Consumption of Dietary Guidelines for Americans Types and Amounts of Vegetables Increases Mean Subjective Happiness Scale Scores: A Randomized Controlled Trial

BackgroundThe health benefits of diets rich in fruits and vegetables (FV) are well established. Recent observational and intervention research suggests that FV consumption may also exert a positive effect on psychological well-being.ObjectiveThis study aimed to assess changes in mean Subjective Happiness Scale (SHS) scores in response to consuming 2010-2015 Dietary Guidelines for Americans (DGA) recommended types and amounts of vegetables. It was hypothesized that increased vegetable consumption would increase mean SHS scores.DesignThis study investigated a secondary outcome of a randomized, parallel, nonblinded controlled trial with a 1:1 allocation ratio to a provided vegetable intervention or attention control group.Participants/settingMen and women (n = 75) aged 18 to 65 years, body mass index ≥ 25, with low habitual vegetable consumption were recruited from Grand Forks, North Dakota, December 2016 to January 2018, for this community-based study.InterventionThe vegetable intervention consisted of an 8-week feeding phase during which participants were provided with vegetables in DGA-recommended types and amounts. The attention control group was not provided vegetables but completed the same testing schedule as the vegetable intervention group.Main outcome measureMean SHS scores were assessed before and after the intervention.Statistical analysesMean SHS scores were analyzed using a 2-way factorial mixed linear model analysis of variance.ResultsA significant interaction between treatment and visit (P = .015) revealed greater mean SHS scores at week 8 than at baseline in the vegetable intervention group (+0.23 ± 0.11) (mean difference ± SE of the difference) but no change in the attention control group (?0.15 ± 0.11).ConclusionsGreater mean SHS scores were observed after increasing vegetable consumption to meet DGA recommendations, suggesting that adhering to DGA vegetable guidance may help promote psychological well-being.     

Relationships Among the Physical and Social Home Food Environments,Dietary Intake,and Diet Quality in Mothers and Children

BackgroundBoth the physical and social home food environment (HFE) are believed to influence dietary intake and diet quality, but few studies have examined both aspects together.ObjectiveThe purpose of this study was to examine the relationships among the physical and social HFE, dietary intake, and diet quality in mothers and children.DesignThis was a cross-sectional substudy of a larger study.Participants/settingThe study included 24 mothers (aged ≥30 years) with a biological child aged 6 to 12 years living in the Newark, DE, area between June and November 2018.Main outcome measuresThe outcome measures of interest included the physical HFE (ie, home food availability); aspects of the social HFE (ie, parenting styles, family meal frequency, and policies); maternal and child intake of fruits, vegetables, sugar-sweetened beverages, and snacks; and diet quality using the 2015 Healthy Eating Index total score.Statistical analysisPearson correlations were used to examine the relationship between physical HFE and dietary intake as well as social HFE and dietary intake in both mothers and children. The relationships were further examined through exploratory regression analyses.ResultsIn mothers, fruit availability in the physical HFE was correlated with fruit intake (r = 0.50; P = 0.02). Fruit and vegetable availability in the physical HFE were correlated with 2015 Healthy Eating Index total score in both the mother and child. Family meals participation was correlated with dietary intake (vegetable intake in children, r = 0.44; P = 0.04; and snack intake in mothers, r = –0.74; P < .001). Exploratory regression analysis showed vegetables in the HFE was associated with vegetable intake and 2015 Healthy Eating Index total score in mothers, and fruits and vegetables in the HFE were associated with child 2015 Healthy Eating Index total score. Family meals participation was negatively associated with maternal snack intake and child sugar-sweetened beverages intake. Authoritative parenting was negatively associated with child snack intake and permissive parenting was negatively associated with mother’s fruit intake.ConclusionsBoth the physical and social HFE are associated with maternal and child dietary intake, but only the physical HFE was associated with dietary quality. Although preliminary, these data indicate the importance of future studies that include measures to assess both the physical and social HFE to better elucidate the influences of the HFE on dietary intake.     

The Contribution of Discrete Vegetables,Mixed Dishes,and Other Foods to Total Vegetable Consumption: US Ages 2 Years and Over, 2017-2018

BackgroundThe 2020-2025 Dietary Guidelines for Americans recommend intake of a variety of vegetables, including dark green, red, and orange vegetables and starchy and other vegetables.ObjectivesThis study aims to describe sociodemographic differences in the contribution of different categories of vegetables and the form in which they are consumed (ie, discrete vegetables, mixed dishes, and other foods such as savory snacks to total vegetable intake on a given day).DesignThis is a cross-sectional, secondary analysis of the 2017-2018 National Health and Nutrition Examination Survey.Participants/settingThis study included the data of 7122 persons aged 2 years with reliable day 1 24-hour dietary recalls.Main outcome measuresServing equivalents of vegetables from 20 discrete categories of vegetables and from mixed dishes and other foods as a percentage of total vegetables.Statistical analysesPairwise differences by age, sex, race, Hispanic origin, and family income were examined using univariate t statistics, and trends by age and income were examined using orthogonal polynomials.ResultsMean serving equivalents of vegetables was 1.4 cups. The serving equivalents increased with age among youth, was higher among non-Hispanic Asian (NHA) persons than other subgroups, and increased with increasing family income. Overall, discrete vegetables contributed 55.2% of total vegetable intake, and the contribution increased with age in adults and with increasing family income. The top 5 discrete vegetable contributors were other vegetables and combinations, french fries and other fried white potatoes, lettuce and lettuce salads, mashed potatoes and white potato mixtures, and baked or boiled white potatoes. Nonstarchy discrete vegetables contributed more to total vegetables for adults (37.6%) than youth (28.0%), and the contribution increased with increasing family income. On the other hand, the contribution of mixed dishes and other foods decreased with increasing family income.ConclusionsDiscrete vegetables only contributed 55.2% of total vegetable intake, and the top sources were not varied. Three of them potato based, which may explain the reported low vegetable intake, relative to the 2020-2025 Dietary Guidelines for Americans. More than one-third of vegetables consumed were nonstarchy discrete vegetables, many of which are high in vitamins. Nonstarchy discrete vegetable intake was higher in adults than youth and increased with family income.     

Dietary Supplement Intake and Factors Associated with Increased Use in Preadolescent Endurance Runners

BackgroundThe prevalence of dietary supplement intake among preadolescent endurance runners is currently unknown.ObjectiveOur aim was to describe use of dietary supplements, higher-risk supplements, and sport foods among preadolescent endurance athletes and identify associated characteristics of dietary supplement users in this population.DesignThis was a retrospective, cross-sectional study.Participants/settingParticipants were 2,113 preadolescent endurance runners (male: n = 1,255, female: n = 858; mean age ± standard deviation = 13.2 ± 0.9 years).Main outcome measuresUse of dietary supplements, higher-risk dietary supplements, and sport foods on 2 or more days per week during the past year.Statistical analyses performedMann-Whitney U tests, χ² tests, univariate and multivariate analyses.ResultsTwenty-six percent (n = 551) of preadolescent runners used dietary supplements on 2 or more days per week during the past year; 1.3% (n = 27) reported taking higher-risk supplements. Compared with male runners, female runners reported higher use of 1 or more supplements (32.5% vs 21.7%; P < .001) and 4 or more supplements (4.0% vs 1.9%; P = 0.005), multivitamin/minerals (24.2% vs 14.4%; P < .001), vitamin D (12.4% vs 5.6%; P < .001), calcium (8.9% vs 4.8%; P < .001), iron (3.1 vs 1.1%; P < .001), probiotic supplements (8.2% vs 1.3%; P < .001), and diet pills (0.5% vs 0.0%; P = .02). Male runners reported higher use of creatine (1.3% vs 0.0%; P < .001) and sport foods, including protein bars and drinks (19.5% vs 8.4%; P < .001), energy bars (23.5% vs 9.7%; P < .001), and carbohydrate-electrolyte drinks (27.9% vs 13.3%; P < .001) than female runners. Factors independently associated with a higher likelihood for dietary supplement use included weight loss in the past year, female (vs male) gender, following a vegetarian diet, skipping meals, attempting to gain weight, and history of a running-related bone stress injury.ConclusionsMore than one-quarter of preadolescent runners regularly consumed dietary supplements. Behaviors consistent with dietary restriction and history of bone stress injury were associated with higher likelihood for supplement use. Further work to understand supplement use patterns and potential value for nutrition education is advised to optimize health of preadolescent runners.     

Contributions of Early Care and Education Programs to Diet Quality in Children Aged 3 to 4 Years in Central North Carolina

BackgroundParents and early care and education (ECE) are the key influencers of young children’s diets, but there is limited information about how each contribute to children’s overall diet quality.ObjectiveThis study aimed to determine what proportion of children’s dietary intake occurs within the ECE setting and whether diet quality is higher at ECE centers and, consequently, on weekdays than weekends.DesignThis cross-sectional analysis of a larger cluster randomized controlled trial used multiple 24-hour dietary intakes measured through a combination of the Dietary Observation in Child Care protocol and parent-reported food diaries.Participants/settingParticipants (N=840) included children aged 3 to 4 years enrolled in ECE centers in central North Carolina for whom 24-hour dietary intake was captured via observation of meals and snacks consumed at ECE and parent-report of all remaining meals and snacks. Data were collected from 2015 to 2016.Main outcome measuresDiet quality at ECE and elsewhere was evaluated using the Healthy Eating Index 2015.Statistical analyses performedMixed-effects models were used to determine differences in mean Healthy Eating Index 2015 component and total scores. Models were adjusted for children’s age and sex and accounted for clustering within ECE centers and families.ResultsChildren consumed approximately 40% of daily energy, nutrients, and food groups at ECE centers. The mean total Healthy Eating Index 2015 score was higher for foods and beverages consumed at ECE centers (58.3±0.6) than elsewhere (52.5±0.6) (P<0.0001). The mean total Healthy Eating Index 2015 score was also higher on weekdays (58.5±0.5) than on weekends (51.3±0.5) (P<0.0001).ConclusionsChildren consume a majority of dietary intake away from ECE centers. Overall, diet quality is low, but the quality of foods consumed by children at ECE centers is higher than that consumed elsewhere. ECE centers remain an important source of nutrition and further investigation is warranted to identify ways to support both ECE centers and families to provide healthier eating environments.     

Longitudinal Diet Quality Trajectories Suggest Targets for Diet Improvement in Early Childhood

BackgroundThere is little information about how diet quality evolves in early childhood, whether children exhibit varying diet quality trajectories, or which components of diet quality should be targeted for intervention.ObjectiveThe goal of this study was to identify and evaluate trajectories of dietary quality in young children.DesignThis was a secondary analysis of an observational, longitudinal cohort study of non-Hispanic African American or White children and their parents from racially concordant households with 4 years of follow-up (up to 13 study visits). Data on mother, infant feeding, and body mass index were assessed at baseline. Diet was evaluated using 3-day diaries at each visit.Participants/settingOf 372 children enrolled, 349 children had at least 3 study visits with dietary data for this analysis. Participants were enrolled at age 3 years between March 2001 and August 2002 in Cincinnati, OH. Final study visits were conducted between February 2005 and June 2006.Main outcome measureThe main outcome measure was the total Healthy Eating Index 2005 (HEI-2005) score and HEI-2005 component scores.Statistical analysesDiet quality trajectories were modeled using group-based modeling techniques.ResultsThe total HEI-2005 score was low at age 3 years (mean ± standard error = 55.1 ± 0.4 of maximum 100 points) and remained stable to age 7 years (mean ± standard error = 54.0 ± 0.6; P = 0.08 for trend). Five HEI-2005 trajectory groups were identified, of which 1 declined and 1 improved over time. HEI-2005 component scores, except milk intake and meat/beans scores, differed significantly (all, P ≤ 0.02) among trajectory groups at age 3 years, and most differences were maintained at age 7 years. Total vegetables, dark green and orange vegetables and legumes, and whole grains component scores were low for all trajectory groups. Whole fruit; total fruit; saturated fat; and calories from solid fats, alcoholic beverages, and added sugars (SoFAAS) were highly variable among trajectory groups. Children in the lowest diet quality trajectory group were less likely to be breastfed and more likely to have been regular consumers of soft drinks (e.g., powdered drink mixes, sport drinks, or soda pop) before age 3 years.ConclusionsYoung childhood diet quality was low at age 3 years and remained stable to age 7 years. Improving intake of vegetables and whole grains is needed for all children. Focused attention regarding increasing fruit intake and reducing SoFAAS may be needed for families at increased risk for low overall diet quality.     

Subtypes and Severity of Irritable Bowel Syndrome Are Not Related to Patients’ Self-Reported Dietary Triggers: Results From an Online Survey in Dutch Adults

BackgroundDiet plays an important role in symptom management of irritable bowel syndrome (IBS). However, current diet therapies are not optimal nor successful for everyone.ObjectiveTo investigate whether subgroups based on IBS subtypes or severity identify different self-reported dietary triggers, and whether these are associated with severity and psychological factors.DesignOnline cross-sectional surveyParticipantsPatients with IBS (n = 1601) who fulfilled the Rome IV criteria or had an IBS diagnosis.Main outcomesSelf-reported response to 44 preselected dietary triggers, IBS quality of life, and anxiety and depression. Subgroups were based on subtypes or severity.Statistical analysisResponse to dietary triggers was analyzed using multiple correspondence analysis. Moreover, a food score was calculated to quantify the number and severity of responses to dietary triggers.ResultsResponse to greasy foods, onions, cabbage, and spicy and fried foods were mentioned most often (ranging between 55% and 65%). Response to dietary triggers differed between subtypes and severity groups, but absolute differences were small. Multiple correspondence analysis did not reveal clustering between dietary triggers, and ellipses for the subtypes overlapped. Some clustering was seen when ellipses were drawn for severity, which indicates that severity explained a fraction of the variation in response to dietary triggers, and subtypes did not. The food score was not significantly different between subtypes but was significantly higher with higher levels of severity (mild = 20.9 ± 17, moderate = 29.2 ± 19, severe = 37.9 ± 20, P < .001), having depressive (no = 31.4 ± 20, yes = 37.4 ± 20, P < .001) or anxious symptoms (no = 30.7 ± 20, yes = 35.2 ± 20, P < .001), and lower quality of life (lower quality of life = 38.5 ± 19, higher quality of life = 26.5 ± 19, P < .001).ConclusionPatients with different IBS subtypes or IBS severity do not identify different self-reported dietary triggers. Patients with more severe IBS and who experience anxiety or depression tend to have severe responses to more dietary triggers. IBS severity seems a better classifier than Rome IV criteria regarding diet. Dietary treatment needs to be individualized under guidance of a dietitian.     

Multiple Indicators of Poor Diet Quality in Children and Adolescents with Type 1 Diabetes Are Associated with Higher Body Mass Index Percentile but not Glycemic Control

BackgroundDiet is a cornerstone of type 1 diabetes treatment, and poor diet quality may affect glycemic control and other health outcomes. Yet diet quality in children and adolescents with type 1 diabetes remains understudied.ObjectiveTo evaluate multiple indicators of diet quality in children and adolescents with type 1 diabetes and their associations with hemoglobin A1c and body mass index percentile.DesignIn this cross-sectional study, participants completed 3-day diet records, and data were abstracted from participants' medical records. Diet quality indicators included servings of fruit, vegetables, and whole grains; Healthy Eating Index-2005 (HEI-2005) score; Nutrient Rich Foods 9.3 score (NRF 9.3); and glycemic index.Participants/settingChildren and adolescents with type 1 diabetes ≥1 year, aged 8 to 18 years, were recruited at routine clinic visits. Of 291 families enrolled, 252 provided diet data.Statistical analysesAssociations of diet quality indicators to HbA1c and body mass index percentile were examined using analysis of covariance and multiple linear regression.ResultsParticipants demonstrated low adherence to dietary guidelines; mean HEI-2005 score was 53.4±11.0 (range=26.7 to 81.2). Intake of fruit, vegetables, and whole grains was less than half the recommended amount. Almost half of the participants' daily energy intake was derived from refined-grain products, desserts, chips, and sweetened beverages. Higher fruit (P=0.04) and whole-grain (P=0.03) intake were associated with lower HbA1c in unadjusted, but not adjusted analyses; vegetable intake, HEI-2005 score, NRF 9.3 score, and glycemic index were not associated with HbA1c. Higher fruit (P=0.01) and whole-grain (P=0.04) intake and NRF 9.3 score (P=0.02), but not other diet quality indicators, were associated with lower body mass index percentile in adjusted analyses.ConclusionsData demonstrate poor diet quality in youth with type 1 diabetes and provide support for the importance of diet quality for weight management. Future research on determinants of dietary intake and methods to promote improved diet quality would be useful to inform clinical care.     

Changes in Food and Nutrient Intake and Diet Quality on a Low-Fat Vegan Diet Are Associated with Changes in Body Weight,Body Composition,and Insulin Sensitivity in Overweight Adults: A Randomized Clinical Trial

BackgroundConsuming different food groups and nutrients can have differential effects on body weight, body composition, and insulin sensitivity.ObjectiveThe aim was to identify how food group, nutrient intake, and diet quality change relative to usual-diet controls after 16 weeks on a low-fat vegan diet and what associations those changes have with changes in body weight, body composition, and measures of metabolic health.DesignSecondary analysis of a randomized clinical trial conducted between October 2016 and December 2018 in four replications.Participants/settingParticipants included in this analysis were 219 healthy, community-based adults in the Washington, DC, area, with a body mass index (BMI) between 28 and 40, who were randomly assigned to either follow a low-fat vegan diet or make no diet changes.InterventionA low-fat, vegan diet deriving approximately 10% of energy from fat, with weekly classes including dietary instruction, group discussion, and education on the health effects of plant-based nutrition. Control group participants continued their usual diets.Main outcome measuresChanges in food group intake, macronutrient and micronutrient intake, and dietary quality as measured by Alternate Healthy Eating Index-2010 (AHEI-2010), analyzed from 3-day diet records, and associations with changes in body weight, body composition, and insulin sensitivity were assessed.Statistical analyses performedA repeated-measure analysis of variance model that included the factors group, subject, and time was used to test the between-group differences throughout the 16-week study. Interaction between group and time was calculated for each variable. Within each diet group, paired comparison t tests were calculated to identify significant changes from baseline to 16 weeks. Spearman correlations were calculated for the relationship between changes in food group intake, nutrient intake, AHEI-2010 score, and changes in body weight, body composition, and insulin sensitivity. The relative contribution of food groups and nutrients to weight loss was evaluated using linear regression.ResultsFruit, vegetable, legume, meat alternative, and whole grain intake significantly increased in the vegan group. Intake of meat, fish, and poultry; dairy products; eggs; nuts and seeds; and added fats decreased. Decreased weight was most associated with increased intake of legumes (r = ?0.38; P < 0.0001) and decreased intake of total meat, fish, and poultry (r = +0.43; P < 0.0001). Those consuming a low-fat vegan diet also increased their intake of carbohydrates, fiber, and several micronutrients and decreased fat intake. Reduced fat intake was associated with reduced body weight (r = +0.15; P = 0.02) and, after adjustment for changes in BMI and energy intake, with reduced fat mass (r = +0.14; P = 0.04). The intervention group’s AHEI-2010 increased by 6.0 points on average, in contrast to no significant change in the control group (treatment effect, +7.2 [95% CI +3.7 to +10.7]; P < 0.001). Increase in AHEI-2010 correlated with reduction in body weight (r = 0.14; P = 0.04), fat mass (r = ?0.14; P = 0.03), and insulin resistance as measured by the Homeostasis Model Assessment (HOMA-IR; r = ?0.17; P = 0.02), after adjustment for changes in energy intake.ConclusionsWhen compared with participants’ usual diets, intake of plant foods increased, and consumption of animal foods, nuts and seeds, and added fats decreased on a low-fat vegan diet. Increased legume intake was the best single food group predictor of weight loss. Diet quality as measured by AHEI-2010 improved on the low-fat vegan diet, which was associated with improvements in weight and metabolic outcomes. These data suggest that increasing low-fat plant foods and minimizing high-fat and animal foods is associated with decreased body weight and fat loss, and that a low-fat vegan diet can improve measures of diet quality and metabolic health.     

Select Food Group Intake of US Children Aged 2 to 4 Years by WIC Participation Status and Income

BackgroundFood group and nutrient priorities for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Package IV for children aged 2 to 4 years were described in the 2017 review of the WIC Food Package. Research has evaluated priority nutrient intake, but priority food group intake remains unknown.ObjectivesTo compare mean intake of priority food groups/subgroups of WIC children to WIC-eligible nonparticipants and higher income children. Further, we hoped to assess differences in percent contribution of food subgroups to total food group intake by WIC participation status and income.DesignCross-sectional study conducted using data from the 2011-14 National Health and Nutrition Examination Survey.Participants/settingOne thousand forty-seven children aged 2 to 4 years.Main outcome measuresMean intake reported in cup equivalents and ounce equivalents. We also looked at mean percent that food subgroups contributed to total intake within a food group. Analyses were performed for high and low priority food groups/subgroups: high = seafood, total vegetables, dark green vegetables, red/orange vegetables, whole grains, and nuts/seeds/soy; low = total starchy vegetables, other vegetables, legumes computed as vegetables, total dairy, and total protein foods.Statistical analyses performedMultivariable linear regression analysis was used evaluate the relationship between income/WIC participation and mean intake/percent food subgroups contributed to total food group intake.ResultsAmong low-income WIC-eligible children, participation in WIC was associated with greater mean intake of red/orange vegetables (0.18 ± 0.03 vs 0.01 ± 0.06 c equivalents; P < 0.05) and legumes (0.07 ± 0.01 vs 0.01 ± 0.02 c equivalents; P < 0.01). No differences in mean intake were observed between WIC children and higher income children. Grain intake of WIC children was composed of a higher percentage of whole grains (19.1% ± 1.6% vs 13.2% ± 1.5%; P < 0.01) compared with higher income children. The percent vegetable subgroups contributed to total vegetable intake varied by income; no differences were observed for dairy or protein subgroups.ConclusionsAmong low-income children, participation in WIC was associated with greater intake of certain vegetables. Participation in WIC may also help close the diet quality gap between low-income and higher income children for priority foods targeted by the WIC food package. Future research should explore socioeconomic disparities in intake of nutrient-poor foods.     

Associations Among Food Security,Diet Quality,and Dietary Intake During Pregnancy in a Predominantly African American Group of Women from North Carolina

BackgroundLow food security during pregnancy can negatively affect women’s physical and mental health. Although many women make a greater effort to eat a healthy diet during pregnancy, the influence of low food security during pregnancy on maternal diet is not well understood.ObjectiveThis study aimed to assess the association between adult food security and maternal diet during pregnancy in a sample from North Carolina.DesignThis was a cross-sectional, secondary data analysis of food security (marginal, low, and very low vs high) and maternal diet during pregnancy.Participants and settingThis study included 468 predominantly Black/African American women during pregnancy from the Nurture cohort, enrolled through prenatal clinics in central North Carolina between 2013 and 2016.Main outcome measureDiet quality was assessed using the Alternate Healthy Eating Index-Pregnancy and the Mediterranean Diet Score. Dietary intake from seven food groups included in the Alternate Healthy Eating Index-Pregnancy and/or Mediterranean Diet Score was assessed as well.Statistical analysis performedMultiple linear regression models were used to examine the association between food security and diet quality and dietary intake during pregnancy, adjusting for race/ethnicity; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children; education; prepregnancy body mass index; age; parity; and mean daily energy intake.ResultsIn this study, there was no association between maternal food security status and diet quality during pregnancy. However, researchers observed an association between low and marginal food security and greater intake of red and processed meats (marginal: β = 2.20 [P = 0.03]; low: β = 2.28 [P = 0.04]), as well as an association between very low food security and decreased vegetable consumption (β = –.43; P = 0.03).ConclusionsVery low food security was associated with reduced vegetable intake. In addition, low and marginal food security were associated with greater red and processed meat intake. Future research should focus on nationally representative populations and include longitudinal assessments to allow for the study of the influence of food security on health during pregnancy.     

Association of Dietary Patterns with Cognitive Function and Cognitive Decline in Sydney Memory and Ageing Study: A Longitudinal Analysis

BackgroundThe relationship of dietary patterns to cognitive health in older adults has attracted much research attention. However, results from existing studies are inconclusive.ObjectiveThe aim of this study was to investigate the association between dietary patterns and overall cognitive performance and cognitive change over time.DesignThis analysis was conducted as part of the longitudinal Sydney Memory and Ageing study with 6 years’ follow-up. Mediterranean diet and Dietary Approaches to Stop Hypertension diet scores were generated based on dietary intake for each individual, assessed by the Dietary Questionnaire for Epidemiological Studies Version 2.Participants/settingThis longitudinal study comprised 1037 community dwelling nondemented participants aged 70 to 90 years at baseline (September 2005 to December 2007), recruited from Sydney, Australia.Main outcome measuresNeuropsychological tests assessed global cognition and 6 cognitive domains on 4 occasions, at baseline and 2, 4, and 6 years later.Statistical analyses performedLinear mixed-model analyses were conducted to examine the relationship between dietary scores, food components, and overall cognitive function and cognitive change over 6 years.ResultsNo associations of Mediterranean or Dietary Approaches to Stop Hypertension dietary scores with overall cognition and cognitive decline over 6 years were found. Higher intake of legumes and nuts was related to better overall performance in global cognition (β = .091; 95% CI: 0.035-0.146; P = .001) and to multiple cognitive domains and to less decline in global cognition (β = ?.016; 95% CI: ?0.032 to ?0.001; P = .032).ConclusionStudy findings suggest that greater consumption of legumes and nuts may be important to slow cognitive decline with age.     

Relative Validity and Reproducibility of a Food Frequency Questionnaire for Assessing Dietary Patterns and Food Group Intake in Older New Zealand Adults: The Researching Eating,Activity, and Cognitive Health Study

BackgroundDietary pattern analysis considers the overall dietary intake and combinations of foods eaten. Valid and reproducible tools for determining dietary patterns are necessary to assess diet–disease relationships.ObjectiveThis study evaluated the relative validity and reproducibility of the Researching Eating, Activity, and Cognitive Health (REACH) Study food frequency questionnaire (FFQ) specifically designed to identify dietary patterns in older adults.DesignA subset of participants from the REACH study completed two identical 109-item FFQs 1 month apart (FFQ1 and FFQ2) to assess reproducibility and a 4-day food record between FFQ administrations to assess relative validity. Foods from each dietary assessment tool were assigned to 57 food groups. Principal component analysis was applied to the food group consumption reported in each dietary assessment tool to derive dietary patterns.Participants and settingDietary data were collected (2018 and 2019) from a subset of the REACH study (n = 294, 37% men) aged 65 to 74 years, living in Auckland, New Zealand.Main outcome measuresDaily intakes of 57 food groups and dietary patterns of older adults participating in REACH living in New Zealand.Statistical analysisAgreement of dietary pattern loadings were assessed using Tucker’s congruence coefficient. Agreement of dietary pattern scores and food group intakes were assessed using Spearman correlation coefficients (acceptable correlation rho = 0.20 to 0.49), weighted kappa statistic (acceptable statistic κ_w = 0.20 to 0.60), and Bland-Altman analysis, including mean difference, limits of agreement, plots, and slope of bias.ResultsThree similar dietary patterns were identified from each dietary assessment tool: Mediterranean style, Western, and prudent. Congruence coefficients between factor loadings ranged from 0.54 to 0.80. Correlations of dietary pattern scores ranged from 0.47 to 0.59 (reproducibility) and 0.33 to 0.43 (validity) (all P values < 0.001); weighted kappa scores from 0.40 to 0.48 (reproducibility) and 0.27 to 0.37 (validity); limits of agreement from ± 1.79 to ± 2.09 (reproducibility) and ± 2.09 to ± 2.27 (validity); a negative slope of bias was seen in the prudent pattern for reproducibility and validity (P < 0.001).ConclusionsThe REACH FFQ generated dietary patterns with acceptable reproducibility and relative validity and therefore can be used to examine associations between dietary patterns and health outcomes in older New Zealand adults.     

Native Youth Participating in the Together on Diabetes 12-Month Home-Visiting Program Reported Improvements in Alternative Healthy Eating Index-2010 Diet Quality Domains Likely to Be Associated With Blood Pressure and Glycemic Control

BackgroundThe Together on Diabetes (TOD) intervention was a home-visiting diabetes prevention and management program for Native youth.Objectives(1) Examine the impact of the TOD program on diet quality using the Alternative Healthy Eating Index (AHEI-2010); (2) determine association between diet quality and cardiometabolic health.DesignThe TOD program was conducted from October 2012 to June 2014 and was evaluated using a pretest-posttest study design from baseline to 12 months. Dietary intake was assessed using a food frequency questionnaire.Participants/settingThere were 240 participants between 10 and 19 years of age from 4 reservation-based, rural tribal communities in the southwestern United States that had been diagnosed with T2DM or prediabetes or were identified as at risk based on body mass index and a qualifying laboratory test.InterventionYouth were taught a 12-lesson curriculum on goal setting, nutrition, and life skills education.Main outcome measuresBehavioral and physiologic outcomes related to diabetes.Statistical analysisChanges in AHEI-2010 score and associations with cardiometabolic measures were tested, over time, using adjusted longitudinal linear mixed-effects models.ResultsThe study sample reported an average energy intake of 2016 kcal/d (±1260) and AHEI-2010 score of 47.4 (±7.4) (range: 0-110, higher = better diet quality), indicating low diet quality at baseline. At 12 months’ follow-up, there was a reduction in kilocalories (mean = −346 kcal/d; P < .001), sugar-sweetened beverages (mean = −2 fluid oz/d; P = .032), red/processed meat (mean = −1.5 oz/d; P = .008), and sodium (mean = −650 mg/d; P < .001) but no change in AHEI-2010 score (P = .600). The change in systolic blood pressure from baseline to 12 months for participants within the highest AHEI-2010 quartile group was significantly larger than the change in participants within the lowest quartile group (mean = −5.90 mm Hg; P = .036).ConclusionsDespite stable AHEI-2010 scores during follow-up, there were improvements in diet quality domains likely to be associated with cardiometabolic health. Home-visiting programs like TOD are promising interventions for decreasing dietary intake of poor-quality foods.     

Determinants and Consequences of Adherence to the Dietary Approaches to Stop Hypertension Diet in African-American and White Adults with High Blood Pressure: Results from the ENCORE Trial

BackgroundAlthough the Dietary Approaches to Stop Hypertension (DASH) diet is an accepted nonpharmacologic treatment for hypertension, little is known about what patient characteristics affect dietary adherence and what level of adherence is needed to reduce blood pressure (BP).ObjectiveOur aim was to determine what factors predict dietary adherence and the extent to which dietary adherence is necessary to produce clinically meaningful BP reductions.DesignAncillary study of the ENCORE (Exercise and Nutrition Interventions for Cardiovascular Health) trial—a 16-week randomized clinical trial of diet and exercise.Participants/settingParticipants included 144 sedentary, overweight, or obese adults (body mass index 25 to 39.9) with high BP (systolic 130 to 159 mm Hg and/or diastolic 85 to 99 mm Hg).InterventionPatients were randomized to one of three groups: DASH diet alone, DASH diet plus weight management, and Usual Diet Controls.Main outcomes measuresOur primary outcomes were a composite index of adherence to the DASH diet and clinic BP.Statistical analyses performedGeneral linear models were used to compare treatment groups on post-treatment adherence to the DASH diet. Linear regression was used to examine potential predictors of post-treatment DASH adherence. Analysis of covariance was used to examine the relation of adherence to the DASH diet and BP.ResultsParticipants in the DASH diet plus weight management (16.1 systolic BP [SBP]; 95% CI 13.0 to 19.2 mm Hg and 9.9 diastolic BP [DBP]; 95% CI 8.1 to 11.6 mm Hg) and DASH diet alone (11.2 SBP; 95% CI 8.1 to 14.3 mm Hg and 7.5 DBP; 95% CI 5.8 to 9.3 mm Hg) groups showed significant reductions in BP in comparison with Usual Diet Controls participants (3.4 SBP; 95% CI 0.4 to 6.4 mm Hg and DBP 3.8; 95% CI 2.2 to 5.5 mm Hg). Greater post-treatment consumption of DASH foods was noted in both the DASH diet alone (mean=6.20; 95% CI 5.83 to 6.57) and DASH diet plus weight management groups (mean=6.23; 95% CI 5.88 to 6.59) compared with Usual Diet Controls (mean=3.66; 95% CI 3.30 to 4.01; P<0.0001), and greater adherence to the DASH diet was associated with larger reductions in clinic SBP and DBP (P≤0.01). Only ethnicity predicted dietary adherence, with African Americans less adherent to the DASH diet compared with whites (4.68; 95% CI 4.34 to 5.03 vs 5.83; 95% CI 5.50 to 6.11; P<0.001).ConclusionsGreater adherence to the DASH diet was associated with larger BP reductions independent of weight loss. African Americans were less likely to be adherent to the DASH dietary eating plan compared with whites, suggesting that culturally sensitive dietary strategies might be needed to improve adherence to the DASH diet.     

Diet Quality of Americans Differs by Age,Sex, Race/Ethnicity,Income, and Education Level

An index that assesses the multidimensional components of the diet across the lifecycle is useful in describing diet quality. The purpose of this study was to use the Healthy Eating Index-2005, a measure of diet quality in terms of conformance to the 2005 Dietary Guidelines for Americans, to describe the diet quality of Americans by varying sociodemographic characteristics in order to provide insight as to where diets need to improve. The Healthy Eating Index-2005 scores were estimated using 1 day of dietary intake data provided by participants in the 2003-2004 National Health and Nutrition Examination Survey. Mean daily intakes of foods and nutrients, expressed per 1,000 kilocalories, were estimated using the population ratio method and compared with standards that reflect the 2005 Dietary Guidelines for Americans. Participants included 3,286 children (2 to 17 years), 3,690 young and middle-aged adults (18 to 64 years), and 1,296 older adults (65+ years). Results are reported as percentages of maximum scores and tested for significant differences (P≤0.05) by age, sex, race/ethnicity, income, and education levels. Children and older adults had better-quality diets than younger and middle-aged adults; women had better-quality diets than men; Hispanics had better-quality diets than blacks and whites; and diet quality of adults, but not children, generally improved with income level, except for sodium. The diets of Americans, regardless of socioeconomic status, are far from optimal. Problematic dietary patterns were found among all sociodemographic groups. Major improvements in the nutritional health of the American public can be made by improving eating patterns.     

Children's Dietary Intake by Early Care and Education Setting in the US Affiliated Pacific

ObjectiveExamine differences in dietary intake of children aged 2–5 years in early care and education (ECE) setting in the US Affiliated Pacific (USAP).DesignSecondary analysis of cross-sectional data collected by the Children's Healthy Living program.ParticipantsChildren (n = 1,423) with complete dietary records and information on the ECE setting.Main Outcome MeasuresDietary intake by ECE setting; Head Start (HS), other ECE (OE), and no ECE.AnalysisComparison of mean dietary intake across ECE settings and multivariate logistic regression to evaluate ECE setting and likelihood for meeting dietary reference intake (DRI).ResultsChildren in HS and OE settings had a significantly higher intake of several food groups and nutrients, compared with no ECE; vegetables (0.4 cup-equivalents per thousand kcals [CETK] vs 0.3 CETK; P < 0.001), fruits (0.8 CETK vs 0.6 CETK; P = 0.001), milk (0.9 CETK for HS and 1.0 CETK for OE vs 0.8 CETK; P < 0.001). Sixty-five percent of the HS group met DRI and had greater odds of meeting calcium DRI (odds ratio, 1.8; 95% confidence interval, 1.2–2.7) compared with other groups. The OE group had the lowest proportion of children meeting recommended intakes for 19 out of 25 nutrients.Conclusions and ImplicationsMean intakes of foods and nutrients for children across the USAP meet some, but not all, recommendations and intakes vary across children attending various ECE setting types. Additional research on the clinical importance of these differences and the impact of the complex food systems in the USAP may identify systematic strategies for improving diet among children.     

Dietary Intakes of Children Enrolled in US Early Child-Care Programs During Child-Care and Non-Child-Care Days

BackgroundEarly-child-care (ECE) programs may substantially influence child diet quality.ObjectiveThe Study of Nutrition and Activity in Child Care Settings describes the usual food group intake of preschool-aged children attending ECE programs relative to Dietary Guidelines for Americans (DGA) recommendations, comparing intakes during child-care and non-child-care days.DesignMeal observations and parent-completed food diaries in a cross-sectional nationally representative multistage cluster sample of Child and Adult Care Food Program-participating ECE programs.Participants/settingOne thousand four hundred sixty-eight children aged 3 to 5 years attending 217 Child and Adult Care Food Program-participating ECE programs (eg, child-care centers and Head Start) during 2017.Main outcome measuresDaily energy intake, daily US Department of Agriculture Food Pattern Food Group intakes, and percentage of daily intakes meeting 2015-2020 DGA Food Pattern recommendations.Statistical analyses performedRegression-adjusted usual intakes and percentage of children meeting recommendations were estimated using the National Cancer Institute method. Single-day mean intakes were used to test for statistical differences between child-care and non-child-care days.ResultsMean usual energy intake was 1,524 ± 19.3 kcal during child-care days and exceeded the recommended range at 1,702 ± 30.2 kcal during non-child-care days; single-day means indicated significantly lower energy intake on child-care days (P < 0.001). The percent of children meeting DGA recommendations on a child-care day varied by DGA food group: fruits (51.4%), grains (50.1%), dairy (42.5%), vegetables (6.5%), whole grains (4.6%), and protein foods (0.1%). Recommended limits on calories from added sugar and solid fats were met by 28.2% and 14.6% of children, respectively. Compared with mean food group intakes during a single child-care day, non-child-care day intakes were similar for fruits and vegetables, lower for dairy and whole grains, and higher for total grains, protein foods, and calories from added sugars and solid fats.ConclusionsAlthough there is room to increase nutrient density inside and outside of child care, intakes on child-care days more closely align to DGAs.