Although disclosure of all funding sources, including those from industry, is mandatory for publication, it is no longer adequate. Given the skepticism surrounding industry-funded research, we need guidelines for communication with funding organizations and publication venues, and we need to safeguard and preserve research and scientific integrity.

The objective of this study was to compare the quick-and-easy undernutrition screening tools, ie, Short Nutritional Assessment Questionnaire and Malnutrition Universal Screening Tool, in patients undergoing cardiac surgery with respect to their accuracy in detecting undernutrition measured by a low-fat free mass index (FFMI; calculated as kg/m(2)), and secondly, to assess their association with postoperative adverse outcomes. Between February 2008 and December 2009, a single-center observational cohort study was performed (n=325). A low FFMI was set at ≤14.6 in women and ≤16.7 in men measured using bioelectrical impedance spectroscopy. To compare the accuracy of the Malnutrition Universal Screening Tool and Short Nutritional Assessment Questionnaire in detecting low FFMI sensitivity, specificity, and other accuracy test characteristics were calculated. The associations between the Malnutrition Universal Screening Tool and Short Nutritional Assessment Questionnaire and adverse outcomes were analyzed using logistic regression analyses with odds ratios and 95% confidence intervals (CI) presented. Sensitivity and receiver operator characteristic-based area under the curve to detect low FFMI were 59% and 19%, and 0.71 (95% CI: 0.60 to 0.82) and 0.56 (95% CI: 0.44 to 0.68) for the Malnutrition Universal Screening Tool and Short Nutritional Assessment Questionnaire, respectively. Accuracy of the Malnutrition Universal Screening Tool improved when age and sex were added to the nutritional screening process (sensitivity 74%, area under the curve: 0.72 [95% CI: 0.62 to 0.82]). This modified version of the Malnutrition Universal Screening Tool, but not the original Malnutrition Universal Screening Tool or Short Nutritional Assessment Questionnaire, was associated with prolonged intensive care unit and hospital stay (odds ratio: 2.1, 95% CI: 1.3 to 3.4; odds ratio: 1.6, 95% CI: 1.0 to 2.7). The accuracy to detect a low FFMI was considerably higher for the Malnutrition Universal Screening Tool than for the Short Nutritional Assessment Questionnaire, although still marginal. Further research to evaluate the modified version of the Malnutrition Universal Screening Tool, ie, the cardiac surgery-specific Malnutrition Universal Screening Tool, is needed prior to implementing.

Childhood cancer survivors are at increased risk for chronic health conditions that may be influenced by their cancer treatment and unhealthy lifestyle behaviors. Despite the possibility that interventions targeting the survivor-parent dyad may hold promise for this population, a clearer understanding of the role of family factors and the lifestyle behaviors of both survivors and parents is needed. A mailed cross-sectional survey was conducted in 2009 to assess weight status (body mass index), lifestyle behaviors (eg, diet, physical activity), and the quality of the parent-child relationship among 170 childhood cancer survivors who were treated at MD Anderson Cancer Center and 114 of their parents (80% mothers). Survivors were more physically active and consumed more fruits and vegetables than their parents. However, fewer than half of survivors or parents met national guidelines for diet and physical activity, and their weight status and fat intakes were moderately correlated (r=.30-.57; P<0.001). Multilevel models showed that, compared with survivors with better than average relationships, those with poorer than average relationships with their parents were significantly more likely to consume high-fat diets (P<0.05). Survivors and their parents may thus benefit from interventions that address common lifestyle behaviors, as well as issues in the family environment that may contribute to an unhealthy lifestyle.

Fortification can help individuals achieve adequate nutritional intake. Foods may be fortified with soy flour as a source of protein for individuals limiting their intake of animal products, either due to personal dietary preference or to reduce their intake of saturated fat, a known risk factor for heart disease. This study determined the feasibility of fortifying peanut butter graham crackers by substituting soy flour for all-purpose wheat flour at 25%, 50%, 75%, or 100% weight/weight. Graham crackers fortified with soy flour were compared to similarly prepared nonfortified peanut butter graham crackers. Moisture contents of all graham crackers were similar. Consumers (n=102) evaluated each graham cracker using a hedonic scale and reported liking the color, smell, and texture of all products. However, unlike peanut butter graham crackers fortified with lower levels of soy, graham crackers fortified with 100% weight/weight soy flour had less than desirable flavor, aftertaste, and overall acceptability. Overall, this study shows that fortification of peanut butter graham crackers up to 75% weight/weight with soy flour for all-purpose wheat flour is acceptable.

Large disparities exist in obesity and other chronic diseases across racial/ethnic and socioeconomic status (SES) groups in the United States. This study examined how much of racial/ethnic differences in diet, exercise, and weight status could be explained by nutrition- and health-related psychosocial factors (NHRPF) and SES among US adults. Nationally representative data of 4,356 US adults from the 1994-1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey were used. NHRPF were assessed using 24 questions and related index scores. Dietary intakes were assessed using two nonconsecutive 24-hour dietary recalls. The US Department of Agriculture 2005 Healthy Eating Index was applied to evaluate diet quality. Body mass index was calculated based on self-reported weight and height. SES was assessed using education and household income. Americans with higher SES had better NHRPF and Healthy Eating Index scores. There were some small racial/ethnic differences in NHRPF, including making food choices and awareness of nutrition-related health risks. Multivariable linear and logistic regression models revealed some racial/ethnic differences in diet, exercise, and body mass index, but few of these disparities was explained by NHRPF, whereas SES explained some. The odds ratio of body mass index ≥25 for non-Hispanic blacks compared with whites decreased by 38% after SES was adjusted for. For exercise, we found a smaller change (9.5%) in the racial/ethnic differences when controlling for SES. In conclusion, NHRPF may explain very few, but SES may contribute some of the racial/ethnic disparities in diet, exercise, and weight status in the United States.

Snacking may play a role in weight control. The associations of timing and frequency of snacking with observed weight change and nutrient intake were assessed in an ancillary study to a 12-month randomized controlled trial in Seattle, WA. Overweight-to-obese postmenopausal women (n=123) enrolled in the two dietary weight-loss arms from 2007 to 2008 with complete data at 12 months were included in these analyses. Generalized linear models were used to test the associations between snacking and weight loss (percent) and nutrient intake at the 12-month time point. Participants were, on average, 58 years old and mainly non-Hispanic white (84%). Ninety-seven percent reported one or more snacks per day. Weight loss (percent) was significantly lower among mid-morning (10:30 am to 11:29 am) snackers (7.0%, 95% confidence interval: 4.3 to 9.7) compared to non-mid-morning snackers (11.4%, 95% confidence interval: 10.2 to 12.6; P=0.005). A higher proportion of mid-morning snackers reported more than one snack per day (95.7%), compared to afternoon (82.8%) and evening (80.6%) snackers, although differences were not statistically significant (P>0.005). Women who reported two or more snacks per day vs one or no snacks per day had higher fiber intake (P=0.027). Afternoon snackers had higher fruit and vegetable intake compared to non-afternoon-snackers (P=0.035). These results suggest that snack meals can be a source for additional fruits, vegetables, and fiber-rich foods; however, snacking patterns might also reflect unhealthy eating habits and impede weight-loss progress. Future dietary weight-loss interventions should evaluate the effects of timing, frequency, and quality of snacks on weight loss.

Information regarding associations between types of away-from-home family meal sources and obesity and other chronic diseases could help guide dietetics practitioners. The present study describes the purchase frequency of away-from-home food sources for family dinner (fast food, other restaurant purchases, home delivery, and takeout foods) and associations with weight status and percent body fat among adolescents (n=723) and parents (n=723) and related biomarkers of chronic disease among adolescents (n=367). A cross-sectional study design was used with baseline parent surveys and anthropometry/fasting blood samples from two community-based obesity studies (2006-2008) in Minnesota. Logistic regression and general linear modeling assessed associations between frequency of family dinner sources (weekly vs none in past week) and outcomes (parent and adolescent overweight/obesity and percent body fat; adolescent metabolic risk cluster z score, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein, triglycerides, fasting glucose, insulin, and systolic blood pressure. Models accounted for clustering and adjusted for study allocation, baseline meal frequency, and demographic characteristics. The odds of overweight/obesity were considerably greater when families reported at least one away-from-home dinner purchase in the past week (odds ratio=1.2 to 2.6). Mean percent body fat, metabolic risk cluster z scores, and insulin levels were significantly greater with weekly purchases of family dinner from fast-food restaurants (P<0.05). Mean percent body fat, metabolic risk cluster z scores, and high-density lipoprotein levels were significantly higher for families who purchased weekly family dinner from takeout sources (P<0.05). Although frequent family dinners may be beneficial for adolescents, the source of dinners is likely as important in maintaining a healthy weight. Interventions should focus on encouragement of healthful family meals.

Adverse reactions to foods are classified according to the presence or absence of involvement of the immune system, which may or may not include the production of immunoglobulin E (IgE) antibodies. This review focuses on the epidemiology, diagnosis, and management of adverse food reactions, primarily in adults, and excluding celiac disease and lactose intolerance. Reported reactions to foods are often believed to be manifestations of a food allergy; however, IgE-mediated food allergy only affects 1% to 4% of adults, with seafood, tree nuts, peanuts, fruits, and vegetables being the most common triggers. Diagnosis is challenging and most commonly achieved through careful evaluation of clinical history followed by elimination and reintroduction or challenge with the suspected offending food. With acute-onset allergic reactions, estimation of food-specific IgE antibodies is frequently used to confirm or refute the diagnosis. Recent developments, such as single allergen assays, enhance the diagnosis of IgE-mediated food allergy, but the gold standard remains oral food challenge. Despite recent advances in the management of food allergy, including the promotion of oral tolerance, the mainstay of management is still the avoidance of food triggers. Dietary management can be compromised by nutritional inadequacy, accidental exposure, food labeling, and quality of life or adherence issues. It is essential that adults with confirmed food allergy receive optimal nutrition and dietetic support to enable them to manage their condition.

Medical nutrition therapy is reported to contribute to wound healing. However, effective intervention requires an accurate estimation of individual energy needs, which, in turn, relies on accurate methods of assessment. The primary aims of this systematic review and meta-analysis were to evaluate the resting energy expenditure (REE) of patients with pressure ulcers (PUs) compared to matched control groups and the potential estimation bias of REE predictive equations. The recommended daily energy requirements of patients with PUs were also assessed, along with their energy balance (daily energy requirement vs intake). All language, original, full-text research articles published between January 1, 1950, and July 31, 2010, were searched through electronic databases. Relevant studies were also identified by reviewing citations. Observational (case-control and case-series) studies providing data on measured REE were initially included. Data extracted were measured REE, predicted REE, and daily energy intake. Five studies were included in the meta-analysis. Compared to controls (n=101), patients with PUs (n=92) presented higher measured REE (weighted mean 20.7±0.8 vs 23.7±2.2 kcal/kg/day; P<0.0001). In these patients, measured REE was also higher than predicted REE (calculated using the Harris-Benedict formula in all studies; 21.0±1.0 kcal/kg/day; P<0.0001), whereas energy intake (n=78; 21.7±3.1 kcal/kg/day) was significantly lower (P<0.0001) than total daily requirement, which was calculated as 29.4±2.7 kcal/kg/day. Patients with PUs are characterized by increased REE and reduced energy intake. In the estimation of REE using the Harris-Benedict formula, a correction factor (×1.1) should be considered to accurately assess energy needs. Moreover, an energy intake of 30 kcal/kg/day seems appropriate to cover the daily requirements of patients with PUs.

This study sought to identify maternal styles of talking about child feeding from a semistructured interview and to evaluate associated maternal and child characteristics. Mothers of preschool-aged children (n=133) of diverse race/ethnicity and socioeconomic status (SES) (45 lower SES black, 29 lower SES white, 32 lower SES Hispanic, 15 middle to upper SES white, and 12 middle to upper SES Asian) participated in a semistructured interview about feeding. Interviews were audiotaped and transcribed. Themes were identified, and individual interviews were coded within these themes: authority (high/low), confidence (confident/conflicted/unopinionated), and investment (deep/mild/removed). Demographic characteristics were collected and a subset of children had measured weights and heights. Cluster analysis was used to identify narrative styles. Participant characteristics were compared across clusters using Fisher's exact test and analysis of variance. Six narrative styles were identified: Easy-Going, Practical No-Nonsense, Disengaged, Effortful No-Nonsense, Indulgent Worry, and Conflicted Control. Cluster membership differed significantly based on maternal demographic group (P<0.001) and child weight status (P<0.05). More than half (60%) of children of mothers in the Conflicted Control cluster were obese. Maternal styles of talking about feeding are associated with maternal and child characteristics.