(Sean C. Lucan)

Data from animal experiments and human studies implicate added sugars (eg, sucrose and high-fructose corn syrup) in the development of diabetes mellitus and related metabolic derangements that raise cardiovascular (CV) risk. Added fructose in particular (eg, as a constituent of added sucrose or as the main component of high-fructose sweeteners) may pose the greatest problem for incident diabetes, diabetes-related metabolic abnormalities, and CV risk. Conversely, whole foods that contain fructose (eg, fruits and vegetables) pose no problem for health and are likely protective against diabetes and adverse CV outcomes...

No abstract text is available yet for this article.

Prevailing thinking about obesity and related diseases holds that quantifying calories should be a principal concern and target for intervention. Part of this thinking is that consumed calories - regardless of their sources - are equivalent; i.e. 'a calorie is a calorie'. The present commentary discusses various problems with the idea that 'a calorie is a calorie' and with a primarily quantitative focus on food calories. Instead, the authors argue for a greater qualitative focus on the sources of calories consumed (i...

INTRODUCTION: Few studies have assessed how people's perceptions of their neighborhood environment compare with objective measures or how self-reported and objective neighborhood measures relate to consumption of fruits and vegetables. METHODS: A telephone survey of 4,399 residents of Philadelphia, Pennsylvania, provided data on individuals, their households, their neighborhoods (self-defined), their food-environment perceptions, and their fruit-and-vegetable consumption...

This study describes mobile food vendors (street vendors) in Bronx, NY, considering neighborhood-level correlations with demographic, diet, and diet-related health measures from City data. Vendors offering exclusively "less-healthy" foods (e.g., chips, processed meats, sweets) outnumbered vendors offering exclusively "healthier" foods (e.g., produce, whole grains, nuts). Wet days and winter months reduced all vending on streets, but exclusively "less-healthy" vending most. In summer, exclusively "less-healthy" vending per capita inversely correlated with neighborhood-mean fruit-and-vegetable consumption and directly correlated with neighborhood-mean BMI and prevalences of hypertension and hypercholesterolemia (Spearman correlations 0...

BACKGROUND: Since 1965, Medicare has publically financed graduate medical education (GME) in the United States. Given public financing, various advisory groups have argued that GME should be more socially accountable. Several efforts are underway to develop accountability measures for GME that could be tied to Medicare payments, but it is not clear how to measure or even define social accountability. OBJECTIVE: We explored how GME stakeholders perceive, define, and measure social accountability...

The American Heart Association recently strongly recommended a dietary sodium intake of <1500 mg/d for all Americans to achieve "Ideal Cardiovascular Health" by 2020. However, low sodium diets have not been shown to reduce cardiovascular events in normotensive individuals or in individuals with pre-hypertension or hypertension. Moreover, there is evidence that a low sodium diet may lead to a worse cardiovascular prognosis in patients with cardiometabolic risk and established cardiovascular disease. Low sodium diets may adversely affect insulin resistance, serum lipids, and neurohormonal pathways, leading to increases in the incidence of new cardiometabolic disease, the severity of existing cardiometabolic disease, and greater cardiovascular and all-cause mortality...

Coffee, after water, is the most widely consumed beverage in the United States, and is the principal source of caffeine intake among adults. The biological effects of coffee may be substantial and are not limited to the actions of caffeine. Coffee is a complex beverage containing hundreds of biologically active compounds, and the health effects of chronic coffee intake are wide ranging. From a cardiovascular (CV) standpoint, coffee consumption may reduce the risk of type 2 diabetes mellitus and hypertension, as well as other conditions associated with CV risk such as obesity and depression; but it may adversely affect lipid profiles depending on how the beverage is prepared...

In food-environment research, an alternative to resource-intensive direct observation on the ground has been the use of commercial business lists. We sought to determine how well a frequently used commercial business list measures a dense urban food environment like the Bronx, NY. On 155 Bronx street segments, investigators compared two different levels for matches between the business list and direct ground observation: lenient (by business type) and strict (by business name). For each level of matching, researchers calculated sensitivities and positive predictive values (PPVs) for the business list overall and by broad business categories: General Grocers (eg, supermarkets), Specialty Food Stores (eg, produce markets), Restaurants, and Businesses Not Primarily Selling Food (eg, newsstands)...

OBJECTIVES: Methadone maintenance treatment (MMT) effectively reduces illicit opioid use and its negative consequences when patients participate in and adhere to treatment. Patients' participation and adherence may relate to their perceptions about methadone doses and dose adjustments and the meanings that patients associate with treatment. This study assessed patient perceptions about methadone dosing and the meanings associated with methadone treatment to better support patient adherence to and success in MMT...

No abstract text is available yet for this article.

OBJECTIVES: To understand perceived influences on consumption of fruits, vegetables, and fast foods for urban, low-income African Americans. METHODS: Semi-structured interviews with 33 African American adults from Philadelphia, Pennsylvania, using continuous, iterative, thematic analysis. RESULTS: Influences on dietary behaviors that emerged included economic considerations; food characteristics; health concerns and health effects; participants' personal influences; social and cultural influences; neighborhood, home, and work environments; and broader contextual influences...

We sought to explore concepts of healthy diet and to elicit recommendations to support healthier eating among urban, low-income, African Americans. We conducted semi-structured interviews with 33 self-identified African American adults (18-81 years of age, 15 male participants) from a low-income neighborhood in west Philadelphia, PA, during summer and fall 2008. Our qualitative approach was continuous, iterative and thematic considering gender, age category, and participants' "mentions" of fast-food and fruit-and-vegetable intake from the preceding day...

OBJECTIVES: Diets low in fruits and vegetables and/or high in fast foods are associated with obesity and chronic diseases. Such diets may relate to different aspects of neighborhood food environments. We sought to evaluate if people's perceptions of their neighborhood food environment are associated with reported fruit-and-vegetable and fast-food consumption. METHODS: Cross-sectional analysis of a community health survey from Philadelphia, PA and four surrounding suburban counties (n = 10,450 individuals)...

Poor access to fresh produce likely contributes to disparities in obesity and diet-related diseases in the Bronx. New York City's Green Cart program is a partial response to the problem. We evaluated this program (permitting street vendors to sell fresh produce) by canvassing the Bronx for carts, interviewing vendors, and analyzing their locations and food offerings. Green Carts were clustered in areas of probable high pedestrian traffic, covering only about 57% of needy areas by liberal estimates. Some carts sold outside allowed boundaries; a few sold sugary snacks...

Advisory committees perform pivotal tasks at the National Institutes of Health (NIH), informing funding decisions, helping establish research priorities, and contributing to the vision for the nation's biomedical research agenda. Family medicine has not had a substantial role on these committees, but could, helping the NIH make research more patient centered and informing translational efforts to improve population health.

Corner stores are part of the urban food environment that may contribute to obesity and diet-related diseases, particularly for low-income and minority children. The snack foods available in corner stores may be a particularly important aspect of an urban child's food environment. Unfortunately, there is little data on exactly what snack foods corner stores stock, or where these foods come from. We evaluated snack foods in 17 Philadelphia corner stores, located in three ethnically distinct, low-income school neighborhoods...

Family medicine is the predominant provider of primary health care in the United States, yet it receives relatively little research funding from the National Institutes of Health (NIH). Family medicine can help the NIH speed research discovery and improve research relevance; the NIH can help family medicine build its research capacity; and such mutual benefit could mean improvement in public health.

To identify promoters of and barriers to fruit, vegetable, and fast-food consumption, we interviewed low-income African Americans in Philadelphia. Salient promoters and barriers were distinct from each other and differed by food type: taste was a promoter and cost a barrier to all foods; convenience, cravings, and preferences promoted consumption of fast foods; health concerns promoted consumption of fruits and vegetables and avoidance of fast foods. Promoters and barriers differed by gender and age. Strategies for dietary change should consider food type, gender, and age...

BACKGROUND AND OBJECTIVES: Family medicine has had little engagement with the National Institutes of Health (NIH), and it is unclear what NIH officials think about this. METHODS: Purposive sampling identified 13 key informants at NIH for open-ended, semi-structured interviews. Evaluation was by content analysis. RESULTS: NIH officials expressed the perception that family physicians have strong relationships with patients and communities and focus on interdisciplinary collaboration but that they do limited research and have weak research infrastructure...