There have been unsafe levels of unpaired fructose in the high fructose corn syrup (HFCS) in U.S. beverages, and research/case study evidence shows their intake is associated with greater asthma prevalence/risk/incidence, a debilitating disease, likely due to fructose-malabsorption, gut fructosylation, and gut dysbiosis mechanisms. The “unexplained” asthma epidemic has disproportionately affected children and Black individuals, groups with higher fructose-malabsorption prevalence than others, and research to assess disproportionately higher asthma risk/incidence among Black individuals in association with HFCS sweetened beverage intake is lacking.

Demographic, lifestyle, dietary data collected at enrollment/(1985-86), and incident asthma through exam 5/(1995-96), were used in Cox proportional hazards models to assess HFCS intake associations (hazard-ratios) with asthma risk/incidence.

CARDIA-Study participants from Birmingham, AL, Chicago, IL, Minneapolis, MN, and Oakland, CA.

1998 Black and 2104 White young adults.

HFCS sweetened beverage intake >once/wk was significantly associated with higher asthma risk relative to ≤ once/wk, (P-trend=0.04), among Black participants only; risk was 2.8 times higher among 2-4 times/wk consumers (HR=2.8, 95% CI 1.1-7.3, P=0.04), and 3.5 times higher when consumed multiple times/d, independent of sucrose intake/obesity/dietary quality/smoking/in-home smoke-exposure (HR=3.5, 95% CI 1.3-9.9, P=0.02). Intake of orange juice, with nominal unpaired fructose, was not associated with asthma in either group, nor was intake of sucrose, a disaccharide (paired) of fructose/glucose.

Ubiquitous HFCS in the U.S. food supply, with HFCS that contains high/unsafe unpaired fructose, a.k.a. excess-free-fructose, and the fructose/gut/lung/axis are overlooked risk factors in the “unexplained” U.S. asthma epidemic that disproportionately affects Black individuals.

Prior studies have found evidence of a relationship between food insecurity and functional limitations among older populations in the USA.

This is a longitudinal investigation of food security in relation to functional limitations, assessed as Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores.

The Greater Boston, MA area.

1461 Boston Puerto Rican Health study participants, predominantly (70·5 %) female and aged 57·1 years (sd ± 7·6) at baseline followed for 6·2 (sd ± 0·98) years.

In cross-sectional analysis at baseline, participants reporting severe food insecurity had greater functional limitations (higher ADL; β = 2·34; 95 % CI (1·48, 3·19)) and higher IADL (β = 1·17, 95 % CI (0·68, 1·65)) compared with food secure participants. In longitudinal linear mixed models, severely food insecure participants at baseline had greater functional limitations over 5 years, as assessed by ADL (β = 1·74; 95 % CI (0·95, 2·53); P < 0·001) and IADL (β = 0·93, 95 % CI (0·48, 1·38)) compared with food secure participants. However, baseline food security did not significantly alter the 5-year trajectory in ADL (P-interaction between baseline food security and time for ADL and IADL = 0·41 and 0·47, respectively).

In this cohort of Boston area Puerto Rican adults, those who are food insecure had consistently higher ADL and IADL scores over time, compared with those who are food secure. Baseline food security did not appear to alter the trajectory in ADL or IADL score.

We investigated the prospective associations between meat consumption and CVD and whether these relationships differ by dietary quality among African American (AA) adults.

Baseline diet was assessed with a regionally specific FFQ. Unprocessed red meat included beef and pork (120 g/serving); processed meat included sausage, luncheon meats and cured meat products (50 g/serving). Incident total CVD, CHD, stroke and heart failure were assessed annually over 9·8 years of follow-up. We characterised dietary quality using a modified Healthy Eating Index-2010 score (m-HEI), excluding meat contributions.

Jackson, MS, USA.

AA adults (n 3242, aged 55 y, 66 % female).

Mean total, unprocessed red and processed meat intakes were 5·7 ± 3·5, 2·3 ± 1·8 and 3·3 ± 2·7 servings/week, respectively. Mostly, null associations were observed between meat categories and CVD or subtypes. However, greater intake of unprocessed red meat (three servings/week) was associated with significantly elevated risk of stroke (hazard ratio = 1·43 (CI: 1·07,1·90)). With the exception of a more positive association between unprocessed meat consumption and stroke among individuals in m-HEI Tertile 2, the strength of associations between meat consumption categories and CVD outcomes did not differ by m-HEI tertile. In formal tests, m-HEI did not significantly modify meat–CVD associations.

In this cohort of AA adults, total and processed meat were not associated with CVD outcomes, with the exception that unprocessed red meat was related to greater stroke risk. Dietary quality did not modfiy these associations. Research is needed in similar cohorts with longer follow-up and greater meat consumption to replicate these findings.

Depression is strongly associated with chronic disease; yet, the direction of this relationship is poorly understood. Allostatic load (AL) provides a framework for elucidating depression-disease pathways. We aimed to investigate bidirectional, longitudinal associations of baseline depressive symptoms or AL with 5-year AL or depressive symptoms, respectively.

Data were from baseline, 2-year, and 5-year visits of 620 adults (45–75 years) enrolled in the Boston Puerto Rican Health Study. The Center for Epidemiology Studies Depression (CES-D) scale (0–60) captured depressive symptoms, which were categorized at baseline as low (<8), subthreshold (8–15), or depression-likely (⩾16) symptoms. AL was calculated from 11 parameters of biological functioning, representing five physiological systems. Baseline AL scores were categorized by the number of dysregulated parameters: low (0–2), moderate (3–5), or high (⩾6) AL. Multivariable, multilevel random intercept and slope linear regression models were used to examine associations between 3-category baseline CES-D score and 5-year continuous AL score, and between baseline 3-category AL and 5-year continuous CES-D score.

Baseline subthreshold depressive symptoms [(mean (95% CI)): 4.8 (4.5–5.2)], but not depression-likely symptoms [4.5 (4.2–4.9)], was significantly associated with higher 5-year AL scores, compared to low depressive symptoms [4.3 (3.9–4.7)]. Baseline high AL [19.4 (17.6–21.2)], but not low AL [18.5 (16.5–20.6)], was significantly associated with higher 5-year CES-D score, compared to baseline moderate AL [16.9 (15.3–18.5)].

Depressive symptoms and AL had a bi-directional relationship over time, indicating a nuanced pathway linking depression with chronic diseases among a minority population.

We examined whether breakfast frequency was associated with chronic inflammatory, as assessed by high-sensitivity C-reactive protein (CRP) concentration.

Cross-sectional study.

Kailuan community, China.

Included were 70 092 Chinese adults without CVD and cancer in 2014 with CRP concentrations <10 mg/l, when breakfast frequency was assessed via a questionnaire, and plasma CRP concentration was measured.

Breakfast frequency was associated with CRP concentration (P-trend < 0·001). The adjusted mean CRP was 1·33 mg/l (95 % CI 1·23, 1·44) for the ‘no breakfast’ group and 1·07 mg/l (95 % CI 1·0, 1·14) for the ‘breakfast everyday’ group (P-difference < 0·001), adjusting for age, sex, diet quality, total energy, obesity, education, occupation, marital status, smoking, alcohol consumption, blood pressure, sleep parameters, fasting blood glucose and lipid profiles. Consistently, the adjusted OR for CRP ≥ 1·0 mg/l and CRP ≥ 3·0 mg/l were 1·86 (95 % CI 1·73, 2·00) and 1·27 (95 % CI 1·15, 1·40), respectively, when comparing these two breakfast consumption groups (P-trend < 0·001 for both). The associations were more pronounced among older adults, relative to those who were younger (P-interaction < 0·001). Significant association between breakfast skipping and elevated CRP concentration was observed in those with poor diet quality, but not those with good diet quality.

Habitually skipping breakfast is associated with elevated concentrations of CRP. Future prospective studies including repeated assessment of inflammatory biomarkers and a collection of detailed information on type and amount of breakfast foods are warranted.

The 2009 American Recovery and Reinvestment Act (ARRA) increased monthly Supplemental Nutrition Assistance Program (SNAP) benefits and expanded SNAP eligibility, yet limited evidence exists on the potential impact of ARRA on dietary intake among at-risk individuals. We aimed to examine pre-/post-ARRA differences in food insecurity (FI) and dietary intake by SNAP participation status.

Pre/post analysis.

Boston, MA, USA.

Data were from the longitudinal Boston Puerto Rican Health Study (2007–2015). The US Department of Agriculture ten-item adult module assessed FI. A validated FFQ assessed dietary intake. Diet quality was assessed using the Alternate Healthy Eating Index-2010 (AHEI-2010). Self-reported pre-/post-ARRA household SNAP participation responses were categorized as: sustained (n 249), new (n 95) or discontinued (n 58). We estimated differences in odds of FI and in mean nutrient intakes and AHEI-2010 scores post-ARRA.

Compared with pre-ARRA, OR (95 % CI) of FI post-ARRA were lower for all participants (0·69 (0·51, 0·94)), and within sustained (0·63 (0·43, 0·92)) but not within new (0·94 (0·49, 1·80)) or discontinued (0·63 (0·25, 1·56)) participants. Post-ARRA, total carbohydrate intake was higher, and alcohol intake was lower, for sustained and new participants, and dietary fibre was higher for sustained participants, compared with discontinued participants. Scores for AHEI-2010 and its components did not differ post-ARRA, except for lower alcohol intake for sustained v. discontinued participants.

Post-ARRA, FI decreased for sustained participants and some nutrient intakes were healthier for sustained and new participants. Continuing and expanding SNAP benefits and eligibility likely protects against FI and may improve dietary intake.

Childhood obesity has increased rapidly in Mexico, along with changes in the food environment. However, little is known about the dietary patterns (DP) of Mexican children. We aimed to characterize the DP of schoolchildren and to analyse their associations with sociodemographic factors.

Cross-sectional analysis. Dietary and sociodemographic information was obtained, including a single 24 h recall, socio-economic status (SES), geographic region, area of residence and ethnicity. DP were defined with cluster analysis (using k-means). Multinomial logistic regression models, adjusted for the survey design, were used to assess associations between DP and sociodemographic variables.

2012 Mexican National Health and Nutrition Survey (ENSANUT-2012).

Schoolchildren (n 2751) aged 5–11 years who participated in ENSANUT-2012.

Four DP were identified: ‘Traditional’, ‘Industrialized’, ‘Varied’ and ‘Modern’. Reported energy intake (mean (sd)) was lowest in the ‘Traditional’ and highest in the ‘Industrialized’ DP (7037 (3707) kJ/d (1682 (886) kcal/d) v. 8427 (3753) kJ/d (2014 (897) kcal/d), respectively, P<0·05). Significant differences in fat and fibre intakes were seen across DP. Non-indigenous v. indigenous children were 22·0 times (95 % CI 5·1, 93·6) more likely to have a ‘Modern’ rather than ‘Traditional’ DP. Relative likelihood of having an ‘Industrialized’ rather than ‘Traditional’ DP was 6·2 (95 % CI 3·9, 9·9) among schoolchildren from high SES v. low SES.

Among Mexican schoolchildren, DP were associated with sociodemographic variables. Non-indigenous children were significantly more likely to consume a ‘Modern’ than a ‘Traditional’ DP. Children with higher SES were more likely to have an ‘Industrialized’ pattern. It is necessary to consider dietary characteristics in the different sociodemographic strata when dietary interventions are designed.

To assess the relative validity of a semi-quantitative, web-based FFQ completed by female pregnancy planners in the Danish ‘Snart Forældre’ study.

We validated a web-based FFQ based on the FFQ used in the Danish National Birth Cohort against a 4 d food diary (FD) and assessed the relative validity of intakes of foods and nutrients. We compared means and medians of intakes, and calculated Pearson correlation coefficients and de-attenuated coefficients to assess agreement between the two methods. We also calculated the proportion correctly classified based on the same or adjacent quintile of intake and the proportion of grossly misclassified (extreme quintiles).

Participants (n 128) in the ‘Snart Forældre’ study who had completed the web-based FFQ were invited to participate in the validation study.

Participants in the ‘Snart Forældre’ study, in total ninety-seven women aged 20–42 years.

Reported intakes of dairy products, vegetables and potatoes were higher in the FFQ compared with the FD, whereas reported intakes of fruit, meat, sugar and beverages were lower in the FFQ than in the FD. Overall the de-attenuated correlation coefficients were acceptable, ranging from 0·33 for energy to 0·93 for vitamin D. The majority of the women were classified in the same or adjacent quintile and few women were misclassified (extreme quintiles).

The web-based FFQ performs well for ranking women of reproductive age according to high or low intake of foods and nutrients and, thus, provides a solid basis for investigating associations between diet and fertility.

High soft drink consumption has been linked with asthma. Anecdotal evidence links high-fructose corn syrup with asthma. The receptor of advanced glycation end products (RAGE) has emerged as a mediator of asthma. The objectives of the present study were to: (i) assess the correlation between intake of beverages containing excess free fructose (EFF beverages) and asthma in children; and (ii) epidemiologically test the mechanistic hypothesis that intake of high EFF beverages, such as apple juice or beverages sweetened with high-fructose corn syrup, is associated with increased risk of asthma. This hypothesis is based on the possible effect of increases in the in situ intestinal formation of advanced glycation end products (enFruAGE) with EFF, which may be absorbed and play a role in RAGE-mediated asthma.

We examined cross-sectional associations between beverage intake and self-reported current or history of asthma. Exposure variables were EFF beverages, including apple juice (AJ), non-diet soft drinks (ndSD) and fruit drinks (FD). Orange juice (OJ), not an EFF beverage, was included as a comparison. Rao–Scott χ2 analysis was used for prevalence differences and logistic regression for associations, adjusted for age, sex, race/ethnicity, BMI and total energy intake.

Data are from the National Health and Nutrition Examination Survey 2003–2006, a nationally representative survey.

US children (n 1961) aged 2–9 years with complete responses on the dietary frequency questionnaire.

Intakes of EFF beverages were significantly associated with asthma in 2–9-year-olds. Adjusted odds of asthma in children consuming EFF beverages ≥5 times/week was more than five times that in children consuming these beverages ≤1 time/month (OR=5·29, P=0·012). Children consuming AJ ≥5 times/week v. ≤1 time/month, adjusted for the other beverages, were more than twice as likely to have asthma (OR=2·43, P=0·035). In contrast, there was a tendency for OJ to be protective.

These results support the hypothesis that intake of high EFF beverages, including AJ and beverages sweetened with high-fructose corn syrup, is associated with asthma in children aged 2–9 years. Results support the mechanistic hypothesis that enFruAGE may be an overlooked contributor to asthma in children. Longitudinal studies are needed to provide evidence of causal association.

We aimed to assess the relative validity and reproducibility of a semi-quantitative FFQ in Puerto Rican adults.

Participants completed an FFQ, followed by a 6 d food record and a second administration of the FFQ, 30 d later. All nutrients were log transformed and adjusted for energy intake. Statistical analyses included correlations, paired t tests, cross-classification and Bland–Altman plots.

Medical Sciences Campus, University of Puerto Rico.

Convenience sample of students, employees and faculty members (n 100, ≥21 years). Data were collected in 2010.

A total of ninety-two participants completed the study. Most were young overweight females. All nutrients were significantly correlated between the two FFQ, with an average correlation of 0·61 (range 0·43–0·73) and an average difference of 4·8 % between them. Most energy-adjusted nutrients showed significant correlations between the FFQ and food record, which improved with de-attenuation and averaged 0·38 (range 0·11–0·63). The lowest non-significant correlations (≤0·20) were for trans-fat, n 3 fatty acids, thiamin and vitamin E. Intakes assessed by the FFQ were higher than those from the food record by a mean of 19 % (range 4–44 %). Bland–Altman plots showed that there was a systematic trend towards higher estimates with the FFQ, particularly for energy, carbohydrate and Ca. Most participants were correctly classified into the same or adjacent quintile (average 66 %) by both methods with only 3 % gross misclassification.

This semi-quantitative FFQ is a tool that offers relatively valid and reproducible estimates of energy and certain nutrients in this group of mostly female Puerto Ricans.

There is little research on factors associated with alcohol consumption among Puerto Ricans living in the USA; thus the aim of the present study was to examine alcohol intake patterns, and factors associated with drinking categories, in a cohort of Puerto Rican adults in Massachusetts.

Cross-sectional study. Descriptive and polytomous logistic regression analyses were used to identify factors associated with drinking patterns, stratified by gender.

Greater Boston area, MA, USA.

Puerto Rican adults (n 1292), aged 45–75 years.

Eight per cent of men and 39 % of women were lifetime abstainers; 40 % of men and 25 % of women were former drinkers; 31 % of men and 27 % of women were moderate drinkers; and 21 % of men and 8 % of women were heavy drinkers. Thirty-five per cent of participants reported drinking alcohol while taking medications with alcohol contraindications. After multivariable adjustment, young men were less likely than older men to be moderate drinkers. Among women, higher BMI, age, lower income and lower psychological acculturation were associated with abstention; age and lower perceived emotional support were associated with increased likelihood of former drinking; and women without v. with diabetes were more likely to be heavy drinkers.

High prevalence of chronic disease, heavy drinking and alcohol use while taking medications with alcohol contraindications suggest an urgent need for better screening and interventions tailored to this rapidly growing Hispanic national subgroup. As heavy drinking appears to increase with acculturation for women, public health initiatives are needed to support appropriate alcohol use.

To examine (i) the association of percentage of total energy intake from protein (protein intake %) with bone mineral density (BMD, g/cm2) and bone loss at the femoral neck, trochanter and lumbar spine (L2–L4) and (ii) Ca as an effect modifier.

The Framingham Offspring Study.

Men (n 1280) and women (n 1639) completed an FFQ in 1992–1995 or 1995–1998 and underwent baseline BMD measurement by dual-energy X-ray absorptiometry in 1996–2000. Men (n 495) and women (n 680) had follow-up BMD measured in 2002–2005.

Cohort study using multivariable regression to examine the association of protein intake % with each BMD, adjusting for covariates. Statistical interaction between protein intake % and Ca (total, dietary, supplemental) intake was examined.

The mean age at baseline was 61 (sd 9) years. In the cross-sectional analyses, protein intake % was positively associated with all BMD sites (P range: 0·02–0·04) in women but not in men. Significant interactions were observed with total Ca intake (<800 mg/d v. ≥800 mg/d) in women at all bone sites (P range: 0·002–0·02). Upon stratification, protein intake % was positively associated with all BMD sites (P range: 0·04–0·10) in women with low Ca intakes but not in those with high Ca intakes. In the longitudinal analyses, in men, higher protein intake % was associated with more bone loss at the trochanter (P = 0·01) while no associations were seen in women, regardless of Ca intake.

This suggests that greater protein intake benefits women especially those with lower Ca intakes. However, protein effects are not significant for short-term changes in bone density. Contrastingly, in men, higher protein intakes lead to greater bone loss at the trochanter. Longer follow-up is required to examine the impact of protein on bone loss.

To investigate genetic and lifestyle factors and their interactions on plasma homocysteine (Hcy) concentrations in the Boston Puerto Rican population.

Cross-sectional study. Plasma concentrations of Hcy, folate, vitamin B12 and pyridoxal phosphate were measured, and genetic polymorphisms were determined. Data on lifestyle factors were collected in interviews.

A population survey of health and nutritional measures.

A total of 994 Puerto Rican men and women residing in the Boston metropolitan area.

Smoking status was positively associated with plasma Hcy. Genetic polymorphisms MTHFR 677C→T, FOLH1 1561C→T, FOLH1 rs647370 and PCFT 928A→G interacted significantly with smoking for Hcy. MTHFR 1298A→C (P = 0·040) and PCFT 928A→G (P = 0·002) displayed significant interactions with alcohol intake in determining plasma Hcy. Subjects with PCFT 928GG genotype had significantly higher plasma Hcy concentrations compared with carriers of the A allele (AA+AG; P = 0·030) among non-drinking subjects. When consuming alcohol, GG subjects had lower plasma Hcy levels compared with AA+AG subjects. Physical activity interacted significantly with MTR 2756A→G in determining plasma Hcy (P for interaction = 0·002). Smoking interacted with physical activity for plasma Hcy (P for interaction = 0·023).

Smoking and drinking were associated plasma Hcy concentrations. Genetic variants involved in folate metabolism further modify the effects of lifestyle on plasma Hcy.

The proportion of the Latin American population aged >60 years is expected to double during the next few decades. Metabolic syndrome (MetS) is associated with high morbidity and mortality worldwide. However, little is known about MetS in Latin America in general, and in Ecuador in particular. The present study aimed to examine the prevalence of MetS and its association with blood micronutrient, homocysteine (Hcy) and C-reactive protein (CRP) concentrations in the elderly living in a low-income urban area.

We performed a cross-sectional study. MetS, using the International Diabetes Federation definition, dietary intake and plasma micronutrient, CRP and Hcy concentrations were assessed.

A total of 352 elderly (≥65 years) Ecuadorians.

Quito, Ecuador.

MetS was prevalent (40 %) – considerably more so among women (81 %) than men (19 %; χ2 = 32·6, P < 0·0001). Further, 53 % of those without MetS exhibited two or more of its components. Micronutrient deficiencies were prevalent, including those of vitamin C, zinc, vitamin B12 and folate. Vitamin C and E concentrations were inversely (OR = 0·78, 95 % CI 0·71, 0·86; OR = 0·16, 95 % CI 0·03, 0·81, respectively) and CRP (OR = 1·79, 95 % CI 1·04, 3·06) was positively associated with MetS.

The coexistence of MetS with micronutrient deficiencies suggests that elderly Ecuadorians suffer from the double burden of diseases that are increasingly being observed in less developed countries. More research is needed to determine the causal factors, but results presented suggest that these older adults would benefit from interventions to reduce the risk factors for MetS, in particular higher consumption of micronutrient-rich foods.

With the upsurge in online dietary modification programmes, online dietary assessment tools are needed to capture food intake. Although the DASH (Dietary Approaches to Stop Hypertension) diet is recommended by the US Department of Agriculture, there are no online instruments that capture DASH food servings. Our objective was to assess the validity of a new, short, online dietary questionnaire developed to capture intake of DASH food servings. The DASH Online Questionnaire (OLQ) was validated against the well-known Block Food Frequency Questionnaire (FFQ).

This was a cross-sectional validation of the DASH OLQ, which contained eleven food groups (breakfast cereals; dairy; drinks; fats and oils; fruits; grains and snacks; meat, fish and poultry; mixed dishes; sweets; vegetables; and nuts, seeds and legumes). Each subject completed a DASH OLQ once weekly for four weeks and one 98.2 Block FFQ (110 questions) between weeks 2 and 4. DASH OLQ were averaged and then compared with the Block FFQ for nutrient intakes as well as intakes of DASH food groups.

Boston University Medical Center, Boston, Massachusetts.

One hundred and ninety-one faculty and staff at Boston University Medical Center aged 20–70 years.

There were significant positive correlations between the Block FFQ and the DASH OLQ for all food groups ranging from r = 0·8 for the nuts/seeds/legumes category to r = 0·3 for vegetables and mixed dishes. A comparison of nutrient intakes found strong positive correlations in all nutrient categories. Of particular interest in the DASH diet and the web-based nutrition and physical activity programme were total fat (r = 0·62), total carbohydrate (r = 0·67), total K (r = 0·68), total Ca (r = 0·69), total vitamin C (r = 0·60) and total energy intake (r = 0·68).

The DASH OLQ captures food and nutrient intake well in relation to the more established Block FFQ.