Dietary Patterns and All-Cause Mortality: A NESR Systematic Review

Objectives To inform the 2020–2025 Dietary Guidelines for Americans, the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) identified important public health questions to be examined by the 2020 Dietary Guidelines Advisory Committee. The Committee conducted a systematic review with support from USDA's Nutrition Evidence Systematic Review (NESR) team to answer the following question: What is the relationship between dietary patterns consumed and all-cause mortality? Methods The Committee developed protocols that described how they would use NESR's systematic review methodology to examine the evidence related to dietary patterns and all-cause mortality. NESR librarians conducted a literature search. NESR analysts dual-screened the results using pre-defined inclusion and exclusion criteria to identify articles published between 2000 and 2019 that evaluated dietary patterns and all-cause mortality. NESR analysts extracted data and assessed risk of bias of included studies. The Committee synthesized the evidence, developed conclusion statements, and graded the strength of the evidence underlying the conclusion statements. Results This review included one hundred and fifty-three studies, which were well-designed and conducted using rigorous methods, with low or moderate risks of bias. Precision, directness, and generalizability were demonstrated across the body of evidence. Results across studies were highly consistent in the foods and beverages included in the dietary patterns associated with reduced ACM risk. Robustness of results were confirmed by analyses with confounding factors. Conclusions Strong evidence demonstrates that dietary patterns in adults and older adults characterized by vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, and fish, lean meat or poultry when meat was included, are associated with decreased risk of all-cause mortality. These patterns were also relatively low in red and processed meat, high-fat dairy, and refined carbohydrates or sweets. Some of these dietary patterns also included alcoholic beverages in moderation. (Grade: Strong) Funding Sources USDA, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Alexandria, VA.

Dietary Patterns and Bone Health: A NESR Systematic Review

Objectives To inform the 2020–2025 Dietary Guidelines for Americans, USDA and HHS identified important public health questions to be examined by the 2020 Dietary Guidelines Advisory Committee. The Committee conducted a systematic review with support from USDA's Nutrition Evidence Systematic Review (NESR) team to answer the question: What is the relationship between dietary patterns consumed and bone health? Methods The Committee developed protocols that described how they would use NESR's systematic review methodology to examine the evidence. NESR librarians conducted a literature search, and NESR analysts dual-screened the results using pre-defined inclusion and exclusion criteria to identify articles published between 2014 and 2019 that evaluated dietary patterns and bone health, which updates an existing review of evidence from 2000 to 2014. NESR analysts extracted data and assessed risk of bias of included studies. The Committee synthesized the evidence, developed conclusion statements, and graded the strength of the evidence underlying the conclusion statements. Results This systematic review update includes seven prospective cohort studies in adults and two in children, in addition to the thirteen studies included in the existing review. Most studies had few risks of bias, with good consistency, directness, precision and generalizability. Results from studies in adults were consistent in the foods and beverages in the dietary patterns associated with reduced fracture risk. Based on this new evidence in adults, the Committee updated the grade from limited to moderate. Evidence in children remains insufficient. Conclusions Moderate evidence indicates that a dietary pattern higher in fruits, vegetables, legumes, nuts, low-fat dairy, whole grains, and fish, and lower in meats (particularly processed meats), sugar sweetened beverages, and sweets is associated with favorable bone health outcomes in adults, primarily decreased risk of hip fracture. (Grade: Adults – Moderate) Insufficient evidence is available to determine the relationship between dietary patterns consumed during childhood and bone health. (Grade: Children – Grade not assignable) Funding Sources USDA, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Alexandria, VA.

Prenatal Perception of WIC Breastfeeding Recommendation Affects First Month Postpartum Breastfeeding Outcomes

Objectives Promoting breastfeeding (BF) is a priority of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Pregnant WIC participants may differ in their perception of WIC recommendations, some believing WIC recommends BF only while others believe WIC recommends BF and formula equally. We examine the relationship between prenatal perceptions and BF outcomes at one month postpartum. Methods We use the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2), a longitudinal study of WIC mother-infant dyads, with 2649 mothers providing prenatal and 1-month interviews. Binary BF outcomes were created, including BF initiation, food first fed after birth, BF in the first hour, food first fed after hospital discharge, and current feeding in the first month. We compared BF outcomes for the two perception groups (BF only recommended vs. BF and formula recommended), using logistic regression and controlling for socio-demographic factors. The mechanism was explored via mediation analyses, using prenatal infant feeding intent (IFI) as the mediator. Analyses accounted for survey design effects. Results Of the pregnant mothers, 41.3% (±1.1%) perceived that WIC recommends BF only, and 58.7% (±1.1%) perceived that WIC recommends BF and formula equally. The “recommend BF only” group had consistently better BF outcomes than the other group: BF initiation: 89.1% vs. 81.4%; BF first fed after birth: 70.4% vs. 59.9%; Breastfed in the first hour: 62.9% vs. 55.8%; First breastfed after leaving hospital: 48.3% vs. 35.1%; Current BF feeding: 37.7% vs. 28.3% (All Ps < 0.001). Perceiving WIC recommends BF only significantly predicted higher odds of all BF outcomes [Odds Ratios (OR) varied from 1.4 to 1.6, all significant at 0.01 level]. IFI was significantly associated with perception of WIC BF recommendation (P < 0.001). After controlling for IFI, perceived WIC recommendation only significantly predicted BF first in the first hour and BF first after leaving hospital (P < 0.05). Conclusions Prenatal perception of WIC BF recommendations significantly predicts BF outcomes in the first month postpartum. Mediation analysis suggests perception may affect BF intention and then affect BF outcomes. Funding Sources The ITFPS-2 was funded by the Food and Nutrition Service, USDA. Study supported by the Economic Research Service, USDA, Agreement 58–4000-8–0038-R.

Beyond Funding

The Rural Child Poverty Nutrition Center (RCPNC) was created through grant funding from the United States Department of Agriculture Food and Nutrition Service and designed to address childhood food insecurity in persistently poor, rural counties in the United States. The RCPNC selected various community projects that focused on child nutrition assistance programs. Administration and technical assistance from the RCPNC allowed for improvements to child nutrition programs for the sub-grantees through the grant beginning with community needs assessments and programming meeting their individual needs. Evaluation found that the RCPNC was successful in assisting the sub-grantees reach their unique goals, which improve the initial outcomes as desired by the grant. Additionally, despite the unique communities the sub-grantees served, there were commonalities that linked all of the communities. This chapter describes the process with which the RCPNC sought unique communities with creative projects and explains the ways in which others can improve child nutrition outcomes.

Duration of WIC Participation Is Associated with Higher Dietary Quality at 24 Months (P11-048-19)

Objectives This study examined how duration of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is associated with dietary quality at age 24 months using Healthy Eating Index-2015 (HEI-2015) scores. Methods Data from the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2), a longitudinal study on WIC caregivers and their children, was used to examine WIC participation and diet quality. A weighted sample of 407,416 caregivers (unweighted = 1,349) from 80 WIC sites nationwide was included. Duration of WIC participation reflects the number of interviews during which caregivers responded that they were receiving WIC benefits (9 interviews occurred between 3 and 24 months). Responses were categorized into low (< 4 interviews), intermediate (5-7 interviews), and high (8-9 interviews) duration groups. Dietary intake was assessed using 24-h dietary recalls administered to caregivers. One-way ANOVA was used to compare average HEI component and total scores by WIC duration. Multivariate linear regression was used to examine independent effects of WIC participation duration on HEI-2015 total score, controlling for maternal race, ethnicity, and education, and household poverty status. Results The mean total HEI-2015 score of all children at 24 months was 60.5 (SE = 0.4). Total unadjusted HEI-2015 scores were statistically different across WIC duration categories, with more favorable scores among those in the high duration group [Low duration = 55.2 (SE = 1.8), Intermediate duration = 59.2 (SE = 0.8), High duration = 60.9 (SE = 0.4)]. After controlling for sociodemographic factors, high WIC duration was associated with a significantly higher HEI-2015 total score compared with the low WIC duration group (b = 4.06, P < 0.05). Ethnicity was also significantly associated with total HEI; Hispanic participants had higher mean HEI-2015 scores compared with non-Hispanic Whites (b = 6.25, P < 0.05). Conclusions Higher dietary quality was significantly positively associated with WIC duration, as reflected in higher scores for total HEI-2015 and in key categories such as total vegetables, refined grains, and saturated fat. Findings suggest that longer participation in WIC contributes to continued nutritional benefits. Funding Sources WIC ITFPS-2 is a federally funded study under the direction of the Office of Policy Support in the Food and Nutrition Service, U.S. Department of Agriculture.

Likelihood of Breastfeeding Within the USDA’s Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children Population

Background: Breastfeeding is an important public health initiative. Low-income women benefiting from the U.S. Department of Agriculture’s Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are a prime population for breastfeeding promotion efforts. Research aim: This study aims to determine factors associated with increased likelihood of breastfeeding for WIC participants. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the systematic review of literature. Database searches occurred in September and October 2014 and included studies limited to the previous 10 years. The following search terms were used: low-income; WIC; women, infants, and children; breastfeeding; breast milk; and maternal and child health. The criterion for inclusion was a study sample of women and children enrolled in the WIC program, thereby excluding non-United States–based research. Results: Factors that increased the likelihood of breastfeeding for WIC participants included sociodemographic and health characteristics ( n = 17); environmental and media support ( n = 4); government policy ( n = 2); intention to breastfeed, breastfeeding in hospital, or previous breastfeeding experience ( n = 9); attitudes toward and knowledge of breastfeeding benefits ( n = 6); health care provider or social support; and time exposure to WIC services ( n = 5). Conclusion: The complexity of breastfeeding behaviors within this population is clear. Results provide multisectored insight for future research, policies, and practices in support of increasing breastfeeding rates among WIC participants.

Looking Upstream

This introductory chapter presents an overview of the four “upstream” policies on austerity, schools, food, and drugs. These policies are not typically regarded as urban policies, but they ought to be. In their present forms, they damage cities; but they can be changed. Such changes have the best potential for improving cities. In each of the four areas, city advocates and researchers have produced enormous bodies of evidence calling for reform. Vast troves of annual survey data as well as solid statistical analyses come from public agencies such as the National Center for Education Statistics, the Bureau of Justice Statistics, and the Food and Nutrition Service. More information comes from various state and city research organizations, new local programs, investigative journalists, and the research reports, journal articles, and books written by hundreds of individual researchers and research teams based for the most part at colleges and universities.