Association between time-of-day for eating, exercise, and sleep with blood pressure in adults with elevated blood pressure or hypertension: a systematic review.

The purpose of this review is to synthesize results from studies examining the association between time-of-day for eating, exercise, and sleep with blood pressure (BP) in adults with elevated BP or hypertension. Six databases were searched for relevant publications from which 789 were identified. Ten studies met inclusion criteria. Four studies examined time-of-day for eating, five examined time-of-day for exercise, and one examined time-of-day for sleep and their associations with BP. Results suggested that later time-of-day for eating ( n  = 2/4) and later sleep mid-point ( n  = 1/1) were significantly related to higher BP in multivariable models, whereas morning ( n  = 3/5) and evening ( n  = 4/5) exercise were associated with significantly lower BP. Although this small body of work is limited by a lack of prospective, randomized controlled study designs and underutilization of 24 h ambulatory BP assessment, these results provide preliminary, hypothesis-generating support for the independent role of time-of-day for eating, exercise, and sleep with lower BP.

Translating the Recommended Multicomponent Intervention for Childhood Overweight and Obesity into Practice: Implementation Challenges.

A multicomponent, family-based intervention with ≥ 26 contact hours is recommended for the treatment of childhood overweight and obesity. This intervention utilizes behavioral strategies to improve diet, physical activity, and sedentary behaviors. The evidence-based recommendations for this treatment have predominantly come from randomized trials in which the intervention is implemented by research-trained staff in academic research settings, with the intervention delivered to fairly homogeneous samples that are limited in being inclusive of those experiencing health disparities. Thus, there are challenges in implementing the recommended intervention into practice. In particular, there are implementation challenges related to providers, contact time, and settings that impact all children. Specifically, the structure of the intervention may diminish its ability to be delivered by many types of providers in different settings, limiting overall accessibility. There are implementation challenges affecting children who experience health disparities, as it is not clear how efficacious the recommended intervention is for African American or Latinx children, or children from households with low income. Several strategies to reduce identified implementation challenges, such as reducing contact time and intensity of the dietary intervention, are discussed. However, use of these strategies may reduce the effect size of the weight improvements commonly seen with the recommended intervention. Suggestions for future research regarding implementation, specifically using study designs that enhance the ability to create cost-efficient and adaptive interventions that can generalize to many different children and families, are provided.

Sleep Variability, Eating Timing Variability, and Carotid Intima-Media Thickness in Early Adulthood.

Background Day-to-day variability in sleep patterns and eating timing may disrupt circadian rhythms and has been linked with various adverse cardiometabolic outcomes. However, the extent to which variability in sleep patterns and eating timing relate to atherosclerotic development in subclinical stages remains unclear. Methods and Results Generally healthy adults (N=62, 29.3±7.3 years, 66% female) completed 14 days of sleep and dietary assessments via wrist accelerometry and photo-assisted diet records, respectively. Variability in sleep duration, sleep onset, eating onset (time of first caloric consumption), eating offset (time of last caloric consumption), and caloric midpoint (time at which 50% of total daily calories are consumed) were operationalized as the SD across 14 days for each variable. Separate regression models evaluated the cross-sectional associations between sleep and eating variability metrics with end-diastolic carotid intima-media thickness (CIMT) measured via ultrasonography. Models adjusted for age, sex, systolic blood pressure, sleep duration, and total energy intake. Each 60-minute increase in sleep duration SD and sleep onset SD were associated with a 0.049±0.016 mm (P=0.003) and 0.048±0.017 mm (P=0.007) greater CIMT, respectively. Variability in eating onset and offset were not associated with CIMT; however, each 60-minute increase in caloric midpoint SD was associated with a 0.033±0.015 mm greater CIMT (P=0.029). Exploratory post hoc analyses suggested that sleep duration SD and sleep onset SD were stronger correlates of CIMT than caloric midpoint SD. Conclusions Variability in sleep patterns and eating timing are positively associated with clinically relevant increases in CIMT, a biomarker of subclinical atherosclerosis, in early adulthood.

Family Meals and Cardiometabolic Risk Factors in Young Children.

PURPOSE OF THE REVIEW: Family meals represent a novel strategy for improving cardiovascular health in youth. The purpose of this paper is to describe the association between family meals, dietary patterns, and weight status in youth. REVIEW FINDINGS: According to the American Heart Association's Life's Essential 8, poor diet quality and overweight/obesity status are key contributors to suboptimal cardiovascular health. Current literature highlights a positive correlation between the number of family meals and healthier eating patterns, including greater consumption of fruits and vegetables, and a reduced risk of obesity in youth. However, to date, the role of family meals in improving cardiovascular health in youth has been largely observational and prospective studies are needed to assess causality. Family meals may be an effective strategy for improved dietary patterns and weight status in youth.

Temporal associations between nightly sleep with daytime eating and activity levels in free-living young adults.

STUDY OBJECTIVES: This study aimed to quantify the temporal associations between nightly sleep quantity and timing with daytime eating behavior and activity levels in free-living (i.e. non-experimental) settings. METHODS: Generally healthy young adults (N = 63; 28.9 ± 7.1 years) completed concurrent sleep (wrist actigraphy), eating (photo-assisted diet records), and activity (waist actigraphy) assessments over 14 days. Multilevel models quantified the associations between nightly sleep (total sleep time, timing of sleep and wake onset) with next-day eating behavior (diet quality, caloric intake, timing of eating onset/offset, eating window duration) and activity levels (total physical activity, sedentary time). Associations in the reverse direction (i.e. eating and activity predicting sleep) were explored. Models adjusted for demographic and behavioral confounders and accounted for multiple testing. RESULTS: At within- and between-subject levels, nights with greater-than-average total sleep time predicted a shorter eating window the next day (all p ≤ 0.002). Later-than-average sleep and wake timing predicted within- and between-subject delays in next-day eating onset and offset, and between-subject reductions in diet quality and caloric intake (all p ≤ 0.008). At within- and between-subject levels, total sleep time was bidirectionally, inversely associated with sedentary time (all p < 0.001), while later-than-average sleep and wake timing predicted lower next-day physical activity (all p ≤ 0.008). CONCLUSIONS: These data underscore the complex interrelatedness between sleep, eating behavior, and activity levels in free-living settings. Findings also suggest that sleep exerts a greater influence on next-day behavior, rather than vice versa. While testing in more diverse samples is needed, these data have potential to enhance health behavior interventions and maximize health outcomes.

A Systematic Review of Behavioral Interventions on Children at Risk for Diabetes.

INTRODUCTION: In adults, behavioral-based interventions support prevention of Type 2 diabetes; less is known in children. The aim of this systematic review was to examine the impact of behavioral-based interventions on cardiometabolic outcomes among children at risk for diabetes. METHODS: PubMed, CINAHL Plus with Full Text, PsycINFO, and Web of Science were searched between September 2011 and September 2021. RCTs in children aged 6-12 years at risk for Type 2 diabetes that implemented a behavioral-based intervention and included ≥1 cardiometabolic outcome were eligible. If reported, dietary quality data were extracted. Risk of bias was assessed using the revised Cochrane risk-of-bias tool. RESULTS: Of the 2,386 records identified, 4 met the inclusion criteria. Study length ranged from 10 weeks to 24 months, with sample sizes ranging from 53 to 113 participants. Among the 4 studies, there were 5 behavioral-based arms. All studies included weight status outcomes, with 3 finding significant between-group differences. Four studies assessed fasting glucose, and 3 assessed HbA1c; none found significant changes between groups. Of the 4 studies reporting blood pressure outcomes, 1 found a significant between-group difference for systolic blood pressure. Three studies assessed cholesterol and found no changes. No studies reported measures of dietary quality. All studies had some concerns about risk of bias. DISCUSSION: Behavioral-based interventions improved weight status and supported the maintenance of cardiometabolic parameters. Stronger consideration of the most important risk factors in children along with intermediate outcomes (e.g., diet quality) may help to elucidate the relationship between behavioral-based interventions and cardiometabolic outcomes.

Perspectives on Engagement With Youth Physical Activity Opportunities in Low-Income, African American, Urban Neighborhoods.

PURPOSE: To identify and describe factors related to low-income, African American youth's participation in neighborhood youth physical activity opportunities (YPAO). APPROACH: Formative research. SETTING: Face-to-face focus groups in New Castle County, Delaware. PARTICIPANTS: Fifty-five adults (parents/guardians of youth, YPAO providers, small business representatives) living and/or working in low-income, African American neighborhoods. METHOD: Nine, 60-90 minute focus groups were conducted from December 2018 through March 2019. Focus group questions were developed a priori and included domains related to neighborhood YPAOs. The domains were awareness of YPAOs, benefits and barriers to providing YPAOs, ways to increase youth participation in YPAOs, and strategies for creating, improving, and sustaining YPAOs. Focus group recordings were transcribed, and thematic analysis was performed to identify themes related to increasing youth participation in YPAOs. RESULTS: Four major themes related to YPAOs emerged: 1) exposure/access, 2) parent buy-in/accountability (e.g., personal values and trust with YPAOs), 3) technology, and 4) increasing a sense of community. Three minor themes included liability, advertising, and schools. Small businesses desired to support YPAOs mainly through non-monetary means, while mutually benefitting from receiving local recognition. CONCLUSION: Developing strategies to incorporate effective community partnerships, creative program ideas with advertising, and active, multisector involvement including small businesses into practice has the potential to increase engagement of low-income, African American youth in YPAOs.

Human Milk, Infant Formula, and Other Milks Fed to Infants and Toddlers in the United States, NHANES 2007-2018.

BACKGROUND: For the first time, the 2020-2025 Dietary Guidelines for Americans provide specific guidance regarding the types of foods and beverages that should be offered in the first 2 years of life. Milk, in various forms (eg, human milk, infant formula, and cow's milk) contributes a large proportion of key nutrients to the diets of infants and toddlers in the United States. OBJECTIVE: The aim of this study was to determine the types of milk (human milk, infant formula, and other milk) fed to US infants and toddlers in the past 12 years and to describe trends over time. DESIGN: This was a cross-sectional analysis of 2-day, 24-hour dietary recalls. PARTICIPANTS/SETTING: Data from the 2007-2018 National Health and Nutrition Examination Survey were used for these analyses. Infants and toddlers aged 0 through 23.9 months with 2 days of dietary recall data (n = 3,079) were included. MAIN OUTCOME MEASURES: The main outcome was proportion of infants and toddlers fed different milk types. STATISTICAL ANALYSES PERFORMED: Survey-adjusted weighted percentages were used to report sociodemographic characteristics and the proportion of subjects fed each milk type category by age group and survey cycles. Binary and multinomial logistic regressions were used to assess differences in subject characteristics by age groups. RESULTS: Sociodemographic characteristics did not differ by age group. The proportion of infants aged 0 to <6 months fed infant formula only was 60.2% in 2007-2012 and 44.8% in 2013-2018. The proportion of infants aged 6 to <12 months fed partially hydrolyzed infant formula only was 7.3% in 2007-2012 and 13.1% in 2013-2018. In toddlers (>12 months old), cow's milk was the predominant milk type in both 2007-2012 and 2013-2018. CONCLUSIONS: The percentage of infants fed any human milk increased over the past decade. Unsweetened cow's milk was the most predominate milk type consumed among toddlers.

A low-energy-dense dietary pattern: a narrative review.

BACKGROUND: Dietary recommendations have promoted the consumption of a low-energy-dense dietary pattern; however, guidelines to implement this dietary pattern are lacking. OBJECTIVES: The objectives of this narrative review are to discuss approaches used to implement a low-energy-dense dietary pattern within dietary interventions and to understand if these approaches achieve a lower energy-dense diet. METHODS: Interventions that modified the diet for the purpose of altering energy density were referenced. Articles were chosen on the basis of the authors' knowledge of the energy density literature, reviewing relevant articles' reference lists, and discussion among coauthors. RESULTS: Eight articles were chosen for this review. Two approaches have been used to alter energy density: 1) modification to the consumption of dietary components that influence energy density (eg, reducing fat, increasing fruits and vegetables) or 2) use of an energy density classification method based on the numeric energy density value of foods. Although both approaches were used successfully to lower energy density, only the approach that used an energy density classification method allowed for the establishment of specific behavioral goals for participants to achieve regarding energy density. CONCLUSION: The use of an energy density classification method to develop specific intake goals may aid in the behavioral implementation of a low-energy-dense dietary pattern, but more high-quality studies are needed to draw stronger conclusions. Furthermore, barriers to consuming a low-energy-dense dietary pattern, such as dietary costs, need to be considered.

Dietary Energy Density from Infancy to 5 Years: Results from NHANES 2009-2018.

BACKGROUND: Nutrient-dense foods, which are often low in energy density (ED), are recommended for a healthy diet in infants and children. How ED changes during the transition from a complementary diet in infancy to a conventional diet is unknown. OBJECTIVES: We aimed to describe the ED, the amount of energy (e.g., kcal) per weight (e.g., g), of food or beverage in infants and preschool-age children. It was hypothesized that ED would be higher among older children. METHODS: The ED of food (ED-Food Only) and of food and all beverages excluding human milk and infant formula (ED-Food and Beverages) of children's (6 mo-5 y) diets were examined overall and by age subgroups using data from the NHANES (2009-2018). Survey-adjusted linear regression followed by pairwise comparisons were used to compare ED across age subgroups. The percentages of calories consumed from low-, medium-, and high-ED foods across age subgroups were also examined. RESULTS: Mean ED-Food Only was 1.21 kcal/g (95% CI: 1.13, 1.29 kcal/g) among 6- to 11-mo-olds and 1.62 kcal/g (95% CI: 1.54, 1.69 kcal/g) among 12- to 17-mo-olds (P < 0.05). ED-Food and Beverages was higher across consecutive age subgroups from 0.99 kcal/g (95% CI: 0.96, 1.02 kcal/g) in 12-17 mo through 3 y (1.22 kcal/g; 95% CI: 1.19, 1.26 kcal/g; P < 0.05). Mean percentage of calories consumed from low-ED food (≤1.0 kcal/g) became lower with age from 6- to 11-mo-olds (47.3%; 95% CI: 44.3%, 50.4%) through 18- to 23-mo-olds (16.2%; 95% CI: 14.5%, 17.9%; P < 0.05). A greater percentage of calories was consumed from high-ED food (≥3.0 kcal/g) among 18- to 23-mo-olds (39.0%; 95% CI: 37.1%, 40.9%) than among 12- to 17-mo-olds (34.0%; 95% CI: 32.0%, 35.9%; P < 0.05). CONCLUSIONS: ED increased across age subgroups, driven by a decrease in the percentage of calories consumed from low-ED food and an increase in the percentage of calories consumed from high-ED food.

Feasibility of Implementing a Food Skills Intervention.

BACKGROUND: Food skills are defined as meal planning, preparation, shopping, budgeting, resourcefulness, and label reading/consumer awareness. To date, food skills have not been tested in intervention-based studies. OBJECTIVE: To evaluate the feasibility of implementing a food skills intervention. DESIGN: This was an 8-week prospective food skills intervention. Study measures were completed through questionnaires provided before the start of the intervention and after the intervention was completed. For questionnaires, the web platform REDCap was used. PARTICIPANTS AND SETTING: Thirty parents (aged 18 years or older) with at least one child (aged 2 to 12 years), attended weekly virtual intervention sessions via Zoom. The intervention took place from August to October 2020 with assessment measures collected within 2 months of the start and end date of the intervention. Participants were from the mid-Atlantic region of the United States INTERVENTION: A food skills intervention based on behavior modification strategies from the Social Cognitive Theory was implemented. Intervention goals included meal planning (six of seven dinner meals per week), meal plan implementation (at least four of six planned dinner meals), and always using a grocery list when shopping. MAIN OUTCOME MEASURES: Feasibility was evaluated based on parent attendance, number of self-monitoring booklets completed, adherence to goals, implementation fidelity, and qualitative responses to interviews. Change in food skills confidence and nutrition knowledge were also assessed. STATISTICAL ANALYSIS: Descriptive statistics and qualitative responses were used to describe feasibility. Paired t tests were used to evaluate change in food skills confidence and nutrition knowledge from baseline to 8 weeks. RESULTS: Parents attended a mean of 7.6 ± 1.0 (out of eight) sessions and completed a mean of 6.2 ± 1.7 (out of seven) self-monitoring booklets. Parents planned a mean of 6.1 ± 1.5 dinners per week and implemented a mean of 4.7 ± 1.6 of the six planned dinners, achieving the intervention goals. Of the mean 1.2 ± 0.6 trips/week to the grocery store reported, grocery lists were used a mean of 1.1 ± 0.6 times. Mean food skills confidence score increased significantly from baseline to 8 weeks (baseline = 86.5 ± 18.0; 8 weeks = 101.4 ± 15.3; P < 0.001). Mean nutrition knowledge score also significantly increased (baseline = 64.1 ± 7.2; 8 weeks = 69.1 ± 6.6; P < 0.001). Parents reported on a scale of zero ("easy") to 10 ("difficult") a mean difficulty rating of 2.4 ± 2.4 for meal planning, a mean of 2.1 ± 2.1 for meal plan implementation, and a mean of 1.0 ± 1.7 for always using a grocery shopping list indicating acceptability of goals. CONCLUSIONS: Feasibility of a food skills intervention was demonstrated by high session attendance, high numbers of self-monitoring booklets turned in, high achievement of intervention goals, parent acceptability, and high ratings of implementation fidelity. There was an increase in food skill confidence and nutrition knowledge. Future research should examine the efficacy of changing food skill behaviors on dietary intake.

Utilizing Participatory Research to Engage Underserved Populations to Improve Health-Related Outcomes in Delaware.

Cooperative Extension is a community outreach program. Despite its large reach, there is a need for the evaluation of changes in health-related outcomes for individuals engaged with Cooperative Extension. A team-based challenge was developed using community-engaged participatory research integrated with Cooperative Extension to encourage healthy eating and physical activity behaviors through Cooperative Extension programming. Thus, the primary purpose of this secondary analysis was to (1) evaluate changes in anthropometric outcomes and (2) evaluate changes in health behavior outcomes. Associations of anthropometric changes and health behavior changes with engagement in the three-month team-based challenge were explored. Anthropometrics were measured using standard procedures, and intake of fruits and vegetables and physical activity were self-reported. Of the 145 participants in the community-engaged participatory research portion of the study, 52.4% (n = 76) had complete anthropometrics before and after the team-based challenge and were included in this study. At 3 months, there was a significant reduction in body mass index (-0.3 kg/m2, p = 0.024) and no significant change in waist circumference (p = 0.781). Fruit and vegetable intake significantly increased (+0.44 servings/day, p = 0.018). Physical activity did not significantly change based on (1) the number of days 30 or more minutes of physical activity was conducted (p = 0.765) and (2) Godin Leisure-Time Exercise Questionnaire scores (p = 0.612). Changes in anthropometrics and health behaviors were not associated with engagement in the team-based challenge. Using community-engaged participatory research with community outreach programs, such as Cooperative Extension, can improve health-related outcomes in underserved populations. However, despite a participatory approach, changes in anthropometrics and health behaviors were not associated with engagement in the developed team-based challenge.

More Frequent Food Shopping May Promote Fruit and Vegetable Intake: A Systematic Review.

BACKGROUND: Food shopping frequency may be an important modifiable factor related to increasing fruit and vegetable (FV) intake. Because of mixed findings of individual studies of shopping frequency, a systematic review is needed to examine findings across studies and store types. OBJECTIVE: To conduct a systematic review of articles examining the relationship between frequency of food shopping and FV intake including examination of participation in federal nutrition assistance programs on FV intake, if reported. METHODS: A search, guided by the Preferred Reported Items for Systematic Reviews and Metanalyses, using terms related to FV consumption and food shopping across 4 online databases, was conducted. Studies conducted in the US and published through October, 2020, included adults, and had a cross-sectional, longitudinal, cohort, or randomized study design were eligible for inclusion. RESULTS: Twenty-four articles were included. The majority of studies found at least 1 positive finding between the frequency of food shopping and FV intake, indicating that as the frequency of food shopping increased, FV intake increased. In studies with 100% participation in government/federal nutrition assistance programs, participation was associated with FV intake. Studies that included participation as a subset found participation not associated with FV intake. IMPLICATIONS FOR FUTURE RESEARCH AND PRACTICE: The frequency of shopping may be modifiable to increase FV intake. Experimental research is needed to test the directionality and causality of the relationship. Federal nutrition assistance programs may be a logical place to test the relationship through the adjustment of fund disbursements.

Food Shopping Frequency of Rural Tennessee Adults With Comparisons by Federal Nutrition Assistance Participation.

OBJECTIVE: To describe food shopping frequency across 7 store types in a rural context and compare food shopping frequency between federal nutrition assistance recipients and nonrecipients. METHODS: This cross-sectional study was conducted at county fairs in rural Tennessee. RESULTS: Reported overall mean food shopping frequency was 18.4 (SD, 13.9) times in the past 30 days. A mean of 3.1 (SD, 1.2) store types were visited, with supermarkets, convenience stores, and dollar stores the most frequented stores. Federal nutrition assistance program recipients shopped significantly less frequently than nonrecipients for overall shopping frequency (P = 0.02), supermarkets (P = 0.02), and farmers' markets (P = 0.04). CONCLUSIONS AND IMPLICATIONS: Educating and counseling individuals on how food shopping frequency may promote nutrition and health may be important. Federal nutrition assistance programs that distribute benefits monthly may impact food shopping frequency.

Relationships Among the Physical and Social Home Food Environments, Dietary Intake, and Diet Quality in Mothers and Children.

BACKGROUND: Both the physical and social home food environment (HFE) are believed to influence dietary intake and diet quality, but few studies have examined both aspects together. OBJECTIVE: The purpose of this study was to examine the relationships among the physical and social HFE, dietary intake, and diet quality in mothers and children. DESIGN: This was a cross-sectional substudy of a larger study. PARTICIPANTS/SETTING: The study included 24 mothers (aged ≥30 years) with a biological child aged 6 to 12 years living in the Newark, DE, area between June and November 2018. MAIN OUTCOME MEASURES: The outcome measures of interest included the physical HFE (ie, home food availability); aspects of the social HFE (ie, parenting styles, family meal frequency, and policies); maternal and child intake of fruits, vegetables, sugar-sweetened beverages, and snacks; and diet quality using the 2015 Healthy Eating Index total score. STATISTICAL ANALYSIS: Pearson correlations were used to examine the relationship between physical HFE and dietary intake as well as social HFE and dietary intake in both mothers and children. The relationships were further examined through exploratory regression analyses. RESULTS: In mothers, fruit availability in the physical HFE was correlated with fruit intake (r = 0.50; P = 0.02). Fruit and vegetable availability in the physical HFE were correlated with 2015 Healthy Eating Index total score in both the mother and child. Family meals participation was correlated with dietary intake (vegetable intake in children, r = 0.44; P = 0.04; and snack intake in mothers, r = -0.74; P < .001). Exploratory regression analysis showed vegetables in the HFE was associated with vegetable intake and 2015 Healthy Eating Index total score in mothers, and fruits and vegetables in the HFE were associated with child 2015 Healthy Eating Index total score. Family meals participation was negatively associated with maternal snack intake and child sugar-sweetened beverages intake. Authoritative parenting was negatively associated with child snack intake and permissive parenting was negatively associated with mother's fruit intake. CONCLUSIONS: Both the physical and social HFE are associated with maternal and child dietary intake, but only the physical HFE was associated with dietary quality. Although preliminary, these data indicate the importance of future studies that include measures to assess both the physical and social HFE to better elucidate the influences of the HFE on dietary intake.

Examining the consumer restaurant environment and dietary intake in children.

Within the away-from-home food environment there is a need to account for individual exposure (e.g., frequency of visitation) to that environment. The present study examined the consumer environment in both proximal and visited restaurants and their association with childrens' diet quality and anthropometrics. A cross-sectional analysis used baseline data from the Neighborhood Impact on Kids (NIK) study (2007-2009). Participants were 6-12-year-olds living in King County, WA and San Diego County, CA. This analysis (conducted 2019-2020) examined relationships between nearby restaurant count, Nutrition Environment Measures Survey in Restaurants (NEMS-R) within the child's block group, and weighted NEMS-R scores based on the restaurant where the child ate most frequently in relation to child energy intake, Healthy Eating Index (HEI-2010) total score and anthropometrics. Children's HEI-2010 scores were associated with NEMS-R scores within block groups, with children in the lowest NEMS-R tertile having significantly higher HEI scores than participants in the middle tertile. Weighted NEMS-R scores were significantly associated with waist circumference, with children in the highest NEMS-R tertile having a lower waist circumference than children in the lowest tertile. Nearby restaurant count was not associated with children's diet quality or anthropometrics. Our findings suggest the relationship between nutrition environment and child diet and anthropometrics varied depending on how nutrition environment was defined. However, findings may be limited by the low frequency of eating out reported in this sample. Food environment measures that account for individual-level behavior are needed to better understand the influence of food environments on diet and anthropometrics.

A cross-sectional examination of the home food environments of mothers who have undergone metabolic and bariatric surgery: a pilot study.

BACKGROUND: Healthful dietary changes after metabolic and bariatric surgery (MBS) may benefit not only patients, but the type and/or availability of foods/beverages in the family home food environment (HFE) overall, thereby reducing obesogenic environmental risks to child offspring in the home. Few studies have investigated the family HFE after MBS. OBJECTIVES: To examine whether the HFE of mothers post-MBS differed from the HFE of mothers of normal weight, overweight, and with obesity using an open home food inventory. SETTING: Cincinnati, Ohio and Newark, Delaware. METHODS: Thirty-two mothers with a child (6-12 yr) participated (8 post-MBS, 8 normal weight, 8 overweight, 8 with obesity) in a pilot study. Research personnel recorded all foods and beverages in the home. Per person total energy and servings of fruits, vegetables, sugar-sweetened beverages, and energy-dense snack foods in the HFE were examined using 1-way analyses of variance and Cohen's d effect sizes. RESULTS: Mothers in the post-MBS group had significantly fewer servings of sugar-sweetened beverages available per person compared with mothers with obesity (P = .01). Effect sizes for group differences indicated total energy, sugar-sweetened beverages, and servings of fruits and vegetables were generally medium to large, most with lower mean values for the post-MBS group relative to comparator groups. CONCLUSION: These findings, while preliminary, highlight areas for future research and add to an emerging literature on obesogenic risks to offspring in the post-MBS home, a known subgroup at high risk for severe obesity.

Family Meal Frequency, Diet, and Family Functioning: A Systematic Review With Meta-analyses.

OBJECTIVE: To examine the direction and magnitude of the relation between family meal frequency and dietary and family functioning outcomes in children (aged 2-18 years). DESIGN: Systematic literature review with meta-analysis. METHODS: Independent electronic searches, 1 for each outcome of interest, were conducted across 5 databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, and PsycINFO. Studies were included if they were peer-reviewed and published in English in the US through December 2018. MAIN OUTCOME MEASURES: Diet and family functioning. RESULTS: Dietary outcomes showed some evidence of a positive association between family meal frequency and fruits, vegetables, fruits and vegetables, sugar-sweetened beverages, and the Healthy Eating Index. There was less clear evidence of this relation in snacks, fast food, and desserts. A positive association was found between family meal frequency or dinner family meal frequency and family functioning outcomes. All studies included had cross-sectional and longitudinal study designs. CONCLUSIONS AND IMPLICATIONS: There is some evidence to show a positive relation between family meal frequency and dietary outcomes. There is stronger evidence for the relation with family functioning outcomes. Most articles included in the systematic reviews were excluded from meta-analysis owing to inadequate data and high methodological diversity across exposure and outcome variables.

Qualitative Research on the Real-Time Decision Making of WIC Participants While Food Shopping: Use of Think-Aloud Methodology.

BACKGROUND: People of lower socioeconomic status often experience disparities related to dietary intake as compared with People of higher socioeconomic status. Foods purchased influence the availability of foods in the home environment, and availability of foods in the home environment is associated with dietary intake. OBJECTIVE: To identify what factors influence food purchasing decisions of low-income parents while food shopping. DESIGN: A qualitative study using think-aloud methodology, the processing of information through verbalization concurrent with task performance, was used to verbally capture real-time decision making. PARTICIPANTS AND SETTING: Twenty-eight parents with a preschool-aged child enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Study visits took place at the WIC clinic office and local grocery stores. MAIN OUTCOMES: Reasons for making decisions while food shopping. ANALYSIS: Audio recordings were transcribed, and thematic analysis was used to analyze the data. Descriptive statistics were used to characterize demographics and shopping behaviors. RESULTS: A parent's decision in a food purchase was based on child preference, value, need of an item, or the parent choice for a product. In addition, themes emerged related to participant shopping behavior included the influence of participation in WIC on food and beverage purchases, multiple trips to the store, and a frequent focus on purchasing bottled water and juice. The average shopping trip was 31.5±15.7 minutes, and the median amount spent was $38.61. CONCLUSION: Understanding the influences of parent decisions while making food purchases can better help inform the nutrition education provided as part of WIC.

Food Purchasing Behaviors of WIC Participants: What Non-WIC Eligible Foods Items Are Being Purchased.

PURPOSE: To describe items purchased during a shopping trip by families enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). DESIGN: Cross-sectional, quantitative, observational study. SETTING: Grocery stores in the Newark, Delaware area. PARTICIPANTS: A convenience sample of mothers (n = 35) were recruited from a local WIC Clinic waiting room. MEASURES: The number of items categorized into 12 food groups, (baby food, beverages, dairy, fats/oils, fruit, vegetables, grains, protein, preprepared, seasonings, sweets, and other) extracted from grocery receipts. ANALYSIS: Means and frequencies were used to analyze continuous and categorical data, respectively, for receipt data and demographics. RESULTS: The most common foods purchased not included as part of the WIC food package included protein (1.0 [standard deviation, SD 3.0]), preprepared foods (0.9 [SD 2.0]), and other foods (1.0 [SD 1.9]). The most frequent foods purchased included as part of the WIC food package included fruit (2.3 [SD 1.5]), grains (1.7 [SD 1.6]), and dairy (1.5 [SD 0.8]). CONCLUSIONS: Further investigation of foods purchased that were not part of the WIC food package is warranted, as understanding food purchases particularly among low-income mothers may inform nutrition education practices.