To assess the feasibility of a food-based diabetes self-management education and support (DSMES) intervention delivered to persons with type 2 diabetes (T2DM) and food insecurity.

This single arm pre-/post convergent mixed methods study tested the feasibility of a 3-month intervention using food boxes, recipes, DSMES, and dietitian visits. Feasibility benchmarks assessed were: acceptability (>50% participants satisfied), demand (>50% used program components), and implementation (75% adherence, 80% retention). Assessments included: self-reported food security, health-related quality of life, diabetes self-efficacy, sociodemographic, and dietary intake, height, weight, and HbA1c; and one in-depth interview with participants and key staff. Enrollment, recruitment, and retention rates were summarized; qualitative data were analyzed using structured thematic analysis (participant interviews) and key point summaries (staff interviews). Quantitative/qualitative data integration was conducted using a joint display.

Food bank and Federally Qualified Health Center in the Southwestern U.S.

English- or Spanish-speaking adults with T2DM and food insecurity.

247 patients with T2DM and food insecurity were recruited, 71 expressed interest, 25 consented. 21 participants completed study measurements. 71% (n=15) received 6 home food deliveries and ≥1 dietitian visit. A priori benchmarks were approached or met within each feasibility criterion – most participants found the intervention to be acceptable, used most or all intervention components, and reported some challenges within intervention implementation (e.g., timing of food deliveries). Data integration provided deeper understanding of reported intervention implementation challenges, yet high adherence to the intervention.

The intervention was feasible. Next steps include a clinical trial to establish intervention efficacy.

Telomere length (TL) is a posited pathway through which chronic stress results in biological dysregulation and subsequent adverse health outcomes. Food insecurity is associated with shorter TL. Social support, which is defined by the size and function of an individual’s social network, is associated with better health outcomes. The present study assesses whether social support modifies the relationship between food security and TL.

Cross-sectional study design. Linear regression was used to assess the association between social support and TL, stratified by social support level. A multiplicative interacted model was used to formally test modification.

Data come from the National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2001-2002 waves.

Adults aged 60 years and older who have measurements for TL.

Our sample comprised 2,674 participants, and 63.5% of the total sample had low social support, with 13.3% being food insecure. In fully adjusted models, food insecurity was negatively though modestly associated (P=0.13) with TL. Associations between food insecurity and TL were significantly modified by social support (interaction P=0.026), whereby food insecurity had a stronger effect among individuals with high social support (coefficient = -0.099 (95% CI: -0.161, -0.038)) compared to low social support (coefficient = -0.001, (95% CI: -0.033, 0.032)).

Food insecurity is modestly associated with shorter TL. Contrary to our hypothesis, food insecurity had more deleterious effects on TL among participants with high social support than low social support. Results may indicate that the food insecure population is a higher needs population, and increased social support reflects these needs rather than providing protective effects.

Ultra-processed foods (UPF), including those containing food-additive emulsifiers, have received research attention due to evidence implicating them in the pathogenesis of certain diseases. The aims of this research were to develop a large-scale, brand-level database of UPFs in the UK food supply and to characterise the occurrence and co-occurrence of food-additive emulsifiers.

A database was compiled sampling UPF groups contributing to total dietary energy intake in the UK from the National Diet and Nutrition Survey (2008-2014). Every food in these UPF groups were identified from online supermarket provision from the ‘‘big four’’ supermarkets that dominate the market share in the UK, comprising Tesco, Sainsbury’s, Asda and Morrisons.

A total of 32,719 food products in the UK supermarket food supply were returned in searches. Of these, 12,844 UPF products were eligible and manually reviewed for the presence of emulsifiers. Emulsifiers were present in 6,642 (51.7%) food products. Emulsifiers were contained in 95.0% of ‘‘Pastries, buns and cakes’’; 81.9% of ‘‘Milk-based drinks”, 81.0% in ‘‘Industrial desserts’’ and in 77.5% of “Confectionary”. Fifty-one percent of all emulsifier-containing foods contained multiple emulsifiers. Across emulsifier-containing foods there were a median of 2 emulsifiers (IQR 2) per product. The five most common emulsifiers were lecithin (23.4% of all UPF), mono- and diglycerides of fatty acids (14.5%), diphosphates (11.6%), xanthan gum and pectin (8.0%).

Findings from this study are the first to demonstrate the wide-spread occurrence and co-occurrence of emulsifiers in UPF in the UK food supply.

To examine parents’/caregivers’ willingness to participate and willingness to pay (WTP) for a cost-shared school food program, and its associated factors.

A quantitative survey design was used where WTP for a hypothetical school food program was elicited using a double bounded dichotomous choice elicitation method. We used a double hurdle (logistic and truncated regression) model to examine WTP and positively or negatively associated factors.

Saskatoon Public School Division elementary schools situated in high, mid, or low median income neighborhoods.

Parents or caregivers of children attending grades 1 to grade 8 in the Saskatoon Public School Division elementary schools.

94% respondents were willing to participate in a school food program while less than two-thirds of participants were willing to pay for such a program. Over 90% respondents from all the socio-economic groups were willing to participate. Multiple household income earners, higher household income, higher number of children, household food security status, and higher academic attainment of parents’/caregivers predicted greater willingness to pay. Mean willingness to pay was $4.68 (CAN) and households reporting moderate or severe food insecurity were likely to be willing to pay significantly less for a school food program.

A cost shared program might be financially sustainable in Canada if community characteristics such as household food insecurity status, economic participation of women and average household size are kept in mind while determining the price of the program.

to evaluate the impact of increased availability of healthier options on purchasing of different types of vending snack products sold in English leisure (sports) centres.

An evaluation of an intervention using pre-post methods and interrupted time series analysis. Products within the vending machines were altered over three phases to increase availability of healthier options, using agreed nutrition criteria - Government Buying Standards for Food and Catering Services (GBSF) for England - as a guide; as well as product availability. The primary outcome was the change in mean weekly purchased energy between the first and third phase. Secondary outcomes included changes by phase and by week in weekly number of purchases, fats, sugars and salt for all products combined and by individual product categories.

15 sports centres in the city of Leeds, West Yorkshire, UK.

Snack products sold in 18 vending machines.

Energy purchased reduced from baseline to phase 2, for all product categories combined, by 47.25MJ (95% CI -61.22 to -33.27MJ) per machine and by 279KJ, (95% CI -325 to -266KJ) per product unit. There were reductions in most nutrients purchased in all individual product categories except chocolate confectionery. Nutrients per product unit decreased for all product categories except saturated fat in chocolate confectionery. Minimal underlying trends in the baseline phase were identified, indicating changes in outcomes were likely to be due to the intervention.

Introducing standards to increase the availability of healthier snack products in vending machines is feasible without substantially affecting sales.

This study uses participatory modeling with stakeholders to assess the potential impacts of three interventions intended to increase fruit and vegetable consumption in urban Kenya.

A participatory process using Group Model Building developed a conceptual model of the determinants of vegetable consumption. A subsequent quantitative System Dynamics model using data from primary and secondary sources simulated vegetable consumption from 2020 to 2024 under three proposed interventions suggested by stakeholders: increasing consumer awareness, reducing post-harvest losses and increasing farm yields. Model analyses assumed mean parameter values and assessed uncertainty using 200 simulations with randomized parameter values.

The research was implemented in Nairobi, Kenya with simulation analyses of mean per capita consumption in this location.

Workshops convened diverse fruit and vegetable value chain stakeholders (farmers, government officials, NGO staff, and technical experts) to develop the conceptual model, data inputs and intervention scenarios.

Increasing consumer awareness was simulated to increase vegetable consumption by relatively modest amounts by 2024 (5 grams/person/day from a base of 131 grams/person/day) under mean assumed value of value chain response parameters. Reducing perishability was simulated to reduce consumption due to the higher costs required to reduce losses. Increasing farm yields was simulated to have the largest impact on consumption at assumed parameter values (about 40 grams/person/day) but would have a negative impact on farm profits, which could undermine efforts to implement this intervention.

The combination of Group Model Building and simulation modeling informed intervention priorities for an important public health nutrition issue.

This study aimed to identify the amount of discretionary foods and drinks consumed by Norwegian children and adolescents, describe how such products contribute to the intake of total energy and nutrients, and study the distribution in intake of discretionary foods and drinks across different meals. Secondly, the aim was to explore factors associated with those children and adolescents having the highest consumption of discretionary foods and drinks.

Secondary analysis of data from a national survey of dietary intake among Norwegian children and adolescents.

Schools in 50 randomly selected municipalities in Norway.

The study population included 636 pupils in 4th grade (9-11 years) and 687 pupils in 8th grade (12-14 years).

Discretionary foods and drinks contributed to about 20% of the children and adolescents’ total energy intake. These food and beverage items contributed to about two-thirds of the participants’ intake of added sugar, and limited amounts of dietary fiber, vitamins and minerals. The quartile which had the lowest proportion of their energy intake from discretionary foods and drinks seemed to have a higher intake of whole grains, and fish and seafood.

Almost all 4th and 8th graders in Norway consumed discretionary foods and drinks and these products contributed to a substantial proportion of the total energy intake and limited amounts of nutrients. Those children and adolescents consuming the least discretionary foods and drinks had a higher intake of whole grains, fish and seafood, indicating healthier and more sustainable food habits.

Sustainable diet is one of the main factors that support food security, and the Mediterranean diet (MD) one of the sustainable diet models associated with low ecological impact and optimum health results, has come to the fore. It was aimed to compare the results of the 2010 and 2017 Turkish Nutrition and Health Studies (TNHS) according to the Mediterranean Adequacy Index (MAI) and in order to evaluate the environmental impact of the current nutritional status in Turkey through water footprints (WFs).

The MAI score was calculated using the published results of the 2010 and 2017 TNHS, and the WFs have been calculated as indicators of environmental impact.

Turkey.

There are no participants.

In the TNHS, there was an increase in the amount of energy provided by foods non-MD in 2017 compared to 2010, with a decrease in the total MAI score. The group with the lowest adherence to the MD in both years was the adult group (MAI20102.74 and MAI20172.31), while the group with the highest adherence was the adolescent group (MAI20103.21 and MAI20172.53). The MAI scores of females were higher than those of males in both years. The males aged 19-64 years had the largest (841 m3/year) WF and the females aged 65+ years had the smallest (483 m3/year). The food group that contributed the most to WF was meat and meat products (21.0-35.0%).

Adherence to the MD has decreased due to the increase in the consumption of the Western-type diet in Turkey.

Religious/spiritual beliefs and behaviours (RSBB) have been associated with health outcomes, with diet a potential mediator of this relationship. We therefore explored whether RSBBs were associated with differences in diet.

Dietary patterns and nutrient intakes were derived from food frequency questionnaires completed by pregnant women in 1991-1992 (mean age=28.3 years, range=15-46), and by the mothers and partners 4 years post-partum (mothers mean age=32.3, range=19-49; partners mean age=34.5, range=18-74). RSBB exposures measured in pregnancy included religious belief, affiliation and attendance. We first explored whether RSBBs were associated with dietary patterns in confounder-adjusted linear regression models. If associations were found, we examined whether RSBBs were associated with nutrient intake (linear regression) and following nutrient intake guidelines (logistic regression).

Prospective birth cohort study in Southwest England (Avon Longitudinal Study of Parents and Children; ALSPAC).

13,689 enrolled mothers and their associated partners.

In pregnant women, RSBBs were associated with higher “traditional” (i.e., ‘meat and two veg’) and lower “vegetarian” dietary pattern scores. Religious attendance and non-Christian religious affiliation were associated with higher “health-conscious” dietary pattern scores. Religious attendance was associated with increased micronutrient intake and following recommended micronutrient intake guidelines, with weaker effects for religious belief and affiliation. Comparable patterns were observed for mothers and partners 4 years post-partum, although associations between RSBBs and nutrient intakes were weaker for partners.

RSBBs are associated with broad dietary patterns and nutrient intake in this cohort. If these reflect causal relationships, diet may potentially mediate the pathway between RSBB and health.

To assess the relationship between program attendance in a produce prescription program and changes in cardiovascular risk factors.

The Georgia Food for Health (GF4H) program provided 6 monthly nutrition education sessions, 6 weekly cooking classes, and weekly produce vouchers. Participants became program graduates attending at least 4 of the 6 of both the weekly cooking classes and monthly education sessions. We used a longitudinal, single-arm approach to estimate the association between the number of monthly program visits attended and changes in health indicators.

GF4H was implemented in partnership with a large safety-net health system in Atlanta, GA.

331 participants living with or at-risk of chronic disease and food insecurity were recruited from primary care clinics. Over three years, 282 participants graduated from the program.

After adjusting for program site, year, participant sex, age, race & ethnicity, SNAP participation, and household size, we estimated that each additional program visit attended beyond 4 visits was associated with a 0.06 kg/m2 reduction in BMI (95% CI: -0.12, -0.01; p=0.02), a 0.37 inch reduction in waist circumference (95% CI: -0.48, -0.27; p<0.001), a 1.01 mmHg reduction in systolic blood pressure (95% CI: -1.45, -0.57; p<0.001), and a 0.43 mmHg reduction in diastolic blood pressure (95% CI: -0.69, -0.17; p=0.001).

Each additional cooking and nutrition education visit attended beyond the graduation threshold was associated with modest but significant improvements in cardiovascular disease risk factors, suggesting that increased engagement in educational components of a produce prescription program improves health outcomes.

To measure incidence of conflicts of interest (COI) with food and pharmaceutical industry actors on the advisory committee for the 2020- 2025 U.S. Dietary Guidelines for Americans (DGA) and assess the adequacy of current mechanisms to disclose and manage COI among the committee’s members.

We compiled longitudinal data from archival sources on connections between members of the DGA’s advisory committee and actors. We hypothesed that these committee members, who oversee the science for the most influential dietary policy in the U.S, might have significant COI that would be relevant to their decision making. Disclosure of COI on this committee was recommended in 2017 by the National Academies of Sciences in order to increase transparency and manage bias, but public disclosure of the committee’s COI does not appear to have taken place.

the committee was comprised of 20 experts.

None.

Our analysis found that 95% of the committee members had COI with the food, and/or pharmaceutical industries and that particular actors, including Kellogg, Abbott, Kraft, Mead Johnson, General Mills, Dannon, and the International Life Sciences had connections with multiple members. Research funding and membership of an advisory/executive board jointly accounted for more than 60% of the total number of COI documented.

Trustworthy dietary guidelines result from a transparent, objective, and science-based, process. Our analysis has shown that the significant and widespread COI on the committee prevent the DGA from achieving the recommended standard for transparency without mechanisms in place to make this information publicly available.