Adherence to the Planetary Health Diet Index and Obesity Indicators in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

The EAT-Lancet Commission has proposed a model diet to improve the health of human beings and that of the planet. Recently, we proposed the Planetary Health Diet Index (PHDI) to assess adherence of the population to this model diet. In this study, we aimed to evaluate adherence to the PHDI and obesity outcomes using baseline data from 14,515 participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The dietary data were assessed using a 114-item FFQ. Body mass index (BMI) and waist circumference (WC) were both used continuously and categorized. Linear and multinomial regression models adjusted for potential confounding factors were performed to assess the relationship between adherence to PHDI and outcomes. An inverse association was observed between adherence to PHDI and obesity indicators. Individuals with high adherence to the PHDI had lower BMI (β−0.50 95% CI−0.73:−0.27) and WC (β−1.70 95% CI−2.28:−1.12) values. They were also 24% less likely to be overweight (OR 0.76 95% CI 0.67:0.85) or obese (OR 0.76 95% CI 0.65:0.88), and they were 14% and 27% less likely to have increased WC (OR 0.86 95% CI 0.75:0.98) or substantially increased WC (OR 0.73 95% CI 0.64:0.83) than those with lower adherence. Our results showed that higher adherence to the PHDI may decrease obesity indicators.     

Low Adherence to the EAT-Lancet Sustainable Reference Diet in the Brazilian Population: Findings from the National Dietary Survey 2017–2018

Diets are simultaneously connected with population health and environment. The EAT-Lancet Commission proposed a sustainable reference diet to improve population health and respect the planetary boundaries. Recently, the Planetary Health Diet Index (PHDI) has been developed to assess the adherence to this reference diet. In the present study, we aimed to evaluate the adherence to the EAT-Lancet diet through the PHDI in a nationwide population-based study carried out in Brazil. We used data from the National Dietary Survey conducted through the Household Budget Survey in 2017–2018, with 46,164 Brazilians aged over 10 years old. Food consumption was evaluated with a 24 h dietary recall. The average PHDI total score in the Brazilian population was 45.9 points (95% CI 45.6:46.1) on a total score that can range from 0 to 150 points. The adherence to EAT-Lancet diet was low among all Brazilian regions. Women, elderly, those overweighed/obese, with higher per capita income and living in the urban area had higher scores in the PHDI. In general, the Brazilian population presented low adherence to a healthy and sustainable dietary pattern and seems far from meeting the EAT-Lancet recommendations.     

Healthy and Sustainable Diet Index: Development,Application and Evaluation Using Image-Based Food Records

There are limited methods to assess how dietary patterns adhere to a healthy and sustainable diet. The aim of this study was to develop a theoretically derived Healthy and Sustainable Diet Index (HSDI). The HSDI uses 12 components within five categories related to environmental sustainability: animal-based foods, seasonal fruits and vegetables, ultra-processed energy-dense nutrient-poor foods, packaged foods and food waste. A maximum of 90 points indicates the highest adherence. The HSDI was applied to 4-day mobile food records (mFR^TM) from 247 adults (18–30 years). The mean HSDI score was 42.7 (SD 9.3). Participants who ate meat were less likely to eat vegetables (p < 0.001) and those who ate non-animal protein foods were more likely to eat more fruit (p < 0.001), vegetables (p < 0.05), and milk, yoghurt and cheese (p < 0.05). After adjusting for age, sex and body mass index, multivariable regression found the strongest predictor of the likelihood of being in the lowest total HSDI score tertile were people who only took a bit of notice [OR (95%CI) 5.276 (1.775, 15.681) p < 0.005] or did not pay much/any attention to the health aspects of their diet [OR (95%CI) 8.308 (2.572, 26.836) p < 0.0001]. HSDI provides a new reference standard to assess adherence to a healthy and sustainable diet.     

Adhering to Canada’s Food Guide Recommendations on Healthy Food Choices Increases the Daily Diet Cost: Insights from the PREDISE Study

The aim of this study was to assess the association between daily diet costs and the Healthy Eating Food Index (HEFI)-2019, an index that reflects the alignment of dietary patterns to recommendations on healthy food choices in the 2019 Canada’s Food Guide (CFG). Dietary intake data from 24 h recalls, completed between 2015 and 2017, of 1147 French-speaking participants of the web-based multicenter cross-sectional PRÉDicteurs Individuels, Sociaux et Environnementaux (PREDISE) study in Quebec were used. Diet costs were calculated from dietary recall data using a Quebec-specific 2015–2016 Nielsen food price database. Usual dietary intakes and diet costs were estimated using the National Cancer Institute’s multivariate method. Linear regression models were used to evaluate associations between diet costs and HEFI-2019 scores. When standardized for energy intake, a higher HEFI-2019 score (75th vs. 25th percentiles) was associated with a 1.09 $CAD higher daily diet cost (95% CI, 0.73 to 1.45). This positive association was consistent among different sociodemographic subgroups based on sex, age, education, household income, and administrative region of residence. A higher daily diet cost was associated with a higher HEFI-2019 score for the Vegetables and fruits, Beverage, Grain foods ratio, Fatty acids ratio, Saturated fats, and Free sugars components, but with a lower score for the Sodium component. These results suggest that for a given amount of calories, a greater adherence to the 2019 CFG recommendations on healthy food choices is associated with an increased daily diet cost. This highlights the challenge of conciliating affordability and healthfulness when developing national dietary guidelines in the context of diet sustainability.     

The Mediterranean Diet and the Western Diet in Adolescent Depression-Current Reports

Depression is one of the most common mental disorders in the world and a current and growing social and health problem. The growing scale of the problem not only concerns adults, but now it particularly affects children and adolescents. Prevention, early diagnosis and treatment of mood disorders in adolescence is crucial because adolescent depression is a risk factor for recurrence of depression later in life, as well as many other mental health disorders in adulthood. The purpose of this study was to analyze data on the dietary patterns and composition of the Mediterranean diet as a modifiable risk factor for depression, which would be a viable prevention strategy and a good target for early intervention and supportive treatment of depression. Research shows that the Mediterranean diet pattern can reduce the risk and symptoms of depression, while western eating styles can increase the risk and severity of depression in adolescents. The number of studies in adolescent populations continues to increase, but most longitudinal and clinical studies are still insufficient. Modification of the diet can be a helpful strategy for the prevention and treatment of depression in adolescents; therefore, the diet of young people should be considered a key and modifiable goal in the prevention of mental disorders.     

The Benefits of Including Hummus and Hummus Ingredients into the American Diet to Promote Diet Quality and Health: A Comprehensive Review

Over the last decade, hummus has become an increasingly popular food. Given the ingredients (i.e., primarily chickpeas and tahini), nutrient composition, versatility, and acceptability, hummus can play a unique role when included in the American diet, to promote diet quality and improve health. The purpose of this paper is to provide a comprehensive review of the scientific evidence examining the effects of acute and long-term consumption of hummus and hummus ingredients on diet quality and risk factors related to type 2 diabetes, cardiovascular disease, and obesity. In addition, food pattern/menu modeling is included to illustrate the potential nutritional impact of consuming hummus to meet dietary guidelines. In general, the consumption of hummus and/or its respective ingredients has been shown to improve postprandial glycemic control, fasting lipids, appetite control, and daily food intake compared to other commonly consumed foods. The incorporation of hummus into the American diet can also improve diet quality by replacing foods higher in saturated fats, sodium, or added sugars. Collectively, these findings support the addition of hummus and/or hummus ingredients as an important component of a healthy dietary pattern.     

A Systematic Review of Diet Quality Index and Obesity among Chinese Adults

Diet quality scores are designed mainly based on Western-style dietary patterns. They were demonstrated to be good indicators of obesity in developed but not developing countries. Several diet quality scores were developed based on the Chinese dietary guidelines, yet no systematic review exists regarding how they were related to obesity. We searched research articles published between 2000 and 2021 in PubMed, CINAHL, and Scopus databases. Both cross-sectional and prospective studies that examined the relationship between a diet quality score and weight, body mass index, obesity, or waist circumference conducted in a Chinese population were selected. From the 602 articles searched, 20 articles were selected (12 are cross-sectional studies and 8 are prospective cohort studies). The relationship between internationally used scores and obesity was inconsistent among studies. Scores tailored to the Chinese diet demonstrated a strong relationship with both being underweight and obesity. The heterogeneity of the populations and the major nutrition transition in China may partially explain the discrepancies among studies. In conclusion, diet quality scores tailored to the Chinese diet may be associated with both undernutrition and overnutrition, as well as being underweight and obesity outcomes.     

Mediterranean Diet as an Antioxidant: The Impact on Metabolic Health and Overall Wellbeing

It has been established, worldwide, that non-communicable diseases such as obesity, diabetes, metabolic syndrome, and cardiovascular events account for a high percentage of morbidity and mortality in contemporary societies. Several modifiable risk factors, such as sedentary activities, sleep deprivation, smoking, and unhealthy dietary habits have contributed to this increase. Healthy nutrition in terms of adherence to the Mediterranean diet (MD), rich in fruits, legumes, vegetables, olive oil, herbs, spices, and high fiber intake may contribute to the decrease in this pandemic. The beneficial effects of the MD can be mainly attributed to its numerous components rich in anti-inflammatory and antioxidant properties. Moreover, the MD may further contribute to the improvement of reproductive health, modify the risk for neurodegenerative diseases, and protect against depression and psychosocial maladjustment. There is also evidence highlighting the impact of healthy nutrition in female people on the composition of the gut microbiota and future metabolic and overall health of their offspring. It is therefore important to highlight the beneficial effects of the MD on metabolic, reproductive, and mental health, while shaping the overall health of future generations. The beneficial effects of MD can be further enhanced by increased physical activity in the context of a well-balanced healthy lifestyle.     

Diet,Sleep, and Mental Health: Insights from the UK Biobank Study

Diet has long been the focus of attention as a leading risk factor for non-communicable diseases. As such, a better understanding of it is crucial to establish priorities for dietary guidelines and to inform, design, and implement strategies for preventing, helping manage, and stopping the progression of sleep and mental health-related symptoms/disorders. The aim of the current study is to conduct the largest investigation of diet, sleep, and mental health to date by utilizing the UK Biobank (UKB) dataset to identify the associations between diet and (i) sleep quality/health, and (ii) mental health symptomatology. This cross-sectional population-based study involved 502,494 middle-aged adults. UKB food frequency, sleep, and psychological factors and mental health questionnaires at baseline were used. Scores were also calculated for healthy diet, healthy sleep, mental health symptomatology, partial fibre intake, and milk intake. We observed positive associations with healthy diet and sleep and mental health, especially benefits of high intakes of vegetable, fruit, fish, water, and fibre. However, processed meat and milk intake were adversely associated with sleep and mental health. These findings make clear that there are health and wellbeing benefits and drawbacks of different diets, but do not, at this stage, demonstrate the clear causal relationships, which would support dietary interventions that might play a role in the treatment and also self-management of sleep and mental health disorders/symptoms. Further research is required to understand mechanisms of actions of which diet acts on to modulate sleep and mental health, while taking comorbidity of sleep and mental health disorders/symptoms into consideration.     

The Relationships between Sleep and Mental and Physical Health of Chinese Elderly: Exploring the Mediating Roles of Diet and Physical Activity

Sleep quality, diet quality, and physical activity are significant factors influencing physical and mental health. However, few studies have explored their underlying mechanisms, especially among the elderly population in East Asia, where people have food culture and lifestyles distinct from those living in Western countries. Therefore, the current study aimed to explore the relationships among sleep quality, diet quality, physical activity, and physical and mental health in a Chinese elderly sample. Sleep quality, diet quality, physical activity, physical health, and mental health were investigated among 313 Chinese elderly (aged 51–92 years, M = 67.90, SD = 7.94). Mediation analysis was used to examine the empirical model based on previous theories and literature. Close positive relationships were observed between all factors investigated (r = 0.22~0.73, p < 0.001). The relationships between sleep quality and physical and mental health were partially mediated by diet quality and physical activity. In clinical interventions, sleep quality, diet quality, and physical activity can be targeted to improve physical and mental health among the older adult populations.     

Understanding the Role of Maternal Diet on Kidney Development; an Opportunity to Improve Cardiovascular and Renal Health for Future Generations

The leading causes of mortality and morbidity worldwide are cardiovascular disease (high blood pressure, high cholesterol and renal disease), cancer and diabetes. It is increasingly obvious that the development of these diseases encompasses complex interactions between adult lifestyle and genetic predisposition. Maternal malnutrition can influence the fetal and early life environment and pose a risk factor for the future development of adult diseases, most likely due to impaired organogenesis in the developing offspring. This then predisposes these offspring to cardiovascular disease and renal dysfunction in adulthood. Studies in experimental animals have further illustrated the significant impact maternal diet has on offspring health. Many studies report changes in kidney structure (a reduction in the number of nephrons in the kidney) in offspring of protein-deprived dams. Although the early studies suggested that increased blood pressure was also present in offspring of protein-restricted dams, this is not a universal finding and requires clarification. Importantly, to date, the literature offers little to no understanding of when in development these changes in kidney development occur, nor are the cellular and molecular mechanisms that drive these changes well characterised. Moreover, the mechanisms linking maternal nutrition and a suboptimal renal phenotype in offspring are yet to be discerned—one potential mechanism involves epigenetics. This review will focus on recent information on potential mechanisms by which maternal nutrition (focusing on malnutrition due to protein restriction, micronutrient restriction and excessive fat intake) influences kidney development and thereby function in later life.     

Validation of a Diet Quality Screening Tool for Use in the Oldest Old*

Abstract

The oldest old (aged ≥80?years) are often the population subgroup at high nutritional risk due to age-related metabolic changes. We performed a validation analysis of a dietary screening tool (DST) which was developed for older adults among the oldest old. We examined dietary intakes using three 24-hour dietary recalls and the DST among 122 participants (aged 82–97) of the Geisinger Rural Aging Study. DST scores were compared with the Health Eating Index (HEI)-2015 scores, which were calculated based on three-day dietary recalls. Pearson correlations were used to characterize concurrent validity and Bland-Altman plots were used to identify potential bias. DST scores were significantly correlated with HEI scores (adjusted r?=?0.68; p?<?0.001) in an age- and sex-adjusted model. Those within the not-at-risk DST group had significantly higher HEI scores (adjusted means = 79.6?±?3.68) compared with those who were in the at-risk (adjusted means = 51.2?±?1.56) and the possibly-at-risk (adjusted means = 66.3?±?1.79) groups (p-trend < 0.001). The DST appears to be a valid measure of diet quality in the oldest old when compared with the HEI and may be a potential tool to assess overall diet quality in this population.     

Self-Reported Diet and Health Outcomes of Participants of the CCSVI-Tracking Survey Study

Of the 1575 participants of the CCSVI-Tracking Survey, 475 patients recorded their quality of life and EDSS outcomes for at least 2 months. Self-reported use of complementary and conventional therapies included diet, use of drug therapy, symptoms, quality of life, and mobility. Analysis included comparing outcomes related to different diets within and between groups. Adherence to the MS diet was not associated with a greater quality of life, less disability, a lower Symptom Score, or faster walking speed compared to other diets. Alternately, the participants from the Mediterranean diet region as a whole (µ = 32.65 (SD = 11.37, SE_M = 2.37, p = 0.05) had a significantly greater QoL (µ = 60, p = 0.05) and a lower MS symptom score, µ = 32.65 (11.37), p = 0.0029. A decline of symptoms was observed in all diet groups over 3 months with the most dramatic decline observed in participants from the Eastern Mediterranean diet region. The main effect for the within-subjects factor was significant, F(3, 1056) = 55.95, p < 0.001, indicating that there were significant differences between the groups.     

The Comparative Validity and Reproducibility of a Diet Quality Index for Adults: The Australian Recommended Food Score

Adult diet quality indices are shown to predict nutritional adequacy of dietary intake as well as all-cause morbidity and mortality. This study describes the reproducibility and validity of a food-based diet quality index, the Australian Recommended Food Score (ARFS). ARFS was developed to reflect alignment with the Australian Dietary Guidelines and is modelled on the US Recommended Food Score. Dietary intakes of 96 adult participants (31 male, 65 female) age 30 to 75 years were assessed in two rounds, five months apart. Diet was assessed using a 120-question semi-quantitative food frequency questionnaire (FFQ). The ARFS diet quality index was derived using a subset of 70 items from the full FFQ. Reproducibility of the ARFS between round one and round two was confirmed by the overall intraclass correlation coefficient of 0.87 (95% CI 0.83, 0.90), which compared favourably to that for the FFQ at 0.85 (95% CI 0.80, 0.89). ARFS was correlated with FFQ nutrient intakes, particularly fiber, vitamin A, beta-carotene and vitamin C (0.53, 95% CI 0.37–0.67), and with mineral intakes, particularly calcium, magnesium and potassium (0.32, 95% CI 0.23–0.40). ARFS is a suitable brief tool to evaluate diet quality in adults and reliably estimates a range of nutrient intakes.     

Socioeconomic Status Impact on Diet Quality and Body Mass Index in Eight Latin American Countries: ELANS Study Results

Poor health and diet quality are associated with living within a low socioeconomic status (SES). This study aimed to investigate the impact of SES on diet quality and body mass index in Latin America. Data from the “Latin American Health and Nutrition Study (ELANS)”, a multi-country, population-based study of 9218 participants, were used. Dietary intake was collected through two 24 h recalls from participants of Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. Diet quality was assessed using the dietary quality score (DQS), the dietary diversity score (DDS) and the nutrients adequacy ratio (NAR). Chi-squared and multivariate-variance analyses were used to estimate possible associations. We found that participants from the low SES consumed less fruits, vegetables, whole grains, fiber and fish and seafood and more legumes than those in the high SES. Also, the diet quality level, assessed by DQS, DDS and NAR mean, increased with SES. Women in the low SES also showed a larger prevalence of abdominal obesity and excess weight than those in the middle and high SES. Health policies and behavioral-change strategies should be addressed to reduce the impact of socioeconomic factors on diet quality and body weight, with gender as an additional level of vulnerability.     

Environmental and economic sustainability of the Mediterranean Diet

The Mediterranean diet (MD) has been proposed as a healthy dietary pattern for disease prevention. However, little information exists on the cost and on the environmental impact of such a dietary model. We compared the environmental impact and the costs of the current food consumption pattern of the Italian population and the Mediterranean model in order to investigate its overall sustainability. The environmental impact was calculated on the basis of three indexes, i.e. Carbon, Ecological and Water Footprint. The costs (Euro) per person of the MD and of the current Italian household food expenditure were considered on a weekly basis according to the 2013 data from the Observatory prices and tariffs of the Ministry of Economic Development and the service SMS consumers of the Ministry of Agriculture, Food and Forestry. The MD resulted to produce a lower environmental impact than the current food consumption of the Italian population. The monthly expenditure of the MD is slightly higher in the overall budget compared to the current expenditure allocated to food by the Italian population, but there is a substantial difference in the distribution of budget according to the different food groups.     

Development,Validation, and Reproducibility of Food Group-Based Frequency Questionnaires for Clinical Use in Brazil: A Pre-Hypertension and Hypertension Diet Assessment

The Blood pressure control diet is well described; however, it has not been implemented in clinical care, possibly due to the impracticability of the diet assessment in these contexts. In order to facilitate the dietary assessment, we developed and assessed the validity and reproducibility of two food group-based food frequency questionnaires (FG-FFQs), with a one-week (7-day FG-FFQ) and a one-month (30-day FG-FFQ) period of coverage for patients with pre-hypertension or hypertension. In 2010, 155 men and women, 30–70 years old, were invited to participate in a prospective study in two outpatient clinics in Porto Alegre, southern Brazil. The participants responded to two 30-day, two 7-day FG-FFQ, four 24-h dietary recalls, and underwent demographic, anthropometric, and blood pressure assessments. The validity and reproducibility were assessed using partial correlation coefficients adjusted for sex and age, and the internal validity was tested using the intra-class correlation coefficient. The participants were aged 61 (±10) years and 60% were women. The validity correlation coefficient was higher than r = 0.80 in the 30-day FG-FFQ for whole bread (r = 0.81) and the 7-day FG-FFQ for diet/light/zero soda and industrialized juices (r = 0.84) in comparison to the 24-h dietary recalls. The global internal validity was α = 0.59, but it increased to α = 0.76 when 19 redundant food groups were excluded. The reproducibility was higher than r = 0.80 for pasta, potatoes and manioc, bakery goods, sugar and cocoa, and beans for both versions. The 30-day had a slightly higher validity, both had good internal validity, and the 7-day FG-FFQ had a higher reproducibility.     

A Revised Australian Dietary Guideline Index and Its Association with Key Sociodemographic Factors,Health Behaviors and Body Mass Index in Peri-Retirement Aged Adults

The Dietary Guideline Index, a measure of diet quality, was updated to reflect the 2013 Australian Dietary Guidelines. This paper describes the revision of the index (DGI-2013) and examines its use in older adults. The DGI-2013 consists of 13 components reflecting food-based daily intake recommendations of the Australian Dietary Guidelines. In this cross-sectional study, the DGI-2013 score was calculated using dietary data collected via an 111-item food frequency questionnaire and additional food-related behaviour questions. The DGI-2013 score was examined in Australian adults (aged 55–65 years; n = 1667 men; 1801 women) according to sociodemographics, health-related behaviours and BMI. Women scored higher than men on the total DGI-2013 and all components except for dairy. Those who were from a rural area (men only), working full-time (men only), with lower education, smoked, did not meet physical activity guidelines, and who had a higher BMI, scored lower on the DGI-2013, highlighting a group of older adults at risk of poor health. The DGI-2013 is a tool for assessing compliance with the Australian Dietary Guidelines. We demonstrated associations between diet quality and a range of participant characteristics, consistent with previous literature. This suggests that the DGI-2013 continues to demonstrate convergent validity, consistent with the original Dietary Guideline Index.     

Parental Self-Efficacy and Child Diet Quality between Ages 2 and 5: The STEPS Study

Parental self-efficacy (PSE), a measure of the subjective competence in the parental role, has been linked with child well-being and health. Research on the influence of PSE on child eating habits is scarce, and the few studies have concentrated on certain food groups, such as vegetables or fruits, and have mostly included only maternal PSE. Thus, the aim of this study was to explore the associations between PSE (separately for mothers and fathers and as a total family-level score) and child diet quality in a cross-sectional and longitudinal study setting. PSE was measured at child ages of 1.5 and 5 years, and diet quality was measured at ages 2 and 5. Participants are from the Steps to Healthy Development (STEPS) Study (n = 270−883). We found that maternal PSE and family level PSE score were associated with child diet quality. Paternal PSE was not, but the dimension Routines was associated with child diet quality. PSE was similarly associated with child diet quality at both age points. Our results suggest that PSE is an important construct in the development of healthy dietary habits in children, and supporting parenting programs aimed at higher PSE could promote healthy diet quality in children.