Kiyah J. Duffey

The Healthy Beverage Index (HBI) is an emerging approach to assess beverage pattern quality. HBI total scores range from 0 to 100, with higher scores indicating greater adherence to proposed beverage recommendations. However, assessing patterns is resource-intensive due to the need for extensive dietary data, typically 24-h dietary records or recalls. The BEVQ-15, a beverage intake questionnaire, may be used as an alternative method to rapidly measure HBI scores. The objective of this cross-sectional investigation is to assess the comparative validity of the HBI-Q, a method to rapidly assess HBI scores via the BEVQ-15, as compared to the traditional method of deriving HBI scores via dietary recalls/records. Between 2012 and 2016, a cross-sectional sample of adults in southwest Virginia completed three 24-h dietary recalls (30–60 min administration and analysis time per recall) and the BEVQ-15 (3–4 min administration time). HBI scores were generated by both methods, and compared via paired-samples t-tests, correlations, and Bland–Altman analysis. Among 404 adults (mean age = 40 years), total mean HBI scores were 63.7 from the HBI-Q and 67.3 from the recalls (mean difference = 3.6 out of 100; r = 0.63; both p ≤ 0.001). Agreement between the two methods for total HBI scores via Bland–Altman plots was 92%. Using the HBI-Q to rapidly assess HBI scores in adults will increase the utility of the HBI by decreasing the time and resources required, thus allowing researchers and practitioners to provide targeted feedback for improvement.

Sugar-sweetened beverages (SSB) contribute to excessive weight gain through added energy intake. Replacing SSB with water is one strategy that has shown promise in helping lower excessive energy intake. Using nationally representative data from US adults (n = 19,718) from NHANES 2007–2012 we examine the impact of replacing SSB with water on Healthy Beverage Index (HBI) scores and obesity prevalence. Replacing an 8-ounce serving of SSB with water lowered the percent of energy from beverages from 17% to 11% (among those consuming 1 serving SSB/day). Reductions in the percent energy from beverages were observed across all SSB consumption groups (1–2 servings/day and >2 servings/day). Among adults there was a 9% to 21% improvement in HBI score when one serving of water replaced one serving of SSB. Using previously published randomized controlled trials (RCT) and meta-analyses of measured weight loss we also predicted a reduction in the prevalence of obesity (observed: 35.2%; predicted 33.5%–34.9%, p < 0.05) and increase in the prevalence of normal weight (observed: 29.7%; high weight loss: 31.3%, p < 0.05). Our findings provide further epidemiologic evidence that water in the place of SSB can be used as a strategy to limit energy intake and help individuals meet beverage intake recommendations.

The purpose of this study was to review state regulations promoting increased physical activity and decreased sedentary behaviors in infants in child care and to assess consistency with recent Institute of Medicine (IOM) recommendations. We compared existing state and territory licensing and administrative regulations to recent IOM recommendations to promote physical activity and decrease sedentary time in very young children attending out-of-home child care (both child care centers and family child care homes). Three independent reviewers searched two sources (a publicly available website and WestlawNext™) and compared regulations with five IOM recommendations: 1) providing daily opportunities for infants to move, 2) engaging with infants on the ground, 3) providing daily tummy time for infants less than six months of age, 4) using cribs, car seats and high chairs for their primary purpose, and 5) limiting the use of restrictive equipment for holding infants while they are awake. We used Pearson chi-square tests to assess associations between geographic region, year of last update, and number of state regulations consistent with the IOM recommendations. The mean (SD) number of regulations for states was 1.9 (1.3) for centers and 1.6 (1.2) for homes out of a possible 5.0. Two states had regulations for all five recommendations, Arizona for centers and Virginia for homes. Six states and territories had zero regulations for child care centers and seven states and territories had zero regulations for family child care homes. There were no significant associations between geographic region and number of regulations consistent with IOM recommendations. Out-of-home child care settings are important targets for optimal early child health interventions. While most states had some regulations related to the promotion of physical activity among infants, few states had regulations for more than three of the five IOM recommendations. Enhancing state regulations in child care facilities could aid in early childhood obesity prevention efforts.

Flavonoids, present in high levels in cranberries, are potent bioactives known for their health-promoting benefits, but cranberry beverages (CB) are not typically recommended as part of a healthy diet. We examine the association between CB consumption with macronutrient intake and weight status. Data for US adults (≥19 years, n = 10,891) were taken from the National Health and Nutrition Examination Survey (NHANES) Survey 2005–2008. Total CB consumption was measured over two non-consecutive 24-h dietary recalls. Linear and logistic regression models adjusting for important covariates were used to examine predicted differences between CB consumers and non-consumers on macronutrient and anthropometric outcomes. Results are weighted to be nationally representative. CB consumers (n = 581) were older (>50 year) non-Hispanic black females. They consumed an average 221 mL (7.5 oz) CB per day. In fully adjusted models CB consumers (vs. non-consumers) had higher carbohydrates and total sugars and lower percent energy from protein and total fat (all p < 0.001), but no difference in total energy. A significantly higher proportion of CB consumers were predicted to be normal weight (BMI < 25 kg/m²; p = 0.001) and had to have lower waist circumferences (p = 0.001). Although there was not a significant trend across level of CB intake, low and middle level CB consumers compared to non-consumers were more likely to be normal weight (p < 0.001) and less likely to be overweight/obese (BMI ≥ 25 kg/m², p < 0.001). Despite having slightly higher daily macronutrient intakes, CB consumers have more desirable anthropometric measures compared to non-consumers.