Search Results (28)

Background/Objectives: The increasing prevalence of overweight and obesity in adolescents represents a major global health concern. Adolescent weight gain frequently shows additional metabolic risk factors, including insulin resistance, hypertension, and dyslipidemia, whose co-occurrence defines the metabolic syndrome (MetS). Adherence to a healthy dietary pattern, such as the Mediterranean Diet (MD), has been shown to reduce the metabolic risk among adolescents. Skin carotenoid score has emerged as an objective and non-invasive indicator of MD adherence; however, its relationship with a cluster of metabolic parameters which characterize the MetS, including the triglyceride levels, diastolic blood pressure, and waist circumference, remains poorly explored. Here, we investigated the role of skin carotenoid score as an early biomarker of metabolic syndrome risk in adolescents. Methods: A sample of 634 healthy adolescents underwent anthropometric and clinical measurements, blood sample collection, and evaluation of the MD adherence by the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED) questionnaire and the skin carotenoid levels by the Veggie Meter^®. Student’s t-test, chi-square test, Pearson correlation, and the multivariable linear regression model were used for analyses. Results: Participants had a mean BMI Z-score of 0.02 ± 1.01; the metabolic serum profile and the cardiovascular parameters were within the normal range. Mean KIDMED and skin carotenoid scores were 5.21 ± 2.56 and 357 ± 96.58, respectively. Skin carotenoids were positively associated with height (p = 0.02), while they were inversely associated with weight (p = 0.008), BMI Z-score (p < 0.0001), diastolic blood pressure (p = 0.013), and triglycerides (p = 0.003). Moreover, the carotenoid score was positively associated with male gender and KIDMED score and negatively associated with waist circumference and triglyceride levels in multivariable regression analyses. Conclusions: Our results suggested the potential application of skin carotenoid score as a complementary biomarker for the early identification of adolescents at increased metabolic risk. Full article

Background/Objective: Nutrition security, defined as consistent access to and consumption of nutritious foods that support health, remains a persistent challenge in rural populations. The HEALTHY (Helping Early Adolescents Live Their Healthiest Youth) program aimed to improve rural adolescents’ nutrition security through school-based strategies. This study evaluated its effectiveness by examining changes in fruit consumption, fruit waste, and skin carotenoid levels. Methods: A quasi-experimental, pre–post program was assessed in five rural middle schools (two experimental sites, three comparison sites). The programming paired four biweekly smoothie taste tests with nutrition education grounded in Social Cognitive Theory and Choice Architecture. Students in grades 3–8 (N = 149) participated. Digital tray photographs quantified selection and waste. The Veggie Meter^® assessed skin carotenoids on a scale from 0 to 800. Surveys captured perceptions and self-reported intakes. Analyses included χ², McNemar’s, GLMM, paired t-tests, and ANCOVA. Significance was set at p < 0.005. Results: At post-program, 98.3% of experimental trays contained the standard fruit option and/or a smoothie, compared with 41.0% of comparison trays (χ² = 41.66, p < 0.001). Fruit selection odds were 16.22 times higher in experimental schools (95% CI: 6.30–41.77, p < 0.001). Among trays with both (n = 39), smoothie waste was lower than the standard fruit option waste (t(38) = −7.10, p < 0.001, d = 1.14), resulting in greater estimated consumption (~0.43 vs. ~0.15 cups). Skin carotenoids increased in both groups, with greater improvement among experimental students in the lowest baseline quartile, F (1,19) = 9.20, p = 0.007, partial η² = 0.326. Conclusions: The HEALTHY program, which paired frozen-fruit smoothies with nutrition education, may offer a feasible and scalable approach to improving nutrition security among rural adolescents. Full article

Background/Objectives: Advanced glycation end products (AGEs) and carotenoids are systemic indicators of metabolic and oxidative status, yet their influence on ocular tissue biomechanics remains unclear. This study investigated the relationships between systemic AGEs and skin carotenoid levels, as well as corneal biomechanical properties in glaucoma patients. Methods: A retrospective observational analysis was performed on 676 patients (1278 eyes) who attended the glaucoma clinic at Shimane University Hospital between May 2019 and August 2024. Fingertip skin autofluorescence (sAF)-based AGE scores using AGE Sensor^® and skin carotenoid scores using the Veggie Meter^® were collected as part of systemic evaluation. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal compensated intraocular pressure (IOPcc) were measured using the ocular response analyzer (ORA). Associations between systemic variables, AGEs, carotenoids, and ORA parameters were analyzed using univariate tests, mixed-effects regression models, and quartile-based comparisons. Results: The mean AGEs and carotenoid scores were 0.42 ± 0.10 arbitrary units and 338.5 ± 130.8 optical density units, respectively. Via a univariate analysis, an inverse association was found between carotenoid level and CRF; however, via multivariate analyses, neither AGEs nor carotenoid levels were associated with IOPg, IOPcc, CH, or CRF in any analysis. In contrast, demographic parameters showed significant associations with ORA parameters. Via quartile-based comparisons, a significant inverse correlation was found between AGEs and carotenoids (p < 0.0001). Conclusions: In conclusion, sAF-measured AGEs and skin carotenoids showed no remarkable associations with corneal biomechanical properties. AGEs and carotenoids demonstrated an inverse relationship with each other, and each marker was associated with several demographic parameters. Full article

Adequate intake of fruits and vegetables (F + V) supports healthy growth and development in children, yet many New Zealand children do not meet national dietary recommendations, and methods to evaluate intake require good reliability. Objectives: To establish the validity and reliability of a modified 24 h multiple pass recall (MPR) for evaluating F + V and carotenoid intakes in children aged 9–13 years. The reliability of the Veggie Meter^® (VM^®), a non-invasive reflection spectrometer to estimate skin carotenoid scores and derive blood carotenoid concentrations, was also examined. Methods: Thirty-two children (20 boys, 12 girls) completed three 24 h MPRs and parent-assisted weighed food diaries (WFDs) on randomised weekdays and weekends. Skin carotenoid scores were assessed using the VM^®. The validity of the MPR was evaluated against WFDs using log-transformed Pearson correlations and mean x-axis bias. The reliability was assessed by the coefficient of variation (CV) and Pearson correlations. Results: Participants did not meet recommended F + V intakes (5–5.5 servings/day): MPR (mean fruit 1.3 servings/day; vegetables 2.0), WFD (fruit 1.3; vegetables 1.9). The MPR was a valid tool to estimate fruit and vegetable daily servings (combined-day Pearson coefficients > 0.71) with only trivial–small standardized mean bias-offset vs. WFD; however, the reliability was poor for the MPR-estimated carotenoid intake (CV 126%) and F + V intake. In contrast, the VM^® was reliable (Pearson correlation 0.97–0.99) with low measurement error (CV 4.0–5.2%). Conclusions: The modified 24 h MPR was valid but unreliable for estimating F + V and carotenoid intake. The VM^® demonstrated high reliability as a biomarker of skin carotenoid status in children. Full article

Background/Objectives: Early childhood represents a sensitive period for developing positive dietary preferences and important school readiness skills. However, few evidence-based programs leverage opportunities to support children’s development in both areas. Our study aimed to assess the preliminary effects of multi-level, teacher-led More PEAS Please! on Head Start children’s (3–5 years old) science knowledge, development of academic language, fruit-and-vegetable (FV) liking, and dietary quality. Methods: In this pilot study, we used a repeated-measure research design to assess child-level outcomes. Trained teachers implemented 16 food-based science-learning activities. We assessed child outcomes using validated measures of science knowledge, academic language, FV liking, and dietary quality (Veggie Meter^®). We used linear mixed models to examine changes from the baseline to post intervention. Fixed effects included age, sex, and race/ethnicity, while the center was treated as a random effect. Results: A total of 273 children were enrolled in the study. The children were mostly male (51.6%), Black/African American (82.1%) and, on average, 3.94 (SD = 0.70) years old. The children demonstrated significant improvements in science knowledge (T1 M = −0.01, SD = 0.82; T4 M = 0.33, SD = 0.90; 95% CI [0.17, 0.50]; p < 0.001) and vocabulary (T1 M = 14.4, SD = 4.5; T4 M = 16.7, SD = 5.3; 95% CI [1.4, 3.3]; p < 0.001). The children’s dietary quality improved from the baseline, but the changes were not significant. Conclusions: The findings suggest that the intervention may support improvements in science knowledge and academic vocabulary among preschool-aged children. We theorize a longer intervention with additional FV exposures may be needed to observe significant dietary changes. Future research should evaluate program effects with a comparison group. Full article

Childhood obesity represents a public concern worldwide. Evidence indicates that fruits and vegetables (FV) consumed as part of the daily diet reduce the global burden of obesity. Indeed, FV are rich in bioactive compounds, including carotenoids, which exert health benefits as very potent natural antioxidants. Here, we compared the anthropometric characteristics and the skin carotenoid content between two schoolchildren populations from Southern and Central Italy to evaluate their dietary habits. A sample of 121 and 124 schoolchildren from primary schools in Central and Southern Italy, respectively, was recruited. All participants underwent anthropometric measurements and assessment of the adherence to the Mediterranean Diet (MD) by the KIDMED questionnaire and the skin carotenoid score by Veggie Meter^®. The mean body mass index (BMI) was significantly lower in participants from Central Italy than in those from Southern Italy. A significantly higher percentage of overweight and obesity was found in the overall sample from Southern than in Central Italy. The adherence to the MD was in the average range for both populations, with no gender-related differences. The carotenoid score was higher and negatively correlated with BMI in the schoolchildren from Central Italy. In multiple regression analyses, skin carotenoids were positively associated with the consumption of fruit in the entire sample. This study suggests the importance of increasing FV intake, particularly in Southern Italy, as a strategy for preventingof obesity during the whole lifespan. Further studies are essential to better understand the influence of skin carotenoids on different variables and their potential role as indicators of health status in children. Full article

Background: Fruit and vegetable (FV) intake is critical for optimizing pregnancy outcomes. Several socio-demographic factors are associated with FV intake, but less is known about behavioral and mental health correlates. Furthermore, existing knowledge is largely based on self-reported FV intake. The current cross-sectional study examined depressive symptoms and income as moderators of the association between eating behaviors and skin carotenoids (FV status biomarker) in pregnancy. Methods: Participants living in an urban area of the south-astern part of the U.S. (N = 299) and who were in their third trimester of pregnancy were recruited for lab visits between 2019 and 2022 and completed the Dutch Eating Behavior Questionnaire and the Center for Epidemiological Studies Depression Scale. FV status was assessed using a pressure-mediated reflection spectroscopy to determine skin carotenoids. Hypotheses were tested via multiple regression. Results: There was an interaction between dietary restraint and depressive symptomatology such that greater restraint predicted higher skin carotenoids at low levels of depressive but not high levels. There was an interaction between restrained eating and family income in predicting skin carotenoids that was significant at high- but not low-income level. External and emotional eating did not predict skin carotenoids. Conclusions: Restrained eating might positively influence skin carotenoids during pregnancy. However, those who suffer from higher levels of depressive symptoms and/or live in lower-income households face additional barriers that might impede FV status. Further research is warranted to advance our understanding of the interplay between mental health, restrained eating and income on FV status in pregnancy. Full article

Objectives: Food insecurity among college students, combined with limited nutrition knowledge and barriers to healthy eating, significantly impacts diet quality and fruit and vegetable intake. Efforts to address these issues are further complicated by the challenges of accurately and efficiently collecting dietary data in research settings. This study aimed to explore the relationship between nutrition knowledge and fruit/vegetable intake using skin, plasma, and dietary carotenoid levels as biomarkers. Methods: Undergraduate and graduate students aged 18 years and older (n = 166) from a California public university were recruited. The sample was predominately female (n = 133, 80%), with 30 males (18%) and three individuals (2%) identifying as non-binary. Food security was assessed using the USDA’s 10-item Adult Food Security Survey Module and nutrition knowledge through a validated questionnaire. Biological data included blood samples and skin carotenoid measurements (Veggie Meter^®). Dietary quality (HEI-2015) and carotenoid intake were assessed through Diet ID™, a photo-based assessment tool. Results: The mean nutrition knowledge scores were 36.55 ± 8.83 out of 58 points, and the mean skin carotenoid score was 307.07 ± 110.22. Higher knowledge scores were associated with increased plasma carotenoids, HEI-score, and Diet ID™ total carotenoids. Food security classification did not significantly impact nutrition knowledge but did influence HEI scores and skin carotenoid levels, with very low food security linked to poorer diet quality and lower carotenoid levels. Conclusions: Nutrition knowledge may serve as a significant predictor of fruit and vegetable intake in university students. Despite this correlation, the impact of overall diet quality is potentially hindered by an individual’s food security status. Therefore, while knowledge is critical, addressing food insecurity is essential for enhancing diet quality among college students. Full article

Background/Objectives: An adapted version of an online pictorial food frequency questionnaire (FFQ), VioScreen-Allergy, assesses total dietary intake and intake of allergens and foods in the maternal diet index (MDI), linked to offspring allergy. This study assessed intermethod reliability, test–retest reliability, and external validity of the VioScreen-Allergy. Methods: Females of childbearing age were recruited at Denver Health and Children’s Hospital, Colorado, USA, and were asked to complete four 24 h recalls and two VioScreen-Allergy FFQs over the course of a month. All those with at least two 24 h dietary recalls and both VioScreen-Allergy assessments were analyzed. Energy-adjusted and non-adjusted linear mixed models (1) compared MDI scores and intake of nutrients and allergens as measures of intermethod reliability; (2) evaluated VioScreen-Allergy test–retest reliability as differences between repeated measurements; and (3) assessed external validity by modeling associations between VioScreen-Allergy-derived intake of beta-carotene and orange vegetables and Veggie Meter^®-assessed skin carotenoids. Bonferroni corrections controlled multiple comparisons within the assessment. Results: Of 53 participants enrolled, 25 demographically dissimilar participants were included in the analysis. There were no significant differences between 24 h recall and VioScreen-Allergy mean intakes of macronutrients, micronutrients, allergens, or MDI, except for Vitamin C, niacin, and cashew allergen protein. There were no significant differences between repeated measurements of VioScreen-Allergy, either energy-adjusted or unadjusted. Both beta-carotene and orange vegetable servings were significantly associated with Veggie Meter^®. Conclusions: Although non-significance could have been due to low power, clinical as well as statistical assessments of intermethod reliability, test–retest reliability, and external validity suggest that VioScreen-Allergy has reasonable utility for trials assessing food allergens and MDI in the context of overall intake. The VioScreen questionnaire can also be used in future studies to assess macro- and micronutrient intake. Additional validation studies assessing different portion sizes and foods eaten by infants and young children are currently undergoing. Full article

The Mediterranean Diet (MD) is characterized by a high intake of fruits and vegetables (FVs), which is considered as an important contributor to the beneficial effects of the MD pattern. In this cross-sectional study, we compared the food choices, evaluated by dietary habit questionnaires, of a sample of 995 adults, including 601 and 394 participants from Southern Italy and the Dominican Republic, respectively. In addition, we focused on their FV consumption, assessed by the Mediterranean Diet Adherence Screener (MEDAS) questionnaire, and on its association with skin carotenoid levels as measured by the Veggie Meter^®. We found that a significantly higher percentage of Italians had five meals/day and breakfast compared to Dominicans (five meals/day: 43 vs. 25, p < 0.05; breakfast: 89 vs. 79, p < 0.05), whereas a lower percentage of participants from Italy consumed snacks between the two meals compared to the Dominican Republic population (47 vs. 70, p < 0.005). Most of the participants from both populations had breakfast at home. However, 59.3% of Italians and 27.5% of Dominicans (p = 0.005) had breakfast between 7:00 and 9:00 a.m., whereas 5.8% and 27.5% (p = 0.001) had breakfast after 9:00 a.m., respectively. Milk/yogurt and eggs were the most consumed foods for breakfast in Italy and the Dominican Republic, respectively. Regarding the main meals, most of the Italians and Dominicans had a first course for lunch and a second course for dinner. Of note, we observed that approximately half of the Italians ate FVs in their main meals and had a higher carotenoid score than the Dominicans. Interestingly, in the multiple linear regression analysis, we found that the carotenoid score was positively associated with sex (β = 0.078; p = 0.009), age (β = 0.008; p = 0.001), vegetable consumption (β = 0.12; p = 0.041) and the perception of a healthy diet (β = 0.12; p = 0.001) in the Dominic Republic population, while the carotenoid score was directly associated with sex (β = 54.97; p < 0.0001) and both vegetable (β = 25.42; p = 0.0008) and fruit (β = 38.61; p < 0.0001) consumption in the Italian sample. Our findings confirm the need to promote nutrition-based interventions to encourage FV intake, particularly in non-Mediterranean countries. Full article

Background: Nutrition, cooking, and gardening lessons individually and together have been shown to increase fruit and vegetable (FV) consumption in school-aged children. The CATCH Rainbow program incorporated nutrition education, cooking, and gardening lessons aimed at increasing FV consumption in elementary school-aged children and assessed changes in participants’ BMI, self-reported FV consumption, and skin carotenoid levels at baseline and post-intervention. Methods: Two-hundred and twenty-five 4th and 5th graders (mean age: 9.8 years and 52% male participants) at Genoa Elementary School participated in six cooking and six gardening sessions between September 2021 and May 2022. Each nutrition education session was 25 min long, paired with either hands-on cooking activities or gardening skills. At baseline and post-intervention, participants’ height and weight were assessed with a stadiometer/scale, and skin carotenoid measurement was taken by a Veggie Meter^® (Longevity Link Corporation (Salt Lake City, UT, USA)). Students also completed the Block Food Frequency Questionnaire to self-report FV consumption at both time points. Focus groups were conducted with children at the end of the program for qualitative feedback. Results: paired samples T-test and regression analysis results indicate no significant decrease in BMI or significant increase in skin carotenoid scores from pre- to post-intervention. However, though not significant, there was an increase in self-reported FV intake by 0.4 servings. Additionally, the qualitative feedback was positive, as children mentioned benefits of healthy eating and expressed enjoyment for growing, cooking, and tasting fruits and vegetables. Conclusions: Results from this study can be used to guide future cooking and gardening programs for elementary school children. Time of the year when implementing these programs and collecting data may impact study outcomes due to seasonal variations in fruit and vegetable intake. Full article

This study explored the link between different types of glaucoma and cognitive function in a cohort of 620 Japanese patients. Participants were categorized into primary open-angle glaucoma (PG), exfoliation glaucoma (EG), and non-glaucomatous control groups. The findings revealed a significant decline in cognitive function as indicated by the Mini-Cog test in the EG group (mean ± SD: 4.0 ± 1, 95% CI: 3.9 to 4.2) compared to the PG group (4.4 ± 0.1, 4.3 to 4.5, p < 0.0001). Levels of fingertip measured advanced glycation end-products (AGEs) were significantly higher in the EG group (mean ± SD: 0.45 ± 0.006, 95% CI: 0.44 to 0.46) compared to the PG group (0.43 ± 0.004, 0.42 to 0.44, p = 0.0014). Although the multivariate analysis initially showed no direct association between glaucoma types and Mini-Cog scores, the EG group exhibited higher age and intraocular pressure (IOP) compared to the PG group. Further analysis revealed that high levels of AGEs were associated with cognitive decline and decreased mean visual fields in the EG group. Age was identified as a cofounding factor in these associations. An inverse correlation was observed between the accumulation of AGEs and skin carotenoid levels. Early detection of cognitive decline in glaucoma patients could enable timely intervention to preserve visual fields. Fingertip measurements of skin carotenoids and AGEs offer promising potential as non-invasive, straightforward diagnostic tools that could be widely adopted for monitoring ophthalmic and cognitive health in glaucoma patients. Full article

Carotenoids, having strong antioxidant properties, have been associated with neurodegenerative conditions like dementia and glaucoma, characterized by neuronal loss leading to cognitive and visual dysfunction. Therefore, carotenoids have attracted attention as factors predictive of the onset and progression of these neurodegenerative diseases. However, the impact of carotenoids on cognitive impairment and glaucomatous visual field defects remains unexplored. We conducted a retrospective, observational clinical study to investigate the association between skin carotenoid (SC) levels and cognitive impairment, as screened by the Mini-Cog test, in glaucoma patients. The study included 406 participants and 812 eyes were examined (average age: 69.7 ± 11.4 years; 228 men, 178 women) with various types of glaucoma: primary open angle (57.6%), exfoliation (18.6%), and other types (23.8%). SC levels were estimated via pressure-mediated reflection spectroscopy. Mixed-effects regression models were utilized to examine the relationship between SC levels, visual field defects, and Mini-Cog results. Of the participants, 28 (6.9%) tested positive on the Mini-Cog, suggesting cognitive impairment. The average SC level in the Mini-Cog positive group was significantly lower than in the negative group (269.5 ± 86.4 A.U. vs. 329.2 ± 120.4 A.U., respectively; p = 0.01). Additionally, the visual field mean deviation (MD) in the Mini-Cog positive group was notably worse than that in the negative group (−19.64 ± 9.07 dB vs. −12.46 ± 9.28 dB, respectively; p < 0.0001). The mixed-effects regression analysis revealed a significant association between Mini-Cog positivity and lower SC levels (p = 0.0006), although SC levels did not significantly correlate with MD (p = 0.3). Our findings suggest that cognitive impairment in glaucoma patients is associated with lower SC levels, underscoring the potential benefits of maintaining carotenoid levels to slow cognitive function decline. The protective role of carotenoids in glaucoma merits further investigation. Full article

The Veggie Meter^® (Longevity Link Corporation, Salt Lake City, UT, USA), is a new portable device for the non-invasive and rapid detection of skin carotenoid content, which represents an acceptable biomarker for the evaluation of fruit and vegetable (FV) intake. FVs are important components of a healthy diet, including the Mediterranean Diet (MD), which is a plant-based dietary pattern. Here, we evaluated the adherence to the MD via the administration of two online food questionnaires, and we measured the skin carotenoid content using the Veggie Meter^® in a cohort of 498 healthy adolescents (233 males and 265 females) from Southern Italy. Using KIDMED and the MD Pyramid tests to assess the adherence to the MD, we found an average adherence (5.43 ± 2.57 and 7.20 ± 1.93, respectively) to the MD in our sample population. Moreover, we observed that the skin carotenoid score was 364.75 ± 98.29, which was within the normal range and inversely related to the BMI (r = −0.1461, p = 0.0011). Similar results were observed when the population was categorized by sex. Interestingly, we demonstrated, for the first time, a positive correlation between the carotenoid score and the adherence to the MD assessed using both the KIDMED and MD Pyramid tests in the total population (r = −0.2926, p < 0.0001 and r = −0.1882, p < 0.0001, respectively). The same direct correlation was found in adolescents according to their sex. Our findings highlight the potential of the Veggie Meter^® as a feasible and promising tool for evaluating adherence to the MD and, ultimately, to promote healthy eating habits among adolescents. Full article

Assessing children’s skin carotenoid score (SCS) using reflection spectroscopy (RS) is a non-invasive, widely used method to approximate fruit and vegetable consumption (FVC). The aims for the current review were to (1) identify distributions of SCS across demographic groups, (2) identify potential non-dietary correlates for RS-based SCS, (3) summarize the validity and reliability of RS-based SCS assessment, and (4) conduct meta-analyses of studies examining the correlation between RS-based SCS with FVC. A literature search in eight databases in June 2021 resulted in 4880 citations and peer-reviewed publications written in English that investigated children’s (2–10 years old) SCS using RS. We included 11 studies (intervention = 3, observational = 8). Potential covariates included weight status, ethnicity, seasonal variation, age, sex, and income. Studies reported criterion validity with children’s FVC but not with plasma carotenoid. Additionally, no studies reported the reliability of RS-based SCS in children. Among the 726 children included in the meta-analysis, the correlation between RS-based SCS and FVC was r = 0.2 (p < 0.0001). RS-based SCS is a valid method to quantify skin carotenoids for children’s FVC estimation with the potential for evaluating nutrition policies and interventions. However, future research should use standardized protocol for using RS and establish how RS-based SCS can translate to the amount of daily FVC in children. Full article