Changes in fruit and vegetable consumption in relation to changes in sleep characteristics over a 3-month period among young adults

OBJECTIVE: To evaluate whether increases in fruit and vegetable (FV) consumption were associated with concomitant changes in insomnia symptoms, sleep duration, and quality. DESIGN: Secondary longitudinal analysis of a randomized trial, baseline to 3 months. SETTING: Integrated health care systems in Detroit, Michigan and Danville, Pennsylvania. PARTICIPANTS: About 1165 young adults who were low consumers of FV (/day) at baseline. INTERVENTION: Online 3-arm program designed to increase FV consumption. MEASUREMENTS: We categorized FV changes into 4 categories: no change or decrease, 1 serving increase, 2 serving increase, and 3 or more serving increase. We then compared the changes in chronic insomnia classification (yes or no), sleep duration, quality, and time to fall asleep (all self-reported) across the FV change categories. Analyses were both overall and stratified by gender, adjusting for potential confounders (depression, physical activity, education, children, and study site). RESULTS: Average age ± SD was 26 ± 2.8 years (71% women). At 3-month follow-up, participants on average increased FV intake by 1.2 ± 1.4 servings. Women who increased FV intake by 3+ servings showed improvements in insomnia symptoms (2-fold higher odds of improvement; 95% CI 1.1 to 3.6), sleep quality (0.2-point higher sleep quality score; 95% CI -0.01, 0.3), and time to fall asleep (4.2 minutes; 95% CI -8, 0) compared to women who did not change or decreased their FV intake. Associations were not as apparent among men. CONCLUSION: Young women with low consumption of FV may experience improvements in insomnia-related sleep difficulties by increasing their consumption of FV

Maintenance of Weight Loss in Adolescents: Current Status and Future Directions

There is a dearth of research on the long-term efficacy and safety of treatments for adolescent obesity. This narrative review examined several approaches to treatment, focusing on long-term effectiveness data in adolescents, as well as relevant findings from studies of adults. The available research suggests that lifestyle modification has promise in obese adolescents, although it is not clear that any particular dietary or physical activity approach is more effective than another. Meal replacements are quite effective in adults and deserve further research in adolescents. Extending the length of treatment to teach weight loss maintenance skills is likely to improve long-term outcomes in adolescents, and delivering treatment via the Internet or telephone is a novel way of doing so. Treatment that combines lifestyle modification with the medication orlistat generally appears to be safe but only marginally superior to lifestyle modification alone. More research is needed on the management of adolescent obesity, which has been overlooked when compared with research on the treatment of obesity in children and adults

Improving Confidence to Eat Better Among Young Adults –– Gender Differences in 3-Month Results of the MENU GenY Online Intervention

Background/Aims: Improving food choices requires both internal resources, particularly confidence in ability to change, and external challenges or temptations. Self-efficacy and social influence, especially through informal close relationships, play important roles in health behavior. We assessed dietary and self-efficacy changes related to dietary choices by gender and initial fruit and vegetable intake among young adults enrolled in a randomized online intervention trial to improve food choices. Methods: Young adults, 21–30 years old, from integrated health systems in urban Michigan and rural Pennsylvania enrolled and were randomized into Arm 1 (control website), Arm 2 (tailored and age-targeted website) or Arm 3 (Arm 2 website + email coaching). Baseline and 3-month online surveys included questions assessing fruit and vegetable (F/V) intake, and confidence about eating healthy foods in a number of circumstances (e.g. when really hungry, tired, with friends). Repeated measures ANOVA and F-tests compared overall and groups by study arm, gender and baseline F/V intake. Results: Of 1,390 (81% of baseline, 71% women) completing the 3-month survey, mean gain in F/V intake was 1.0 (SD: 1.4), 1.0 (SD: 1.5) and 1.2 (SD: 1.5) servings by Arms 1, 2 and 3, respectively; those with low (1 or fewer) F/V at baseline (n = 153) improved by 2+ servings, across arms, with no differences by gender. Greatest self-efficacy improvement, regardless of gender, was in eating well in front of friends (P \u3c 0.0001), making good choices eating out (P \u3c 0.0001) and eating healthy when depressed/in a bad mood (P \u3c 0.0001); men also gained in self-efficacy to eat healthy around junk food (P \u3c 0.001). The low baseline F/V group resembled men and gained self-efficacy to prepare healthy meals (P \u3c 0.001) and avoid higher-fat foods. Conclusion: Internal perceptions of self-efficacy across a number of social situations and internal conditions in both men and women corresponded to personal experience of working to eat more F/V. More self-confidence improvements occurred in those starting with lowest rates of healthy eating, and those who ultimately made the greatest gains in dietary change, regardless of gender

Sleep Duration and Quality in Relation to Fruit and Vegetable Intake of US Young Adults: a Secondary Analysis

BACKGROUND: Sleep is gaining recognition as a determinant of diet, yet this relationship remains understudied among young adults. We sought to examine how sleep duration and quality were related to fruit and vegetable (FV) intake within a diverse sample of young adults. METHODS: Participants (n = 1444) ages 21-30 (69% women, 15% African American, 35% full or part time in college) consuming \u3c 5 servings/day of FV (eligibility criteria) completed a baseline survey to enroll in a randomized online FV intervention. Sleep questions included duration, perceived sleep quality, time to fall asleep, and insomnia symptoms. Overall and gender-stratified linear regression models compared average daily FV intake and sleep characteristics, adjusting for confounders. RESULTS: One-third (32%) of the participants reported \u3c 7 h of sleep per night, and 36% noted insomnia symptoms ≥ 3 times per week. Women, a BMI \u3e 30, African American race/ethnicity, less education, unemployment, higher depression, and stress were related to suboptimal sleep. Bivariate analyses showed that better sleep was associated with higher FV intake. After accounting for confounders, men with better sleep quality and shorter time to fall asleep had higher intakes of FV (1.12 serving/day difference in highest versus lowest quality [95% CI 0.48, 1.75] and a 0.52 serving/day higher intake difference for shortest versus longest fall asleep time [95% CI 0.90, 0.15], respectively). CONCLUSION: Sleep was highly prevalent in a diverse sample of community-based young adults and may contribute to lower FV intake among men. These associations highlight young adulthood as an important period for promoting healthy sleep habits

Motivations of Young Adults for Improving Dietary Choices: Focus Group Findings Prior to the MENU GenY Dietary Change Trial

BACKGROUND: Young adulthood is often associated with poor dietary habits that may increase risk of obesity and chronic diseases. As independence grows, little is known about strategies to help balance social, work, and education commitments that may override desires to incorporate healthful food choices. OBJECTIVE: In advance of a randomized trial to test an online intervention targeting young adults, we sought to identify views and experiences with healthy eating, and specifically, eating more fruits and vegetables. METHODS: We conducted 13 focus groups with 68 young adults in metropolitan Detroit (Henry Ford Health System) and rural Pennsylvania (Geisinger Health System). Randomly selected adults aged 21 to 30 years, using health system automated data, were sent recruitment letters. Questions were grounded in social cognitive theory and self-determination theory. Audiotapes were transcribed, content themes identified, coded, verified for reliability, and analyzed qualitatively. RESULTS: Young adults\u27 efforts to eat healthfully included three major themes of (1) motivations to create a healthy lifestyle, teach by example, feel better, and manage weight and future health problems; (2) learning to eat well from childhood, independent living, and peers; and (3) strategies to eat better through planning, tracking, and commitment. DISCUSSION: We uncovered theory-based factors that facilitate healthy dietary behavior change among young adults, including managing their behavior through self-monitoring, goal-setting, small steps, meaningful reinforcements, and social opportunities. CONCLUSIONS: Targeted interventions encouraging reflection on personal values related to meaningful contemporary health benefits are likely to resonate with young adults, as will opportunities to receive and share new information

Predicting, Recruiting and Tracking Enrollment of Young Adults to an Online Intervention to Support Healthy Eating

Background/Aims: Young adults, known as Generation Y, eat well below the daily recommended servings of fruits and vegetables and consume high rates of sweetened beverages. With a busy, ever-evolving lifestyle and lifelong exposure to the instant and browsable Internet, recruitment and engagement efforts require accommodating challenges of preference for quick food, quick read, and low attention to snail mail. We describe strategies and monitoring utilized to engage this diverse and understudied population in a two-site, online, randomized intervention trial (MENU GenY) designed to support healthy food choices. Methods: Recruitment from two geographically diverse sites, metropolitan Detroit, MI, and rural Danville, PA, is ongoing. Automated data were utilized to identify young adult HMO members ages 21–30. Mailing strategy, envelope and invitation letter style were evaluated by focus groups across both sites and consultants in a two-phase process. Team meetings guided collaboration efforts on enrollment strategies, and technical meetings were established and run by project management to allow the programing staff across sites to focus and drive technology-specific developments on the study. Mailing volume, based on sample composition by predicted enrollment rates, was modeled across the 12-month recruitment timeframe. Tracking software was developed with two online applications, an internally built program at Henry Ford Health, Flash Manager V3, and an administrative console at University of Michigan CHCR, using the Django framework, to provide immediate feedback on enrollment rates overall and by site. Results: An invitation letter was developed with a unique and catchy color study logo along with a color insert and magnet, sent in a business-style envelope, and followed by a second notice letter 10 days following. Young adults responded favorably to the second “reminder” letter, which nearly doubled enrollment rate, with the study on schedule to meet its n=1,624 goal. By comparing prediction to tracking, with consideration of enrollment by site and by gender, we adjusted mailing volume and rates to reach quarterly enrollment goals. Discussion: Through rigorous planning, collaborative team coordination and guidance by young adult advisors, we addressed challenges and experienced success with enrolling a hard-to-reach young adult population. We will provide enrollment updates and further details

5-2-1-0 Lifestyle risk factors predict obesity in Millennials

The Making Effective Nutritional Choices Generation Y (MENU GenY) study is a web-based intervention trial aimed at improving food choices in those aged 21-30 years. We report baseline levels of the 5-2-1-0 healthy lifestyle patterns to predict a body mass index (BMI) \u3e/=30 vs \u3c30 kg m(-2) . Overall, 1674 young adults (69% female) from two large health systems enroled and completed an online survey asking questions about lifestyle habits. A multivariable binary logistic regression model was utilized to predict a BMI \u3e/=30 while controlling for known predictors of obesity. Consuming \u3e3 daily servings of fruits/vegetables (odds ratio, OR = 0.90, 95% confidence interval, CI = 0.81, 0.99), and reporting \u3e2.5 hours/week of vigorous physical activity (OR = 0.93, 95% CI = 0.89-0.96, P \u3c 0.001) was associated with a BMI \u3c30. Conversely, time sitting (OR = 1.07, 95% CI = 1.04, 1.11) and consuming sugar-sweetened beverages (OR = 1.08, 95% CI = 1.00, 1.15) were related to a BMI \u3e/=30. In this cohort of 20-30-year-olds, we observed a consistent relationship between obesity and the 5-2-1-0 healthy lifestyle patterns previously reported among children and adolescents