Carrie Durward

All-Cause Mortality Risk of Metabolically Healthy Obese Individuals in NHANES III

Mortality risk across metabolic health-by-BMI categories in NHANES-III was examined. Metabolic health was defined as: (1) homeostasis model assessment-insulin resistance (HOMA-IR) <2.5; (2) ≤2 Adult Treatment Panel (ATP) III metabolic syndrome criteria; (3) combined definition using ≤1 of the following: HOMA-IR ≥1.95 (or diabetes medications), triglycerides ≥1.7 mmol/L, HDL-C <1.04 mmol/L (males) or <1.30 mmol/L (females), LDL-C ≥2.6 mmol/L, and total cholesterol ≥5.2 mmol/L (or cholesterol-lowering medications). Hazard ratios (HR) for all-cause mortality were estimated with Cox regression models. Nonpregnant women and men were included (n = 4373, mean ± SD, age 37.1 ± 10.9 years, BMI 27.3 ± 5.8 kg/m2, 49.4% female). Only 40 of 1160 obese individuals were identified as MHO by all definitions. MHO groups had superior levels of clinical risk factors compared to unhealthy individuals but inferior levels compared to healthy lean groups. There was increased risk of all-cause mortality in metabolically unhealthy obese participants regardless of definition (HOMA-IR HR 2.07 (CI 1.3–3.4), P < 0.01; ATP-III HR 1.98 (CI 1.4–2.9), P < 0.001; combined definition HR 2.19 (CI 1.3–3.8), P < 0.01). MHO participants were not significantly different from healthy lean individuals by any definition. While MHO individuals are not at significantly increased risk of all-cause mortality, their clinical risk profile is worse than that of metabolically healthy lean individuals.

Increasing Fruit and Vegetable Intake among Children and Youth through Gardening-Based Interventions: A Systematic Review

Although there are numerous health benefits associated with eating fruit and vegetables (F/V), few children are consuming recommended amounts. Gardening interventions have been implemented in various settings in an effort to increase childrens F/V consumption by expanding knowledge, exposure, and preferences for a variety of F/V. The purpose of this review was to identify the effectiveness of gardening interventions that have been implemented to increase F/V consumption among children. A systematic review was conducted using four electronic databases: Web of Science, PubMed, Scopus, and the Cumulative Index to Nursing and Allied Health Literature. English language studies conducted in developed countries between January 2005 and October 2015 were included in this review. Included studies measured F/V consumption among children aged 2 to 15 years before and after implementation of a gardening intervention in a school, community, or afterschool setting. All study designs were included in this review. A total of 891 articles were identified through database searching and cross-referencing. After removing duplicates, 650 articles remained and were screened using inclusion and exclusion criteria. Twenty-seven full-text articles were analyzed and 14 articles were included in this review. Of the 14 articles reviewed, 10 articles found statistically significant increases in fruit or vegetable consumption among participants after implementation of a gardening intervention. However, many studies were limited by the use of convenience samples, small sample sizes, and self-reported measurements of F/V consumption. Although the evidence is mixed and fraught with limitations, most studies suggest a small but positive influence of gardening interventions on childrens F/V intake. Future studies that include control groups, randomized designs, and assessments of F/V consumption over at least 1 year are needed to advance the literature on this topic.

An energy-reduced dietary pattern, including moderate protein and increased nonfat dairy intake combined with walking promotes beneficial body composition and metabolic changes in women with excess adiposity: a randomized comparative trial.

Moderate protein and nonfat dairy intake within an energy-reduced diet (ERD) may contribute to health benefits achieved with body weight (BW) loss. The current study examined the effectiveness of a weight-loss/weight-loss maintenance intervention using an ERD with moderate dietary protein (30% of kcals) and increased nonfat dairy intake (4–5 svg/d), including yogurt (INT group) and daily walking compared to an ERD with standard protein (16–17% of kcals) and standard nonfat dairy intake (3 svg/d) (COM group) with daily walking. A randomized comparative trial with 104 healthy premenopausal women with overweight/obesity was conducted in a university setting. Women were randomized to INT group or COM group. Anthropometric measurements, as well as dietary intake, selected vital signs, resting energy expenditure, blood lipids, glucose, insulin, and selected adipose-derived hormones were measured at baseline, and weeks 2, 12, and 24. Targets for dietary protein and nonfat dairy intake, while initially achieved, were not sustained in the INT group. There were no significant effects of diet group on anthropometric measurements. Women in the INT group and COM group, respectively, reduced BW (−4.9 ± 3.2 and −4.3 ± 3.3 kg, P < 0.001) and fat mass (−3.0 ± 2.2 and −2.3 ± 2.3 kg, P < 0.001) during the 12-week weight-loss phase and maintained these losses at 24 weeks. Both groups experienced significant decreases in body mass index, fat-free soft tissue mass, body fat percentage, waist and hip circumferences and serum triglycerides, total cholesterol, and leptin (all P < 0.001). Healthy premenopausal women with excess adiposity effectively lost BW and fat mass and improved some metabolic risk factors following an ERD with approximately 20% protein and 3 svg/d of nonfat dairy intake.

Understanding the Experiences of Low-Income Individuals Receiving Farmers’ Market Incentives in the United States: A Qualitative Study

Objective. The objective of this study was to identify benefits and barriers to using a farmers’ market (FM) incentive program among program participants. Design. In qualitative semistructured interviews, participants were asked about their experiences with shopping at FM, using FM incentives, barriers to fruit and vegetable (F&V) intake, and changes in dietary intake. Interviews were recorded and transcribed. Inductive content analysis was used to code, categorize, and develop themes based on the transcriptions. Setting. A FM in Northern Utah. Subjects. A convenience sample of participants (n = 14) completed a 45- to 60-minute interview after receiving FM incentives for an 8-week intervention period. Results. FM incentives reduced barriers associated with shopping at FM such as cost and accessibility among program participants. Incentives provided participants with greater spending flexibility, allowing parents to provide children with F&V that previously did not fit into their food budget. Participants reported greater family and community involvement when shopping at FM. However, the limited hours and days of operation were factors that reduced the use of FM among participants, even when incentives were provided. Conclusions. The perceived benefits and barriers to shopping at FM and receiving FM incentives should be considered by future programmers and funding agencies.

The Liabilities of Iron Deficiency

The overt physical manifestations of iron deficiency include the generic symptoms of anemia, which are tiredness, lassitude, and general feelings of lack of energy [1, 2]. Clinical manifestations of iron deficiency are glossitis, angular stomatitis, koilonychia (spoon nails), blue sclera, esophageal webbing (Plummer-Vinson Syndrome), and microcytic hypochromic anemia. Behavioral disturbances such as pica, which is characterized by abnormal consumption of nonfood items such as dirt (geophagia) and ice (pagophagia), are often present in iron deficiency, but clear biological explanations for these abnormalities are lacking. More recently, restless legs syndrome (RLS) has been described as being causally related to iron deficiency anemia [3]. This aphasic involuntary muscle contraction appears related to altered movement of iron to and within motor-control centers in the brain and is treatable in most cases with either iron or levodopa [4]. Neuro-maturational delays have been described by many research groups and will be discussed in detail in a later section. Physiological manifestations of iron deficiency have also been noted in immune function, thermoregulatory performance, energy metabolism, and exercise or work performance [2]. The current understanding of the iron biology underlying deficits in the neurobiology, muscle and energy metabolism, and consequences specific to pregnancy outcomes will be discussed in the remaining sections of this chapter.

Being Motivated by Nutrition Is Associated With Healthy Home Food Environment of Supplemental Nutrition Assistance Program (SNAP) Recipients

Objective To examine the relationship between food shopping motivating factors and the home food environment (HFE). Methods Participants in the Supplemental Nutrition Assistance Program (n = 123) who were taking part in the Utah State Double‐Up Food Bucks evaluation program were interviewed about their HFE, factors motivating shopping, and food security status. Composite HFE scores were derived from the Perceived Nutrition Environment Measure Survey questionnaire and food security score from the 6‐item US Household Food Security Survey questionnaire. Analysis included multiple linear regression. Results Mean age was 46 ± 16.1 years. Regression models showed significant associations of being motivated by nutrition, education, and food security with HFE (&bgr; = 4.70, P = .03; &bgr; = 1.44, P = .06; and &bgr; = 1.44, P = .06, respectively). Conclusion and Implications In‐store interventions to improve perceived nutrition importance among shoppers may be a useful tool to improve home food supplies. Further research is recommended examining the association between food shopping motivators and the HFE in a larger population.