Dena Herman

Life Course Perspective: Evidence for the Role of Nutrition

The “Life Course Perspective” proposes that environmental exposures, including biological, physical, social, and behavioral factors, as well as life experiences, throughout the entire life span, influence health outcomes in current and future generations. Nutrition, from preconception to adulthood, encompasses all of these factors and has the potential to positively or negatively shape the individual or population health trajectories and their intergenerational differences. This paper applies the T2E2 model (timing, timeline, equity and environment), developed by Fine and Kotelchuck, as an overlay to examine advances in nutritional science, as well as the complex associations between life stages, nutrients, nutrigenomics, and access to healthy foods, that support the life course perspective. Examples of the application of nutrition to each of the four constructs are provided, as well as a strong recommendation for inclusion of nutrition as a key focal point for all health professionals as they address solutions to optimize health outcomes, both domestically and internationally. The science of nutrition provides strong evidence to support the concepts of the life course perspective. These findings lend urgency to the need to improve population health across the life span and over generations by ensuring ready access to micronutrient-dense foods, opportunities to balance energy intake with adequate physical activity and the need for biological, social, physical, and macro-level environments that support critical phases of human development. Recommendations for the application of the life course perspective, with a focus on the emerging knowledge of nutritional science, are offered in an effort to improve current maternal and child health programs, policies, and service delivery.

Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

OBJECTIVES We investigated whether nonelderly US adults (aged 18-64 years) in food-insecure households are more likely to report cost-related medication underuse than the food-secure, and whether the relationship between food insecurity and cost-related medication underuse differs by gender, chronic disease, and health insurance status. METHODS We analyzed data from the 2011 and 2012 National Health Interview Survey (n = 67 539). We examined the relationship between food insecurity and cost-related medication underuse with the χ(2) test and multivariate logistic regression with interaction terms. RESULTS Bivariate and multivariate analyses showed a dose-response relationship between food insecurity and cost-related medication underuse, with an increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < .001). This association was conditional on health insurance status, but not substantially different by gender or chronic disease status. Being female, low-income, having no or partial health insurance, chronic conditions, functional limitations, or severe mental illness were positively associated with cost-related medication underuse. CONCLUSIONS Using food insecurity as a risk factor to assess cost-related medication underuse could help increase identification of individuals who may need assistance purchasing medications and improve health for those in food-insecure households.

Estimation of dietary boron intake in six countries: Egypt, Germany, Great Britain, Kenya, Mexico, and the United States

Dietary boron (B) intakes were estimated from six countries selected because of the availability of adequate food consumption survey data and nutrient databases (with the exception of boron), and a wide variety of dietary patterns were represented. Large-scale nationwide survey data were provided by the United States (1989–91), Germany (1985–89) and Great Britain (1986–87). Survey data from rural agricultural communities of Mexico, Kenya, and Egypt were provided by the Human Nutrition Collaborative Research Support Program (1983–86). A boron nutrient database was created to include boron concentrations for the foods consumed in each country. This database incorporated boron analytical data from various sources in the United States, Finland, United Kingdom, Italy, Japan, and China. Each persons average daily boron intake was estimated by linking the boron database with the survey food records. Mean dietary intake estimates for adults in the United States, Germany, Great Britain, Mexico, Kenya, and Egypt, respectively, were 1.11 ± 0.69, 1.72 ± 0.47, 1.30 ± 0.63, 2.12 ± 0.69, 1.95 ± 0.57 and 1.31 ± 0.50 mg B/d for males and 0.89 ± 0.57, 1.62 ± 0.76, 1.14 ± 0.55, 1.75 ± 0.48, 1.80 ± 0.49 and 1.24 ± 0.40 mg B/d for females. The major contributors to dietary boron intake were identified in each country. The top contributors in the United States, Great Britain, Germany, Mexico, Kenya, and Egypt, respectively, are coffee (6.5%), wine (14%), wine (15.4%), tortillas (56.1%), maize (35.3%), and rural breads (27.4%). These dietary boron intake estimates provide data that will be useful for setting recommended daily intake levels when boron is confirmed to be essential in humans. J. Trace Elem. Exp. Med. 12:263–270, 1999.