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The Academy for Nutrition and Dietetics' (AND's) Child Nutrition Reauthorization working group new statement provides an overview of their position regarding the increasing prevalence of unpaid meal debt and associated lunch shaming within our nation's schools. Healthy school meals are as important to learning as textbooks and pencils. Every day, children face the ramifications of shaming children with unpaid school meal debt. The Academy advocates addressing unpaid school meal debt, by expanding and strengthening universal school meal policies and programs with the Community Eligibility Provision.


Participation in the National School Lunch Program has declined over the last few years. The biggest decline was in the paid category, whereas that in the free category increased. The shift in participation away from the paid toward the free category probably reflects the greater number of students qualifying for free and reduced-price meals and the use and expansion of Community Eligibility Provision. Community Eligibility Provision is a nonpricing meal service option for schools and school districts in low-income areas. Community Eligibility Provision allows the nation's highest poverty schools and districts to serve breakfast and lunch at no cost to all enrolled students without collecting household applications. Instead, schools that adopt Community Eligibility Provision are reimbursed using a formula based on the percentage of students categorically eligible for free meals based on their participation in other specific means-tested programs, such as SNAP (Supplemental Nutrition Assistance Program) and TANF (Temporary Assistance for Needy Families). Another reason for the decline in participation in the paid category is increasing school meal prices. A recent US Department of Agriculture's School Nutrition and Meal Cost Study reported a 10-cent increase in the price of a paid lunch was associated with a decline of 0.7% in the rate of paid meal National School Lunch Program participation.


Students with unpaid meal debt may be so embarrassed that they go hungry. The process of calling attention to them is called lunch shaming, Today, there is no federal mandate on what must be included in district unpaid school meal fee policies; school meal debt continues to grow. The AND supports developing a federal data strategy to get a more accurate annual estimate of unpaid meal debt and a better understanding of the sources of unpaid meal debt across diverse school settings. The Academy's child nutrition reauthorization priorities include promoting direct certification systems and the CEP addressing both unpaid meal debt and lunch shaming. The AND is concerned that many local solutions are temporary and not sustainable and not always an option for communities with limited resources and that a national solution is needed. The AND views that access to enough food for an active, healthy life is a basic human need and a fundamental right. The AND is also tackling feeding low-income children during this COVID-19 pandemic and sees the recognize need for innovative federal nutrition assistance approaches.


Source: Fleischhacker S, Campbell E. Ensuring equitable access to school meals. J Acad Nutr Diet 2020;120(5):893-897.



Different combinations of lifestyle factors may have different effects on the years someone lives without chronic diseases, says a recent study of more than 100 000 in 12 European studies that analyzed lifestyle factors associated with the most disease-free years between the ages of 40 and 75 years. The mean follow-up period for those in the study was 12.5 years, and the chronic conditions monitored included cancer, coronary heart disease, stroke, diabetes, asthma, and chronic obstructive pulmonary disease. Four lifestyle profiles with different combinations of factors associated with staying healthier for longer were discovered. Interestingly, exactly how the factors were combined did not have an impact on the positive association. The first lifestyle factor associated with good health was having a body mass index of less than 25 kg/m2 regarded as a "normal" weight by the National Institutes of Health. In addition to having a body mass index of less than 25 kg/m2, people who remained disease-free for longer also had at least 2 of 3 of the following lifestyle factors in their profiles: never smoking, keeping physically active, and drinking alcohol only moderately.


Still, some other factors may also be beneficial. People with better healthy lifestyle scores were younger and more likely to be of higher socioeconomic status. The study did face some limitations, including the possibility that confounding factors may have skewed the results and variations in questionnaires between participating cohort studies.


Source: Nyberg ST, Singh-Manoux A, Pentti J, et al. Association of healthy lifestyle with years lived without major chronic diseases [published online April 06, 2020]. JAMA Intern Med doi:10.1001/jamainternmed.2020.061.



In an effort to help guide clinicians to provide optimal care to patients, the American Heart Association has released a new scientific statement that provides an overview of advances in care for patients with both coronary artery disease (CAD) and type 2 diabetes (T2D). With the need for more aggressive CAD treatment in patients with diabetes compared with those without, the document outlines medications, procedures, and lifestyle modifications to aid in the management of both diseases.


The document itself is broken down into different sections and subjects addressing issues in both medical management and strategies following revascularization. Highlights of the document include guidance on blood pressure management, lipid management, antiplatelet therapies, and lifestyle modifications and give a comprehensive overview and critical assessment of the management of these patients as of the end of 2019 as a consensus from a panel of 11 experts. The statement also stressed that "substantial portions of patients with T2DM and CAD, including those after an acute coronary syndrome, do not receive therapies with proven cardiovascular benefit, such as high-intensity statins, dual-antiplatelet therapy, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and glucose-lowering agents with proven cardiovascular benefits."


Another notable feature of the statement is the potential it assigns to bariatric surgery as a management tool with documented safety and efficacy for improving cardiovascular risk factors. However, the statement also notes that randomized trials "have thus far been inadequately powered to assess cardiovascular events and mortality, although observational studies have consistently shown cardiovascular risk reduction with such procedures." The statement continues that despite potential cardiovascular benefits "bariatric surgery remains underused among eligible patients" and said that surgery performed as roux-en-Y bypass or sleeve gastrectomy "may be another effective tool for cardiovascular risk reduction in the subset of patients with obesity," particularly patients with a body mass index of at least 35 kg/m2.


Other sections of the statement also recommend that clinicians


* target long-term dual-antiplatelet therapy to CAD and T2DM patients with additional high-risk markers such as prior myocardial infarction, younger age, and tobacco use;


* prescribe a low-dose oral anticoagulant along with an antiplatelet drug such as aspirin for secondary-prevention patients;


* promote a blood pressure target of less than 140/90 mm Hg for all CAD and T2DM patients and apply a goal of less than 130/80 mm Hg in higher-risk patients such as blacks, Asians, and those with cerebrovascular disease; and


* reassure patients that "despite a modest increase in blood sugar, the risk-benefit ratio is clearly in favor of administering statins to people with T2DM and CAD."



For more information, go to


Source: Arnold SV, Bhatt DL, Barsness GW, et al; on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health and Council on Clinical Cardiology. Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association. Circulation 2020;141(19):e779-e806. doi: 10.1161/CIR.0000000000000766.



The ability to measure the gut microbiome led to a surge in studies about its role in health and disease. There is no consensus on what defines a "healthy" gut microbiome. Future research must also consider individual responses of the microbiome to dietary influences. What we know for sure is that diet is a fueler and influencer of the microbiome's composition. In order to assess understanding of interactions between nutrition and the gut microbiome in healthy adults, a recent study looked at a total of 86 articles, which were independently screened for duplicates and relevance. There was a bidirectional relationship between nutrition and the gut microbiome. Research has focused on dietary fiber as fuel-feeding microbes, centering most on the benefits of fiber, such as on feeding the microbiota to produce short-chain fatty acids required by colonocytes. There were also articles on some fibers improving absorption and reducing intestinal transit time.


Protein promotes microbial protein metabolism, but the articles here focused more on potentially harmful by-products sometimes produced. Other articles discussed how the microbiota utilize and produce micronutrients.


Source: Frame LA, Costa E, Jackson SA. Current explorations of nutrition and the gut microbiome: a comprehensive evaluation of the review literature. Nutr Revi nuz106,