Community characteristics modify the relationship between obesity prevention efforts and dietary intake in children: the Healthy Communities Study.

BACKGROUND: The influence of community characteristics on the effectiveness of childhood obesity prevention efforts is not well understood. OBJECTIVE: Examine the interaction of community characteristics with the relationship between community programmes and policies (CPPs) and dietary intake. METHODS: An observational study of 5138 children in grades K-8 in 130 US communities was conducted in 2013-2015. Key informant interviews identified and characterized CPPs. CPP scores were generated for the number of target behaviours (CPP-Behav) and the number of behaviour change strategies (CPP-Strat) addressed by all CPPs and CPPs with nutrition goals over the prior 6 years in each community. Dietary intake was assessed by dietary screener and included intake of sugar from sugar-sweetened beverages; energy-dense foods; fruits and vegetables; whole grains; and fibre. Multivariate statistical models assessed the interactions between US region, urbanicity, community-level income, and community-level race/ethnicity and CPP scores in relation to dietary intake. RESULTS: CPP-Strat was positively associated with healthier dietary intakes in the Northeast and West, and in high Hispanic communities; the reverse was true in the South, and in high African-American and low-income communities. The CPP-Behav was positively associated with healthier dietary intakes in the South and rural areas, and the reverse was true in the West. CONCLUSION: The relationships between CPP index scores and dietary intake were most strongly influenced by region and urbanicity and to a lesser extent by community-level race/ethnicity and income. Findings suggest that different considerations may be needed for childhood obesity prevention efforts in communities with different characteristics.

Associations of community programs and policies with children's dietary intakes: the Healthy Communities Study.

BACKGROUND: The impact of community-based obesity prevention efforts on child nutrition has not been adequately studied. OBJECTIVE: Examine relationships between number, type and intensity of community programs and policies (CPPs) and child nutrition. METHODS: An observational study of 5138 children (grades K-8) in 130 U.S. communities was conducted in 2013-2015. CPPs were identified by 10-14 key informant interviews per community. CPPs were characterized based on: count, intensity, number of different strategies used and number of different behaviours targeted. Scores for the prior 6 years were calculated separately for CPPs that addressed primarily nutrition, primarily physical activity (PA) or total combined. Child intakes were calculated from a dietary screener and dietary behaviours were based on survey responses. Multi-level statistical models assessed associations between CPP indices and nutrition measures, adjusting for child and community-level covariates. RESULTS: Implementing more types of strategies across all CPPs was related to lower intakes of total added sugar (when CPPs addressed primarily PA), sugar-sweetened beverages (for nutrition and PA CPPs) and energy-dense foods of minimal nutritional value (for total CPPs). Addressing more behaviours was related to higher intakes of fruit and vegetables (for nutrition and total CPPs) and fibre (total CPPs). Higher count and intensity (PA and total CPPs) were related to more consumption of lower fat compared with higher fat milk. A higher count (PA CPPs) was related to fewer energy-dense foods and whole grains. No other relationships were significant at P < 0.05. CONCLUSION: Multiple characteristics of CPPs to prevent obesity appear important to improve children's diets.

Association between community characteristics and implementation of community programmes and policies addressing childhood obesity: the Healthy Communities Study.

BACKGROUND: Little is known about whether characteristics of communities are associated with differential implementation of community programmes and policies to promote physical activity and healthy eating. This study examines associations between community characteristics (e.g. region and race/ethnicity) and the intensity of community programmes and policies implemented to prevent childhood obesity. It explores whether community characteristics moderate the intensity of community efforts to prevent childhood obesity. OBJECTIVE: The objective of this study is to investigate associations between community characteristics and the intensity of community policies and programmes to prevent childhood obesity documented in the Healthy Communities Study that engaged a diverse sample of US communities. METHOD: Programmes and policies were documented in 130 communities across the USA, reporting over 9000 different community programmes and policies to prevent obesity among children ages 4-15. We examined associations between community characteristics and the intensity of community programmes and policies implemented (i.e. their amount and reach, duration and strength of change strategy). CONCLUSION: Community characteristics explain 25% of the variability in the intensity of community programmes and policies implemented in communities. Particular characteristics - urbanicity, region, being a large county and the per cent of African-Americans in a community - contributed to more (over 18% of the 25%) of the observed variability.

Changes in carotenoid intake in the United States: the 1987 and 1992 National Health Interview Surveys.

OBJECTIVES: To assess the changes in carotenoid intake between 1987 and 1992 among US adults by sociodemographic characteristics and high-risk groups for chronic disease; and to identify the dietary sources of specific carotenoid intake. DESIGN: A food frequency questionnaire (FFQ) was collected from a representative sample of respondents to the 1987 and 1992 National Health Interview Surveys throughout two calendar quarters. Black and white adults, 18 to 69 years old, participated in 1987 (n = 8,161) and 1992 (n = 8,341). METHOD: FFQ data were matched and linked to the US Department of Agriculture-National Cancer Institute carotenoid food composition database for analysis. STATISTICAL ANALYSIS: Mean differences in carotenoid intake over time were compared by sociodemographic characteristics and region of the country, after adjustment for sampling weights in a multiple linear regression model. RESULTS: Mean intake of the carotenoid lutein declined among white women (18%), among adults aged 40 to 69 years (16%), among persons with 9 to 12 years of education (11%), among nondrinkers (18%), among drinkers of 1 to 6 alcoholic drinks/ week (7%), among smokers (former smokers by 11%, current smokers by 7%, and never smokers by 9%), among income groups (< $20,000 by 7%, > or = $20,000 by 9%), and residents in the south and northeast (by 13% each, respectively). Mean intake of the carotenoid lycopene increased among white men (9%), among adults aged 18 to 39 years and aged 40 to 69 years (by 5% and 6%, respectively), among those with 13 years of education or more (12.5%), among alcohol drinkers (by 10% and 7% for 1 to 6 vs 7 or more drinks/week, respectively), among former and current smokers (by 6% each), among those with incomes > or = $20,000 (8%), and among residents in the west (16%) and midwest (5%). All differences described were statistically significant (P < .01). APPLICATION: The decline in lutein intake (from dark green leafy vegetables), particularly in white women, may have public health implications as a result of the recognized inverse association between carotenoid intake and disease risk.

The impact of lifestyle characteristics on carotenoid intake in the United States: the 1987 National Health Interview Survey.

OBJECTIVES: This study compared mean carotenoid intake in the United States by demographic and lifestyle variables to identify potential high-risk subgroups for disease. METHODS: Adults 18 to 99 years of age (n = 22 080) completed a food frequency questionnaire in the 1987 National Health Interview Survey, and mean carotenoid intakes were estimated. RESULTS: Carotenoid intakes were lower among Whites (vs Blacks), current smokers (vs nonsmokers), nondrinkers (vs drinkers), adults 18 to 39 years of age (vs those 40 to 69 years of age), frequent restaurant consumers (vs those who ate at home), and less educated (vs college-educated) persons. CONCLUSIONS: The benefits of a carotenoid-rich diet should be communicated to high-risk subgroups.

Specific and total carotenoid intakes among oral contraceptive and estrogen hormone users in the United States.

OBJECTIVE: To compare carotenoid intakes between hormone users and nonusers in a nationally representative sample of US women by demographic and lifestyle characteristics and to identify those with potentially greater risk for disease. DESIGN: Data from the 1987 National Health Interview Survey's-Epidemiology Supplement food frequency questionnaire were linked to the USDA-NCI Carotenoid database to estimate mean total and specific carotenoid intakes. SUBJECTS: Women (n = 8,962) were grouped by menopausal status and classified by hormone use into premenopausal oral contraceptive users/nonusers (n = 5,918) and postmenopausal estrogen replacement hormone users/nonusers (n = 3,044). STATISTICAL ANALYSES PERFORMED: Mean carotenoid intakes and standard errors were weighted using SUDAAN and adjusted for potential confounding factors using multiple linear regression analysis. Statistically significant differences were at p values < 0.01. RESULTS: Compared to nonusers, oral contraceptive users had lower specific carotenoid intakes. Demographic and lifestyle characteristics differed between oral contraceptive users/nonusers and were examined in relation to carotenoid intakes. More oral contraceptive users than nonusers were married, highly educated, drank alcoholic beverages, and smoked. After adjustment for these factors in a multiple linear regression model, the associations between oral contraceptive use and carotenoid intake remained statistically significant. Mean carotenoid intakes were not significantly different among estrogen hormone replacement users versus nonusers. CONCLUSIONS: Oral contraceptive users have lower dietary carotenoid intakes than nonusers. Since oral contraceptive users smoke and drink more than nonusers, and both factors are associated with lower carotenoid intakes, oral contraceptive users form a potential high risk group for disease.

Influence of using different sources of carotenoid data in epidemiologic studies.

OBJECTIVE: This study compared distributions of carotenoid intake and diet-serum correlations using two sources of carotenoid data: the US Department of Agriculture-National Cancer Institute (USDA-NCI) carotenoid food composition database and values accompanying the Block-NCI Health Habits and History Questionnaire (HHHQ). DESIGN AND SUBJECTS: A 100-item food frequency questionnaire was used to collect dietary data from 2,152 adults, aged 43 to 85 years, who were participating in the Nutritional Factors in Eye Disease Study, a population-based study designed to evaluate nutritional factors associated with age-related eye disease. Blood samples were collected from a random sample of 400 nonfasting participants in the study. RESULTS: Median carotenoid intakes using HHHQ vs USDA-NCI data were alpha carotene (229 vs 223 micrograms/day), beta carotene (1,321 vs 1,325 micrograms/day), beta cryptoxanthin (72 vs 21 micrograms/day), lutein + zeaxanthin (653 vs 811 micrograms/day), and lycopene (593 vs 1,615 micrograms/day). all paired differences in carotenoid intake were significantly different from zero (Wilcoxon signed-rank, P < .0001). Despite these differences, the two databases similarly ranked individuals according to carotenoid intake: Spearman correlations ranged from .71 (lycopene) to .93 (alpha carotene). Differences between diet-serum correlations (adjusted for energy, body mass index, high density lipoprotein, and total cholesterol) using HHHQ vs USDA-NCI data were minor and not significant (P > .05): alpha carotene (r = .33 vs .32), beta carotene (r = .27 vs .32), beta cryptoxanthin (r = .48 vs .53), lutein+zeaxanthin (r = .28 vs .24), and lycopene (r = .29 vs .25). CONCLUSIONS: Although estimates of carotenoid intake differed significantly, only minor differences in carotenoid rankings and diet-serum correlations were observed using either data source in this population.

Implementing a ketogenic diet based on medium-chain triglyceride oil in pediatric patients with cancer.

Traditionally, a ketogenic diet is given to drug-resistant children with epilepsy to improve seizure control. Inducing a ketogenic state in patients with cancer may be a useful adjunct to cancer treatment by affecting tumor glucose metabolism and growth while maintaining the patient's nutritional status. A ketogenic diet consisting of 60% medium-chain triglyceride (MCT) oil, 20% protein, 10% carbohydrate, and 10% other dietary fats was provided to a select group of pediatric patients with advanced-stage cancer to test the effects of dietary-induced ketosis on tumor glucose metabolism. Issues of tolerance and compliance for patients consuming an oral diet (consisting of normal table foods and daily MCT oil "shakes") and for patients receiving an enteral formula are reviewed. Preliminary use of the MCT oil-based diet suggests a potential in pediatric patients with cancer.

Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports.

OBJECTIVE: Establish dietary-induced ketosis in pediatric oncology patients to determine if a ketogenic state would decrease glucose availability to certain tumors, thereby potentially impairing tumor metabolism without adversely affecting the patient's overall nutritional status. DESIGN: Case report. SETTING: University Hospitals of Cleveland. SUBJECTS: Two female pediatric patients with advanced stage malignant Astrocytoma tumors. INTERVENTIONS: Patients were followed as outpatients for 8 weeks. Ketosis was maintained by consuming a 60% medium chain triglyceride oil-based diet. MAIN OUTCOME MEASURES: Tumor glucose metabolism was assessed by Positron Emission Tomography (PET), comparing [Fluorine-18] 2-deoxy-2-fluoro-D-glucose (FDG) uptake at the tumor site before and following the trial period. RESULTS: Within 7 days of initiating the ketogenic diet, blood glucose levels declined to low-normal levels and blood ketones were elevated twenty to thirty fold. Results of PET scans indicated a 21.8% average decrease in glucose uptake at the tumor site in both subjects. One patient exhibited significant clinical improvements in mood and new skill development during the study. She continued the ketogenic diet for an additional twelve months, remaining free of disease progression. CONCLUSION: While this diet does not replace conventional antineoplastic treatments, these preliminary results suggest a potential for clinical application which merits further research.