This mini-review examines the complex relationship between diet and sleep and explores the clinical and public health implications of the current evidence. Dietary quality and intake of specific nutrients can impact regulatory hormonal pathways to alter sleep quantity and quality. Sleep, in turn, affects the intake of total energy, as well as of specific foods and nutrients, through biological and behavioral mechanisms. Initial research in this field focused primarily on the effects of short sleep duration on nutritional quality. However, more recent studies have explored the dynamic relationship between long sleep duration and diet. Current evidence suggests that extremes of sleep duration alter sleep patterns, hormonal levels, and circadian rhythms, which contribute to weight-related outcomes and obesity, and other risk factors for the development of chronic disease such as type 2 diabetes and cardiovascular disease. These patterns may begin as early as childhood and have impacts throughout the life course. Given that non-communicable diseases are among the leading causes of death globally, deeper understanding of the interactions between sleep and nutrition has implications for both public health and clinical practice.

Background The WHO recommends 400 g/d of fruits and vegetables (the equivalent of ∼5 servings/d) for the prevention of noncommunicable diseases (NCDs). However, there is limited evidence regarding individual-level correlates of meeting these recommendations in low- and middle-income countries (LMICs). In order to target policies and interventions aimed at improving intake, global monitoring of fruit and vegetable consumption by socio-demographic subpopulations is required. Objectives The aims of this study were to 1) assess the proportion of individuals meeting the WHO recommendation and 2) evaluate socio-demographic predictors (age, sex, and educational attainment) of meeting the WHO recommendation. Methods Data were collected from 193,606 individuals aged ≥15 y in 28 LMICs between 2005 and 2016. The prevalence of meeting the WHO recommendation took into account the complex survey designs, and countries were weighted according to their World Bank population estimates in 2015. Poisson regression was used to estimate associations with socio-demographic characteristics. Results The proportion (95% CI) of individuals aged ≥15 y who met the WHO recommendation was 18.0% (16.6–19.4%). Mean intake of fruits was 1.15 (1.10–1.20) servings per day and for vegetables, 2.46 (2.40–2.51) servings/d. The proportion of individuals meeting the recommendation increased with increasing country gross domestic product (GDP) class (P < 0.0001) and with decreasing country FAO food price index (FPI; indicating greater stability of food prices; P < 0.0001). At the individual level, those with secondary education or greater were more likely to achieve the recommendation compared with individuals with no formal education: risk ratio (95% CI), 1.61 (1.24–2.09). Conclusions Over 80% of individuals aged ≥15 y living in these 28 LMICs consumed lower amounts of fruits and vegetables than recommended by the WHO. Policies to promote fruit and vegetable consumption in LMICs are urgently needed to address the observed inequities in intake and prevent NCDs.

Close economic ties encourage production and trade of meat between Canada, Mexico, and the US. Understanding the patterns of red and processed meat consumption in North America may inform policies designed to reduce meat consumption and bolster environmental and public health efforts across the continent. We used nationally-representative cross-sectional survey data to analyze consumption of unprocessed red meat; processed meat; and total red and processed meat. Generalized linear models were used to separately estimate probability of consumption and adjusted mean intake. Prevalence of total meat consumers was higher in the US (73.6, 95% CI: 72.3–74.8%) than in Canada (65.6, 63.9–67.2%) or Mexico (62.7, 58.1–67.2%). Men were more likely to consume unprocessed red, processed, and total meat, and had larger estimated intakes. In Mexico, high wealth individuals were more likely to consume all three categories of meat. In the US and Canada, those with high education were less likely to consume total and processed meat. Estimated mean intake of unprocessed red, processed, and total meat did not differ across sociodemographic strata. Overall consumption of red and processed meat remains high in North America. Policies to reduce meat consumption are appropriate for all three countries.

The relative cost of living in rural areas has long been of interest to rural sociologists. Today, the popular perception is that rural prices are lower. This study examines geographic differences in the costs of living in Kentucky. The results indicate that, contrary to the popular perception, when prices of the same products and services were compared, there was no consistent pattern of lower prices in the rural counties. Furthermore, differences in the material conditions of rural living meant that there were additional costs that price comparisons alone did not capture.

The emerging epidemic of obesity and type II diabetes in Mexico has recently propelled the nation into the public health spotlight. In the state of Yucatán, the experience of diabetes is greatly impacted by two cultural constructions of disease. In this setting, elements of Yucatec Mayan health practices as well as the biomedical model affect the approach to type II diabetes. Both frameworks offer unique understandings of the etiology of diabetes and recommend different ways to manage the condition. Based on in-depth and semi-structured interviews with both community members and clinicians, the present study seeks to understand how diabetes is understood and treated in indigenous settings in rural Yucatán. We explore the context in which community members navigate between locally available healthcare options, choose one over the other, or incorporate strategies from both into their diabetes care regimens. The tension between indigenous community members and their biomedical healthcare providers, the changing food environment of this community, and the persistence of traditional gender constructions affect the management of type II diabetes and its associated symptoms.

Objective: Dietary patterns characterized by high intake of red and processed meat are associated with detrimental health and environmental outcomes. To better understand how Americans consume red and processed meat, this study examined the food groups that are the greatest contributors to red and processed meat intake in US diets. Design: Cross-sectional analysis of total red and processed meat, unprocessed red meat, and processed meat using data from the National Health and Nutrition Examination Survey (2015-2016 and 2017-2018). Items containing red or processed meat were classified into 13 mutually-exclusive food groups. For highly-consumed food groups (≥10% of meat intake), contribution to meat intake was further assessed by source, sex, income, and education. Setting: Nationally-representative sample of the US population. Participants: Teens (12-19 years) and adults (≥20 years) who reported meat consumption (N=8,178). Results: Meat mixed dishes [18.9% (95% CI: 16.4-21.3%)], Burgers [17.6% (15.5-19.7%)], and Beef excluding ground [17.1% (13.8-20.4%)], were the top contributors to unprocessed red meat intake. For processed meat, four food groups made up about four-fifths of total intake: Cold cuts and cured meats [37.7% (34.6-40.8%)], Sausages and frankfurters [20.2% (18.6-22.0%)], Bacon [14.0% (12.3-15.6%)], and Pizza [10.1% (8.7-11.5%)]. Fast-food restaurants were the top source for Burgers and Pizza, whereas stores were the top source for all other highly-consumed food groups. Few differences were seen in patterns of intake by sociodemographic characteristics. Conclusions: No single food group accounts for a majority of meat intake in the United States. Many behavior change opportunities for healthier, more sustainable substitutions exist.

Objectives: To investigate the associations between household wealth, household consumption, and chronic disease risk behaviors among older adults in rural South Africa. Methods: Data were from baseline assessments of 5,059 adults aged ≥40 in the population-based “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI) in 2015. Confounder-adjusted prevalence ratios were estimated for the associations between each of household wealth and household consumption quintiles with low moderate-to-vigorous physical activity (MVPA), current smoking, frequent alcohol intake, and overweight/obese body mass index (BMI). Results: Low MVPA and overweight/obese BMI were common (57% and 58%, respectively), and linearly increased in prevalence across household wealth quintiles. Low MVPA decreased and overweight/obese BMI increased in prevalence across household consumption quintiles. Smoking and frequent alcohol intake were rare (9% and 6%, respectively); they decreased in prevalence across wealth quintiles but did not vary by consumption quintile. Conclusions: Chronic disease risk behaviors are socioeconomically graded among older, rural South African adults. The high prevalence of overweight and obesity in rural South Africa is a public health concern requiring urgent attention.

Objectives Close economic ties have encouraged production and trade of meat between the US, Canada, and Mexico. Understanding the sociodemographic correlates of red and processed meat intake in North America may inform policies designed to reduce greenhouse gas emissions and non-communicable diseases. Methods Data were from one day of 24-hour dietary recall in the US National Health and Nutrition Examination Survey (2013–2016), Mexico National Health and Nutrition Survey (2016), and Canadian Community Health Survey (2015). Adult participants were classified as consumers or non-consumers of the following three categories: red meat (mammalian muscle and organ meat); processed meat (all meats processed for preservation and flavor); and any meat (red and/or processed meat). Negative binomial regression accounting for complex survey design was used to model sociodemographic correlates (sex, ten-year age categories, wealth, and education) of being a consumer of red, processed, and any meat. Results The overall prevalence of any meat consumption in a given day was higher in the US (74%) than in Canada (66%) or Mexico (63%). Age was not associated with meat intake. In the US and Canada, females were less likely to consume all three categories of meat (all P &lt; 0.001). In Mexico, females were less likely to be in the any meat consumer category (P &lt; 0.001). Compared to high school or lower, those with college education or higher were less likely to consume processed (all P &lt; 0.05) and any meat (all P &lt; 0.05). In the US only, college education or higher was associated with a lower likelihood of eating red meat (P &lt; 0.001). There was no association between education and meat intake in Mexico. Compared to the lowest wealth tertile, in Canada and Mexico, individuals in the highest wealth tertile were more likely to consume processed (all P &lt; 0.01) or any (all P &lt; 0.01) meat. In Mexico only, those with greater wealth were more likely to eat red meat (P &lt; 0.05). There was no association between wealth and meat intake in the US. Conclusions Overall consumption of red and processed meat remains high in North America. Although the sociodemographic predictors vary across country, population-based approaches to reduce meat intake are appropriate for all three settings. Funding Sources Carolina Population Center; Wellcome Trust.