The Association Between Depressive Symptoms and the Weekly Duration of Physical Activity Subset by Intensity and Domain: Population-Based, Cross-Sectional Analysis of the National Health and Nutrition Examination Survey From 2007 to 2018.

BACKGROUND: Prior literature suggests a dose-response relationship between physical activity (PA) and depressive symptoms. The intensity and domain of PA are suggested to be critical to its protective effect against depression; however, existing literature has shown mixed results. OBJECTIVE: The purpose of this population-based study is to examine the associations between depressive symptoms and weekly duration of (1) total PA and (2) PA subset by intensity, domain, or both. METHODS: A cross-sectional analysis of National Health and Nutrition Examination Survey data from 2007 to 2018 was conducted using multivariable logistic and linear regression models and survey weights. Participants (N=29,730) were 20 years and older and completed the Physical Activity Questionnaire and Depression Screener. The primary outcome was the presence of depressive symptoms, and the secondary outcomes were cognitive-affective and somatic symptoms of depression. RESULTS: Participants (N=29,730) had a weighted mean age of 47.62 (SD 16.99) years, and 15,133 (51.34%) were female. On average, participants without depressive symptoms engaged in 10.87 hours of total PA per week, whereas participants with depressive symptoms engaged in 8.82 hours (P<.001). No significant associations were seen between the weekly duration of total PA and depressive symptom odds, somatic, or cognitive-affective symptoms (all P>.05). Participants with an increased weekly duration of recreational PA had decreases in depressive symptom odds (adjusted odds ratio [aOR] 0.965, 95% CI 0.944-0.986) and in somatic (adjusted coefficient [aß]=-0.016, 95% CI -0.022 to -0.009) and cognitive-affective (aß=-0.015, 95% CI -0.023 to -0.007) symptoms. When recreational PA was subset by intensity, participants with an increased weekly duration of vigorous-intensity recreational PA had decreases in depressive symptom odds (aOR 0.926, 95% CI 0.883-0.972) and in somatic (aß=-0.021, 95% CI -0.032 to -0.010) and cognitive-affective (aß=-0.022, 95% CI -0.035 to -0.009) symptoms. However, significant associations were not seen for the weekly duration of work-related, moderate- or vigorous-intensity PAs (all P>.05). CONCLUSIONS: Findings suggest that recreational, not work-related PA is associated with reduced symptoms of depression. Future studies should explore the impact of the different types and contexts of PA on depressive symptomatology.

Effect of Physical Activity on the Association Between Diet and Constipation: Evidence From the National Health and Nutrition Examination Survey 2007-2010.

Background/Aims: Previous studies have shown that diet and physical activity can influence constipation. However, the combined effect of diet and physical activity on constipation remains unclear. Methods: Constipation was defined based on stool consistency and frequency, while overall diet quality was assessed using Healthy Eating Index (HEI)-2015 scores. Participants were categorized into low (metabolic equivalent [MET]-min/wk < 500) and high physical activity groups (MET-min/wk ≥ 500). The association between diet and constipation across physical activity groups was analyzed using survey logistic regression and restricted cubic splines. Results: Higher HEI-2015 scores were associated with reduced constipation risk in the high physical activity group when constipation was defined by stool consistency (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97-0.99). However, in the low physical activity group, increased HEI-2015 scores did not significantly affect constipation risk (OR, 1.01; 95% CI, 0.97-1.05). Similar results were found when constipation was defined based on stool frequency. In the high physical activity group, increased HEI-2015 scores were significantly associated with a reduced constipation risk (OR, 0.96; 95% CI, 0.94-0.98). Conversely, in the low physical activity group, increased HEI-2015 scores did not affect the risk of constipation (OR, 0.96; 95% CI, 0.90-1.03). Conclusions: Our findings suggest that a higher HEI-2015 score is negatively associated with constipation among individuals with high physical activity levels but not among those with low physical activity levels. This association was consistent when different definitions of constipation were used. These results highlight the importance of combining healthy diet with regular physical activity to alleviate constipation.

Dietary Flavonoid and Subclass Intakes are not Associated with Markers of Bone Health in U.S. Adults Age 50+ Years.

BACKGROUND: Dietary flavonoid intakes have been associated with improved markers of bone health in Chinese and Scottish cohorts, but little data exist in middle aged to older adults in the United States. OBJECTIVES: The objective of our research was to assess if dietary flavonoid intakes are associated with bone mineral density (BMD), bone mineral content (BMC), and bone area of the lumbar spine and femoral neck in a nationally representative population of middle aged to older U.S. adults. We further sought to investigate if relationships of the main flavonoid subgroups (i.e., anthocyanins, flavan-3-ols, flavanones, flavones, flavonols, and isoflavones) exist, as a secondary objective. METHODS: Cross-sectional data from individuals aged 50+ years enrolled in the 2017-2018 National Health and Nutrition Examination Survey (NHANES) were used in our analyses (N = 2590). Weighted multivariate logistic regression models were used to investigate the relationship between quartiles of flavonoid intake and BMD, BMC, and bone area of the lumbar spine and femoral neck of participants. RESULTS: Mean age of participants was 63.4 ± 0.52 years and 64.1 ± 0.52 years for men and women, respectively. Average total flavonoid intake was 217 ± 19.4 mg/day and 306 ± 26.9 mg/day for men and women, respectively. Total flavonoid intakes were not significantly associated with BMD, BMC, or bone area of the femoral neck or lumbar spine in male or female participants. Flavonoid subclass intakes were also not consistently associated with improved markers of bone health. CONCLUSION: Although several limitations exist, this cross-sectional analysis of U.S. adults aged 50+ years provides contradictory evidence to the hypothesis that higher flavonoid and flavonoid subclass intakes beneficially impacts markers of bone health. Large prospective cohort investigations that better capture long-term dietary flavonoid intake and ascertain fractures the primary outcome, as well as randomized controlled trials, are needed to fully elucidate the effects flavonoids on bone health.

Associations between body weight dissatisfaction and diet quality in women with a body mass index in the healthy weight category: Results from the 2014-2015 Swiss National Nutrition Survey.

BACKGROUND: Few studies have examined whether diet quality is lower in women with body weight dissatisfaction compared to women without body weight dissatisfaction. OBJECTIVES: 1) To examine the association between body weight dissatisfaction and diet quality among women (18-65 years old) in the healthy weight body mass index (BMI) category and 2) to explore dietary and behavioral patterns among women with body weight dissatisfaction. DESIGN: Data were extracted from the cross-sectional 2014-2015 Swiss National Nutrition Survey. PARTICIPANTS/SETTING: Population-based sample of 507 women with BMI ≥ 18.5 and < 25 kg/m2. OUTCOME MEASURES: Dietary intakes assessed by dietitians using two non-consecutive computer-assisted multi-pass 24-hour dietary recalls. Diet quality was measured with a slightly modified version of the Healthy Eating Index (HEI) -2020. STATISTICAL ANALYSES PERFORMED: Multiple linear regressions to test the association between body weight dissatisfaction and total HEI-2020 score. Hierarchical cluster analysis to identify subgroups of women with body weight dissatisfaction. RESULTS: Body weight dissatisfaction was not found to be associated with diet quality (ß = - 1.73 [-4.18 ; 0.71], P =0.16). However, women who were dissatisfied with their body weight had lower scores for the HEI-2020 total fruits (P = 0.050) and whole grains (P = 0.014) components than women who were satisfied with their body weight. Four profiles with different dietary patterns were identified among women with body weight dissatisfaction: "Unhealthy diet with dairy", "Protein and fat", "Vegetables without protein", and "Healthier diet without dairy". CONCLUSIONS: Among women with a BMI in the healthy weight category, overall diet quality was not observed to differ between those with or without body weight dissatisfaction. More research is needed to explore the different profiles of dietary intake in women with body weight dissatisfaction.

Effect of statin use on liver enzymes and lipid profile in patients with Non-Alcoholic Fatty Liver Disease (NAFLD).

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor for cardiovascular disease (CVD). Statins are recommended for treatment of dyslipidemia to reduce the overall cardiovascular risk in patients with NAFLD. However, statin treatment was underutilized and the effect of statins on liver enzymes remained unclear in this patient population. OBJECTIVES: This study aimed to provide real-world evidence of the safety and effect of statin use in patients with NAFLD. METHODS: We conducted a cross-sectional survey study of adults with NAFLD using pooled data from the US NHANES database 2009-2018. NAFLD was defined by Fatty Liver Index (FLI) ≥ 60 and United States Fatty Liver Index (USFLI) ≥ 30. Multivariate regression analyses adjusted for baseline clinical and demographic characteristics were performed to compare the liver enzymes and lipid profile between statin and non-statin users. RESULTS: The study included 2,533 adults with NAFLD, representing 22.6 million individuals in the US, with 27% receiving statin treatment between 2009 and 2018. The mean differences of liver enzymes for AST, ALT, ALP, and GGT between statin and non-statin users were -0.86 (p=0.539), -3.49 (p=0.042), -0.25 (p=0.913), and 0.57 (p=0.901), respectively. In individuals with NAFLD and dyslipidemia, total cholesterol and LDL levels were significantly lower in statin users compared to non-statin users (mean difference, -28.9; p<0.001 and -27.7; p<0.001). CONCLUSION: The use of statins was not associated with elevated liver enzymes in patients with NAFLD. Significantly lower levels of ALT, total cholesterol, and LDL were observed in statin users compared to non-statin users.

Consumption of beef sandwiches in the United States and contributions to intake of energy and select nutrients.

Introduction: Sandwiches are commonly consumed in the United States. This study summarizes contributions of beef sandwiches to energy and select nutrient intakes. Methods: Beef sandwiches were categorized as beef burger sandwiches (hamburgers or cheeseburgers) and non-burger beef sandwiches. Per capita and per user consumption of beef sandwiches (total and by type) and contributions to total nutrient intakes from beef and non-beef sandwich components were estimated for the population ages ≥2 years (n = 15,984) participating in WWEIA/NHANES, 2013-2016. Results: On any given day, 21.4% of the population consumed a beef sandwich. Among all Americans, beef sandwiches provided 6.3% of mean energy intake and accounted for approximately 10% of the population's mean intake of vitamin B12 and saturated fat, 9% of protein and sodium, 7% of iron, 6% of choline, and 5% of potassium. Among beef sandwich consumers, beef sandwiches accounted for 26.2% of mean energy intake on a day of consumption. The beef component of sandwiches accounted for the majority of vitamin B12, choline, and protein, non-beef components accounted for the majority of sodium, iron, and potassium, and beef and non-beef components made similar contributions to saturated fat. Hamburgers provided consumers the lowest energy, sodium, and saturated fat intake, while non-burger sandwiches provided the highest intake of these nutrients. Discussion: Beef sandwiches are an important source of energy, protein, vitamin B12, iron, and choline, and like other sandwiches, are also a source of sodium and saturated fat. Americans could enhance nutrient contributions from sandwiches by selecting lean meat and limiting use of saturated fat- or sodium-rich non-beef components.

The impact of long working hours on daily sodium intake.

Background: Long working hours are associated with an increased risk of cardiovascular disease, yet the underlying mechanism(s) remain unclear. The study examines how occupational factors like working hours, shift work, and employment status correlate with dietary choices and sodium intake, impacting hypertension risk. Methods: This study used data from the Korea National Health and Nutrition Examination Survey conducted between 2013 and 2020. The dataset included 8,471 respondents, all of whom were wage workers aged 20 or older and reported working at least 36 hours per week. Individuals who have been previously diagnosed with or are currently diagnosed with hypertension, diabetes, or dyslipidemia were excluded. The average daily sodium intake was assessed via a 24-hour dietary recall method. Average weekly working hours were categorized into 3 groups: 36-40 hours, 41-52 hours, and over 52 hours. Multiple logistic regression models were used. Results: Study findings revealed that 83.7% of participants exceeded the recommended daily sodium intake of 2 g set by the World Health Organization. After adjusting for confounding factors, a positive correlation was observed between average working hours and daily sodium intake. Among males, statistical significance was found in the group with average weekly working hours of 41-52 hours (prevalence ratio [PR]: 1.17; 95% confidence interval [CI]: 1.05-1.30) and the group exceeding 52 hours (PR: 1.22; 95% CI: 1.09-1.38) when comparing the fourth quartile of daily sodium intake to the combined quartiles of Q1, Q2, and Q3. Among females, no significance was noted. Conclusions: Long working hours were associated with increased sodium intake, primarily among male workers. This connection is likely attributed to having less time for home-cooked meals, resulting in higher fast food consumption and dining out. A workplace intervention promoting healthy eating and reducing stress is essential to lower sodium consumption and mitigate hypertension risk.

Analysis of dietary behavior and intake related to glycemic control in patients with type 2 diabetes aged 30 years or older in Korea: Utilizing the 8th Korea National Health and Nutrition Examination Survey (2019-2021).

BACKGROUND/OBJECTIVES: Over the past 10 yrs, the prevalence of diabetes in Korea has continued to incline, and the importance of lifestyle modification to manage diabetes has been highlighted. For patients with diabetes, carbohydrate intake reduction is effective in improving glycemic control; thus, we aimed to analyze the effect of carbohydrate intake ratio and suggest an appropriate carbohydrate intake ratio. SUBJECTS/METHODS: Using the 8th Korea National Health and Nutrition Examination Survey (2019-2021), we analyzed the data including participants aged 30 yrs or older with diabetes, and they were stratified into good and poor glycemic control groups. To analyze the correlation between the dietary behavior characteristics of participants with diabetes and the carbohydrate intake ratio, sociodemographic characteristics, dietary behavior, and health behavior were adjusted, and multivariate logistic regression analysis was conducted to present the adjusted odds ratio and 95% confidence interval (CI). RESULTS: In the unadjusted crude model, when carbohydrate intake ratio in total energy intake increased by 1%, the likelihood of poor glycemic control increased by 1.007-fold (95% CI, 0.998-1.016; P = 0.121). In model 1, which uses age and sex as adjustment variables, an increase of up to 1.011-fold was possible (95% CI, 1.001-1.021; P = 0.008). In model 2, which added variables such as diabetes duration, frequency of fruit consumption, frequency of lunch and, frequency of dinner, the risk of poor glycemic control increased by 1.010-fold as the carbohydrate intake ratio increased (95% CI, 0.998-1.022; P < 0.001). CONCLUSION: This study confirmed that as the ratio of carbohydrate intake to total energy intake increases the likelihood of poor glycemic control also increases in patients with diabetes. Therefore, to improve glycemic control in patients with diabetes, controlling the carbohydrate intake may be helpful.

Analysis of the influence of educational level on the nutritional status and lifestyle habits of the young Spanish population.

Aim: This study aims to analyze some nutrition and health habits of young people and the impact of educational attainment on health. Methods: An observational, descriptive, and cross-sectional study was carried out using surveys. Using non-probabilistic snowball sampling, a previously validated questionnaire was disseminated through networks, collecting a sample of 9,681 people between 18 and 30 years old. Comparative analyses between groups were obtained by clustering and the corresponding statistical tests. Results: The results showed how young people with higher education generally have a lower BMI, a higher healthy nutrition index, less frequent consumption of sugary drinks, and less smoking than their peers with basic education. These healthier habits are reflected in the higher self-perceived health status of the higher-educated group. While for all the educational levels analyzed, the minutes of physical activity practice are above the 150 min recommended by the WHO. Conclusion: Our findings suggest that young people's education level is of fundamental importance for health, particularly for nutritional habits. In general, the lifestyle habits of the young Spanish population are healthy, but there is a need for improvement in those aspects related to nutrition and food.

Trends in Income Inequities in Cardiovascular Health Among US Adults, 1988-2018.

BACKGROUND: Mean cardiovascular health has improved over the past several decades in the United States, but it is unclear whether the benefit is shared equitably. This study examined 30-year trends in cardiovascular health using a suite of income equity metrics to provide a comprehensive picture of cardiovascular income equity. METHODS: The study evaluated data from the 1988-2018 National Health and Nutrition Examination Survey. Survey groupings were stratified by poverty-to-income ratio (PIR) category, and the mean predicted 10-year risk of a major cardiovascular event or death based on the pooled cohort equations (PCE) was calculated (10-year PCE risk). Equity metrics including the relative and absolute concentration indices and the achievement index-metrics that assess both the prevalence and the distribution of a health measure across different socioeconomic categories-were calculated. RESULTS: A total of 26 633 participants aged 40 to 75 years were included (mean age, 53.0-55.5 years; women, 51.9%-53.0%). From 1988-1994 to 2015-2018, the mean 10-year PCE risk improved from 7.8% to 6.4% (P<0.05). The improvement was limited to the 2 highest income categories (10-year PCE risk for PIR 5: 7.7%-5.1%, P<0.05; PIR 3-4.99: 7.6%-6.1%, P<0.05). The 10-year PCE risk for the lowest income category (PIR <1) did not significantly change (8.1%-8.7%). In 1988-1994, the 10-year PCE risk for PIR <1 was 6% higher than PIR 5; by 2015-2018, this relative inequity increased to 70% (P<0.05). When using metrics that account for all income categories, the achievement index improved (8.0%-7.1%, P<0.05); however, the achievement index was consistently higher than the mean 10-year PCE risk, indicating the poor persistently had a greater share of adverse health. CONCLUSIONS: In this serial cross-sectional survey of US adults spanning 30 years, the population's mean 10-year PCE risk improved, but the improvement was not felt equally across the income spectrum.

Association between dietary protein intake and constipation: Data from the National Health and nutrition examination survey 2005-2010.

BACKGROUND: The association between dietary protein intake and constipation remains inconclusive. The aim of this study was to investigate whether dietary protein intake is associated with constipation. METHODS: This cross-sectional study included 13,941 adults from the 2005 to 2010 National Health and Nutrition Examination Survey. A weighted logistic regression analysis was used to control for confounding factors. In addition, weighted interaction and stratified analyses were conducted to ascertain the potential modifying factors. RESULTS: The prevalence of constipation was 7.5% when constipation was defined by stool consistency and 3.5% when constipation was defined by stool frequency. After adjusting for covariates, an increase in dietary protein intake of 10 g was not associated with constipation, as defined by stool frequency (OR = 0.94, 95% CI = 0.54, 1.62) or stool consistency (OR = 1.02, 95% CI = 0.75, 1.39). Subgroup analyses revealed that dietary protein intake was associated with an increase in constipation defined by stool consistency risk in participants who consumed a low amount of carbohydrates (OR = 1.08, 95% CI = 1.02-1.14 for every 10-g increase in protein intake), but a decrease in risk in participants in the moderate-carbohydrate group (OR = 0.94, 95% CI = 0.89-0.99 for every 10-g increase in protein intake), suggesting a significant interaction (p = 0.001). CONCLUSION & INFERENCES: Dietary protein intake is not associated with stool consistency or frequency-defined constipation. However, the association between dietary protein intake and constipation defined by stool consistency in participants with a low carbohydrate intake differed from that in participants with a moderate carbohydrate intake.

Perceiving a need for dietary change in adults living with and beyond cancer: A cross-sectional study.

BACKGROUND: Many people living with and beyond cancer (LWBC) do not meet dietary recommendations. To implement a healthier diet, people LWBC must perceive a need to improve their diet. METHODS: Participants included people diagnosed with breast, prostate or colorectal cancer in the UK. Two binary logistic regression models were conducted with perceived need for dietary change as the outcome (need to improve vs. no need). Predictor variables included demographic and clinical characteristics, receipt of dietary advice, and either body mass index (BMI) or adherence to seven relevant World Cancer Research Fund (WCRF) dietary recommendations. RESULTS: The sample included 5835 responses. Only 31% perceived a need to improve their diet. Being younger (odds ratio [OR] 0.95, 95% confidence interval [CI] = 94-0.95), female (OR = 1.33, 95% CI = 1.15-1.53), not of white ethnicity (OR = 1.8, 95% CI = 1.48-2.27), not married/cohabiting (OR = 1.32, 95% CI = 1.16-1.52) and having received dietary advice (OR = 1.36, 95% CI = 1.43-1.86) was associated with an increased odds of perceiving a need to improve diet. This association was also seen for participants with two or more comorbidities (OR = 1.31, 95% CI = 1.09-1.57), those not meeting the recommendations for fruit and vegetables (OR = 0.47, 95% CI = 0.41-0.55), fat (OR = 0.67, 95% CI = 0.58-0.77), and sugar (OR = 0.86, 95% CI = 0.75-0.98) in the dietary components model and those who had a higher BMI (OR = 1.53, 95% CI = 1.32-1.77) in the BMI model. CONCLUSIONS: Most of this sample of people LWBC did not perceive a need to improve their diet. More research is needed to understand the reasons for this and to target these reasons in dietary interventions.

Machine learning-based prediction of vitamin D deficiency: NHANES 2001-2018.

Background: Vitamin D deficiency is strongly associated with the development of several diseases. In the current context of a global pandemic of vitamin D deficiency, it is critical to identify people at high risk of vitamin D deficiency. There are no prediction tools for predicting the risk of vitamin D deficiency in the general community population, and this study aims to use machine learning to predict the risk of vitamin D deficiency using data that can be obtained through simple interviews in the community. Methods: The National Health and Nutrition Examination Survey 2001-2018 dataset is used for the analysis which is randomly divided into training and validation sets in the ratio of 70:30. GBM, LR, NNet, RF, SVM, XGBoost methods are used to construct the models and their performance is evaluated. The best performed model was interpreted using the SHAP value and further development of the online web calculator. Results: There were 62,919 participants enrolled in the study, and all participants included in the study were 2 years old and above, of which 20,204 (32.1%) participants had vitamin D deficiency. The models constructed by each method were evaluated using AUC as the primary evaluation statistic and ACC, PPV, NPV, SEN, SPE, F1 score, MCC, Kappa, and Brier score as secondary evaluation statistics. Finally, the XGBoost-based model has the best and near-perfect performance. The summary plot of SHAP values shows that the top three important features for this model are race, age, and BMI. An online web calculator based on this model can easily and quickly predict the risk of vitamin D deficiency. Conclusion: In this study, the XGBoost-based prediction tool performs flawlessly and is highly accurate in predicting the risk of vitamin D deficiency in community populations.

Who chooses "healthy" meals? An analysis of lunchtime meal quality in a workplace cafeteria.

BACKGROUND: The workplace can play an important role in shaping the eating behaviors of U.S. adults. Unfortunately, foods obtained in the workplace tend to be low in nutritional quality. Questions remain about the best way to approach the promotion of healthy food purchases among employees and to what extent health promotion activities should be tailored to the demographic characteristics of the employees. The purpose of this study was to (1) assess the nutritional quality of lunchtime meal purchases by employees in cafeterias of a large organization, (2) examine associations between lunchtime meal quality selection and the demographic characteristics of employees, and (3) determine the healthfulness of foods and beverages offered in the cafeterias of this organization. METHODS: A cross-sectional analysis was conducted using secondary data from a food labeling study implemented in three worksite cafeterias. Demographic data was collected via surveys and meal data was collected using a photo capture system for 378 participants. The Healthy Eating Index 2015 (HEI-2015) was used to determine meal quality and a total score for the menu of options available in the cafeterias during the study period. Summary statistics were generated, and the analysis of variance (ANOVA) was used to compare the HEI-2015 scores between groups. RESULTS: The mean HEI-2015 total score for the menu items offered (n = 1,229) in the cafeteria during the study period was 63.1 (SD = 1.83). The mean HEI-2015 score for individual lunchtime meal observations (n = 378) was 47.1 (SD = 6.8). In general, HEI-2015 total scores were higher for non-smokers, individuals who self-identified as Asian, had higher physical activity levels, scored higher on numeracy and literacy assessments, and reported higher education levels, incomes, and health status. CONCLUSIONS: The overall HEI-2015 scores indicate that the menu of options offered in the cafeterias and individual meal selections did not align with the Dietary Guidelines for Americans, and there were significant associations between average lunchtime meal quality scores and several demographic characteristics. These results suggest that healthy eating promotion activities in workplaces may need to be tailored to the demographic characteristics of the employees, and efforts to improve the food environment in the workplace could improve meal quality for all employees.

Exploring Diet and Nutrient Insufficiencies across Age Groups: Insights from a Population-Based Study of Brazilian Adults.

Assessing dietary inadequacies can contribute to understanding the nutritional vulnerabilities of a country. This study aimed to investigate nutrient intakes and micronutrient inadequacies in the Brazilian adult population, with an interest in different age subgroups. We conducted a cross-sectional study with 1812 individuals aged 19 to 65 years from a population-based study with a representative sample of Brazilian adults. Dietary intake was assessed by two 24 h food recalls, and the probabilities of inadequate intake were estimated using the Dietary Reference Intake targets. Adequate macronutrient intake was over 99% for proteins, 84.7% for carbohydrates, and 80.7% for total fats. There was a high probability of inadequacy (above 90%) for vitamins D and E, but vitamin D inadequacy was very similar between the sexes. In contrast, vitamin E was more likely to be inadequately consumed among women. A high probability of inadequacies (above 85%) of calcium and magnesium were found in the population, regardless of age group. Except for iron, the probability of an inadequacy of other minerals increased with age. The results showed a relevant proportion of nutrient inadequacies, with those most at risk being women and older individuals, helping with the better targeting and monitoring of public-health policies that address nutritional problems in the population.

Association between urinary organophosphate ester metabolite exposure and thyroid disease risk among US adults: National Health and Nutrition Examination Survey 2011-2014.

Background: Organophosphate esters (OPEs) may interfere with thyroid function, but the relationship between OPEs and thyroid disease remains unclear. This study aims to elucidate the relationship between OPEs exposure and thyroid disease risk in the general population in the United States. Method: Data were obtained from the 2011-2014 National Health and Nutrition Examination Survey cycle. All participants were tested for seven OPE metabolites in their urine and answered questions about whether they had thyroid disease through questionnaires. Logistic regression was employed to analyze the association between exposure to individual OPE metabolites and thyroid disease. Weighted Quantile Sum (WQS) regression modeling was utilized to assess exposure to mixed OPE metabolites and risk of thyroid disease. Bayesian kernel machine regression(BKMR) models to analyze the overall mixed effect of OPE metabolites. Result: A total of 2,449 participants were included in the study, 228 of whom had a history of thyroid disease. Bis(1,3-dichloro-2-propyl) phos (BDCPP), Diphenyl phosphate (DPHP) and Bis(2-chloroethyl) phosphate (BCEP) were the top three metabolites with the highest detection rates of 91.75%, 90.77% and 86.57%, respectively. In multivariate logistic regression models, after adjustment for confounding variables, individuals with the highest tertile level of BCEP were significantly and positively associated with increased risk of thyroid disease (OR=1.57, 95% CI=1.04-2.36), using the lowest tertile level as reference. In the positive WQS regression model, after correcting for confounding variables, mixed exposure to OPE metabolites was significantly positively associated with increased risk of thyroid disease (OR=1.03, 95% CI=1.01-1.06), with BCEP and DPHP having high weights. In the BKMR model, the overall effect of mixed exposure to OPE metabolites was not statistically significant, but univariate exposure response trends showed that the risk of thyroid disease decreased and then increased as BCEP exposure levels increased. Conclusion: The study revealed a significant association between exposure to OPE metabolites and an increased risk of thyroid disease, with BCEP emerging as the primary contributor. The risk of thyroid disease exhibits a J-shaped pattern, whereby the risk initially decreases and subsequently increases with rising levels of BCEP exposure. Additional studies are required to validate the association between OPEs and thyroid diseases.

Chewing Gum Is Associated with Better Diet Quality but Not Oral Health Measures in U.S. Adults.

OBJECTIVE: Chewing gum (especially sugar-free gum) has been linked to improved oral health, however there is an absence of observational research using nationally-representative data in the United States. We sought to examine the factors associated with chewing gum and its relationship with the oral health status of U.S. adults. METHODS: Cross-sectional data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2013-2018 cycles were used in these analyses. Primary outcomes were the odds of having gum disease, treatment for gum disease, ever being told of bone loss around teeth, root caries, caries, and restoration. Unadjusted and multivariate logistic regression models were used to investigate the relationship of chewing gum use with demographic/lifestyle factors and the oral health status of participants. RESULTS: 2.40% (n = 365) of adults were users of chewing gum and the average among users was 5.20 ± 0.40 g/d. Users of chewing gum were more likely to be female, younger in age, and non-Hispanic Black or Hispanic. Self-reported chewing gum use did not affect the oral health status of U.S. adults (OR: 1.10, 95% CI: 0.42-2.88 for gum disease; OR: 1.34, 95% CI: 0.64-2.81 for treatment for gum disease; OR: 0.56, 95% CI: 0.27-1.17 for bone loss around teeth; OR: 1.01, 95% CI: 0.32-3.12 for root caries; OR: 0.96, 95% CI: 0.54-1.69 for caries), except for restoration (OR: 3.54, 95% CI: 1.78-7.06), but was associated with improved diet quality (OR: 1.86, 95% CI: 1.11-3.12 for a healthy eating index (HEI) of 51-59; OR: 1.96, 95% CI: 1.08-3.56 for HEI of 60-93); and decreased intakes of snacks (OR: 1.64, 1.01-2.69), and added sugars. CONCLUSION: Future observational studies that more accurately capture chewing gum usage are needed, as these analyses have several limitations.

Infant and young child feeding practices in refugee settings across 203 population-based surveys from 2013-2019.

Infant and young child feeding (IYCF) plays a crucial role in early childhood growth and development. This study summarizes recent IYCF practices in multiple refugee settings and compares them to those in the host countries. We analyzed 203 surveys conducted among refugees residing in 15 countries and 120 unique sites and assessed eight IYCF indicators available from those surveys. A total of 146 surveys were conducted in Eastern and Southern Africa (ESA) and 50 in Western and Central Africa (WCA) regions. The median prevalence across surveys of all four indicators describing intake of breast milk was relatively high: 96.6% for ever breastfed, 81.2% for initiation of breastfeeding within 1 h of birth, 76.9% for exclusive breastfeeding 0-5 months, and 75.0% for continued breastfeeding 12-23 months. The median prevalence of early initiation and exclusive breastfeeding was markedly higher in ESA than in WCA (85.0% vs. 37.5% and 83.5% vs. 56.1%, respectively). Conversely, the overall median prevalence of timely introduction of solid and semisolid foods and flesh food consumption was low: 51.8% and 16.1%, respectively. Flesh food consumption was higher in WCA than in ESA (27.4% vs. 11.6%). The median prevalence of mixed milk feeding at 0-5 months and bottle feeding was very low: 2.4% and 3.8%, respectively. Indicators describing breast milk intake were generally either similar or higher in refugees than in the host country populations, whereas the other indicators were generally higher in the host populations than in refugees. The low prevalence of timely introduction of solids and of flesh food consumption in refugees is concerning and requires substantial improvement.

How many meals and snacks do Brazilians eat a day? Findings from the 2017-2018 Brazilian National Dietary Survey / Quantas refeições e lanches os brasileiros fazem por dia? Resultados do Inquérito Nacional de Alimentação de 2017-2018 / ¿Cuántas comidas y meriendas tienen los brasileños por día? Resultados de la Encuesta Nacional de Alimentación 2017-2018

The habit of eating specific meals has been addressed in several studies, but the evaluation of meal patterns has received less attention. This study aimed to describe the meal patterns of the Brazilian population. A complex sampling design was used to select the 46,164 ≥ 10-year-old individuals examined in the Brazilian National Dietary Survey. Food consumption was assessed by two non-consecutive 24-hour recalls applied throughout a one-week period. The exploratory data analysis approach was used to determine the meal patterns, i.e., how individuals combined the main meals (breakfast, lunch, dinner) and snacks (morning, afternoon, evening/night) throughout the day. The most common meal patterns were three main meals + one snack, reported by 25.1% of the individuals, and three main meals + two snacks (24.6%). Other meal patterns identified were: three main meals + three snacks (18.5%); three main meals and no snacks (10.9%); one or two main meals + two snacks (7.4%); one or two main meals + one snack (6.9%); one or two main meals + three snacks (4.2%); and one or two main meals and no snacks (2.3%). Meal patterns varied according to gender and age group, and on typical versus atypical food consumption days. We found that eight patterns characterized the daily meal consumption in Brazil. Furthermore, around 80% of the population had three main meals every day and about 13% did not report having any snacks. The characterization of meal habits is important for tailoring and targeting health promotion actions.

Os hábitos de consumo de refeições específicas têm sido abordados em diversos estudos, no entanto, a avaliação dos padrões refeições tem recebido menos atenção. O objetivo deste estudo foi descrever os padrões de refeições da população brasileira. Um desenho amostral complexo foi utilizado para selecionar os 46.164 indivíduos de ≥ 10 anos examinados no Inquérito Nacional de Alimentação de 2017-2018. O consumo alimentar foi avaliado por meio de dois recordatórios de 24 horas não consecutivos, aplicados durante um período de uma semana. A análise exploratória de dados foi utilizada para determinar os padrões de refeições, ou seja, como os indivíduos combinam as principais refeições (café da manhã, almoço, jantar) e lanches (manhã, tarde, noite) ao longo do dia. Os padrões de refeições mais frequentes foram três refeições principais + um lanche, conforme relatado por 25,1% dos indivíduos, e três refeições principais + dois lanches (24,6%). Outros padrões de refeições identificados foram: três refeições principais + três lanches (18,5%); três refeições principais e nenhum lanche (10,9%); uma ou duas refeições principais + dois lanches (7,4%); uma ou duas refeições principais + um lanche (6,9%); uma ou duas refeições principais + três lanches (4,2%); e uma ou duas refeições principais e nenhum lanche (2,3%). Os padrões de refeições variaram de acordo com o sexo e a faixa etária, e nos dias típicos em comparação com os atípicos de consumo alimentar. Verificou-se que oito padrões caracterizaram o consumo diário de refeições no Brasil. Além disso, cerca de 80% da população realizava três refeições principais diárias e cerca de 13% reportaram não lanchar. A caracterização dos padrões de refeições é importante para adequar e direcionar ações de promoção da saúde.

Los hábitos alimenticios específicos se han abordado en varios estudios, sin embargo, poco se sabe sobre la evaluación de los patrones de alimentación. El objetivo de este estudio fue describir el patrón de alimentación de la población brasileña. Se utilizó un diseño de muestra complejo para seleccionar a 46.164 individuos de ≥ 10 años quienes participaron en la Encuesta Nacional de Alimentación 2017-2018. El consumo alimentario se evaluó mediante dos registros de 24 horas no consecutivos, aplicados durante una semana. Para determinar el patrón de alimentación, se aplicó el análisis exploratorio, es decir, cómo las personas combinan las comidas principales (desayuno, almuerzo, cena) y las meriendas (mañana, tarde, noche) a lo largo del día. Los patrones de alimentación más frecuentes fueron tres comidas principales + una merienda según informan el 25,1% de los individuos, y tres comidas principales + dos meriendas (24,6%). Otros patrones identificados destacaron tres comidas principales + tres meriendas (18,5%); tres comidas principales sin merienda (10,9%); una o dos comidas principales + dos meriendas (7,4%); una o dos comidas principales + una merienda (6,9%); una o dos comidas principales + tres meriendas (4,2%); y una o dos comidas principales sin merienda (2,3%). Los patrones de alimentación tuvieron una variación según el sexo y el grupo de edad, y en días típicos en comparación con los atípicos de consumo de alimentos. Se encontró que ocho patrones caracterizan el consumo diario de comidas en Brasil. Por lo tanto, aproximadamente el 80% de la población tienen tres comidas principales al día y aproximadamente el 13% informan que no tienen merienda. Es importante caracterizar los patrones de alimentación para adaptar y orientar las acciones de promoción de la salud.

Sodium intake according to NOVA food classification in Brazil: trends from 2002 to 2018 / Ingestão de sódio segundo a classificação NOVA no Brasil: tendências de 2002 a 2018 / Ingesta de sodio según la clasificación NOVA en Brasil: tendencias del 2002 al 2018

Abstract: Excessive sodium intake is a major global public health issue and the identification of dietary sources and temporal trends in its consumption are a key to effective sodium reduction policies. This study aims to update estimates of sodium intake and its dietary sources in Brazil according to the NOVA food classification system. Records of 7-day food purchases of households from the Brazilian Household Budgets Survey of 2002-2003, 2008-2009, and 2017-2018 were converted into nutrients using food composition tables and the mean availability was estimated per 2,000kcal/day. Mean daily sodium available for consumption in Brazilian households has increased from 3.9 to 4.7g per 2,000kcal, from 2002-2003 to 2017-2018, over twice the recommended levels of sodium intake. From 2002-2003 to 2017-2018, the processed culinary ingredients, including table salt, represented the largest dietary source of sodium, although their participation in dietary sodium was reduced by 17% (66.6% to 55%), while the percentage of dietary sodium from processed foods increased by 20.3% and from ultra-processed foods increased by 47.6% (11.3% to 13.6% and 17% to 25.1%, respectively). In conclusion, the total household sodium availability remains high and has increased over time in Brazil, yet the participation of different dietary sources of sodium have gradually changed.

Resumo: A ingestão excessiva de sódio é um dos principais problemas de saúde pública em todo o mundo e a identificação de fontes alimentares e tendências temporais no seu consumo são fundamentais para a elaboração de políticas eficazes de redução de sódio. Este estudo tem como objetivo atualizar as estimativas de ingestão de sódio e suas fontes alimentares no Brasil de acordo com o sistema de classificação NOVA. Os registros de compras de alimentos no período de 7 dias de famílias das Pesquisas de Orçamentos Familiares de 2002-2003, 2008-2009 e 2017-2018 foram convertidos em nutrientes utilizando tabelas de composição de alimentos. A disponibilidade média foi estimada em 2.000kcal/dia. A média diária de sódio disponível para consumo nos domicílios brasileiros aumentou de 3,9 para 4,7g por 2.000kcal, de 2002-2003 a 2017-2018, mais do que o dobro dos níveis recomendados de ingestão desse nutriente. De 2002-2003 a 2017-2018, os ingredientes culinários processados, incluindo o sal de cozinha, representaram a maior fonte de sódio, embora a sua participação no sódio dietético tenha sido reduzida em 17% (de 66,6% para 55%), enquanto a porcentagem de sódio dietético dos alimentos processados aumentou 20,3% e dos alimentos ultraprocessados aumentou 47,6% (11,3% para 13,6% e 17% para 25,1%, respectivamente). Concluindo, a disponibilidade total de sódio nos domicílios permanece alta e tem aumentado ao longo do tempo no Brasil, mas a participação de diferentes fontes dietéticas de sódio mudou gradualmente.

Resumen: La ingesta excesiva de sodio es uno de los principales problemas de salud pública en todo el mundo, y la identificación de las fuentes alimentarias y tendencias temporales en su consumo son esenciales para desarrollar políticas efectivas de reducción de sodio. Este estudio tiene como objetivo actualizar las estimaciones de la ingesta de sodio y sus fuentes alimentarias en Brasil según el sistema de clasificación NOVA. Los registros de compras de alimentos en el período de 7 días de familias de las Encuestas de Presupuestos Familiares de Brasil de 2002-2003, 2008-2009 y 2017-2018 se convirtieron en nutrientes utilizando tablas de composición de alimentos. La disponibilidad media se estimó en 2.000kcal/día. El promedio diario de sodio disponible para el consumo en los hogares brasileños aumentó de 3,9 a 4,7g por 2.000kcal, entre 2002-2003 y 2017-2018, más del doble de los niveles de ingesta recomendados de este nutriente. Entre 2002-2003 y 2017-2018, los ingredientes culinarios procesados, incluida la sal de mesa, representaron la mayor fuente de sodio, aunque su participación en el sodio dietético se redujo en un 17% (del 66,6% al 55%), mientras que el porcentaje de sodio dietético de los alimentos procesados aumentó un 20,3% y de los alimentos ultraprocesados aumentó un 47,6% (11,3% a 13,6% y 17% a 25,1%, respectivamente). En conclusión, la disponibilidad total de sodio en los hogares sigue siendo alta y ha aumentado a lo largo del tiempo en Brasil, pero la proporción de diferentes fuentes dietéticas de sodio ha cambiado gradualmente.