Iron nutriture following roux-en-y gastric bypass surgery

Roux-en-Y gastric bypass surgery (RYGB) is effective for weight loss, but is commonly associated with iron deficiency and its clinical manifestation, anemia. Diagnosing iron deficiency is complex because iron status depends on other nutrients; additionally, anemia following surgery is not specifically due to deficiency in iron, as it can be due to deficiencies in other nutrients including zinc, copper, vitamin B6, folate, and vitamin B 12. In patients who have undergone RYGB, our aims were to 1) conduct a comprehensive assessment of nutrients involved in iron homeostasis, 2) determine the contribution of dietary intake to iron deficiency, and 3) describe associations between anemia and nutritional status of iron and other nutrients. Systemic measures of hemoglobin, ferritin, serum transferrin receptor (sTfR), total iron binding capacity (TIBC), copper (Cu), vitamins B6 and B 12, folate, zinc (Zn), and C–reactive protein (CRP) were determined using reference methods. Iron deficiency equaled having ≥ 2 abnormalities in: ferritin, sTfR, sTfR:ferritin, or TIBC. Ferritin, a measure of iron stores, was defined as normal (ferritin ≥ 20 mcg/L) or low (ferritin \u3c 20 mcg/L). Statistics included prevalence, mean ± standard error of the mean (s.e.m.) for normally–distributed data, median ± semi-interquartile range for skewed data (indicated with an asterisk [*]), frequency tables, t–tests (independent, by group), correlations, and general linear models (significant if p \u3c 0.05). Subjects (N=70) were 91% female, age 49 ± 1 years, *4 ± 2 years post surgery, and 79% Caucasian. Fifty–six percent of the total population and 96% of the subpopulation with anemia (N=26) presented with deficiencies related to iron nutriture, including deficiencies in iron, zinc, copper, vitamin B6, folate, and vitamin B12. The most prevalent nutrient deficiencies in the total population and the subpopulation with anemia were iron and zinc; prevalence of iron and zinc deficiency in the total population was 24.3% and 20.0%, respectively, and prevalence of iron and zinc deficiency in the subpopulation with anemia was 46.2% and 23.1%, respectively. Participants in the total population and the subpopulation with anemia were also deficient in copper, vitamin B6, vitamin B 12, and folate (11.5% and 26.9%, respectively). In the total population, iron and zinc deficiency occurred in isolation and also in combination with other nutrient deficiencies; all other nutrient deficiencies occurred in combination. In the subpopulation with anemia, only iron deficiency occurred in isolation. The dietary intake of the study population exceeded the RDAs for all nutrients assessed. In addition, patients with low ferritin concentrations consumed lower total energy (p= 0.009), fat (p= 0.026), protein (p=0.013), and animal protein (p=0.023), compared to patients with normal ferritin concentrations. Dietary intake of heme iron was correlated with years post–RYGB surgery (r=0.67, p\u3c0.05). In conclusion, in a community-based surveillance of RYGB patients we found that, more often than not, RYGB patients presented with micronutrient deficiencies related to iron nutriture; this includes deficiencies in iron, copper, zinc, vitamin B6, folate, and vitamin B12 . It was more likely for multiple deficiencies to occur simultaneously than for deficiencies to occur alone. In addition, there was a high prevalence of anemia, a clinical manifestation of deficiencies in these nutrients. Implications of these findings are that clinicians who evaluate post–RYGB patients, especially patients who present with known symptoms or manifestations of iron deficiency, should also screen patients for deficiencies in copper, zinc, vitamin B6, folate, and vitamin B12, as these deficiencies are also prevalent following surgery, may occur simultaneously with iron deficiency, and are also implicated in anemia. Based on our findings that RYGB patients who have more favorable iron stores consume more energy, fat, and protein than patients with low iron stores, increasing protein intake following surgery may improve iron status; although, increasing consumption of fat may have detrimental effects on weight regain in the RYGB population. Findings of this study may be used to enhance prophylactic measures and treatments for iron deficiency following RYGB

Daily Dietary Intake Patterns Improve after Visiting a Food Pantry among Food-Insecure Rural Midwestern Adults.

Emergency food pantries provide food at no cost to low-resource populations. The purpose of this study was to evaluate single-day dietary intake patterns before and after visiting a food pantry among food-secure and food-insecure pantry clients. This observational cohort study comprised a paired, before-and-after design with a pantry visit as the intervention. Participants (n = 455) completed a demographic and food security assessment, and two 24-h dietary recalls. Adult food security was measured using the U.S. Household Food Security Survey Module. Dietary intake patterns were assessed using Automated Self-Administered 24-h Recall data and classified by Healthy Eating Index (HEI-2010) scores, dietary variety, number of eating occasions, and energy intake. Paired t-tests and Wilcoxon signed-rank tests compared outcomes before and after a pantry visit. Mean dietary variety increased after the pantry visit among both food-secure (p = 0.02) and food-insecure (p \u3c 0.0001) pantry clients. Mean energy intake (p = 0.0003), number of eating occasions (p = 0.004), and HEI-2010 component scores for total fruit (p \u3c 0.001) and whole fruit (p \u3c 0.0003) increased among food-insecure pantry clients only. A pantry visit may improve dietary intake patterns, especially among food-insecure pantry clients

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

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

Intermediate Effects of a Social Ecological Modeled, Community-Based Intervention on the Food Security and Dietary Intake of Rural, Midwestern, Adult Food Pantry Clients

Food insecurity, or limited access to enough foods for an active, healthy life, characterizes the situation of 65% of US food pantry clients. Food insecurity is associated with poor dietary intake of key food groups and nutrients, diet-related chronic disease, poor physical and mental health, and reduced quality of life. Although food pantry clients are prevalently food insecure, there is a sizeable proportion of food pantry clients who are classified as food secure (FS), or report having adequate access to healthy foods. Previous studies suggest that food secure pantry clients may use pantry resources differently, and have diets that differ in quality and intake, compared to food insecure clients (including low food secure [LFS] and very low food secure [VLFS] clients). The high prevalence of food insecurity among food pantry clients suggests that food pantries may be an important venue to reach food insecure individuals and intervene to improve dietary outcomes. Since dietary intake and use of food pantries may differ by food security status, the efficacy of interventions to improve dietary outcomes in the food pantry setting may also differ by food security status. A social ecological modeled (SEM), community-based intervention in the food pantry setting is promising in sustaining local change efforts and may facilitate long-term implementation of strategies to improve food security and dietary intake among food pantry clients. Therefore, the aims of this dissertation were to 1) characterize differences in dietary intake between FS, LFS and VLFS pantry clients in a cross-sectional analysis; 2) explore associations between the nutritional quality of the food pantry environment (foods stocked and distributed by foods pantries) and pantry client diet quality by food security status in a cross-sectional analysis; and 3) evaluate the intermediate effects of a SEM, community-based intervention to improve dietary outcomes among pantry clients with comparison by food security status in a longitudinal analysis. This dissertation begins with an introductory chapter that will provide an overview of the problem of food insecurity and the venue food pantries represent as a food assistance resource, the evidence base for conducting nutrition interventions in the food pantry setting, the rationale and design of the Voices for Food (VFF) intervention, and a detailed review of contemporary food security and dietary assessment tools that were utilized in analyses. The first chapter ends with a description of the research aims, hypotheses, and objectives, as well as a guide to the structure of the dissertation. The research studies presented in chapters 2-4 fill a gap in the literature by addressing how food security status may be related to dietary intake, the foods clients consume and are exposed to at food pantries, and the capability for improvements in the nutritional quality of the pantry food environment to influence their dietary patterns. The second chapter describes a cross-sectional analysis at baseline that compared dietary quality and usual intake of energy, nutrients that are currently under-consumed in the US, and related food groups by FS, LFS, and VLFS status. Adult food pantry clients (n = 617) completed a demographic survey, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls (24-HRs) on non-consecutive days including weekdays and weekend days. Healthy Eating Index-2010 (HEI-2010) total and component scores and usual intake using the National Cancer Institute method were estimated using ≥3 client 24-HRs. Mixed multiple linear regression models adjusting for confounders determined associations between food security status and both diet quality and usual intake (in separate models). Cross-sectional analyses at baseline determined that FS status was associated with a higher HEI-2010 whole grains score, as well as a higher mean usual intake of whole grains and iron, compared to LFS status. FS status was also associated with higher mean usual intakes of dark green vegetables and total dairy compared to LFS and VLFS status. The third chapter describes a cross-sectional analysis at baseline that evaluated the relationship between the quality of the mix of foods in stock (pantry inventories) and distributed (client food bags) by food pantries with client diet quality, and investigated how these relationships varied by food security status. Pantry inventories, client food bags, and client diets were scored using the HEI-2010. Multiple linear regression models adjusting for confounders determined 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. Client food bag HEI-2010 scores were positively associated with client diet scores for the total vegetables, total fruit, total protein foods, and sodium components, while pantry inventory HEI-2010 scores were negatively associated with client diet scores for the total score and for the total fruit and fatty acids component scores. VLFS clients consumed more whole grains from client food bags compared to FS clients, and consumed more greens and beans compared to LFS clients from pantry inventories

Daily Dietary Intake Patterns Improve after Visiting a Food Pantry among Food-Insecure Rural Midwestern Adults

Emergency food pantries provide food at no cost to low-resource populations. The purpose of this study was to evaluate single-day dietary intake patterns before and after visiting a food pantry among food-secure and food-insecure pantry clients. This observational cohort study comprised a paired, before-and-after design with a pantry visit as the intervention. Participants (n = 455) completed a demographic and food security assessment, and two 24-h dietary recalls. Adult food security was measured using the U.S. Household Food Security Survey Module. Dietary intake patterns were assessed using Automated Self-Administered 24-h Recall data and classified by Healthy Eating Index (HEI-2010) scores, dietary variety, number of eating occasions, and energy intake. Paired t-tests and Wilcoxon signed-rank tests compared outcomes before and after a pantry visit. Mean dietary variety increased after the pantry visit among both food-secure (p = 0.02) and food-insecure (p \u3c 0.0001) pantry clients. Mean energy intake (p = 0.0003), number of eating occasions (p = 0.004), and HEI-2010 component scores for total fruit (p \u3c 0.001) and whole fruit (p \u3c 0.0003) increased among food-insecure pantry clients only. A pantry visit may improve dietary intake patterns, especially among food-insecure pantry clients