Journal of the Academy of Nutrition and Dietetics最新文献

Background: Moderate coffee consumption has been associated with various health benefits. However, coffee consumption is often accompanied by the addition of milk, non-dairy creamer, sugar, or sugar substitutes, which can contribute to an increased consumption of energy from added sugar and saturated fat.

Objective: The objective of this study is to characterize trends in the consumption of coffee and coffee additions among adults in the United States (U.S.) from 2003 to 2018.

Design: This study is a serial cross-sectional analysis.

Participants/setting: This study analyzed a sample of U.S. adults aged 20+ years (n = 30,459) from eight-cycle of the nationally representative National Health and Nutrition Examination Survey (NHANES) from 2003-2004 to 2017-2018.

Main outcomes and measures: The main outcomes of this study are the daily consumption of coffee and coffee additions in both grams and calories assessing using 24-hour diet recalls.

Statistical analyses performed: Survey-weighted linear regression and analysis of variance are applied in this study.

Results: From 2003-2018, the consumption of total coffee among U.S. adults was stable by weight (from 373 to 378 g/day; difference: 4.49 g/d; p=0.791 for trend), but the energy consumed from total coffee increased from 43 to 60 kcal/day (difference: 17 kcal/day; p <0.001 for trend). In 2017-2018, the mean (± SE) total coffee consumption was 378 ± 16.7 g/day (equivalent to 1.67 eight-oz cups/day), among which 40.9 g/day was consumed as coffee additions. Although the most common coffee additions by weight were dairy milk (21.4 g/day), followed by non-dairy creamer (8.1 g/day) and sugar (4.4 g/day), non-dairy creamer contributed the largest amount of energy (19 kcal/day), followed by sugar (16 kcal/day) and dairy milk (11 kcal/day). Higher total coffee consumption was observed among men, non-Hispanic White adults, and individuals with higher income compared with their counterparts.

Conclusions: From 2003 to 2018, the estimated energy consumed from coffee has increased among U.S. adults aged 20+ years, primarily due to an increased consumption of non-dairy creamer.

Background: While considerable research has focused on undergraduate students, food insecurity among graduate students remains a comparatively understudied yet critical issue.

Objective: The objective of this study was to investigate the challenges food insecurity creates for graduate students, the perceived influence of food insecurity on their academic, social, physical, and psychosocial well-being, and the coping mechanisms they employ within their unique institutional and local context.

Design: This is a qualitative study, where semi-structured interviews were conducted.

Participants/setting: A total of 15 graduate students in the health sciences (4 Master's, 11 PhD) at Harvard University participated in the study in Spring 2024.

Analysis performed: Interviews were audio-recorded, transcribed, and checked for accuracy. Narrative data were analyzed using inductive thematic analysis and themes were generated through discussion. Food insecurity was assessed using the Six-item Short Form Food Security Survey Module. Descriptive statistics were used to describe the sociodemographic characteristics of the students.

Results: Several themes were identified from graduate students' narratives demonstrating 1) the economic landscape of graduate student food insecurity; 2) perceived influence of food insecurity on food acquisition strategies; 3) the perceived influence of food insecurity on physical health; 4) the perceived influence of food insecurity on psychosocial health; and 5) student strategies and support pathways in navigating food insecurity, including individual coping strategies, community support, and government assistance through the Supplemental Nutrition Assistance Program. Most students did not discuss their food situation with faculty or advisors, partially due to embarrassment.

Conclusions: Graduate students described how food insecurity contributed to challenges in food acquisition, poorer physical and mental health and well-being, limited social interactions, and difficulties in academic and research activities. Several students adopted individual coping strategies and sought support from the community as well as government assistance; however, more well-rounded efforts are needed to ensure graduate student well-being and success.

Background: School food programs (SFPs) provide access to nutritious food, particularly for youth from food-insecure households. There is limited population-level data on participation in Canadian SFPs over time.

Objective: This study aimed to examine trends in self-reported awareness of and participation in SFPs among Canadian youth, including differences across sociodemographic and food insecurity groups.

Design: This study was a secondary analysis of repeat cross-sectional data from national surveys conducted annually from 2019 to 2023. Data were not collected from Northwest Territories, Yukon, and Nunavut.

Participants/setting: A total of 16173 youth aged 10 to 17 years residing in Canada participated in the study.

Main outcome measures: The main outcome measures observed were youth self-reported school breakfast and lunch program awareness and participation.

Statistical analyses: Weighted logistic regression models examined changes in breakfast or lunch program self-reported awareness and self-reported participation across survey years and by sex, age, province, and household food insecurity.

Results: Across all years, less than 30% of youth reported awareness of a breakfast program and approximately 7.5-13.9% of youth reported participation in a breakfast program. In the same period, 16.2% or fewer youth reported awareness of a lunch program and 4.5-9.1% reported participation in a lunch program. Decreases in self-reported participation coinciding with the onset of the COVID-19 pandemic were observed in 2020 for both breakfast (OR=0.59; 95% CI: 0.50, 0.71; p< 0.001) and lunch programs (OR=0.73; 95% CI: 0.58, 0.92; p=0.009), followed by a return to pre-pandemic levels by 2023. Self-reported participation in SFPs was associated with household food insecurity, race, and province of residence (all contrasts p<0.001). Less than one-third of youth from food-insecure households reported participation.

Conclusion: Despite decreases in participation in 2020, no statistically significant change in self-reported participation was observed between 2019 and 2023, with self-reported participation highest among youth experiencing food insecurity.

Background: The development and use of brief dietary screeners is recommended for cardiovascular disease (CVD) prevention, yet validated Spanish-language tools for diverse U.S. Hispanic/Latino communities are lacking. Existing tools inadequately capture cultural foods, potentially introducing measurement bias.

Objective: This study evaluated the content validity of ¿SABE Lo Que Come? (SABE), a culturally adapted Spanish-language dietary screener derived from the Penn Healthy Diet screening instrument.

Design: A cross-sectional, mixed-methods study was employed to examine content validity of the SABE screener.

Participants/setting: Bilingual Hispanic/Latino adults living within the contiguous United States were recruited through convenience and snowball sampling between October and December 2025. Of 40 adults who responded to initial study invitation and met eligibility criteria, 25 (mean age 32 years, SD = 15.0, 56% women) completed the online survey.

Main outcome measures: Participant ratings of 35 screener items on 4-point Likert scales for clarity and relevance.

Statistical analyses: Item-level content validity indices (I-CVI) and modified kappa (κ*) scores were calculated. Items with a I-CVI or κ* less than 0.70 underwent revision and retesting.

Results: Four items required revision based on quantitative thresholds; 182 participant comments informed culturally appropriate modifications. Major revisions addressed cultural relevance, including replacing unfamiliar terms and incorporating culturally relevant examples. After revisions, all retested items achieved I-CVI and κ* > 0.70. The final SABE questionnaire demonstrated Scale-CVI of 0.865 for clarity and 0.969 for relevance.

Conclusions: SABE is a brief and culturally relevant dietary screening tool with content validity for diverse US Hispanic/Latino adults. This instrument addresses a critical gap in CVD prevention by providing a brief Spanish-language dietary assessment tool that captures culturally specific dietary patterns that is feasible for use in clinical and research settings.

Background: Pregnant individuals with low-income face socioeconomic barriers affecting nutrition and increasing risk for gestational weight gain (GWG) outside of recommendations. A multicomponent eHealth intervention lowered GWG, but the contribution of dietary changes remains unknown.

Objective: The objective of the study was to evaluate intervention effects on dietary intake and its association with GWG.

Design: The ∼24-week, investigator- and assessor-blinded, parallel-arm randomized clinical trial "SmartMoms in WIC", conducted between July 2019 and May 2024, assessed dietary intake by 24-hour recalls and Healthy Eating Index (HEI)-2020 in early (10,0-16,6 weeks) and late (35,0-37,6 weeks) pregnancy. GWG (kg) was calculated as late minus early pregnancy weight, and weekly GWG (g/week) as total GWG divided by weeks between visits.

Participants: /setting: Pregnant individuals (n=351) in Louisiana Women, Infants, and Children (WIC) program were randomized to Intervention (n=179) or Usual Care (n=172) at 15.2±1.6 (mean ± SD) weeks gestation.

Intervention: The intervention supported dietary intake modification through health education, cooking equipment and recipes, in addition to WIC services. Usual Care received WIC services only.

Main outcome measures: Dietary intake included total energy, macro- and micronutrients, and food components, with HEI-2020 assessing alignment with the 2020-2025 Dietary Guidelines for Americans.

Statistical analyses performed: Linear mixed models assessed intervention effects on dietary intake and linear models examined associations with GWG, reporting estimated means, 95% confidence intervals, and P values.

Results: From early to late pregnancy, energy intake did not change in the Intervention Group (-44 kcal/d; 95% CI: -179, 92; P=0.53, P_adj=0.79) compared to an increase of 263 kcal/d (95% CI: 123, 402; P<0.001; P_adj=0.001) in Usual Care, yielding a significant between-group difference of -306 kcal/d (95% CI: -500, -112; P=0.002; P_adj=0.008). The Intervention Group had a greater increase in protein proportion (+2% total energy; 95% CI: 0.4, 3.5; P=0.02; P_adj=0.03), and decreased intake of total fat (-12 g/day; 95% CI: -22, -3; P=0.01; P_adj=0.02) and carbohydrate (-48 g/day; -75, -21; P<0.001; P_adj=0.008) versus Usual Care. Dietary intake changes did not predict GWG.

Conclusions: By integrating a remote eHealth intervention within WIC's established framework, the intervention resulted in maintained energy intake in the Intervention Group, while the Usual Care Group showed increases in total energy, fat, and carbohydrate intake, and unhealthier food choices.

Background: The Healthy Eating Index (HEI) is a measure of diet quality that has been used in nutrition surveillance, epidemiology and health outcomes research, evaluation of interventions and policies, research on the food stream, and to advance statistical methods for dietary assessment. Although the HEI is familiar to researchers, there are opportunities to adapt it and further extend its application in participant and patient-facing communications that recommend healthy eating. The HEI Report was developed as a return-of-results feature for the National Cancer Institute's (NCI) Diet History Questionnaire (DHQ) III.

Objective: The objective of this study was to user-test a HEI Report that provides information on how individualized intakes compare to population-level dietary guidance.

Design: This was a cross-sectional mixed-methods user-testing study involving eye-tracking and qualitative data. Two rounds of user testing were performed and the HEI Report was modified based on user feedback after each round.

Participants: /Setting: From March 31 to October 4, 2021, twelve adult participants (six per round of user testing) completed both eye-tracking and qualitative interviews remotely nationwide.

Main outcome measures: The main outcome measures were feasibility and acceptability.

Statistical analyses: All qualitative data were transcribed verbatim and recommended changes were categorized into high priority, low priority, and optional desired changes that would affect design but not comprehension. Eye tracking data were used to aid interpretation of qualitative data.

Results: The report's content (e.g., simplified instructions, resources page, title page, personalized phrasing) and design (e.g., graphical depictions, key, colors) were modified based on user-testing feedback.

Conclusions: The HEI Report was designed, usability tested, and launched in the NCI's Diet History Questionnaire (DHQ) III. The HEI Report may be used to return value to participants as part of an effective participant engagement and retention plan in human research studies.

Background: Cystic Fibrosis (CF) care has been transformed by modulator therapies, extending survival and reshaping health management. While CF-specific nutrition guidelines have evolved to emphasise not only energy intake but also diet quality, we still know little about the lived experiences and dietary perspectives of adults living with CF in this new treatment era.

Objectives: To explore the lived experiences and perspectives of Irish adults with CF regarding dietary behaviours and food choices in the modulator era.

Design: This qualitative study used reflexive thematic analysis and involved virtual semi-structured interviews and focus groups.

Participants: Twenty-nine adults with CF (male: 62%, mean age: 35 ± 10) were recruited via CF Ireland networks and specialist clinics. Eligible participants were adults (≥18 years) with a confirmed diagnosis of CF living in Ireland; those receiving enteral nutrition, following a prescribed diet for another condition, pregnant, or post-transplant were excluded. One participant was underweight, and 48% were overweight/obese.

Analysis: Transcripts were managed in NVivo®, and Braun and Clarke's reflexive thematic analysis framework was used.

Results: Twenty interviews and three focus groups (n = 9) were completed. Five interconnected themes were generated: Legacy effects of CF historic diet; Evolving relationship with food; Weight gain and altered body image; Reclaiming authority over their own health; Navigating dietary choices. Participants described persistent anxieties, shifting habits, and the influence of social, emotional, and practical factors on food practices. While modulators increased autonomy, participants expressed a need for more holistic nutrition guidance and highlighted concerns related to self-image.

Conclusion: This study provides an in-depth exploration of Irish adults with CF, showing how historic diets, modulators, and daily contexts shape food experiences. Findings highlight shifting relationships with food, body image, and autonomy in the modulator era, emphasising the need for holistic, patient-centred nutrition care that integrates medical guidance with lived experience.

Background: Optimal nutrition is integral for health, particularly in oncologic patients undergoing active treatment. However, the impact of inadequate nutrition on tolerance of medical therapy remains unclear.

Objective: This study aimed to discern whether patients with malnutrition have worse treatment tolerance and identify malnutrition risk factors to guide dietitian-implemented interventions.

Design: This retrospective observational study scored nutritional status throughout treatment using Box 3 + Worksheet 1 of the Patient-Generated Subjective Global Assessment (PG-SGA). Scores >3 out of 8 indicated need for dietitian involvement.

Participants/setting: Eligible patients included those approached for the Moving Through Cancer initiative at the Hillman Cancer Center in Pittsburgh, Pennsylvania with an initial diagnosis between January 2015 and August 2025, no prior treatment, and at least one follow-up visit.

Main outcomes measures: Main outcomes included early therapy termination and therapy changes secondary to intolerance.

Statistical analyses performed: Linear and logistic regressions analysis were performed; significance was set a priori at 0.05 using Stata.

Results: Among 361 records: 169 (46.8%) were female; average age ± SD was 61.4 ± 14.0 years; 123 (34.1%) scored >3 on the PG-SGA. Patients scoring >3 had greater odds of terminating therapy early (adjusted odds ratio (AOR), 6.35 [95% CI, 3.30-12.21]; P < 0.001), changing therapy secondary to intolerance (AOR, 2.79 [95% CI, 1.55-5.02]; P = 0.001 for cytopenia; AOR, 1.93 [95% CI, 1.13-3.30]; P = 0.02 for fatigue; AOR: 2.97 [95% CI, 1.63-5.40]; P < 0.001 for gastrointestinal distress), and seeing outpatient dietitians (AOR, 1.96 [95% CI 1.18-3.25]; P = 0.01). Chemotherapy exposure was associated with 3.10 greater odds of malnutrition ([95% CI, 1.51-6.37]; P = 0.002). Patients with pancreatic cancer had 4.64 times greater odds of scoring >3 on the PG-SGA ([95% CI, 2.29-9.41]; P < 0.001).

Conclusions: These study findings support that dietitian resources should be triaged to higher-risk groups, namely patients with pancreatic cancer or those receiving chemotherapy, to prevent early therapy termination or changes secondary to intolerance.