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BackgroundA strong association exists between consuming a healthy diet and lowering cholesterol levels among individuals with high cholesterol. However, implementing and sustaining a healthy diet in the real world is a major challenge. Digital technologies are at the forefront of changing dietary behavior on a massive scale, as they can reach broad populations. There is a lack of evidence that has examined the benefit of a digital nutrition intervention, especially one that incorporates nutrition education, meal planning, and food ordering, on cholesterol levels among individuals with dyslipidemia. ObjectiveThe aim of this observational longitudinal study was to examine the characteristics of people with dyslipidemia, determine how their status changed over time, and evaluate the changes in total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and triglycerides among individuals with elevated lipids who used Foodsmart, a digital nutrition platform that integrates education, meal planning, and food ordering. MethodsWe included 653 adults who used Foodsmart between January 2015 and February 2021, and reported a lipid marker twice. Participants self-reported age, gender, weight, and usual dietary intake in a 53-item food frequency questionnaire, and lipid values could be provided at any time. Dyslipidemia was defined as total cholesterol ≥200 mg/dL, HDL-C ≤40 mg/dL, LDL-C ≥130 mg/dL, or triglycerides ≥150 mg/dL. We retrospectively analyzed distributions of user characteristics and their associations with the likelihood of returning to normal lipid levels. We calculated the mean changes and percent changes in lipid markers among users with elevated lipids. ResultsIn our total sample, 54.1% (353/653) of participants had dyslipidemia at baseline. Participants with dyslipidemia at baseline were more likely to be older, be male, and have a higher weight and BMI compared with participants who had normal lipid levels. We found that 36.3% (128/353) of participants who had dyslipidemia at baseline improved their lipid levels to normal by the end of follow-up. Using multivariate logistic regression, we found that baseline obesity (odds ratio [OR] 2.57, 95% CI 1.25-5.29; P=.01) and Nutriscore (OR 1.04, 95% CI 1.00-1.09; P=.04) were directly associated with achieving normal lipid levels. Participants with elevated lipid levels saw improvements as follows: HDL-C increased by 38.5%, total cholesterol decreased by 6.8%, cholesterol ratio decreased by 20.9%, LDL-C decreased by 12.9%, non-HDL-C decreased by 7.8%, and triglycerides decreased by 10.8%. ConclusionsThis study characterized users of the Foodsmart platform who had dyslipidemia and found that users with elevated lipid levels showed improvements in the levels over time.

BackgroundDigital nutrition apps that monitor or provide recommendations on diet have been found to be effective in behavior change and weight reduction among individuals with obesity. However, there is less evidence on how integration of personalized nutrition recommendations and changing the food purchasing environment through online meal planning and grocery delivery, meal kits, and grocery incentives impacts weight loss among individuals with obesity. ObjectiveThe objective of this observational longitudinal study was to examine weight loss and predictors of weight loss among individuals with obesity who are users of a digital nutrition platform that integrates tools to provide nutrition recommendations and changes in the food purchasing environment grounded in behavioral theory. MethodsWe included 8977 adults with obesity who used the digital Foodsmart platform, created by Zipongo, Inc, DBA Foodsmart between January 2013 and April 2020. We retrospectively analyzed user characteristics and their associations with weight loss. Participants reported age, gender, height, at least 2 measures of weight, and usual dietary intake. Healthy Diet Score, a score to measure overall diet quality, was calculated based on responses to a food frequency questionnaire. We used paired t tests to compare differences in baseline and final weights and baseline and final Healthy Diet Scores. We used univariate and multivariate logistic regression models to estimate odds ratios and 95% CI of achieving 5% weight loss by gender, age, baseline BMI, Healthy Diet Score, change in Healthy Diet Score, and duration of enrollment. We conducted stratified analyses to examine mean percent weight change by enrollment duration and gender, age, baseline BMI, and change in Healthy Diet Score. ResultsOver a median (IQR) of 9.9 (0.03-54.7) months of enrollment, 59% of participants lost weight. Of the participants who used the Foodsmart platform for at least 24 months, 33.3% achieved 5% weight loss. In the fully adjusted logistic regression model, we found that baseline BMI (OR 1.02, 95% CI 1.02-1.03; P

Our aim was to test the hypothesized relationships between trauma exposure and alcohol-related problems, mediated by PTS symptoms, moderated by prior trauma exposure and help-seeking. Participants were 244 members of a private university who were enrolled or employed at the school on the date of a campus shooting. Online measures were distributed via e-mail in October 2014, and included the AUDIT, BTQ, PCL-5, and self-report measures of trauma exposure and counseling services utilized. The overall moderated mediation model examining the indirect effect of exposure to trauma on alcohol-related problems through PTSD symptoms, moderated by prior trauma and help seeking was significant, ß(SE) = 0.310(0.3554), p = 0.0001. This study highlights the importance of crisis interventions following trauma exposure.

This study aimed to examine (a) the impact of the change in the "Diagnostic and Statistical Manual of Mental Disorders" ("DSM") from a categorical to dimensional classification of substance use diagnoses, (b) the elimination of the legal criterion, and (c) the inclusion of a craving criterion in the "DSM"-5. Specifically, we aimed to compare the differential diagnostic outcomes among high-risk substance-using adolescents enrolled in a school-based Motivational Enhancement Therapy (MET) intervention. We explored the alterations of diagnoses of adolescents in this sample and the prevalence of diagnostic promotions and demotions. We hypothesized that the dimensional approach of the "DSM"-5 would improve the utility of diagnosis in predicting severity of consequences and treatment outcomes in our sample. Method: Participants included 273 adolescents enrolled in a school-based intervention and were primarily male (76%) and Caucasian (47%), with 17% Asian/Pacific Islander, 17% Hispanic, 7% African-American, and 1% American Indian/Alaska Native. Results: We found that adolescents who lost diagnoses in the "DSM"-5 generally used substances less frequently and had fewer non-diagnostic negative consequences than those who remained consistently diagnosed across systems. Those who gained a diagnosis via the dimensional system tended to show higher use patterns and have more negative consequences than those who were never diagnosed. These findings indicate that the changes in the "DSM" are appropriate in this school-based clinical sample, at least in matching diagnostic status with substance use topography and negative consequences.