Research Update: JAND Volume 120 Issue 6 (June 2020)

By Rachael Manasseh

Keeping up with new research can feel overwhelming. So here at A+ RD, we provide you with summaries and reflections on the latest research in the field of nutrition. Stay tuned for our continuing Research Update series!

(Pro tip: if you’re a member of the Academy, you get access to all editions of the JAND!)

Research

Longer Participation in WIC is Associated with Better Diet Quality in 24-month old Children

Authors: Nancy S.Weinfield, Christine Borger, Lauren E. Au, Shannon E.Whaley Danielle Berman, Lorrene D.Ritchie

Research question: “Is longer duration of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) associated with better diet quality in 24-month-old children?”

Study design: A national observational study of mothers with 24 month old children who participated in WIC from 2013 to 2016.

Methods: Diet information was collected through 24-hour recalls and assessed using Healthy Eating Index 2015 scores.

Results: Children that participated longer in WIC were found to have significantly higher scores than those that left the program. 

Conclusion: Children who participate in WIC for longer during the first two years of life seem to have more health benefits than those who left the program earlier

Reflections: How does this study support the need for funding for WIC? How does this research affect your understanding of reasons to refer a family to WIC? How can clinicians encourage families to fully utilize their WIC benefits? What obstacles might get in their way?

Prenatal Depression and Diet Quality During Pregnancy

Authors: Lyndsay A. Avalos, Bette Caan, Nerissa Nance, Yeyi Zhu, De-Kun Li, Charles Quesenberry, Rebecca J.Hyde, Monique M. Hedderson 

Research question: “Is prenatal depression associated with diet quality during pregnancy as measured with the Healthy Eating Index 2010 (HEI-2010) and does this relationship differ by race/ethnicity? Are there differences in the 12 HEI-2010 dietary components for women with prenatal depression compared with women without prenatal depression?”

Study design: Cross sectional analysis of a cohort study of women who were receiving prenatal care between Oct 2011 and April 2013

Methods: Participants were sent food frequency questionnaires regarding their dietary intake during pregnancy, diet quality was analyzed by using Healthy Eating Index 2010 scores.

Results: Women who had prenatal depression were more likely to consume foods high in fat and added sugars, and thus less likely to consume nutrient-dense foods such as whole fruits and beans during pregnancy.  In particular, these results were significant among Hispanic women that participated in the study. 

Conclusion: Considerations for prenatal nutrition counseling include education on how to limit energy dense food and encouraging an increased intake of fruits, green veg, and beans. In addition, diet recommendations should be culturally relevant to individuals.  More research is needed to determine if prenatal depression directly influences diet, or if poor diet quality leads to the development of depression during pregnancy. 

Reflections: The “directionality” of this relationship is yet to be determined (see “Conclusion”) – how would you change your application of this knowledge depending on the direction? Additionally, how would you incorporate awareness of mental health into your patient counseling?

Associations of Serum Carotenoids with DXA-Derived Body Fat and Fat Distribution in Chinese Adults: A Prospective Study

Authors: Cheng Wang, Chu-wen Ling, Ding Ding, Yi-hong Li, Wen-ting Cao, Xin-yi Tang, Yu-ming Chen

Research question: “Are serum carotenoids associated with body fat, and do these associations differ by different types of obesity (general vs central)?”

Study design: a cross-sectional and prospective study of Chinese adults ages 40-75 that were recruited from 2008 to 2013. 

Methods: anthropometric data and serum carotenoid levels were collected from the study population 

Results: Serum carotenoids were found to be inversely associated with lower adiposity, specifically in the abdominal area. Beta-carotene in particular was found to have the most beneficial effects on body fat distribution in this study. 

Conclusion: more randomized trials needed to further explore relationship between carotenoids and fat distribution in the body

Reflections: Why do the authors call for randomized-controlled trials specifically? How does this research, though preliminary, reinforce the benefits of fruits and vegetables for preventing obesity?

Phenolic Acid Subclasses, Individual Compounds, and Breast Cancer Risk in a Mediterranean Cohort: The SUN Project

Authors: Andrea Cristina Sánchez-Quesada, Itziar Gardeazábal, Miguel Ángel Martínez-González, Alfredo Gea, Estefanía Toledo

Research question: “Are subclasses and individual compounds of phenolic acids associated with breast cancer risk?”

Study design: cohort of 10,812 middle aged women enrolled in the Seguimiento Universidad de Navarra (SUN) Project 

Methods: participants were given food frequency questionnaires at the start of the study and after 10 years of follow up. 

Results: Among this cohort, there was an inverse correlation between intake of hydroxycinnamic acids (notably chlorogenic acids) and breast cancer incidence. The main sources of hydroxycinnamic acids in the diet were from coffee, fruit, and vegetables.

Conclusion: More research is needed as this study is the first of its kind to explore the role of different subclasses of phenolic acids in breast cancer prevention.

Reflection: Many patients and clients may want to know how to prevent cancer because they are worried about a family history. What other research can you find that supports the usefulness of fruits, vegetables, or coffee in reducing risk? On the other hand, nutrition research related to cancer prevention is often sensationalized in the media – how could this article be sensationalized? What would you say if asked to comment on this in the media?

Review

Antioxidant Micronutrients and Essential Fatty Acids Supplementation on Cystic Fibrosis Outcomes: A Systematic Review

Authors: Miriam Isabel Souza dos Santos Simon, Roberta Dalle Molle, Flávia Moraes Silva, Thais Wabner Rodrigues, Marceli Feldmann, Gabriele Carra Forte, Paulo José Cauduro Marostica

Research question: “Do oral antioxidant micronutrients and essential fatty acids supplementation improve nutritional status, pulmonary function, inflammatory markers, and the quality of life of patients with cystic fibrosis (CF)?”

This was a review of past studies that have examined the role of antioxidant and essential fatty acid (EFA) supplementation in the management of cystic fibrosis symptoms. 

While some of the studies showed improved lung function and nutritional status, the results are not consistent enough to recommend antioxidant and EFA supplementation as part of CF management. 

Reflection: Conditions like cystic fibrosis can seriously affect a patient’s life, so patients may be more inclined to try novel forms of management. How would you analyze the potential risks and benefits of a treatment and counsel a patient who really wants to try it?

Original Research: Brief

Resistant Starch Has No Effect on Appetite and Food Intake in Individuals with Prediabetes

Authors: Ursula White, Courtney M.Peterson, Robbie A. Beyl, Corby K.Martin, Eric Ravussin

Research question: “Does 12 weeks of daily type 2 resistant starch (RS2) supplementation affect appetite perception, food intake, and appetite-related gut hormones in adults with prediabetes, relative to the placebo control (CTL) group?”

Study design: Randomized controlled trial of 59 adults with prediabetes over 12 weeks

Methods: Participants were given either high-amylose maize/RS2 (variable) or amylopectin (control).

Results: Those that were given high-amylose maize did not have significant differences in satiety, appetite, or energy/macronutrient compared to those that were given amylopectin. 

Conclusion: more research is needed to better understand the effects of high-amylose maize in appetite and satiety for prediabetic patients

Reflection: Take a look at the methods of this study. How could the researchers have been more thorough in their understanding of the participants’ diets beyond the addition of the fiber?

Associations between Red Meat Intake and Sleep Parameters in Patients with Obstructive Sleep Apnea

Authors: Ioanna Kechribari, Meropi D.Kontogianni, Michael Georgoulis, Kallirroi Lamprou, Irene Mourati, Emmanuel Vagiakis, Nikos Yiannakouris

Research question: “Is red meat consumption associated with apnea and hypopnea indices in patients with obstructive sleep apnea evaluated by polysomnography?”

Study design: This was a cross-sectional study of 243 patients diagnosed with obstructive sleep apnea.

Methods: participants were evaluated for physical activity, sleep patterns, and diet quality though FFQ and 24 hour dietary recalls

Results: Patients that consumed more red meat were more likely to have higher apnea and hypopnea values

Conclusion: Results were consistent with past studies in the literature, indicating a potential relationship between red meat consumption and obstructive sleep apnea. The authors noted that sleep deprivation and tiredness contribute to craving high-fat, energy-dense food as well.

Reflection: How does this study fit into your understanding of the health risks associated with high red meat consumption.

Public Policy News

Food System Sustainability: An Academy Advocacy Priority

Authors: Jeanne Blankenship, Robyn Smith Brown

Over the past few years, the Academy has advocated for a greater focus on sustainability in the field of nutrition. Some of these efforts include:  

Reauthorizing the Farm Bill in 2018, which provided more support for  sustainable agricultural methods that conserve the environment and reduce waste during food production,

Considering the role of  food sustainability in the revision of  future Dietary Guidelines for Americans, 

Providing more education on food safety and food date labels in order to prevent excessive amounts of food waste in landfills, 

Renovating school kitchens with more efficient equipment so that schools can provide healthy lunches in a more affordable and sustainable manner,

Supporting the Farm to School initiative, which provides schools with fresh produce while supporting local farms with nutrition education, 

Expanding peer mentoring for breastfeeding in WIC to help reduce waste from infant formula packaging while also improving breastfeeding rates, 

And implementing food service guidelines for federal facilities to encourage local food sourcing, waste reduction, and improved cleaning in the food service industry. 

Reflection: Which of these policy initiatives interests you? Which do you know the least about?

Cultivating Sustainable, Resilient, and Healthy Food and Water Systems: A Nutrition-Focused Framework for Action

Authors: Marie L.Spiker, Amy Knoblock-Hahn, Katie Brown, Janice Giddens, Amanda S.Hege Kevin Sauer, Diane M.Enos, Alison Steiber

The Academy has developed a plan to support food and water sustainability through five “entry points” : 

Shape and Deliver Dietary Guidance

Improve Food and Nutrition Security and Water Security

Align Food Production and Nutrition

Optimize Supply Chains and Food Environments

Reduce Waste

Through these points, nutrition professionals can address issues regarding sustainability in their own education and practice. One option is to include education on food and water systems in the curriculum for future dietetic students. Another is to have RDNs and NDTRs as part of interdisciplinary teams when conducting food system and sustainability research. RDNs can also help develop sustainability programs in their own practice via hospital gardens, composting, and/or food service systems. More broadly, nutrition professionals can be advocates for sustainability by supporting public policies that help preserve food and water systems. 

Reflection: How can you incorporate sustainability into your career interests?

Advancements in Personalized Nutrition Technologies: Guiding Principles for Registered Dietitian Nutritionists

Authors: Mary Rozga, Marie E. Latulippe, Alison Steiber

Personalized nutrition (PN) is a new and rapidly growing field that is becoming more relevant in nutrition counseling. PN technologies use genomic data to predict an individual’s metabolism and response to certain foods. However, PN may not be appropriate for everyone, so each patient should be assessed before implementing these methods. Additionally, PN technologies need to be evidenced-based in order to ensure safety and accuracy. Future dietetic programs will most likely include education on PN as this field continues to expand.

Reflection: How would advancements in personalized nutrition affect the fields you’re interested in?

People and Events 

Coronavirus resources for nutrition professionals

www.eatrightpro.org/coronavirus

www.elsevier.com/connect/coronavirus-information-center

International Congress of Dietetic Professionals will be held on the African continent for the first time in South Africa from Sept 15-18, 2020

Dietary assessment primer created by the national cancer institute (NCI)

https://dietassessmentprimer.cancer.gov/