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Objective: Nutrition labelling is mandatory on food products in retail stores, but compliance in the rapidly expanding online setting remains unclear. We assessed mandatory and voluntary labelling information across major U.S. online retailers., Design: Between January and August 2022, we evaluated a representative basket of sixty food and beverage items across eight product categories of ten major retailers. We evaluated online presence, accessibility and legibility of four mandatory elements - Nutrition Facts, ingredients, allergen statements and percent juice for fruit drinks - and presence of seven voluntary elements - nutrient content claims, health/qualified health claims, ingredient claims, structure-function claims, additive claims, front-of-package nutrient profiling symbols and other marketing claims., Setting: Major online food retailers in the USA., Participants: N/A., Results: On average, each mandatory element was present, accessible and legible for only 35·1 % of items, varying modestly by element (from 38·3 % for ingredients lists to 31·5 % for Nutrition Facts) but widely by retailer (6·6-86·3 %). Voluntary elements were present for 45·8 % of items, ranging from 83·7 % for marketing claims to 2·0 % for structure-function claims. Findings were generally consistent across the eight product categories. Voluntary elements were more frequently present than accessible and legible mandatory elements for six of ten retailers and seven of eight product categories., Conclusions: Mandatory nutrition label elements are not commonly present, accessible and legible in online retail settings and are less consistently present than marketing elements. Coordinated industry and regulatory actions may be needed to ensure consumers can access mandatory nutrition information to make healthy and safe food choices online.

The rapid growth of dollar stores as retail sources of food in the United States is a phenomenon with implications for diets, nutrition, and well-being. We convened a broadly interdisciplinary group of researchers and experts from government and academia at the 2-day Food Access at Dollar Stores (FADS) workshop, held in Boston, MA in 2022. The event brought together economists, social scientists, public health researchers, and advocates to discuss the concerns and research questions raised by the growth of dollar stores and their increased role in food retail and access. In-person, moderated discussions on day 2 of the workshop generated a range of topics considered important for future research. A subsequent survey, using a modified Delphi approach, identified priority research areas. Nine research area categories emerged as a result of discussion at the FADS workshop and received prioritization from the experts: Local community impacts; Health and nutrition impacts; Policy and programs; Systemic issues - racism, poverty, and food access; Store offerings and locations; Shoppers and customers; Employees and employment; Corporate distribution, strategy, and marketing; and Dollar stores compared with other food sources. The growth of dollar stores as food retailers remains an under-researched area of study for food access and nutrition that requires interdisciplinary expertise and collaboration to understand., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The social dimension of sustainable diets, which addresses the impacts of food value chains on people, animals and communities, is under-represented in the food systems field. We present a definition of the social dimension of sustainable diets, clarify its boundaries and propose corresponding outcomes. Three case studies highlight the connectivity of social outcomes with the health, environment and economic dimensions of sustainable diets. The continued development of social metrics, data and methods and the implementation of integrated solutions co-developed with affected communities are needed to transform systems and structures that perpetuate unjust and inequitable food systems outcomes., (© 2024. Springer Nature Limited.)

Restenosis following percutaneous revascularization is a major challenge in patients with insulin resistance and diabetes. Currently, the vascular effects of insulin are not fully understood. In vitro, insulin's effects on endothelial cells (ECs) are beneficial, whereas on vascular smooth muscle cells (SMCs), they are mitogenic. We previously demonstrated a suppressive effect of insulin on neointimal growth under insulin-sensitive conditions that was abolished in insulin-resistant conditions. Here, we aimed to determine the cell-specific effects of insulin on neointimal growth in a model of restenosis under insulin-sensitive and insulin-resistant conditions. Vascular cell-specific insulin receptor (IR)-deficient mice were fed a low-fat diet (LFD) or a high-fat, high-sucrose diet (HFSD) and implanted with an insulin pellet or vehicle prior to femoral artery wire injury. In insulin-sensitive conditions, insulin decreased neointimal growth only in controls. However, under insulin-resistant conditions, insulin had no effect in either control, EC-specific or SMC-specific IR-deficient mice. These data demonstrate that EC and SMC IRs are required for the anti-restenotic effect of insulin in insulin-sensitive conditions and that, in insulin resistance, insulin has no adverse effect on vascular SMCs in vivo.

Objective: To quantify global intakes of sugar sweetened beverages (SSBs) and trends over time among children and adolescents., Design: Population based study., Setting: Global Dietary Database., Population: Children and adolescents aged 3-19 years in 185 countries between 1990 and 2018, jointly stratified at subnational level by age, sex, parental education, and rural or urban residence., Results: In 2018, mean global SSB intake was 3.6 (standardized serving=248 g (8 oz)) servings/week (1.3 (95% uncertainly interval 1.0 to 1.9) in south Asia to 9.1 (8.3 to 10.1) in Latin America and the Caribbean). SSB intakes were higher in older versus younger children and adolescents, those resident in urban versus rural areas, and those of parents with higher versus lower education. Between 1990 and 2018, mean global SSB intakes increased by 0.68 servings/week (22.9%), with the largest increases in sub-Saharan Africa (2.17 servings/week; 106%). Of 185 countries included in the analysis, 56 (30.3%) had a mean SSB intake of ≥7 servings/week, representing 238 million children and adolescents, or 10.4% of the global population of young people., Conclusion: This study found that intakes of SSBs among children and adolescents aged 3-19 years in 185 countries increased by 23% from 1990 to 2018, parallel to the rise in prevalence of obesity among this population globally. SSB intakes showed large heterogeneity among children and adolescents worldwide and by age, parental level of education, and urbanicity. This research should help to inform policies to reduce SSB intake among young people, particularly those with larger intakes across all education levels in urban and rural areas in Latin America and the Caribbean, and the growing problem of SSBs for public health in sub-Saharan Africa., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare the following: support from the Bill & Melinda Gates Foundation, American Heart Association, and Consejo Nacional de Ciencia y Tecnología in Mexico. LLC reports research funding from the Bill & Melinda Gates Foundation, the American Heart Association, and Consejo Nacional de Ciencia y Tecnología in Mexico (CONACyT), outside of the submitted work. RM reports research funding from the Bill & Melinda Gates Foundation; and (ended) the US National Institutes of Health, Danone, and Nestle. She also reports consulting from Development Initiatives and as IEG chair for the Global Nutrition Report, outside of the submitted work. FC, JZ, and PS report research funding from the Bill & Melinda Gates Foundation, as well as the National Institutes of Health, outside of the submitted work. VM reports research funding the Canadian Institutes of Health Research and from the American Heart Association, outside the submitted work. JRS reports research funding from the Bill & Melinda Gates Foundation, as well as the National Institutes of Health, Nestlé, Rockefeller Foundation, and Kaiser Permanent Fund at East Bay Community Foundation, outside of the submitted work. SBC reports research funding from the US. National Institutes of Health, US. Department of Agriculture, the Rockefeller Foundation, US. Agency for International Development, and the Kaiser Permanente Fund at East Bay Community Foundation, outside the submitted work. SB reports funding from Bloomberg Philanthropies, CONACyT, United Nations International Children’s Emergency Fund (Unicef), and Fundación Rio Arronte, outside the submitted work. DM reports research funding from the US National Institutes of Health, the Bill & Melinda Gates Foundation, the Rockefeller Foundation, Vail Innovative Global Research, and the Kaiser Permanente Fund at East Bay Community Foundation; personal fees from Acasti Pharma, Barilla, Danone, and Motif FoodWorks; is on the scientific advisory board for Beren Therapeutics, Brightseed, Calibrate, Elysium Health, Filtricine, HumanCo, Instacart, January, Perfect Day, Tiny Organics, and (ended) Day Two, Discern Dx, and Season Health; has stock ownership in Calibrate and HumanCo; and receives chapter royalties from UpToDate, outside the submitted work. The investigators did not receive funding from a pharmaceutical company or other agency to write this report, and declare no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The prevalence of metabolic diseases is increasing globally at an alarming rate; thus, it is essential that effective, accessible, low-cost therapeutics are developed. Peroxisome proliferator-activated receptors (PPARs) are transcription factors that tightly regulate glucose homeostasis and lipid metabolism and are important drug targets for the treatment of type 2 diabetes and dyslipidemia. We previously identified LDT409, a fatty acid-like compound derived from cashew nut shell liquid, as a novel pan-active PPARα/γ/δ compound. Herein, we aimed to assess the efficacy of LDT409 in vivo and investigate the molecular mechanisms governing the actions of the fatty acid mimetic LDT409 in diet-induced obese mice., Methods: C57Bl/6 mice (6-11-month-old) were fed a chow or high fat diet (HFD) for 4 weeks; mice thereafter received once daily intraperitoneal injections of vehicle, 10 mg/kg Rosiglitazone, 40 mg/kg WY14643, or 40 mg/kg LDT409 for 18 days while continuing the HFD. During treatments, body weight, food intake, glucose and insulin tolerance, energy expenditure, and intestinal lipid absorption were measured. On day 18 of treatment, tissues and plasma were collected for histological, molecular, and biochemical analysis., Results: We found that treatment with LDT409 was effective at reversing HFD-induced obesity and associated metabolic abnormalities in mice. LDT409 lowered food intake and hyperlipidemia, while improving insulin tolerance. Despite being a substrate of both PPARα and PPARγ, LDT409 was crucial for promoting hepatic fatty acid oxidation and reducing hepatic steatosis in HFD-fed mice. We also highlighted a role for LDT409 in white and brown adipocytes in vitro and in vivo where it decreased fat accumulation, increased lipolysis, induced browning of WAT, and upregulated thermogenic gene Ucp1. Remarkably, LDT409 reversed HFD-induced weight gain back to chow-fed control levels. We determined that the LDT409-induced weight-loss was associated with a combination of increased energy expenditure (detectable before weight loss was apparent), decreased food intake, increased systemic fat utilization, and increased fecal lipid excretion in HFD-fed mice., Conclusions: Collectively, LDT409 represents a fatty acid mimetic that generates a uniquely favorable metabolic response for the treatment of multiple abnormalities including obesity, dyslipidemia, metabolic dysfunction-associated steatotic liver disease, and diabetes. LDT409 is derived from a highly abundant natural product-based starting material and its development could be pursued as a therapeutic solution to the global metabolic health crisis., Competing Interests: Declaration of competing interest CLC, LASR, and LM are co-authors on a patent related to this work. They wish to pursue collaborations to further develop LDT409 as an orally bioavailable low-cost therapy to treat obesity-related metabolic disease., (Copyright © 2024 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Introduction: Produce prescription programs are rapidly expanding as a type of Food is Medicine intervention with prospects for mitigating food insecurity and reducing diet-related health disparities. Gaining insight into participant perspectives on program logistics and perceived impacts is crucial to program success and improvements., Methods: Between May and June 2021, we conducted individual and small group interviews with 23 caregivers with children aged 1-5 years who participated in a produce prescription program from 2020 to 2021 in Texas, U.S. They were provided with a gift card to a major national grocery retailer to purchase fresh produce. The card was reloaded $60 monthly for 8 months with automatic roll-over of unused funds to the next month. Participants also received nutrition education in the form of two videos. A deductive analysis approach was employed, and NVivo qualitative data analysis software was used to perform coding and to assist with subsequent analyses., Results: All 23 participants were female, with an average age of 37.5 years, and the majority identified as Hispanic/Latino (83%). About 43% of the families had three or more children. Six themes were generated from interviews. Three of these themes were related to program logistics: (1) ease of program use; (2) participant satisfaction with the incentive; and (3) desire for additional store options. The remaining main themes pertained to program impact: (1) the enhanced ability to purchase produce; (2) the usefulness of the nutrition education; and (3) persistent challenges encountered when preparing the produce for picky eaters and young children., Conclusion: A pediatric produce prescription program was perceived as logistically easy and a helpful source of financial support for accessing fresh produce. Program features such as card-based incentive system and partnership with major grocery retailer were favored by participants. For future program design, it may be beneficial to consider collaborating with multiple grocery outlets and enhancing the intensity and targeting of nutrition education., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer MK declared a past co-authorship with the author SF to the handling editor. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Li, Zhang, Cash, Hager, Trevino and Folta.)

Objectives: To examine youths' (ages 6-15 years) autonomous snack purchases in corner stores and pilot use of coupons to encourage more healthful snack purchases., Methods: This pilot study involved four corner stores proximal to K-8 schools in Massachusetts. Kids-only coupons of varying discounts were provided in store and paired with simple visual and verbal economic and health messages. Observational data about youths' autonomous snack purchases was recorded pre- and post-intervention. Outcomes of interest were snack item, price, and nutrient content. Comparisons of purchase characteristics and nutritional content across intervention conditions were made using Chi-squared and t -tests., Results: Across all stores, 2,973 purchase observations were recorded totaling approximately $6,000. Researchers estimated that about 55% of shoppers were 10-12 years old. Modest coupon usage (2.2% of purchases) was noted. However, candy purchases decreased, and the percentage of purchase events that included at least one healthier food item more than doubled, regardless of coupon use. Improvements in the nutritional content of snacks were also observed., Conclusion: Kids-only coupons have the potential to assist with shifting autonomous snack purchase behavior in outside of school settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Mayer, McAlister, Economos, Mack, Plank and Cash.)

Objective: Federal law requires calorie information on chain restaurant menus. We sought to assess the prevalence of calorie disclosures on online menus and determine if the menus are controlled by restaurants subject to US labelling requirements., Design: Cross-sectional., Setting: Restaurant websites and mobile apps for restaurant located in New York City, Los Angeles, Chicago, and Houston., Participants: US chain restaurants (top seventy-five by number of outlets) and third-party platforms (TPP): Grubhub, Uber Eats, DoorDash., Results: There was at least one calorie disclosure (for at least one food or beverage, in at least one location) on sixty-eight of seventy-two (94 %) menus on restaurant websites or apps, thirty-two of fifty-five (58 %) menus on DoorDash, six of forty-nine (12 %) menus on Grubhub and thirty of fifty-nine (51 %) menus on Uber Eats. There was consistent calorie labelling (all foods and beverages, all locations) on forty-three of seventy-two (60 %) menus on restaurant websites or apps, fifteen of fifty-five (27 %) menus on DoorDash, three of forty-nine (6 %) menus on Grubhub and eleven of fifty-nine (19 %) menus on Uber Eats. Only four restaurant chains consistently labelled calories for all items, in all locations, on all platforms where their menus were found. All three TPP provided restaurants the ability to enter and modify menu items, making the menus subject to US labelling requirements. Only Uber Eats provided guidance to restaurants on entering calorie information., Conclusions: As consumers increasingly rely on TPP for restaurant ordering, menus on these platforms should include calories in order to promote transparency and nutrition.

Our objective was to convene interdisciplinary experts from government, academia, and industry to develop a Research Roadmap to identify research priorities about processed food intake and risk for obesity and cardiometabolic diseases (CMD) among United States populations. We convened attendees at various career stages with diverse viewpoints in the field. We held a "Food Processing Primer" to build foundational knowledge of how and why foods are processed, followed by presentations about how processed foods may affect energy intake, obesity, and CMD risk. Breakout groups discussed potential mechanistic and confounding explanations for associations between processed foods and obesity and CMD risk. Facilitators created research questions (RQs) based on key themes from discussions. Different breakout groups convened to discuss what is known and unknown for each RQ and to develop sub-RQs to address gaps. Workshop attendees focused on ultra-processed foods (UPFs; Nova Group 4) because the preponderance of evidence is based on this classification system. Yet, heterogeneity and subjectivity in UPF classification was a challenge for RQ development. The 6 RQs were: 1) What objective methods or measures could further categorize UPFs, considering food processing, formulation, and the interaction of the two? 2) How can exposure assessment of UPF intake be improved? 3) Does UPF intake influence risk for obesity or CMDs, independent of diet quality? 4) What, if any, attributes of UPFs influence ingestive behavior and contribute to excess energy intake? 5) What, if any, attributes of UPFs contribute to clinically meaningful metabolic responses? 6) What, if any, external environmental factors lead people to consume high amounts of UPFs? Uncertainty and complexity around UPF intake warrant further complementary and interdisciplinary causal, mechanistic, and methodological research related to obesity and CMD risk to understand the utility of applying classification by degree of processing to foods in the United States., (Published by Elsevier Inc.)

Background: Produce prescription programs represent a promising intervention strategy in the healthcare setting to address disparities in diet quality and diet-related chronic disease. The objective of this study was to understand adoption and implementation factors related to these programs that are common across contexts and those that are context-specific., Methods: In this qualitative case comparison study, we conducted qualitative interviews with eight clinic staff from five primary care "safety net" clinics, identified by a partnering non-profit organization that operated the programs, in April-July 2021., Results: Across clinics, the ability to provide a tangible benefit to patients was a key factor in adoption. Flexibility in integrating into clinic workflows was a facilitator of implementation. Fit with usual operations varied across clinics. Common challenges were the need for changes to the workflow and extra staff time. Clinic staff were skeptical about the sustainability of both the benefits to patients and the ability to continue the program at their clinics., Discussion: This study adds to a growing body of knowledge on the adoption and implementation of produce prescription programs. Future research will further this understanding, providing the evidence necessary to guide adopting clinics and to make informed policy decisions to best promote the growth and financial sustainability of these programs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Folta, Li, Cash, Hager and Zhang.)

Sugar-sweetened beverages (SSBs) are associated with cardiometabolic diseases and social inequities. For most nations, recent estimates and trends of intake are not available; nor variation by education or urbanicity. We investigated SSB intakes among adults between 1990 and 2018 in 185 countries, stratified subnationally by age, sex, education, and rural/urban residence, using data from the Global Dietary Database. In 2018, mean global SSB intake was 2.7 (8 oz = 248 grams) servings/week (95% UI 2.5-2.9) (range: 0.7 (0.5-1.1) in South Asia to 7.8 (7.1-8.6) in Latin America/Caribbean). Intakes were higher in male vs. female, younger vs. older, more vs. less educated, and urban vs. rural adults. Variations by education and urbanicity were largest in Sub-Saharan Africa. Between 1990 and 2018, SSB intakes increased by +0.37 (+0.29, +0.47), with the largest increase in Sub-Saharan Africa. These findings inform intervention, surveillance, and policy actions worldwide, highlighting the growing problem of SSBs for public health in Sub-Saharan Africa., (© 2023. Springer Nature Limited.)

Objective: To assess the association between child ultra-processed food (UPF) consumption and home-school learning environment characteristics during school closures due to the COVID-19 pandemic in schoolchildren with low- and middle income in Chile., Design: Cross-sectional. UPF consumption was collected using the Nova screener. We apply the structured days hypothesis (SDH) to assess home-school learning environment characteristics with three constructs that summarised school preparedness for online teaching and learning, school closure difficulties for caregivers and child routine. We explored associations between child UPF consumption and home-school environment characteristics using multivariate linear regression analyses after controlling for child demographic and school characteristics., Setting: Low- and middle-income neighbourhoods in southeastern Santiago, Chile., Participants: Children from the Food Environment Chilean Cohort ( n 428, 8-10 years old)., Results: Based on the Nova score, child mean consumption of UPF was 4·3 (sd 1·9) groups. We found a statistically significant negative association between child routine for eating, play and study and child UPF consumption when we adjusted for child sociodemographic (model 1: β = -0·19, (95 % CI -0·40, 0·02)) and school characteristics (model 2: β = -0·20, (95 % CI -0·41, 0·00)). Associations between school preparedness for online teaching or school closure difficulties and UPF were not statistically significant., Conclusions: Variations in child routines during the COVID-19 pandemic were negatively associated with UPF intake in schoolchildren with low- and middle income. Our findings are consistent with the SDH, suggesting the school environment helps regulate eating behaviours. Future research should evaluate what happens when children return to in-person classes at school.

Background: Produce prescriptions may improve cardiometabolic health by increasing fruit and vegetable (F&V) consumption and food insecurity yet impacts on clinical outcomes and health status have not been evaluated in large, multisite evaluations., Methods: This multisite, pre- and post-evaluation used individual-level data from 22 produce prescription locations in 12 US states from 2014 to 2020. No programs were previously evaluated. The study included 3881 individuals (2064 adults aged 18+ years and 1817 children aged 2-17 years) with, or at risk for, poor cardiometabolic health recruited from clinics serving low-income neighborhoods. Programs provided financial incentives to purchase F&V at grocery stores or farmers markets (median, $63/months; duration, 4-10 months). Surveys assessed F&V intake, food security, and self-reported health; glycated hemoglobin, blood pressure, body mass index (BMI), and BMI z -score were measured at clinics. Adjusted, multilevel mixed models accounted for clustering by program., Results: After a median participation of 6.0 months, F&V intake increased by 0.85 (95% CI, 0.68-1.02) and 0.26 (95% CI, 0.06-0.45) cups per day among adults and children, respectively. The odds of being food insecure dropped by one-third (odds ratio, 0.63 [0.52-0.76]) and odds of improving 1 level in self-reported health status increased for adults (odds ratio, 1.62 [1.30-2.02]) and children (odds ratio, 2.37 [1.70-3.31]). Among adults with glycated hemoglobin ≥6.5%, glycated hemoglobin declined by -0.29% age points (-0.42 to -0.16); among adults with hypertension, systolic and diastolic blood pressures declined by -8.38 mm Hg (-10.13 to -6.62) and -4.94 mm Hg (-5.96 to -3.92); and among adults with overweight or obesity, BMI decreased by -0.36 kg/m 2 (-0.64 to -0.09). Child BMI z -score did not change -0.01 (-0.06 to 0.04)., Conclusions: In this large, multisite evaluation, produce prescriptions were associated with significant improvements in F&V intake, food security, and health status for adults and children, and clinically relevant improvements in glycated hemoglobin, blood pressure, and BMI for adults with poor cardiometabolic health., Competing Interests: Disclosures Dr Mozaffarian reports personal fees from Acasti Pharma, Barilla, Danone, and Motif FoodWorks; scientific advisory board, Beren Therapeutics, Brightseed, Calibrate, DayTwo (ended 6/2020), Elysium Health, Filtricine, Foodome, HumanCo, January, Inc, Perfect Day, Season, and Tiny Organics; stock ownership in Calibrate and HumanCo; and chapter royalties from UpToDate, all outside of the submitted work. Dr Hager reports personal fees from the Aspen Institute, outside of the submitted work.

Food purchase choices, one of the main determinants of food consumption, is highly influenced by food environments. Given the surge in online grocery shopping because of the COVID-19 pandemic, interventions in digital environments present more than ever an opportunity to improve the nutritional quality of food purchase choices. One such opportunity can be found in gamification. Participants (n = 1228) shopped for 12 items from a shopping list on a simulated online grocery platform. We randomized them into four groups in a 2 × 2 factorial design: presence vs. absence of gamification, and high vs. low budget. Participants in the gamification groups saw foods with 1 (least nutritious) to 5 (most nutritious) crown icons and a scoreboard with a tally of the number of crowns the participant collected. We estimated ordinary least squares and Poisson regression models to test the impact of the gamification and budget on the nutritional quality of the shopping basket. In the absence of gamification and low budget, participants collected 30.78 (95% CI [30.27; 31.29]) crowns. In the gamification and low budget condition, participants increased the nutritional quality of their shopping basket by collecting more crowns (B = 4.15, 95% CI [3.55; 4.75], p < 0.001). The budget amount ($50 vs. $30) did not alter the final shopping basket (B = 0.45, 95% CI [-0.02; 1.18], p = 0.057), nor moderated the gamification effect. Gamification increased the nutritional quality of the final shopping baskets and nine of 12 shopping list items in this hypothetical experiment. Gamifying nutrition labels may be an effective strategy to improve the nutritional quality of food choices in online grocery stores, but further research is needed., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Importance: US firefighters are a working population at risk of chronic diseases, including obesity, cardiovascular disease, and cancer. This risk may be mitigated by a healthy diet., Objective: To evaluate the effect of a Mediterranean nutrition intervention using a behavioral/environmental approach (firefighter/fire station/home) at the individual participant level., Design, Setting, and Participants: This 12-month cluster randomized clinical trial included US career firefighters from fire stations and homes within 2 Indiana fire departments. Participants were randomized by fire station to either Mediterranean diet or control (usual care). The study was conducted from October 2016 to December 2019, and data were analyzed in November 2022., Intervention: For the first 12 months of the study, firefighters located at fire stations randomized to the intervention group were provided with access to supermarket discounts and free samples of Mediterranean diet foods, online nutrition education platforms, email announcements and reminders, family and peer education and support, and chef demonstrations. Firefighters in fire stations allocated to the control group received no intervention and were instructed to follow their usual diet., Main Outcomes and Measures: Change in dietary habits at 12 months as measured by a modified Mediterranean diet score (range, 0 to 51 points) at baseline and 6-month and 12-month follow-up. Cardiometabolic parameters were secondary outcomes., Results: Of 485 included firefighters, 458 (94.4%) were male, and the mean (SD) age was 47 (7.5) years. A total of 241 firefighters (27 fire stations) were randomized to the Mediterranean nutrition intervention, and 244 (25 fire stations) were randomized to usual diet. Outcomes were analyzed using generalized linear mixed models for modified Mediterranean diet score at 6 months (n = 336) and 12 months (n = 260), adjusting for baseline age, sex, race and ethnicity, fire department, physical activity, and waist circumference. In the intervention group compared with the control group, the modified Mediterranean diet score significantly increased by 2.01 points (95% CI, 0.62-3.40; P = .005) at 6 months and by 2.67 points (95% CI, 1.14-4.20; P = .001) at 12 months. Among secondary outcomes, changes in cardiometabolic risk factors were not statistically significant at 1 year. Results from analyses with multilevel multiple imputation for missingness were similar., Conclusions and Relevance: In this Mediterranean nutrition intervention of multicomponent behavioral/environmental changes, career firefighters had increased adherence to a Mediterranean diet., Trial Registration: ClinicalTrials.gov Identifier: NCT02941757.

Introduction: Autism spectrum disorder (ASD) often presents a unique set of risk factors that impact healthy eating and physical activity. Animal-assisted interventions (AAI) are a promising approach for autistic children. There is growing evidence for the positive impact of AAIs on self-regulation, which is necessary for initiating and maintaining behavioral changes. Pet dogs offer several potential advantages as a vehicle for an AAI focused on health behaviors. However, little is known about the experiences of autistic children and their families with respect to dog ownership and the mechanisms through which such an AAI might operate., Methods: We conducted interviews with ten parent-child dyads to explore the role of pet dogs in the lives and lifestyle habits of families with an autistic child. Interview guides were designed to explore the relationship between the autistic child and the pet dog and the role of the dog in family life; attitudes and practices related to physical activity and nutrition; and thoughts about intervention strategies. We used a directed qualitative content analysis approach for analysis., Results: Themes indicate a strong bond between the child and the dog, the child's enjoyment in caring for their dog, and successful integration of dogs within family routines. In contrast, minor themes emerged around the challenges that owning a pet dog posed for families with an autistic child. In terms of nutrition and physical activity, a major theme among children was that healthy eating and exercise were important for both them and their dogs. However, minor themes suggest challenges with healthy eating and exercise and room for improvement for these behaviors. Parents held favorable views toward an intervention that would incorporate the family dog to teach children about nutrition and physical activity, although they expressed some concerns about feasibility., Discussion: This exploratory work suggests that AAIs to improve nutrition and physical activity could build on the strong bond that children have with their pet dogs, but should consider the specific needs of each family, including the needs of the pet dog., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Adkins, Mulé, Linder, Must, Cash and Folta.)

Policy Points Suboptimal diet is a leading cause of mortality and morbidity in the United States. Excise taxes on junk food are not widely utilized in the United States. The development of a workable definition of the food to be taxed is a substantial barrier to implementation. Three decades of legislative and regulatory definitions of food for taxes and related purposes provide insight into methods to characterize food to advance new policies. Defining policies through Product Categories combined with Nutrients or Processing may be a method to identify foods for health-related goals., Context: Suboptimal diet is a substantial contributor to weight gain, cardiometabolic diseases, and certain cancers. Junk food taxes can raise the price of the taxed product to reduce consumption and the revenue can be used to invest in low-resource communities. Taxes on junk food are administratively and legally feasible but no definition of "junk food" has been established., Methods: To identify legislative and regulatory definitions characterizing food for tax and other related purposes, this research used Lexis+ and the NOURISHING policy database to identify federal, state, territorial, and Washington DC statutes, regulations, and bills (collectively denoted as "policies") defining and characterizing food for tax and related policies, 1991-2021., Findings: This research identified and evaluated 47 unique laws and bills that defined food through one or more of the following criteria: Product Category (20 definitions), Processing (4 definitions), Product intertwined with Processing (19 definitions), Place (12 definitions), Nutrients (9 definitions), and Serving Size (7 definitions). Of the 47 policies, 26 used more than one criterion to define food categories, especially those with nutrition-related goals. Policy goals included taxing foods (snack, healthy, unhealthy, or processed foods), exempting foods from taxation (snack, healthy, unhealthy, or unprocessed foods), exempting homemade or farm-made foods from state and local retail regulations, and supporting federal nutrition assistance objectives. Policies based on Product Categories alone differentiated between necessity/staple foods on the one hand and nonnecessity/nonstaple foods on the other., Conclusions: In order to specifically identify unhealthy food, policies commonly included a combination of Product Category, Processing, and/or Nutrient criteria. Explanations for repealed state sales tax laws on snack foods identified retailers' difficulty pinpointing which specific foods were subject to the tax as a barrier to implementation. An excise tax assessed on manufacturers or distributors of junk food is a method to overcome this barrier and may be warranted., (© 2023 Milbank Memorial Fund.)

Background: More than one-third of children and adolescents consume foods from quick-service restaurants (QSRs) daily, which is associated with an increased risk of diet-related adverse health conditions., Objective: To examine trends in the proximity of top-selling QSR chains to all public schools across the United States between 2006 and 2018 by community-, school-, and student-level characteristics., Design: This longitudinal study examined changes in the number QSRs between the 2006-2007 and 2017-2018 school years using data from National Center for Education Statistics, Infogroup US Historical Business Data, and the US Department of Agriculture's Economic Research Service., Statistical Analysis: A mixed-model analysis of variance using census tract as a random effect and accounting for repeated measures by school was used to examine the proximity of QSRs near schools. Models adjusted for demographic characteristics and census tract population density. Data were analyzed in 2021., Results: During 2006, 9% of schools had QSRs within 400 m, and 25% of schools in the most populated areas had at least one QSR within 400 m. There were more QSRs near schools with a high percentage of poverty (12%), and near schools with high school students with the highest population of Black or African American (16%) and Hispanic or Latino (18%) students. By 2018, the percent of all public schools within 400 m of QSRs increased to 12%. The increase over time was greater near schools with a high percentage of poverty (16%) and near schools with high school students with the highest population of Black or African American students (22%) and Hispanic or Latino (23%) students., Conclusions: This is the first nationwide study to examine trends in QSR proximity to all public schools. QSRs were most likely to be located near schools with high school students, near schools with a high percentage of poverty, and near schools with a higher proportion of racial and ethnic minority students. Over time, there were greater increases in QSRs near these schools which may have important implications for children's health and diet-related disparities., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Objective: Produce prescriptions have shown promise in improving diabetes care, although most studies have used small samples or lacked controls. Our objective was to evaluate the impacts of a produce prescription program on glycemic control for patients with diabetes., Research Design and Methods: Participants included a nonrandom enrollment of 252 patients with diabetes who received a produce prescription and 534 similar control participants from two clinics in Hartford, Connecticut. The start of the COVID-19 pandemic in March 2020 coincided with program implementation. Produce prescription enrollees received vouchers ($60 per month) for 6 months to purchase produce at grocery retail. Controls received usual care. The primary outcome was change in glycated hemoglobin (HbA1c) between treatment and control at 6 months. Secondary outcomes included 6-month changes in systolic (SBP) and diastolic blood pressure (DBP), BMI, hospitalizations, and emergency department admissions. Longitudinal generalized estimating equation models, weighted with propensity score overlap weights, assessed changes in outcomes over time., Results: At 6 months, there was no significant difference in change in HbA1c between treatment and control groups, with a difference of 0.13 percentage points (95% CI -0.05, 0.32). No significant difference was observed for change in SBP (3.85 mmHg; -0.12, 7.82), DBP (-0.82 mmHg; -2.42, 0.79), or BMI (-0.22 kg/m2; -1.83, 1.38). Incidence rate ratios for hospitalizations and emergency department visits were 0.54 (0.14, 1.95) and 0.53 (0.06, 4.72), respectively., Conclusions: A 6-month produce prescription program for patients with diabetes, implemented during the onset of the COVID-19 pandemic, was not associated with improved glycemic control., (© 2023 by the American Diabetes Association.)

Background: In June 2016, a comprehensive food policy was implemented in Chile that included front-of-package warning labels on key nutrients of concern (total sugars, added saturated fats, sodium, and calories), child-directed food advertisement bans, and school regulations. The policy was implemented in 3 phases from 2016 to 2019 and the primary objective was to improve children's food environments. This study's objective was to assess changes in child and adolescent intake of key nutrients of concern (total sugars, saturated fats, and sodium) at school after the initial implementation of Chile's Law of Food Labeling and Advertisement., Methods: Longitudinal study of 349 children from the Food Environment Chilean Cohort (FECHIC) and 294 adolescents from the Growth and Obesity Cohort Study (GOCS). Data were from single 24-hour dietary recalls collected from 2016 to 2019. Fixed-effects models stratified by school, home, and other locations compared nutrient consumption in each year to consumption at the pre-policy 2016 baseline. Nutrient intakes are expressed as percent of total energy., Results: Compared to 2016 (pre-policy), total sugars consumed by children at school decreased 4.5 [-8.0, -0.9] percentage points (pp) and 11.8 [-15.4, -8.3] pp in 2018 and 2019 respectively. In 2019, children's saturated fats and sodium intake at school also decreased (1.1 [-1.9, -0.2] pp and 10.3 [-18.1, -2.5] mg/100 kcal respectively). Likewise, in adolescents, total sugars and saturated fats consumed at school decreased in 2018 (5.3 [-8.4, -2.2] pp and 1.5 [-2.7, -0.3] pp respectively). However, consumption of key nutrients of concern at other locations increased after implementation of the policy., Conclusions: After initial implementation of Chile's Labeling Law, intake of most key nutrients of concern significantly declined at school. However, we found evidence of compensatory behavior in out-of-school settings. Further research is needed to evaluate what other actions are needed to impact overall diets in the long term both at schools and out of school., (© 2023. The Author(s).)

Dollar stores have rapidly expanded their food offerings in recent years. These foods tend to be higher in calories and lower in nutrients, raising public health concerns, especially in rural and low-income areas where food-access challenges are often greatest. However, there is limited empirical evidence evaluating the impact of this expansion on household food purchases on a national scale. Using data from a yearly, nationally representative panel of approximately 50 000 households, we estimated the share of food purchases from 2008 to 2020 by store type and evaluated the role of dollar stores as food retailers in the United States. We found that dollar stores were the fastest-growing food retailers by household expenditure share (increasing by 89.7%), with rural growth outpacing growth elsewhere (increasing by 102.9%). Though dollar stores still represent a small share of national household food purchases (2.1% in 2020), they play an increasingly prominent role in food-at-home purchases for certain disadvantaged and rural communities. Understanding the quality of the foods they offer and how this may affect diet-related health outcomes is warranted. ( Am J Public Health . 2023;113(3):331-336. https://doi.org/10.2105/10.2105/AJPH.2022.307193).

Objective: The rapid growth in web-based grocery food purchasing has outpaced federal regulatory attention to the online provision of nutrition and allergen information historically required on food product labels. We sought to characterise the extent and variability that online retailers disclose required and regulated information and identify the legal authorities for the federal government to require online food retailers to disclose such information., Design: We performed a limited scan of ten products across nine national online retailers and conducted legal research using LexisNexis to analyse federal regulatory agencies' authorities., Setting: USA., Participants: N/A., Results: The scan of products revealed that required information (Nutrition Facts Panels, ingredient lists, common food allergens and per cent juice for fruit drinks) was present, conspicuous and legible for an average of only 36·5 % of the products surveyed, ranging from 11·4 % for potential allergens to 54·2 % for ingredients lists. More commonly, voluntary nutrition-related claims were prominently and conspicuously displayed (63·5 % across retailers and products). Our legal examination found that the Food and Drug Administration, Federal Trade Commission and United States Department of Agriculture have existing regulatory authority over labelling, online sales and advertising, and Supplemental Nutrition Assistance Programme retailers that can be utilised to address deficiencies in the provision of required information in the online food retail environment., Conclusions: Information regularly provided to consumers in conventional settings is not being uniformly provided online. Congress or the federal agencies can require online food retailers disclose required nutrition and allergen information to support health, nutrition, equity and informed consumer decision-making.

Stakeholder involvement in research has been demonstrated to increase the effectiveness, validity, and quality of a study. This paper describes the engagement of a stakeholder panel in the development and implementation of an animal-assisted intervention (AAI) assessment and program for children diagnosed with Autism Spectrum Disorder (ASD). Canines for Autism Activity and Nutrition (CAAN) aims to promote physical activity and wellness among children diagnosed with ASD by integrating activities with their pet dog during the child's ongoing Applied Behavioral Analysis (ABA) in-home therapy sessions. Feedback from stakeholders guided program development at each stage of the research process, including this publication. Utilizing a stakeholder-informed approach was essential for the development of assessment tools, program materials, and program design. Methods that may assist others to effectively partner with stakeholders to implement an AAI among children diagnosed with ASD or related disorders are described., Competing Interests: DL is a faculty advisor and DG is the program coordinator for a Pet Partner Community Partners group at Tufts University. DG is also a Pet Partners trainer and evaluator. CC was employed by company Behavioral Concepts, Inc. ES was employed by company Perfect Piece LLC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication., (Copyright © 2021 Linder, Folta, Must, Mulé, Cash, Halbreich, Colón, Sullivan, Sanabria, Gibbs and Farrell.)

Snacks contribute nearly one-quarter of children's daily energy intake in the USA. Snack time therefore represents an opportunity for parents to provide foods with key nutrients. Instead, the most common snack foods are major contributors to children's consumption of added sugars and sodium. Parents face major barriers to providing healthier snacks, including perceptions of high cost and lack of child acceptance. We obtained both economic and qualitative data to inform and optimize interventions for parents to promote vegetable snacks for children. We conducted a survey with parents (n = 368) to estimate how much of a discount would influence vegetable snack purchases by estimating willingness-to-pay using the contingent valuation method, using baby-cut carrots as a sample product. We conducted three focus groups (n = 19) and 1 group interview (n = 2) with children to help understand how to increase the appeal of vegetable snacks. Most (70%) parents accepted the reference price for the vegetable snack. Among those who did not, contingent valuation analysis revealed that a mean discount of approximately 30% would shift consumers to purchasing the snack. Focus group results revealed that the appeal of vegetable snacks to children was influenced by how they were prepared and presented, and the child's familiarity with the vegetables and ability to choose among them. This study lays the groundwork for effective interventions to promote the provision of vegetable snacks by parents., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Food is inextricably linked to human health and environmental sustainability; however, very little is known about children's perceptions of the concept of sustainability in the context of food choices. We aimed to explore the perceptions of Chilean schoolchildren about environmental sustainability, food, and nutrition. Eight online focus groups were conducted with boys and girls aged 8-9 ( n = 30). Questions related to environmental sustainability, pocket money, and food characteristics such as price, front-of-package (FOP) warning label, and eco-labels were included. Data analysis was conducted using ATLAS.ti through a hybrid content analysis approach. Five central themes were identified: (1) children's favorite snacks, (2) knowledge of sustainability, (3) sustainability and eco-labels use, (4) healthfulness of food products, and (5) pocket money and food prices. Most children were not aware of the meaning of "environmental sustainability", but the concept was understood when it was explained in plain language. Participants showed awareness about the environmental impact of their eating behavior, had a positive perception of eco-labels, and identified food with fewer warning labels as "better" options. Results indicate that children understand the concept of sustainability in food if it is communicated clearly, and that eco-labels may be an effective tool in that effort.

Introduction: In the U.S., children regularly consume foods from quick-service restaurants, but little is known about the marketing strategies currently used inside quick-service restaurants. This study aims to validate a child-focused Environmental Assessment Tool for quick-service restaurants, evaluate marketing strategies inside and on the exterior of quick-service restaurants, and examine differences by community race/ethnicity or income., Methods: The inter-rater and test-retest reliability of the Environmental Assessment Tool were assessed across the top 5 national quick-service restaurant chains. Marketing techniques in 165 quick-service restaurants (33 per national chain) in socioeconomically and racially/ethnically diverse communities throughout New England were examined in 2018-2019. Mixed methods ANOVA examined the differences in marketing techniques in 2020., Results: The inter-rater and test-retest reliability of the Environmental Assessment Tool were high (Cohen's κ>0.80). Approximately 95% of quick-service restaurants marketed less healthy foods, whereas only 6.5% marketed healthy options. When examining the differences by community demographics, there were significantly more price promotion advertisements inside and on the exterior of quick-service restaurants in lower-income communities. In addition, there was a greater number of child-directed advertisements with cartoon or TV/movie characters as well as fewer healthy entrée options and more sugar-sweetened beverage and dessert options on the children's menu inside quick-service restaurants in communities with higher minority populations., Conclusions: Environmental Assessment Tool is a valid tool to evaluate marketing inside quick-service restaurants. Results suggest that there is a substantial amount of unhealthy food and beverage marketing inside quick-service restaurants, with differences in the number and types of techniques used in lower-income and minority communities. Policies that limit quick-service restaurant marketing to children should be considered., (Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Proton pump inhibitors (PPIs) are widely used to treat and prevent acid-related disorders. Despite high efficacy, PPI safety has been increasingly scrutinised. However, no comprehensive review summarising investigations of various adverse events is available., Aims: To perform an umbrella review to comprehensively assess associations between adverse events and PPI use., Methods: In accordance with PRISMA, an umbrella review of systematic reviews with meta-analyses was conducted. PubMed and EMBASE were searched from 2015 to July 2019. AMSTAR 2 and GRADE were used to assess quality and certainty of evidence. Author-reported quality assessments were also reviewed., Results: Forty-two systematic reviews with meta-analyses, supported predominantly by observational evidence, were included. The most comprehensive studies reported statistically significant associations with PPI use for several outcomes, including: fractures (eg, hip; RR = 1.20; 95% CI = 1.14-1.28; n = 2 103 800), kidney disease (eg, acute kidney injury; RR = 1.61; 95% CI = 1.16-2.22; n = 2 396 640), infections (eg, Clostridioides difficile; OR = 1.99; 95% CI = 1.73-2.30; n = 356 683), gastric cancer (OR = 2.50; 95% CI = 1.74-3.85; n = 943 070) and gastrointestinal events (eg, fundic gland polyps; OR = 2.46; 95% CI = 1.42-4.27; n = 40 218). No associations with non-gastric cancers, or neurological disease were concluded, with conflicting evidence for cardiovascular outcomes. Certainty based on GRADE was very low for most outcomes., Conclusions: This review identified several published associations between PPIs and adverse outcomes, however, further investigation is needed to understand their clinical significance and the likelihood of causal relationship. If higher quality evidence is generated substantiating the potential risks, it may be necessary for clinicians to consider alternative treatment strategies, especially when PPI efficacy is suboptimal., (© 2021 John Wiley & Sons Ltd.)

Competing Interests: DL was a faculty advisor for a Pet Partner community partner group at Tufts University. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Importance: Programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) inhibitors are immune checkpoint inhibitors widely used in the treatment of metastatic clear cell renal cell carcinoma (ccRCC) and other cancers. There is a lack of understanding regarding which factors are associated with therapeutic response., Objectives: To conduct a systematic literature review of trials reporting on factors associated with differential response to PD-1/PD-L1 inhibitors among patients diagnosed with metastatic ccRCC and quantitatively synthesize the magnitude to which each factor modified the response to PD-1/PD-L1 inhibitors., Data Sources: The MEDLINE and Cochrane Register of Trials databases were searched for studies published in English from 2006 onward. Searches were last run on September 3, 2019., Study Selection: This systematic review and meta-analysis assessed 662 phase 2/3 randomized clinical trials that provided subgroup analyses of any baseline characteristics regarding the treatment response to PD-1/PD-L1 inhibitors, alone or as part of a combination therapy, with respect to overall survival (OS) or progression-free survival (PFS) among patients with metastatic ccRCC., Data Extraction and Synthesis: A novel quantitative approach was used to synthesize subgroup findings across trials. The ratio of the subgroup-specific hazard ratios (HRs) from each study were pooled using a random-effects meta-analysis whereby ratios of 1.00 would indicate that the subgroup-specific HRs were equal in magnitude., Main Outcomes and Measures: Main outcomes were OS and PFS., Results: From an initial 662 reports, 7 trials were considered eligible for inclusion. Meta-analyses suggested the treatment response to PD-1/PD-L1 inhibitors in patients with metastatic ccRCC was significantly associated with age (OS: ratio of HR for age ≥75 years to HR for age <65 years, 1.51; 95% CI, 1.01-2.26), PD-L1 expression (PFS: ratio of HR for PD-L1 < 1% to HR for PD-L1 ≥ 10%, 2.21; 95% CI, 1.14-4.27; ratio of HR for PD-L1 < 1% to HR for PD-L1 ≥ 1%, 1.36; 95% CI, 1.10-1.68), Memorial Sloan Kettering Cancer Center risk score (PFS: ratio of HR for immediate risk score to HR for poor risk score, 1.62; 95% CI, 1.14-2.29; ratio of HR for favorable risk score to HR for poor risk score, 1.53; 95% CI, 1.00-2.34; ratio of HR for favorable risk score to HR for intermediate risk score, 0.96; 95% CI, 0.70-1.30), and sarcomatoid tumor presence (PFS: ratio of HR for no sarcomatoid differentiation to HR for sarcomatoid differentiation, 1.54; 95% CI, 1.07-2.21)., Conclusions and Relevance: This analysis suggests that older age, low levels of PD-L1 expression, and the absence of sarcomatoid tumor differentiation are associated with a diminished response to anti-PD-1/PD-L1 immunotherapies with respect to survival outcomes among patients with metastatic ccRCC.

Insect herbivores have dramatic effects on the chemical composition of plants. Many of these induced metabolites contribute to the quality (e.g., flavor, human health benefits) of specialty crops such as the tea plant ( Camellia sinensis ). Induced chemical changes are often studied by comparing plants damaged and undamaged by herbivores. However, when herbivory is quantitative, the relationship between herbivore pressure and induction can be linearly or non-linearly density dependent or density independent, and induction may only occur after some threshold of herbivory. The shape of this relationship can vary among metabolites within plants. The tea green leafhopper ( Empoasca onukii ) can be a widespread pest on tea, but some tea farmers take advantage of leafhopper-induced metabolites in order to produce high-quality "bug-bitten" teas such as Eastern Beauty oolong. To understand the effects of increasing leafhopper density on tea metabolites important for quality, we conducted a manipulative experiment exposing tea plants to feeding by a range of E. onukii densities. After E. onukii feeding, we measured volatile and non-volatile metabolites, and quantified percent damaged leaf area from scanned leaf images. E. onukii density had a highly significant effect on volatile production, while the effect of leaf damage was only marginally significant. The volatiles most responsive to leafhopper density were mainly terpenes that increased in concentration monotonically with density, while the volatiles most responsive to leaf damage were primarily fatty acid derivatives and volatile phenylpropanoids/benzenoids. In contrast, damage (percent leaf area damaged), but not leafhopper density, significantly reduced total polyphenols, epigallocatechin gallate (EGCG), and theobromine concentrations in a dose-dependent manner. The shape of induced responses varied among metabolites with some changing linearly with herbivore pressure and some responding only after a threshold in herbivore pressure with a threshold around 0.6 insects/leaf being common. This study illustrates the importance of measuring a diversity of metabolites over a range of herbivory to fully understand the effects of herbivores on induced metabolites. Our study also shows that any increases in leafhopper density associated with climate warming, could have dramatic effects on secondary metabolites and tea quality., (Copyright © 2020 Scott, Li, Wei, Kfoury, Morimoto, Guo, Agyei, Robbat, Ahmed, Cash, Griffin, Stepp, Han and Orians.)

Children regularly consume foods from quick service restaurants (QSRs) in the United States, but little is known about how ordering decisions are made and the impact on selection and consumption. A total of n = 218 parents dining with a child (ages 4-16 years) inside a participating QSR completed interviews and demographic surveys and provided their child's leftover foods at the end of the meal. Children's meal consumption was measured using plate-waste methodology. The majority of children selected their meal without parental involvement (80%) and decided what to order prior to entering the QSR (63%). Using mixed-model analysis of variance, children selected and consumed significantly fewer calories and less total fat and sodium when a parent ordered the meal compared with when the child ordered the meal alone. There were no significant differences in selection or consumption when a parent and child ordered the meal together. Approximately one-third of the children consumed foods that were shared. In conclusion, because children primarily select foods without parental involvement and prior to entering QSRs, innovative strategies are needed to influence ordering decisions inside QSRs toward healthier options. Additionally, because food is frequently shared, policies that only focus on children's menus may not be as effective in impacting children's dietary intake.

Today's collaborations across fields of health and wellness are insufficient to meet societies' challenges in combating disease and maintaining the ecosystem and public health. In this article, we present a One Health curriculum model designed to encourage undergraduate students of varying disciplines to value the connectedness of animals, humans, and the environment and to think innovatively about solutions to priority global health issues. We present the design and implementation of a course that brought together multiple faculty from different fields of study, including the dental, medical, nutrition, and veterinary schools, in a curriculum designed for undergraduates primarily from Arts & Sciences fields. The curriculum was collaboratively designed around four key One Health categories: 1) Infectious zoonotic diseases and global health, 2) Naturally occurring shared disease in companion animals that can serve as models for human disease, 3) Human-animal interactions, and 4) Impact of environmental health on human and animal health. We show this course successfully deepened students' understandings of One Health, its role in addressing high priority health issues and the overall benefits of a One Health approach to tackling societal problems. We also report a positive experience by the faculty working in collaboration to implement the curriculum model and the overall enthusiasm of students for the course, all of whom would recommend it to their peers. We conclude by proposing the potential of the curriculum model underlying this course to fill the need for One Health Curricula in programs preparing future health professionals., Competing Interests: The authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript., (© 2020 The Authors.)

Climatic conditions affect the chemical composition of edible crops, which can impact flavor, nutrition and overall consumer preferences. To understand these effects, we sampled tea ( Camellia sinensis (L.) Kuntze) grown in different environmental conditions. Using a target/nontarget data analysis approach, we detected 564 metabolites from tea grown at two elevations in spring and summer over 3 years in two major tea-producing areas of China. Principal component analysis and partial least squares-discriminant analysis show seasonal, elevational, and yearly differences in tea from Yunnan and Fujian provinces. Independent of location, higher concentrations of compounds with aromas characteristic of farmers' perceptions of high-quality tea were found in spring and high elevation teas. Yunnan teas were distinct from Fujian teas, but the effects of elevation and season were different for the two locations. Elevation was the largest source of metabolite variation in Yunnan yet had no effect in Fujian. In contrast seasonal differences were strong in both locations. Importantly, the year-to-year variation in chemistry at both locations emphasizes the importance of doing multi-year studies, and further highlights the challenge farmers face when trying to produce teas with specific flavor/health (metabolite) profiles., (Copyright © 2019 Kfoury, Scott, Orians, Ahmed, Cash, Griffin, Matyas, Stepp, Han, Xue, Long and Robbat.)

Objective: To determine if US household food purchases with lower levels of red meat spending generate lower life-cycle greenhouse gas emissions (GHGE), greater nutritional quality and improved alignment with the Dietary Guidelines for Americans. Affordability of purchasing patterns by red meat spending levels was also assessed., Design: Household food purchase and acquisition data were linked to an environmentally extended input-output life-cycle assessment model to calculate food GHGE. Households (n 4706) were assigned to quintiles by the share of weekly food spending on red meat. Average weekly kilojoule-adjusted GHGE, total food spending, nutrients purchased and 2010 Healthy Eating Index (HEI-2010) were evaluated using ANOVA and linear regression., Setting: USA.ParticipantsHouseholds participating in the 2012-2013 National Household Food Acquisition and Purchase Survey., Results: There was substantial variation in the share of the household food budget spent on red meat and total spending on red meat. The association between red meat spending share and total food spending was mixed. Lower red meat spending share was mostly advantageous from a nutritional perspective. Average GHGE were significantly lower and HEI-2010 scores were significantly higher for households spending the least on red meat as a share of total food spending., Conclusions: Only very low levels of red meat spending as a share of total food spending had advantages for food affordability, lower GHGE, nutrients purchased and diet quality. Further studies assessing changes in GHGE and other environmental burdens, using more sophisticated analytical techniques and accounting for substitution towards non-red meat animal proteins, are needed.

The objective of this study was to identify determinants of pet food purchasing decisions. An online survey was administered via e-mail, newsletters, and social media. A total of 2181 pet owners completed the survey: 1209 dog owners and 972 cat owners; 26% of respondents were animal professionals. Pet food characteristics ranked the highest were health and nutrition, quality, ingredients, and freshness. The veterinary healthcare team was reported to be the primary (43.6%) and most important source of nutrition information for pet owners; Internet sources were the primary information source for 24.6% of respondents. Most pet owners reported giving equal (53.1%) or more priority (43.6%) to buying healthy food for their pets compared with themselves. Results suggest that pet owners face numerous challenges in determining the best diet to feed their pets.

Objective: Food literacy provides a framework for food-related knowledge, skills, and behaviors. The aim of this study was to develop a Tool for Food Literacy Assessment in Children (TFLAC), grades 4-5., Methods: Development of the TFLAC consisted of 3 phases: (1) content validity using a 2-round modified Delphi panel (n = 16) and content validity ratios (CVR); (2) pilot-testing (n = 38); and (3) assessment of internal consistency and test-retest reliability (n = 706) using Cronbach α and intraclass correlation coefficients, respectively. Statistical significance was set at P < .05., Results: Round 1 (CVR = 0.40) and 2 (CVR = 0.70) Delphi panel feedback and the pilot test informed modifications to the TFLAC question format, wording, and difficulty. Food literacy domain-specific Cronbach α values were acceptable (range, .80-.98) except for cooking knowledge (.63), and intraclass correlation coefficients were 0.64-0.70 (P < .001)., Conclusions and Implications: The TFLAC meets basic psychometric standards and may serve as a foundation for nutrition education intervention design and evaluation. Further testing with a broader geographic audience may be warranted., (Copyright © 2019 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Plant-climate interactions affect the edible crop composition, impacting flavor, nutrition, and overall consumer liking. In this study, principal components analysis was used to assess the macro- and micronutrient metal concentrations in pre-monsoon (spring), monsoon (summer), and post-monsoon (autumn) tea (Camelia sinensis (L.) Kuntze) from Yunnan Province, China in 2014-2016. Statistical differences were observed (p = 1.35E-24). Fe, Ca, Mg, Mn, Al, and Ba concentrations were higher in June (monsoon) than in March (pre-monsoon) and September (post-monsoon) compared to Pb, K, Cu, Zn, and Na, which were higher in March and September. Although Fe, Ca, Mg, Mn, Al, and Ba concentrations increased during the monsoon season, sensory analysis did not detect metallic taste in either minimally processed or farmer-processed (commercial) teas. This finding shows the seasonal differences in flavor were due to striking differences in organic chemical composition and concentration., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Facebook, the online social network, has more than 2 billion global users. Because those users do not pay for the service, its benefits are hard to measure. We report the results of a series of three non-hypothetical auction experiments where winners are paid to deactivate their Facebook accounts for up to one year. Though the populations sampled and the auction design differ across the experiments, we consistently find the average Facebook user would require more than $1000 to deactivate their account for one year. While the measurable impact Facebook and other free online services have on the economy may be small, our results show that the benefits these services provide for their users are large., Competing Interests: The authors have declared that no competing interests exist.

Background: Recent efforts supporting children's dietary behaviors suggest the importance of food literacy (FL), which is a multidimensional concept that encompasses food-related knowledge, skills, and behaviors. To date, FL has been largely informed by adult and adolescent research., Aims: To assess the FL experiences, perceived skills, and knowledge of school-age children to inform FL educational opportunities., Method: Six focus groups were conducted with children (age 9-12 years) from three Massachusetts elementary schools. Two team members independently reviewed and coded a portion of the transcripts to assess interrater reliability. Predominant themes connected to children's perceived FL skills and knowledge were identified using an inductive and deductive content analysis approach., Results: There were five central FL themes identified during the focus groups ( n = 31 children), including (1) food systems concepts; (2) food safety and food freshness; (3) gardening environment, perceived skills, and knowledge; (4) cooking environment, perceived skills, and safety; and (5) autonomy of meal preparation., Discussion: The themes that emerged in these focus groups with children provided new information surrounding children's perceived FL skills and knowledge as well as important context regarding the food environment (school vs. home). These findings captured important concepts across the "farm to plate" spectrum and highlight potential school-based opportunities where FL topics could be expanded upon most successfully., Conclusion: This formative research informed educational opportunities for a FL curriculum, which holds promise for improving food-based education and programs, designing more effective interventions, and developing measurement tools.

Climate effects on crop quality at the molecular level are not well-understood. Gas and liquid chromatography-mass spectrometry were used to measure changes of hundreds of compounds in tea at different elevations in Yunnan Province, China. Some increased in concentration while others decreased by 100's of percent. Orthogonal projection to latent structures-discriminant analysis revealed compounds exhibiting analgesic, antianxiety, antibacterial, anticancer, antidepressant, antifungal, anti-inflammatory, antioxidant, anti-stress, and cardioprotective properties statistically (p = 0.003) differentiated high from low elevation tea. Also, sweet, floral, honey-like notes were higher in concentration in the former while the latter displayed grassy, hay-like aroma. In addition, multivariate analysis of variance showed low elevation tea had statistically (p = 0.0062) higher concentrations of caffeine, epicatechin gallate, gallocatechin, and catechin; all bitter compounds. Although volatiles represent a small fraction of the total mass, this is the first comprehensive report illustrating how normal variations in temperature, 5 °C, due to elevational effects impact tea quality., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: To determine predictors of fluid milk waste in a Breakfast in the Classroom School Breakfast Program., Design: Cross-sectional with 3 repeated measures/classroom., Setting: Elementary schools in a medium-sized, low-income, urban school district., Participants: Twenty third- through fourth-grade classrooms across 6 schools., Main Outcomes: Dependent variables include percentage of total and served milk wasted. Independent variables included observed daily menu offerings, program factors, and teacher and student behavior., Analysis: Descriptive statistics were used to characterize variables across classrooms and schools. Multilevel mixed-effects models were used to test associations between predictors and outcomes of interest. P ≤ .05 was considered statistically significant., Results: Total milk waste increased 12% when juice was offered and 3% for each additional carton of unserved milk. Teacher encouragement to take and/or consume breakfast was associated with a 5% and 9% increase in total and served milk waste, respectively. When students were engaged in other activities in addition to eating breakfast, total milk waste decreased 10%., Conclusions and Implications: Beverage offerings were predictive of greater total milk waste. Teacher and student behavior also appeared to influence milk consumption. Findings suggest that specific changes to School Breakfast Program implementation policies and practices could have an important role in waste mitigation., (Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)