Kiyah J. Duffey

Environmental influences on food choice, physical activity and energy balance

In this paper, the environment is defined as the macro- and community-level factors, including physical, legal and policy factors, that influence household and individual decisions. Thus, environment is conceived as the external context in which household and individual decisions are made. This paper reviews the literature on the ways the environment affects diet, physical activity, and obesity. Other key environmental factors discussed include economic, legal, and policy factors. Behind the major changes in diet and physical activity in the US and globally lie large shifts in food production, processing, and distribution systems as well as food shopping and eating options, resulting in the increase in availability of energy-dense foods. Similarly, the ways we move at home, work, leisure, and travel have shifted markedly, resulting in substantial reductions in energy expenditure. Many small area studies have linked environmental shifts with diet and activity changes. This paper begins with a review of environmental influences on diet and physical activity, and includes the discussion of two case studies on environmental influences on physical activity in a nationally representative sample of US adolescents. The case studies illustrate the important role of physical activity resources and the inequitable distribution of such activity-related facilities and resources, with high minority, low educated populations at strong disadvantage. Further, the research shows a significant association of such facilities with individual-level health behavior. The inequity in environmental supports for physical activity may underlie health disparities in the US population.

Shifts in patterns and consumption of beverages between 1965 and 2002

Background: Beverage patterning may play a role in partially explaining the rising rates of obesity in the United States, yet little work on overall trends and patterns exits. Our objective was to examine trends and patterns of beverage consumption among U.S. adults.

Energy density, portion size, and eating occasions: Contributions to increased energy intake in the United States, 1977-2006

Using data from three surveys, Kiyah Duffey and Barry Popkin found that changes in eating/drinking occasions and portion size consistently account for most of the change in daily total energy intake over a 30-year period.

Food price and diet and health outcomes: 20 years of the CARDIA Study.

BACKGROUND Despite surging interest in taxation as a policy to address poor food choice, US research directly examining the association of food prices with individual intake is scarce. METHODS This 20-year longitudinal study included 12 123 respondent days from 5115 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Associations between food price, dietary intake, overall energy intake, weight, and homeostatic model assessment insulin resistance (HOMA-IR) scores were assessed using conditional log-log and linear regression models. RESULTS The real price (inflated to 2006 US dollars) of soda and pizza decreased over time; the price of whole milk increased. A 10% increase in the price of soda or pizza was associated with a -7.12% (95% confidence interval [CI], -63.50 to -10.71) or -11.5% (95% CI, -17.50 to -5.50) change in energy from these foods, respectively. A

Does hunger and satiety drive eating anymore? Increasing eating occasions and decreasing time between eating occasions in the United States

1.00 increase in soda price was also associated with lower daily energy intake (-124 [95% CI, -198 to -50] kcal), lower weight (-1.05 [95% CI, -1.80 to -0.31] kg), and lower HOMA-IR score (0.42 [95% CI, -0.60 to -0.23]); similar trends were observed for pizza. A

Drinking caloric beverages increases the risk of adverse cardiometabolic outcomes in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

1.00 increase in the price of both soda and pizza was associated with greater changes in total energy intake (-181.49 [95% CI, -247.79 to -115.18] kcal), body weight (-1.65 [95% CI, -2.34 to 0.96] kg), and HOMA-IR (-0.45 [95% CI, -0.59 to -0.31]). CONCLUSION Policies aimed at altering the price of soda or away-from-home pizza may be effective mechanisms to steer US adults toward a more healthful diet and help reduce long-term weight gain or insulin levels over time.

High-fructose corn syrup: is this what's for dinner?

BACKGROUND The design of dietary, metabolic, and intervention studies should reflect the meal patterning of free-living individuals, but this design has not been systematically reviewed recently. OBJECTIVE Our objective was to examine meal-patterning trends [meals and snacks, termed eating occasions (EOs)] in a sample of US children and adults. DESIGN This was a nationally representative cross-sectional study of US data sets from 1977 to 1978, 1994 to 1998, and 2003 to 2006 in 28,404 children (2-18 y of age) and 36,846 adults (> or = 19 y of age). The main outcomes of interest included the number and size (energy/d) of meal and snack EOs, the composition (food or beverage) of each EO, and the time interval between each EO. RESULTS The number of EOs increased over the previous 30 y among all ages. For adults and children, the change in the number of EOs from 1977 to 2006 was greatest for those in the 75th and 90th percentiles, although the mean number increased across all percentiles. Energy intake, particularly from snacking, increased for both groups in all percentiles of the distribution. The time between EOs decreased by 1 h for adults and children (to 3.0 and 3.5 h in 2003-2006, respectively). Overwhelmingly, meals consisted of both food and beverages, but the percentage of snacking occasions that consisted of beverages only increased considerably among children. CONCLUSIONS US children and adults are consuming foods more frequently throughout the day than they did 30 y ago. Researchers undertaking future clinical, preload, and related food studies need to consider these marked shifts as they attempt to design their research to fit the reality of the eating patterns of free-living individuals.

Regular Consumption from Fast Food Establishments Relative to Other Restaurants Is Differentially Associated with Metabolic Outcomes in Young Adults

BACKGROUND Intake of caloric beverages is hypothesized to contribute to adverse health outcomes, but the beverages and populations studied vary considerably. OBJECTIVE Our objective was to examine the relation between consumption of low- and whole-fat milk, fruit juice, and sugar-sweetened beverages (SSBs) and cardiometabolic risk factors. DESIGN We used data from a prospective 20-y cohort of 2774 adults. Data are taken from CARDIA (Coronary Artery Risk Development in Young Adults) Study examination years 0 (1985-1986), 7 (1992-1993), and 20 (2005-2006). Beverage intake was averaged across years 0 and 7, and continuous and categorical (quartile) distributions were used. Incident (year 20) high waist circumference (WC), high triglycerides, high LDL cholesterol, low HDL cholesterol, hypertension, and metabolic syndrome were examined by using multivariable-adjusted Poisson regression models. RESULTS Higher SSB consumption (across quartiles) was associated with higher risk of high WC [adjusted relative risk (aRR): 1.09; 95% CI: 1.04, 1.14; P for trend < 0.001]; high LDL cholesterol (aRR: 1.18; 95% CI: 1.02, 1.35; P for trend = 0.018), high triglycerides (aRR: 1.06; 95% CI: 1.01, 1.13; P for trend = 0.033), and hypertension (aRR: 1.06; 95% CI: 1.01, 1.12; P for trend = 0.023). Whole-fat milk consumption was associated with lower risk of high triglycerides (aRR: 0.91; 95% CI: 0.81, 1.00; P for trend = 0.046). With the use of continuous beverage intake, results were similar. Consumers of whole-fat milk and SSBs were more likely to be younger, black, and male and to have lower levels of physical activity and higher total energy intake in comparison with nonconsumers (P < 0.05). CONCLUSIONS Our findings suggest that higher SSB consumption is associated with cardiometabolic risk. Recommendations to limit consumption of these caloric beverages may help reduce the burden of these risk factors in US adult populations.

Beverage consumption among European adolescents in the HELENA study.

BACKGROUND Research on trends in consumption of added sugar and high-fructose corn syrup (HFCS) in the United States has largely focused on calorically sweetened beverages and ignored other sources. OBJECTIVE We aimed to examine US consumption of added sugar and HFCS to determine long-term trends in availability and intake from beverages and foods. DESIGN We used 2 estimation techniques and data from the Nationwide Food Consumption Surveys (1965 and 1977), Continuing Survey of Food Intake by Individuals (1989-1991), and the National Health and Nutrition Examination Surveys (1999-2000, 2001-2002, and 2003-2004) to examine trends in HFCS and added sugar both overall and within certain food and beverage groups. RESULTS Availability and consumption of HFCS and added sugar increased over time until a slight decline between 2000 and 2004. By 2004, HFCS provided roughly 8% of total energy intake compared with total added sugar of 377 kcal x person(-1) x d(-1), accounting for 17% of total energy intake. Although food and beverage trends were similar, soft drinks and fruit drinks provided the most HFCS (158 and 40 kcal x person(-1) x d(-1) in 2004, respectively). Moreover, among the top 20% of individuals, 896 kcal x person(-1) x d(-1) of added sugar was consumed compared with 505 kcal x person(-1) x d(-1) of HFCS. Among consumers, sweetened tea and desserts also represented major contributors of calories from added sugar (>100 kcal x person(-1) x d(-1)). CONCLUSION Although increased intake of calories from HFCS is important to examine, the health effect of overall trends in added caloric sweeteners should not be overlooked.

Dietary patterns matter: diet beverages and cardiometabolic risks in the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) Study

Although away-from-home eating is adversely associated with weight, other comorbidities have not been examined; therefore, we sought to determine the associations of fast food (e.g. Wendys, McDonalds) and restaurant (sit-down style) consumption (times per week) with weight and multiple metabolic outcomes, including homeostatic model assessment insulin resistance (HOMA-IR), waist circumference, and plasma triglycerides (TG), LDL cholesterol, and HDL cholesterol (HDL-C). We used 3 waves of data (exam y 7, 10, and 20) from the Coronary Artery Risk Development in Young Adults Study, a prospective cohort study of black and white young adults [aged 25-42 y in 1992-93, n = 3643 (men, 1659; women, 1984)]. Individuals in the highest (vs. lowest) quartile of baseline (defined as the mean of y 7 and 10) fast food consumption had higher y 20 weight [adjusted mean (95% CI): 5.6 kg (CI, 2.1, 9.2); P = 0.002], HOMA-IR [0.9 (CI, 0.4, 1.3); P < 0.001], waist circumference [5.3 cm (CI, 2.8, 7.9); P < 0.000], TG concentrations [0.25 mmol/L (CI, 0.10, 0.40), 22.7 mg/dL (CI, 9.1, 36.3); P = 0.001], and lower HDL-C concentrations [-0.014 mmol/L (CI, -0.215, -0.067), 5.4 mg/dL (CI, -8.3, -2.6); P < 0.000]. Baseline restaurant consumption was unrelated to y 20 outcomes. Adjusted change in weekly restaurant (P < 0.05) and fast food intake (P < 0.001) was associated with 13-y changes in body weight [0.09 kg (CI, 0.02, 0.17) and 0.15 kg (CI, 0.06, 0.24), respectively] and waist circumference [0.08 cm (CI, 0.02, 0.14) and 0.12 cm (CI, 0.04, 0.20), respectively]. Fast food consumption may be an important target for the prevention of adverse metabolic health outcomes.