Session

Nutritional Epidemiology

Kiran Nagdeo, BDS, MPH, Department of Epidemiology, New York University School of Global Public Health, New York, NY

APHA 2024 Annual Meeting and Expo

Abstract

A randomized crossover pilot study investigating the impact of a "natural" low-calorie sweetener (Allulose) on glycemic and metabolic measures

Anais Fernandez Calzavara1, Syma Rashid2, Grace Schoenhoff2, Ashley Meyer2 and Andrew Odegaard2
(1)University of California Irvine, Irvine, (2)Irvine, CA

APHA 2024 Annual Meeting and Expo

The average U.S. adult consumes over double the recommended daily intake of added sugars, which is positively associated with multiple chronic diseases. Palatable sugar-free alternatives are scarce, challenging intake control, particularly for type 2 diabetes (T2D) patients. Substituting with low- and no-calorie sweeteners (LNCS) is recommended for diabetes management despite limited supporting evidence. Allulose, an FDA-approved natural "zero-calorie" sweetener, provides a promising solution. This pilot study investigated allulose-sweetened products’ potential to reduce added sugar intake and improve glycemia in individuals with T2D.

In a single-blinded, three-period (2-week period), crossover trial, participants with T2D (HbA1c < 8.5%) were assigned to three dietary approaches in random order: Usual added sugar and processed (SP, control), allulose-sweetened foods and processed (AP), or unsweetened and whole/minimally processed (UMP). Blinded continuous glucose monitoring metrics served as the primary outcome measure, alongside assessment of dietary intake and quality, blood pressure, weight, and psychosocial metrics.

Data were analyzed with linear-mixed models. Compared to SP, the AP period had lower mean glucose over 2-weeks (-13.3 mg/dL, SE 5.5, p=0.02), whereas there was no difference with the UMP period. % Time-in-range (70-180 mg/dL) supported this data (SP v. AP) but revealed that participants spent 9.5% less time-in-range on the UMP period v. AP period (-9.5, SE 3.9, p=0.02). There were no other effects across the measures. Overall diet quality (Healthy Eating Index) was low across periods (~57, SE 2.9).

These preliminary findings suggest that allulose-sweetened food products may beneficially impact glycemia in diabetes control, highlighting the need for further studies.

Chronic disease management and prevention Epidemiology Public health or related research Social and behavioral sciences

Abstract

Association between body composition standards and disordered eating among active-duty service women, FY 2018-2019

Tracey Koehlmoos, PHD, MHA1, Jessica Korona-Bailey, MPH2, Amanda Banaag, MPH3, Stephanie Fortin1, Megan Eyeler1 and Jasmine Walker, MPH1
(1)Uniformed Services University of the Health Sciences, Bethesda, MD, (2)Columbus, GA, (3)Chesapeake, VA

APHA 2024 Annual Meeting and Expo

Introduction: Eating disorders are of particular concern to the Department of Defense and Military Health System (MHS) where strict body composition standards are in place. We sought to examine the relationship between body composition standards and eating disorder diagnosis.

Methods: We conducted a cross-sectional study of active-duty service women (ADSW) ages 18 and older in the U.S. Army, Air Force, Navy, and Marine Corps during fiscal years (FY) 2018-2019. Utilizing claims data from the MHS Data Repository (MDR), we identified ADSW with a Body Mass Index (BMI) measure during the study period. Service-specific standard BMI indicators were generating including below the Service-specific standard BMI, exceeding the Service-specific standard BMI, and borderline defined as +/- one BMI value above/below the Services’ maximum value. We compared ADSW’s BMI to Service-specific BMI requirements and diagnosis of eating disorder using descriptive statistics and multivariate logistic regression.

Results: We identified 161,209 ADSW, of whom 38.3% had a BMI exceeding the maximum BMI Service-specific standard during the study period and 61.7% had a BMI below the maximum Service-specific standard. Overall, 21.0% of ADSW had a borderline BMI. Prevalence of eating disorder diagnosis was 0.5%. Increased risk of an eating disorder was found in ADSW with an underweight BMI. There was no increased risk among ADSW who were near the BMI standard set by their Service.

Conclusion: There is no association between body composition standards of the Services and disordered eating diagnoses in ADSW. The largest risk of eating disorder diagnoses occurred for ADSW who are underweight.

Conduct evaluation related to programs, research, and other areas of practice Epidemiology Occupational health and safety Public health or related public policy Public health or related research

Abstract

School-level socioeconomic polarization associated with socioemotional and nutrition-related well-being during adolescence and into emerging adulthood

Vivienne Hazzard, PhD, MPH, RD1, Hannah Cory, PhD, MPH, RD2, Mikayla Barry, PhD, MPH3, Nicole Larson, PhD, MPH, RDN4, Susan Marshall Mason, PhD4 and Dianne Neumark-Sztainer, PhD, MPH, RD3
(1)Beverly Hills, MI, (2)OHSU-PSU School of Public Health, Portland, OR, (3)University of Minnesota School of Public Health, Minneapolis, MN, (4)University of Minnesota, Minneapolis, MN

APHA 2024 Annual Meeting and Expo

Background: Socioemotional and nutrition-related disparities by socioeconomic status are well documented.

Objective: To examine socioeconomic polarization (i.e., the degree of concentration of students from lower versus higher socioeconomic backgrounds) within secondary schools in relation to socioemotional and nutrition-related well-being during adolescence and into emerging adulthood.

Methods: Racially/ethnically diverse participants (N=2,793) in the Eating and Activity over Time (EAT) study were recruited from 20 public middle and high schools in the Minneapolis-St. Paul area in 2009-2010. To represent socioeconomic polarization, an Index of Concentrations at the Extremes (ICE) was calculated using school-level distributions of students eligible for free lunch versus those required to pay full price. Markers of socioemotional and nutrition-related well-being were self-reported by participants at baseline (Mage=14.4±2.0 years) and 8-year follow up (Mage=22.1±2.0 years). Regressions accounting for within-school clustering examined associations between school-level ICE at baseline in relation to (a) baseline levels and (b) changes from baseline to follow-up for each well-being marker, adjusting for school enrollment size, participant age, and participant sex.

Results: Most schools had negative ICE values (M=-0.51±0.33), indicating greater concentrations of socioeconomic deprivation. Lower baseline ICE values were significantly associated with poorer diet quality, lower intuitive eating, greater prevalence of restrictive weight-control behaviors (WCBs) and binge eating, lower self-esteem, and lower body satisfaction cross-sectionally, and predicted increased prevalence of compensatory WCBs but decreased depressive symptoms at 8-year follow up.

Conclusion: Greater within-school concentrations of socioeconomic deprivation corresponded to less favorable socioemotional and nutrition-related outcomes. Inequitable resource allocation across schools may help explain these findings.

Epidemiology Social and behavioral sciences