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Concept: Healthy diet

209

Confronting the Social Determinants of Health After failed intervention efforts, a physician files a Child Protective Services report alleging the medical neglect of two girls with morbid obesity, serious coexisting conditions, and medical nonadherence. But CPS agencies can do little to alter the milieu shaping behavior.

Concepts: Medicine, Nutrition, Obesity, Physician, Illness, Weight loss, Population health, Healthy diet

185

Christopher Millett and colleagues argue that artificially sweetened beverages should not be promoted as part of a healthy diet.

Concepts: Health, Nutrition, Obesity, Weight loss, Healthy diet

175

Awareness of federal nutrition programs and use of the nutrition facts label are associated with reduced risk for obesity and increased intake of fruits and vegetables. Relationships between nutrition programs, use of food labels and risk for overweight and obesity have rarely been evaluated in adolescents.

Concepts: Health, Nutrition, Obesity, Malnutrition, Vegetable, Dieting, Healthy diet, Cooking

173

BACKGROUND: Less healthy diets are common in high income countries, although proportionally higher in those of low socio-economic status. Food subsidy programs are one strategy to promote healthy nutrition and to reduce socio-economic inequalities in health. This review summarises the evidence for the health and nutritional impacts of food subsidy programs among disadvantaged families from high income countries. METHODS: Relevant studies reporting dietary intake or health outcomes were identified through systematic searching of electronic databases. Cochrane Public Health Group guidelines informed study selection and interpretation. A narrative synthesis was undertaken due to the limited number of studies and heterogeneity of study design and outcomes. RESULTS: Fourteen studies were included, with most reporting on the Special Supplemental Nutrition Program for Women, Infants and Children in the USA. Food subsidy program participants, mostly pregnant or postnatal women, were shown to have 10–20% increased intake of targeted foods or nutrients. Evidence for the effectiveness of these programs for men or children was lacking. The main health outcome observed was a small but clinically relevant increase in mean birthweight (23–29g) in the two higher quality WIC studies. CONCLUSIONS: Limited high quality evidence of the impacts of food subsidy programs on the health and nutrition of adults and children in high income countries was identified. The improved intake of targeted nutrients and foods, such as fruit and vegetables, could potentially reduce the rate of non-communicable diseases in adults, if the changes in diet are sustained. Associated improvements in perinatal outcomes were limited and most evident in women who smoked during pregnancy. Thus, food subsidy programs for pregnant women and children should aim to focus on improving nutritional status in the longer term. Further prospective studies and economic analyses are needed to confirm the health benefits and justify the investment in food subsidy programs.

Concepts: Health care, Pregnancy, Childbirth, Health, Nutrition, Food, Malnutrition, Healthy diet

126

BACKGROUND: Consumption of 100% orange juice (OJ) has been positively associated with nutrient adequacy and diet quality, with no increased risk of overweight/obesity in children; however, no one has examined these factors in adults. The purpose of this study was to examine the association of 100% OJ consumption with nutrient adequacy, diet quality, and risk factors for metabolic syndrome (MetS) in a nationally representative sample of adults. METHODS: Data from adults 19+ years of age (n = 8,861) participating in the National Health and Nutrition Examination Survey 2003-2006 were used. The National Cancer Institute method was used to estimate the usual intake (UI) of 100% OJ consumption, selected nutrients, and food groups. Percentages of the population below the Estimated Average Requirement (EAR) or above the Adequate Intake (AI) were determined. Diet quality was measured by the Healthy Eating Index-2005 (HEI-2005). Covariate adjusted logistic regression was used to determine if consumers had a lower odds ratio of being overweight or obese or having risk factors of MetS or MetS. RESULTS: Usual per capita intake of 100% OJ was 50.3 ml/d. Among consumers (n = 2,310; 23.8%), UI was 210.0 ml/d. Compared to non-consumers, consumers had a higher (p < 0.05) percentage (% +/- SE) of the population meeting the EAR for vitamin A (39.7 +/- 2.5 vs 54.0 +/- 1.2), vitamin C (0.0 +/- 0.0 vs 59.0 +/- 1.4), folate (5.8 +/- 0.7 vs 15.1 +/- 0.9), and magnesium (51.6 +/- 1.6 vs 63.7 +/- 1.2). Consumers were also more likely to be above the AI for potassium (4.1 +/- 0.8 vs 1.8 +/- 0.2). HEI-2005 was significantly (p < 0.05) higher in consumers (55.0 +/- 0.4 vs 49.7 +/- 0.3). Consumers also had higher intakes of total fruit, fruit juice, whole fruit, and whole grain. Consumers had a lower (p < 0.05) mean body mass index (27.6 +/- 0.2 vs 28.5 +/- 0.1), total cholesterol levels (197.6 +/- 1.2 vs 200.8 +/- 0.75 mg/dL), and low density lipoprotein-cholesterol levels (112.5 +/- 1.4 vs 116.7 +/- 0.93 mg/dL). Finally, compared to non-consumers of 100% OJ, consumers were 21% less likely to be obese and male consumers were 36% less likely to have MetS. CONCLUSION: The results suggest that moderate consumption of 100% OJ should be encouraged to help individuals meet the USDA daily recommendation for fruit intake and as a component of a healthy diet.

Concepts: Cholesterol, Health, Nutrition, Obesity, Nutrient, Vitamin, Essential nutrient, Healthy diet

83

The United States (US) Equal Employment Opportunity Commission has proposed rules allowing employers to penalize employees up to 30% of health insurance costs if they fail to meet ‘health’ criteria such as reaching a specified Body Mass Index (BMI). Our objective was to examine cardiometabolic health misclassifications given standard BMI categories. Participants (N=40 420) were individuals aged 18+ in the nationally representative 2005-2012 National Health and Nutrition Examination Survey (NHANES). Using blood pressure, triglyceride, cholesterol, glucose, insulin resistance, and C-reactive protein data, population frequencies/percentages of metabolically healthy versus unhealthy individuals were stratified by BMI. Nearly half of overweight individuals, 29% of obese individuals, and even 16% of obesity type II/III individuals were metabolically healthy. Moreover, over 30% of normal weight individuals were cardiometabolically unhealthy. There was no significant race x BMI interaction, but there was a significant gender x BMI interaction, F(4,64)=3.812, P=0.008. Using BMI categories as the main indicator of health, an estimated 74 936 678 US adults are misclassified as cardiometabolically unhealthy or cardiometabolically healthy. Policymakers should consider the unintended consequences of relying solely on BMI, and researchers should seek to improve diagnostic tools related to weight and cardiometabolic health.International Journal of Obesity accepted article preview online, 04 February 2016. doi:10.1038/ijo.2016.17.

Concepts: Health care, Nutrition, Insulin, Obesity, Body mass index, Healthy diet, Body shape, Equal Employment Opportunity Commission

53

Recent progresses in data-driven analysis methods, including network-based approaches, are revolutionizing many classical disciplines. These techniques can also be applied to food and nutrition, which must be studied to design healthy diets. Using nutritional information from over 1,000 raw foods, we systematically evaluated the nutrient composition of each food in regards to satisfying daily nutritional requirements. The nutrient balance of a food was quantified and termed nutritional fitness; this measure was based on the food’s frequency of occurrence in nutritionally adequate food combinations. Nutritional fitness offers a way to prioritize recommendable foods within a global network of foods, in which foods are connected based on the similarities of their nutrient compositions. We identified a number of key nutrients, such as choline and α-linolenic acid, whose levels in foods can critically affect the nutritional fitness of the foods. Analogously, pairs of nutrients can have the same effect. In fact, two nutrients can synergistically affect the nutritional fitness, although the individual nutrients alone may not have an impact. This result, involving the tendency among nutrients to exhibit correlations in their abundances across foods, implies a hidden layer of complexity when exploring for foods whose balance of nutrients within pairs holistically helps meet nutritional requirements. Interestingly, foods with high nutritional fitness successfully maintain this nutrient balance. This effect expands our scope to a diverse repertoire of nutrient-nutrient correlations, which are integrated under a common network framework that yields unexpected yet coherent associations between nutrients. Our nutrient-profiling approach combined with a network-based analysis provides a more unbiased, global view of the relationships between foods and nutrients, and can be extended towards nutritional policies, food marketing, and personalized nutrition.

Concepts: Nutrition, Vitamin, Essential nutrient, Healthy diet, Cooking

53

Protein is an essential component of a healthy diet and is a focus of research programs seeking to optimize health at all stages of life. The focus on protein as a nutrient often centers on its thermogenic and satiating effect, and when included as part of a healthy diet, its potential to preserve lean body mass. A growing body of literature, including stable isotope based studies and longer term dietary interventions, suggests that current dietary protein recommendations may not be sufficient to promote optimal muscle health in all populations. A protein intake moderately higher than current recommendations has been widely endorsed by many experts and working groups and may provide health benefits for aging populations. Further, consuming moderate amounts of high-quality protein at each meal may optimally stimulate 24-h muscle protein synthesis and may provide a dietary platform that favors the maintenance of muscle mass and function while promoting successful weight management in overweight and obese individuals. Dietary protein has the potential to serve as a key nutrient for many health outcomes and benefits might be increased when combined with adequate physical activity. Future studies should focus on confirming these health benefits from dietary protein with long-term randomized controlled studies.

Concepts: Health, Metabolism, Nutrition, Energy, Obesity, Physical exercise, Adipose tissue, Healthy diet

38

Disease risk is lower in metabolically healthy obese adults than in their unhealthy obese counterparts. Studies considering physical activity as a modifiable determinant of healthy obesity have relied on self-reported measures, which are prone to inaccuracies and do not capture all movements that contribute to health.

Concepts: Health care, Medicine, Health, Epidemiology, Nutrition, Obesity, Weight loss, Healthy diet

31

Little is known about health variables and if these variables could increase the risk of injuries among adolescent elite athletes. The primary aim was to present overall data on self-perceived stress, nutrition intake, self-esteem, and sleep, as well as gender and age differences, on two occasions among adolescent elite athletes. A secondary aim was to study these health variables as potential risk factors on injury incidence. A questionnaire was e-mailed to 340 adolescent elite athletes on two occasions during a single school year: autumn semester and spring semester. The results show that during autumn semester, the recommended intake of fruits, vegetables, and fish was not met for 20%, 39%, and 43% of the adolescent elite athletes, respectively. The recommended amount of sleep during weekdays was not obtained by 19%. Multiple logistic regression showed that athletes sleeping more than 8 h of sleep during weekdays reduced the odds of injury with 61% (OR, 0.39; 95% CI, 0.16-0.99) and athletes reaching the recommended nutrition intake reduced the odds with 64% (OR, 0.36; 95% CI, 0.14-0.91). Our findings suggest that nutrition intake and sleep volume are of importance in understanding injury incidence.

Concepts: Regression analysis, Logistic regression, Health, Epidemiology, Nutrition, High school, Healthy diet, Academic term