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History of modern nutrition science-implications for current research, dietary guidelines, and food policy

DOI:10.1136/bmj.k2392
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Dariush Mozaffarian
Dariush Mozaffarian
Dariush Mozaffarian
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Irwin Rosenberg
Irwin Rosenberg
Irwin Rosenberg
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Ricardo Uauy at London School of Hygiene and Tropical Medicine
Ricardo Uauy
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Dariush Mozaffarian and colleagues describe how the history of modern nutrition science has shaped current thinking
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... One of the most important achievements of nutritional research in the last decades was the design of several large studies, including observational cohorts and clinical trials [1]. However, their results were often controversial, particularly for specific questions about the effect of vitamins and other micronutrients on cardiovascular diseases and cancers [2,3]. ...
... However, their results were often controversial, particularly for specific questions about the effect of vitamins and other micronutrients on cardiovascular diseases and cancers [2,3]. Some researchers interpreted these controversies as evidence of one of the main weaknesses of the single-nutrient approach against chronic diseases [1]. Indeed, clinical trials often evaluated the short-term effect of vitamin supplements in high-risk patients, while observational cohorts usually investigated the habitual intake of vitamins from diets in the general population. ...
... Indeed, clinical trials often evaluated the short-term effect of vitamin supplements in high-risk patients, while observational cohorts usually investigated the habitual intake of vitamins from diets in the general population. This, at least in part, revealed that single-nutrient approaches were insufficient to clarify many aspects of the effect of diet on chronic diseases [1]. For this reason, several researchers began to focus on the recognition of relevant dietary patterns characterized by higher intakes of fruits and vegetables, legumes, nuts, and whole grains rather than high-calorie and processed foods rich in sugar, salt, and additives [4]. ...
The Application of Clustering on Principal Components for Nutritional Epidemiology: A Workflow to Derive Dietary Patterns
Article
Full-text available
  • Dec 2022
In the last decades, different multivariate techniques have been applied to multidimensional dietary datasets to identify meaningful patterns reflecting the dietary habits of populations. Among them, principal component analysis (PCA) and cluster analysis represent the two most used techniques, either applied separately or in parallel. Here, we propose a workflow to combine PCA, hierarchical clustering, and a K-means algorithm in a novel approach for dietary pattern derivation. Since the workflow presents certain subjective decisions that might affect the final clustering solution, we also provide some alternatives in relation to different dietary data used. For example, we used the dietary data of 855 women from Catania, Italy. Our approach—defined as clustering on principal components—could be useful to leverage the strengths of each method and to obtain a better cluster solution. In fact, it seemed to disentangle dietary data better than simple clustering algorithms. However, before choosing between the alternatives proposed, it is suggested to consider the nature of dietary data and the main questions raised by the research.
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... Conflicts, political instability, and other disasters compromise people's ability to manage their day-to-day livelihoods, and these worsen their food and nutritional vulnerability [3,4]. "Food assistance has become a key element of humanitarian aid to conflict-affected populations, intended to promote the survival and growth of infants and young children" [5,6]. Throughout human history, humanitarian food aid was provided in the form of food or non-food items for people affected by famine, drought, or natural disaster [4,[7][8][9]. ...
... Food assistance is a key element of humanitarian aid to conflict-affected populations, intended to promote the survival and growth of infants and young children in vulnerable populations [5,6]. Food assistance is an alternative to food aid because it addresses the food needs of people suffering the effects of disasters and war [20,56]. ...
Article no.JSRR.95864 Review Article Guli et al
Article
Full-text available
  • Feb 2023
Background: Humanitarian interventions are done after a significant disruption of people's daily life which in turn affect their food security and nutrition needs. Food assistance has become a key element of humanitarian aid to conflict-affected populations. Hunger and undernutrition can significantly worsen during situations of prolonged conflicts and where institutional capacities are weak. Humanitarian food aid provided in the form of food or non-food items for people affected by famine, drought, or natural disaster is intended to feed, shelter, and provide legal protection. Malnutrition in children is related to insufficient food intake, poor food quality, and severe or repeated infectious diseases. Therefore, humanitarian food assistance is given to ensure sufficient, safe, and nutritious food is consumed to prevent malnutrition and prevent death. Objectives: This paper seeks to understand the following specific objectives; to explore the evolution of humanitarian food assistance or food aid; to gain an understanding of the contemporary views on humanitarian food assistance; to explore the comparative views on humanitarian food assistance, and to find out the implications of shifting from Food Aid to Food Assistance. 27 Study Design/Method: Secondary data collection method was used and both published and official documents were reviewed based on the objectives of this paper, and relevant information was picked. The review provides evidence on the benefits as well as gaps related to humanitarian food assistance interventions and their relationship with the nutrition status of children below the age of five years. Results: Food in-kind directly impacts positively on the nutrition status of households and influences the coping mechanisms of the affected populations. In Mali, a study found food transfers exert a protective effect on food-insecure populations in conflict situations and increased micro-nutrient availability. Another study found improvement in nutrition status among children in Myanmar, Kenya, Niger, and South Sudan. While global acute malnutrition (GAM) in Myanmar declined from 6.6% to 2.6% and from 7.5% to 4.7%, in Niger, GAM rates declined from 21.3% to 13.6%, and 11.4% to 7.3% in Kenya and South Sudan, a decline of 6% GAM. Also, a study on the "impact of cash transfers on food consumption in humanitarian settings found cash transfer" is an appropriate and effective modality in humanitarian settings for meeting the needs of vulnerable populations. Conclusion: The strategic shift from food aid to food assistance has the potential to enhance effectiveness in addressing hunger because there is increased use of non-food aid in operational modalities and other initiatives to enhance local production and purchase, and the use of vouchers and cash transfers in humanitarian response.
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... The concept of revolutionized and prevention strategies were developed focusing on the consumption of a balanced diet. [4] The 21 st century shifted the gears from balanced to optimum nutrition and scientists developed novel foods and novel ingredients to improve human health. Amongst, medicinal plants gained a promising place due to their rich phytochemistry. ...
Phytochemical profile and pro-healthy properties of Terminalia chebula: A comprehensive review
Article
Full-text available
  • Feb 2023
Globalization witnessed changing trends in consumer markets. However, their long-term impacts include lifestyle and dietary changes. Although research in the pharmaceutical and chemical sciences led to the discovery and development of drugs saving millions of lives, their persistent use led to safety and toxicological issues. The plants previously used in Chinese and Ayurveda medicines received attention of the researchers to validate their traditional therapeutic applications. As a result, the reliance of communities on complementary and alternative medicines started to recover in the last few decades. The myrobalan (Terminalia chebula) is one such example that was renowned as the king of medicinal plants in Ayurveda due to its wide range of utilization in herbal decoctions to treat various health disparities. The current review showed phytochemical profile, that includes phenolic acids, casuarinin, chebulagic acid, chebulinic acid, rutin, and corilagin. Phytochemistry is linked with its medicinal applications and several research studies validated its antioxidant, antimicrobial, anti-inflammatory, hypoglycemic, and digestive tonic. The facts presented in the current article are derived from cell culture, animal, and human studies. Moreover, conceptualized framework regarding the effectiveness against cardiovascular disorders, immune dysfunction, cancer insurgence, and neurological disorders is in the limelight of the article. In last, a comprehensive discussion regarding its potential inclusion in the modern-day functional food market and presents its future applications.
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... The concept of revolutionized and prevention strategies were developed focusing on the consumption of a balanced diet. [4] The 21 st century shifted the gears from balanced to optimum nutrition and scientists developed novel foods and novel ingredients to improve human health. Amongst, medicinal plants gained a promising place due to their rich phytochemistry. ...
Phytochemical profile and pro-healthy properties of Terminalia chebula : A comprehensive review
Article
Full-text available
  • Jan 2023
Globalization witnessed changing trends in consumer markets. However, their long-term impacts include lifestyle and dietary changes. Although research in the pharmaceutical and chemical sciences led to the discovery and development of drugs saving millions of lives, their persistent use led to safety and toxicological issues. The plants previously used in Chinese and Ayurveda medicines received attention of the researchers to validate their traditional therapeutic applications. As a result, the reliance of communities on complementary and alternative medicines started to recover in the last few decades. The myrobalan (Terminalia chebula) is one such example that was renowned as the king of medicinal plants in Ayurveda due to its wide range of utilization in herbal decoctions to treat various health disparities. The current review showed phytochemical profile, that includes phenolic acids, casuarinin, chebulagic acid, chebulinic acid, rutin, and corilagin. Phytochemistry is linked with its medicinal applications and several research studies validated its antioxidant, antimicrobial, anti-inflammatory, hypoglycemic, and digestive tonic. The facts presented in the current article are derived from cell culture, animal, and human studies. Moreover, conceptualized framework regarding the effectiveness against cardiovascular disorders, immune dysfunction, cancer insurgence, and neurological disorders is in the limelight of the article. In last, a comprehensive discussion regarding its potential inclusion in the modern-day functional food market and presents its future applications.
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... However, these findings should be interpreted with caution as some associations were graded as weak, and most are derived from case-control studies with significant heterogeneity [164]. Because different dietary components are consumed in combination and because they usually correlate and interact with one another, recent recommendations suggest studying whole dietary patterns in relation to different health outcomes [165,166]. Nevertheless, for ESCC, the unusual geographical pattern of the high-risk areas points to a potential role of some geographical pattern risk factors, which might include diet in communities that rely upon subsistence farming. ...
Current Status and Future Prospects for Esophageal Cancer
Article
Full-text available
  • Jan 2023
Esophageal cancer (EC) is the ninth most common cancer and the sixth leading cause of cancer deaths worldwide. Esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) are the two main histological subtypes with distinct epidemiological and clinical features. While the global incidence of ESCC is declining, the incidence of EAC is increasing in many countries. Decades of epidemiologic research have identified distinct environmental exposures for ESCC and EAC subtypes. Recent advances in understanding the genomic aspects of EC have advanced our understanding of EC causes and led to using specific genomic alterations in EC tumors as biomarkers for early diagnosis, treatment, and prognosis of this cancer. Nevertheless, the prognosis of EC is still poor, with a five-year survival rate of less than 20%. Currently, there are significant challenges for early detection and secondary prevention for both ESCC and EAC subtypes, but Cytosponge™ is shifting this position for EAC. Primary prevention remains the preferred strategy for reducing the global burden of EC. In this review, we will summarize recent advances, current status, and future prospects of the studies related to epidemiology, time trends, environmental risk factors, prevention, early diagnosis, and treatment for both EC subtypes.
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... By its very nature, the answer to question 1 ("What actions should be executed?") is often highly context-dependent and individual. For example, the selection of "correct" actions in the area of nutrition is a highly complex, multi-layered issue that depends strongly on individual preferences, priorities and life circumstances (e.g., Franz et al., 2014;Cecil and Barton, 2020), and the relevant scientific body of knowledge is constantly evolving (Mozaffarian et al., 2018;Ridgway et al., 2019). In such cases, it is conceivable in principle that a technical system will inquire about the corresponding preferences and priorities of the user and then derive suitable suggestions for action on the basis of certain rules or heuristics. ...
Cognitive assistance for action selection: Challenges and approaches
Article
Full-text available
  • Jan 2023
Cognitive assistance systems aim at compensating shortcomings of natural cognition concerning specific activities. Notable progress has been made regarding data acquisition, analysis, and the exploration of technical means for supporting human action selection and execution. The related challenges and potential solutions can be associated to four largely independent questions: What actions should be executed, when this must or should be done, whether assistance is needed for a specific action, and if so, how the action should be supported. A broad range of technological and methodical approaches can be taken for tackling each of these issues, including recent advances and new challenges in the automatized analysis of task-related mental representation structures.
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Healthy Eating Patterns and Risk of Total and Cause-Specific Mortality
Article
  • Jan 2023
Importance: The current Dietary Guidelines for Americans recommend multiple healthy eating patterns. However, few studies have examined the associations of adherence to different dietary patterns with long-term risk of total and cause-specific mortality. Objective: To examine the associations of dietary scores for 4 healthy eating patterns with risk of total and cause-specific mortality. Design, setting, and participants: This prospective cohort study included initially healthy women from the Nurses' Health Study (NHS; 1984-2020) and men from the Health Professionals Follow-up Study (HPFS; 1986-2020). Exposures: Healthy Eating Index 2015 (HEI-2015), Alternate Mediterranean Diet (AMED) score, Healthful Plant-based Diet Index (HPDI), and Alternate Healthy Eating Index (AHEI). Main outcomes and measures: The main outcomes were total and cause-specific mortality overall and stratified by race and ethnicity and other potential risk factors. Results: The final study sample included 75 230 women from the NHS (mean [SD] baseline age, 50.2 [7.2] years) and 44 085 men from the HPFS (mean [SD] baseline age, 53.3 [9.6] years). During a total of 3 559 056 person-years of follow-up, 31 263 women and 22 900 men died. When comparing the highest with the lowest quintiles, the pooled multivariable-adjusted HRs of total mortality were 0.81 (95% CI, 0.79-0.84) for HEI-2015, 0.82 (95% CI, 0.79-0.84) for AMED score, 0.86 (95% CI, 0.83-0.89) for HPDI, and 0.80 (95% CI, 0.77-0.82) for AHEI (P < .001 for trend for all). All dietary scores were significantly inversely associated with death from cardiovascular disease, cancer, and respiratory disease. The AMED score and AHEI were inversely associated with mortality from neurodegenerative disease. The inverse associations between these scores and risk of mortality were consistent in different racial and ethnic groups, including Hispanic, non-Hispanic Black, and non-Hispanic White individuals. Conclusions and relevance: In this cohort study of 2 large prospective cohorts with up to 36 years of follow-up, greater adherence to various healthy eating patterns was consistently associated with lower risk of total and cause-specific mortality. These findings support the recommendations of Dietary Guidelines for Americans that multiple healthy eating patterns can be adapted to individual food traditions and preferences.
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Promoting and disseminating consistent and effective nutrition messages: Challenges and opportunities
Article
  • Jan 2023
Nutrition messages are a central part of policy making as well as communication via product information, advertising, healthcare advice and lifestyle campaigns. However, with amplified information (and misinformation) from a growing number of sources, inconsistent and conflicting food landscapes, and limited engagement from the public, nutrition messaging tensions have become more accentuated than previously. In this review, we focus on the challenges facing those wishing to effect dietary change through communication; and identify opportunities and future research questions . Beginning with a new working definition and taxonomy for the term ‘nutrition message’, we consider the evolution of public health nutrition messages from the past century and discuss which types of messages may be more effective. We then turn to the challenges of implementation and highlight specific barriers to recipients' understanding and change. While the evidence has many gaps and there is a need for systematic evaluation of nutrition messages, research indicates that recipients are more likely to act on fewer messages that provide clear benefits and which resonate with their perceived health needs, and which are relatively straightforward to implement. Effectiveness may be improved through consideration of how nutrition messages can be designed to complement key non-health drivers of food choice (taste, cost) and societal/cultural norms. Consistency can be achieved by aligning the wider food and messaging environment to desired public health actions; that is by ensuring that retail settings provide and signpost healthier choices, and that mass media nutrition messages work with, not against, public health advice.
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Role of the gut microbiota in nutrition and health
Article
Full-text available
  • Jun 2018
Ana M Valdes and colleagues discuss strategies for modulating the gut microbiota through diet and probiotics © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to.
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Prevotella-to-Bacteroides ratio predicts body weight and fat loss success on 24-week diets varying in macronutrient composition and dietary fiber: results from a post-hoc analysis
Article
Full-text available
Background/objectives: Individuals with high pre-treatment bacterial Prevotella-to-Bacteroides (P/B) ratio have been reported to lose more body weight on diets high in fiber than subjects with a low P/B ratio. Therefore, the aim of the present study was to examine potential differences in dietary weight loss responses between participants with low and high P/B. Subjects/methods: Eighty overweight participants were randomized (52 completed) to a 500 kcal/d energy deficit diet with a macronutrient composition of 30 energy percentage (E%) fat, 52 E% carbohydrate and 18 E% protein either high (≈1500 mg calcium/day) or low ( ≤ 600 mg calcium/day) in dairy products for 24 weeks. Body weight, body fat, and dietary intake (by 7-day dietary records) were determined. Individuals were dichotomized according to their pre-treatment P/B ratio derived from 16S rRNA gene sequencing of collected fecal samples to test the potential modification of dietary effects using linear mixed models. Results: Independent of the randomized diets, individuals with high P/B lost 3.8 kg (95%CI, 1.8,5.8; P < 0.001) more body weight and 3.8 kg (95% CI, 1.1, 6.5; P = 0.005) more body fat compared to individuals with low P/B. After adjustment for multiple covariates, individuals with high P/B ratio lost 8.3 kg (95% CI, 5.8;10.9, P < 0.001) more body weight when consuming above compared to below 30 g fiber/10MJ whereas this weight loss was 3.2 kg (95% CI, 0.8;5.5, P = 0.008) among individuals with low P/B ratio [Mean difference: 5.1 kg (95% CI, 1.7;8.6, P = 0.003)]. Partial correlation coefficients between fiber intake and weight change was 0.90 (P < 0.001) among individuals with high P/B ratio and 0.25 (P = 0.29) among individuals with low P/B ratio. Conclusions: Individuals with high P/B lost more body weight and body fat compared to individuals with low P/B, confirming that individuals with a high P/B are more susceptible to weight loss on a diet rich in fiber.
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5000 years of dietary variations of prehistoric farmers in the Great Hungarian Plain
Article
Full-text available
  • May 2018
The development of farming was a catalyst for the evolution of the human diet from the varied subsistence practices of hunter-gatherers to the more globalised food economy we depend upon today. Although there has been considerable research into the dietary changes associated with the initial spread of farming, less attention has been given to how dietary choices continued to develop during subsequent millennia. A paleogenomic time transect for 5 millennia of human occupation in the Great Hungarian Plain spanning from the advent of the Neolithic to the Iron Age, showed major genomic turnovers. Here we assess where these genetic turnovers are associated with corresponding dietary shifts, by examining the carbon and nitrogen stable isotope ratios of 52 individuals. Results provide evidence that early Neolithic individuals, which were genetically characterised as Mesolithic hunter-gatherers, relied on wild resources to a greater extent than those whose genomic attributes were of typical Neolithic European farmers. Other Neolithic individuals and those from the Copper Age to Bronze Age periods relied mostly on terrestrial C 3 plant resources. We also report a carbon isotopic ratio typical of C 4 plants, which may indicate millet consumption in the Late Bronze Age, despite suggestions of the crop's earlier arrival in Europe during the Neolithic.
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Obesity and the food system transformation in Latin America
Article
Full-text available
  • Dec 2017
The Latin America and the Caribbean (LAC) region faces a major diet‐related health problem accompanied by enormous economic and social costs. The shifts in diet are profound: major shifts in intake of less‐healthful low‐nutrient‐density foods and sugary beverages, changes in away‐from‐home eating and snacking and rapid shifts towards very high levels of overweight and obesity among all ages along with, in some countries, high burdens of stunting. Diet changes have occurred in parallel to, and in two‐way causality with, changes in the broad food system – the set of supply chains from farms, through midstream segments of processing, wholesale and logistics, to downstream segments of retail and food service (restaurants and fast food chains). An essential contribution of this piece is to marry and integrate the nutrition transition literature with the literature on the economics of food system transformation. These two literatures and debates have been to date largely ‘two ships passing in the night’. This review documents in‐depth the recent history of rapid growth and transformation of that broad food system in LAC, with the rapid rise of supermarkets, large processors, fast food chains and food logistics firms. The transformation is the story of a ‘double‐edged sword’, showing its links to various negative diet side trends, e.g. the rise of consumption of fast food and highly processed food, as well as in parallel, to various positive trends, e.g. the reduction of the cost of food, de‐seasonalization, increase of convenience of food preparation reducing women's time associated with that and increase of availability of some nutritious foods like meat and dairy. We view the transformation of the food system, as well as certain aspects of diet change linked to long‐run changes in employment and demographics (e.g. the quest for convenience), as broad parameters that will endure for the next decades without truly major regulatory and fiscal changes. We then focus in on what are the steps that are being and can be taken to curb the negative effects on diet of these changes. We show that countries in LAC are already among the global leaders in initiating demand‐related solutions via taxation and marketing controls. But we also show that this is only a small step forward. To shift LAC's food supply towards prices that incentivize consumption of healthier diets and demand away from the less healthy component is not simple and will not happen immediately. We must be cognizant that ultimately, food industry firms must be incentivized to market the components of healthy diets. This will primarily need to be via selective taxes and subsidies, marketing controls, as well as food quality regulations, consumer education and, in the medium term, consumers' desires to combine healthier foods with their ongoing quest for convenience in the face of busy lives. In the end, the food industry in LAC will orient itself towards profitable solutions, ie those demanded by the broad mass of consumers.
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Adoption and Design of Emerging Dietary Policies to Improve Cardiometabolic Health in the US
Article
Full-text available
Purpose of review: Suboptimal diet is a leading cause of cardiometabolic disease and economic burdens. Evidence-based dietary policies within 5 domains-food prices, reformulation, marketing, labeling, and government food assistance programs-appear promising at improving cardiometabolic health. Yet, the extent of new dietary policy adoption in the US and key elements crucial to define in designing such policies are not well established. We created an inventory of recent US dietary policy cases aiming to improve cardiometabolic health and assessed the extent of their proposal and adoption at federal, state, local, and tribal levels; and categorized and characterized the key elements in their policy design. Recent findings: Recent federal dietary policies adopted to improve cardiometabolic health include reformulation (trans-fat elimination), marketing (mass-media campaigns to increase fruits and vegetables), labeling (Nutrition Facts Panel updates, menu calorie labeling), and food assistance programs (financial incentives for fruits and vegetables in the Supplemental Nutrition Assistance Program (SNAP) and Women, Infant and Children (WIC) program). Federal voluntary guidelines have been proposed for sodium reformulation and food marketing to children. Recent state proposals included sugar-sweetened beverage (SSB) taxes, marketing restrictions, and SNAP restrictions, but few were enacted. Local efforts varied significantly, with certain localities consistently leading in the proposal or adoption of relevant policies. Across all jurisdictions, most commonly selected dietary targets included fruits and vegetables, SSBs, trans-fat, added sugar, sodium, and calories; other healthy (e.g., nuts) or unhealthy (e.g., processed meats) factors were largely not addressed. Key policy elements to define in designing these policies included those common across domains (e.g., level of government, target population, dietary target, dietary definition, implementation mechanism), and domain-specific (e.g., media channels for food marketing domain) or policy-specific (e.g., earmarking for taxes) elements. Characteristics of certain elements were similarly defined (e.g., fruit and vegetable definition, warning language used in SSB warning labels), while others varied across cases within a policy (e.g., tax base for SSB taxes). Several key elements were not always sufficiently characterized in government documents, and dietary target selections and definitions did not consistently align with the evidence-base. These findings highlight recent action on dietary policies to improve cardiometabolic health in the US; and key elements necessary to design such policies.
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Meal Delivery Programs Reduce The Use Of Costly Health Care In Dually Eligible Medicare And Medicaid Beneficiaries
Article
Full-text available
Delivering food to nutritionally vulnerable patients is important for addressing these patients' social determinants of health. However, it is not known whether food delivery programs can reduce the use of costly health services and decrease medical spending among these patients. We sought to determine whether home delivery of either medically tailored meals or nontailored food reduces the use of selected health care services and medical spending in a sample of adults dually eligible for Medicare and Medicaid. Compared with matched nonparticipants, participants had fewer emergency department visits in both the medically tailored meal program and the nontailored food program. Participants in the medically tailored meal program also had fewer inpatient admissions and lower medical spending. Participation in the nontailored food program was not associated with fewer inpatient admissions but was associated with lower medical spending. These findings suggest the potential for meal delivery programs to reduce the use of costly health care and decrease spending for vulnerable patients.
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Effectiveness of school food environment policies on children’s dietary behaviors: A systematic review and meta-analysis
Article
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Background: School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear. Objective: To systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children. Methods: We systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children’s dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg’s and Egger’s test evaluated potential publication bias. Results: From 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified. Conclusions: Specific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health.
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Third-party fecal microbiota transplantation following allo-HCT reconstitutes microbiome diversity
Article
Full-text available
  • Apr 2018
Key Points The administration of third-party FMT capsules early after allogeneic HCT is feasible and appears safe. FMT is associated with early expansion of microbiome diversity in transplant recipients.
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Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health
Article
  • Apr 2018
A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from high, low and middle income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high and lower income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Numerous studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little impact on maternal and newborn health outcomes. There have been comparatively few attempts at preconception diet and lifestyle intervention. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that this is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and to action at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable disease. Alongside continued efforts to reduce smoking, alcohol and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly health professionals should be alerted to ways of identifying women who are planning a pregnancy. <br/
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