Professor of Public Health Nutrition
Associate Vice Provost of Faculty Initiatives, Office of the Provost
Dr. Niyati Parekh’s research and teaching are motivated by a deep commitment to reduce nutrition-related disease outcomes in at-risk groups. In pursuit of this goal, as a nutritional epidemiologist, she has developed a robust research portfolio that examines the intersection of biological and behavioral factors of non-communicable diseases in US populations. The overarching theme of her research program is to examine the role of nutrition and diet-related factors in the etiology of non-communicable diseases, with a particular focus on obesity, metabolic dysregulation and cancer. Her multidisciplinary research integrates the intricacies from four distinct areas of expertise: disease biology, nutritional biochemistry, epidemiology and biostatistics. She has developed a research program with three interconnected areas that are unified under the theme of investigating diet and non-communicable diseases in populations, using epidemiologic methods. The first arm consists of leveraging existing data to identify dietary patterns, dietary quality and food consumption patterns in populations of interest. The second is to identify dietary determinants and biomarkers that predict disease outcomes including obesity, diabetes, cardiovascular disease and cancer. The third arm is to measure diets using novel dietary assessment methods that will contribute to more accurate and multi-dimensional measurement of diet. The three areas of her work complement each other and reveal preventive measures for populations, inform health policy and guide clinical practice. She has 75 peer-reviewed publications and her work has been supported by awards from the American Cancer Society and NIH.
Dr. Parekh holds an MS in Clinical Nutrition from Mumbai University and a PhD in Nutritional Sciences with a minor in Population Health Sciences from the University of Wisconsin-Madison (2005). After completing a 2-year postdoctoral fellowship in Cancer Epidemiology at the Cancer Institute of New Jersey-Rutgers, she joined New York University Steinhardt’s Department of Nutrition, Food Studies and Public Health in January 2008. With doctoral and postdoctoral training in epidemiological methods, she cross-pollinated the fields of nutrition and public health. In 2015, as Associate Professor of Public Health Nutrition, she transitioned to NYU’s newly launched School of Global Public Health (GPH), as Director of the Public Health Nutrition program (until 2019). She also has an affiliated appointment at the Department of Population Health-Grossman School of Medicine.
Her recent honors include being inducted as a New York Academy of Medicine Fellow, and her appointment as Independent Consultant at UNICEF. She has served the American Society for Nutrition as Chair of the Nutritional Epidemiology Research Group. She teaches graduate courses in the New York Campus and at study abroad sites (Mexico, Abu Dhabi and Florence). Graduate courses taught include Global Nutrition, Nutritional Epidemiology, Perspectives in Public Health and Global Cancer Epidemiology for which she has received awards. Dr. Parekh has served as the Executive Director of Doctoral Programs at GPH since 2017. In this role, she supports about 30 PhD students, and promotes all aspects of their rigorous research and professional development towards impactful careers.
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
A systematic review of randomized controlled trials examining workplace wellness interventions
Development of an Integrated Approach to Virtual Mind-Mapping: Methodology and Applied Experiences to Enhance Qualitative Health ResearchAli, S. H., Merdjanoff, A. A., Parekh, N., & DiClemente, R. J.
Journal titleQualitative Health Research
Page(s)571-580AbstractThere is a growing need to better capture comprehensive, nuanced, and multi-faceted qualitative data while also better engaging with participants in data collection, especially in virtual environments. This study describes the development of a novel 3-step approach to virtual mind-mapping that involves (1) ranked free-listing, (2) respondent-driven mind-mapping, and (3) interviewing to enhance both data collection and analysis of complex health behaviors. The method was employed in 32 virtual interviews as part of a study on eating behaviors among second-generation South Asian Americans. Participants noted the mind-mapping experience to be (1) helpful for visual learners, (2) helpful in elucidating new ideas and to structure thoughts, as well as (3) novel and interesting. They also noted some suggestions that included improving interpretability of visual data and avoiding repetition of certain discussion points. Data collection revealed the adaptability of the method, and the power of mind-maps to guide targeted, comprehensive discussions with participants.
Food Insecurity, Associated Health Behaviors, and Academic Performance Among Urban University Undergraduate StudentsRyan, R. A., Murphy, B., Deierlein, A. L., Lal, S., Parekh, N., & Bihuniak, J. D.
Journal titleJournal of Nutrition Education and Behavior
Page(s)269-275AbstractObjective: To explore associations between food insecurity, health behaviors, and academic performance among undergraduates at a private, urban US university. Methods: A cross-sectional web-based survey was conducted among a convenience sample of New York University undergraduates. Multivariable logistic regression estimated associations of food security (using the 6-item US Household Food Security Survey Module) and health behaviors (fruit/vegetable, beverage and alcohol intakes, and sleep), self-rated health, and academic performance. Results: Of the 257 students who completed the survey, 41% reported food insecurity. Food insecurity was associated with approximately 2-fold higher odds of sugar-sweetened beverage consumption (adjusted odds ratio, 1.97; 95% confidence interval, 1.14–3.41) and fair/poor health (adjusted odds ratio, 2.29; 95% confidence interval, 1.23–4.25). Conclusions and Implications: Increased awareness of food insecurity and associated health behaviors among students has implications for higher education's provision of on-campus food support programs.
Mapping drivers of second-generation South Asian American eating behaviors using a novel integration of qualitative and social network analysis methods
Ultra-processed food consumption among US adults from 2001 to 2018Juul, F., Parekh, N., Martinez-Steele, E., Monteiro, C. A., & Chang, V. W.
Journal titleAmerican Journal of Clinical Nutrition
Page(s)211-221AbstractBACKGROUND: Accumulating evidence links ultra-processed foods to poor diet quality and chronic diseases. Understanding dietary trends is essential to inform priorities and policies to improve diet quality and prevent diet-related chronic diseases. Data are lacking, however, for trends in ultra-processed food intake. OBJECTIVES: We examined US secular trends in food consumption according to processing level from 2001 to 2018. METHODS: We analyzed dietary data collected by 24-h recalls from adult participants (aged >19 y; N = 40,937) in 9 cross-sectional waves of the NHANES (2001-2002 to 2017-2018). We calculated participants' intake of minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods as the relative contribution to daily energy intake (%kcal) using the NOVA framework. Trends analyses were performed using linear regression, testing for linear trends by modeling the 9 surveys as an ordinal independent variable. Models were adjusted for age, sex, race/ethnicity, education level, and income. Consumption trends were reported for the full sample and stratified by sex, age groups, race/ethnicity, education level, and income level. RESULTS: Adjusting for changes in population characteristics, the consumption of ultra-processed foods increased among all US adults from 2001-2002 to 2017-2018 (from 53.5 to 57.0 %kcal; P-trend < 0.001). The trend was consistent among all sociodemographic subgroups, except Hispanics, in stratified analyses. In contrast, the consumption of minimally processed foods decreased significantly over the study period (from 32.7 to 27.4 %kcal; P-trend < 0.001) and across all sociodemographic strata. The consumption of processed culinary ingredients increased from 3.9 to 5.4 %kcal (P-trend < 0.001), whereas the intake of processed foods remained stable at ∼10 %kcal throughout the study period (P-trend = 0.052). CONCLUSIONS: The current findings highlight the high consumption of ultra-processed foods in all parts of the US population and demonstrate that intake has continuously increased in the majority of the population in the past 2 decades.
Association between dairy product intake and body composition among South Asian adults from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study
Changing the landscape of South Asian migrant health research by advancing second-generation immigrant health needs
Ecological momentary assessment for health behaviors and contextual factors in persons with diabetes: A systematic reviewNam, S., Griggs, S., Ash, G. I., Dunton, G. F., Huang, S., Batten, J., Parekh, N., & Whittemore, R.
Journal titleDiabetes Research and Clinical Practice
Volume174AbstractAim: The objective of this systematic review was to summarize the ecological momentary assessment (EMA) methodology and associations between EMA-measured psychosocial, contextual factors and diabetes self-management. Methods: The inclusion criteria were: research of EMA and diabetes self-management behaviors such as glucose checks, administration of insulin and eating-and dietary intake behaviors among persons with diabetes. A comprehensive search of several databases was conducted across all dates until July 2020. Results: A modified Checklist for Reporting EMA Studies was used to assess the quality of studies. Among the ten included studies, participants were predominantly White adolescents with type 1 diabetes (T1D) and type 2 diabetes was studied in two studies. Time-varying, psychosocial contexts such as negative affect or negative social interaction were associated with missed insulin injection and poor adherence to glucose check. More preceding psychological stress was associated with more calorie intake from snacks or binge eating behaviors. Mornings were the most challenging time of day for adherence to diabetes self-management among adolescents with T1D. Intentional insulin withholding was more common in the afternoon in adults with T1D. Conclusions: EMA has potential clinical utility in the assessment of diabetes self-management and in the development of timely and individualized diabetes interventions.
Food insecurity among households with children during the COVID-19 pandemic: results from a study among social media users across the United States
Longitudinal dimensions of alcohol consumption and dietary intake in the Framingham Heart Study Offspring Cohort (1971-2008)Parekh, N., Lin, Y., Chan, M., Juul, F., & Makarem, N.
Journal titleBritish Journal of Nutrition
Page(s)685-694AbstractExisting studies addressing alcohol consumption have not captured the multidimensionality of drinking patterns, including drinking frequency, binge drinking, beverage preference and changes in these measures across the adult life course. We examined longitudinal trends in drinking patterns and their association with diet over four decades in ageing US adults from the Framingham Offspring Study (n 4956; baseline mean age 36·2 years). Alcohol intake (drinks/week, drinking frequency, beverage-specific consumption, drinks/occasion) was assessed quadrennially from examinations 1 to 8. Participants were classified as binge drinkers, moderate drinkers or heavy drinkers (4+ and 5+ drinks/occasion; ≤1 and ≤2 drinks/d and >7 and >14 drinks/week for women and men, respectively). Dietary data were collected by a FFQ from examinations 5 to 8 (1991-2008). We evaluated trends in drinking patterns using linear mixed effect models and compared dietary intake across drinking patterns using heterogeneous variance models. Alcohol consumption decreased from 1971 to 2008 (3·7 v. 2·2 oz/week; P < 0·05). The proportion of moderate (66 v. 59·3 %), heavy (18·4 v. 10·5 %) and binge drinkers (40·0 v. 12·3 %) declined (P < 0·05). While average wine consumption increased (1·4 v. 2·2 drinks/week), beer (3·4 v. 1·5 drinks/week) and cocktail intake (2·8 v. 1·2 drinks/week) decreased. Non-binge drinkers consumed less sugary drinks and more whole grains than binge drinkers, and the latter consumed more total fat across all examinations (P < 0·05). There was a significant difference in consumption trends of total grains by drinking level (P < 0·05). In conclusion, alcohol drinking patterns are unstable throughout adulthood. Higher intakes were generally associated with poorer diets. These analyses support the nuanced characterisation of alcohol consumption in epidemiological studies.
Trends in food consumption by degree of processing and diet quality over 17 years: Results from the Framingham Offspring Study
Ultra-processed Foods and Cardiovascular Diseases: Potential Mechanisms of ActionJuul, F., Vaidean, G., & Parekh, N.
Journal titleAdvances in Nutrition
Page(s)1673-1680AbstractUltra-processed foods are industrially manufactured ready-to-eat or ready-to-heat formulations containing food additives and little or no whole foods, in contrast to processed foods, which are whole foods preserved by traditional techniques such as canning or pickling. Recent epidemiological studies suggest that higher consumption of ultra-processed food is associated with increased risk of cardiovascular disease (CVD). However, epidemiological evidence needs to be corroborated with criteria of biological plausibility. This review summarizes the current evidence on the putative biological mechanisms underlying the associations between ultra-processed foods and CVD. Research ranging from laboratory-based to prospective epidemiological studies and experimental evidence suggest that ultra-processed foods may affect cardiometabolic health through a myriad of mechanisms, beyond the traditionally recognized individual nutrients. Processing induces significant changes to the food matrix, for which ultra-processed foods may affect health outcomes differently than unrefined whole foods with similar nutritional composition. Notably, the highly degraded physical structure of ultra-processed foods may affect cardiometabolic health by influencing absorption kinetics, satiety, glycemic response, and the gut microbiota composition and function. Food additives and neo-formed contaminants produced during processing may also play a role in CVD risk. Key biological pathways include altered serum lipid concentrations, modified gut microbiota and host-microbiota interactions, obesity, inflammation, oxidative stress, dysglycemia, insulin resistance, and hypertension. Further research is warranted to clarify the proportional harm associated with the nutritional composition, food additives, physical structure, and other attributes of ultra-processed foods. Understanding how ultra-processing changes whole foods and through which pathways these foods affect health is a prerequisite for eliminating harmful processing techniques and ingredients.
Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring StudyJuul, F., Vaidean, G., Lin, Y., Deierlein, A. L., & Parekh, N.
Journal titleJournal of the American College of Cardiology
Page(s)1520-1531AbstractBackground: Ultra-processed foods provide 58% of total energy in the U.S. diet, yet their association with cardiovascular disease (CVD) remains understudied. Objectives: The authors investigated the associations between ultra-processed foods and CVD incidence and mortality in the prospective Framingham Offspring Cohort. Methods: The analytical sample included 3,003 adults free from CVD with valid dietary data at baseline. Data on diet, measured by food frequency questionnaire, anthropometric measures, and sociodemographic and lifestyle factors were collected quadrennially from 1991 to 2008. Data regarding CVD incidence and mortality were available until 2014 and 2017, respectively. Ultra-processed foods were defined according to the NOVA framework. The authors used Cox proportional hazards models to determine the multivariable association between ultra-processed food intake (energy-adjusted servings per day) and incident hard CVD, hard coronary heart disease (CHD), overall CVD, and CVD mortality. Multivariable models were adjusted for age, sex, education, alcohol consumption, smoking, and physical activity. Results: During follow-up (1991 to 2014/2017), the authors identified 251, 163, and 648 cases of incident hard CVD, hard CHD, and overall CVD, respectively. On average, participants consumed 7.5 servings per day of ultra-processed foods at baseline. Each additional daily serving of ultra-processed foods was associated with a 7% (95% confidence interval [CI]: 1.03 to 1.12), 9% (95% CI: 1.04 to 1.15), 5% (95% CI: 1.02 to 1.08), and 9% (95% CI: 1.02 to 1.16) increase in the risk of hard CVD, hard CHD, overall CVD, and CVD mortality, respectively. Conclusions: The current findings support that higher consumption of ultra-processed foods is associated with increased risk of CVD incidence and mortality. Although additional research in ethnically diverse populations is warranted, these findings suggest cardiovascular benefits of limiting ultra-processed foods.
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
Volume138AbstractWomen'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)1020-1030AbstractObjective: 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 behaviours during the coronavirus disease 2019 pandemic: Implications for obesityParekh, N., & Deierlein, A. L.
Journal titlePublic Health Nutrition
Page(s)3121-3125AbstractObjective: Obesity 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. Design: 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. Results: 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. Conclusions: 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.
Prenatal dietary exposures and offspring body size from 6 months to 18 years: A systematic reviewLitvak, J., Parekh, N., & Deierlein, A.
Journal titlePaediatric and Perinatal Epidemiology
Page(s)171-189AbstractBackground: In utero dietary exposures may influence childhood obesity. Objectives: To evaluate the relationship between prenatal dietary exposures and offspring body size from 6 months to 18 years. Data sources: Articles were identified in PubMed and Web of Science (January 2010-March 2018) using the PRISMA guidelines. Additional studies were identified through a reference review of articles that met the inclusion criteria and related reviews. Study selection: Prospective cohort studies that assessed dietary patterns, foods, macronutrients, or beverages during healthy pregnancy and offspring body size. The extraction of articles was done using predefined data fields. Synthesis: One author extracted all information and evaluated bias with the NHLBI's Quality Assessment Tool. Results: A total of 851 research articles were evaluated. Twenty-one studies assessing dietary patterns, macronutrients, foods, and beverages met inclusion criteria. Consumption of a Mediterranean dietary pattern during pregnancy was associated with reduced body size, while refined carbohydrates were associated with offspring obesity. No association was observed between data-driven dietary patterns and offspring body size, as well as a pro-inflammatory diet pattern and offspring body size. Mixed and null findings were observed for the relationship between total carbohydrates, n-3 polyunsaturated fatty acids, protein, sugar-sweetened beverages, and artificially sweetened beverages and offspring body size. Conclusions: Adhering to a Mediterranean diet and limiting refined carbohydrates during pregnancy may influence offspring body size between 6 months and 18 years. The diverging results that exist between studies highlight the complexity of this topic.
Preventing type 2 diabetes among South Asian Americans through community-based lifestyle interventions: A systematic review
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)1-18AbstractInsufficient 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 Healthy Eating and Living Against Noncommunicable Diseases Study: An Innovative Family-Based InterventionParekh, N., Khalife, G., Hellmers, N., & D’Eramo Melkus, G.
Journal titleDiabetes Educator
Page(s)569-579AbstractObjective: Inadequate nutrition literacy within families is a barrier for healthy dietary choices and influences chronic disease risk. This pilot study examined the feasibility of providing an in-person nutrition intervention for families at high risk of developing prediabetes or type 2 diabetes and cardiovascular risk-factors. Methods: Eligible families had at least one member with a non-communicable disease (NCD) or metabolic risk factor, fluency in English, willingness to attend all three educational sessions and complete questionnaires as a family unit. Sessions included didactic and experiential activities on food label reading, portion sizing, physical activity and modifiable lifestyle factors to reduce NCD risk. Demographics and fruit and vegetable screeners were collected from all participants at baseline and after completion of sessions. Families participated in focus groups to evaluate the program. Results: Twelve families (n=35;17 adults;18 children) were recruited from New York City. Participants self-identified as Asian, Hispanic or Black. Adults had a mean age of 40y, BMI of 32.29kg/m2, household income of $35,000-$49,000y, and 13 of 17 adult participants had college degrees. Children ranged from 1-17y. Based on focus group feedback, three sessions were acceptable, families reported enjoying interactive activities and group learning and requested child-friendly activities. They reported improved knowledge of food labels, strategies for grocery shopping, portion-sizing, and increased awareness of the links between diet quality and NCDs. Conclusions and Implications: The study met recruitment goals within 4 months. The educational intervention was acceptable and may be scaled-up for future studies on NCD prevention, particularly prediabetes and type 2 diabetes.
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 Health
Page(s)1037-1044AbstractObjective: 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.
Issue5AbstractBackground: 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.
Issue6AbstractObjective 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)2357-2366AbstractObjective: 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.
Quantity, Quality, and Timing of Carbohydrate Intake and Blood PressureByun, S. S., Mayat, Z. K., Aggarwal, B., Parekh, N., & Makarem, N.
Journal titleCurrent Nutrition Reports
Page(s)270-280AbstractPurpose of Review: This review discusses recent evidence on the association of dietary carbohydrates (quantity, quality, and timing of intake) with hypertension (HTN) risk and out-of-clinic blood pressure (BP) measures. Recent Findings: Studies on carbohydrate quantity are inconclusive, but low carbohydrate diets may be associated with lower BP. Plant-based carbohydrate-containing foods such as fruits, vegetables, and whole grains may lower HTN risk and 24-h BP. Excessive sugar intakes from sugar-sweetened beverages are associated with higher BP levels and HTN risk, with evidence of a dose-response relationship. Preliminary data suggest that timing of carbohydrate intake may influence HTN risk and 24-h BP. Summary: The role of carbohydrate nutrition in HTN’s etiology warrants further investigation. Additional studies are needed to investigate the influence of dietary carbohydrates on HTN risk and the circadian pattern of BP, evaluate potential sex and racial/ethnic differences in these associations, and elucidate underlying mechanisms.