Lalitha Samuel

Body Mass Index Categories and Mortality Risk in US Adults: The Effect of Overweight and Obesity on Advancing Death

OBJECTIVES We examined the association of body mass index with all-cause and cardiovascular disease (CVD)-specific mortality risks among US adults and calculated the rate advancement period by which death is advanced among the exposed groups. METHODS We used data from the Third National Health and Nutrition Examination Survey (1988-1994) linked to the National Death Index mortality file with follow-up to 2006 (n = 16 868). We used Cox proportional hazards regression to estimate the rate of dying and rate advancement period for all-cause and CVD-specific mortality for overweight and obese adults relative to their normal-weight counterparts. RESULTS Compared with normal-weight adults, obese adults had at least 20% significantly higher rate of dying of all-cause or CVD. These rates advanced death by 3.7 years (grades II and III obesity) for all-cause mortality and between 1.6 (grade I obesity) and 5.0 years (grade III obesity) for CVD-specific mortality. The burden of obesity was greatest among adults aged 45 to 64 years for all-cause and CVD-specific mortality and among women for all-cause mortality. CONCLUSIONS These findings highlight the impact of the obesity epidemic on mortality risk and premature deaths among US adults.

A Comparison of the Nutritional Quality of Food Products Advertised in Grocery Store Circulars of High- versus Low-Income New York City Zip Codes

Grocery stores can be an important resource for health and nutrition with the variety and economic value of foods offered. Weekly circulars are a means of promoting foods at a sale price. To date, little is known about the extent that nutritious foods are advertised and prominently placed in circulars. This study’s aim was to compare the nutritional quality of products advertised on the front page of online circulars from grocery stores in high- versus low-income neighborhoods in New York City (NYC). Circulars from grocery stores in the five highest and five lowest median household income NYC zip codes were analyzed. Nutrition information for food products was collected over a two-month period with a total of 805 products coded. The study found no significant difference between the nutritional quality of products advertised on the front page of online circulars from grocery stores in high- versus low-income neighborhoods in New York City (NYC). In both groups, almost two-thirds of the products advertised were processed, one-quarter were high in carbohydrates, and few to no products were low-sodium, high-fiber, or reduced-, low- or zero fat. Through innovative partnerships with health professionals, grocery stores are increasingly implementing in-store and online health promotion strategies. Weekly circulars can be used as a means to regularly advertise and prominently place more healthful and seasonal foods at an affordable price, particularly for populations at higher risk for nutrition-related chronic disease.

Food Advertisements in Two Popular U.S. Parenting Magazines: Results of a Five-Year Analysis

Obesity rates among American youth have prompted an examination of food advertisements geared towards children. Research indicates children’s high exposure to these advertisements and their influence on food preferences. Less is known about the presence of these advertisements in parenting magazines. This study’s objective was to examine prevalence of food advertisements in popular parenting magazines and identify products by USDA food category. We analyzed 116 issues of two popular U.S. parenting magazines across five years. All food and beverage advertisements for USDA Food Category were coded. Breakfast cereals were coded for nutritional quality. The coding took place at varied libraries in New Jersey, in the United States. A total of 19,879 food and beverage products were analyzed. One-third of advertisements (32.5%) were for baked goods, snacks, and sweets -- products generally low in nutrient density. Two-thirds of the breakfast cereals were low in nutritional quality (64.6%). Beverages comprised 11% of the advertisements, fruit juices the highest proportion. Less than 3% of advertisements were for fruits and vegetables combined. No significant food product trends were evident across the five-year period. Food advertisements identified in parenting magazines were generally low in nutritional value. Additional research is necessary to determine the influence of food advertisements on parents’ purchasing habits.

A review of college-level health textbooks for coverage of type 2 diabetes, prediabetes, and metabolic syndrome

Objective: Type 2 diabetes, prediabetes, and metabolic syndrome are increasingly relevant health problems for United States (US) college-aged students and their family members. This study’s aim was to determine the extent to which these chronic conditions were covered in leading college-level personal health textbooks and to what degree the books emphasized the preventive steps students can take to promote their health and minimize development or worsening of these conditions. Design: A convenience sample of 10 leading college-level personal health textbooks was used in this cross-sectional study. Setting: Textbooks selected for analysis are frequently used in introductory personal health courses on college campuses across the US. Method: Textbooks were coded for level of coverage for select criteria that included risk factors, definitions, prevalence among college-aged youth, African Americans, and Hispanics, serious consequences associated with unmanaged type 2 diabetes, presence of self-assessment tool, prediabetes’ and metabolic syndrome’s association with type 2 diabetes, prevention strategies, student portrayals, and messages geared towards students living with these conditions. Results: Exemplary coverage of information related to diabetes, prediabetes, and metabolic syndrome was uncommon for the following criteria: prevalence among African Americans and Hispanics, depiction of a student with diabetes or prediabetes, prevalence of messages geared toward readers with these conditions, and in-depth discussion of prevention strategies. Conclusion: More thorough coverage in personal health textbooks is necessary given the rising prevalence of these health problems in young adults, the positive impact of healthy lifestyle choices, and the formal opportunity for learning presented through college personal health courses.

A Comparative Study of the Sodium Content and Calories from Sugar in Toddler Foods Sold in Low- and High-Income New York City Supermarkets

Information from the nutrition facts labels of toddler foods marketed in low- and high-income New York City zip codes were analyzed for sodium content, the proportion of sugar-derived calories, and presence of sugar and/or high-fructose corn syrup as an added sweetener in the list of ingredients. Among the 272 toddler foods analyzed, more than a quarter were high in sodium, over one-third derived at least 20% their calories from sugar, and more than 41% of the foods had sugar and/or high-fructose corn syrup listed among the first five ingredients. The proportion of foods with such nutritional characteristics did not significantly differ between the low- and high-income neighborhood supermarkets. Median sodium content was highest among “side dishes” and “meals.” The proportion of calories derived from sugar was found to be highest among “snacks and yogurt blends” in both low- and high-income neighborhoods and “breakfast foods and cereals” in low-income neighborhoods. When compared to high-income neighborhoods, more than three times the proportion of total calories in “breakfast foods and cereals” sold in low-income neighborhoods were derived from sugar. Since taste preferences established during childhood can have long-lasting influence on dietary habits, it is imperative to limit the promotion of toddler foods that are high in sodium and sugar as well as educate parents to make nutritionally sound decisions at the point of purchase.

Disparate Advertising of Sugary Drinks: An Analysis of Beverages Promoted in Circulars from Grocery Stores in High- and Low-Income New York City Zip Codes

Background: The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of chronic disease including obesity, type 2 diabetes, and coronary heart disease. A correlation between low socioeconomics (SES) status and higher SSB intake has also been established. Objective: The objective of this study was to analyze the calorie content and added sugar in beverages advertised in circulars of grocery stores in high- and low-income New York City zip codes. Methods: Across a two-month period, we analyzed various nutritional characteristics of beverage products advertised on the front page of online circulars from grocery stores in 5 low- and 5 high-income New York City zip codes. Results: Three-fourths of beverage products for sale in circulars from low-income zip codes were sugar-sweetened (74.4%) as compared with just over one-third advertised in those from high-income zip codes (35.7%). Conclusion: High-calorie, sugary beverages are being marketed and priced to sell by grocery stores serving low SES populations with high SSB consumption patterns. Health education and promotion efforts that grocery stores can implement to contribute to chronic disease prevention are discussed.

Obesity, diabetes and heart disease: effects of globalization on population health, preventive efforts, and the importance of social change

Globalization has had an impact on many systems that affect daily living. Internationally, food systems have undergone substantial changes including increased availability and affordability of processed foods and an unprecedented inundation of the food supply with low-cost caloric sweeteners and more efficient production of fatty oils. These changes in the food supply have had an impact on the nutritional status of many by contributing to a paradoxical increase in obesity in countries with historically high rates of malnutrition. This higher global prevalence of obesity has been implicated in the increase in leading causes of death, namely diabetes and cardiovascular disease (CVD). This paper includes an introductory section highlighting the notable effects of globalization on our food systems followed by a more in-depth discussion of obesity, diabetes, and CVD, and its related conditions considered as significant health consequences of these changes. To address the pervasive nature of these problems, several international health promotion initiatives are discussed and organized using the five action means outlined in the World Health Organizations Ottowa Charter for Health Promotion (WHO, 2013). We conclude by highlighting the important contribution health educators can make toward improving health status in their communities by moving beyond the traditional approach of individual behavior change and becoming more proactive initiators of social change. Strategies for carrying out this charge include the assessment of social and environmental health determinants on the population level in concert with mobilizing and engaging community stakeholders through culturally appropriate interventions.