Sensory-Related Industrial Additives in the US Packaged Food Supply.

Background: Increasing evidence suggests that ultra-processed foods (UPFs) lead to elevated risk of obesity-related conditions, but UPF measurement has been criticized for its subjectivity and lack of clarity on biological mechanism. Sensory-related industrial additives (SRIAs) are a defining feature of UPFs and may encourage overconsumption by enhancing the sensory quality of foods. However, practical challenges have prevented systematic incorporation of SRIAs into UPF measurement. Objective: The objectives of this work were to describe a new, open-source ingredient list search method and to apply this method to describe the presence of SRIAs in US packaged foods. Methods: We developed computer coding to search for 64 common SRIAs related to sweetness, flavor, appearance, and texture in 241,688 foods in the US Branded Food Products Database (BFPD). The BFPD includes manufacturer-provided ingredient lists for ~300,000 branded and private label food items. We determined the total number of SRIAs (0-64) and the number of different types of SRIAs (sweetness, flavor, appearance, texture, 0-4) in each food, then calculated the percent of all foods with SRIAs. This was done for all foods, and by food group for 224,098 items with food group data. Results: Most (64.9%) foods in the BFPD contained at least one SRIA, and more than a third had at least three. Sweets (89.5%), beverages (84.9%), and ready-to-eat (RTE) foods (82.0%) were the most likely to contain SRIAs. With respect to SRIA types, 25.7% of all food items had at least three of the four types of SRIAs examined, with texture-related additives being the most common. Among sweets, 20% had all four types of SRIAs. Discussion: This work confirms the high prevalence of SRIAs in US packaged foods. They are ubiquitous in sweets, beverages, and RTE foods, but also present in substantial proportions of other food groups. Quantifying the presence of SRIAs in ingredient lists offers a novel way to identify UPFs for research; to distinguish more vs. less ultra-processed foods; and to test whether UPFs increase risk for obesity-related conditions through additives that enhance the product's sensory qualities.

Fruit and Vegetable Purchasing Patterns and Supplemental Nutrition Assistance Program Participation: Findings From a Nationally Representative Survey.

BACKGROUND: Previous studies suggest that Supplemental Nutrition Assistance Program (SNAP) participants purchase less produce than nonparticipants. Whether this is due to buying smaller amounts or to being less likely to buy any produce is unclear. Purchase patterns may also differ over the monthly distribution cycle. OBJECTIVE: To examine differences in the likelihood and amounts of fruits and vegetables purchased between SNAP household compared with nonparticipant households and to determine differences in produce purchases among SNAP households at different time points in the monthly distribution cycle. DESIGN: Cross-sectional. PARTICIPANTS/SETTING: Data from 4708 households in the National Household Food Acquisition and Purchase Survey (April 2012 to January 2013). Participants recorded all foods acquired over 7 days. MAIN OUTCOME MEASURES: Fruits and vegetables acquired over a 7-day period. STATISTICAL ANALYSES PERFORMED: Weighted logistic and linear regression models adjusting for household and primary respondent characteristics were used to compare odds of purchasing fruits and vegetables and amounts purchased across 3 categories: SNAP participants, SNAP-eligible nonparticipants, and ineligible nonparticipants. SNAP participants were further subdivided according to weeks since last receiving benefits. RESULTS: In adjusted analyses, SNAP participants and nonparticipants were similarly likely to purchase fruits and vegetables. However, SNAP households within a week of receiving benefits were more likely than SNAP households later in the benefit cycle to buy fruit overall, especially frozen or canned fruit, and vegetables overall, including fresh, frozen or canned, starchy, and nonstarchy vegetables (fruit odds ratio [OR] 1.68, 95% confidence interval [CI] 1.12, 2.53; vegetable OR 1.63, 95% CI 1.04, 2.55 vs households in middle of cycle). In contrast, those in the last week of the benefit cycle were less likely to purchase fruit, especially fresh fruit, and vegetables, especially fresh and nonstarchy vegetables (fruit OR 0.58, 95% CI 0.35, 0.94; vegetable OR 0.58, 95% CI 0.42, 0.79 vs. households in middle of cycle), and when they bought vegetables, they bought significantly less. CONCLUSION: Considering all SNAP households together at different points in their distribution cycle masks substantial declines in purchasing fruits and vegetables over the monthly cycle.

A Nutrition Education Intervention Using NOVA Is More Effective Than MyPlate Alone: A Proof-of-Concept Randomized Controlled Trial.

The ability to classify foods based on level of processing, not only conventional MyPlate food groups, might be a useful tool for consumers faced with a wide array of highly processed food products of varying nutritional value. The objective of this study was to assess the impact of a proof-of-concept nutrition education intervention on nutrition knowledge, assessed by correct classification of foods according to MyPlate food groups, MyPlate 'limit' status (for fat, sugar, sodium), and level of processing (NOVA categories). We utilized a randomized, controlled design to examine the impact of a MyPlate vs. combined MyPlate + NOVA intervention vs. control group. Intervention groups received educational flyers via email and participants were assessed using electronic baseline and follow-up surveys. The MyPlate + NOVA intervention group performed at least as well as the MyPlate group on classifying conventional food groups and 'limit' status. Moreover, the MyPlate + NOVA group far outperformed the other groups on classifying NOVA categories. Longer-term trials are needed, but our results suggest that NOVA principles may be more easily understood and applied than those of MyPlate. Education strategies focusing on level of food processing may be effective in the context of the modern food environment.

Pathways from Food Insecurity to Health Outcomes among California University Students.

The prevalence of food insecurity (FI) among college students is alarmingly high, yet the impact on student health has not been well investigated. The aim of the current study was to examine the simultaneous relationships between food insecurity and health-related outcomes including body mass index (BMI) and overall health in a college student population. Randomly sampled students in the University of California 10 campus system were invited to participate in an online survey in spring 2015. The analytic sample size was 8705 graduate and undergraduate students. Data were collected on FI in the past year, daily servings of fruits and vegetables (FV), number of days in the past week of enough sleep and moderate- to vigorous-intensity physical activity (MVPA), height and weight, self-rated health, and student characteristics. Using path analysis, mediated pathways between FI, BMI, and poor health were examined through FV intake, number of days of MVPA and enough sleep. Analyses controlled for student characteristics. Mean BMI was 23.6 kg/m2 (SD, 5.0), and average self-rated health was good. FI was directly and indirectly related to higher BMI and poor health through three pathways. First, FI was related to fewer days of enough sleep, which in turn was related to increased BMI and poor health. Second, FI was related to fewer days of MVPA, which in turn was related to increased BMI and poor health. Third, FI was related to fewer daily servings of FV, which in turn was related to poor health. FI is associated with poor health behaviors among college students, which may contribute to higher weight status and poor health. These findings highlight the importance of food security for a healthy college experience.

Alternative MyPlate Menus: Effects of Ultra-Processed Foods on Saturated Fat, Sugar, and Sodium Content.

OBJECTIVE: Compare saturated fat, sugar, and sodium in the US Department of Agriculture sample menu with a version in which menu items were replaced with comparable ultra-processed foods. DESIGN AND SETTING: The authors modified 7 days of a US Department of Agriculture sample menu providing approximately 2,000 kcal/d by replacing foods with comparable ultra-processed alternatives and then visited 2 chain supermarkets in San Luis Obispo, CA (August, 2016) to locate shopping list items for the 2 menu versions. Product-specific bar codes were entered into an application for recording dietary intake and analyzing nutrient content. VARIABLES MEASURED/ANALYSIS: Paired t tests (with Bonferroni correction, α = .003) were performed to compare the menus' percent energy from saturated fat and sugar, and energy and sodium content. RESULTS: Mean energy was lower (1,618 vs 1,892 kcal/d; P = .002) whereas percent energy from sugar (24.9% vs 21.4%; P ≤ .001) and sodium content (2,784 vs 2,101 mg/d; P = .001) were higher in the ultra-processed vs original menu. In secondary analyses, mean cost of the ultra-processed version exceeded that of the original menu by $36.87. CONCLUSIONS AND IMPLICATIONS: In a sample menu developed to meet US Dietary Guidelines, substituting items with ultra-processed foods provided fewer calories but more sugar and sodium. Distinguishing ultra-processed from less processed foods may help consumers make healthier choices when using MyPlate tools, particularly in a food environment that presents a wide range of alternatives.

Reduction in bacterial contamination of hospital textiles by a novel silver-based laundry treatment.

Treating hospital patient textiles with ionic silver after each washing results in a significant decrease in microbial contamination. Although further study is needed to better understand the role textiles play in hospital-acquired infections and to quantify the influence of silver textile treatment on health care-associated infection risk and patient outcomes, ionic silver treatment of textiles may prove useful in hospital-acquired infection reduction strategies.

Seasonality of infant feeding practices in three Brazilian birth cohorts.

BACKGROUND: We assessed the influence of season of birth on duration of breastfeeding and other feeding patterns in three population-based birth cohort studies in the city of Pelotas, Southern Brazil. METHODS: In 1982, 1993 and 2004, all hospital-born children in the city were enrolled in three cohort studies (n = 5914, 5249 and 4287, respectively). Children and their mothers were periodically visited in the first 2 years of life, to collect information on the duration of breastfeeding and the ages at which different types of foods were introduced on a regular basis. Two independent variables were studied: month of birth and mean environmental temperature in the first month of life. Survival analyses and chi-squared tests were used to evaluate the associations. Temperature-based slope indices of inequality were also calculated. RESULTS: Duration of breastfeeding was lower among children born from April to June (months preceding winter) and spending their first month of life in colder temperatures. The influence of season of birth on breastfeeding patterns and the introduction of cow's milk differed according to maternal education, with the strongest effects among children belonging to less educated mothers. Early introduction of fruits (1982 and 1993 cohorts) and vegetables (1982 cohort) were also associated with lower environmental temperature in the first month of life, but not with trimester of birth. CONCLUSION: Colder temperatures adversely affect duration of breastfeeding and feeding patterns in infancy, especially among the poorest. This finding should be considered in breastfeeding promotion programmes.

Maternal smoking during pregnancy and risk factors for cardiovascular disease in adulthood.

OBJECTIVE: This study was aimed at assessing the effect of maternal smoking during pregnancy on metabolic cardiovascular risk factors in early adulthood in a Brazilian birth cohort, after controlling for possible confounding variables and health behaviors in early adulthood. METHODS: In 1982, the maternity hospitals in Pelotas, southern Brazil, were visited and all births were identified. Those livebirths whose family lived in the urban area of the city were studied prospectively. In 2004-2005, we attempted to follow the whole cohort, the subjects were interviewed, examined and blood sample was collected. The following outcomes were studied: blood pressure; HDL cholesterol; triglycerides; random blood glucose and C-reactive protein. To explore the effect of maternal smoking, we adjusted the coefficients for the following possible mediators: perinatal factors (low birthweight and preterm births); adult behavioral factors (physical activity, dietary pattern, intake of fat and fiber, and tobacco smoking) and adult anthropometry (body mass index and waist circumference). RESULTS: In 2004-2005, we interviewed 4297 subjects, with a follow-up rate of 77.4%. The only significant finding in the unadjusted analyses was lower HDL cholesterol among females. After adjustment for lifestyle variables in early adulthood, birthweight and waist circumference, the difference in HDL levels between offspring of smokers and non-smokers reduced from -2.10mg/dL (95% confidence interval: -3.39; -0.80) to -1.03 mg/dL (-2.35; 0.30). CONCLUSION: Evidence that maternal smoking during pregnancy programs offspring metabolic cardiovascular risk factors are scarce, and reported associations are likely due to postnatal exposure to lifestyle patterns.

The influence of persistent pathogens on circulating levels of inflammatory markers: a cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis.

BACKGROUND: Systemic inflammation is linked to cardiovascular risk, but the influence of persistent pathogens, which are conventionally dichotomously categorized, on circulating levels of inflammatory markers is not clear. Antibody levels of pathogens have not been examined in relation to inflammation. METHODS: Using data from a subsample of the Multi-Ethnic Study of Atherosclerosis, we examined circulating levels of interleukin-6 (IL-6), C-reactive protein (CRP) and fibrinogen in relation to five common persistent pathogens: cytomegalovirus, herpes simplex virus-1, Hepatitis A virus, Helicobacter pylori and Chlamydia pneumoniae. We tested the hypothesis that the number of seropositive pathogens (based on conventional cut-off points) would not be as sensitive a marker of inflammation as immune response measured by antibody levels to pathogens. RESULTS: High antibody response to multiple pathogens showed graded and significant associations with IL-6 (p < 0.001), CRP (p = 0.04) and fibrinogen (p = 0.001), whereas seropositive pathogen burden did not. In multiple linear regression models, high antibody response to multiple pathogens maintained a positive association only with IL-6 (4.4% per pathogen exhibiting high antibody response, 95% CI 0.0-8.9). CONCLUSIONS: High antibody response to pathogens was a more consistent marker of inflammatory outcomes compared to seropositivity alone and high antibody response to multiple pathogens was a stronger marker compared to any single pathogen.

Cross-sectional and longitudinal associations of neighborhood characteristics with inflammatory markers: findings from the multi-ethnic study of atherosclerosis.

We investigated cross-sectional associations of neighborhood deprivation, problems, safety, and cohesion with circulating levels of fibrinogen, interleukin-6, and C-reactive protein (n = 5370) and longitudinal associations with changes in IL-6 over a 3-4 year period (n = 946). In cross-sectional analyses, higher levels of neighborhood deprivation and problems were associated with higher levels of all three inflammatory markers, whereas higher levels of safety were associated with lower levels. Fibrinogen remained associated with all neighborhood characteristics except cohesion and IL-6 remained associated with safety after adjustment for race and SES. In longitudinal analyses, higher levels of neighborhood deprivation and problems, and lower levels of safety were associated with greater longitudinal increases in IL-6 after adjustment for age, sex, race, and SES. These findings were not substantially modified by further risk factor adjustment. Although findings regarding different inflammatory markers were mixed, the longitudinal results that are less limited by race confounding suggest that inflammatory pathways may contribute to neighborhood differences in cardiovascular disease risk.

Lifecourse socioeconomic trajectories and C-reactive protein levels in young adults: findings from a Brazilian birth cohort.

Socioeconomic factors are associated with cardiovascular disease. C-reactive protein (CRP) is increasingly implicated as a candidate linking conventional risk factors and atherosclerosis. The impact of early- and later-life socioeconomic status (SES) on CRP levels has not been widely investigated and a handful of studies from high-income countries are inconsistent. We set out to examine the associations between lifecourse socioeconomic indicators (family income at birth, maternal education, family income at age 23 and own education) on CRP levels in young adults belonging to the 1982 Pelotas (Brazil) Birth Cohort Study (n=5914). Early-life SES showed significant and graded associations with CRP levels at age 23 independently of later SES. For example, men with higher family income at birth showed higher CRP levels at age 23 (p=0.001 for trend) and women with less educated mothers showed higher CRP levels (p=0.01 for trend). Notably, differential directions of association between SES indicators and CRP levels between men and women were found. When adjusted for SES at age 23, men with the lowest family income at birth showed 42% lower CRP levels when compared to men in the highest family income group (-42; 95% CI: -60,-16). In contrast women born to the least educated mothers had the highest CRP levels (35; 95% CI -2, 86). In both sexes, adiposity accounted for the overwhelming majority of the associations between SES and CRP levels. Sex and gender roles specific to middle-income countries, socio-cultural and environmental conditions that may impact adiposity, and the level of epidemiological transition may be key factors that are linked to the associations between lifecourse SES and CRP levels. Public health strategies aimed at decreasing the burden of cardiovascular disease in middle-income settings, in addition to highlighting the risks associated with adult obesity, should not overlook the wide-ranging impacts of lifecourse social determinants.

Childhood poverty and abdominal obesity in adulthood: a systematic review.

Adverse socioeconomic conditions in childhood can have lasting effects on health, but evidence is lacking from prospective studies concerning the effects of early poverty on abdominal obesity in adulthood. Cross-sectional studies in adults from middle and high-income countries show that current socioeconomic status is inversely related to obesity in women, but the pattern in men is not consistent. A systematic review was undertaken to assess the influence of early socioeconomic status on waist circumference, hip circumference, and waist-hip ratio in adulthood. Thirteen relevant articles were located (five cross-sectional and eight cohort), including only one from a middle-income country and the remainder from high-income settings. In all the studies, childhood poverty was associated with higher levels of abdominal obesity in women. In men, the associations were weaker, and no clear pattern emerged.

Life-course socio-economic factors, skin colour and abdominal obesity in adulthood in a Brazilian birth cohort.

OBJECTIVE: Obesity is an increasingly prevalent nutritional disorder throughout the world. In particular, abdominal obesity is associated with cardiovascular and metabolic risk. The present study aimed to evaluate the effects of skin colour and life-course socio-economic indicators on waist circumference (WC), hip circumference (HC) and waist:hip ratio (WHR) in young adults. DESIGN: Population-based birth cohort study. Individuals born in 1982 in Pelotas (southern Brazil) were visited on a number of occasions from birth to age 23-24 years. A sample of the cohort was sought in 2006 and 972 individuals were located. The analysis was restricted to individuals with complete data available (442 males, 414 females). RESULTS: In men, family income at birth and in 2004-5 were positively associated with WC and HC, but not with WHR. Regardless of current income, men born to wealthier families had larger WC and HC as adults. Skin colour was not associated with any of the outcomes. In women, early poverty was associated with smaller HC, and current poverty with larger WC. Poverty at any age thus led to higher WHR. Black women had larger WC and HC than white women, but there were no differences in WHR. All the associations were partially mediated by education and behavioural variables. CONCLUSIONS: The effects of early socio-economic position on WC and HC persist even after adjustment for adult socio-economic position, highlighting the importance of interventions during the first years of life.

Life course weight gain and C-reactive protein levels in young adults: findings from a Brazilian birth cohort.

Rapid weight gain in childhood is associated with increased risk of chronic diseases in adults. C-reactive protein (CRP) is a mediator of atherosclerosis and chronically elevated levels predict cardiovascular outcomes. The effects of life course weight gain on CRP levels are not clear. The 1982 Pelotas (Brazil) birth cohort study (n = 5,914) has prospectively collected weight and health data at several follow-ups since birth. The most recent was in 2004-05, when 77.4% of the cohort was traced and CRP levels were measured in 89% of those interviewed (n = 3827). Geometric mean (SE) C-reactive protein levels were 0.89 mg/l (0.03) and 1.66 mg/l (0.04) in men and women, respectively. In analyses adjusted for confounding variables, weight gain in infancy showed a weak negative association among males, but from the second year onwards, weight gain was positively associated with CRP levels. In females, weight gain was associated with higher CRP at every period tested. The strongest associations were observed in the most recent (18-23 years) period; CRP ratios (95% CI) per z score increase in weight gain were 1.78 (1.57-2.00) and 1.52 (1.30-1.78) for men and women, respectively. Males who were stunted at 2 years and centrally obese at 23 years had the highest CRP levels (P = 0.002 for interaction). In summary, rapid weight gain throughout life predicted higher CRP levels. Public health efforts need to tackle chronic under-nutrition in infancy, together with rapid weight gain in later childhood and adolescence, especially in countries undergoing the nutritional transition.

Childhood poverty and abdominal obesity in adulthood: a systematic review / Pobreza na infância e obesidade abdominal na vida adulta: revisão sistemática

Adverse socioeconomic conditions in childhood can have lasting effects on health, but evidence is lacking from prospective studies concerning the effects of early poverty on abdominal obesity in adulthood. Cross-sectional studies in adults from middle and high-income countries show that current socioeconomic status is inversely related to obesity in women, but the pattern in men is not consistent. A systematic review was undertaken to assess the influence of early socioeconomic status on waist circumference, hip circumference, and waist-hip ratio in adulthood. Thirteen relevant articles were located (five cross-sectional and eight cohort), including only one from a middle-income country and the remainder from high-income settings. In all the studies, childhood poverty was associated with higher levels of abdominal obesity in women. In men, the associations were weaker, and no clear pattern emerged.

Condições sócio-econômicas adversas na infância podem exercer efeitos duradouros sobre a saúde de adultos, mas são poucos os estudos longitudinais que avaliaram os efeitos sobre a obesidade abdominal. Estudos transversais em adultos de países de renda média e alta mostram uma associação inversa entre obesidade e posição sócio-econômica atual em mulheres, mas para os homens não se observa um padrão consistente. Entre homens e crianças de ambos os sexos não existe um padrão definido. Foi realizada uma revisão sistemática dos estudos que avaliaram a posição sócio-econômica precoce e o seu efeito na circunferência da cintura, a circunferência do quadril e/ou na razão cintura-quadril em adultos. Dos 13 trabalhos incluídos (cinco transversais e oito coortes), apenas um foi realizado em um país de renda média, sendo os demais provenientes de países de renda alta. Em todos os estudos, a pobreza na infância esteve associada com maiores níveis de obesidade abdominal em mulheres. Em homens, as associações foram de menor magnitude e não houve consistência entre os estudos em termos da direção do efeito da posição sócio-econômica.

Socioeconomic and racial/ethnic differentials of C-reactive protein levels: a systematic review of population-based studies.

BACKGROUND: Socioeconomic and racial/ethnic factors strongly influence cardiovascular disease outcomes and risk factors. C-reactive protein (CRP), a non-specific marker of inflammation, is associated with cardiovascular risk, and knowledge about its distribution in the population may help direct preventive efforts. A systematic review was undertaken to critically assess CRP levels according to socioeconomic and racial/ethnic factors. METHODS: Medline was searched through December 2006 for population-based studies examining CRP levels among adults with respect to indicators of socioeconomic position (SEP) and/or race/ethnicity. Bibliographies from located studies were scanned and 26 experts in the field were contacted for unpublished work. RESULTS: Thirty-two relevant articles were located. Cross-sectional (n = 20) and cohort studies (n = 11) were included, as was the control group of one trial. CRP levels were examined with respect to SEP and race/ethnicity in 25 and 15 analyses, respectively. Of 20 studies that were unadjusted or adjusted for demographic variables, 19 found inverse associations between CRP levels and SEP. Of 15 similar studies, 14 found differences between racial/ethnic groups such that whites had the lowest while blacks, Hispanics and South Asians had the highest CRP levels. Most studies also included adjustment for potential mediating variables in the causal chain between SEP or race/ethnicity and CRP. Most of these studies showed attenuated but still significant associations. CONCLUSION: Increasing poverty and non-white race was associated with elevated CRP levels among adults. Most analyses in the literature are underestimating the true effects of racial/ethnic and socioeconomic factors due to adjustment for mediating factors.