Faculty Bibliography

AIM/OBJECTIVE:The objective of this systematic review was to summarize the ecological momentary assessment (EMA) methodology and associations between EMA-measured psychosocial, contextual factors and diabetes self-management. METHODS:The inclusion criteria were: research of EMA and diabetes self-management behaviors such as glucose checks, administration of insulin and eating-and dietary intake behaviors among persons with diabetes. A comprehensive search of several databases was conducted across all dates until July 2020. RESULTS:A modified Checklist for Reporting EMA Studies was used to assess the quality of studies. Among the ten included studies, participants were predominantly White adolescents with type 1 diabetes (T1D) and type 2 diabetes was studied in two studies. Time-varying, psychosocial contexts such as negative affect or negative social interaction were associated with missed insulin injection and poor adherence to glucose check. More preceding psychological stress was associated with more calorie intake from snacks or binge eating behaviors. Mornings were the most challenging time of day for adherence to diabetes self-management among adolescents with T1D. Intentional insulin withholding was more common in the afternoon in adults with T1D. CONCLUSIONS:EMA has potential clinical utility in the assessment of diabetes self-management and in the development of timely and individualized diabetes interventions.

Ultraprocessed foods provide the majority of energy content in the American diet, yet little is known regarding consumption trends over time. We determined trends in diet processing level and diet quality from 1991 to 2008 within the prospective Framingham Offspring Cohort. Dietary intakes were collected by FFQ quadrennially 1991-2008 (total of four examinations). The analytical sample included 2893 adults with valid dietary data for ≥3 examinations (baseline mean age = 54 years). Based on the NOVA framework, we classified foods as: unprocessed/minimally processed foods; processed culinary ingredients (salt/sugar/fats/oils); and processed foods and ultraprocessed foods. We evaluated diet quality using the Dietary Guidelines for Americans Adherence Index (DGAI) 2010. Trends in consumption of foods within each processing level (servings/d) and diet quality over the four examinations were evaluated using mixed effects models with subject-specific random intercepts. Analyses were stratified by sex, BMI (<25 kg/m2, 25-29·9 kg/m2, ≥30 kg/m2) and smoking status. Over 17 years of follow-up, ultraprocessed food consumption decreased from 7·5 to 6·0 servings/d and minimally processed food consumption decreased from 11·9 to 11·3 servings/d (Ptrend < 0·001). Changes in intakes of processed foods, culinary ingredients and culinary preparations were minimal. Trends were similar by sex, BMI and smoking status. DGAI-2010 score increased from 60·1 to 61·5, P < 0·001. The current study uniquely describes trends in diet processing level in an ageing US population, highlighting the longstanding presence of ultraprocessed foods in the American diet. Given the poor nutritional quality of ultraprocessed foods, public health efforts should be designed to limit their consumption.

South Asians, who are at a disproportionately greater risk of atherosclerotic CVD (ASCVD), represent a rapidly growing population in the USA. The relationship between dairy products, a major component of South Asian diets, and body composition - an established risk factor for ASCVD, is unclear. The aim of the present study was to examine associations between dairy intake and multiple measures of body composition (BMI, waist and hip circumference, waist:hip ratio, abdominal lean mass, subcutaneous, visceral, and intermuscular fat areas) among South Asian adults in the USA. A baseline analysis was conducted using existing data from the Mediators of Atherosclerosis in South Asians Living in America cohort. In women, the highest (>1·9 servings/d) v. lowest (<1 serving/d) tertile of dairy intake was associated with 53 % lower odds of a waist circumference >80 cm (95 % CI 0·25, 0·89, Pfor trend<0·05). No associations were observed between dairy intake and measures of body composition. However, >3 servings of low-fat yogurt/week was associated with a 9·9 cm2 lower visceral fat area (95 % CI -19·07, -0·72, P<0·05) and 2·3 cm2 lower intermuscular fat area (95 % CI -3·76, -0·79, P<0·05) as compared with those with three servings/week. Milk and cheese were not associated with body composition measures. These analyses suggest that higher consumption of low-fat yogurt is associated with lower visceral and intermuscular fat in the whole sample, and women with higher dairy intake have lower waist circumference. Our study supports dietary incorporation of dairy products, and recognises the utility of multidimensional measures of central adiposity.

Ethnic South Asian Americans (SAAs) have the highest relative risk of type 2 diabetes mellitus (T2DM) in the United States (US). Culturally tailored lifestyle interventions have the potential to promote South Asian diabetes prevention; however, the extent of their use and evaluation in US settings remains limited. This systematic review characterizes and evaluates outcomes of community-based lifestyle interventions targeted towards T2DM indicators among South Asians living in the US. A PRISMA-informed search of Pubmed, Embase, Cochrane, Web of Science, and clinical trial registry databases using key words pertaining to South Asians migrants and diabetes indicators (glucose and insulin outcomes) was conducted of community-based lifestyle interventions published up until October, 31 2019. Of the eight studies included in the final synthesis, four interventions focused on cultural and linguistic adaptations of past chronic disease prevention curricula using group-based modalities to deliver the intervention. Hemoglobin A1c (A1c) was the most common outcome indicator measured across the interventions. Three of the five studies observed improvements in indicators post-intervention. Based on these findings, this review recommends 1) greater exploration of community-based lifestyle interventions with high quality diabetes indicators (such as fasting blood glucose) in ethnic SAA communities, 2) expanding beyond traditional modalities of group-based lifestyle interventions and exploring the use of technology and interventions integrated with passive, active, and individualized components, and 3) development of research on diabetes prevention among second generation SAAs.

OBJECTIVE:Inadequate nutrition literacy within families is a barrier for healthy dietary choices and influences chronic disease risk. This pilot study examined the feasibility of providing an in-person nutrition intervention for families at high risk of developing prediabetes or type 2 diabetes and cardiovascular risk-factors. METHODS:Eligible families had at least one member with a non-communicable disease (NCD) or metabolic risk factor, fluency in English, willingness to attend all three educational sessions and complete questionnaires as a family unit. Sessions included didactic and experiential activities on food label reading, portion sizing, physical activity and modifiable lifestyle factors to reduce NCD risk. Demographics and fruit and vegetable screeners were collected from all participants at baseline and after completion of sessions. Families participated in focus groups to evaluate the program. RESULTS:Twelve families (n=35;17 adults;18 children) were recruited from New York City. Participants self-identified as Asian, Hispanic or Black. Adults had a mean age of 40y, BMI of 32.29kg/m2, household income of $35,000-$49,000y, and 13 of 17 adult participants had college degrees. Children ranged from 1-17y. Based on focus group feedback, three sessions were acceptable, families reported enjoying interactive activities and group learning and requested child-friendly activities. They reported improved knowledge of food labels, strategies for grocery shopping, portion-sizing, and increased awareness of the links between diet quality and NCDs. CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:The study met recruitment goals within 4 months. The educational intervention was acceptable and may be scaled-up for future studies on NCD prevention, particularly prediabetes and type 2 diabetes.

Existing studies addressing alcohol consumption have not captured the multidimensionality of drinking patterns, including drinking frequency, binge drinking, beverage preference and changes in these measures across the adult life course. We examined longitudinal trends in drinking patterns and their association with diet over four decades in ageing US adults from the Framingham Offspring Study (n 4956; baseline mean age 36·2 years). Alcohol intake (drinks/week, drinking frequency, beverage-specific consumption, drinks/occasion) was assessed quadrennially from examinations 1 to 8. Participants were classified as binge drinkers, moderate drinkers or heavy drinkers (4+ and 5+ drinks/occasion; ≤1 and ≤2 drinks/d and >7 and >14 drinks/week for women and men, respectively). Dietary data were collected by a FFQ from examinations 5 to 8 (1991-2008). We evaluated trends in drinking patterns using linear mixed effect models and compared dietary intake across drinking patterns using heterogeneous variance models. Alcohol consumption decreased from 1971 to 2008 (3·7 v. 2·2 oz/week; P < 0·05). The proportion of moderate (66 v. 59·3 %), heavy (18·4 v. 10·5 %) and binge drinkers (40·0 v. 12·3 %) declined (P < 0·05). While average wine consumption increased (1·4 v. 2·2 drinks/week), beer (3·4 v. 1·5 drinks/week) and cocktail intake (2·8 v. 1·2 drinks/week) decreased. Non-binge drinkers consumed less sugary drinks and more whole grains than binge drinkers, and the latter consumed more total fat across all examinations (P < 0·05). There was a significant difference in consumption trends of total grains by drinking level (P < 0·05). In conclusion, alcohol drinking patterns are unstable throughout adulthood. Higher intakes were generally associated with poorer diets. These analyses support the nuanced characterisation of alcohol consumption in epidemiological studies.

OBJECTIVE:The objective of this study was to map and describe the different corporate political activity (CPA) strategies used by the sugar-sweetened beverage (SSB) industry to influence public health policymaking geared toward decreasing the consumption of SSB in Mexico. METHODS:We applied an existing approach to identify and monitor the CPA of the SSB industry. A documentary analysis was conducted for two main actors in the SSB industry, for the period 2017-2019, and was triangulated with eleven semi-structured interviews with key informants in public health nutrition and from the SSB industry. The information was analyzed using an existing framework for categorizing the CPA. RESULTS:Although data were found for six CPA strategies, the SSB industry mainly highlighted its economic importance and spoke openly against the 2014 SSB tax. We documented the industry's relationships with governmental bodies and civil society actors to promote corporate social responsibility and gain public support. CONCLUSIONS:The SSB industry in Mexico uses a variety of strategies, directly or through third parties, to influence public policies related to the prevention and control of obesity and non-communicable diseases.

Insufficient research has explored whether sociodemographic differences in self-reported, individual-level diet quality are similarly reflected by grocery purchase quality. This cross-sectional analysis of n = 3961 U.S. households from the nationally representative Food Acquisition and Purchase Survey (FoodAPS) compared Healthy Eating Index (HEI)-2015 scores from 1 week of food-at-home acquisitions across self-reported demographic factors (race/ethnicity, Supplemental Nutrition Assistance Program (SNAP) participation, food security, and household-level obesity status). Multivariable-adjusted, survey-weighted regression models compared household HEI-2015 scores across sociodemographic groups. Respondents were primarily White and female, with a mean age of 50.6 years, 14.0% were food insecure, and 12.7% were SNAP-participating. Mean HEI-2015 scores were 54.7; scores differed across all sociodemographic exposures (p < 0.05). Interactions (p < 0.1) were detected between SNAP participation and (1) food insecurity and (2) household-level obesity, and race/ethnicity and (1) household-level obesity. HEI-2015 scores were higher among food secure, non-SNAP households than among food insecure, SNAP-participating households (53.9 ± 0.5 vs. 50.3 ± 0.7, p = 0.007); non-SNAP households without obesity had significantly higher HEI-2015 scores than other households. Household-level obesity was associated with lower HEI-2015 scores in White (50.8 ± 0.5 vs. 52.5 ± 0.7, p = 0.046) and Black (48.8 ± 1.5 vs. 53.1 ± 1.4, p = 0.018) but not Hispanic households (54.4 ± 1.0 vs. 52.2 ± 1.2, p = 0.21). Sociodemographic disparities in household HEI-2015 scores were consistent with previous research on individual-level diet quality.

Obesity is a risk factor for severe complications and death from the coronavirus disease 2019 (COVID-19). Public health efforts to control the pandemic may alter health behaviors related to weight gain, inflammation, and poor cardiometabolic health, exacerbating the prevalence of obesity, poor immune health, and chronic diseases. We reviewed how the pandemic adversely influences many of these behaviors, specifically physical activity, sedentary behaviors, sleep, and dietary intakes, and provided individual level strategies that may be used to mitigate them. At the community level and higher, public health and health care professionals need to advocate for intervention strategies and policy changes that address these behaviors, such as increasing nutrition assistance programs and creating designated areas for recreation and active transportation, to reduce disparities among vulnerable populations. The long-lasting impact of the pandemic on health behaviors, and the possibility of a second COVID-19 wave, emphasize the need for creative and evolving, multi-level approaches to assist individuals in adapting their health behaviors to prevent both chronic and infectious diseases.

Women's diet quality during reproductive years and children's diet quality during early life influence long term health. Few studies have evaluated the impact of food assistance programs and income on the diet quality of grocery purchases made by households consisting of women of reproductive age and young children. We used data from the Food Acquisition and Purchase Survey 2012-2013 (FoodAPS) to evaluate how household income, Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC) participation, and Supplemental Nutrition Assistance Program (SNAP) participation are related to the diet quality of grocery purchases made by households that include women of reproductive age or young children (n = 2436). The diet quality of household grocery purchases was assessed with the Healthy Eating Index (HEI) 2015. HEI-2015 total score (0-100) and component scores were evaluated according to household income (eligible for WIC: income-to-poverty ratio ≤ 185%; ineligible for WIC: income-to-poverty ratio > 185%) and WIC, SNAP, and WIC + SNAP participation. Median HEI-2015 total score was lowest among SNAP households and highest among income ineligible for WIC and WIC households (47.2 and 54.1, respectively). Compared to income ineligible for WIC households, WIC + SNAP and SNAP households had lower HEI-2015 whole fruit (β = -0.30, 95% CI: -0.59, -0.01 and β = -0.41, 95% CI: -0.63, -0.20, respectively) and total vegetable scores (β = -0.58, 95% CI: -0.83, -0.32 and β = -0.27, 95% CI: -0.45, -0.08, respectively). The diet quality of grocery purchases in this population varies according to household income and food assistance participation.