS: Data came from 1823 older adults (≥60 y) with incomes ≤300% of the federal poverty level (FPL) from the 2011–2014 NHANES. Food security was measured using the 10-item Adult Food Security Survey Module. Cognitive function was measured using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word learning subtest and delayed word recall, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). The cognitive assessments were then standardized and an overall cognitive function z score was created by averaging across all cognitive assessments. Associations with food insecurity were examined using multivariate linear regression models, adjusting for sociodemographic and health characteristics. RESULTS: In the analytic population, the prevalence of food insecurity was 23.7%. Across all cognitive assessments, the mean scores among food-insecure adults was significantly lower than the mean scores among food-secure adults. After adjusting for sociodemographic and health characteristics, food insecurity was associated with lower scores on the CERAD word learning subtest (β = −0.14, 95% CI: −0.26, −0.01), the AFT (β = −0.13, 95% CI: −0.25, −0.002), and the DSST (β = −0.24, 95% CI: −0.33, −0.15). Food insecurity was also associated with a lower score on the overall cognitive function z score (β = −0.15, 95% CI: −0.26, −0.05). CONCLUSIONS: In this national sample of 1823 adults aged ≥60 y, food insecurity was inversely associated with cognitive function, which may translate into higher risk of cognitive impairment over time.

BackgroundAdiposity status in adolescence is associated with various health outcomes in adulthood. Waist circumference [WC] and waist-to-height ratio [WHtR] are measures of abdominal obesity and have shown to be valid predictors of future chronic diseases. However, the relationship between sociodemographic characteristics and WC, as well as WHtR in U.S. adolescents remain unclear. Thus, the study aims to examine associations between sociodemographic characteristics and abdominal obesity among a nationally representative sample of U.S. adolescents.MethodsThe sample included 4712 adolescents (12–19 years) in the 2007–2016 National Health and Nutrition Examination Survey. Associations between sociodemographic characteristics and abdominal obesity (WC and WHtR) were examined using multiple logistic regression models, adjusted for age, physical activity level, and sedentary activity.ResultsAround 18% of adolescents had high-risk WC (≥90th percentile) and 34% had high-risk WHtR (≥0.5). Females had higher odds of high-risk WHtR compared to males (OR = 1.46, 95%CI = 1.23–1.72). Mexican American adolescents had higher odds of high-risk WHtR compared to non-Hispanic White (OR = 1.66, 95%CI = 1.24–2.20), non-Hispanic Black (OR = 1.73, 95%CI = 1.26–2.36), and other race/multi-racial adolescents (OR = 1.84, 95%CI = 1.21–2.80). When their parent were college graduates, adolescents had lower odds for high-risk WC compared to when the parent had some college education (OR = 0.68, 95%CI = 0.49–0.93) or a high school degree or less (OR = 0.70, 95%CI = 0.51–0.97). Similar associations were seen between parental education level and high-risk WHtR, as well as between household income and high-risk WHtR.ConclusionsMeasures of abdominal obesity should be considered to assess burden of adiposity, especially among female adolescents, adolescents from racial/ethnic minority and low socioeconomic status backgrounds. Additionally, future health interventions should consider including changes in WC and WHtR to measure the impact of these interventions.

The Supplemental Nutrition Assistance Program (SNAP) is critical to alleviating food insecurity, but low diet quality among program participants is a concern. Nutrition-related interventions have focused on SNAP-authorized food retailers, but the perspectives of small food store owners and managers have not been represented in national policy discussions. This study aimed to explore the opinions of store owners/managers of SNAP-authorized small food stores about their overall perceptions of the program and the stricter stocking standards previously proposed in 2016. We conducted in-depth, semi-structured interviews with 33 small food store owners and managers in San Francisco and Oakland, California in 2016. Interviews were analyzed for thematic content using the general inductive approach. Four themes emerged from owners/managers’ discussion of their overall perceptions of SNAP: the beneficial impact of SNAP on their business, how SNAP enables them to connect with the broader community, the importance of SNAP in preventing hunger, and the nutrition-related struggles that SNAP participants face. Store owners/managers had a generally favorable response towards the proposed stricter stocking standards. Additional themes discussed pertained to the concern about whether stocking changes would lead SNAP participants to purchase more healthful food and some logistical challenges related to sourcing and storing perishable foods.

Objectives:To assess the association between perceived stress and adiposity among Chinese adults.Design:Cross-sectional study. Perceived stress was assessed using the 14-item perceived stress scale. Associations between quintiles of perceived stress and BMI and waist circumference were assessed using linear regression models and multinomial regression models. Estimates were adjusted for sociodemographic characteristics.Setting:2015 China Health and Nutrition Survey: 12 provinces covering a variety of geographic, economic development and health indicator situations.Participants:A total of 8385 adults of both sexes, aged 18–99 years, were included.Results:Overall, the mean perceived stress score was 22·7 (6·2), mean BMI was 24·3 (3·6) kg/m2 and prevalence of obesity (BMI ≥ 30 kg/m2) was 6·0 %. There were inverse associations between perceived stress quintiles with continuous BMI (P < 0·001), BMI categories (P = 0·015) and waist circumference (P = 0·047). Compared to adults in the lowest quintile of perceived stress, adults in the highest quintile of perceived stress had 0·44 kg/m2 lower mean BMI (95 % CI: −0·67, −0·21), 0·72 times the prevalence of obesity (95 % CI: 0·55, 0·94) and 0·73 times the prevalence of abdominal obesity (95 % CI: 0·61, 0·88). Results were similar when using Chinese-specific cut-points.Conclusion:Our results showed inverse associations between perceived stress quintiles and adiposity among Chinese adults. Future studies should aim to better understand the directionality of the observed associations and the potential biological and behavioural mechanisms underlying these associations in the Chinese population.

Lifestyle change is the cornerstone of nonalcoholic fatty liver disease management. Sugar-sweetened beverages (SSBs) are a promising target. First, SSBs are associated with nonalcoholic fatty liver disease, and interventions to reduce SSB consumption reduce the burden of liver fat.1 Second, formal guidance uniformly recommend against SSBs.2 Herein, we analyze the 2017-2018 wave of the National Health and Nutrition Examination Survey (NHANES), examining a nationally representative sample of persons without comorbidities or known liver disease to examine the associations between SSB consumption and both liver fibrosis and liver fat using vibration-controlled transient elastography.

Purpose To examine cross-sectional associations between food insecurity and 12-month eating disorders, mood disorders, and anxiety disorders among U.S. adults. Methods This study used data collected between 2001 and 2003 from 2914 participants in the National Comorbidity Survey-Replication, a nationally representative sample of U.S. adults (mean age = 44.9 years; 53.4% female). Twelve-month food insecurity was assessed with a modified version of the Short Form U.S. Household Food Security Scale. Twelve-month DSM-IV diagnoses of mental disorders were based on the World Health Organization Composite International Diagnostic Interview. Modified Poisson regression models were conducted, adjusting for age, sex, race/ethnicity, education, and income-to-poverty ratio. Results Food insecurity was experienced by 11.1% of participants. Food insecurity was associated with greater prevalence of bulimic-spectrum eating disorders (prevalence ratio [PR] = 3.81; 95% confidence interval [CI] 2.26–6.42), mood disorders (PR = 2.53; 95% CI 1.96–3.29), and anxiety disorders (PR = 1.69; 95% CI 1.39–2.07). Conclusion Results indicate that food insecurity is associated with a range of internalizing mental disorders, though these findings should be confirmed with contemporary data to reflect DSM-5 diagnostic updates and the economic effects of the COVID-19 pandemic. Findings from this study emphasize the need to expand food insecurity interventions and improve access to mental health services for food-insecure populations. Supplementary Information The online version contains supplementary material available at 10.1007/s00127-021-02126-5.

Introduction Large prospective cohort studies show a lower risk of developing type 2 diabetes among adults with higher whole grain consumption. Less is known about the relationship between whole grain consumption and precursors for diabetes risk in adolescents. We examined whether intake of whole grains was associated with impaired fasting glucose (IFG) in adolescents. Methods We analyzed data on dietary intake from an average of two 24-hour diet recalls from fasting, nondiabetic adolescents aged 12-18 years (N = 2,286) across 5 cycles of the National Health and Nutrition Examination Survey (NHANES 2005-2014). We used logistic regression to calculate the odds of having IFG (100-125 mg/dL) with respect to servings of whole and refined grains, as well as percentage of whole grains, adjusting for sex, age, race/ethnicity, annual household income, obesity, total energy, and diet quality. Results IFG was present in 17% of participants. After adjusting for covariates, number of servings per day of whole grains was significantly associated with lower odds of IFG, but there was no relationship between IFG and servings of refined grains or percentage of whole grains. Consuming at least 1 ounce-equivalent serving (16 g) of whole grains daily, compared with consuming no whole grains, was associated with a 40% reduction in the adjusted odds of having IFG (adjusted odds ratio = 0.60; 95% CI, 0.38-0.93). Conclusion Analysis of 10 years of national cross-sectional data suggests that US adolescents whose daily diets consist of a minimum threshold amount of whole grains may be less likely to have IFG, a finding that has implications for diabetes prevention in adolescents.

The critical role social determinants of health play in shaping physical and mental health across the life span has long been established.[1][1] Upstream factors such as the neighborhood in which one lives, access to affordable and healthy food, access to safe, affordable housing, access to

Household food insecurity has been associated with adverse health outcomes, however, the mechanisms underlying these associations are not well-defined. Using data from 5005 adults from the 2007&ndash, 2010 National Health and Nutrition Examination Surveys (NHANES), we examined associations between household food insecurity and cumulative biological risk, a measure of the body&rsquo, s physiological response to chronic stress. Household food security was assessed using the 18-item Household Food Security Survey Module. Marginal food security refers to 1&ndash, 2 positive responses, and food insecurity refers to &ge, 3 positive responses. The cumulative biological risk scores were calculated based on the distributions of ten biomarkers from the cardiovascular, metabolic, and immune systems. Elevated biological risk was defined as a risk score of &ge, 3. Multivariable regression models were used to examine associations between food security and cumulative biological risk scores, adjusting for sociodemographic characteristics. After multivariable adjustment, food insecurity was associated with a 0.14-unit higher cumulative biological risk score (95% CI 0.05&ndash, 0.22, p-trend = 0.003) and higher odds of elevated biological risk (OR 1.20, 95% CI 1.05&ndash, 1.37, p-trend = 0.003). These associations differed by gender. Among women, food insecurity was associated with 0.30-unit higher cumulative biological risk score (95% CI 0.14&ndash, 0.45, p-trend = 0.0004) and higher odds of elevated biological risk (OR 1.61, 95% CI 1.29&ndash, 2.00, p-trend &lt, 0.0001). These associations were not observed in men. Women experiencing food insecurity demonstrated elevated levels of biological risk. These findings support the hypothesis that food insecurity may be associated with women&rsquo, s chronic health outcomes through the pathway of chronic stress. Further research is needed to understand why these associations were not observed in men.

Objective:To examine the association between cooking frequency and Healthy Eating Index (HEI)-2015, overall and by income, among US adults.Design:Cross-sectional analysis using multivariable linear regression models to examine the association between cooking frequency and total HEI-2015 score adjusted for sociodemographic variables, overall and stratified by income.Setting:Nationally representative survey data from the USA.Participants:Adults aged ≥20 years (with 2 d of 24 h dietary recall data) obtained from the 2007 to 2010 National Health and Nutrition Examination Survey (n 8668).Results:Compared with cooking dinner 0–2 times/week, greater cooking frequency was associated with higher HEI-2015 score overall (≥7 times/week: +3·57 points, P < 0·001), among lower-income adults (≥7 times/week: +2·55 points, P = 0·001) and among higher-income adults (≥7 times/week: +5·07 points, P < 0·001). Overall, total HEI-2015 score was higher among adults living in households where dinner was cooked ≥7 times/week (54·54 points) compared with adults living in households where dinner was cooked 0–2 times/week (50·57 points). In households in which dinner was cooked ≥7 times/week, total HEI-2015 score differed significantly based on income status (lower-income: 52·51 points; higher-income: 57·35 points; P = 0·003). Cooking frequency was associated with significant differences in HEI-2015 component scores, but associations varied by income.Conclusions:More frequent cooking at home is associated with better diet quality overall and among lower- and higher-income adults, although the association between cooking and better diet quality is stronger among high-income adults. Strategies are needed to help lower-income Americans consume a healthy diet regardless of how frequently they cook at home.

Accelerated telomere shortening has been associated with several age-related diseases and/or decreased lifespan in humans. The Mediterranean diet (MedDiet) is considered to be 1 of the most recognized diets for disease prevention and healthy aging, partially due to its demonstrated anti-inflammatory and antioxidative properties which may impact on telomere length (TL). The aim of this meta-analysis was to determine the associations between MedDiet adherence and TL maintenance. MEDLINE-PubMed and Cochrane databases were searched up to December 2018 for studies evaluating the association between MedDiet adherence and TL in blood cells. Two reviewers, working independently, screened all titles and abstracts to identify studies that met the inclusion criteria [cross-sectional, case-control, and prospective cohort studies and randomized clinical trials (RCTs) published in English and excluded nonoriginal articles]. Data were pooled by the generic inverse variance method using the random effects model and expressed as standardized mean difference (SMD). Heterogeneity was identified using the Cochran Q test and quantified by the I(2) statistic. A total of 8 original cross-sectional studies were included for the quantitative meta-analysis, comprising a total of 13,733 participants from 5 countries. A positive association between adherence to the MedDiet and TL was observed in all meta-analyses, with the exception of those conducted only in men: SMD (95% CI) of 0.130 (0.029; 0.231) for all subjects, 0.078 (0.005; 0.152) for women, and 0.095 (–0.005; 0.195) for men. Only 1 prospective cohort study and 1 RCT were identified, therefore, we could not undertake a meta-analysis for these study designs. The present meta-analysis of cross-sectional studies demonstrates that higher MedDiet adherence is associated with longer TL. At the same time, larger and high-quality prospective studies and clinical trials are warranted to confirm this association.

INTRODUCTION: Sugar-sweetened beverages (SSBs) are a major contributor to children’s added sugar consumption. This study examines whether children’s SSB and water intake are associated with diet quality and total energy intake. METHODS: Using data on children ages 2–18 years from the 2009–2014 National Health and Nutrition Examination Survey, linear regression models were used to analyze SSB and water intake in relation to Healthy Eating Index (HEI-2010) scores and total energy intake. Generalized linear models were used to analyze SSB and water intake in relation to the HEI-2010 scores. Analyses were conducted including and excluding caloric contributions from SSBs, and were conducted in 2016–2017. RESULTS: SSB intake was inversely associated with the HEI-2010 total scores (9.5-point lower score comparing more than two servings/day with zero servings/day, p-trend

Introduction The Supplemental Nutrition Assistance Program (SNAP) is the largest federal food assistance program designed to alleviate food insecurity and improve dietary intake. This study assessed the opinions of SNAP participants and food-insufficient nonparticipants on their perceptions of the program and strategies to improve its nutritional impact. Methods This study surveyed 387 individuals via Amazon Mechanical Turk, of whom 118 were SNAP participants and 269 were food insufficient but not enrolled in SNAP (nonparticipants). Open-ended questions were coded and analyzed for thematic content. For closed-ended questions, response frequencies were compared using chi-square tests. Data were analyzed in 2016. Results SNAP participants reported that the program successfully served its primary purpose: to allow individuals to buy enough food to make ends meet and reduce food insecurity. Importance was placed on buying food for their children/families and the ability to allocate money for other expenses. To improve the nutritional impact, SNAP participants suggested more nutrition education, increasing the benefit allotment, incentivizing healthful foods, and excluding unhealthful foods for purchase with SNAP. When participants and nonparticipants were asked to choose between SNAP and a nutritionally enhanced program combining healthy incentives with exclusions for sugary beverages (i.e., SNAP+), 68% of participants and 83% of nonparticipants chose SNAP+. Of those who initially chose SNAP, 68% of participants and 64% of nonparticipants chose SNAP+ if paired with a 50% increase in total benefits. Conclusions SNAP participants and food-insufficient nonparticipants support policies that facilitate purchases of healthful foods and limit purchases of unhealthful foods, specifically sugary beverages.

OBJECTIVE Overweight adolescents exhibit greater cortisol reactivity in response to acute stress and are more likely to eat in response to emotional cues, which suggest an increased susceptibility to stress-induced eating. The purpose of this study was to examine the biological (cortisol and α-amylase reactivity) and behavioral (caloric intake) responses to an acute stressor in overweight adolescents. METHODS Fifty-one adolescents ages 14 to 19 years (47% female, 55% white; body mass index, 31.2 ± 0.8 kg/m) were exposed to the Trier Social Stress Test and a control condition on separate days. Immediately after each condition, participants were provided with snacks to eat at their leisure. Reactivity was assessed via salivary cortisol and α-amylase area under the curve (AUC), and adolescents were categorized as high or low reactors. RESULTS Cortisol AUC was higher during the stress condition (19.6 ± 0.2 μg/dl · min) compared with the control condition (11.4 ± 0.9 μg/dl · min, p < .001). α-Amylase AUC was not different during the stress condition (9999 ± 987 U/ml · min) compared with the control condition (8762 ± 865 U/ml · min, p = .145). Overall, adolescents consumed fewer calories during the stress condition (488 ± 51 kcal) compared with the control condition (637 ± 42 kcal, p = .007). High cortisol reactors decreased their calorie consumption from the control condition (716 ± 52 kcal) to the stress condition (457 ± 53 kcal, p = .001), whereas low cortisol reactors did not change their consumption (stress: 518 ± 87 kcal versus control: 561 ± 62 kcal, p = .574). CONCLUSION High cortisol reactivity in overweight adolescents resulted in decreased calorie consumption after an acute stressor. Further research is needed to understand the mechanisms underlying stress-induced suppression of food intake in overweight adolescents.

Background A carbohydrate-restricted (CR) diet can improve glycemic control in people with type 2 diabetes mellitus (T2DM). There are concerns, however, that the high dietary fat content of CR diets can increase low-density lipoprotein cholesterol (LDL-C), thus increasing cardiovascular disease (CVD) risk. Quantifying CVD risk associated with changes in LDL-C in the context of CR diets is complicated by the fact that LDL-C reflects heterogeneous lipids. For example, small LDL particle number (sLDL-P) is more closely associated with CVD risk than is total LDL-C, and CR diets tend to decrease the proportion of sLDL-C in LDL-C, which standard lipid measures do not indicate. Advanced lipoprotein assays, such as nuclear magnetic resonance (NMR) testing, can subfractionate lipoproteins by size and density and may better depict the effects of CR diets on CVD risk. Methods Adults (N = 58) with T2DM (n = 37 women; baseline HbA1c ≥ 6.5%) completed a 6-month group-based CR diet intervention. We obtained a standard lipid panel, advanced lipoprotein assays (NMR testing), and two 24-h diet recalls at baseline and post-intervention (6 months). Participants also completed home-based blood ketone testing (a biological index of dietary adherence) during the final five weeks of the intervention. Results From baseline to post-intervention, participants had increased mean HDL-C, decreased triglycerides and triglyceride/HDL ratio, decreased mean sLDL-P, and increased LDL size, which reflect reductions in CVD risk (ps

Objective Identify the socio-economic correlates of sugar sweetened beverage (SSB) consumption among pregnant women and analyze to what extent SSB consumption is associated with diet quality and total energy intake. Additionally, we aim to predict how diet quality scores and totally energy intakes would change if SSB consumption was artificially set to 0. Design Repeated Cross Sectional Study. Setting United States. Subjects SSB consumption was estimated from 1–2 24-hour dietary recalls from 1,154 pregnant women who participated in the 1999–2006 National Health and Nutrition Examination Survey. Methods Linear regression models were used to identify socioeconomic and demographic factors associated with SSB consumption and to assess the associations between SSB consumption and diet quality and total energy intake. Diet quality was measured with the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P). Results The mean SSB intake was 1.3 servings per day (sd 1.5). Having a household income ≤100% of the Federal Poverty Level, being born in the United States, and not being married or living with a partner were positively associated with SSB consumption. Every 12 oz. of SSBs consumed was associated with a 2.3 lower AHEI-P score (95% CI: 1.6, 2.9) and the consumption of 124 more calories (95% CI: 85, 163), after adjusting for age, country of birth, race/ethnicity, educational attainment, marital status, household income, survey year and day/s of the week the recall/s were collected. Our predictive models indicated that average AHEI-P would be 6.4 (5.4, 7.6) higher and average total energy intakes would be 203.5 calories (122.2, 284.8) lower if SSB intake was set to 0. Conclusions SSB consumption is associated with poorer diet quality and higher total energy intake among pregnant women.

Background Stress can lead to excessive weight gain. Mindfulness-based stress reduction that incorporates mindful eating shows promise for reducing stress, overeating, and improving glucose control. No interventions have tested mindfulness training with a focus on healthy eating and weight gain during pregnancy, a period of common excessive weight gain. Here, we test the effectiveness of such an intervention, the Mindful Moms Training (MMT), on perceived stress, eating behaviors, and gestational weight gain in a high-risk sample of low income women with overweight/obesity. Method We conducted a quasi-experimental study assigning 115 pregnant women to MMT for 8 weeks and comparing them to 105 sociodemographically and weight equivalent pregnant women receiving treatment as usual. Our main outcomes included weight gain (primary outcome), perceived stress, and depression. Results Women in MMT showed significant reductions in perceived stress (β = − 0.16) and depressive symptoms (β = − 0.21) compared to the treatment as usual (TAU) control group. Consistent with national norms, the majority of women (68%) gained excessive weight according to Institute of Medicine weight-gain categories, regardless of group. Slightly more women in the MMT group gained below the recommendation. Among secondary outcomes, women in MMT reported increased physical activity (β = 0.26) and had lower glucose post-oral glucose tolerance test (β = − 0.23), being 66% less likely to have impaired glucose tolerance, compared to the TAU group. Conclusion A short-term intervention led to significant improvements in stress, and showed promise for preventing glucose intolerance. However, the majority of women gained excessive weight. A longer more intensive intervention may be needed for this high-risk population. Clinical Trials.gov #NCT01307683.

The relationship between alcohol consumption and mortality generally exhibits a U-shaped curve. The longevity observed with moderate alcohol consumption may be explained by other confounding factors, and, if such a relationship is present, the mechanism is not well understood. Indeed, the optimal amount of alcohol consumption for health has yet to be determined. Leukocyte telomere length is an emerging quantifiable marker of biological age and health, and a shorter telomere length is a predictor of increased mortality. Because leukocyte telomere length is a quantifiable and objectively measurable biomarker of aging, we sought to identify the amount of alcohol consumption associated with the longest telomere length and least telomere length attrition. Among over 2,000 participants from two distinct cohort studies, we found no pattern of alcohol consumption that was associated with longer telomere length or less telomere length attrition over time. Binge drinking may reduce telomere length. Using telomere length as a marker of age and health, these data fail to demonstrate any benefits of alcohol consumption, even when consumed in moderation.

Objective. The purpose of this study was to examine the relationships between individual parent stressors (financial, legal, career, relationships, home safety, community safety, medical, housing, authority, and prejudice) and adolescent obesity in African American adolescents. Methods. Data were from a cross section convenience sample of 273 African American parent-child dyads (ages 11–19) from Washtenaw County, Michigan. A subset of 122 dyads who completed parent and child questionnaires were included in this analysis. Parent stressors were assessed using the Crisis in Family Systems Revised (CRISYS-R) questionnaire. Height, weight, and waist circumference were measured by trained staff; height and weight were converted to BMI. Multivariate linear regression models were used to examine the relationships between individual parent stressors and adolescent BMI and waist circumference. Results. Parental exposure to stressors related to safety in the community was positively associated with adolescent BMI (β = 1.20(0.47), p=0.01) and waist circumference (β = 2.86(1.18), p=0.02). Parental appraisal of stressors related to safety in the community as “difficult to get through” was positively associated with adolescent BMI (β = 0.39(0.14), p=0.006) and waist circumference (β = 1.00(0.35), p=0.005). These relationships remained significant when adjusting for behavioral and psychosocial covariates. There were no significant relationships observed between other parent stressors and adolescent BMI or waist circumference. Conclusion. These findings suggest parents’ exposure and appraisal of stressors related to community safety are associated with increased adolescent obesity in African American youth. Longitudinal, larger-scale studies are needed to better understand the mechanisms by which community safety may increase obesity risk in this ethnic minority pediatric population. This trail is registered with NCT02938663.

Analyze the association between household food security status and diet quality during pregnancy. Cross-sectional analysis of pregnant women from the National Health and Nutrition Examination Survey from 1999 to 2008. Of the 1158 pregnant women with complete household food security information, we analyzed 688 women who had complete dietary information and household incomes ≤300 % of the Federal Poverty Level (FPL). Diet quality was measured by the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P) from 1 to 2 24 h dietary recalls. Multivariate linear and logistic regression models were implemented to assess the association between household food security status and AHEI-P, adjusting for age, nativity, marital status, race/ethnicity, education, and household income. Among women with household incomes ≤300 % of the FPL, 19 % were food insecure and 4 % were marginally food secure. The mean AHEI-P score was 41.9 (95 % CI 40.4, 43.3). Household food insecurity was not associated with overall diet quality. However, living in a food insecure household compared to a food secure household was associated with a 2.3 (1.3, 4.1) greater odds of having a calcium component score greater than the median intake of calcium scores among food secure women in the sample. In a nationally representative sample of pregnant women, 80 % lived in a fully food secure household. Improving household food security during pregnancy is a public health opportunity to improve health outcomes; however household food security status may not be associated with overall diet quality.

Insufficient sleep duration is a recognized determinant of cardiometabolic disease, with poor diet quality as a likely intermediate. Yet, inconsistencies in findings on sleep duration and diet quality among adult populations remain, particularly regarding a potential non-linear relationship. Thus, within a nationally representative survey of US adults (2011–2016 National Health and Nutrition Survey), we evaluated cross-sectional associations between sleep duration and diet quality. Self-reported typical sleep duration was categorized into four groups (≤5 h per night, 6 h, 7–8 h, and ≥9 h per night). Diet was assessed with two 24-h recalls (averaged), and diet quality was measured with the Healthy Eating Index-2015 (score range 0–100), which is comprised of 13 dietary components. Regression analyses that accounted for complex survey weights were used to compute multivariable-adjusted models of sleep duration categories and HEI-2015 overall scores, and individual HEI components. Within this nationally-representative sample of adults ≥18 years, 10% reported 5 or fewer hours of sleep, and 20% reported 6 h, while 12% obtained ≥9 h (long sleep duration). Compared to adults with 7–8 h of sleep, those with ≤5 h had 1.7 lower multivariable-adjusted HEI-2015 score (95% CI 0.6, 2.7), and those with ≥9 h had 1.2 lower adjusted HEI-2015 score (95% CI 0.2, 2.2). Upon examination of individual HEI-2015 components, short sleepers had lower consumption of healthier components (total fruits, whole fruits, total vegetables, greens and bean, whole grains, dairy, total protein, and seafood), while long sleepers had higher consumption of some unhealthier components (refined grains and added sugar) as well as some healthier components (dairy and total protein). In conclusion, within a nationally-representative US survey, a reverse U-shaped association was observed between sleep duration and dietary quality.

In the past two decades, food insecurity has increased by 45% among older adults but its relationship to health outcomes has not been extensively studied. The objective of this study was to examine the associations between food insecurity, multiple chronic conditions, and self-reported health status among a nationally representative sample of older U.S. adults. Data came from the National Poll on Healthy Aging, a national cross-sectional survey conducted in December 2019 among 2,048 individuals aged 50–80 years. Food insecurity was assessed using the six-item short form of the USDA Food Security Survey Module. The primary outcomes of interest were the number of self-reported chronic conditions and self-reported physical health status. Multinomial logistic regression models were used to examine the associations between food security status and the outcomes of interest, adjusting for sociodemographic characteristics. The overall prevalence of food insecurity among older adults was 14%. After adjustment for sociodemographic characteristics, food insecurity was positively associated with multiple chronic conditions (RRR 1.60, 95% CI 1.08, 2.36, for 2–3 conditions vs. 0–1; RRR 2.59, 95% CI 1.55, 4.33 for 4–10 chronic conditions vs. 0–1). Food insecurity was also associated with lower self-reported health status (RRR 1.84, 95% CI 1.16, 2.93 for good vs. excellent/ very good health; RRR 5.13, 95% CI 3.08, 8.52 for fair/poor vs. excellent/very good health). Food insecurity is an important social determinant of health among older adults. These findings can contribute to clinical and public health efforts to simultaneously alleviate food insecurity and promote health behaviors among older adults.

ImportanceReductions in sugar-sweetened beverage (SSB) intake can improve health, but are difficult for individuals to achieve on their own.ObjectivesTo evaluate whether a workplace SSB sales ban was associated with SSB intake and cardiometabolic health among employees and whether a brief motivational intervention provides added benefits to the sales ban.Design, setting, and participantsThis before-after study and additional randomized trial conducted from July 28, 2015, to October 16, 2016, at a Northern California university and hospital assessed SSB intake, anthropometrics, and cardiometabolic biomarkers among 214 full-time English-speaking employees who were frequent SSB consumers (≥360 mL [≥12 fl oz] per day) before and 10 months after implementation of an SSB sales ban in a large workplace, with half the employees randomized to receive a brief motivational intervention targeting SSB reduction.InterventionsThe employer stopped selling SSBs in all workplace venues, and half the sample was randomized to receive a brief motivational intervention and the other half was a control group that did not receive the intervention. This intervention was modeled on standard brief motivational interventions for alcohol used in the workplace that promote health knowledge and goal setting.Main outcomes and measuresOutcomes included changes in SSB intake, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and measures of abdominal adiposity. The primary associations tested were the correlation between changes in SSB intake and changes in HOMA-IR.ResultsAmong the 214 study participants, 124 (57.9%) were women, with a mean (SD) age of 41.2 (11.0) years and a baseline mean (SD) body mass index of 29.4 (6.5). They reported a mean daily intake of 1050 mL (35 fl oz) of SSBs at baseline and 540 mL (18 fl oz) at follow-up-a 510-mL (17-fl oz) (48.6%) decrease (P

© The Author(s) 2018. Aging is the biggest risk factor for the development of chronic diseases. Telomere length may represent one important mechanism by which dietary intake influences risk of age-related diseases; however, it is unknown which diet pattern is most strongly related to telomere length. We compared the relationships between 4 evidence-based diet quality indices and leukocyte telomere length in a nationally representative sample of healthy adults, and the extent to which these associations differed between men and women. Data on 4,758 adults aged 20-65 years with no prior diagnosis of major chronic disease were obtained from the 1999-2002 cycles of the National Health and Nutrition Examination Survey. Diet was assessed using one 24-hour dietary recall. After adjustment for sociodemographic and health characteristics, comparison of the top and bottom quintiles showed that higher Healthy Eating Index 2010 scores (β = 0.065, 95% confidence interval (CI): 0.018, 0.112; P-trend = 0.007), Alternate Healthy Eating Index 2010 scores (β = 0.054, 95% CI: 0.010, 0.097; P-trend = 0.007), Mediterranean Diet scores (β = 0.058, 95% CI: 0.017, 0.098; P-trend = 0.008), and Dietary Approaches to Stop Hypertension (DASH) scores (β = 0.052, 95% CI: 0.014, 0.090; P-trend = 0.007) were each associated with longer telomere length in women. These results may provide insight into the complex associations between optimal nutrition and longevity. Further investigation is needed to understand why associations were not observed in men.

Following publication of the original article [1], the author reported that the co-author’s name was missing in the original article.

Background The issue of food insecurity is one of growing concern among institutions of higher learning in the United States. In addition to studies on the prevalence and risk factors, research is needed to better understand the mechanisms by which food insecurity affects students' health and well-being. Objective To critically explore the experience of food insecurity among college students and its impact on psychosocial health and academic performance. Design In-depth qualitative interviews were conducted with college students to gain a better understanding of the mechanisms by which food insecurity affects their psychosocial health and academic performance. Participants/setting Twenty-five undergraduate students from a large public university in California who were recruited from a campus food pantry. Results Students discussed several themes related to the psychosocial effects of food insecurity: the stress of food insecurity interfering with daily life, a fear of disappointing family, resentment of students in more stable food and financial situations, an inability to develop meaningful social relationships, sadness from reflecting on food insecurity, feeling hopeless or undeserving of help, and frustration directed at the academic institution for not providing enough support. Students also discussed how food insecurity affected their academic performance through physical manifestations of hunger and the mental trade-off between focusing on food and focusing on academics. Conclusion These findings contribute to the understanding of what it means to experience food insecurity in higher education and can inform how universities support students’ basic needs.

BACKGROUND AND OBJECTIVES: As a distinct group, 2- to 5-year-olds with severe obesity (SO) have not been extensively described. As a part of the Expert Exchange Workgroup on Childhood Obesity, nationally-representative data were examined to better characterize children with SO. METHODS: Children ages 2 to 5 (N = 7028) from NHANES (1999–2014) were classified as having normal weight, overweight, obesity, or SO (BMI ≥120% of 95th percentile). Sociodemographics, birth characteristics, screen time, total energy, and Healthy Eating Index 2010 scores were evaluated. Multinomial logistic and linear regressions were conducted, with normal weight as the referent. RESULTS: The prevalence of SO was 2.1%. Children with SO had higher (unadjusted) odds of being a racial and/or ethnic minority (African American: odds ratio [OR]: 1.7; Hispanic: OR: 2.3). They were from households with lower educational attainment (OR: 2.4), that were single-parent headed (OR: 2.0), and that were in poverty (OR: 2.1). Having never been breastfed was associated with increased odds of obesity (OR: 1.5) and higher odds of SO (OR: 1.9). Odds of >4 hours of screen time were 1.5 and 2.0 for children with obesity and SO. Energy intake and Healthy Eating Index 2010 scores were not significantly different in children with SO. CONCLUSIONS: Children ages 2 to 5 with SO appear to be more likely to be of a racial and/or ethnic minority and have greater disparities in social determinants of health than their peers and are more than twice as likely to engage in double the recommended screen time limit.

INTRODUCTION Whole-grain consumption reduces risk of chronic disease, yet adolescents consume suboptimal amounts. It is unclear whether trends in consumption of whole grains have been positive among adolescents, and research assessing disparities by socioeconomic status is limited. The objective of our study was to evaluate recent trends in whole-grain consumption by US adolescents. METHODS We examined data on 3,265 adolescents aged 13 to18 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2012. Intake of whole and refined grains was analyzed by using generalized linear models, and odds of no whole-grain intake were examined with logistic regression, adjusting for socioeconomic and demographic factors. We evaluated trends and examined heterogeneity of trends with respect to annual household income. RESULTS Daily whole-grain consumption among adolescents increased overall by about a quarter-ounce-equivalent per day (oz-eq/d) (P trend

Objective To examine whether short-term participation in the Supplemental Nutrition Assistance Program (SNAP) affects food security and dietary quality among low-income adults recruited from a Massachusetts-wide emergency food hotline. Methods A 3-month, longitudinal study was conducted among 107 adults recruited at the time of SNAP application assistance. Outcomes included household food security (10-item US Department of Agriculture Food Security Survey Module), dietary intake (eg, grains, fruit) and diet quality (modified Alternate Healthy Eating Index). Data were analyzed using paired t tests and multivariable linear regression. Results Supplemental Nutrition Assistance Program participation was not associated with improved household food security over 3 months (P = .25). Compared with non-participants, SNAP participants increased refined grain intake by 1.1 serving/d (P = .02), from baseline to follow-up. No associations were observed with other foods, nutrients, or dietary quality. Conclusion and Implications Policies that simultaneously improve household food security and dietary quality should be implemented to support the health of low-income Americans participating in this crucial program.

Objectives Sugar-sweetened beverages (SSBs) are a major factor in the development of obesity and cardiometabolic disease. Shortened sleep duration has also been linked to increased appetite and obesity. Here, we examined whether there was an association between self-reported sleep duration and SSB consumption among adults 18 years and older. Methods Using data from 2005-2012 National Health and Nutrition Examination Survey, we examined self-reported sleep duration and beverage intake (types of SSBs, juice, water, coffee, tea) from two 24-hour dietary recalls among 18,779 adults. Adults who slept 7-8 h/night were considered the reference group. Generalized linear models were computed adjusting for sociodemographics and health characteristics as well as total energy intake. Results Thirteen percent slept 5 or fewer hours per night. In fully adjusted models, those who slept 5 hours or less had 21% higher SSB consumption (relative difference, 1.21; 95% confidence interval, 1.11-1.32). When broken down by beverage type, this was due to caffeinated sugary beverages. Longer sleepers (≥9-hour sleepers) consumed fewer servings of coffee and water. There were no associations between self-reported sleep duration and consumption of 100% juice, tea, or diet drinks. Conclusions Short sleep is associated with greater intake of sugared caffeinated sodas, a relationship that may have important, though unrecognized, implications for physical health. Directionality of this relationship cannot be determined from this study. Although caffeinated drinks could account for impaired sleep, it is possible that short sleep could influence one's appetitive drive for sugared caffeine drinks. Further examination of this relationship using prospective designs is warranted.

Some studies indicate that older adults lead active lives and travel to many destinations including those not in their immediate residential neighborhoods. We used global positioning system (GPS) devices to track the travel patterns of 40 older adults (mean age: 69) in San Francisco and Los Angeles. Study participants wore the GPS devices for 7 days in fall 2010 and winter 2011. We collected survey responses concurrently about travel patterns. GPS data showed a mean of four trips/day, and a mean trip distance of 7.6 km. Survey data indicated that older adults commonly made trips for four activities (e.g., volunteering, work, visiting friends) at least once each week. Older adults regularly travel outside their residential neighborhoods. GPS can document the mode of travel, the path of travel, and the destinations. Surveys can document the purpose of the travel and the impressions or experiences in the specific locations.

OBJECTIVE: To determine if obesity and dietary quality in low-income children differed by participation in the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program. METHODS: The study population included 5193 children aged 4 to 19 with household incomes ≤130% of the federal poverty level from the 1999–2008 NHANES. Diet was measured by using 24-hour recalls. RESULTS: Among low-income US children, 28% resided in households currently receiving SNAP benefits. After adjusting for sociodemographic differences, SNAP participation was not associated with a higher rate of childhood obesity (odds ratio = 1.11, 95% confidence interval [CI]: 0.71–1.74). Both SNAP participants and low-income nonparticipants were below national recommendations for whole grains, fruits, vegetables, fish, and potassium, while exceeding recommended limits for processed meat, sugar-sweetened beverages, saturated fat, and sodium. Zero percent of low-income children met at least 7 of 10 dietary recommendations. After multivariate adjustment, compared with nonparticipants, SNAP participants consumed 43% more sugar-sweetened beverages (95% CI: 8%–89%), 47% more high-fat dairy (95% CI: 7%, 101%), and 44% more processed meats (95% CI: 9%–91%), but 19% fewer nuts, seeds, and legumes (95% CI: –35% to 0%). In part due to these differences, intakes of calcium, iron, and folate were significantly higher among SNAP participants. Significant differences by SNAP participation were not evident in total energy, macronutrients, Healthy Eating Index 2005 scores, or Alternate Healthy Eating Index scores. CONCLUSIONS: The diets of low-income children are far from meeting national dietary recommendations. Policy changes should be considered to restructure SNAP to improve children’s health.

ObjectiveTo determine public attitudes towards federal spending on nutrition assistance programmes and support for policies to improve the nutritional impact of the Supplemental Nutrition Assistance Program (SNAP).DesignParticipants answered survey questions by telephone assessing support for SNAP spending and proposed programme policy changes.SettingUSA.SubjectsSurvey of 3024 adults selected by random digit dialling conducted in April 2012, including 418 SNAP participants.ResultsA majority (77 %; 95 % CI 75, 79 %) of all respondents supported maintaining or increasing SNAP benefits, with higher support among Democrats (88 %; 95 % CI 86, 90 %) than Republicans (61 %; 95 % CI 58, 65 %). The public supported policies to improve the nutritional impact of SNAP. Eighty-two per cent (95 % CI 80, 84 %) of respondents supported providing additional benefits to programme participants that can only be used on healthful foods. Sixty-nine per cent (95 % CI 67, 71 %) of respondents supported removing SNAP benefits for sugary drinks. A majority of SNAP participants (54 %; 95 % CI 48, 60 %) supported removing SNAP benefits for sugary drinks. Of the 46 % (95 % CI 40, 52 %) of SNAP participants who initially opposed removing sugary drinks, 45 % (95 % CI 36, 54 %) supported removing SNAP benefits for sugary drinks if the policy also included additional benefits to purchase healthful foods.ConclusionsThe US public broadly supports increasing or maintaining spending on SNAP. The majority of respondents, including SNAP participants, supported policies to improve the nutritional impact of SNAP by restricting the purchase of sugary drinks and incentivizing purchase of healthful foods with SNAP benefits.

ObjectiveTo examine whether the cross-sectional association between food insecurity and overweight/obesity varied according to birthplace and length of residence in the USA among California women.DesignUsing cross-sectional, population-based data from the California Women’s Health Survey (CWHS) 2009–2012, we examined whether the association between food insecurity and overweight or obesity varied by birthplace–length of US residence.SettingCalifornia, USA.SubjectsWomen (n16 008) aged 18 years or older.ResultsAmong US-born women, very low food security (prevalence ratio (PR)=1·21; 95 % CI 1·11, 1·31) and low food security (PR=1·19; 95 % CI 1·10, 1·28) were significantly associated with higher prevalence of overweight/obesity, after controlling for age, marital status, race/ethnicity, poverty and education. Among immigrant women who lived in the USA for 10 years or longer, very low food security was significantly associated with higher prevalence of overweight/obesity, after controlling for covariates (PR=1·16; 95 % CI 1·07, 1·27). Among immigrant women who had lived in the USA for less than 10 years, low and very low food security were not significantly associated with overweight/obesity, after controlling for covariates.ConclusionsFood insecurity may be an important pathway through which weight may increase with longer US residence among immigrant women. Public health programmes and policies should focus on increasing food security for all women, including immigrant women, as one strategy to reduce the prevalence of overweight/obesity.

Leukocyte telomere length (LTL) has been inversely associated with sugar-sweetened beverage (SSB) consumption in cross-sectional studies, but no studies have examined whether dietary intake influences LTL over time. This study examined longitudinal associations between sugary foods and beverages and LTL. Participants were 65 overweight and obese pregnant women, aged 18-45 years, from a mindfulness intervention study conducted from early pregnancy (⩽16 weeks gestation) and followed through 9 months postpartum. During pregnancy and postpartum, dietary intake was measured with 24-h diet recalls, and LTL was assessed using quantitative PCR. Adjusting for sociodemographic and health characteristics, decreased SSB consumption from baseline to 9 months postpartum was associated with greater concurrent LTL lengthening (β=-0.102, 95% confidence interval (CI) -0.192, -0.013). No associations between sugary foods and LTL were found in either period. The finding that reduced SSB consumption is associated with increased LTL warrants investigation in large cohort studies.

BACKGROUND AND OBJECTIVES: In October 2009, the Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) food package was revised to include more fruits, vegetables, whole grains, and lower-fat milk. We examined the impact of the WIC food package revisions on the diet quality of children in households using WIC. METHODS: A total of 1197 children aged 2 to 4 years from low-income households were studied from before and after the policy implementation (using the 2003–2008 and 2011–2012 National Health and Nutrition Examination Survey). The Healthy Eating Index–2010 (HEI-2010) was calculated using two 24-hour diet recalls. Linear regression was used to examine the difference in HEI-2010 score attributable to the food package change, adjusting for baseline and secular trends among WIC participants and nonparticipants, as well as child and household characteristics. Component scores of the HEI-2010 index were analyzed with generalized linear models. RESULTS: Average HEI-2010 scores for participants and nonparticipants were 52.4 and 50.0 at baseline, and 58.3 and 52.4 after the policy change, respectively. The WIC food package revisions were associated with an adjusted average of 3.7 additional HEI-2010 points (95% confidence interval, 0.6–6.9) for WIC participants compared with nonparticipants. In particular, the revisions were associated with a 3.4-fold relative increase (95% confidence interval, 1.3–9.4) in the Greens and Beans component score for WIC participants compared with nonparticipants. CONCLUSIONS: Results from this national sample indicate that the WIC food package revisions were associated with higher diet quality for children participating in WIC.