Telehealth programs have long held promise for addressing rural health disparities perpetuated by inadequate healthcare access. The COVID-19 (coronavirus disease 2019) pandemic and accompanying ...social distancing measures have hastened the implementation of telehealth programs in hospital systems around the globe. Here, we provide specific examples of telehealth efforts that have been implemented in a large rural healthcare system in response to the pandemic, and further describe how the massive shift to telehealth and reliance on virtual connections in these times of social isolation may impact rural health disparities for those without access to necessary broadband to deploy digital technologies. Finally, we provide recommendations for researchers and policymakers to ensure that telehealth initiatives do not amplify existing health disparities experienced by those living in rural communities.
Although adequate nutritional status during pregnancy is necessary to support optimal fetal development, many low-income women have poor access to fresh, high-nutrient foods. To address these ...challenges, a pediatric fruit and vegetable (FV) prescription program was expanded to include pregnant women, providing one prescription for fresh FVs worth 15 US dollars during each prenatal office visit for redemption at farmers'/mobile markets. This analysis describes baseline sociodemographic characteristics, food security, and dietary intake among 253 pregnant women in Flint, Michigan in 2022-23. Dietary recall data were collected and analyzed using the Automated Self-Administered 24-h Tool developed by the US National Cancer Institute, with nutrition output reported in relation to adherence to US Dietary Guidelines. Most participants (mean ± SD age 26.51 ± 4.90 years) identified as African American (53%) and were receiving publicly funded health insurance (66%). Most (75%) reported no food insecurity, yet the majority failed to meet dietary recommendations for whole grains (99.3%), vegetables (93.1%), dairy (93.1%), and fruits (69.4%). Moreover, most did not meet micronutrient recommendations through food sources, including vitamin D (100%), iron (98.6%), folic acid (98.6%), vitamin A (82.6%), calcium (68.8%), and vitamin C (62.5%). Results raise deep concerns regarding diet and nutrition among pregnant women in this US city.
We aimed to describe preliminary dietary intake results using DietID
for dietary assessment during pregnancy. A sub-sample of participants in the Research Enterprise to Advance Children's Health ...(REACH) prospective birth cohort from Detroit, MI received a unique web link to complete the DietID
assessment multiple times during pregnancy. We present results for the first dietary assessment completed during pregnancy by each participant. DietID
uses an image-based algorithm to estimate nutrient intake, dietary patterns, and diet quality and provides immediate results to participants. Descriptive statistics were used to summarize participant characteristics, nutrient intakes, dietary patterns, diet quality, and participant-rated accuracy of individual dietary assessment results. Differences in diet parameters were assessed by participant race with an independent t-test.
Participants (n = 84) identified as majority Black (n = 47; 56%), reflective of the source population. Mean (SD) maternal age and gestational age at dietary assessment were 32 (5.6) years and 14.3 (4.8) weeks, respectively. Mean dietary quality, as reported in the DietID
data output as the Healthy Eating Index (HEI), was 68 (range 12-98; higher scores indicate higher diet quality) and varied significantly between Black (mean SD 61 23) and White (mean SD 81 19) race (p < 0.01). Mean participant-rated accuracy of individual dietary assessment results was high at 87% on a scale of 0-100% ("not quite right" to "perfect"; range 47-100%).
Although nutrients in fruits and vegetables are necessary for proper development and disease prevention, most US children consume fewer servings than recommended. Prescriptions for fruits and ...vegetables, written by physicians to exchange for fresh produce, address access and affordability challenges while emphasizing the vital role of diet in health promotion and disease prevention. Michigan's first fruit and vegetable prescription program (FVPP) exclusively for children was introduced in 2016 at one large pediatric clinic in Flint and expanded to a second clinic in 2018. The program provides one $15 prescription for fresh produce to all pediatric patients at every office visit. Prescriptions are redeemable at a year-round farmers' market or a local mobile market. The current study will assess the impact of this FVPP on diet, food security, and weight status of youth.
Demographically similar pediatric patient groups with varying levels of exposure to the FVPP at baseline will be compared: high exposure (> 24 months), moderate exposure (12-24 months), and no previous exposure. Data collection will focus on youth ages 8-16 years. A total of 700 caregiver-child dyads (one caregiver and one child per household) will be enrolled in the study, with approximately 200 dyads at clinic 1 (high exposure); 200 dyads at clinic 2 (moderate exposure), and 300 dyads at clinic 3 (no previous exposure). Children with no previous exposure will be introduced to the FVPP, and changes in diet, food security, and weight status will be tracked over two years. Specific aims are to (1) compare baseline diet, food security, and weight status between pediatric patients with varying levels of exposure to the FVPP; (2) measure changes in diet, food security, and weight status before and after never-before-exposed children are introduced to the FVPP; and (3) compare mean 12- and 24-month follow-up measures of diet, food security, and weight status in the initial no exposure group to baseline measures in the high exposure group.
Completion of study aims will provide evidence for the effectiveness of pediatric FVPPs and insights regarding the duration and intensity of exposure necessary to influence change.
The study was registered through clinicaltrials.gov ID: NCT04767282 on February 23, 2021.
Pregnancy nutrition is important for maternal and child health and may affect the development of the infant gut microbiome. Our objective was to assess the feasibility of implementing a food-based ...intervention designed to increase fiber intake among pregnant women in a rural setting. Participants were enrolled (
= 27) mid-pregnancy from a prenatal care clinic in rural Michigan, randomized to intervention (
= 13) or usual care (
= 14), and followed to 6 weeks postpartum. The intervention was designed to be easily replicable and scalable by partnering with hospital foodservices and included non-perishable high fiber foods and recipes, as well as weekly delivery of salads, soup, and fresh fruit. Surveys, maternal blood, urine, and stool were collected at 24- and 36-weeks gestation and at 6 weeks postpartum. Infant stool was collected at 6 weeks. Participants were 100% White (7% Hispanic White, 7% Native American and White); 55% with education < 4-year college degree. Data on dietary intake and urinary trace elements are presented as evidence of feasibility of outcome measurement. Retention was high at 93%; 85% reported high satisfaction. The intervention described here can be replicated and used in larger, longer studies designed to assess the effects of pregnancy diet on the establishment of the infant gut microbiome and related health outcomes.
Breastfeeding and introduction of solid food are the two major components of infant feeding practices that influence gut microbiota composition in early infancy. However, it is unclear whether ...additional factors influence the microbiota of infants either exclusively breastfed or not breastfed. We obtained 194 fecal samples from infants at 3-9 months of age, extracted DNA, and sequenced the V4 region of the 16S rRNA gene. Feeding practices and clinical information were collected by questionnaire and abstraction of birth certificates. The gut microbiota of infants who were exclusively breastfed displayed significantly lower Shannon diversity (
-adjust < 0.001) and different gut microbiota composition compared to infants who were not breastfed (
-value = 0.001). Among the exclusively breastfed infants, recipients of vitamin D supplements displayed significantly lower Shannon diversity (
-adjust = 0.007), and different gut microbiota composition structure than non-supplemented, breastfed infants (
-value = 0.02). MaAslin analysis identified microbial taxa that associated with breastfeeding and vitamin D supplementation. Breastfeeding and infant vitamin D supplement intake play an important role in shaping infant gut microbiota.
The maternal microbiome plays a vital role in shaping pregnancy outcomes, but there remains a substantial gap in understanding its precise relationships to maternal health, particularly in relation ...to potential effects of body mass index (BMI) on gut microbial diversity. The aim of this observational study was to assess maternal characteristics in association with pre-pregnancy BMI and to further assess microbial diversity in association with specific maternal characteristics. Eighty-four pregnant women were recruited during their third trimester of pregnancy from various prenatal clinics across the state of Michigan. The participants completed an enrollment questionnaire including self-reported pre-pregnancy BMI; stool samples were collected to assess the fecal microbial community composition. Pre-pregnancy obesity (BMI 30+) was associated (univariably) with antibiotic use before pregnancy, ever smoked, lower education level, and being unmarried. The gut microbiota alpha diversity was significantly different for pregnant women by pre-pregnancy BMI category (normal, overweight, obese). The beta diversity was unique for the gut microbiotas of pregnant women within each BMI category, by education level, and by marital status. Multivariable models revealed that pre-pregnancy BMI, maternal education, marital status, and maternal age were associated with the microbial diversity of the gut microbiota during pregnancy. These results give new insight into the relationship between a woman’s microbiome during pregnancy and their prenatal health, along with an understanding of the relationships between socioeconomic factors and microbial diversity.
IntroductionTo reduce obesity-related disparities, reaching economically disadvantaged and/or minority status adolescents to assist them in meeting physical activity (PA) and nutrition ...recommendations is important. To address the problem, a 16-week intervention called Guys/Girls Opt for Activities for Life (GOAL) was designed. The purpose of this randomised controlled trial is to evaluate any effect of the intervention, compared with a control condition, on improving: (1) adolescents’ % body fat (primary outcome), moderate-to-vigorous PA (MVPA), diet quality and cardiorespiratory fitness from 0 to 4 months; (2) body mass index (BMI), overweight/obesity percentage and quality of life from 0 to 4 months and to 13 months; and (3) perceived social support, self-efficacy and motivation from 0 to 4 months with evaluation of any mediating effect on adolescent PA and diet quality. An exploratory aim is to evaluate any effect of the intervention, compared with the control, on improving parents’/guardians’ home environment, MVPA and diet quality from 0 to 4 months; and BMI from 0 to 4 months and to 13 months.Methods and analysisAdolescents (fifth to eighth grade) in 14 schools located in underserved urban communities are randomly assigned to the intervention or usual school offerings. One parent per adolescent is enrolled (882 dyads total). Cohort 1 includes four schools (2022–2023). Cohorts 2 and 3 include 5 schools in 2023–2024 and 2024–2025, respectively. The 16-week intervention has three components: (1) after-school GOAL club for adolescents to engage in PA and healthy eating/cooking activities; (2) three parent–adolescent meetings to empower parents to assist adolescents; and (3) GOAL social networking website for parents to share how they helped their adolescent.Ethics and disseminationThe Michigan State University Biomedical Institutional Review Board provided ethical approval for the study. Findings will be shared via the trial registration database, peer-reviewed publications, conferences and community-oriented strategies.Trial registration numberNCT04213014.
Background: Certain nutrients are well established as dietary risk factors for cardiovascular disease (CVD), but dietary patterns may be a better predictor of CVD risk. Objective: This study tested ...the hypothesis that the complex dietary behaviors of US adults can be grouped into major dietary patterns that are related to risk factors for CVD. Design: With the use of food-frequency questionnaire data from the third National Health and Nutrition Examination Survey, dietary patterns of healthy US adults (greater than or equal to 20 y old; n = 13 130) were identified by factor analysis. Log-transformed biomarker data were associated with major dietary patterns after control for confounding variables in regression analyses. All statistical analyses accounted for the survey design and sample weights. Results: Of 6 dietary patterns identified, 2 patterns emerged as the most predominant: the Western pattern was characterized by high intakes of processed meats, eggs, red meats, and high-fat dairy products, and the American-healthy pattern was characterized by high intakes of green, leafy vegetables; salad dressings; tomatoes; other vegetables (eg, peppers, green beans, corn, and peas); cruciferous vegetables; and tea. The Western pattern was associated (P < 0.05) positively with serum C-peptide, serum insulin, and glycated hemoglobin and inversely with red blood cell folate concentrations after adjustment for confounding variables. The American-healthy pattern had no linear relation with any of the biomarkers examined. Conclusions: The identification of common dietary patterns among free-living persons is promising for characterizing high-risk groups at the US population level. The dietary patterns identified here are similar to those reported in other nonrepresentative samples and are associated with biomarkers of CVD risk, which confirms that dietary pattern analysis can be a valuable method for assessing dietary intakes when predicting CVD risk.
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