MedicalResearch.com Interview with:
Joyce Maalouf MS MPH
Nutrition Epidemiologist
CDC, Atlanta
Medical Research: What is the background for this study? What are the main findings?
Response: Although significant research shows U.S. children are eating too much sodium, data on the top dietary sources contributing to that intake is limited – particularly among babies and toddlers. This study identifies the primary sources of dietary sodium consumed by children from birth to 24-months-old, as well as differences in intake and food source broken down by demographic characteristics including age, gender and race/ethnicity.
Overall, our research revealed that after the age of six months, more than 70 percent of sodium intake comes from foods other than breast milk and infant formula. Commercial baby foods, soups and pasta mixed dishes are top sodium contributors for U.S. infants 6 to 11.9 months, while soups, cheese, pasta mixed dishes and frankfurters and sausages are key contributors among toddlers aged 12 up to 24 months. Top sodium sources varied by race/ethnicity within age groups, suggesting that for sodium reduction to be effective, it needs to occur across a wide variety of foods.
In addition, we found that non-Hispanic black toddlers ate more sodium than non-Hispanic white and Mexican-American children. Average sodium intake increased almost 9-fold from children under six months to those between one and two-years-old, while average energy intake only doubled. This suggests that, during the first two years of life, U.S. children increasingly consume sodium-rich foods.
To determine these findings, we examined eight years of data encompassing more than 2,900 participants between birth and two-years-old. The information was pulled from the nationwide NHANES What We Eat in America survey between 2003 and 2010.
MedicalResearch.com Interview with: Jaspreet Ahuja, Nutritionist
USDA, Agricultural Research Service
Nutrient Data Laboratory
Beltsville, MD 20705
MedicalResearch: What is the background for this study? What are the main findings?
Response: Most sodium in the U.S. diet comes from commercially processed and restaurant foods. Sodium reduction in these foods is key to several recent public health efforts. In this paper, we provide an overview of a program led by Nutrient Data Laboratory, USDA, in partnership with CDC and FDA to monitor sodium contents in commercially processed and restaurant foods in United States.
We track about 125 highly consumed, sodium-contributing foods, termed “Sentinel Foods” annually using information from food manufacturers and periodically by nationwide sampling and laboratory analyses. In addition, we monitor over 1,100 other commercially processed and restaurant food items, termed “Priority-2 Foods,” biennially using information from food manufacturers. These foods serve as indicators for assessing changes in the sodium content of commercially processed and restaurant foods in the U.S. In addition to sodium, we are monitoring related nutrients (potassium, total dietary fiber, total and saturated fat, total sugar) because their levels may change when manufacturers and restaurants reformulate their products to reduce their sodium content.
We sampled all Sentinel Foods nationwide and reviewed all Priority-2 Foods in 2010–2013 to determine baseline sodium concentrations. The results of sodium reduction efforts, based on re-sampling of the Sentinel Foods or re-review of P2Fs, will become available in 2015 on our website. The updated data are also released in USDA food composition databases, National Nutrient Database for Standard Reference and Food and Nutrient Database for Dietary Studies.
MedicalResearch.com Interview with:
Professor Dr. Bernd Weber
Heisenberg Professor
Department of Epileptology
Head - NeuroCognition | Imaging
Life&Brain Center Board of Directors
Center for Economics and Neuroscience Bonn
MedicalResearch.com Interview with:
Michael J. Orlich, MD, PhD
Program Director, Preventive Medicine Residency
Loma Linda University
Co-Investigator, Adventist Health Studies
Medical Research: What is the background for this study? What are the main findings?
Dr. Orlich: Colorectal cancer is the second leading cause of death from cancer in the United States. Screening efforts such as colonoscopies have helped save many lives by detecting pre-cancerous polyps and removing them. However, it is even better to prevent cancers from forming in the first place. We call this primary prevention. Diet is a potentially important approach to reduce the risk of developing colorectal cancer. In this analysis, we compared those eating different categories of vegetarian dietary patterns to those eating a non-vegetarian diet. About half of our study population was classified as non-vegetarian, which we defined as eating meat at least weekly. The other half of our population we called vegetarian and further divided them into four different vegetarian groups: semi-vegetarians ate meat but less than once per week; pesco-vegetarians ate fish but avoided other meats; lacto-ovo-vegetarians avoided meat but ate eggs and/or dairy products; and vegans avoided all meats, eggs, and dairy. All vegetarians together had on average a 22% relative reduction in the risk of developing colorectal cancer, compared to non-vegetarians, after carefully adjusting for many other factors. Pesco-vegetarians in particular had a much lower risk compared to non-vegetarians.
MedicalResearch.com Interview with:
Luc Djousse, MD, ScD, FAHA
Associate Professor of Medicine, Harvard Medical School
Editor-in-Chief, Current Nutrition Reports
Director of Research, Division of Aging
Brigham and Women's Hospital Boston, MA 02120
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Djousse: While some studies have reported a higher risk of coronary heart disease, diabetes, or high blood pressure with frequent consumption of fried foods, other investigators did not confirm those results. To date, only few studies have evaluated whether frequent consumption of fried foods can raise the risk of developing heart failure. Frying foods not only increases the energy density of foods, but also increase the amount of trans fats. Trans fats can lead to development of heart disease and diabetes and consumption of energy-dense foods in large quantity can lead to weight gain and resulting cardiovascular consequences.
We followed about 15000 US male physicians who were free of heart failure for an average of 10 years and found that frequent consumption of fried foods was related to a higher risk of developing heart failure. For example, people that consumed fried foods daily or more were twice more likely to develop heart failure than individuals who consumed fried foods less than once per week.
MedicalResearch.com Interview with:
Anestis Dougkas, MSc, PhD
Food for Health Science Centre
Lund University Lund, Sweden
MedicalResearch: What is the background for this study?
Dr. Dougkas: There has been an increased interest in the macronutrient profile of diets and meals as a factor that influences appetite. Dietary protein is considered as the most satiating macronutrient, yet there is little evidence on whether the effects observed are attributed to the protein or to the concomitant manipulation of carbohydrates and fat. The aim was to examine the effect of consumption of beverages varying in macronutrient content on appetite ratings, energy intake and appetite-regulating hormones.
MedicalResearch: What are the main findings?
Dr. Dougkas: Increased protein content suppressed more average appetite than carbohydrate and fat with a more pronounced effect of protein intake on subjective ratings of prospective consumption. Protein was also the most influential macronutrient for postprandial glucagon like peptide-1 (GLP-1, an appetite- suppressing hormone) response. This appetite-suppressing effect of protein was independent of the changes in fat and carbohydrates.
MedicalResearch.com Interview with:
Brian Elbel, PhD, MPH
Associate Professor, Department of Population Health;
Associate Professor, Department of Medicine
Population Health NYU School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Elbel: This study tried to determine whether a new supermarket that received tax and zoning credits from New York City, locating in a high need area, impacted healthy eating for children. No previous controlled study has looked at children, and supermarkets are tool being increasingly used to improve healthy eating. We did not find, at least one year after the store opened, any appreciable change in shopping or eating.
MedicalResearch.com Interview with:
James J. DiNicolantonio, PharmD
Associate Editor BMJ Open Heart
Cardiovascular Research Scientist
Saint Luke's Mid America Heart Institute
Medical Research: What is the background for this study? What are the main findings
Response: There were 6 randomized controlled dietary trials performed before the government dietary fat recommendations were released. When we performed a systematic review and meta-analysis of the available trials at this time, there was no significant difference in all-cause mortality or cardiovascular heart disease mortality. In essence, there was no support from randomized controlled trials at the time to support a reduction in fat and saturated fat (and there still isn't from recent meta-analysis including newer trials).
The reductions in mean serum cholesterol levels were significantly higher in the intervention groups but this did not result in significant differences in cardiovascular heart disease or all-cause mortality.
MedicalResearch.com Interview with:
Jinnie J. Rhee MSc, ScD
Department of Medicine, Stanford University School of Medicine Palo Alto, CA
Medical Research: What is the background for this study? What are the main findings?
Response: The goal of this study was to see if the dietary determinants of type 2 diabetes observed in predominantly white populations were similar to those in other racial and ethnic groups. We created a dietary diabetes risk reduction score using eight different dietary factors found to be associated with risk of type 2 diabetes, where a higher score indicates a healthier overall diet (A higher score included low intakes trans fat, sugar-sweetened beverages, and red and processed meats; lower glycemic index; and higher intakes of cereal fiber, nuts, and coffee; and higher polyunsaturated to saturated fat ratio). We found a protective association of similar magnitude between a healthy overall diet and type 2 diabetes risk in all racial and ethnic groups. However, in terms of the actual number of preventable cases, a healthier diet conferred even greater benefit for minority women because they were initially at higher risk than white women.
This study is significant because diabetes is a rapidly growing epidemic in most parts of the world, but most previous studies of diet and diabetes have been conducted in populations of European origin. This analysis was very powerful because it combined two large populations with a total of 156,030 women who were followed for up to 28 years with many repeated assessments of diet. This allowed us to conduct detailed analyses within specific racial and ethnic groups.
MedicalResearch.com Interview with:
Cecilia Cesa Schiavon
Department of Nutrition, Federal University of Santa Catarina
Florianópolis, Santa Catarina, Brazil
Medical Research: What is the background for this study? What are the main findings?
Response: The study was based on a nutritional intervention for patients undergoing treatment for breast cancer. The intervention took place right after the surgical procedure and lasted about a year, until the end of chemotherapy. The patients were submitted to a special methodology of intervention, aimed at increasing fruit and vegetable intake and reducing red and processed meat, following the World Cancer Research Fund and the American Institute for Cancer Research in the document entitled Food, Nutrition, Physical Activity and the prevention of Cancer: A Global Perspective”.
The main findings show that women undergoing breast cancer treatment may benefit from immediate, individualized, and detailed nutrition monitoring through appropriate nutrition education.
MedicalResearch.com Interview with:
Qi Sun, MD ScD
Assistant Professor of Medicine
Channing Division of Network Medicine
Brigham and Women’s Hospital and Harvard Medical School, Assistant Professor, Department of Nutrition
Harvard School of Public Health Boston, MA 02115
Medical Research: What is the background for this study? What are the main findings?
Dr. Sun: While we know whole grains are beneficial for reducing the risk of some major chronic diseases, such as heart disease and diabetes, evidence regarding whether whole grains are also able to lower mortality is sparse. We therefore want to answer this important research question in the current analysis. Using data collected from two prospective cohort studies consisted of more than 100 thousand US men and women, we found that whole grain intake was significantly associated with lower total mortality and lower cardiovascular mortality, but not cancer mortality. For every serving (28 grams) of whole grain intake per day, the total mortality is reduced by 5% and cardiovascular mortality by 9%.
MedicalResearch.com Interview with:
Refaat Hegazi, MD, PhD, MS, MPH
Medical Director at Abbott Nutrition and an author of the FeedM.E. study. Affiliate Research Associate Professor
Department of Internal Medicine, Division of Gastroenterology
Brody School of Medicine at East Carolina University
Medical Research: What is the background for this study? What are the main findings?
Dr. Hegazi: When we think about malnutrition, we don’t believe it can impact us and our families. But malnutrition is a widespread condition that can affect anyone, especially when sick or injured, and exists in every country of the world - both in emerging and developed nations. In fact, an estimated one in three patients who enter a hospital are malnourished and up to one out of two older adults are at risk for malnutrition.
The consequences of malnutrition are serious and include increased complications, (pressure ulcers, infections, falls), longer hospital stays, frequent readmissions, increased cost of care and higher risk of mortality. However, the condition often goes undiagnosed despite being preventable and treatable if identified early.
This is why we authored “Evidence-Based Recommendations for Addressing Malnutrition in Health Care: An Updated Strategy From the feedM.E. Global Study Group”. It aims to create a call to action for clinicians worldwide and provides a simple clinical nutrition care pathway that can be implemented in any health care setting, in any part of the world.
MedicalResearch.com Interview with:
Refaat Hegazi, MD, PhD, MS, MPH
Medical Director, Abbott Nutrition
Affiliate Research Associate Professor,
The Brody School of Medicine at East Carolina University
Medical Research: What is the background for this study? What are the main findings?
Dr. Hegazi: This study stems from the need to address the financial and health burdens that Chronic Obstructive Pulmonary Disease (COPD) places on the United States. It is the third leading cause of death in the U.S. and costs us about $50 billion a year. It’s a devastating and chronic condition that plagues patients on a daily basis, and previous studies have shown that proper nutrition is essential for proper pulmonary function and rehabilitation.
In a retrospective study of inpatient medical records, we found that by ensuring the nutritional needs of COPD patients were met with oral nutritional supplements (ONS), we were able to tackle the issue of cost, as well as better health outcomes. Specifically, the COPD patients that received oral nutritional supplements, experienced reduced length of hospitalization, lower average hospital costs, and lower readmission rates within 30 days, compared to those that did not.
MedicalResearch.com Interview with:
James J. DiNicolantonio, PharmD
Associate Editor BMJ Open Heart
Cardiovascular Research Scientist
Saint Luke's Mid America Heart Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. DiNicolantonio: Focusing on calories misdirects eating away from healthy foods (that are higher in calories - such as nuts, salmon, and avocados) and towards harmful foods (e.g. rapidly absorbable carbohydrates - including added sugars such as table sugar and high fructose corn syrup).
Treating obesity should not focus on decreasing caloric intake, rather, it should focus on eating quality foods. Lower calorie foods - that are high in rapidly absorbable carbohydrates - drive increased hunger throughout the day, whereas higher calorie foods (such as full-fat milk and eggs) leads to satiety. Consuming rapidly absorbable carbohydrates leads to increased total caloric intake throughout the day (driven by insulin resistance and leptin resistance). These metabolic consequences derived from overconsuming these types of foods leads us to eat more and exercise less. In essence, eating more and exercising less doesn't cause obesity, overconsuming rapidly absorbable carbohydrates causes us to eat more and exercise less, which then causes obesity - a subtle but important distinction.
MedicalResearch.com Interview with
Punam Ohri-Vachaspati, Ph.D.,R.D
Associate Professor, Nutrition
Arizona State University
School of Nutrition and Health Promotion
College of Health Solutions Phoenix, AZ 85004
Medical Research: What is the background for this study? What are the main findings?
Dr. Ohri-Vachaspati: Fast food is heavily marketed to kids -- with the food industry spending over $700 million each year to market their products specifically to children and adolescents. About half of this money goes towards premiums like toys given away with kids meals. And marketing works --exposure to food marketing is associated with higher fast food consumption among children. Research has shown us that 2-18 year olds consume 13% of their total calories at fast food restaurants. Children who eat at fast food restaurants are likely to have poor diets and worse health outcomes.
In this study we wanted to examine which communities are more vulnerable to child-directed marketing on the interior and exterior of fast food restaurants. Over a three year period (2010, 2011, and 2012) we sampled nearly 7000 restaurants from a whole spectrum of communities across the US. Child-directed marketing measured inside fast food restaurants included indoor play area and display of kids’ meal toys, and on the exterior included advertisements with cartoon characters, advertisements with movie, TV or sports figures, and advertisements for kids’ meal toys among others.We found that more than a fifth of fast food restaurants used child-directed marketing on the inside or on the exterior of their premises. Middle-income communities, majority black communities and rural areas were disproportionately exposed to this type of child-directed marketing.
MedicalResearch.com Interview with:
Sara N. Bleich, Ph.D.
Associate Professor Department of Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD 21205
Medical Research: What are the main findings of the study?
Dr. Bleich: Providing easily understandable calorie information — particularly in the form of miles of walking — makes adolescents more likely to buy a beverage with fewer calories, a healthier beverage or a smaller size beverage. Adolescents were also more likely to not buy any drink at all after seeing the signs with calorie information.
MedicalResearch.com Interview with:
Daniel (Dong) Wang MD, MSc
Department of Nutrition, Harvard School of Public Health
Boston, MA 02115
Medical Research: What are the main findings of the study?
Dr. Wang:
MedicalResearch.com Interview with:
Dr. Wenjun Li PhD
Associate Professor of Medicine (Biostatistics)
University of Massachusetts Medical School of Medicine
University of Massachusetts Medical School
Medical Research: What are the main findings of the study?
Dr. Li: The study discovered that the effectiveness of dietary interventions is significantly influenced by the presence of a supportive community nutrition environment.
MedicalResearch.com Interview with:
Rosa M. Lamuela-Raventos, PhD
Associate Professor
Department of Nutrition and Food Science
School of Pharmacy, University of Barcelona
MedicalResearch: What are the main findings of the study?
Dr. Lamuela-Raventós: We have found an inverse relationship between polyphenol intake and risk of overall mortality among elderly subjects at high cardiovascular risk. Adjusting for confounders and comparing the highest versus the lowest quintiles of intake, total polyphenols were inversely associated with total mortality (HR=0.63, 95 CI=0.41-0.97, P-trend=0.12), as well as stilbenes (HR=0.48, 95 CI=0.25-0.91, P-trend=0.04) and lignans (HR=0.60, 95 CI=0.37-0.97, P-trend=0.03). In fact, our results showed that all polyphenols subgroups, except for dihydrochalcones, trended to be protective although their intake did not reach statistical significance. In stratified analyses we also found a stronger association between total polyphenol intake and mortality risk for women and for those who did not drink alcohol.
MedicalResearch.com Interview with:
Professor Marion M. Hetherington BSc (Hons) DipEd DPhil
Institute of Psychological Sciences
University of Leeds , Leeds, England
MedicalResearch: What are the main findings of the study?
Professor Hetherington: This study was part of a much larger, funded project called HabEat (European Community’s Seventh Framework Programme (FP7/2007-2013) under the grant agreement n°245012.
In this study we investigated the effects of offering a new vegetable (artichoke puree) to 332 children in the UK, Denmark and France from weaning age to 38 months. During the experiment each child was given between five and 10 servings of at least 100g of the artichoke puree in one of three versions: basic; sweetened, with added sugar; or added energy, where vegetable oil was mixed into the puree.
There was a strong effect of repeated exposure with no additional, clear benefit of adding sweetness or energy. Thus little difference in how much was eaten between children fed basic puree and those who ate the sweetened puree. This suggests that making vegetables sweeter does not make a significant difference to the amount children eat.
MedicalResearch.com Interview
Anna Peeters
Associate Professor, BSc(Hons) PhD
Head Obesity & Population Health | Baker IDI Heart and Diabetes Institute
President Australian & New Zealand Obesity Society
MedicalResearch: What are the main findings of the study?
Professor Peeters: The context for this study is that ‘point of sale menu labelling’ policies in fast food restaurants have some evidence of generally decreasing how many calories are consumed by people who go there. They may also lead the companies to reformulate their food to become slightly healthier. The key finding of our study is that those from more disadvantaged/ poorer backgrounds are unlikely to have a direct benefit from ‘point of sale menu labelling’ policies in fast food restaurants through a decreased number of calories consumed.