Coffee Consumption among Adults in the United States by Demographic Variables and Purchase Location: Analyses of NHANES 2011-2016 Data.

Coffee, obtained from various sources, is consumed by most United States adults. The present analyses of one and two 24-h dietary recalls for 14,865 persons aged ≥20 years in the 2011-2016 National Health and Nutrition Examination Survey (NHANES 2011-2016) aimed to identify socio-demographic predictors of coffee consumption and to examine whether coffee purchase locations differed by population sub-group. Given the emphasis on food and beverage consumption patterns, the relation between coffee consumption and compliance with the Dietary Guidelines of Americans was also examined. Coffee was consumed by 59% of the sample (n = 8551). Survey-adjusted mean intake among consumers was 544.7 g/day. Percent consumers and mean amounts consumed were highest among adults aged 51-70 years (p < 0.001), higher income groups (p < 0.001), and non-Hispanic Whites (p < 0.001). About 74% of coffee consumers obtained their coffee from stores, 9.8% from fast food restaurants, 4.3% from convenience stores, and 4.2% from someone else. Coffee source locations also varied by age, education, income, and race/ethnicity. Coffee consumers had significantly higher Healthy Eating Index (HEI-2015) and higher Nutrient-Rich Foods (NRF9.3) scores in energy-adjusted models and significantly higher HEI 2015 scores in multivariable models. In multivariable models, coffee consumers had diets with less added sugar (p < 0.001) but slightly more fat (of all types, including monounsaturated (MUFA), polyunsaturated (PUFA), saturated and solid fats), cholesterol, and alcohol. Their diets had more potassium and magnesium (p < 0.001) but less vitamin C (p < 0.001). Mean caffeine consumption was 233 mg/day for consumers and 72.3 mg/day for non-consumers. Coffee consumption patterns in the US vary across socio-demographic groups.

Consumption of low-calorie sweetened beverages and water is associated with lower intake of carbohydrates and sugars and not associated with glycemic response in U.S. non-diabetic adolescents: Results from the 2001-2014 National Health and Nutrition Examination Surveys.

OBJECTIVES: Consumption of no- and low-calorie sweetened beverages (LCSBs) in the United States appears to be on the rise. To our knowledge, the relationships between LCSB consumption and dietary intake and metabolic outcomes in adolescents have not been thoroughly investigated. The aim of this study was to evaluate possible associations between LCSB and water consumption with nutrient intake and prediabetes criteria among adolescents who were free of diabetes. METHODS: This cross-sectional study evaluated possible associations between LCSB consumption and water consumption using a 24-h diet recall from the National Health and Nutrition Examination Survey (NHANES) 2001-2014 in 8868 adolescents 12 to 18 y of age who were free of diabetes. RESULTS: Compared with consuming <1 serving/d, consuming ≥1 serving/d of either LCSB or water was significantly associated with lower consumption of carbohydrates (LCSB: -22 g; water: -15 g), total sugars (LCSB: -29 g; water: -20 g), and added sugars (LCSB: -5.7 tsp eq; water: -6 tsp eq). Neither LCSB nor water intake were associated with any measures of glycemic response. CONCLUSIONS: These findings suggest that consuming ≥1 serving/d of either LCSB or water is not associated with an increased risk for prediabetes. Confirmation of these findings with a larger sample within the context of a randomized clinical trial would further suggest that LCSBs may represent an additional beverage option other than water for adolescents to help moderate overall dietary sugar intake.

Consumption of Low-Calorie Sweetened Beverages Compared to Water Is Associated with Reduced Intake of Carbohydrates and Sugar, with No Adverse Relationships to Glycemic Responses: Results from the 2001-2012 National Health and Nutrition Examination Surveys.

Although the 2015 Dietary Guidelines Advisory Committee concluded that there was moderate evidence that substituting sugar-containing sweeteners with low-calorie sweeteners (LCS) reduces calorie intake and weight, dietary recommendations encourage substituting only water for sugar-sweetened beverages during weight management. This cross-sectional study evaluated the relation of water and no- and low-calorie sweetened beverage (LCSB) intake with nutrient intakes and prediabetes criteria using data from the National Health and Nutrition Examination Survey (NHANES) 2001-2012 in 25,817 adults that were free of diabetes. Although linear trends were observed with both beverages, higher LCSB intake was associated with significantly lower consumption of carbohydrates (-9.1 g/day vs. -1.4 g/day), total sugars (-10.9 g/day vs. -2.2 g/day), and added sugars (-2.0 tsp eq vs. -0.8 tsp eq) than those associated with higher water intake. Higher intake of both beverages was significantly associated with lower insulin levels (p < 0.01); however, higher intake of LCSB was also associated with lower hemoglobin A1c (HbA1c) and lower homeostatic model assessment of insulin resistance (HOMA-IR) (p < 0.01). We observed lower odds ratios for elevated HbA1c (adjusted odds ratio [OR] 0.79, 95% CI 0.64-0.98), HOMA-IR (0.68, 0.53-0.87), and insulin levels (0.63, 0.49-0.80) in LCSB among the higher (2+ servings) intake group compared to the lowest (<1 serving) intake group. Contrary to conventional wisdom, LCSB consumption was associated with equal, if not better, dietary intake and glycemic response than water consumption. Although observational in nature, these results contribute to the growing body of evidence from human studies suggesting that in addition to water, LCSBs can also be sensible choices for reducing sugars and carbohydrate intake, with no adverse associations to measures of glycemic response.

An open-label pilot trial of alpha-lipoic acid for weight loss in patients with schizophrenia without diabetes.

UNLABELLED: A possible mechanism of antipsychotic-induced weight gain is activation of hypothalamic monophosphate-dependent kinase (AMPK) mediated by histamine 1 receptors. Alpha-lipoic acid (ALA), a potent antioxidant, counteracts this effect and may be helpful in reducing weight for patients taking antipsychotics. The objective of this open-label study was to assess the efficacy of ALA (1,200 mg) on twelve non-diabetic schizophrenia patients over ten weeks. Participants lost significant weight during the intervention (-2.2 kg±2.5 kg). ALA was well tolerated and was particularly effective for individuals taking strongly antihistaminic antipsychotics (-2.9 kg±2.6 kg vs. -0.5 kg±1.0 kg). CLINICAL TRIAL REGISTRATION: NCT01355952.

Reliability and practicality of measuring waist circumference to monitor cardiovascular risk among community mental health center patients.

The aim of this study was to evaluate the clinical utility of measuring waist circumference (WC) in obese individuals with severe psychiatric disabilities. Reliability of the measure and researchers' comfort were assessed. Thirty outpatients with a diagnosis of schizophrenia or schizoaffective disorder were recruited from an urban community mental health center and WC was measured using two methods by three different raters. Inter- and intra-rater reliability was calculated. Raters reported on their comfort with obtaining WC. There was good inter-rater reliability and an acceptable rate of error independent of measurement location. Overall, raters were not comfortable with the WC measurement process for multiple reasons and reported difficulty with the measurement process. Our findings suggest that non-medical staff can reliably and validly measure WC within a typical outpatient mental health treatment setting, but discomfort with the procedure and difficulty with the measurement process may interfere with this practice as part of usual care.

Cardiovascular mortality in schizophrenia: defining a critical period for prevention.

OBJECTIVE: Better understanding of the temporal development of cardiovascular risk will permit more targeted prevention of premature cardiovascular mortality in schizophrenia. METHODS: The sample for this analysis was drawn from referrals (between 2006 and '11) to an early psychosis clinic based in a U.S. urban community mental health center. 76 individuals with schizophrenia who were young (mean 22.4 years, SD 4.8), early course (median duration of illness 31 weeks) and with minimal prior antipsychotic exposure (median 2 weeks) were compared to age-, gender-, and race-matched peers drawn from the National Health and Nutrition Survey (2007-'08). Measures of cardiovascular risk at baseline, 6 months, and 1 year are reported. RESULTS: While indistinguishable from peers at entry, patients suffered pervasive adverse trajectories of cardiovascular risk factors over the subsequent year. 16 of 44 initial non-smokers became nicotine dependent and none of 32 entering smokers quit. 17 patients transitioned to overweight (BMI 25-29.9, n = 3) or obese (BMI>30, n = 14) categories, while only 24 of 38 (63%) sustained normal weight over one year. Similar adverse trends in blood pressure, lipids, and fasting glucose led to an increase in prevalence of metabolic syndrome (1.31% to 5.26%). 10-year cardiovascular risk estimates showed a small and significant increase although remaining in the low risk (<10%) category. CONCLUSIONS: The early emergence of obesity and smoking in younger schizophrenia samples provides a rational focus for primary prevention of premature cardiovascular mortality. The first year of treatment constitutes the beginning of a critical period for such preventive efforts.

Prevalence of night eating in obese individuals with schizophrenia and schizoaffective disorder.

The prevalence of Night Eating Syndrome (NES) in the general population is estimated to be 1.5%, however, the rates among individuals with schizophrenia and schizoaffective disorder are not yet established. This study sought to examine the frequency and correlates of NES-related behaviors in a sample of obese patients with schizophrenia. One-hundred outpatients diagnosed with schizophrenia or schizoaffective disorders completed the self-report Night Eating Questionnaire (NEQ) and were then interviewed as a follow-up for the specific assessment of NES. Based on a diagnostic interview, 12% of this sample met full criteria for NES, with an additional 10% meeting partial criteria for NES. Based on the NEQ alone, 8% met full criteria with an additional 8% meeting partial criteria. Night eating behaviors were associated with increased insomnia and depression. Our findings suggest that screening for NES among patients with serious mental illness may efficiently identify a subgroup with additional clinical needs.

Obese schizophrenia spectrum patients have significantly higher 10-year general cardiovascular risk and vascular ages than obese individuals without severe mental illness.

BACKGROUND: Individuals with schizophrenia have a life expectancy that is 20 years less than the general population, along with high rates of obesity and cardiovascular disease (CVD) mortality. OBJECTIVE: This study assessed the 10-year general CVD risk and vascular ages of 106 obese schizophrenia spectrum patients and 197 demographically matched obese controls without severe mental illness (SMI) from the National Health and Nutrition Examination Survey (NHANES). METHODS: Vascular age and general CVD risk were calculated using the Framingham global CVD calculator, which incorporates age, sex, total and HDL cholesterol levels, systolic blood pressure, smoking status, and diabetes or hypertension treatment. RESULTS: Obese schizophrenia spectrum patients had a mean vascular age that was 14.1 years older than their mean actual age, whereas obese NHANES participants had only a 6.7-year difference. The probability of experiencing a CVD event within the next 10 years was 10.7% for obese patients and 8.5% for obese NHANES participants. CONCLUSION: These findings suggest that schizophrenia spectrum patients experience increased metabolic risk independent of weight. Primary care clinicians can utilize general CVD risk and vascular age scores to communicate metabolic risk more easily and to help make treatment decisions.

The effect of dietary and physical activity pattern on metabolic profile in individuals with schizophrenia: a cross-sectional study.

OBJECTIVE: With the rate of obesity on the rise worldwide, individuals with schizophrenia represent a particularly vulnerable population. The aim of this study was to assess the metabolic profile of individuals with schizophrenia in relation to dietary and physical activity habits compared with healthy controls. METHODS: Dietary and physical activity habits of 130 individuals with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of schizophrenia or schizoaffective disorder were compared with 250 body mass index-, age-, and sex-matched and racially matched controls from the 2005-2008 National Health and Nutrition Examination Surveys using a 24-hour diet recall and a self-report physical activity questionnaire. RESULTS: Individuals with schizophrenia had significantly higher levels of glycosylated hemoglobin and insulin compared with matched controls. In addition, these individuals had an increased waist circumference and diastolic blood pressure than did the comparison group. Daily energy intake was not different between groups; however, individuals with schizophrenia consumed significantly greater amounts of sugar and fat. Individuals with schizophrenia reported engaging in moderate physical activity less frequently compared with the National Health and Nutrition Examination Surveys group, but there was no difference in reported vigorous physical activity. CONCLUSIONS: These findings suggest that the dietary and physical activity habits of individuals with schizophrenia contribute to an adverse metabolic profile. Increased opportunities for physical activity and access to healthy foods for individuals with schizophrenia may ease the burden of disease.

Contingency management for the treatment of antipsychotic-induced weight gain: a randomized controlled pilot study.

OBJECTIVE: Weight gain is common for individuals with serious mental illness (SMI) receiving antipsychotic drug therapy. Contingency management (CM) is a behavioral intervention that rewards positive performance and has demonstrated effectiveness in reducing drug use in SMI populations. This study evaluated the feasibility of using CM to promote weight loss in individuals with SMI over 8 weeks. METHOD: 30 individuals (BMI ≥ 28 kg/m(2)) were randomized to one of three conditions: i) The combination of a standardized lifestyle modification (LM) program for individuals with SMI and payment for group attendance (CM(attendance)), ii) The combination of LM and payment for weight loss (CM(weight)), and iii) waitlist control (CON). After the waitlist period, those participants joined a LM group and received payment for behavioral change (CM(behavior)). RESULTS: Subjects in the CM(attendance) and in the CM(weight) group lost a mean of 1.16 kg and 1.23 kg, respectively, while subjects in the CON gained a mean of 0.68 kg. Subjects receiving CM(behavior), lost a mean of 2.54 kg, which was a significant weight loss compared to the control period. CONCLUSION: LM supplemented with CM may facilitate weight loss in patients taking antipsychotic medications; financial reimbursement for behavioral change may be particularly effective in this population.

Insomnia is frequent in schizophrenia and associated with night eating and obesity.

BACKGROUND: Sleep difficulties are common in schizophrenia, however these complaints are often overshadowed by more prominent clinical concerns. The point prevalence of insomnia in this population is not well documented. Poor sleep is associated with lower quality of life, impaired cognition, and weight gain. OBJECTIVES: The objectives of this study are to evaluate the prevalence of insomnia in schizophrenia and to explore the relationship of sleep to cognition, quality of life, and clinical variables. METHOD: 175 outpatients with schizophrenia or schizoaffective disorder were assessed for insomnia. Participants were evaluated for sleep difficulties, sleep patterns, body mass index, and psychiatric symptoms. Participants were also administered a brief cognitive assessment of processing speed. RESULTS: 44% of the sample currently met the criteria for clinical insomnia. An additional 4% were successfully treated with medications. Insomnia was associated with depression and was an independent predictor of lower quality of life. Insomnia was also associated with high rates of night eating and patients with severe insomnia were significantly more obese. The type of antipsychotic did not account for the difference in body mass index. No difference between group means in cognition was detected, although those with severe insomnia did perform least well. CONCLUSION: Clinical insomnia in outpatients with schizophrenia is highly prevalent and has a negative impact on quality of life and psychiatric symptoms. This study offers additional support to the association between poor sleep and higher weight, as well as indicating a potential link to night eating in this population. Assessment for sleep difficulties should be a routine part of clinical care.

Cardiovascular risk in a first-episode psychosis sample: a 'critical period' for prevention?

OBJECTIVE: Studies in first episode psychosis samples about status of cardiovascular risk factors have shown discordant results. We aimed to determine the 10-year risk of developing coronary heart disease in a sample of first episode psychosis patients referred to an early intervention clinic and compared the same with age, gender, and race matched controls from the U.S. National Health and Nutrition Examination Survey (NHANES). METHOD: We conducted a cross-sectional analysis of baseline data of 56 subjects enrolled in first episode psychosis clinic from April 2006 to January 2010. This sample was compared with age, gender, and race matched 145 individuals drawn from NHANES 2005-2006 database. Sociodemographic and clinical variables were collected. Physical examination including laboratory evaluation was used to screen for common medical illnesses. The 10-year risk of developing coronary heart disease was calculated by using a tool developed by the National Cholesterol Education Program (NCEP-ATP III). RESULTS: There were elevated rates of smoking (46%) and hypertension (11%) albeit statistically significant differences from the control could not be demonstrated for these measures or weight, body mass index, or total or HDL cholesterol, fasting plasma glucose, status of diabetes and impaired fasting plasma glucose, HbA1C level. The 10-year median (range) risk of developing coronary heart disease in patients and controls was 1 (0-5)% and 0 (0-9)% respectively. The difference was not statistically significant. CONCLUSIONS: First episode psychosis patients do not present with significantly higher cardiovascular risk than age and race-matched controls despite clinically significant prevalence of individual risk factors. This sample presents an opportunity for early intervention for the primary prevention of cardiovascular morbidity and mortality.

Association of prescription H1 antihistamine use with obesity: results from the National Health and Nutrition Examination Survey.

The incidence of obesity in the United States has reached epidemic proportions. Previous research has shown several medications exert noticeable effects on body-weight regulation. Histamine-1 (H1) receptor blockers commonly used to alleviate allergy symptoms are known to report weight gain as a possible side effect. Therefore, we investigated the association between prescription H1 antihistamine use and obesity in adults using data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES). Adults taking prescription H1 antihistamines were matched by age and gender with controls and compared on the basis of body measurements, plasma glucose, insulin concentrations, and lipid levels. Prescription H1 antihistamine users had a significantly higher weight, waist circumference, and insulin concentration than matched controls. The odds ratio (OR) for being overweight was increased in prescription H1 antihistamine users. H1 antihistamine use may contribute to the increased prevalence of obesity and the metabolic syndrome in adults given these medications are also commonly used as over-the-counter remedies.

Low-carbohydrate diet disrupts the association between insulin resistance and weight gain.

The cornerstone to treat metabolic syndrome and insulin resistance is dietary intervention. Both low-carbohydrate diet (LCD) and low-fat diet (LFD) have been reported to induce weight loss and improve these conditions. One of the factors associated with a subject's adherence to the diet is satiety. The aim of this study was to evaluate the effects of LCD and LFD on body weight, appetite hormones, and insulin resistance. Twenty guinea pigs were randomly assigned to LCD or LFD (60%:10%:30% or 20%:55%:25% of energy from fat/carbohydrate/protein, respectively) for 12 weeks. Weight and food intake were recorded every week. After this period, animals were killed and plasma was obtained to measure plasma glucose and insulin, appetite hormones, and ketone bodies. Guinea pigs fed LCD gained more weight than those fed LFD. The daily amount of food intake in grams was not different between groups, suggesting that food density and gastric distension played a role in satiety. There was no difference in leptin levels, which excludes the hypothesis of leptin resistance in the LCD group. However, plasma glucagon-like peptide-1 was 47.1% lower in animals fed LCD (P < .05). Plasma glucose, plasma insulin, and insulin sensitivity were not different between groups. However, the heavier animals that were fed LFD had impairment in insulin sensitivity, which was not observed in those fed LCD. These findings suggest that satiety was dependent on the amount of food ingested. The weight gain in animals fed LCD may be related to their greater caloric intake, lower levels of glucagon-like peptide-1, and higher protein consumption. The adoption of LCD promotes a unique metabolic state that prevents insulin resistance, even in guinea pigs that gained more weight. The association between weight gain and insulin resistance seems to be dependent on high carbohydrate intake.

Eggs modulate the inflammatory response to carbohydrate restricted diets in overweight men.

BACKGROUND: Carbohydrate restricted diets (CRD) consistently lower glucose and insulin levels and improve atherogenic dyslipidemia [decreasing triglycerides and increasing HDL cholesterol (HDL-C)]. We have previously shown that male subjects following a CRD experienced significant increases in HDL-C only if they were consuming a higher intake of cholesterol provided by eggs compared to those individuals who were taking lower concentrations of dietary cholesterol. Here, as a follow up of our previous study, we examined the effects of eggs (a source of both dietary cholesterol and lutein) on adiponectin, a marker of insulin sensitivity, and on inflammatory markers in the context of a CRD. METHODS: Twenty eight overweight men [body mass index (BMI) 26-37 kg/m2] aged 40-70 y consumed an ad libitum CRD (% energy from CHO:fat:protein = 17:57:26) for 12 wk. Subjects were matched by age and BMI and randomly assigned to consume eggs (EGG, n = 15) (640 mg additional cholesterol/day provided by eggs) or placebo (SUB, n = 13) (no additional dietary cholesterol). Fasting blood samples were drawn before and after the intervention to assess plasma lipids, insulin, adiponectin and markers of inflammation including C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8), monocyte chemoattractant protein-1 (MCP-1), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1(VCAM-1). RESULTS: Body weight, percent total body fat and trunk fat were reduced for all subjects after 12 wk (P < 0.0001). Increases in adiponectin were also observed (P < 0.01). Subjects in the EGG group had a 21% increase in this adipokine compared to a 7% increase in the SUB group (P < 0.05). Plasma CRP was significantly decreased only in the EGG group (P < 0.05). MCP-1 levels were decreased for the SUB group (P < 0.001), but unchanged in the EGG group. VCAM-1, ICAM-1, TNF-alpha, and IL-8 were not modified by CRD or eggs. CONCLUSION: A CRD with daily intake of eggs decreased plasma CRP and increased plasma adiponectin compared to a CRD without eggs. These findings indicate that eggs make a significant contribution to the anti-inflammatory effects of CRD, possibly due to the presence of cholesterol, which increases HDL-C and to the antioxidant lutein which modulates certain inflammatory responses.