OBJECTIVE -To determine the association between serum 25-hydroxyvitamin D (25OHD) and diabetes risk and whether it varies by ethnicity. RESEARCH DESIGN AND METHODS -We performed an analysis of data from participants who attended the morning examination of the Third National Health and Nutrition Examination Survey (1988 -1994), a cross-sectional survey of a nationally representative sample of the U.S. population. Serum levels of 25OHD, which reflect vitamin D status, were available from 6,228 people (2,766 non-Hispanic whites, 1,736 non-Hispanic blacks, and 1,726 Mexican Americans) aged Ն20 years with fasting and/or 2-h plasma glucose and serum insulin measurements.RESULTS -Adjusting for sex, age, BMI, leisure activity, and quarter of year, ethnicityspecific odds ratios (ORs) for diabetes (fasting glucose Ն7.0 mmol/l) varied inversely across quartiles of 25OHD in a dose-dependent pattern .60] for nonHispanic whites and 0.17 [0.08 -0.37] for Mexican Americans) in the highest vitamin D quartile (25OHD Ն81.0 nmol/l) compared with the lowest 25OHD (Յ43.9 nmol/l). This inverse association was not observed in non-Hispanic blacks. Homeostasis model assessment of insulin resistance (log e ) was inversely associated with serum 25OHD in Mexican Americans (P ϭ 0.0024) and non-Hispanic whites (P ϭ 0.058) but not non-Hispanic blacks (P ϭ 0.93), adjusting for confounders.CONCLUSIONS -These results show an inverse association between vitamin D status and diabetes, possibly involving insulin resistance, in non-Hispanic whites and Mexican Americans. The lack of an inverse association in non-Hispanic blacks may reflect decreased sensitivity to vitamin D and/or related hormones such as the parathyroid hormone. Diabetes Care 27:2813-2818, 2004T here is increasing evidence that vitamin D metabolism affects the risk of diabetes. Initial findings from animal studies showed that insulin released from the isolated perfused pancreas of the rat is lower in vitamin D-deficient animals than control animals (1), while pancreatic receptors for 1,25-dihydroxyvitamin D 3 in ␤-cells have been identified in a number of species (2). More recently, human studies have shown that vitamin D supplementation in infancy reduces the risk of type 1 diabetes during early adulthood (3).Vitamin D may also have a role in the development of type 2 diabetes. TaqI vitamin D receptor polymorphisms have been associated with an insulin secretion index among Bangladeshi Asians living in London, who have a high risk of type 2 diabetes (4). The BsmI polymorphism was associated with fasting glucose in inactive German men (5). In the Rancho Bernardo study (6) of older U.S. Caucasians, the ApaI polymorphism was associated with fasting plasma glucose and prevalence of glucose intolerance and the BsmI polymorphism with the homeostatis model assessment (HOMA) of insulin resistance.Given that a number of investigations have shown that vitamin D receptor polymorphisms are associated with various measures of glucose metabolism and diabetes risk, it seems reasonable to conclude t...

Understanding the drivers and dynamics of global ultra-processed food (UPF) consumption is essential, given the evidence linking these foods with adverse health outcomes. In this synthesis review, we take two steps. First, we quantify per capita volumes and trends in UPF sales, and ingredients (sweeteners, fats, sodium and cosmetic additives) supplied by these foods, in countries classified by income and region. Second, we review the literature on food systems and political economy factors that likely explain the observed changes. We find evidence for a substantial expansion in the types and quantities of UPFs sold worldwide, representing a transition towards a more processed global diet but with wide variations between regions and countries. As countries grow richer, higher volumes and a wider variety of UPFs are sold. Sales are highest in Australasia, North America, Europe and Latin America but growing rapidly in Asia, the Middle East and Africa. These developments are closely linked with the industrialization of food systems, technological change and globalization, including growth in the market and political activities of transnational food corporations and inadequate policies to protect nutrition in these new contexts. The scale of dietary change underway, especially in highly populated middle-income countries, raises serious concern for global health.

Vitamin D status, which is amenable to intervention by safely increasing sun exposure or vitamin D supplementation, was associated inversely with BP in a large sample representative of the US population.

IntroductionApplication of system thinking to the development, implementation and evaluation of childhood obesity prevention efforts represents the cutting edge of community-based prevention. We report on an approach to developing a system oriented community perspective on the causes of obesity.MethodsGroup model building sessions were conducted in a rural Australian community to address increasing childhood obesity. Stakeholders (n = 12) built a community model that progressed from connection circles to causal loop diagrams using scripts from the system dynamics literature. Participants began this work in identifying change over time in causes and effects of childhood obesity within their community. The initial causal loop diagram was then reviewed and elaborated by 50 community leaders over a full day session.ResultsThe process created a causal loop diagram representing community perceptions of determinants and causes of obesity. The causal loop diagram can be broken down into four separate domains; social influences; fast food and junk food; participation in sport; and general physical activity.DiscussionThis causal loop diagram can provide the basis for community led planning of a prevention response that engages with multiple levels of existing settings and systems.

BackgroundInternationally, governments have implemented school-based nutrition policies to restrict the availability of unhealthy foods from sale. The aim of the trial was to assess the effectiveness of a multi-strategic intervention to increase implementation of a state-wide healthy canteen policy. The impact of the intervention on the energy, total fat, and sodium of children’s canteen purchases and on schools’ canteen revenue was also assessed.MethodsAustralian primary schools with a canteen were randomised to receive a 12–14-month, multi-strategic intervention or to a no intervention control group. The intervention sought to increase implementation of a state-wide healthy canteen policy which required schools to remove unhealthy items (classified as ‘red’ or ‘banned’) from regular sale and encouraged schools to ‘fill the menu’ with healthy items (classified as ‘green’). The intervention strategies included allocation of a support officer to assist with policy implementation, engagement of school principals and parent committees, consensus processes with canteen managers, training, provision of tools and resources, academic detailing, performance feedback, recognition and marketing initiatives. Data were collected at baseline (April to September, 2013) and at completion of the implementation period (November, 2014 to April, 2015).ResultsSeventy schools participated in the trial. Relative to control, at follow-up, intervention schools were significantly more likely to have menus without ‘red’ or ‘banned’ items (RR = 21.11; 95% CI 3.30 to 147.28; p ≤ 0.01) and to have at least 50% of menu items classified as ‘green’ (RR = 3.06; 95% CI 1.64 to 5.68; p ≤ 0.01). At follow-up, student purchases from intervention school canteens were significantly lower in total fat (difference = −1.51 g; 95% CI −2.84 to −0.18; p = 0.028) compared to controls, but not in energy (difference = −132.32 kJ; 95% CI −280.99 to 16.34; p = 0.080) or sodium (difference = −46.81 mg; 95% CI −96.97 to 3.35; p = 0.067). Canteen revenue did not differ significantly between groups.ConclusionPoor implementation of evidence-based school nutrition policies is a problem experienced by governments internationally, and one with significant implications for public health. The study makes an important contribution to the limited experimental evidence regarding strategies to improve implementation of school nutrition policies and suggests that, with multi-strategic support, implementation of healthy canteen policies can be achieved in most schools.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12613000311752)