Anthony Crimarco, Ph.D., is a Postdoctoral Fellow in Cardiovascular Disease Prevention at the Stanford Prevention Research Center. His primary research interests include diet and lifestyle interventions. More specifically he focuses on the health benefits of plant-based diets, the impact of the built environment on diet and physical activity behaviors, and the use of mHealth and eHealth in lifestyle interventions.
Dr. Crimarco completed a Ph.D. in Health Promotion, Education, and Behavior from the Arnold School of Public Health at the University of South Carolina in 2019. He also completed M.S. degrees in Management at the University of Florida (2013) and Wellness Management at Ball State University (2012).
Ph.D., University of South Carolina, Health Promotion, Education, and Behavior (2019)
M.S., University of Florida, Management (2013)
M.S., Ball State University, Wellness Management (2012)
B.S., Stetson University, Integrative Health Sciences (2009)
Sustainable Diets for Cardiovascular Disease Prevention and Management.
Current atherosclerosis reports
2021; 23 (7): 31
PURPOSE OF REVIEW: Healthy dietary patterns are recommended for prevention of cardiovascular disease, which remains the leading cause of morbidity and mortality globally. In this review, we discuss dietary patterns that are not only optimal for CVD prevention and management but also sustainable in maximizing health, environmental, and economic benefits.RECENT FINDINGS: The growing literature on sustainable diets in the context of environmental sustainability includes subtopics of climate change, land use, biodiversity loss, freshwater use, and reactive nitrogen emissions. Similarly, economic sustainability, beyond the retail cost of food, extends to healthcare costs and the economic costs of environmental destruction related to current agricultural practices and food choices. Dietary patterns that are high in plant foods and low in animal foods could maximize health, environmental, and economic benefits; however, questions remain about how to best promote these patterns to achieve wider adoption in an environmentally and economically sustainable way.
View details for DOI 10.1007/s11883-021-00929-0
View details for PubMedID 33970349
Adherence to Ketogenic and Mediterranean Study Diets in a Crossover Trial: The Keto-Med Randomized Trial.
2021; 13 (3)
Adherence is a critical factor to consider when interpreting study results from randomized clinical trials (RCTs) comparing one diet to another, but it is frequently not reported by researchers. The purpose of this secondary analysis of the Keto-Med randomized trial was to provide a detailed examination and comparison of the adherence to the two study diets (Well Formulated Ketogenic Diet (WFKD) and Mediterranean Plus (Med-Plus)) under the two conditions: all food being provided (delivered) and all food being obtained by individual participants (self-provided). Diet was assessed at six time points including baseline (×1), week 4 of each phase when participants were receiving food deliveries (×2), week 12 of each phase when participants were preparing and providing food on their own (×2), and 12 weeks after participants completed both diet phases and were free to choose their own diet pattern (×1). The adherence scores for WFKD and Med-Plus were developed specifically for this study. Average adherence to the two diet patterns was very similar during both on-study time points of the intervention. Throughout the study, a wide range of adherence was observed among participants-for both diet types and during both the delivery phase and self-provided phase. Insight from this assessment of adherence may aid other researchers when answering the important question of how to improve behavioral adherence during dietary trials. This study is registered at clinicaltrials.gov NCT03810378.
View details for DOI 10.3390/nu13030967
View details for PubMedID 33802709
- Nutrition Study Design Issues-Important Issues for Interpretation. American journal of health promotion : AJHP 2020; 34 (8): 951–54
Nutrition Study Design Issues-Important Issues for Interpretation
AMERICAN JOURNAL OF HEALTH PROMOTION
2020; 34 (8): 951–54
View details for Web of Science ID 000580601900018
Outcomes of a short term dietary intervention involving vegan soul food restaurants on African American adults’ perceived barriers, benefits, and dietary acceptability of adopting a plant-based diet
Food Quality and Preference
View details for DOI 10.1016/j.foodqual.2019.103788
“They Eat What They Eat, I Eat What I Eat”: Examining the Perspectives and Experiences of African Americans Who Adopt Plant-Based Diets
American Journal of Lifestyle Medicine
View details for DOI 10.1177/1559827620908850
A randomized crossover trial on the effect of plant-based compared with animal-based meat on trimethylamine-N-oxide and cardiovascular disease risk factors in generally healthy adults: Study With Appetizing Plantfood-Meat Eating Alternative Trial (SWAP-MEAT).
The American journal of clinical nutrition
Despite the rising popularity of plant-based alternative meats, there is limited evidence of the health effects of these products.We aimed to compare the effect of consuming plant-based alternative meat (Plant) as opposed to animal meat (Animal) on health factors. The primary outcome was fasting serum trimethylamine-N-oxide (TMAO). Secondary outcomes included fasting insulin-like growth factor 1, lipids, glucose, insulin, blood pressure, and weight.SWAP-MEAT (The Study With Appetizing Plantfood-Meat Eating Alternatives Trial) was a single-site, randomized crossover trial with no washout period. Participants received Plant and Animal products, dietary counseling, lab assessments, microbiome assessments (16S), and anthropometric measurements. Participants were instructed to consume ≥2 servings/d of Plant compared with Animal for 8 wk each, while keeping all other foods and beverages as similar as possible between the 2 phases.The 36 participants who provided complete data for both crossover phases included 67% women, were 69% Caucasian, had a mean ± SD age 50 ± 14 y, and BMI 28 ± 5 kg/m2. Mean ± SD servings per day were not different by intervention sequence: 2.5 ± 0.6 compared with 2.6 ± 0.7 for Plant and Animal, respectively (P = 0.76). Mean ± SEM TMAO concentrations were significantly lower overall for Plant (2.7 ± 0.3) than for Animal (4.7 ± 0.9) (P = 0.012), but a significant order effect was observed (P = 0.023). TMAO concentrations were significantly lower for Plant among the n = 18 who received Plant second (2.9 ± 0.4 compared with 6.4 ± 1.5, Plant compared with Animal, P = 0.007), but not for the n = 18 who received Plant first (2.5 ± 0.4 compared with 3.0 ± 0.6, Plant compared with Animal, P = 0.23). Exploratory analyses of the microbiome failed to reveal possible responder compared with nonresponder factors. Mean ± SEM LDL-cholesterol concentrations (109.9 ± 4.5 compared with 120.7 ± 4.5 mg/dL, P = 0.002) and weight (78.7 ± 3.0 compared with 79.6 ± 3.0 kg, P < 0.001) were lower during the Plant phase.Among generally healthy adults, contrasting Plant with Animal intake, while keeping all other dietary components similar, the Plant products improved several cardiovascular disease risk factors, including TMAO; there were no adverse effects on risk factors from the Plant products.This trial was registered at clinicaltrials.gov as NCT03718988.
View details for DOI 10.1093/ajcn/nqaa203
View details for PubMedID 32780794
Examining demographic characteristics and food access indicators from the location of vegan soul food restaurants in the south.
Ethnicity & health
Objective: There have been a number of soul food restaurants serving exclusively vegan meals opening up across the country to appeal to African Americans and others interested in eating healthier soul foods. This study determined the number of restaurants serving vegan soul foods in the South and identified the locations of these restaurants in order to understand the characteristics of the surrounding communities that they serve. Design: Two reviewers identified restaurants using standardized search criteria for menu items in the 16 states (and the District of Columbia) that are categorized as being in the South from the Census Bureau. Mean percentage of African Americans, poverty rates, and obesity rates by county where restaurants were located were collected via census data. Restaurants were classified as being in or out of a food desert zone using the United States Department of Agriculture's (USDA) food atlas map (0.5- and 1.0-mile radius). T-tests were conducted to test for differences in the census data between the restaurants that were considered to be in and out of a food desert zone. Results: Overall, 45 restaurants met the inclusion criteria. Counties where restaurants were located had a mean African American population of 36.5±18.5%, mean poverty rate of 15.5±3.85% and mean obesity rate of 26.8±4.8%. More than one third (n=18, 40.0%) of the restaurants were considered to be in a food desert zone. There were no significant differences in the mean population, obesity, and poverty rates between restaurants classified in a food desert zone and restaurants not located in a food desert zone. Conclusion: A significant number of restaurants were classified in food desert zones, implying their potential to provide healthier meals by serving vegan soul foods to residents in the surrounding neighborhoods. Future work should assess how these restaurants might influence healthier eating habits in their communities.
View details for DOI 10.1080/13557858.2019.1682525
View details for PubMedID 31635482
The effects of meal-timing on self-rated hunger and dietary inflammatory potential among a sample of college students
JOURNAL OF AMERICAN COLLEGE HEALTH
2019; 67 (4): 328–37
College is an important time for young adults to establish healthy eating habits since students are at risk for gaining weight during the college years. An emerging area of research is examining the effect of meal-timing, which involves the timing of food intake throughout the day, in an effort to improve satiety and bodyweight. The purpose of this study was to examine the use of meal-timing among a sample of college students and to assess what aspects from an intervention could help them to adhere to meal-timing long term. Participants were randomly assigned to either a daytime group (≤30% total kcals after 5 pm) or a nighttime group (≥50% total kcals after 5 pm). After completing the intervention, almost half of participants (49%) reported they could adhere to meal-timing long-term. Having more resources that support meal-timing are needed to help students potentially achieve a healthy weight and prevent chronic diseases.
View details for DOI 10.1080/07448481.2018.1481074
View details for Web of Science ID 000469245200003
View details for PubMedID 29979952
Impact of a 12-month Inflammation Management Intervention on the Dietary Inflammatory Index, inflammation, and lipids
CLINICAL NUTRITION ESPEN
2019; 30: 42–51
The objective of this study was to assess the feasibility (ability to recruit participants and develop the 12-month intervention), acceptability (retention of participants in the intervention), and impact on systemic inflammation and Dietary Inflammatory Index (DII®) scores over a 12-month DII-based intervention.Adults were recruited to participate in a self-selection trial (intervention: n = 61, in-person classes; control: n = 34, newsletters). Classes included participatory cooking and dietary recommendations focused on consuming a plant-based diet rich in anti-inflammatory foods (spices, vegetables, etc.). Changes in markers of inflammation, lipids, and DII were analyzed using general linear models with repeated measurements.At 3 months, intervention participants had significantly lower DII scores (-2.66 ± 2.44) compared to controls (-0.38 ± 2.56) (p < 0.01); but not at 12 months (P = 0.10). The only biomarker to approach a significant group effect or group-by-time interaction was CRP (P = 0.11 for the group-by-time interaction). CRP decreased by -0.65 mg/L (95%CI = 0.10-1.20, P = 0.02) at 12 months in the intervention group; no significant decrease was seen for the control group. With both groups combined at 3 months, those with the greatest decrease/improvement in DII score (tertile 1) compared with those whose scores increased (tertile 3) had greater reductions in CRP (-1.09 vs. +0.52 mg/L, P = 0.04), total cholesterol (-9.38 vs. +12.02 mg/dL, P = 0.01), and LDL cholesterol (-11.99 vs. +7.16 mg/dL, P = 0.01).Although the intervention group had reductions in DII and CRP, main inflammation and lipid outcomes did not differ between groups. Overall, those participants with the largest reduction in DII scores had the largest reductions in CRP and LDL and total cholesterol. Future interventions may need to have more components in place to support maintenance and continued reductions in the DII. CLINICALTRIALS.NCT02382458.
View details for DOI 10.1016/j.clnesp.2019.02.008
View details for Web of Science ID 000461813500006
View details for PubMedID 30904228
View details for PubMedCentralID PMC6435295
“We’re Not Meat Shamers. We’re Plant Pushers.”: How Owners of Local Vegan Soul Food Restaurants Promote Healthy Eating in the African American Community
Journal of Black Studies
View details for DOI 10.1177/0021934719895575
Using Commercial Physical Activity Trackers for Health Promotion Research: Four Case Studies.
Health promotion practice
2019; 20 (3): 381–89
Wearable physical activity (PA) trackers are becoming increasingly popular for intervention and assessment in health promotion research and practice. The purpose of this article is to present lessons learned from four studies that used commercial PA tracking devices for PA intervention or assessment, present issues encountered with their use, and provide guidelines for determining which tools to use.Four case studies are presented that used PA tracking devices (iBitz, Zamzee, FitBit Flex and Zip, Omron Digital Pedometer, Sensewear Armband, and MisFit Flash) in the field-two used the tools for intervention and two used the tools as assessment methods.The four studies presented had varying levels of success with using PA devices and experienced several issues that impacted their studies, such as companies that went out of business, missing data, and lost devices. Percentage ranges for devices that were lost were 0% to 29% and was 0% to 87% for those devices that malfunctioned or lost data.There is a need for low-cost, easy-to-use, accurate PA tracking devices to use as both intervention and assessment tools in health promotion research related to PA.
View details for DOI 10.1177/1524839918769559
View details for PubMedID 29618233
Baseline markers of inflammation, lipids, glucose, and Dietary Inflammatory Index scores do not differ between adults willing to participate in an intensive inflammation reduction intervention and those who do not.
Nutrition and health
2019; 25 (1): 9–19
Chronic inflammation is associated with numerous chronic diseases and can be managed with diet.The purpose of this study was to examine differences in baseline characteristics and plasma inflammation levels between two groups of participants that participated in an intensive, lifestyle intervention or a remotely delivered intervention. This work also assessed the association between Dietary Inflammatory Index (DII)® scores and participants' inflammatory and metabolic biomarkers at baseline.Ninety-five participants (61 intervention, 34 control) chose to enroll in either a 12-month intervention consisting of a face-to-face nutrition, physical activity, and stress management intervention or a remotely-delivered intervention (control group) focusing on general cancer prevention. The intervention group met at the University of South Carolina for classes and the control group had materials emailed to them. A quantile regression was used to compare participants' high-sensitivity C-reactive protein and interleukin-6 levels. Multiple linear regression was used to determine the association between DII scores and biomarkers.There were significant differences in age, body mass index, body fat percentage, and blood pressure between groups, but there were no differences in levels of inflammatory biomarkers. Values of interleukin-6 at the 90th percentile of its distribution were 8.31 pg/ml higher among those in DII quartile 4 compared with quartile 1 ( p = 0.02). All other outcomes were not significant.Given similar levels of inflammatory biomarkers, participants opting for the control group would also have benefited from a more intensive lifestyle intervention focusing on reducing inflammation.
View details for DOI 10.1177/0260106018800645
View details for PubMedID 30229691
The Nutritious Eating with Soul (NEW Soul) Study: Study design and methods of a two-year randomized trial comparing culturally adapted soul food vegan vs. omnivorous diets among African American adults at risk for heart disease
Contemporary Clinical Trials
View details for DOI 10.1016/j.cct.2019.105897
Use of Mobile Wearable Devices to Compare Eating, Physical Activity, and Sleep Between Individuals Following Vegetarian and Omnivorous Diets
Journal of Technology in Behavioral Science
2018; 3 (4): 259-267
View details for DOI 10.1007/s41347-018-0060-8
- Mobilizing mHealth for Moms: a Review of Mobile Apps for Tracking Gestational Weight Gain Journal of Technology in Behavioral Science 2018; 3 (1): 32-40
Determinants of Attendance at a Physical Activity Focused Afterschool Program in Elementary School Children.
International journal of exercise science
2018; 11 (5): 137–51
Afterschool youth physical activity (PA) programs provide opportunities for increasing children's time engaged in moderate-to-vigorous physical activity (MVPA). However, low program attendance reduces the benefits of participating in these programs. The purpose of this study was to determine if enjoyment, athletic competence and motivation for PA predict youth attendance at a free afterschool PA program from 3rd to 5th grade. Data were collected from a larger randomized community trial examining the effectiveness of an afterschool program for increasing opportunities to engage in MVPA. Data were collected twice annually (fall/spring) over 3 school years (3rd - 5th grade) in 9 schools. Analyses were stratified by grade and sex, and a series of multi-level linear regression models were utilized to determine if baseline levels of the psychosocial determinants predicted annual attendance as a percentage of afterschool sessions attended. Amotivation for PA was negatively associated with attendance in boys and non-self-determined extrinsic motivation was positively associated with attendance in girls in the 5th grade. Age was associated with a 13.72% reduction in attendance in the 3rd grade, a 12.87% attendance reduction in the 4th grade, and a 7.93% attendance in reduction in the 5th grade. Race was also associated with attendance. Non-White youth attended the program 13.56% less in the 3rd grade, 17.35% less in the 4th grade, and 21.53% less in the 5th grade than White youth. The findings suggest that attendance to PA afterschool programming may be associated with children's motivational characteristics, but that other variables should be identified for further research.
View details for PubMedID 29795736
View details for PubMedCentralID PMC5955309
- Partnerships for active elementary schools: Physical education outcomes after 4 months of a 2-year pilot study HEALTH EDUCATION JOURNAL 2017; 76 (7): 763–74
Byte by Bite: Use of a mobile Bite Counter and weekly behavioral challenges to promote weight loss.
Smart health (Amsterdam, Netherlands)
2017; 3-4: 20–26
The goal of this study was to examine the usability and feasibility of the mobile Bite Counter (a watch-like device that detects when a user consumes food or beverage) and the impact of weekly behavioral challenges on diet and physical activity outcomes. Overweight (mean BMI 31.1±4.9 kg/m2) adults (n=12) were recruited to participate in a four-week study to test both the usability and feasibility of using the device as part of a behavioral weight loss intervention. Participants were instructed to self-monitor number of bites/day using the Bite Counter, attend weekly group sessions, and listen to weekly podcasts. Participants were given weekly challenges: use a daily bite limit goal (wk1), turn off Bite Counter when fruits/vegetables are consumed (wk2), self-monitor kilocalories vs. bites (wk3), and receive a 10 bites/day bonus for every 30 minutes of exercise (wk4). Participants lost a mean of -1.2±1.3 kg. Only the wk3 challenge produced significant differences in kcal change (wk3 1302±120 kcal/day vs. baseline 2042±302 kcal/d, P<0.05). Bite Counter use was significantly correlated with weight loss (r= -0.58, P<0.05). Future studies should examine the use of the Bite Counter and impact of behavioral challenges over a longer period of time in a controlled study.
View details for DOI 10.1016/j.smhl.2017.03.004
View details for PubMedID 29104905
View details for PubMedCentralID PMC5663239
A plant-based diet for overweight and obesity prevention and treatment.
Journal of geriatric cardiology : JGC
2017; 14 (5): 369–74
The goal of this paper is to review the evidence related to the effect of plant-based dietary patterns on obesity and weight loss, including both observational and intervention trials. Literature from plant-based diets (PBDs) epidemiological and clinical trial research was used to inform this review. In addition, data on dietary quality, adherence, and acceptability were evaluated and are presented. Both clinical trials and observational research indicate an advantage to adoption of PBDs for preventing overweight and obesity and promoting weight loss. PBDs may also confer higher levels of diet quality than are observed with other therapeutic diet approaches, with similar levels of adherence and acceptability. Future studies should utilize health behavior theory to inform intervention development and delivery of PBDs studies and new technologies to bring interventions to scale for greater public health impact. Research examining PBDs and weight loss is also needed with more diverse populations, including older adults. Based on the available evidence, PBDs should be considered a viable option for the treatment and prevention of overweight and obesity.
View details for DOI 10.11909/j.issn.1671-5411.2017.05.002
View details for PubMedID 28630616
View details for PubMedCentralID PMC5466943
Accelerometry-Derived Physical Activity of First Through Third Grade Children During the Segmented School Day.
The Journal of school health
2016; 86 (10): 726–33
Schools should provide children 30 minutes/day of moderate-to-vigorous-physical-activity (MVPA). Determining school day segments that contribute to children's MVPA can inform school-based activity promotion. The purpose of this paper was to identify the proportion of children accumulating 30 minutes/day of school-based MVPA, and to identify school day segments' contribution to children's MVPA.First-third graders (N = 323 [173 girls and 150 boys]) accelerometer-derived sedentary behaviors, light activity, and MVPA were measured for 1 to 5 school days. Children's activity was estimated during class time, lunch, physical education (PE), and recess. To explore disparities in MVPA, children were stratified into high/low-active groups.Girls and boys accumulated 30.4 and 34.4 minutes/day of MVPA on PE days and 23.5 and 27.3 minutes/day of MVPA on non-PE days. This translated to 36.5 and 44.1% of girls and boys accumulating 30 minutes of MVPA on PE days and 16.3 and 36.5% on non-PE days. On PE days, PE contributed the most MVPA for girls and boys (11.8 and 13.0 minutes/day), followed by class time (11.4 and 12.5 minutes/day), recess (5.2 and 6.5 minutes/day), and lunch (2.0 and 2.4 minutes/day). Disparities between high/low children were greatest during PE and class time.Most children were not accumulating 30 minutes/day of MVPA. PE and class time are promising school day segments for promoting MVPA.
View details for DOI 10.1111/josh.12426
View details for PubMedID 27619763
The Fast-Casual Conundrum: Fast-Casual Restaurant Entrées Are Higher in Calories than Fast Food.
Journal of the Academy of Nutrition and Dietetics
2016; 116 (10): 1606–12
Frequently eating fast food has been associated with consuming a diet high in calories, and there is a public perception that fast-casual restaurants (eg, Chipotle) are healthier than traditional fast food (eg, McDonald's). However, research has not examined whether fast-food entrées and fast-casual entrées differ in calorie content.The purpose of this study was to determine whether the caloric content of entrées at fast-food restaurants differed from that found at fast-casual restaurants.This study was a cross-sectional analysis of secondary data. Calorie information from 2014 for lunch and dinner entrées for fast-food and fast-casual restaurants was downloaded from the MenuStat database.Mean calories per entrée between fast-food restaurants and fast-casual restaurants and the proportion of restaurant entrées that fell into different calorie ranges were assessed.A t test was conducted to test the hypothesis that there was no difference between the average calories per entrée at fast-food and fast-casual restaurants. To examine the difference in distribution of entrées in different calorie ranges between fast-food and fast-casual restaurants, χ(2) tests were used.There were 34 fast-food and 28 fast-casual restaurants included in the analysis (n=3,193 entrées). Fast-casual entrées had significantly more calories per entrée (760±301 kcal) than fast-food entrées (561±268; P<0.0001). A greater proportion of fast-casual entrées compared with fast-food entrées exceeded the median of 640 kcal per entrée (P<0.0001).Although fast-casual entrées contained more calories than fast-food entrées in the study sample, future studies should compare actual purchasing patterns from these restaurants to determine whether the energy content or nutrient density of full meals (ie, entrées with sides and drinks) differs between fast-casual restaurants and fast-food restaurants. Calorie-conscious consumers should consider the calorie content of entrée items before purchase, regardless of restaurant type.
View details for DOI 10.1016/j.jand.2016.03.020
View details for PubMedID 27179672