Wellness Check: Nutrition
1. In this longitudinal cohort study, individual-level factors such as age >35, more than high school education, English language proficiency, being married, White race, smaller family size, and higher income were associated with lower odds of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
2. State-level factors such as higher earned income tax credit rates were associated with lower rates of WIC participation, while other factors such as higher gross domestic product (GDP) per capita, unemployment rates, and Medicaid caseloads, were associated with higher participation rates.
Evidence Rating Level: 2 (Good)
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) works to safeguard low-income pregnant individuals and their children from poor nutrition during and after pregnancy. Despite the association between WIC participation and both maternal and infant health benefits, WIC participation has been in decline for the last decade. However, the factors that contribute to low rates of WIC participation are unclear. Therefore, the purpose of the present study was to examine individual- and state-level predictors associated with WIC participation.
This longitudinal cohort study included 288,531 individuals from 45 states who recently gave birth and were surveyed between 2004-2019 as part of the Pregnancy Risk Assessment Monitoring System (PRAMS) study. Individuals who were WIC-eligible based on self-reported income and had survey information on WIC receipt during pregnancy were included. The potential predictors of outcome that were examined included age, race, education, family size, household income, language, pre-pregnancy diabetes, and yearly state-level variables such as gross domestic product (GDP) per capita, unemployment rate, state earned income tax credit (EITC) rate, the political party of the governor, and measures of state caseloads for other social programs. The primary outcome was whether the respondent utilized WIC.
The results showed that several individual- and state-level factors influenced WIC participation. Individual-level factors that were associated with lower odds of WIC participation included age >35, English language proficiency, being married, White race, smaller family size, and higher income. State-level factors such as higher GDP per capita, higher unemployment rates, higher Medicaid caseloads, and having a Democrat governor were associated with higher odds of WIC uptake. This study was limited by the use of self-reporting for income to determine WIC eligibility, which may have led to misclassification. Nonetheless, this study highlighted variables that influence WIC participation.
Vitamin D supplementation does not improve leg muscle strength and performance in older adults
1. In this randomized controlled trial, vitamin D supplementation was not associated with change in leg power, strength, or physical performance in older adults with vitamin D deficiency.
2. Furthermore, vitamin D supplementation did not significantly change muscle fiber composition in leg muscle biopsies from older adults compared to controls.
Evidence Rating Level: 1 (Excellent)
In the aging population, loss in muscle strength and performance is highly prevalent and is associated with adverse clinical outcomes. Although vitamin D deficiency is also prevalent in this population, it is unclear whether vitamin D supplementation could improve muscle strength and performance. Therefore, the purpose of the present study was to examine the effect of daily vitamin D supplementation on muscle strength and power in older adults.
This randomized controlled trial included 136 low-functioning adult patients aged 65-89 years living in North Carolina. Patients were included if they were not taking vitamin D supplementation, had vitamin D levels between 18 to <30ng/mL, and had some mobility difficulties. Participants who were dependent on a walker, had a body mass index (BMI) >40 kg/m2, or had insulin-dependent diabetes, heart failure, lung disease, or other chronic conditions were excluded. The participants were randomized 1:1 to either 2000 IU/day of vitamin D3 or placebo for 12 months. The primary outcome was leg power assessed using the Nottingham Power Rig. Secondary outcomes included leg strength and physical performance, as measured by Short Physical Performance Battery (SPPB) score, timed up and go (TUG) test, postural sway, and gait velocity. Outcomes were evaluated at baseline, 4 months, and 12 months. A subset of 38 participants were randomly selected to undergo leg muscle biopsy at baseline and 4-months.
The results demonstrated that there was no difference in leg power, strength, SPPB score, TUG, postural sway, or gait velocity in participants treated with vitamin D supplementation compared to the control group. There were also no observable differences between the muscle biopsies of those in the treatment and control groups with regards to muscle fiber composition. However, this study was limited by its lack of generalizability to older adults who are not low-functioning or those without vitamin D deficiency. Nonetheless, the study comprehensively examined the impact of vitamin D supplementation on outcomes in older adults.
Children in UK nurseries are willing to eat vegetables offered during breakfast
1. In this cluster randomized controlled trial, most children in the intervention group were willing to eat vegetables as part of their daily breakfast.
2. Furthermore, exposure to vegetables at breakfast excited children and resulted in them asking for vegetables in subsequent weeks.
Evidence Rating Level: 1 (Excellent)
Consuming sufficient portions of vegetables is an important part of having a healthy diet, especially during childhood development. Previous interventions for increasing vegetable intake have focused on offering vegetables with midday/evening meals and snack times and have only had limited success. However, the impact of offering vegetables during breakfast time has not been investigated. Therefore, the purpose of the present study was to investigate the feasibility and acceptability of offering vegetables to children during breakfast time in nursery/kindergarten settings.
This randomized control trial included 351 children aged 18 months to 4 years and took place in 8 nurseries in the UK. Children who ate breakfast at a nursery at least once a week were included. Children with allergies to the intervention foods or any conditions which impacted feeding or eating were excluded. In the 6 intervention nurseries, staff offered 3 raw carrots and cucumber sticks alongside breakfast foods each day for 3 weeks. The 2 control nurseries offered children their usual breakfast. The primary outcomes were feasibility and acceptability, which were assessed by nursery staff’s ability to follow the trial protocol and children’s willingness to eat the vegetable at breakfast time, respectively.
The results demonstrated that 62.4% of children were willing to eat the vegetables offered, suggesting that this intervention had high acceptability. Qualitatively, staff reported that children initially asked questions about why vegetables were being served but later asked for vegetables before they were even offered. This study was limited by the lack of diversity in the nurseries included with regards to relative deprivation, which may have affected the generalizability of the results. Nonetheless, the study showed preliminary evidence supporting the inclusion of vegetables during breakfast time in nursery/kindergarten settings.
Image: PD
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