Simulated reductions in consumption of sugar-sweetened beverages improves diet quality in Lower Mississippi Delta adults

Although the effects of replacing sugar-sweetened beverages (SSBs) with water on energy intake and body weight have been reported, little is known about how these replacements affect diet quality.To simulate the effects of replacing SSBs with tap water on diet quality and total energy intake of Lower Mississippi Delta (LMD) adults.Retrospective analysis of cross-sectional dietary intake data using a representative sample of LMD adults (n=1,689). Diet quality was measured using the Healthy Eating Index-2005 (HEI-2005) scores that were computed using the population ratio method. The effects of substituting SSBs with water on diet quality were simulated by replacing the targeted items’ nutrient profile with tap water's profile.Simulating the replacement of SSBs with tap water at 25, 50, and 100% levels resulted in 1-, 2.3-, and 3.8-point increases, respectively, in the HEI-2005 total score. Based on a mean daily intake of 2,011 kcal, 100% substitution of SSBs with tap water would result in 11% reduction in energy intake.Replacing SSBs with water could substantially improve the diet quality of the LMD adult population and potentially lead to significant weight loss overtime. Prioritizing intervention efforts to focus on the replacement of SSBs with energy-free drinks may be the most efficacious approach for conveying potentially substantial health benefits in this and similar disadvantaged populations

A computational model of liver iron metabolism

Iron is essential for all known life due to its redox properties; however, these same properties can also lead to its toxicity in overload through the production of reactive oxygen species. Robust systemic and cellular control are required to maintain safe levels of iron, and the liver seems to be where this regulation is mainly located. Iron misregulation is implicated in many diseases, and as our understanding of iron metabolism improves, the list of iron-related disorders grows. Recent developments have resulted in greater knowledge of the fate of iron in the body and have led to a detailed map of its metabolism; however, a quantitative understanding at the systems level of how its components interact to produce tight regulation remains elusive. A mechanistic computational model of human liver iron metabolism, which includes the core regulatory components, is presented here. It was constructed based on known mechanisms of regulation and on their kinetic properties, obtained from several publications. The model was then quantitatively validated by comparing its results with previously published physiological data, and it is able to reproduce multiple experimental findings. A time course simulation following an oral dose of iron was compared to a clinical time course study and the simulation was found to recreate the dynamics and time scale of the systems response to iron challenge. A disease state simulation of haemochromatosis was created by altering a single reaction parameter that mimics a human haemochromatosis gene (HFE) mutation. The simulation provides a quantitative understanding of the liver iron overload that arises in this disease. This model supports and supplements understanding of the role of the liver as an iron sensor and provides a framework for further modelling, including simulations to identify valuable drug targets and design of experiments to improve further our knowledge of this system

Weight Loss Maintenance in African American Women: A Systematic Review of the Behavioral Lifestyle Intervention Literature

We performed a systematic review of the behavioral lifestyle intervention trials conducted in the United States published between 1990 and 2011 that included a maintenance phase of at least six months, to identify intervention features that promote weight loss maintenance in African American women. Seventeen studies met the inclusion criteria. Generally, African American women lost less weight during the intensive weight loss phase and maintained a lower % of their weight loss compared to Caucasian women. The majority of studies failed to describe the specific strategies used in the delivery of the maintenance intervention, adherence to those strategies, and did not incorporate a maintenance phase process evaluation making it difficult to identify intervention characteristics associated with better weight loss maintenance. However, the inclusion of cultural adaptations, particularly in studies with a mixed ethnicity/race sample, resulted in less % weight regain for African American women. Studies with a formal maintenance intervention and weight management as the primary intervention focus reported more positive weight maintenance outcomes for African American women. Nonetheless, our results present both the difficulty in weight loss and maintenance experienced by African American women in behavioral lifestyle interventions

Infant activity and sleep behaviors in a maternal and infant home visiting project among rural, southern, African American women

Abstract Background Physical inactivity and inadequate amounts of sleep are two potential causes for excessive weight gain in infancy. Thus, parents and caregivers of infants need to be educated about decreasing infant sedentary behavior, increasing infant unrestrained floor time, as well as age specific recommended amounts of sleep for infants. The aims of this study were to determine if maternal knowledge about infant activity and sleep changed over time and to evaluate maternal compliance rates with expert recommendations for infant sleep in a two-arm, randomized, controlled, comparative impact trial. Methods Pregnant women at least 18 years of age, less than 19 weeks pregnant, and residing in a lower Mississippi Delta county were recruited between March 2013 and December 2014. Postnatal data was collected from 54 participants between September 2013 and May 2016. McNemar’s test of symmetry was used to determine if maternal knowledge changed over time, while generalized linear mixed models and Kaplan-Meier survival curves were used to assess compliance with expert recommendations for infant sleep. Results The postnatal retention rate was 85%. Maternal knowledge significantly increased for correct infant sleep position (back) and beginning tummy time by one month of age. Odds of meeting sleep duration recommendations increased by 30% for every one month increase in infant age. Only 20% of the participants were compliant with the back to sleep recommendation for the first 12 months of their infant’s life; median time to noncompliance was 7.8 months. Conclusions Although baseline knowledge concerning infant activity and sleep was high in this cohort of rural, Southern, African American mothers, compliance with recommendations was not optimal. Trial registration The study was registered at clinicaltrials.gov (NCT01746394) on December 5, 2012

Gestational Weight Gain: Results from the Delta Healthy Sprouts Comparative Impact Trial

Introduction. Delta Healthy Sprouts trial was designed to test the comparative impact of two home visiting programs on weight status, dietary intake, and health behaviors of Southern African American women and their infants. Results pertaining to the primary outcome, gestational weight gain, are reported. Methods. Participants (n=82), enrolled early in their second trimester of pregnancy, were randomly assigned to one of two treatment arms. Gestational weight gain, measured at six monthly home visits, was calculated by subtracting measured weight at each visit from self-reported prepregnancy weight. Weight gain was classified as under, within, or exceeding the Institute of Medicine recommendations based on prepregnancy body mass index. Chi-square tests and generalized linear mixed models were used to test for significant differences in percentages of participants within recommended weight gain ranges. Results. Differences in percentages of participants within the gestational weight gain guidelines were not significant between treatment arms across all visits. Conclusions. Enhancing the gestational nutrition and physical activity components of an existing home visiting program is feasible in a high risk population of primarily low income African American women. The impact of these enhancements on appropriate gestational weight gain is questionable given the more basic living needs of such women. This trial is registered with ClinicalTrials.gov NCT01746394, registered 4 December 2012

Understanding Population Health from Multi-level and Community-based Models

Chapter in The Handbook of Health Behavior Change (5th Edition), New York, NY Springer Publishing Compan

Maternal weight in the postpartum: results from the Delta healthy sprouts trial

Abstract Background Excessive postnatal weight retention may pose a threat to a woman’s health and future pregnancies. Women in the Lower Mississippi Delta (LMD) region of Mississippi suffer from among the highest rates of obesity in the U.S. and are more likely to gain an excessive amount of weight during pregnancy. The aim of this study was to determine if LMD women who received a lifestyle enhanced maternal, infant, and early childhood home visiting (MIECHV) curriculum had more favorable weight outcomes through 12-months postpartum compared to women who received a standard MIECHV curriculum. Methods Delta Healthy Sprouts was a two-arm, randomized, controlled, comparative impact trial. Pregnant women at least 18 years of age, less than 19 weeks pregnant with a singleton pregnancy, and residing in the LMD region were recruited. On a monthly basis in the participant’s home, the control arm (PAT) received the Parents as Teachers curriculum while the experimental arm (PATE) received a lifestyle enhanced Parents as Teachers curriculum. Pre-pregnancy body weight via self-report and maternal body weight at baseline (gestational month 4) and at every subsequent monthly visit through 12 months postpartum was measured. Linear mixed models were used to test for significant treatment, time, and treatment by time effects on postnatal weight outcomes. Results Mean postnatal weight losses were 0.8 and 1.1 kg at postnatal month (PM) 6 and PM 12, respectively, for PAT participants. Mean postnatal weight losses for PATE participants were 1.5 and 1.2 kg at PM 6 and PM 12, respectively. Mean weight retention, based on pre-pregnancy weight, were 5.2, 4.0, and 3.6 kg at PM 1, PM 6, and PM 12, respectively, for PAT participants. Mean weight retention for PATE participants were 6.3, 4.5, and 4.0 kg at PM 1, PM 6, and PM 12, respectively. Significant effects were not found for treatment, time, or treatment by time. Conclusions An enhanced MIECHV curriculum was not associated with more favorable postpartum weight outcomes when compared to a standard MIECHV curriculum in a cohort of LMD women during the 12 months following the birth of their infant. Trial registration: clinicaltrials.gov , NCT01746394. Registered 5 December 2012

Low rate of initiation and short duration of breastfeeding in a maternal and infant home visiting project targeting rural, Southern, African American women

Abstract Background Despite the benefits of breastfeeding for both infant and mother, rates in the United States remain below Healthy People 2020 breastfeeding objectives. This paper describes breastfeeding outcomes of the Delta Healthy Sprouts participants during gestational and postnatal periods. Of specific interest was whether breastfeeding intent, knowledge, and beliefs changed from the early to late gestational period. Additionally, analyses were conducted to test for associations between breastfeeding initiation and breastfeeding intent, knowledge and beliefs as well as sociodemographic characteristics and other health measures. Methods Eighty-two pregnant women were enrolled in this project spanning three Mississippi counties. Participants were randomly assigned to one of two treatment groups. Because both groups received information about breastfeeding, breastfeeding outcomes were analyzed without regard to treatment assignment. Hence participants were classified into two groups, those that initiated breastfeeding and those that did not initiate breastfeeding. Generalized linear mixed models were used to test for significant group, time, and group by time effects on breastfeeding outcomes. Results Breastfeeding knowledge scores increased significantly from baseline to late gestational period for both groups. Across time, breastfeeding belief scores were higher for the group that initiated breastfeeding as compared to the group that did not breastfeed. Only 39% (21 of 54) of participants initiated breastfeeding. Further, only one participant breastfed her infant for at least six months. Breastfeeding intent and beliefs as well as pre-pregnancy weight class significantly predicted breastfeeding initiation. Conclusions Our findings indicate that increasing knowledge about and addressing barriers for breastfeeding were insufficient to empower rural, Southern, primarily African American women to initiate or continue breastfeeding their infants. Improving breastfeeding outcomes for all socioeconomic groups will require consistent, engaging, culturally relevant education that positively influences beliefs as well as social and environmental supports that make breastfeeding the more accepted, convenient, and economical choice for infant feeding. Trial Registration clinicaltrials.gov NCT01746394 . Registered 5 December 2012

Associations between Alternate Healthy Eating Index-2010, Body Composition, Osteoarthritis Severity, and Interleukin-6 in Older Overweight and Obese African American Females with Self-Reported Osteoarthritis

Osteoarthritis (OA) is a leading cause of immobility in the United States and is associated with older age, inflammation, and obesity. Prudent dietary patterns have been associated with disease prevention, yet little evidence exists describing diet quality (DQ) in older overweight or obese African American (AA) adults with OA and its relation to body composition. We conducted a secondary data analysis of a dataset containing alternate Healthy Eating Index-2010 (AHEI-2010), body composition, OA severity, and serum interleukin-6 (IL-6) data from 126 AA females (aged 60–87 years) with OA to examine the relationships between these variables. Our sample had poor DQ and reported having higher OA severity as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Interleukin-6 was negatively correlated with AHEI-2010, and AHEI-2010 and the WOMAC physical function subcategory (WOMACpf) were significant predictors of IL-6 (odds ratio (OR): 0.95, 95% confidence interval (CI) 0.92–0.99 and 1.04, 95% CI 1.01–1.07, respectively, p < 0.05) but not body composition. In conclusion, AHEI-2010 and WOMACpf were significant predictors of inflammation (IL-6) and AHEI-2010 accounted for ~16% of the variation of IL-6 (inflammation) in this sample