Publications by authors named "Heather A Eicher-Miller"

54 Publications

Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011-2016.

Am J Clin Nutr 2021 May 8. Epub 2021 May 8.

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Background: Food insecurity is associated with poorer nutrient intakes from food sources and lower dietary supplement use. However, its association with total usual nutrient intakes, inclusive of dietary supplements, and biomarkers of nutritional status among US children remains unknown.

Objective: The objective was to assess total usual nutrient intakes, Healthy Eating Index-2015 (HEI-2015) scores, and nutritional biomarkers by food security status, sex, and age among US children.

Methods: Cross-sectional data from 9147 children aged 1-18 y from the 2011-2016 NHANES were analyzed. Usual energy and total nutrient intakes and HEI-2015 scores were estimated using the National Cancer Institute method from 24-h dietary recalls.

Results: Overall diet quality was poor, and intakes of sodium, added sugars, and saturated fat were higher than recommended limits, regardless of food security status. Food-insecure girls and boys were at higher risk of inadequate intakes for vitamin D and magnesium, and girls also had higher risk for inadequate calcium intakes compared with their food-secure counterparts, when total intakes were examined. Choline intakes of food-insecure children were less likely to meet the adequate intake than those of their food-secure peers. No differences by food security status were noted for folate, vitamin C, iron, zinc, potassium, and sodium intakes. Food-insecure adolescent girls aged 14-18 y were at higher risk of micronutrient inadequacies than any other subgroup, with 92.8% (SE: 3.6%) at risk of inadequate intakes for vitamin D. No differences in biomarkers for vitamin D, folate, iron, and zinc were observed by food security status. The prevalence of iron deficiency was 12.7% in food-secure and 12.0% in food-insecure adolescent girls.

Conclusions: Food insecurity was associated with compromised intake of some micronutrients, especially among adolescent girls. These results highlight a need for targeted interventions to improve children's overall diet quality, including the reduction of specific nutrient inadequacies, especially among food-insecure children. This study was registered at clinicaltrials.gov as NCT03400436.
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http://dx.doi.org/10.1093/ajcn/nqab113DOI Listing
May 2021

Dietary Aspects to Incorporate in the Creation of a Mobile Image-Based Dietary Assessment Tool to Manage and Improve Diabetes.

Nutrients 2021 Apr 2;13(4). Epub 2021 Apr 2.

Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA.

Diabetes is the seventh leading cause of death in United States. Dietary intake and behaviors are essential components of diabetes management. Growing evidence suggests dietary components beyond carbohydrates may critically impact glycemic control. Assessment tools on mobile platforms have the ability to capture multiple aspects of dietary behavior in real-time throughout the day to inform and improve diabetes management and insulin dosing. The objective of this narrative review was to summarize evidence related to dietary behaviors and composition to inform a mobile image-based dietary assessment tool for managing glycemic control of both diabetes types (type 1 and type 2 diabetes). This review investigated the following topics amongst those with diabetes: (1) the role of time of eating occasion on indicators of glycemic control; and (2) the role of macronutrient composition of meals on indicators of glycemic control. A search for articles published after 2000 was completed in PubMed with the following sets of keywords "diabetes/diabetes management/diabetes prevention/diabetes risk", "dietary behavior/eating patterns/temporal/meal timing/meal frequency", and "macronutrient composition/glycemic index". Results showed eating behaviors and meal macronutrient composition may affect glycemic control. Specifically, breakfast skipping, late eating and frequent meal consumption might be associated with poor glycemic control while macronutrient composition and order of the meal could also affect glycemic control. These factors should be considered in designing a dietary assessment tool, which may optimize diabetes management to reduce the burden of this disease.
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http://dx.doi.org/10.3390/nu13041179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066992PMC
April 2021

Temporal physical activity patterns are associated with obesity in U.S. adults.

Prev Med 2021 Jul 30;148:106538. Epub 2021 Mar 30.

Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA. Electronic address:

Few attempts have been made to incorporate multiple aspects of physical activity (PA) to classify patterns linked with health. Temporal PA patterns integrating time and activity counts were created to determine their association with health status. Accelerometry data from the National Health and Nutrition Examination Survey 2003-2006 was used to pattern PA counts and time of activity from 1999 adults with one weekday of activity. Dynamic time warping and kernel k-means clustering partitioned 4 participant clusters representing temporal PA patterns. Multivariate regression models determined associations between clusters and health status indicators and obesity, type 2 diabetes, and metabolic syndrome. Cluster 1 with a temporal PA pattern of the lowest activity counts reaching 4.8e cph from 6:00-23:00 was associated with higher body mass index (BMI) (β = 2.5 ± 0.6 kg/m, 95% CI: 1.0, 4.1), higher waist circumference (WC) (β = 6.4 ± 1.3 cm, 95% CI: 2.8, 10.0), and higher odds of obesity (OR: 2.4; 95% CI: 1.3, 4.4) compared with Cluster 3 with activity counts reaching 9.6e-1.2e cph between 16:00-21:00. Cluster 1 was also associated with higher BMI (β = 1.5 ± 0.5 kg/m, 95% CI: 0.1, 2.8) and WC (β = 3.6 ± 1.3 cm, 95% CI: 0.1, 7.0) compared to Cluster 4 with activity counts reaching 9.6e cph between 8:00-11:00. A Temporal PA pattern with the lowest PA counts had significantly higher mean BMI and WC compared to temporal PA patterns of higher activity counts performed early (8:00-11:00) or late (16:00-21:00) throughout the day. Temporal PA patterns appear to meaningfully link to health status.
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http://dx.doi.org/10.1016/j.ypmed.2021.106538DOI Listing
July 2021

Food Insecurity and Cardiovascular Disease Risk.

Curr Atheroscler Rep 2021 Mar 27;23(6):24. Epub 2021 Mar 27.

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Purpose Of Review: This review examines the current epidemiological evidence for the relationship between levels of food insecurity and cardiovascular disease (CVD) outcomes among US adults > 17 years.

Recent Findings: Review of recent literature revealed that reduced food security was associated with decreased likelihood of good self-reported cardiovascular health and higher odds of reporting CVD-related outcomes such as coronary heart disease, angina, heart attack, peripheral arterial disease, and hypertension. Existing evidence suggests a compelling association between each level of reduced food security and CVD risk with a particularly strong association between very low food security and CVD risk. Policies and public health-based strategies are needed to identify the most vulnerable subgroups, strengthen and enhance access to food assistance programs, and promote awareness and access to healthful foods and beverages to improve food security, nutrition, and cardiovascular health.
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http://dx.doi.org/10.1007/s11883-021-00923-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000689PMC
March 2021

Expanding the Capabilities of Nutrition Research and Health Promotion Through Mobile-Based Applications.

Adv Nutr 2021 Jun;12(3):1032-1041

Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA.

Mobile-based applications are popular and prevalently used in the US population. Applications focusing on nutrition offer platforms for quantifying and changing behaviors to improve dietary intake. Such behavior changes can intervene in the relation of diet to promote health and prevent disease. Mobile applications offer a safe and convenient way to collect user data and share it back to users, researchers, and to health care providers. Other lifestyle factors like activity, sleep, and sedentary behavior, can also be quantified and included in investigations of how lifestyle is related to health. Yet, challenges in the assessment offered through mobile applications and effectiveness to change behavior still remain, including rigorous evaluation, demonstration of successful health improvement, and participant engagement. The data mobile applications generate, however, expands opportunities for discovery of the integrated and time-based nature of various daily activities in relation to health. This article is a summary of a symposium at Nutrition 2020 Live Online on the role of mobile applications as a tool for nutrition research and health promotion. The types and capabilities of mobile applications, challenges in their evaluation and use in research, and opportunities for the data they generate along with a specific example, are reviewed.
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http://dx.doi.org/10.1093/advances/nmab022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166539PMC
June 2021

Fruit and Vegetable Healthy Eating Index Component Scores of Distributed Food Bags Were Positively Associated with Client Diet Scores in a Sample of Rural, Midwestern Food Pantries.

J Acad Nutr Diet 2021 01 21;121(1):74-83. Epub 2020 Oct 21.

Background: Food pantries have the potential to improve the quality of clients' diets.

Objective: This study evaluated the relationship between the quality of the mix of foods in pantry inventories and client food bags (separately), as assessed by the Healthy Eating Index-2010 (HEI-2010), with client diet quality and how these relationships varied by food security status.

Design: This cross-sectional, secondary analysis used baseline data from the Voices for Food intervention study (Clinical Trial Registry: NCT03566095). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected. Foods available in pantry inventories and distributed in client food bags were recorded at one time point during baseline data collection.

Participants And Setting: A convenience sample of adult food pantry clients (N = 575) from 24 rural, food pantries in the US Midwest was recruited from August to November 2014.

Main Outcome Measures: Pantry inventories, client food bags, and client diets were scored using the HEI-2010. Main outcomes were client HEI-2010 scores.

Statistical Analyses Performed: Linear regression models estimated associations between HEI-2010 total and component scores for pantry inventories and client food bags (in separate models) and the corresponding scores for client dietary intake. The interaction of client food security status, and potential pantry- and client-level confounders, was considered.

Results: Client food bag HEI-2010 scores were positively associated with client diet scores for total vegetables, greens and beans, and total fruit components, whereas pantry inventory HEI-2010 scores were negatively associated with client diet scores for total fruit, total protein foods, and seafood and plant proteins components. Client food bag whole-grains scores were more strongly associated with very low food secure compared with food secure client diet scores (all P values < 0.05).

Conclusions: The quality of client food bags, but not of pantry inventories, was positively associated with client diet quality in a rural sample in the US Midwest.
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http://dx.doi.org/10.1016/j.jand.2020.09.033DOI Listing
January 2021

Temporal Dietary Patterns Are Associated with Obesity in US Adults.

J Nutr 2020 12;150(12):3259-3268

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Background: The integration of time with dietary patterns throughout a day, or temporal dietary patterns (TDPs), have been linked with dietary quality but relations to health are unknown.

Objective: The association between TDPs and selected health status indicators and obesity, type 2 diabetes (T2D), and metabolic syndrome (MetS) was determined.

Methods: The first-day 24-h dietary recall from 1627 nonpregnant US adult participants aged 20-65 y from the NHANES 2003-2006 was used to determine timing, amount of energy intake, and sequence of eating occasions (EOs). Modified dynamic time warping (MDTW) and kernel k-means algorithm clustered participants into 4 groups representing distinct TDPs. Multivariate regression models determined associations between TDPs and health status, controlling for potential confounders, and adjusting for the survey design and multiple comparisons (P <0.05/6).

Results: A cluster representing a TDP with evenly spaced, energy balanced EOs reaching ≤1200 kcal between 06:00 to 10:00, 12:00 to 15:00, and 18:00 to 22:00, had statistically significant and clinically meaningful lower mean BMI (P <0.0001), waist circumference (WC) (P <0.0001), and 75% lower odds of obesity compared with 3 other clusters representing patterns with much higher peaks of energy: 1000-2400 kcal between 15:00 and 18:00 (OR: 5.3; 95% CI: 2.8, 10.1), 800-2400 kcal between 11:00 and 15:00 (OR: 4.4; 95% CI: 2.5, 7.9), and 1000-2600 kcal between 18:00 and 23:00 (OR: 6.7; 95% CI: 3.9, 11.6).

Conclusions: Individuals with a TDP characterized by evenly spaced, energy balanced EOs had significantly lower mean BMI, WC, and odds of obesity compared with the other patterns with higher energy intake peaks at different times throughout the day, providing evidence that incorporating time with other aspects of a dietary pattern may be important to health status.
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http://dx.doi.org/10.1093/jn/nxaa287DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726125PMC
December 2020

Nutrition among Vulnerable U.S. Populations.

Nutrients 2020 Oct 15;12(10). Epub 2020 Oct 15.

Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.

Food insecurity and low resources continue to be a burden influencing the health, well-being, growth and development of millions of U [...].
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http://dx.doi.org/10.3390/nu12103150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602584PMC
October 2020

Nutritional contributions of food pantries and other sources to the diets of rural, Midwestern food pantry users in the USA.

Br J Nutr 2021 Apr 2;125(8):891-901. Epub 2020 Sep 2.

Department of Nutrition Science, Purdue University, West Lafayette, IN47907, USA.

Food pantries provide free food to individuals at nutritional risk given lack of available foods. Frequent use of food pantries is associated with higher dietary quality; however, neither the nutrient contributions of food pantries to participant diets nor their relationship with household food security are known. This cross-sectional analysis used secondary data from rural food pantry participants, including sociodemographic characteristics, household food security and 24-h recalls. Mean intakes of selected food groups and nutrients from food pantries, supermarkets, other stores and restaurants, and other were compared by one-way ANCOVA. Interaction effects of household food security with food sources were evaluated by two-way ANCOVA. About 40 % of participants' dietary intake came from food pantries. Mean intakes of fibre (P < 0·0001), Na (P < 0·0001), fruit (P < 0·0001), grains (P < 0·0001) and oils (P < 0·0001) were higher from food pantries compared with all other sources, as were Ca (P = 0·004), vitamin D (P < 0·0001) and K (P < 0·0001) from food pantries compared with two other sources. Percentage total energy intake (%TEI) from added sugars (P < 0·0001) and saturated fat (P < 0·0001) was higher from supermarkets than most other sources. Significant interaction effects were observed between food sources and household food security for vegetables (P = 0·01), Na (P = 0·01) and %TEI from saturated fat (P = 0·004), with food-insecure participants having significantly higher intakes from food pantries and/or supermarkets compared with all other sources. Future interventions may incorporate these findings by providing education on purchasing and preparing healthy meals on limited budgets, to complement foods received from pantries, and by reducing Na in pantry environments.
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http://dx.doi.org/10.1017/S0007114520003372DOI Listing
April 2021

Supplemental Nutrition Assistance Program-Education Improves Food Security Independent of Food Assistance and Program Characteristics.

Nutrients 2020 Aug 29;12(9). Epub 2020 Aug 29.

Health and Human Sciences Cooperative Extension, Purdue University, West Lafayette, IN 47907, USA.

The purpose of this project was to determine whether consistent food assistance program participation or changes in participation over time mediated or moderated the effect of federal nutrition education through the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) on food security and determine the associations of SNAP-Ed program delivery characteristics with change in food security. This secondary analysis used data from a randomized controlled trial from September 2013 through April 2015. SNAP-Ed-eligible participants ( = 328; ≥18 years) in households with children were recruited from 39 counties in Indiana, USA. The dependent variable was one year change in household food security score measured using the United States Household Food Security Survey Module. Assessment of mediation used Barron-Kenny analysis and moderation used interactions of food assistance program use and changes over time with treatment group in general linear regression modeling. Program delivery characteristics were investigated using mixed linear regression modeling. Results showed that neither consistent participation nor changes in food assistance program participation over time mediated nor moderated the effect of SNAP-Ed on food security and neither were SNAP-Ed program delivery characteristics associated with change in food security over the one year study period. SNAP-Ed directly improved food security among SNAP-Ed-eligible Indiana households with children regardless of food assistance program participation and changes over time or varying program delivery characteristics.
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http://dx.doi.org/10.3390/nu12092636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551191PMC
August 2020

Dietary Quality and Usual Intake of Underconsumed Nutrients and Related Food Groups Differ by Food Security Status for Rural, Midwestern Food Pantry Clients.

J Acad Nutr Diet 2020 09 20;120(9):1457-1468. Epub 2020 Jul 20.

Background: Food pantry users represent a predominantly food insecure population, yet dietary intake may differ among food secure (FS), low FS, and very low FS clients. Usual intake of food groups and nutrients by food security status has not previously been compared among food pantry clients.

Objective: This study aimed to estimate the usual intakes of underconsumed nutrients (ie, potassium; dietary fiber; choline; magnesium; calcium; vitamins A, D, E, and C; and iron) and related food groups (ie, vegetables, fruits, whole grains, and dairy) and dietary quality, and to evaluate their relationship with food security status.

Design: This cross-sectional, secondary analysis used baseline data from a prior intervention study (Clinical Trial Registry: NCT03566095). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected.

Participants/setting: This community-based study included a convenience sample of adult, midwestern food pantry clients (N=579) recruited from August to November 2014.

Main Outcome Measures: Main outcomes evaluated were Healthy Eating Index-2010 scores and usual intakes of underconsumed nutrients and related food groups.

Statistical Analyses Performed: Linear regression models and the National Cancer Institute method, adjusting for confounders, were used to estimate associations of food security with diet quality and usual intake, respectively.

Results: Being FS was associated with a higher whole grains HEI-2010 score and higher mean usual intake of whole grains compared with being low FS. Being FS was associated with higher usual intakes of iron and dairy compared with being very low FS. Being FS was associated with a higher mean usual intake of dark green vegetables compared with being low FS and very low FS. Usual intakes were below federal guidance for all subgroups of food security.

Conclusions: Although food security status may differentiate dietary intake among food pantry clients, improvements are needed among all clients.
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http://dx.doi.org/10.1016/j.jand.2020.04.011DOI Listing
September 2020

Associations between Subjective and Objective Measures of the Community Food Environment and Executive Function in Early Childhood.

Nutrients 2020 Jun 30;12(7). Epub 2020 Jun 30.

Human Development & Family Studies, Purdue University, 1202 W. State Street, West Lafayette, IN 47907, USA.

The present study utilized a cross-sectional design to assess whether two indicators of the community food environment, parent perceptions of the community food environment (i.e., as assessed by parent reports of access to, availability, and affordability of foods) and limited food access (via census data), were related to executive function in preschool children. Children were recruited during the 2014-2015 academic year from Head Start and community-based preschools ( = 102) and children's executive function ability was tested using the Head-Toes-Knees-Shoulders task. Multiple linear regression analysis was used, as well as adjusted standard errors to account for clustering at the classroom level. Parent reports of their food environment were significantly related to children's executive function, such that children living in higher quality community food environments had better executive function. In contrast, limited food access using census data was not significantly related to executive function. The results suggest that parent reports of the community food environment in early childhood may contribute to young children's cognitive outcomes more so than being in a limited food access area, as these data may not represent individual behaviors or capture the variability of the accessibility and affordability of healthy foods. Policy makers should consider correlations between the food environment and early executive functioning when developing new community health/wellness legislation.
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http://dx.doi.org/10.3390/nu12071944DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400594PMC
June 2020

Diet Quality and Associations with Food Security among Women Eligible for Indiana Supplemental Nutrition Assistance Program-Education.

J Nutr 2020 08;150(8):2191-2198

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Background: The diet quality among adults receiving nutrition education lessons through Supplemental Nutrition Assistance Program-Education (SNAP-Ed) is currently unknown.

Objectives: The objectives of this study were to characterize the diet quality of Indiana SNAP-Ed-eligible women; estimate their mean usual intake of fruits, vegetables, dairy, and whole grains compared to Dietary Guidelines for Americans (DGA) recommendations; and determine if these dietary outcomes differed by food security status.

Methods: SNAP-Ed paraprofessionals recruited participants from August 2015 to May 2016 for this secondary analysis of cross-sectional data collected as the baseline assessment for a randomized controlled trial. Participants were SNAP-Ed-eligible women aged ≥18 y interested in nutrition education lessons. Dietary outcomes were assessed by one or two 24-h dietary recalls. The Healthy Eating Index (HEI)-2010 was used to characterize diet quality. Mean usual intake of food groups was estimated using the National Cancer Institute Method. Food security status was classified using the US Household Food Security Survey Module. Data were analyzed in October 2019.

Results: Mean ± SEM HEI-2010 total score was 42 ± 0.9 for the study sample. Mean ± SE usual intake of servings of fruits (0.61 ± 0.08 cups [144.32 ± 18.93 mL]), vegetables [1.4 ± 0.10 cups (331.2 ± 23.66 mL)], dairy [1.5 ± 0.11 cups (354.88 ± 26.02 mL)], and whole grains [0.48 ± 0.06 ounces (13.61 ± 1.70 g)] did not differ by food security subgroup. Mean HEI-2010 total score was significantly higher by 4.8 ± 2.0 points for the food-secure than for the food-insecure subgroup (P = 0.01). Mean HEI-2010 component scores were 1.1 ± 0.5 points higher for whole grain (P = 0.01) and 1.0 ± 0.5 points higher for dairy (P = 0.05) in the food-secure than in the food-insecure subgroup. The proportions of the study sample not meeting the DGA recommendations for food group intake were ≥85% for both food-secure and -insecure subgroups.

Conclusions: Indiana SNAP-Ed-eligible women reported poor diet quality, highlighting their need for nutrition interventions aiming to improve food security and diet as per DGA recommendations in low-income populations.
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http://dx.doi.org/10.1093/jn/nxaa171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690761PMC
August 2020

Older adults with obesity have higher risks of some micronutrient inadequacies and lower overall dietary quality compared to peers with a healthy weight, National Health and Nutrition Examination Surveys (NHANES), 2011-2014.

Public Health Nutr 2020 09 29;23(13):2268-2279. Epub 2020 May 29.

Department of Nutrition Science, Purdue University, West Lafayette, IN47907, USA.

Objective: To evaluate total usual intakes and biomarkers of micronutrients, overall dietary quality and related health characteristics of US older adults who were overweight or obese compared with a healthy weight.

Design: Cross-sectional study.

Setting: Two 24-h dietary recalls, nutritional biomarkers and objective and subjective health characteristic data were analysed from the National Health and Nutrition Examination Survey 2011-2014. We used the National Cancer Institute method to estimate distributions of total usual intakes from foods and dietary supplements for eleven micronutrients of potential concern and the Healthy Eating Index (HEI)-2015 score.

Participants: Older adults aged ≥60 years (n 2969) were categorised by sex and body weight status, using standard BMI categories. Underweight individuals (n 47) were excluded due to small sample size.

Results: A greater percentage of obese older adults compared with their healthy-weight counterparts was at risk of inadequate Mg (both sexes), Ca, vitamin B6 and vitamin D (women only) intakes. The proportion of those with serum 25-hydroxyvitamin D < 40 nmol/l was higher in obese (12 %) than in healthy-weight older women (6 %). Mean overall HEI-2015 scores were 8·6 (men) and 7·1 (women) points lower in obese than in healthy-weight older adults. In addition, compared with healthy-weight counterparts, obese older adults were more likely to self-report fair/poor health, use ≥ 5 medications and have limitations in activities of daily living and cardio-metabolic risk factors; and obese older women were more likely to be food-insecure and have depression.

Conclusions: Our findings suggest that obesity may coexist with micronutrient inadequacy in older adults, especially among women.
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http://dx.doi.org/10.1017/S1368980020000257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429309PMC
September 2020

Correction: Marah Aqeel et al. "The Effect of Timing of Exercise and Eating on Postprandial Response in Adults: A Systematic Review". Nutrients 2020, 12, 221.

Nutrients 2020 Apr 29;12(5). Epub 2020 Apr 29.

Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA.

In the original paper, the total number of included studies was = 20 and is = 17 in the revised version. Also, in the original paper, the total number of participants was = 352, while it is = 332 in the revised paper.
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http://dx.doi.org/10.3390/nu12051263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281960PMC
April 2020

A review of the food security, diet and health outcomes of food pantry clients and the potential for their improvement through food pantry interventions in the United States.

Physiol Behav 2020 06 13;220:112871. Epub 2020 Mar 13.

Department of Nutrition Science, Purdue University 700 W. State Street, West Lafayette, IN 47907-2059, United States. Electronic address:

Food pantries are community-based organizations that provide food to prevalently low and very low food secure households, presenting an opportune point of contact and potential site for interventions. This review evaluates the food security, dietary quality, dietary intake and health outcomes of U.S. adults served by food pantries and the potential for interventions based in food pantries to improve these outcomes. Results from the 15 included studies showed the prevalence of food insecurity and very low food security among food pantry clients was higher than national estimates at up to 89% and 52%, respectively; dietary quality was up to 20 points lower on the Healthy Eating Index compared with U.S. adults; intake for 16 nutrients did not meet the Estimated Average Requirement or exceed the Average Intake for 30% to 100% of clients; and a strikingly high prevalence of obesity, diabetes, heart disease and related conditions, and depressive symptoms were present among U.S. food pantry users. Interventions in food pantries have been successful in improving food security, weight and diabetic control but not dietary quality or intake. However, these few interventions hold promise and present a need for further research investment to address food security, dietary intake and health outcomes among food pantry clients.
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http://dx.doi.org/10.1016/j.physbeh.2020.112871DOI Listing
June 2020

Frequently Consumed Foods and Energy Contributions among Food Secure and Insecure U.S. Children and Adolescents.

Nutrients 2020 Jan 23;12(2). Epub 2020 Jan 23.

Department of Nutrition Science, Purdue University, 700 W State St, West Lafayette, IN 47907, USA.

Food insecurity is associated with nutritional risk in children. This study identified and compared the most frequently consumed foods, beverages, and food groups and their contributions to energy intake among U.S. children and adolescents (6-11, 12-17 years) by food security status. Dietary intake from the day-1, 24-h dietary recall, and household child food security status were analyzed in the 2007-2014 National Health and Nutrition Examination Survey ( = 8123). Foods and beverages were classified into food categories, ranked, and compared by weighted proportional frequency and energy contribution for food security groups by age. Significant differences between household child food security groups were determined using the Rao-Scott modified chi-square statistic. The weighted proportional frequency of beverages (including diet, sweetened, juice, coffee, and tea) and their energy was significantly higher among food insecure compared with food secure while the reverse was true for water frequency among 12-17 years. Beverage and mixed dish frequency were higher among food insecure compared with food secure 6-11 years while the reverse was true for frequency and energy from snacks. Frequency-differentiated intake patterns for beverages and snacks by food security across age groups may inform dietary recommendations, population-specific dietary assessment tools, interventions, and policy for food insecure children.
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http://dx.doi.org/10.3390/nu12020304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7070395PMC
January 2020

The Effect of Timing of Exercise and Eating on Postprandial Response in Adults: A Systematic Review.

Nutrients 2020 Jan 15;12(1). Epub 2020 Jan 15.

Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA.

Type 2 diabetes is a major public health concern. Management of this condition has focused on behavior modification through diet and exercise interventions. A growing body of evidence has focused on temporality of dietary intake and exercise and potential effects on health. This review summarizes current literature that investigates the question "how does the timing of exercise relative to eating throughout the day effect postprandial response in adults?" Databases PubMed, Scopus, Cochrane Library, CINAHL, and SPORTDiscus were searched between March-May 2019. Experimental studies conducted in healthy adults (≥18 y) and those with type 2 diabetes were included. Full texts were examined by at least two independent reviewers. Twenty studies with a total of 352 participants met the inclusion criteria. The primary finding supports that exercise performed post-meal regardless of time of day had a beneficial impact on postprandial glycemia. There was insufficient evidence regarding whether timing of exercise performed pre- vs. post-meal or vice versa in a day is related to improved postprandial glycemic response due to inherent differences between studies. Future studies focusing on the investigation of timing and occurrence of meal intake and exercise throughout the day are needed to inform whether there is, and what is, an optimal time for these behaviors regarding long-term health outcomes.
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http://dx.doi.org/10.3390/nu12010221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019516PMC
January 2020

Total Usual Micronutrient Intakes Compared to the Dietary Reference Intakes among U.S. Adults by Food Security Status.

Nutrients 2019 Dec 22;12(1). Epub 2019 Dec 22.

Interdepartmental Nutrition Program, Purdue University, 700 W. State Street, West Lafayette, IN 47907, USA.

This study examined total usual micronutrient intakes from foods, beverages, and dietary supplements (DS) compared to the Dietary Reference Intakes among U.S. adults (≥19 years) by sex and food security status using NHANES 2011-2014 data ( = 9954). DS data were collected via an in-home interview; the NCI method was used to estimate distributions of total usual intakes from two 24 h recalls for food and beverages, after which DS were added. Food security status was categorized using the USDA Household Food Security Survey Module. Adults living in food insecure households had a higher prevalence of risk of inadequacy among both men and women for magnesium, potassium, vitamins A, B6, B12, C, D, E, and K; similar findings were apparent for phosphorous, selenium, and zinc in men alone. Meanwhile, no differences in the prevalence of risk for inadequacy were observed for calcium, iron (examined in men only), choline, or folate by food security status. Some DS users, especially food secure adults, had total usual intakes that exceeded the Tolerable Upper Intake Level (UL) for folic acid, vitamin D, calcium, and iron. In conclusion, while DS can be helpful in meeting nutrient requirements for adults for some micronutrients, potential excess may also be of concern for certain micronutrients among supplement users. In general, food insecure adults have higher risk for micronutrient inadequacy than food secure adults.
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http://dx.doi.org/10.3390/nu12010038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019721PMC
December 2019

Comparison of 4 Methods to Assess the Prevalence of Use and Estimates of Nutrient Intakes from Dietary Supplements among US Adults.

J Nutr 2020 04;150(4):884-893

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Background: Accurate and reliable methods to assess prevalence of use of and nutrient intakes from dietary supplements (DSs) are critical for research, clinical practice, and public health monitoring. NHANES has been the primary source of DS usage patterns using an in-home inventory with a frequency-based DS and Prescription Medicine Questionnaire (DSMQ), but little is known regarding DS information obtained from 24-h dietary recalls (24HRs).

Methods: The objectives of this analysis were to compare results from 4 different methods for measuring DS use constructed from two data collection instruments (i.e., DSMQ and 24HR) and to determine the most comprehensive method for measuring the prevalence of use and estimating nutrient intakes from DS for selected nutrients. NHANES 2011-2014 data from US adults (aged ≥19 y; n = 11,451) were used to examine the 4 combinations of methods constructed for measuring the prevalence of use of and amount of selected nutrients from DSs (i.e., riboflavin, vitamin D, folate, magnesium, calcium): 1) DSMQ, 2) 24HR day 1, 3) two 24HRs (i.e., mean), and 4) DSMQ or at least one 24HR.

Results: Half of US adults reported DS use on the DSMQ (52%) and on two 24HRs (mean of 49%), as compared with a lower prevalence of DS use when using a single 24HR (43%) and a higher (57%) prevalence when combining the DSMQ with at least one 24HR. Mean nutrient intake estimates were highest using 24HR day 1. Mean supplemental calcium from the DSMQ or at least one 24HR was 372 mg/d, but 464 mg/d on the 24HR only. For vitamin D, the estimated intakes per consumption day were higher on the DSMQ (46 μg) and the DSMQ or at least one 24HR (44 μg) than those on the 24HR day 1 (32 μg) or the mean 24HR (31 μg). Fewer products were also classed as a default or reasonable match on the DSMQ than on the 24HR.

Conclusions: A higher prevalence of use of DSs is obtained using frequency-based methods, whereas higher amounts of nutrients are reported from a 24HR. The home inventory results in greater accuracy for products reported. Collectively, these findings suggest that combining the DSMQ with at least one 24HR (i.e., DSMQ or at least one 24HR) is the most comprehensive method for assessing the prevalence of and estimating usual intake from DSs in US adults.This trial was registered at clinicaltrials.gov as NCT03400436.
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http://dx.doi.org/10.1093/jn/nxz306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138661PMC
April 2020

Breakfast Consumption Is Positively Associated with Usual Nutrient Intakes among Food Pantry Clients Living in Rural Communities.

J Nutr 2020 03;150(3):546-553

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Background: Breakfast consumption has declined over the past 40 y and is inversely associated with obesity-related diet and health outcomes. The breakfast pattern of food pantry clients and its association with diet is unknown.

Objective: The objective is to investigate the association of breakfast consumption with diet quality and usual nutrient intakes among food pantry clients (n = 472) living in rural communities.

Methods: This was an observational study using cross-sectional analyses. English-speaking participants ≥18 y (or ≥19 y in Nebraska) were recruited from 24 food pantries in rural high-poverty counties in Indiana, Michigan, Missouri, Nebraska, Ohio, and South Dakota. Participants were surveyed at the pantry regarding characteristics and diet using 24-h recall. A second recall was self-completed or completed via assisted phone call within 2 wk of the pantry visit. Participants were classified as breakfast skippers when neither recall reported breakfast ≥230 kcal consumed between 04:00 and 10:00; breakfast consumers were all other participants. The Healthy Eating Index-2010 was modeled with breakfast pattern using multiple linear regression. Mean usual intake of 16 nutrients was estimated using the National Cancer Institute Method and compared across breakfast pattern groups. Usual nutrient intake was compared with the Estimated Average Requirement (EAR) or Adequate Intake (AI) to estimate the proportion of population not meeting the EAR or exceeding the AI.

Results: A total of 56% of participants consumed breakfast. Compared with breakfast skippers, breakfast consumers had 10-59% significantly higher usual mean intakes of all nutrients (P ≤ 0.05), and had 12-21% lower prevalence of at-risk nutrient intakes except for vitamin D, vitamin E, and magnesium.

Conclusions: Adult food pantry clients living in rural communities experienced hardships in meeting dietary recommendations. Breakfast consumption was positively associated with usual nutrient intakes in this population. This trial was registered at clinicaltrials.gov as NCT03566095.
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http://dx.doi.org/10.1093/jn/nxz258DOI Listing
March 2020

The development and use of an assessment tool to capture changes in the food pantry nutrition environment and system of food distribution.

Transl Behav Med 2019 10;9(5):962-969

Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD, USA.

Rural food pantries aim to improve food access but low-quality nutritional environments and prescribed systems of food distribution may limit these efforts. Voices for Food (VFF) is a six-state U.S. Department of Agriculture-funded intervention, including community coaching and a VFF Food Pantry Toolkit to guide food pantries in transitioning to a healthier nutritional environment and a food distribution system based on client choice and support.The purpose of the article was to create a novel tool (MyChoice Scorecard) to assess the food pantry environment, including client choice, and to use the tool to quantify change in VFF intervention pantries compared with comparison pantries longitudinally over the 3-year study period. Food pantries in rural, high-poverty counties in six Midwestern states participated in a longitudinal, matched treatment and comparison study. Pantries were assigned to treatment (n = 12) or comparison (n = 12) group. A MyChoice Scorecard was completed pre-, mid- and post-intervention. Mixed models were generated with MyChoice Scorecard score as the outcome and included main effects for intervention group and time since pre-intervention visit. Pre-intervention, MyChoice scores did not differ significantly between intervention and comparison pantries (8.5 ± 1.5 vs. 9.1 ± 1.5, p = .19). Marginal mean values for MyChoice Scorecard score differed significantly between treatment and comparison groups at both mid-intervention (14.6 ± 1.4 vs. 10.8 ± 1.4, p = .05) and post-intervention (21.8 ± 1.2 vs. 11.8 ± 1.2, p < .001). The MyChoice Scorecard, either alone or as part of the VFF intervention, can be used by community public health professionals, such as Extension staff, to document and facilitate meaningful change in the nutritional environment of food pantries.
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http://dx.doi.org/10.1093/tbm/ibz114DOI Listing
October 2019

Distance metrics optimized for clustering temporal dietary patterning among U.S. adults.

Appetite 2020 01 12;144:104451. Epub 2019 Sep 12.

School of Electrical and Computer Engineering, 465 Northwestern Avenue, Purdue University, West Lafayette, IN, 47907, USA. Electronic address:

Objective: Few attempts to determine dietary patterns have incorporated concepts of time, specifically time and proportion of energy intake consumed throughout a day. A type of modified dynamic time warping (MDTW) was previously developed using an appropriate distance metric for patterning these aspects to determine temporal dietary patterns (TDP). This study further explores dynamic time warping (DTW) distance metrics including unconstrained DTW (UDTW), constrained DTW (CDTW), and MDTW with modern spectral clustering methods to optimize TDP related to dietary quality. MDTW was expected to create TDP with the strongest relationships to dietary quality and distinct visualization among U.S. adults 20-65y of the National Health and Nutrition Examination Survey 1999-2004.

Methods: Proportional energy intake by time of day metrics were optimized to create TDP from complete day-one 24-h dietary recalls using MDTW, UDTW with only a standard local constraint, and CDTW with standard local and global banding constraints, then clustered using spectral clustering. The association between each TDP distance metric clustering and mean dietary quality, as indicated by the 2005 Healthy Eating Index (HEI-2005), were determined using multiple linear regression controlled for potential confounders. Strength of association for each model was compared using adjusted R-squared. The results were also visualized to make qualitative comparisons.

Results: Four clusters representing distinct TDP for each distance metric by spectral clustering were generated among participants. MDTW exhibited TDP clusters with strongest associations to HEI compared with the TDP clusters generated from unconstrained and constrained DTW, and visualization of the TDP clusters from MDTW supported the association.

Implication: MDTW paired with spectral clustering is a useful tool for dimension reduction and uncovering temporal patterns with dietary data.
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http://dx.doi.org/10.1016/j.appet.2019.104451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875636PMC
January 2020

Effect of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) on food security and dietary outcomes.

Nutr Rev 2019 12;77(12):903-921

Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA.

The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) is the nutrition promotion component of SNAP, formerly known as food stamps. SNAP-Ed assists low-income populations in the United States improve dietary intake and reduce food insecurity through nutrition education. This narrative review summarizes current investigations of SNAP-Ed's effectiveness at improving food security and dietary outcomes, and it can help inform future policy and implementation of the program. There was stronger evidence for SNAP-Ed as an effective means of improving food security (n = 4 reports) than for its effects on nutrition or dietary outcomes (n = 10 reports). Inconsistency in measurement tools and outcomes and a lack of strong study designs characterized the studies that sought to evaluate the effectiveness of SNAP-Ed at improving nutrition or dietary outcomes. Additional rigorous study designs in diverse population groups are needed to strengthen the evidence. In the face of reduced financial SNAP benefits, SNAP-Ed may play an important role in helping to eliminate food insecurity and improve dietary outcomes and, ultimately, the health of low-income Americans.
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http://dx.doi.org/10.1093/nutrit/nuz013DOI Listing
December 2019

Frequency of Food Pantry Use Is Associated with Diet Quality among Indiana Food Pantry Clients.

J Acad Nutr Diet 2019 10 27;119(10):1703-1712. Epub 2019 Apr 27.

Background: Food-insecure households access food pantries to receive supplemental food, yet limited examination of the relationships of food pantry use or household food insecurity with diet quality and health has been documented among food pantry users.

Objective: This study investigated the associations among food pantry use, household food security, body mass index, self-reported chronic disease and related conditions, and diet quality among food pantry users.

Design: Food pantry users in central Indiana were recruited for this cross-sectional study and surveyed for sociodemographic characteristics, food pantry use frequency, household food security, diet quality, and chronic disease and related conditions. Measurements of height and weight were obtained.

Participants/setting: Data from 270 participants, aged 21 to 80 years, were collected from June 2014 to December 2015.

Statistical Analyses Performed: Healthy Eating Index-2010 (HEI-2010) total score, component scores, and body mass index were analyzed across food pantry use and household food security groups using multiple linear regression. Odds of reporting chronic disease and related conditions were compared across food pantry use and household food security groups using logistic regression.

Results: Visiting food pantries more than once a month was associated with higher HEI-2010 total score (P=0.03) and Total Protein Foods score (P=0.05) than visiting less often. HEI-2010 scores were not significantly different across household food security groups. Body mass index was not different across food pantry use groups or household food security groups. Household food insecurity was associated with higher odds of reporting heart disease (age- and sex-adjusted odds ratio=2.65; 95% CI, 1.05-6.69) compared with household food security.

Conclusions: Food pantry use frequency differentiates diet quality, and household food security status differentiates chronic disease and related conditions among low-resource food pantry user subpopulations.
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http://dx.doi.org/10.1016/j.jand.2019.02.015DOI Listing
October 2019

Children's Dietary Quality and Micronutrient Adequacy by Food Security in the Household and among Household Children.

Nutrients 2019 Apr 27;11(5). Epub 2019 Apr 27.

Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA.

Children's food-security status has been described largely based on either the classification of food security in the household or among household children, but few studies have investigated the relationship between food security among household children and overall dietary quality. Our goal was to examine children's dietary quality and micronutrient adequacy by food-security classification for the household and among household children. Data from 5540 children (2-17 years) from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 were analyzed. Food-security status was assessed using the U.S. Household Food Security Survey Module and categorized into high, marginal, low, and very low food security for the households and among household children. Dietary quality and micronutrient adequacy were characterized by the Healthy Eating Index (HEI) 2015 and Mean Adequacy Ratio (MAR; based on total nutrient intakes from diet and dietary supplements), respectively. The HEI 2015 scores did not substantially vary by either food-security classification, but the MAR was greater in high compared to very low food security in households and among household children; a linear relationship was found only among household children. In general, very good agreement was observed between the classifications, but the strength of agreement differed by children's age, race/Hispanic origin, and family income. In conclusion, micronutrient adequacy, but not dietary quality, significantly differed by food-security status. While the agreement between food security in the household and among household children is very good, classification of food security among household children may be more sensitive to detecting differences in exposure to nutrients.
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http://dx.doi.org/10.3390/nu11050965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567152PMC
April 2019

Best Practices for Dietary Supplement Assessment and Estimation of Total Usual Nutrient Intakes in Population-Level Research and Monitoring.

J Nutr 2019 02;149(2):181-197

School of Medicine, Wake Forest, Winston-Salem, NC.

The use of dietary supplements (DS) is pervasive and can provide substantial amounts of micronutrients to those who use them. Therefore when characterizing dietary intakes, describing the prevalence of inadequacy or excess, or assessing relations between nutrients and health outcomes, it is critical to incorporate DS intakes to improve exposure estimates. Unfortunately, little is known about the best methods to assess DS, and the structure of measurement error in DS reporting. Several characteristics of nutrients from DS are salient to understand when comparing to those in foods. First, DS can be consumed daily or episodically, in bolus form and can deliver discrete and often very high doses of nutrients that are not limited by energy intakes. These characteristics contribute to bimodal distributions and distributions severely skewed to the right. Labels on DS often provide nutrient forms that differ from those found in conventional foods, and underestimate analytically derived values. Finally, the bioavailability of many nutrient-containing DS is not known and it may not be the same as the nutrients in a food matrix. Current methods to estimate usual intakes are not designed specifically to handle DS. Two temporal procedures are described to refer to the order that nutrient intakes are combined relative to usual intake procedures, referred to as a "shrinking" the distribution to remove random error. The "shrink then add" approach is preferable to the "add then shrink" approach when users and nonusers are combined for most research questions. Stratifying by DS before usual intake methods is another defensible option. This review describes how to incorporate nutrient intakes from DS to usual intakes from foods, and describes the available methods and fit-for-purpose of different analytical strategies to address research questions where total usual intakes are of interest at the group level for use in nutrition research and to inform policy decisions. Clinical Trial Registry: NCT03400436.
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http://dx.doi.org/10.1093/jn/nxy264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374152PMC
February 2019

Grit is Associated with Food Security among US Parents and Adolescents.

Am J Health Behav 2019 01;43(1):207-218

Professor and Department Head, University of Illinois at Urbana-Champaign, Department of Food Science and Human Nutrition, Urbana, IL;, Email:

We investigated whether the Short Grit Scale (Grit-S) predicted odds of food insecurity (FI) among adults and their children. A cross-sectional panel of parent-child dyads completed an online questionnaire. Eligible dyads included parents with household income below the 2015 median ($52,250 USD/year) and their self-selected household child between the ages of 13 to 17 years. An online questionnaire assessed: (1) FI using the 18-item Household Food Security Survey Module and the Food Security Survey Module for Youth; (2) perseverance and determination using the validated 8-item Grit-S; and (3) sociodemographic FI predictors. Logit regression models estimated the relationship between odds of FI and predictors among parents and children, separately. Among 252 parents, 61.1% reported household FI. Parents' Grit-S score (N = 179) was associated with a significantly lower odds of household FI (OR= 0.4; 95%CI= 0.2, 0.8; p < .01) while adjusting for established predictors. Mean (±SD) Grit-S was 3.1 (±0.7). Children's Grit-S score (N = 178) was associated with a significantly lower odds of child FI (OR= 0.6; 95%CI= 0.4, 0.9; p < .05) while adjusting for established predictors. Perseverance and determination, also known as "grit," may be one further explanation for why some poor households are food secure.
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http://dx.doi.org/10.5993/AJHB.43.1.17DOI Listing
January 2019

Chronic Health Condition Influences on Client Perceptions of Limited or Non-choice Food Pantries in Low-income, Rural Communities.

Am J Health Behav 2019 01;43(1):105-118

Associate Professor, Purdue University, Lafayette, IN.

Food insecurity and diet-related chronic health conditions are interrelated problems in rural communities. The population facing such outcomes may rely on food pantries as a way to gain access to food. Many food pantries use a traditional distribution model that restricts choice. Yet, dietary recommendations and the need to economize food resources place many challenges on households. In this research, we sought to determine whether clients self-reporting chronic health conditions in their households have unique perceptions about food pantries and their ability to meet needs. We surveyed clients (N = 612) of limited or non-choice rural pantries, each representing a unique household. We classified clients into 3 groups: no chronic condition; one chronic condition or more, but no diabetes; one chronic condition or more including diabetes. We compared group perceptions of pantries. All conditions desired more choice, and more preference for certain food groups such as produce and dairy. Clients with chronic conditions and diabetes in their household had a greater percentage of negative comments about the choices offered and were less comfortable talking to volunteers. Rural pantries may serve clients with chronic health conditions by offering client choice and by engaging with them regarding needs and preferences.
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http://dx.doi.org/10.5993/AJHB.43.1.9DOI Listing
January 2019