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To understand if a culinary medicine training program increases food literacy, culinary skills, and knowledge among practicing registered dietitian nutritionists (RDN).Prepost study design evaluating pilot test of RDN train-the-trainer curriculum from September, 2019 to January, 2020.On average, results indicate an increase in culinary nutrition skills (mean difference, 6.7 ± 4.4; P0.001; range, 10-30) and a significant increase in 5 of the 8 food literacy factors. Through process evaluation, RDNs rated the training as extremely useful to their practice (mean, 4.4 ± 0.3).Registered dietitian nutritionist participants increased culinary nutrition skills with statistically significant scores across all individual measures. This study describes an RDN training curriculum in culinary medicine across a diverse group of practicing RDNs from a large county health care system. Culinary medicine shows a promising impact on promoting nutrition skills and confidence; however, it warrants further assessment.

Racial/ethnic and socioeconomic differences were shown to have an influence on child fruit and vegetable intake. This study examined the associations between parent and child fruit and vegetable intake and the home nutrition environment among Hispanic/Latino and African American families. Through a cross-sectional study design, self-reported surveys (n = 6074) were obtained from adult–child dyad participants enrolled in Brighter Bites, an evidence-based health promotion program, in the fall of 2018. For every once/day increase in frequency of parent FV intake, there was an increase in child FV intake by 0.701 times/day (CI: 0.650, 0.751, p < 0.001) and 0.916 times/day (CI: 0.762, 1.07; p < 0.001) among Hispanic/Latinos and African Americans, respectively. In Hispanic/Latino participants, significant positive associations were found between fruits as well as vegetables served at mealtimes ≥3 times/week (p < 0.001), family mealtimes 7 times/week (p = 0.018), parent–child communication about healthy eating and nutrition at least sometimes during the past 6 months (p < 0.05), and frequency of child FV intake, after adjusting for covariates. In African American participants, a significant positive association was found in fruits served at mealtimes ≥1 times/week (p < 0.05), and vegetables served at mealtimes ≥5 times/week (p < 0.05). Meals cooked from scratch a few times a day/all the time were significantly positively associated with frequency of child FV intake for both Hispanic/Latino (p = 0.017) and African American (p = 0.007) groups. The relationship between home nutrition environment and child FV intake varied by race and ethnicity. Future programs should consider designing culturally tailored interventions to address racial/ethnic-specific influences that match the child’s race, culture, and ethnicity.

Introduction: During recovery, stroke patients are at risk of developing psychological complications impacting their quality of life. Diets rich in fat negatively impact anxiety disorders; however, this relationship has not been explored among stroke survivors considering food insecurity status, a social determinant of health (SDOH). Methods: In a population-based cohort of 309 patients with acute stroke, we retrospectively assessed self-administered surveys to evaluate the association between dietary fat intake and anxiety in stroke survivors presenting for an initial visit at a University-based stroke clinic from January 2021-July 2021 in Houston, Texas. Anxiety was measured using the GAD-7 scoring system and dichotomized to either “None/Mild” or “Moderate/Severe.” Dietary fat intake was calculated using the quality frequency screener; food insecurity status, using the Hunger Vital sign screener. Results: Among this population, 15.46% reported food insecurity and 50.8% (N=157) had moderate to severe anxiety. The multivariable logistic regression model showed that total fat intake (Odds Ratio (OR)=1.01, 95% CI: 1.00, 1.03; P-value=0.016) and percent fat (OR=1.06, 95% CI: 1.01, 1.11; P-value=0.018) dietary intake had a statistically significant negative impact on anxiety, adjusting for covariates and an interaction term between food insecurity status and dietary fat intake. Conclusion: Although studies describe the role of a healthy diet in stroke, this is the first study that looks at dietary fat intake as it relates to stroke and anxiety, as well as, food insecurity among stroke survivors. SDOH including food access and affordability are associated with stroke risk and dietary fat outcomes. A better understanding of fat intake and associated factors in this population will provide an opportunity for developing interventions for those at highest risk. Access to healthy foods may prevent higher intake of fat in one’s diet and reduce the risk of stroke.

Background: Food insecurity (FI) is a social determinant of health (SDOH) that impacts access to adequate quality food, which may result in poor nutrition and increased cardiovascular risk. In chronic disease populations, FI is associated with poor nutrition and higher vascular risk. We sought to investigate FI in stroke survivors (SS) and hypothesized that FI would be associated with inadequate fruit and vegetable (FV) intake. We also evaluated relationships between FI, FV intake, and other clinical and demographic factors. Methods: We conducted a retrospective review of SS presenting for an initial visit to the UTHealth Stroke clinic from 1/28/21 to 7/31/21. We included SS who completed a 2-question FI screener (Hunger Vital Sign) and the Block Fruit and Vegetable (FV) Frequency screener. FI and FV scores were determined with standard techniques; FV score was dichotomized (score < 11 indicates inadequate intake - validated). Patient data were self-reported. Chi-squared, fisher’s exact, and t-tests were conducted for univariate analysis (Table). Results: Among 383 potentially eligible SS, we included 285 who completed the FV and FI questionnaires (X age =62; 50% female). Of those, 39 (13.7%) were FI and 149 (52.3%) had inadequate FV. Among demographic and clinical factors, only race/ethnicity was associated with FI. Compared to White SS, Hispanic and Black SS had higher odds of FI (OR 3.62, 95%CI 1.19-11.03 and OR 3.24, 95% CI 1.07- 9.83, respectively). FI was not associated with inadequate FV intake. Inadequate FV intake was not associated with clinical or demographic factors; however, there were trends of better FV intake among currently employed SS and those with more than high school education. Conclusions: We did not find associations between FI and inadequate FV intake. This suggests that there may be other SDOH that contribute to poor dietary intake in this population.

Background: In 2019, an estimated 7.3 US million adults had used stimulants in the past year. Stimulant use is associated with increased stroke risk, yet the prevalence of common stroke risk factors (RFs) in patients who use stimulants is not well described. We sought to examine the association between stimulant use and the presence of stroke risk factors (RFs) in stroke patients. Methods: We conducted an IRB approved retrospective review of ischemic and hemorrhagic stroke patients admitted 9/2019 through 9/2020. Inclusion criteria were age ≥18 and completion of a urine drug screen (UDS) on admission. Logistic regression was used to model the association of RFs (hypertension, type 2 diabetes (DMII), hyperlipidemia, atrial fibrillation, and coronary disease) to acute stimulant use, adjusting for socio-demographic characteristics. Results: Among 1878 patients screened, 814 (43.3%) had a UDS. UDS was more common in younger (median age 60 vs 67), male (60.4% vs 47.6%) and Black (35.6% vs 27.5%) and Hispanic (22.0% vs 21.6%) patients. Of those with UDS, 72(8.84%) had cocaine and/or amphetamine detected and 660 (81.08%) were UDS negative. After controlling for age, sex, race, and insurance status, hypertension (OR 2.28, 95%CI 1.17-4.41) was positively associated with stimulant use while DMII was negatively associated (OR 0.39, 95%CI 0.19-0.81). Other RFs were not associated with stimulant use. Conclusion: Despite being younger, stroke patients with stimulant-positive UDS had a higher prevalence of hypertension, a leading risk factor for recurrent stroke, than UDS-negative patients. This group may represent a high-risk population that may benefit from targeted interventions for secondary stroke prevention. Differences in screening by sex, race, and age may lead to missed opportunities for assessment of recurrent stroke risk. A standard approach to drug screening may eliminate these biases.

Culinary medicine is an evidence-based approach that blends the art of cooking with the science of medicine to inculcate a healthy dietary pattern. Food prescription programs are gaining popularity in the Unites States, as a means to improve access to healthy foods among patient populations. The purpose of this paper is to describe the implementation and preliminary impact of A Prescription for Healthy Living (APHL) culinary medicine curriculum on biometric and diet-related behavioral and psychosocial outcomes among patients with diabetes participating in a clinic-led food prescription (food Rx) program. We used a quasi-experimental design to assess APHL program impact on patient biometric outcome data obtained from electronic health records, including glycosylated hemoglobin (HbA1c), body mass index (BMI), and blood pressure (n = 33 patients in the APHL group, n = 75 patients in the food Rx-only group). Pre-post surveys were administered among those in the APHL group to monitor program impact on psychosocial and behavioral outcomes. Results of the outcome analysis showed significant pre-to-post reduction in HbA1c levels among participants within the APHL group (estimated mean difference = −0.96% (−1.82, −0.10), p = 0.028). Between-group changes showed a greater decrease in HbA1c among those participating in APHL as compared to food Rx-only, albeit these differences were not statistically significant. Participation in APHL demonstrated significant increases in the consumption of fruits and vegetables, fewer participants reported that cooking healthy food is difficult, increased frequency of cooking from scratch, and increased self-efficacy in meal planning and cooking (p < 0.01). In conclusion, the results of our pilot study suggest the potential positive impact of a virtually-implemented culinary medicine approach in improving health outcomes among low-income patients with type 2 diabetes, albeit studies with a larger sample size and a rigorous study design are needed.

Through the Healthy, Hunger-Free Kids Act of 2010, USDA (US Department of Agriculture) made the first major changes in the CACFP (Child and Adult Care Food Program) meal and snack menu patterns. Childcare centers that serve low-income families qualify to participate and receive reimbursement for meals and snacks served. The purpose of this study was to assess what changes in children’s dietary behaviors occurred as a result of the new CACFP meal pattern requirements. This study evaluated these changes at childcare centers operating in Houston and San Antonio, Texas, USA, areas enrolled in the CACFP, pre- (Spring 2016) and post-implementation (Fall 2016–Spring 2017) of the new meal patterns. Dietary intake was assessed via observations of children, 3–5 years old, conducted at breakfast, lunch, and snack times. Results showed improvements in adjusted means of several nutrients and food groups consumption, post-implementation of new CACFP meal guidelines compared to baseline, specifically intake of whole grains, milk, and juice. Additional studies are needed to confirm the impact of the revised CACFP meal patterns along with strategies to assist providers in meeting the new standards to increase the access to and intake of items in accordance with the CACFP meal pattern requirements in childcare settings.

This research commentary reviews the current impact of the COVID-19 pandemic on food insecurity. We explore the impact of the pandemic on existing programs and evaluate how these programs adapted under these unprecedented circumstances. Moreover, we explore currently undertaken, favorable strategies for successfully addressing food insecurity during the pandemic. These initiatives include a nonprofit-retail industry partnership and programmatic strategies implemented by the U.S. Department of Agriculture (USDA). In an effort to bring awareness to addressing this important public health issue, we note the need to document these strategies and determine the most effective solutions to combat food insecurity in a vulnerable population.

Brighter Bites is a school-based health promotion program that delivers fresh produce and nutrition education to low-income children and their families across 6 locations in the US. This article provides a perspective on how, despite coronavirus disease 2019-related school closures, Brighter Bites pivoted rapidly to collaborate with medical and public health institutions to improve health and food literacy among their families. Through these partnerships, Brighter Bites was able to rapidly provide accurate, evidence-based information related to coronavirus disease 2019 and other social needs, including food, housing, transportation, and access to health care, to help fill a needed gap in vulnerable communities.