Director of Doctoral Studies
Associate Professor of Public Health Nutrition
Niyati Parekh, Associate Professor of Public Health Nutrition, worked as a practicing clinical nutritionist in India prior to working in academia and public health. She was involved in several projects related to community outreach within local neighborhoods, such as establishing a breast milk bank in a Mumbai hospital and serving mothers from urban slums. Most notably, she worked as an oncology dietitian, working at the bedside of cancer patients, some living without an esophagus or stomach. While serving cancer patients, the importance of nutrition in cancer care became apparent to her. She decided to pursue a career at the intersection of biology, clinical nutrition and population science, and came to the United States for her training. She subsequently completed her doctoral degree in nutritional epidemiology.
During her eight year tenure at NYU, she has primarily focused on nutrition and chronic diseases. Particularly, she has investigated the links between diet, physical activity, obesity and cancer. Currently, she is Principal Investigator of The Cancer, Insulin Resistance, and Lifestyle (CIRCLE) Study in the multi-generational Framingham Heart Study cohort, funded by the American Cancer Society. This study exams obesity and glucose dysregulation as risk factors for developing cancer in US population.
Based on the findings from the CIRCLE study, Niyati and Dr. Paul Krebs, Co-Principal Investigator of HEAL and a faculty member at NYU School of Medicine, pursued funding a pilot study, The Healthy Eating and Living against Breast Cancer (HEAL-Breast Cancer) to provide breast cancer survivors with nutrition literacy programming. The program concludes with an Iron Chef competition in which the women get into the kitchen, and put into practice everything that they've learned. "It's not just about nutrition, it's about how to make those changes in your day to day life," said Niyati. Her community outreach extends to nutrition workshops and projects in her children's schools.
Niyati has been interested in understanding early-life risk factors of chronic diseases. Recently, Niyati served as a Visiting Scholar at Karolinska Institutet and the Linköping University, funded by County Council of Östergötland, Sweden. She collaborated with faculty and doctoral students on analyses addressing body composition and eating patterns in preschool children, who were enrolled in an mHealth intervention. This work has informed her current grant proposal in which she is preparing to study infancy and childhood-related risk factors of adult cancers.
On campus, Niyati has taught Global Nutrition, Public Health Nutrition, as well as methodology courses for which she has won teaching awards. Niyati thrives on putting nutrition into a global context for her students through study abroad experiences. Notably, she taught a course on Public Health Nutrition and Chronic Disease in Mexico. She fuels conversation around the nutrition and risk factors for chronic diseases (diabetes, heart disease) through visits to the marketplaces and local cantinas. She will be involved in teaching study abroad courses at CGPH.
Niyati's highlights at NYU have been the mentorship of doctoral students. Her first student won the "Best Dissertation Award" from 70 eligible candidates at Steinhardt, who then moved on to be employed at the Harvard School of Public Health. She occasionally enjoys cooking for her doctoral students during her downtime. "They can taste the goodness of nutrition in my food. I don't always have to teach it," she said with a warm laugh.
Dr. Parekh received her MS in Foods, Nutrition, and Clinical Dietetics in 1997 and is a credentialed Registered Dietitian from India. In 2005, she earned a PhD in Nutritional Sciences and Population Health from the University of Wisconsin-Madison. Thereafter, she was awarded a 2-year Department of Defense postdoctoral fellowship at the Rutgers-Cancer Institute of New Jersey.
BS, Life Sciences and Biotechnology, Mumbai University, IndiaMS, Foods, Nutrition, and Clinical Dietetics, Mumbai University, IndiaPhD, Nutritional Sciences (minor Population Health Sciences), University of Wisconsin-Madison, Madison, WI
CancerChronic DiseasesEpidemiologyNutritionObesityPopulation HealthPublic Health Nutrition
Food assistance programs and income are associated with the diet quality of grocery purchases for households consisting of women of reproductive age or young childrenLitvak, J., Parekh, N., Juul, F., & Deierlein, A.
Journal titlePreventive Medicine
Volume138Women's diet quality during reproductive years and children's diet quality during early life influence long term health. Few studies have evaluated the impact of food assistance programs and income on the diet quality of grocery purchases made by households consisting of women of reproductive age and young children. We used data from the Food Acquisition and Purchase Survey 2012–2013 (FoodAPS) to evaluate how household income, Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC) participation, and Supplemental Nutrition Assistance Program (SNAP) participation are related to the diet quality of grocery purchases made by households that include women of reproductive age or young children (n = 2436). The diet quality of household grocery purchases was assessed with the Healthy Eating Index (HEI) 2015. HEI-2015 total score (0−100) and component scores were evaluated according to household income (eligible for WIC: income-to-poverty ratio ≤ 185%; ineligible for WIC: income-to-poverty ratio > 185%) and WIC, SNAP, and WIC + SNAP participation. Median HEI-2015 total score was lowest among SNAP households and highest among income ineligible for WIC and WIC households (47.2 and 54.1, respectively). Compared to income ineligible for WIC households, WIC + SNAP and SNAP households had lower HEI-2015 whole fruit (β = −0.30, 95% CI: −0.59, −0.01 and β = −0.41, 95% CI: −0.63, −0.20, respectively) and total vegetable scores (β = −0.58, 95% CI: −0.83, −0.32 and β = −0.27, 95% CI: −0.45, −0.08, respectively). The diet quality of grocery purchases in this population varies according to household income and food assistance participation.
Greater adherence to a Mediterranean-like diet is associated with later breast development and menarche in peripubertal girlsSzamreta, E. A., Qin, B., Rivera-Núñez, Z., Parekh, N., Barrett, E. S., Ferrante, J., Lin, Y., & Bandera, E. V.
Journal titlePublic Health Nutrition
Page(s)1020-1030Objective: To examine adherence to a Mediterranean-like diet at age 9-10 years in relation to onset of breast development (thelarche) and first menstruation (menarche).Design: We evaluated the associations of adherence to a Mediterranean-like diet (measured by an adapted Mediterranean-like Diet Score, range 0-9) with thelarche at baseline, age at thelarche and time to menarche. Data were collected at baseline during a clinic visit, complemented with a mailed questionnaire and three 24 hour telephone dietary recalls, followed by annual follow-up questionnaires. Multivariable Poisson regression, linear regression and Cox proportional hazards regression were used to evaluate timing of pubertal development in relation to diet adherence.Setting: New Jersey, USA.Participants: Girls aged 9 or 10 years at baseline (2006-2014, n 202).Results: High Mediterranean-like diet adherence (score 6-9) was associated with a lower prevalence of thelarche at baseline compared with low adherence (score 0-3; prevalence ratio = 0·65, 95 % CI 0·48, 0·90). This may have been driven by consumption of fish and non-fat/low-fat dairy. Our models also suggested a later age at thelarche with higher Mediterranean-like diet adherence. Girls with higher Mediterranean-like diet adherence had significantly longer time to menarche (hazard ratio = 0·45, 95 % CI 0·28, 0·71 for high v. low adherence). Further analysis suggested this may have been driven by vegetable and non-fat/low-fat dairy consumption.Conclusions: Consuming a Mediterranean-like diet may be associated with older age at thelarche and menarche. Further research is necessary to confirm our findings in other US paediatric populations and elucidate the mechanism through which Mediterranean-like diet may influence puberty timing.
Health Behaviors during the COVID-19 Pandemic: Implications for ObesityParekh, N., & Deierlein, A.
Journal titlePublic Health NutritionObesity is a risk factor for severe complications and death from the coronavirus disease 2019 (COVID-19). Public health efforts to control the pandemic may alter health behaviors related to weight gain, inflammation, and poor cardiometabolic health, exacerbating the prevalence of obesity, poor immune health, and chronic diseases. We reviewed how the pandemic adversely influences many of these behaviors, specifically physical activity, sedentary behaviors, sleep, and dietary intakes, and provided individual level strategies that may be used to mitigate them. At the community level and higher, public health and health care professionals need to advocate for intervention strategies and policy changes that address these behaviors, such as increasing nutrition assistance programs and creating designated areas for recreation and active transportation, to reduce disparities among vulnerable populations. The long-lasting impact of the pandemic on health behaviors, and the possibility of a second COVID-19 wave, emphasize the need for creative and evolving, multi-level approaches to assist individuals in adapting their health behaviors to prevent both chronic and infectious diseases.
Sociodemographic differences in the dietary quality of food-at-home acquisitions and purchases among participants in the U.S. nationally representative food acquisition and purchase survey (foodaps)Vadiveloo, M. K., Parker, H. W., Juul, F., & Parekh, N.
Page(s)1-18Insufficient research has explored whether sociodemographic differences in self-reported, individual-level diet quality are similarly reflected by grocery purchase quality. This cross-sectional analysis of n = 3961 U.S. households from the nationally representative Food Acquisition and Purchase Survey (FoodAPS) compared Healthy Eating Index (HEI)-2015 scores from 1 week of food-at-home acquisitions across self-reported demographic factors (race/ethnicity, Supplemental Nutrition Assistance Program (SNAP) participation, food security, and household-level obesity status). Multivariable-adjusted, survey-weighted regression models compared household HEI-2015 scores across sociodemographic groups. Respondents were primarily White and female, with a mean age of 50.6 years, 14.0% were food insecure, and 12.7% were SNAP-participating. Mean HEI-2015 scores were 54.7; scores differed across all sociodemographic exposures (p < 0.05). Interactions (p < 0.1) were detected between SNAP participation and (1) food insecurity and (2) household-level obesity, and race/ethnicity and (1) household-level obesity. HEI-2015 scores were higher among food secure, non-SNAP households than among food insecure, SNAP-participating households (53.9 ± 0.5 vs. 50.3 ± 0.7, p = 0.007); non-SNAP households without obesity had significantly higher HEI-2015 scores than other households. Household-level obesity was associated with lower HEI-2015 scores in White (50.8 ± 0.5 vs. 52.5 ± 0.7, p = 0.046) and Black (48.8 ± 1.5 vs. 53.1 ± 1.4, p = 0.018) but not Hispanic households (54.4 ± 1.0 vs. 52.2 ± 1.2, p = 0.21). Sociodemographic disparities in household HEI-2015 scores were consistent with previous research on individual-level diet quality.
The influence of the sugar-sweetened beverage industry on public policies in MexicoOjeda, E., Torres, C., Carriedo, Ángela, Mialon, M., Parekh, N., & Orozco, E.
Journal titleInternational Journal of Public HealthObjective: The objective of this study was to map and describe the different corporate political activity (CPA) strategies used by the sugar-sweetened beverage (SSB) industry to influence public health policymaking geared toward decreasing the consumption of SSB in Mexico. Methods: We applied an existing approach to identify and monitor the CPA of the SSB industry. A documentary analysis was conducted for two main actors in the SSB industry, for the period 2017–2019, and was triangulated with eleven semi-structured interviews with key informants in public health nutrition and from the SSB industry. The information was analyzed using an existing framework for categorizing the CPA. Results: Although data were found for six CPA strategies, the SSB industry mainly highlighted its economic importance and spoke openly against the 2014 SSB tax. We documented the industry’s relationships with governmental bodies and civil society actors to promote corporate social responsibility and gain public support. Conclusions: The SSB industry in Mexico uses a variety of strategies, directly or through third parties, to influence public policies related to the prevention and control of obesity and non-communicable diseases.
Development of a technology-assisted food frequency questionnaire for elementary and middle school children: Findings from a pilot studyDeierlein, A. L., Bihuniak, J. D., Nagi, E., Litvak, J., Victoria, C., Braune, T., Weiss, R., & Parekh, N.
Issue5Background: This pilot study collected preliminary data for the modification of the VioScreen Food Frequency Questionnaire (FFQ), an adult-validated, self-administered, web-based dietary assessment tool for use in older children. Methods: A convenience sample of 55 children, aged 6–14 years, completed the VioScreen FFQ and 3-day diet record (reference standard). Caregivers completed a short sociodemographic questionnaire. Reported dietary intakes from the VioScreen FFQ and 3-day diet record were calculated using standard nutrient databases, and descriptive statistics were used to examine differences in food/beverage items and portion sizes between the two methods. Informal focus groups obtained user feedback and identified components of the VioScreen FFQ that required modifications. Results: The highest de-attenuated Pearson correlation coefficients between the VioScreen FFQ and 3-day diet record were observed for iron (r = 0.69), saturated fat (r = 0.59), and vegetables (r = 0.56), and the lowest were for whole grains (r = 0.11) and vitamin C (r = 0.16). Qualitative feedback was overall positive, and six technological modifications were identified. Conclusion: Findings from this pilot study provided valuable information on the process of evaluating the use of the VioScreen FFQ among older children, and will inform the future development of a modified version for this population.
Geographic differences in the dietary quality of food purchases among participants in the nationally representative food acquisition and purchase survey (FoodAPS)Vadiveloo, M., Perraud, E., Parker, H. W., Juul, F., & Parekh, N.
Issue6Objective grocery transactions may reflect diet, but it is unclear whether the diet quality of grocery purchases mirrors geographic and racial/ethnic disparities in diet-related diseases. This cross-sectional analysis of 3961 households in the nationally representative Food Acquisition and Purchase Survey evaluated geographic and racial/ethnic disparities in grocery purchase quality. Respondents self-reported demographics and recorded purchases over 7 days; the Healthy Eating Index (HEI) 2015 assessed diet quality. Survey-weighted multivariable-adjusted regression determined whether there were geographic and racial/ethnic differences in HEI-15 scores. Respondents were, on average, 50.6 years, non-Hispanic white (NHW) (70.3%), female (70.2%), and had attended some college (57.8%). HEI-15 scores differed across geographic region (p < 0.05), with the highest scores in the West (57.0 ± 0.8) and lowest scores in the South (53.1 ± 0.8), and there was effect modification by race/ethnicity (p-interaction = 0.02). Regionally, there were diet disparities among NHW and non-Hispanic black (NHB) households; NHWs in the South had HEI-15 scores 3.2 points lower than NHWs in the West (p = 0.003). Southern NHB households had HEI-15 scores 8.1 points lower than Western NHB households (p = 0.013). Racial/ethnic disparities in total HEI-15 by region existed in the Midwest and South, where Hispanic households in the Midwest and South had significantly lower diet quality than NHW households. Heterogeneous disparities in the diet quality of grocery purchases by region and race/ethnicity necessitate tailored approaches to reduce diet-related disease.
Processing level and diet quality of the US grocery cart: Is there an association?Juul, F., Simões, B. D. S., Litvak, J., Martinez-Steele, E., Deierlein, A., Vadiveloo, M., & Parekh, N.
Journal titlePublic Health Nutrition
Page(s)2357-2366Objective: The majority of groceries purchased by US households are industrially processed, yet it is unclear how processing level influences diet quality. We sought to determine if processing level is associated with diet quality of grocery purchases. Design: We analysed grocery purchasing data from the National Household Food Acquisition and Purchase Survey 2012-2013. Household grocery purchases were categorized by the NOVA framework as minimally processed, processed culinary ingredients, processed foods or ultra-processed foods. The energy share of each processing level (percentage of energy; %E) and Healthy Eating Index-2015 (HEI-2015) component and total scores were calculated for each household's purchases. The association between %E from processed foods and ultra-processed foods, respectively, and HEI-2015 total score was determined by multivariable linear regression. Foods purchased by households with the highest v. lowest ultra-processed food purchases and HEI-2015 total score <40 v. ≥60 were compared using linear regression. Setting: USA. Participants: Nationally representative sample of 3961 households. Results: Processed foods and ultra-processed foods provided 9·2 (se 0·3) % and 55·8 (se 0·6) % of purchased energy, respectively. Mean HEI-2015 score was 54·7 (se 0·4). Substituting 10 %E from minimally processed foods and processed culinary ingredients for ultra-processed foods decreased total HEI-2015 score by 1·8 points (β = -1·8; 95 % CI -2·0, -1·5). Processed food purchases were not associated with diet quality. Among households with high ultra-processed food purchases, those with HEI-2015 score <40 purchased less minimally processed plant-foods than households with HEI-2015 score ≥60. Conclusions: Increasing purchases of minimally processed foods, decreasing purchases of ultra-processed foods and selecting healthier foods at each processing level may improve diet quality.
Weight perception, weight control intentions, and dietary intakes among adolescents ages 10–15 years in the United StatesDeierlein, A. L., Malkan, A., Litvak, J., & Parekh, N.
Journal titleInternational journal of environmental research and public health
Issue6Background: To examine associations of adolescents’ weight status perception and weight control intentions with dietary intakes. Methods: Cross-sectional data from adolescents aged 10–15 in the National Health and Nutrition Examination Surveys, 2005–2014 (n = 4940). Adolescents responded to questions regarding weight perception and if they were trying to change their weight. Intakes of calories, protein, carbohydrate, fat, saturated fat, sugar, and fiber were assessed using 24-h dietary recalls. Multivariable linear regression estimated associations of intakes with weight perception and weight control intentions. Results: The majority of adolescents perceived their weight as “about right”; however, 45% and 46% of boys and girls, respectively, reported trying to change their weight. Weight perception was not associated with intakes, with the exception of lower sugar (−13.65 g, 95% CI: −23.06, −4.23) and higher percent calories from protein (1.01%, 95% CI: 0.16, 1.87) in boys with overweight/obesity who perceived themselves as overweight, as well as lower percent calories from saturated fat (−1.04%, 95% CI: −2.24, −0.17) among girls with normal weight who perceived themselves as overweight. Weight control intentions were associated with intakes in boys only. Compared to boys who never tried to lose weight, boys who tried to lose weight consumed fewer calories (−188.34 kcal, 95% CI: −357.67, −19.01), a lower percent of calories from fat (−1.41%, 95% CI: −2.80, −0.02), and a greater percent of calories from protein (1.48%, 95% CI: 0.41, 2.55). Conclusions: Despite perceiving weight as “about right”, many adolescents reported trying to change their weight, which was associated with some dietary intakes. Efforts may be necessary to educate adolescents on healthy nutrition and weight management behaviors.
Associations of Parental Self-Efficacy With Diet, Physical Activity, Body Composition, and Cardiorespiratory Fitness in Swedish Preschoolers: Results From the MINISTOP TrialParekh, N., Henriksson, P., Delisle Nyström, C., Silfvernagel, K., Ruiz, J. R., Ortega, F. B., Pomeroy, J., & Löf, M.
Journal titleHealth Education and Behavior
Page(s)238-246Background. High parental self-efficacy (PSE) has been associated with healthy diets and higher levels of physical activity (PA) in children; however, data on PSE in relation to body weight and body composition are scarce. The objective of this study was to investigate associations of PSE with measures of diet, PA, body composition, and physical fitness in early childhood. Method. We used baseline data from the MINISTOP trial in healthy Swedish children (n = 301; 4.5 ± 0.15 years). PSE was assessed using a questionnaire, dietary data were collected using a mobile technology–assisted methodology, and PA was obtained (sedentary behavior and moderate-to-vigorous) by accelerometry. Body composition was measured using the pediatric option for BodPod and cardiorespiratory fitness by the 20 m shuttle run. Linear regression was conducted to evaluate cross-sectional associations of the outcomes in relation to total PSE and scores computed for the individual PSE factors: (1) diet, (2) limit setting of unhealthful behaviors, and (3) PA. Results. Higher scores of total PSE and the diet factor were associated with higher fruit intake (β = 0.82 g/point and 1.99 g/point; p =.014 and.009, respectively) and lower consumption of unhealthy snacks (β = −0.42 g/point and −0.89 g/point; p =.012 and.020, respectively) after adjustment for parental body mass index and education, respondent, and child’s sex and age. No associations were observed between PSE and PA, body composition, or cardiorespiratory fitness. Conclusions. Our study noted that PSE should be considered in conjunction with other strategies for a sustainable impact on childhood obesity.
Associations of Whole and Refined Grain Intakes with Adiposity-Related Cancer Risk in the Framingham Offspring Cohort (1991–2013)Makarem, N., Bandera, E. V., Lin, Y., McKeown, N. M., Hayes, R. B., & Parekh, N.
Journal titleNutrition and Cancer
Page(s)776-786Case-control studies suggest that higher whole grain and lower refined grain intakes are associated with reduced cancer risk, but longitudinal evidence is limited. The objective of this prospective cohort study is to evaluate associations between whole and refined grains and their food sources in relation to adiposity-related cancer risk. Participants were adults from the Framingham Offspring cohort (N = 3,184; ≥18 yr). Diet, measured using a food frequency questionnaire, medical and lifestyle data were collected at exam 5 (1991–95). Between 1991 and 2013, 565 adiposity-related cancers were ascertained using pathology reports. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals for associations of whole and refined grains with risk of adiposity-related cancers combined and with risk of breast and prostate cancers in exploratory site-specific analyses. Null associations between whole and refined grains and combined incidence of adiposity-related cancers were observed in multivariable-adjusted models (HR: 0.94; 95% CI: 0.71–1.23 and HR: 0.98; 95% CI: 0.70–1.38, respectively). In exploratory analyses, higher intakes of whole grains (oz eq/day) and whole grain food sources (servings/day) were associated with 39% and 47% lower breast cancer risk (HR: 0.61; 95% CI: 0.38–0.98 and HR: 0.53; 95% CI: 0.33–0.86, respectively). In conclusion, whole and refined grains were not associated with adiposity-related cancer risk. Whole grains may protect against breast cancer, but findings require confirmation within a larger sample and in other ethnic groups.
Consumption of sugars, sugary foods, and sugary beverages in relation to adiposity-related cancer risk in the framingham offspring cohort (1991–2013)Makarem, N., Bandera, E. V., Lin, Y., Jacques, P. F., Hayes, R. B., & Parekh, N.
Journal titleCancer Prevention Research
Page(s)347-358Background: Higher sugar consumption may increase cancer risk by promoting insulin-glucose dysregulation, oxidative stress, hormonal imbalances, and excess adiposity. This prospective study investigates the association between dietary sugars (fructose and sucrose) and sugary foods and beverages in relation to combined and site-specific (breast, prostate, colorectal) adiposity-associated cancers. Methods: The analytic sample consisted of 3,184 adults, aged 26–84 years, from the Framingham Offspring cohort. Diet data were first collected between 1991 and 1995 using a food frequency questionnaire. Intakes of fructose, sucrose, sugary foods, and sugary beverages (fruit juice and sugar-sweetened beverages) were derived. Participants were followed up until 2013 to ascertain cancer incidence; 565 doctor-diagnosed adiposity-related cancers, including 124 breast, 157 prostate, and 68 colorectal cancers occurred. Multivariable-adjusted Cox proportional hazards models were used to evaluate associations. Tests for interaction with BMI and waist circumference were conducted. Results: No associations were observed between fructose, sucrose, sugary food consumption, and combined incidence of adiposity-related cancers or the examined site-specific cancers. While total consumption of sugary beverages was not associated with site-specific cancer risk, higher intakes of fruit juice were associated with 58% increased prostate cancer risk (HR: 1.58; 95% CI, 1.04–2.41) in multivariable-adjusted models. In exploratory stratified analyses, higher sugary beverage intakes increased overall adiposity-related cancer risk by 59% in participants with excessive central adiposity (HR: 1.59; 95% CI, 1.01–2.50; P trend ¼ 0.057). Conclusions: In this cohort of American adults, higher sugary beverage consumption was associated with increased cancer risk among participants with central adiposity. Impact: These analyses suggest that avoiding sugary beverages represents a simple dietary modification that may be used as an effective cancer control strategy.
Nutrition Literacy among Cancer Survivors: Feasibility Results from the Healthy Eating and Living Against Breast Cancer (HEAL-BCa) Study: a Pilot Randomized Controlled TrialParekh, N., Jiang, J., Buchan, M., Meyers, M., Gibbs, H., & Krebs, P.
Journal titleJournal of Cancer Education
Page(s)1239-1249Knowledge of nutrition among breast cancer patients is insufficient, despite their motivation to seek valid information about healthy food choices. This study examines the feasibility of nutrition education workshops for cancer survivors, to inform the design of a multi-center intervention. Fifty-nine female English-speaking breast cancer patients, who had completed treatment, were enrolled. Participants were randomized to the intervention or control group. The intervention group attended six nutrition education sessions, and the control group received brochures. Measurements were done at baseline and 3-month follow-up and included the Assessment Instrument for Breast Cancer (NLit-BCa), fruit/vegetable and general health literacy screeners. Height and weight were measured. Changes in nutrition literacy, health literacy, and food intake from baseline to follow-up (within-group change) were calculated for both groups (effect sizes were reported as Cohen’s d). Participants were mostly white, with a mean age of 58 years, BMI of 31.6 kg/m2, and had college degrees. Follow-up rates were high (89% = control and 77% = intervention group). At baseline, participants scored high for most NLit-BCa assessment components except food portions in both groups. At the 3-month follow-up, effect sizes (d) on the NLit-BCa ranged from −0.5 to 0.16. The study met its recruitment goals within 6 months. Focus groups indicated that (a) attending six sessions was acceptable, (b) patients found social/emotional support, (c) improvements should include information for special diets and booster sessions. This pilot study suggests that the intervention was acceptable and that scaling up of this intervention is feasible and could provide benefit to breast cancer survivors.
Racial and ethnic disparities in predictors of glycemia: a moderated mediation analysis of inflammation-related predictors of diabetes in the NHANES 2007–2010Nowlin, S., Cleland, C. M., Parekh, N., Hagan, H., & Melkus, G.
Journal titleNutrition and Diabetes
Issue1Background/Objective: Racial/ethnic disparities in type 2 diabetes (T2D) outcomes exist, and could be explained by nutrition- and inflammation-related differences. The objective of this study is to identify associations between race/ethnicity and glucose control among participants from NHANES 2007–2010, as influenced by diet quality, body mass, and inflammation and grouped by T2D status. Subjects/Methods: The following is a cross-sectional, secondary data analysis of two NHANES data cycles spanning 2007–2010. The association between race/ethnicity and hemoglobin A1c (HbA1c) as mediated by dietary intake score, body mass index (BMI), and C-reactive protein (CRP) was assessed, as was the strength of the difference of that association, or moderation, by T2D status. The sample included n = 7850 non-pregnant adult participants ≥ 20 years of age who had two days of reliable dietary recall data, and no missing data on key variables included in the analysis. The primary outcome examined was HbA1c. Results: The model accurately explained the variation in HbA1c measures in participants without T2D, as mediated by diet quality, BMI, and CRP. However, significant variation in HbA1c remained after accounting for aforementioned mediators when contrasting non-Hispanic White to non-Hispanic Black participants without T2D. The model was not a good fit for explaining racial/ethnic disparities in HbA1c in participants with T2D. A test of the index of moderated mediation for this model was not significant for the differences in the effect of race/ethnicity on HbA1c by T2D status (moderator). Conclusions: This study demonstrated that diet quality, BMI, and CRP mediated the effect of race/ethnicity on HbA1c in persons without T2D, but not in persons with T2D. Further research should include additional inflammatory markers, and other inflammation- and T2D-related health outcomes, and their association with racial/ethnic disparities in diabetes.
Ultra-processed food consumption and excess weight among US adultsJuul, F., Martinez-Steele, E., Parekh, N., Monteiro, C. A., & Chang, V. W.
Journal titleThe British journal of nutrition
Page(s)90-100Ultra-processed foods provide 58 % of energy intake and 89 % of added sugars in the American diet. Nevertheless, the association between ultra-processed foods and excess weight has not been investigated in a US sample. The present investigation therefore aims to examine the association between ultra-processed foods and excess weight in a nationally representative sample of US adults. We performed a cross-sectional analysis of anthropometric and dietary data from 15 977 adults (20-64 years) participating in the National Health and Nutrition Examination Survey 2005-2014. Dietary data were collected by 24-h recall. Height, weight and waist circumference (WC) were measured. Foods were classified as ultra-processed/non-ultra-processed according to the NOVA classification. Multivariable linear and logistic regression was used to evaluate the association between ultra-processed food consumption (% energy) and BMI, WC and odds of BMI≥25 kg/m2, BMI≥30 kg/m2 and abdominal obesity (men: WC≥102 cm, women: WC≥88 cm). Prevalence of BMI≥25 kg/m2, BMI≥30 kg/m2 and abdominal obesity was 69·2, 36·1 and 53·0 %, respectively. Consuming ≥74·2 v. ≤36·5 % of total energy from ultra-processed foods was associated with 1·61 units higher BMI (95 % CI 1·11, 2·10), 4·07 cm greater WC (95 % CI 2·94, 5·19) and 48, 53 and 62 % higher odds of BMI≥25 kg/m2, BMI≥30 kg/m2 and abdominal obesity, respectively (OR 1·48; 95 % CI 1·25, 1·76; OR 1·53; 95 % CI 1·29, 1·81; OR 1·62; 95 % CI 1·39, 1·89, respectively; P for trend<0·001 for all). A significant interaction between being female and ultra-processed food consumption was found for BMI (F 4,79=4·89, P=0·002), WC (F 4,79=3·71, P=0·008) and BMI≥25 kg/m2 (F 4,79=5·35, P<0·001). As the first study in a US population, our findings support that higher consumption of ultra-processed food is associated with excess weight, and that the association is more pronounced among women.
Birth weight, early life weight gain and age at menarche: a systematic review of longitudinal studiesJuul, F., Chang, V. W., Brar, P., & Parekh, N.
Journal titleObesity Reviews
Page(s)1272-1288Background and objective: Adiposity in pre- and postnatal life may influence menarcheal age. Existing evidence is primarily cross-sectional, failing to address temporality, for which the role of adiposity in early life remains unclear. The current study sought to systematically review longitudinal studies evaluating the associations between birth weight and infant/childhood weight status/weight gain in relation to menarcheal age. Methods: PubMed, EMBASE, Web of Science, Global Health (Ovid) and CINAHL were systematically searched. Selected studies were limited to English-language articles presenting multi-variable analyses. Seventeen studies reporting risk estimates for birth weight (n = 3), infant/childhood weight gain/weight status (n = 4) or both (n = 10), in relation to menarcheal age were included. Results: Lower vs. higher birth weight was associated with earlier menarche in nine studies and later menarche in one study, while three studies reported a null association. Greater BMI or weight gain over time and greater childhood weight were significantly associated with earlier menarche in nine of nine and six of seven studies, respectively. Conclusions: Studies suggested that lower birth weight and higher body weight and weight gain in infancy and childhood may increase the risk of early menarche. The pre- and postnatal period may thus be an opportune time for weight control interventions to prevent early menarche, and its subsequent consequences.
Consumption of whole grains and cereal fiber in relation to cancer risk: A systematic review of longitudinal studiesMakarem, N., Nicholson, J. M., Bandera, E. V., McKeown, N. M., & Parekh, N.
Journal titleNutrition Reviews
Page(s)353-373Context: Evidence from previous reviews is supportive of the hypothesis that whole grains may protect against various cancers. However, the reviews did not report risk estimates for both whole grains and cereal fiber and only case-control studies were evaluated. It is unclear whether longitudinal studies support this conclusion. Objective: To evaluate associations between whole grains and cereal fiber in relation to risk of lifestyle-related cancers data from longitudinal studies was evaluated. Data Sources: The following 3 databases were systematically searched: PubMed, EMBASE, and Cochrane CENTRAL. Study Selection: A total of 43 longitudinal studies conducted in Europe and North America that reported multivariable-adjusted risk estimates for whole grains (n=14), cereal fiber (n=23), or both (n=6) in relation to lifestyle-related cancers were included. Data Extraction: Information on study location, cohort name, follow-up duration, sample characteristics, dietary assessment method, risk estimates, and confounders was extracted. Data Synthesis: Of 20 studies examining whole grains and cancer, 6 studies reported a statistically significant 6%-47% reduction in risk, but 14 studies showed no association. Of 29 studies examining cereal fiber intake in relation to cancer, 8 showed a statistically significant 6%-49% reduction in risk, whereas 21 studies reported no association. Conclusions: This systematic review concludes that most studies were suggestive of a null association. Whole grains and cereal fiber may protect against gastrointestinal cancers, but these findings require confirmation in additional studies.
Explaining racial/ethnic dietary patter ns in relation to type 2 diabetes: An analysis of NHAN ES 2007-2012Nowlin, S. Y., Cleland, C. M., Vadiveloo, M., Parekh, N., Melkus, G. D. E., & Hagan, H.
Journal titleEthnicity and Disease
Page(s)529-536Objective: The purpose of this article is to examine sociodemographic and health behavior factors associated with dietary intake as measured by the healthy eating index (HEI-2010) for persons with and without diabetes (T2D). Design: A secondary data analysis of three NHANES data cycles spanning 2007-2012. Multiple linear regression assessed racial/ ethnic differences in HEI-2010 scores in those without T2D, with T2D, and with undiagnosed T2D. Participants: The sample included nonpregnant adults aged ≥20 years who had two days of reliable dietary recall data. Outcome Measures: Total scores for the HEI-2010. Results: For those without T2D, there was a significant association between race/ ethnicity and HEI score, with non-Hispanic Blacks achieving significantly lower scores than their non-Hispanic White counterparts. Differences in HEI-2010 score were also associated with age, sex, smoking status and time spent in the United States. Racial/ ethnic differences in dietary patterns were present, but not significant in those with undiagnosed or diagnosed T2D. Conclusions: Racial/ethnic disparities in dietary patterns are present in individuals without T2D, but differences are not statistically significant in those with undiagnosed or diagnosed T2D. Non-Hispanic Blacks without T2D received significantly lower HEI-2010 scores than non-Hispanic Whites. Further research is necessary to determine whether or not similarities in dietary intake across racial/ethnic groups with T2D will be reflected in diabetes-related health outcomes in this population.
Increasing mortality in the United States from cholangiocarcinoma: An analysis of the National Center for Health Statistics DatabaseYao, K. J., Jabbour, S., Parekh, N., Lin, Y., & Moss, R. A.
Journal titleBMC Gastroenterology
Issue1Background: While mortality in the United States has decreased for most cancers, mortality from combined hepatocellular liver cancer and intrahepatic cholangiocarcinoma (ICC) has increased and ranked 1st in annual percent increase among cancer sites. Because reported statistics combine ICC with other liver cancers, mortality rates of cholangiocarcinoma (CCA) remain unknown. This study is to determine CCA mortality trends and variation based on national data. Methods: This nation-wide study was based on the underlying cause of death data collected by the National Center for Health Statistics (NCHS) between 1999 and 2014. The Center for Disease Control (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) system was used to obtain data. ICC and extra-hepatic CCA (ECC) were defined by ICD-10 diagnosis codes. Age-adjusted mortality rate was standardized to the US population in 2000. Results: There were more than 7000 CCA deaths each year in the US after 2013. CCA mortality for those aged 25+ increased 36 % between 1999 and 2014, from 2.2 per 100,000 (95 % confidence interval [CI] 2.1-2.3) to 3.0 per 100,000 (95 % CI, 2.9-3.1). Mortality rates were lower among females compared with males (risk ratio [RR] 0.78, 95 % CI 0.77-0.79). Asians had the highest mortality. Between 2004 and 2014, the increase in CCA mortality was highest among African Americans (45 %) followed by Asians (22 %), and whites (20 %). Conclusion: Based on the most recent national data, CCA mortality rates have increased substantially in the past decade. Among different race/ethnic groups, African Americans have the highest increase in CCA mortality.
Concordance with DASH diet and blood pressure change: Results fromthe Framingham Offspring Study (1991-2008)Jiang, J., Liu, M., Troy, L. M., Bangalore, S., Hayes, R. B., & Parekh, N.
Journal titleJournal of Hypertension
Page(s)2223-2230Background: Concordance with the Dietary Approaches to Stop Hypertension (DASH) diet has been shown to reduce blood pressure (BP) in short-term intervention studies, but the long-term impact is unclear. We evaluated the association of DASH diet concordance with BP trajectories and incidence of hypertension, in 2187 men and women (mean age 52.5 years at baseline) participating in the Framingham Offspring cohort. Method: Diet and BP were assessed from 1991 to 2008, with a median follow-up time of 13.4 years. DASH scores (ranging from 0 for worst to 10 for best concordance with DASH diet) were calculated by summing 10 food components that comprise the DASH diet pattern, including fruits and vegetables, low-fat dairy products, lean meat, and plant-based protein. Mixed-effect and Cox regression models were applied, to assess the association of DASH diet concordance with BP longitudinal change and with incidence of hypertension, respectively. All analyses were adjusted for age, sex, smoking status, history of diabetes, BMI, and physical activity. Result: Overall, SBP increased by 0.34mmHg and DBP by 0.10mmHg annually, in the Framingham Offspring cohort. Every unit increase in the DASH score resulted in a modest increase in SBP of 0.054 mmHg/year (P=0.028). No associations were observed between DASH diet concordance and DBP or incidence of hypertension. Conclusion: Long-term concordance with the DASH diet was not associated with a decreasing BP trajectory over time, or with decreased incidence of hypertension, in this population of middle-aged adults.
Concordance with World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines for cancer prevention and obesity-related cancer risk in the Framingham Offspring cohort (1991–2008)Makarem, N., Lin, Y., Bandera, E. V., Jacques, P. F., & Parekh, N.
Journal titleCancer Causes and Control
Page(s)277-286Purpose: This prospective cohort study evaluates associations between healthful behaviors consistent with WCRF/AICR cancer prevention guidelines and obesity-related cancer risk, as a third of cancers are estimated to be preventable. Methods: The study sample consisted of adults from the Framingham Offspring cohort (n = 2,983). From 1991 to 2008, 480 incident doctor-diagnosed obesity-related cancers were identified. Data on diet, measured by a food frequency questionnaire, anthropometric measures, and self-reported physical activity, collected in 1991 was used to construct a 7-component score based on recommendations for body fatness, physical activity, foods that promote weight gain, plant foods, animal foods, alcohol, and food preservation, processing, and preparation. Multivariable Cox regression models were used to estimate associations between the computed score, its components, and subcomponents in relation to obesity-related cancer risk. Results: The overall score was not associated with obesity-related cancer risk after adjusting for age, sex, smoking, energy, and preexisting conditions (HR 0.94, 95 % CI 0.86–1.02). When score components were evaluated separately, for every unit increment in the alcohol score, there was 29 % lower risk of obesity-related cancers (HR 0.71, 95 % CI 0.51–0.99) and 49–71 % reduced risk of breast, prostate, and colorectal cancers. Every unit increment in the subcomponent score for non-starchy plant foods (fruits, vegetables, and legumes) among participants who consume starchy vegetables was associated with 66 % reduced risk of colorectal cancer (HR 0.44, 95 % CI 0.22–0.88). Conclusions: Lower alcohol consumption and a plant-based diet consistent with the cancer prevention guidelines were associated with reduced risk of obesity-related cancers in this population.
Dietary variety is inversely associated with body adiposity among us adults using a novel food diversity indexVadiveloo, M., Beth Dixon, L., Mijanovich, T., Elbel, B., & Parekh, N.
Journal titleJournal of Nutrition
Page(s)555-563Background: Consuming a variety (vs. monotony) of energy-poor, nutrient-dense foods may help individuals adhere to dietary patterns favorably associated with weight control. Objective: The objective of this study was to examine whether greater healthful food variety quantified using the US Healthy Food Diversity (HFD) index favorably influenced body adiposity. Methods: Men and nonpregnant, nonlactating women aged ≥20 y with two 24-h recalls from the cross-sectional NHANES 2003-2006 (n = 7470) were included in this study. Dietary recalls were merged with the MyPyramid Equivalent database to generate the US HFD index, which ranges from 0 to ~1, with higher scores indicative of diets with a higher number and proportion of healthful foods. Multiple indicators of adiposity including BMI, waist-to-height ratio, android-to-gynoid fat ratio, fat mass index (FMI), and percentage body fat were assessed across US HFD index quintiles. ORs and 95% CIs were computed with use of multivariable logistic regression (SAS v. 9.3). Results: The US HFD index was inversely associated with most adiposity indicators in both sexes. After multivariable adjustment, the odds of obesity, android-to-gynoid ratio >1, and high FMI were 31-55% lower (P-trend < 0.01) among women in quintile 5 vs. quintile 1 of the US HFD index. Among men, the odds of obesity, waist-to-height ratio =0.5, and android-to-gynoid ratio >1 were 40-48% lower (P-trend = 0.01) in quintile 5 vs. quintile 1 of the US HFD index. Conclusions: Higher US HFD index values were inversely associated with indicators of body adiposity in both sexes, indicating that greater healthful food variety may protect against excess adiposity. This study explicitly recognizes the potential benefits of dietary variety in obesity management and provides the foundation to support its ongoing evaluation.
Dietary Variety: An Overlooked Strategy for Obesity and Chronic Disease ControlVadiveloo, M. K., & Parekh, N.
Journal titleAmerican Journal of Preventive Medicine
Greater healthful food variety as measured by the US healthy food diversity index is associated with lower odds of metabolic syndrome and its components in US adults.Vadiveloo, M., Parekh, N., & Mattei, J.
Journal titleJournal of Nutrition
Insulin receptor variants and obesity-related cancers in the Framingham Heart StudyParekh, N., Guffanti, G., Lin, Y., Ochs-Balcom, H. M., Makarem, N., & Hayes, R.
Journal titleCancer Causes and Control
Page(s)1189-1195Purpose: The insulin-signaling pathway plays a pivotal role in cancer biology; however, evidence of genetic alterations in human studies is limited. This case–control study nested within the Framingham Heart Study (FHS) examined the association between inherited genetic variation in the insulin receptor (INSR) gene and obesity-related cancer risk. Methods: The study sample consisted of 1,475 controls and 396 cases from the second familial generation of the FHS. Participants who provided consent were genotyped. Nineteen single-nucleotide polymorphisms (SNPs) in the INSR gene were investigated in relation to risk of obesity-related cancers combined and breast, prostate and colorectal cancers. Generalized estimation equation models controlling for familial correlations and include age, sex, smoking and body mass index as covariates, assuming additive models, were used. Results: Three SNPs, rs2059807, s8109559 and rs919275, were significantly associated with obesity-related cancers (p value < 0.02) with the most significantly associated SNP being rs2059807 (p value = 0.008). Carriers of two copies of SNP rs2059807 risk allele T were significantly less prevalent among subjects with obesity-related cancers [f(TT)cases = 14 vs. f(TT)controls = 18 %; OR 1.23]. In exploratory analyses evaluating site-specific cancers, the INSR rs2059807 association with these cancers was consistent with that observed for the main outcome (ORs colorectal cancer = 1.5, breast cancer = 1.29, prostate = 1.06). There was no statistically significant interaction between the INSR–SNP and blood glucose in relation to obesity-related cancer. Conclusions: The INSR gene is implicated in obesity-related cancer risk, as 3 of 19 SNPs were nominally associated, after false discovery rate (FDR) correction, with the main outcome. Risk allele homozygotes (rs2059807) were less prevalent among subjects with obesity-related cancer. These results should be replicated in other populations to confirm the findings.