Trans Fats in America: A Review of Their Use, Consumption, Health Implications, and Regulation

Trans fatty acids have long been used in food manufacturing due in part to their melting point at room temperature between saturated and unsaturated fats. However, increasing epidemiologic and biochemical evidence suggest that excessive trans fats in the diet are a significant risk factor for cardiovascular events. A 2% absolute increase in energy intake from trans fat has been associated with a 23% increase in cardiovascular risk. Although Denmark has shown it is possible to all but eliminate commercial sources of trans fats from the diet, total elimination is not possible in a balanced diet due to their natural presence in dairy and meat products. Thus, the American Heart Association recommends limiting trans fats to <1% energy, and the American Dietetic Association, the Institute of Medicine, US Dietary Guidelines, and the National Cholesterol Education Project all recommend limiting dietary trans-fat intake from industrial sources as much as possible. The presence of small amounts of trans fat in hydrogenated or partially hydrogenated oils/food products will likely cause many Americans to exceed their recommended maximum. This likelihood is exacerbated by the Food and Drug Administration labeling rules, which allow products containing <0.5 g trans fat per serving to claim 0 g trans fat. Many products with almost 0.5 g trans fat, if consumed over the course of a day, may approximate or exceed the 2 g maximum as recommended by American Heart Association, all while claiming to be trans-fat free. Accordingly, greater transparency in labeling and/or active consumer education is needed to reduce the cardiovascular risks associated with trans fats.     

Letter to the editor: healthy alternatives to trans fats

Consumption of trans fats is associated with an increase of cardiovascular disease (CVD) risk. To comply with regulatory policies and public health authorities recommendations, trans fats should be replaced in food products. The study by Sundram et al. (Nutrition & Metabolism 2007, 4:3) reporting the effect on CVD risk factors of interesterified fat (IE) and partially hydrogenated soybean oil (PHSO) compared to palm olein (POL) has been critically analyzed. The study design and in particular the composition of the tested fats was not suitable to properly answer the question raised regarding the effect of alternative ingredients to trans fats on plasma lipids. The observed effects are divergent with predicted data derived from the literature model consolidated using the individual results of 60 randomized clinical trials. The results of the study published by Sundram and co-workers have to be considered with awareness.     

Nutrition,sensory evaluation,and performance analysis of hydrogenated frying oils

The Food and Drug Administration now requires labeling of trans fats on nutrition labels, a decision that has created a push to reformulate deep-fat frying oils. Prior to the passage of this law, frying oils contained trans fats because trans fats made the oils more stable and thus allowing for longer frying usage. In the present study, oil performance, sensory evaluation and nutritional analysis was conducted on trans fat-free oils through a 10-day degradation process using French fries to break down the oil. The goal of the study was to test oil stability and nutrition analysis and to learn consumer preference between trans fat and trans fat-free oils. Sensory evaluation indicated a preference for fries composed from trans fat-free oil mixtures. The most stable oils were also combination oils. Based on these findings, industry representatives considering using the trans fat-free frying oils should consider using blended oils instead, which met customers’ taste preference and minimized oil rancidity and usage.     

A controlled intervention study of changing health-providers' attitudes toward personal lifestyle habits and health-promotion skills

ObjectiveData regarding health providers' personal lifestyle and the differential effect of a short-term personal lifestyle experience intervention program on health providers are limited.MethodsWe conducted a controlled study aimed at changing personal attitudes toward lifestyle habits among 323 health professionals: 136 (42%) physicians, 140 (43%) dietitians, and 47 (15%) nurses and health promoters. In the intervention group (n = 209) individuals participated in a 2-d intensive self-experience workshop in an isolated location emphasizing healthy lifestyle and behavior-modifying techniques. Intervention and control groups were followed for 6 mo.ResultsAt baseline, avoidance of salt, trans-fatty acids, saturated fats, and processed meat was more frequent among dietitians (P < 0.05 versus physicians). The physicians reported a lower intake of olive/canola oil, nuts/almonds, dietary fibers, vegetables, and fruits (P < 0.05). Furthermore, physicians reported lower confidence in lifestyle primary prevention and felt less useful engaging in health-promotion activities (P < 0.05 versus other health professionals). After 6 mo, waist circumference decreased in the intervention group (?1.3 versus +1.8 cm in control group, P < 0.01). The effect was more prominent among physicians. A modest differential effect of the intervention program was shown in health-promotion activities.ConclusionApproaches toward primary prevention can be improved by an intervention program focusing on personal changes of health care providers. Physicians who are less likely to personally adhere to and believe in lifestyle primary prevention are more likely to benefit from this platform.     

Race, Homelessness, and Other Environmental Factors Associated with the Food-Purchasing Behavior of Low-Income Women

Observance of the hunger-obesity paradox in urban Minnesota has ignited interest in the quality of low-income households' food purchases. This cross-sectional study investigated low-income, urban Minnesotan women's past-month food purchases and their associations with race, homelessness, and aspects of the food system, including food shelf (ie, food pantry) and food store usage, factors believed to influence food choice and grocery shopping behavior. The survey included demographics, the US Department of Agriculture's 18-item Household Food Security Survey Module, and grocery shopping questions related to food purchases and food stores visited in the past month. Participants were a convenience sample of 448 low-income, urban Minnesotan women, and data were collected from February through May 2008. The sample was 44% African American, 35% American Indian, 10% white, and 11% other/mixed race; 37% were homeless. Rates of “less healthy” food group purchases were higher compared to “healthy” food group purchases. Significant racial differences were found with respect to purchasing healthy protein food groups (P<0.05 to P<0.01) but not fruits, vegetables, or whole grains. Homelessness reduced the odds of purchasing most food groups, regardless of nutrient density (P<0.05 to P<0.001). Food shelf and food store usage mainly increased the odds of purchasing “less healthy” food groups (P<0.05 to P<0.01). These findings may help registered dietitians strategize with low-income, urban women how to make best use of food resources within their local food system.     

Changes in Mean Intake of Fatty Acids and Intake of Saturated and trans Fats from Potatoes: NHANES 2005–2006, 2007–2008, and 2009–2010

Studies have shown that higher than usual intakes of trans fatty acids (TFAs) have adverse effects on blood lipids. Because of this, in 2006 the US FDA mandated labeling of TFAs on food packages. The food and restaurant industries, including the potato industry, reformulated their foods to reduce or eliminate partially hydrogenated vegetable oils and TFAs. Before mandatory labeling, grain-based desserts, yeast breads, and French-fried potatoes (FFPs) were the top sources of TFAs in the food supply; by 2007, potato food manufacturers and quick-service restaurants had reduced or eliminated TFAs without increasing saturated fatty acids (SFAs). FFPs are no longer a source of TFAs in the food supply. This study examined energy and fatty acid intake among children aged 6–11 y, adolescents aged 12–18 y, and adults aged ≥19 y across 3 time periods by using data from the NHANES 2005–2006, 2007–2008, and 2009–2010. On average, intakes of total energy, total fat, SFAs, and monounsaturated fatty acids (MUFAs) decreased significantly between 2005–2006 and 2009–2010 among children and adolescents; however, the intake of polyunsaturated fatty acids (PUFAs) did not change. Among adults, intakes of total fat, SFAs, and MUFAs decreased; however, total energy and PUFA intake did not change. On the day of the 2009–2010 survey, ∼13% of children and 10% of adolescents reported consuming fried FFPs, whereas <7% of adults reported consumption of fried FFPs. Intakes of SFAs and TFAs from fried FFPs decreased significantly between 2005–2006 and 2009–2010 among children, adolescents, and adults. This study confirms that intake of TFAs from FFPs is trivial.     

Fatty Acid Composition of Commercial Spanish Fast Food and Snack Food

Fatty acid composition, total fat contents and percentages of saturated (SFA), monounsaturated (MFA), polyunsaturated (PUFA) and trans isomers of fatty acids (t FA) were analysed in commercial Spanish fast food and snack food by capillary gas chromatography (CGC) using a capillary column. The results obtained show a great variability in the percentages of fatty acids (g/100 g total fatty acids) but generally there is a high proportion of saturated fatty acids (from 12.3 in popcorn to 65.8% in ice creams) and monounsaturated fatty acids (from 23.7 in snacks of cheese to 42.8% in hamburgers with a low proportion of trans isomers (from 0.1 in snacks of cheese to 46.0% in popcorn (microwave)) and polyunsaturated fatty acids (from 1.6 in popcorn (microwave) to 51.4% in popcorn).Our results show that commercial Spanish fast food and snack food have a high proportion of saturated fatty acids especially hamburgers, pizzas, ice creams, cakes with cover, biscuits, donuts, and snacks of cheese. The source of these saturated fatty acids in the fat fraction was basically animal fats, coconut oil, palm kernel oil and palm oil.     

Fatty Acid Composition of Margarines and Cooking Fats Available on the Czech Market

In a series of 20 margarines, nine cooking fats, and butter, the fatty acid composition was determined after the American Oil Chemistry Society (AOCS) standard method using capillary gas chromatography. Margarines contained 15.2–54.1% and cooking fats 16.5–59.1% saturated fatty acids, respectively, which was less than in butter. The content of linoleic fatty acid varied between 3.7 and 52.4% in margarines, and small amounts of linolenic acid were present in most samples. Oleic acid prevailed in cooking fats. Monoenoic trans -fatty acids were present only in traces in 10 samples, trans -polyenoic acids were present only in small amounts. Most cooking fats had high contents oftrans -unsaturated fatty acids. The number of free- trans margarines has rapidly increased in a few years.     

The Macronutrient Content of Sodium-Modified Foods Is Unchanged Compared with Regular Counterparts: An Evaluation of Select Categories of Packaged Foods in the United States, 2018

BackgroundLowering excess sodium in packaged foods is part of a public health strategy to reduce cardiovascular disease risk. Sales of foods with labeled sodium claims increased during the past decade. Yet, it is unclear whether sugars or fats were added during the reformulation of foods that might counter the benefits of sodium reduction.ObjectiveIt was hypothesized that the nutrient content of packaged foods with lower sodium label claims (ie, sodium-modified) would differ from their regular (ie, unmodified) counterparts.DesignThis cross-sectional study compared label data of 153 sodium-modified foods and 141 regular, matched counterparts within four food categories: soups, processed meats, vegetables, and savory snacks. Foods were identified by searching manufacturer websites of the top-10 brands in each category. Sodium, calories, total carbohydrate, sugar, protein, total fat, saturated fat, and potassium (when reported) were compared by labeled serving and per 100 g food.ResultsThe average amount in milligrams of sodium per serving in regular foods ranged from 162 mg for savory snacks to 782 mg for soups. Compared with regular foods, the matched lower sodium foods had significantly less sodium per serving (–95 to –387 mg) and per 100 g (–184 to –462 mg) (P<0.01 for all comparisons), except for soups per 100 g (P = 0.166), and were similar to their regular counterparts in calories, total carbohydrate, sugar, protein, total fat, and saturated fat (P>0.05 for all comparisons). Of the soups that reported potassium on the label, potassium was 244 mg/serving (P=0.004) and 139 mg/100 g (P=0.002) higher among matched lower sodium soups.ConclusionsThe similarity in macronutrient contents on the labels for sodium-modified foods and their regular counterparts suggests that reformulation did not include the addition of significant amounts of sugars, fats, or other macronutrients among major food brands in the selected categories. Potassium content and additional food categories deserve further investigation.     

Trends in Dietary Intake among US 2- to 6-Year-Old Children, 1989-2008

BackgroundBetween 1989 and 2008, obesity increased markedly in children of all ages. We examined changes in the diets of children ages 2 to 6 years in the United States between 1989 and 2008. Our study provides new insight into diet changes that might have contributed to the sharp rise in obesity during this period.ObjectiveOur aim was to describe changes in diet among 2- to 6-year-old children from 1989 to 2008 related to sharp rises in obesity during this period.ParticipantsThis analysis included 10,647 children ages 2 to 6 years from the following five nationally representative surveys of dietary intake in the United States: Continuing Survey of Food Intake in Individuals 1989-1991 and 1994-1998 and the What We Eat In America, National Health and Nutrition Examination Surveys 2003-2004, 2005-2006, and 2007-2008. Diet data were categorized into groupings using the University of North Carolina-Chapel Hill approach.Statistical analysesAnalyses were carried out using a single 24-hour dietary recall with appropriate survey weighting. T tests were used to compare means across survey years, with P<0.05 considered significant.ResultsDuring the 20-year period, there were increases in per capita intake of savory snacks (+51 kcal; P<0.01), pizza/calzones (+32 kcal; P<0.01), sweet snacks and candy (+25 kcal; P<0.01), mixed Mexican dishes (+22 kcal; P<0.01), and fruit juice (+18 kcal; P<0.01), and total daily energy intake increased by 109 kcal (from 1,475 to 1,584 kcal) (P<0.05). Fruit intake increased marginally (+24 kcal; P<0.01). Six of the 10 greatest absolute changes in per capita intake between sequential survey years occurred between Continuing Survey of Food Intake in Individuals 1994-1998 and National Health and Nutrition Examination Surveys 2003-2004 (P<0.05).ConclusionsFoods high in added sugars and solid fats, such as savory snacks, pizza/calzones, mixed Mexican dishes, sweet snacks and candy, and fruit juice, predominated the top changes in per capita consumption between 1989 and 2008.     

The 2006–2007 Food Label and Package Survey (FLAPS): Nutrition labeling,trans fat labeling

Since the 1970s, the Center for Food Safety and Applied Nutrition at the United States (US) Food and Drug Administration (FDA) has studied product labels from the US food supply through the Food Label and Package Survey (FLAPS). The sampling frame for the latest survey, FLAPS 2006–2007, was the ACNielsen Strategic Planner food sales database. As the newest addition to the Nutrition Facts label, this latest FLAPS included trans fat and was utilized to characterize the prevalence of foods reporting trans fat information. For this survey, FDA used a new probability-based sample design to draw a list of food products. Products were purchased from retail stores across the US, and label information was recorded to create the FLAPS 2006–2007 database. Results of initial data analyses show that an estimated 96.3% of FDA-regulated processed, packaged foods have nutrition labeling, with an additional 3.7% exempt from mandatory nutrition labeling requirements. FLAPS data show that 12% of products provide a nutrient content claim about the amount of trans fat on the principal display panel, with over 75% displaying “0 g trans fat.” FDA will continue to analyze FLAPS data as a tracking mechanism to monitor the market response to food label regulations and to support policy, regulatory, economic, and food safety decisions.     

Food Label Use and Its Relation to Dietary Intake among US Adults

Rates of diet-related chronic disease combined with the lack of current data on patterns of food label use by the US population warrant re-examination of the use and potential influence of this public health tool. The purpose of this study was to describe the prevalence of food label use and the association between food label use and nutrient intake in a nationally representative sample of US adults who participated in the 2005-2006 National Health and Nutrition Examination Survey. Data on food label use were collected during the interview portion of the survey, and nutrient intake was estimated using the average of two 24-hour dietary recalls. In this sample, 61.6% of participants reported using the Nutrition Facts panel, 51.6% looked at the list of ingredients, 47.2% looked at serving size, and 43.8% reviewed health claims at least sometimes when deciding to purchase a food product. There were significant differences (P<0.05) in food label use across all demographic characteristics examined. Significant differences (P<0.05) in mean nutrient intake of total energy, total fat, saturated fat, cholesterol, sodium, dietary fiber, and sugars were observed between food label users and non-users with label users reporting healthier nutrient consumption. The greatest differences observed were for total energy and fat and for use of specific nutrient information on the food label. Despite food label use being associated with improved dietary factors, label use alone is not expected to be sufficient in modifying behavior ultimately leading to improved health outcomes.     

Relationships of Self-Reported Dietary Factors and Perceived Acne Severity in a Cohort of New York Young Adults

BackgroundRecent observational and experimental evidence suggests that diet may contribute to acne prevalence.ObjectivesTo examine the differences in select dietary factors (glycemic index [GI], total sugar, added sugar, fruit/fruit juice, fruit/vegetables, vegetables, saturated fat, trans fat, and number of milk and fish servings perday) between groups of self-reported acne severity. Secondary objectives were to investigate the differences in food-aggravated acne beliefs and acne-specific quality-of-life between groups of self-reported acne severity.DesignThis study utilized a cross-sectional design.Participants/settingA total of 248 (115 male, 133 female) participants, age 18 to 25 years, completed questionnaires designed to measure self-reported acne severity, select dietary factors, food-aggravated acne beliefs, acne-specific quality-of-life, and anthropometric and demographic characteristics. The Block fat/sugar/fruit/vegetable food frequency questionnaire assessed usual dietary intake. Data were collected in New York City between January and May 2012.Statistical analyses performedOne-way between groups analysis of variance examined differences in dietary factors, anthropometric characteristics, and acne-specific quality-of-life between groups of self-reported acne. χ² tests compared food-aggravated acne beliefs and demographic characteristics between groups of self-reported acne.ResultsCompared with participants with no or mild acne, participants with moderate to severe acne reported greater dietary GI (P<0.001), added sugar (P<0.001), total sugar (P<0.001), number of milk servings per day (P<0.001), saturated fat (P<0.001), and trans-fatty acids (P<0.001), and fewer servings of fish per day (P=0.002). Among all participants, 58.1% perceived diet to aggravate or influence acne.ConclusionsThis study suggests that diet, particularly dietary GI, saturated fat, trans fat, milk, and fish may influence or aggravate acne development. Future research is necessary to elucidate the proposed mechanisms linking diet and acne and determine the impact of medical nutrition therapy on acne development.     

Dietary Total Antioxidant Capacity Is Associated with Diet and Plasma Antioxidant Status in Healthy Young Adults

Dietary total antioxidant capacity (TAC), based on the cumulative antioxidant activities of all the antioxidants present in food, has been shown to be inversely associated with risks of chronic diseases. However, dietary TAC has not been validated for its relevance in a healthy young population or for reliability and predictability for antioxidant status. Our study aimed to validate TAC as a tool in assessing antioxidant intake and to investigate whether dietary TAC predicts plasma antioxidant status in a healthy young population. Sixty healthy, nonsmoking college students at the University of Connecticut ages 18 to 25 years were recruited. Thirty-day food records and two 12-hour fasting blood samples were collected for dietary and plasma antioxidant assessments. After adjustment for total energy intake, TAC from diet and supplement was positively correlated with intakes of carotenoids (P<0.01), beta carotene (P<0.05), β-cryptoxanthin (P<0.05), flavonoids (P<0.0001), isoflavones (P<0.01), flavan-3-ols (P<0.01), flavones (P<0.05), and flavonols (P<0.0001). Dietary TAC was an independent predictor of plasma TAC determined by vitamin C equivalent antioxidant capacity (P<0.01) and by ferric-reducing ability of plasma (P<0.0001), plasma glutathione peroxidase (P<0.01), red blood cell glutathione peroxidase (P<0.05), α-tocopherol (P<0.05), and lutein (P<0.05). Results were similar for TAC from diet sources only. The findings suggest that dietary TAC is a good predictor of dietary and plasma antioxidant status in this sample of young adult men and women.     

Grasas de la dieta y salud cardiovascular

Although dietary fat and its role in cardiovascular prevention has been one of the most extensively studied nutritional topics, it continues to be an ever-expanding research area. Particularly thanks to studies on Mediterranean diet, we now know that fat quality is more relevant than the amount of fat we eat in the diet. Thus, saturated and trans fats have been found to increase the risk of atherogenic disease. This is why it is recommended to substitute complex carbohydrates or unsaturated fat for unsaturated and trans fats with the aim of reducing saturated and trans fat intake to <10% and <1%, respectively, of the total calorie intake. Recent population studies, particularly that conducted in Kuopio, Finland, and those on Mediterranean diet, stress the important role of monounsaturated and polyunsaturated fats as key nutrients in preventing cardiovascular disease in modern societies. Furthermore, a special type of polyunsaturated fatty acids, i.e. those of the omega-3 (n-3) series, is increasingly becoming essential nutrients for a healthy diet, especially in the case of children. Therefore, there is a rationale for four the Scientific Societies that are strongly committed to disseminate the benefits of a healthy diet in preventing cardiovascular disease, and to prepare a joint statement with the purpose of spreading improved knowledge on the importance of changing to a healthy diet with a well-balanced fat intake for industrialized populations. Accordingly, a multidisciplinary panel of experts from the following institutions has developed the present joint statement targeted at both adults and children of different ages: Spanish Society of Arteriosclerosis, Spanish Society of Family and Community Medicine, Spanish Association of Paediatrics, Spanish Society of Gastroenterology, Hepatology and Paediatric Nutrition and Dietetics, and Spanish Society for Food Sciences.     

Optimizing dietary fat in a weight-loss trial requires advice based on a structured “whole-of-diet” model

Dietary trials may link macronutrient intakes to health outcomes, but adherence to dietary targets requires advice based on an understanding of food composition and consumption patterns. Using data from a weight loss trial, we hypothesized that structured advice would be required for significant fat modification to occur. We compared participants' food choice patterns in response to advice based on a structured “whole-of-diet” model vs a general approach to healthy eating. Overweight participants (n = 122) were randomized to 2 advice arms (saturated fat [SFA] < 10% energy [E]): (1) general low fat (LF) control—(a) isoenergy, (b) −2000 kJ; and (2) structured LF high polyunsaturated fat (PUFA) (∼10% energy PUFA; PUFA to SFA ratio ≥1) (LF-PUFA)—(a) isoenergy, (b) −2000 kJ. Intakes of E and fat and fat from food groups (percentage of total fat intake) were compared at baseline, 3 months, P < .05. Baseline diets were similar, with most fat from high-SFA foods (59%): meat and milk-based staple meals and high-fat snacks. By 3 months, all groups reduced E and met the SFA target. Polyunsaturated fat targets were met by the LF-PUFA groups only (P < .001), enabling targeted between-group differences. In response to general advice, LF groups simply switched to LF alternatives of the same foods (P < .05). In comparison, LF-PUFA groups shifted fat intake to high-PUFA choices (54%), consuming more fat than controls from nuts (P < .001), whole grains (P < .001), and oils and spreads (P < .05). Significant reductions in E were achieved regardless of advice, but significant shifts in dietary fat profile relied on structured whole-of-diet advice on a range of meal and snack food sources of fat subtypes.     

“Healthy”/“Unhealthy” Food Brands Influence Health,Calorie, and Price Ratings of Food

ObjectiveTo assess the effect of healthy or unhealthy food brands on consumer ratings of a food's perceived healthfulness, caloric content, and estimated price.MethodsUsing a crossover design, 35 adults aged 18–25 years scored a variety of healthy and unhealthy foods paired with “healthy” or “unhealthy” brands or with no brand present, on their healthfulness, caloric content, and estimated price. For each outcome measure, ANOVA was used to evaluate the effect of brand condition on healthy and unhealthy foods.ResultsPairing an unhealthy food with a “healthy brand” led to increased ratings of healthfulness (P < .001), decreased estimates of caloric content (P < .001), and increased price (P < .001). Pairing a healthy food with an “unhealthy brand” led to decreased ratings of healthfulness (P < .001), increased estimates of caloric content (P < .001), and decreased price (P < .001).Conclusions and ImplicationsThese findings extend previous research showing that brands may influence perceptions of food products. Future studies are needed to understand the implications of pairing healthy foods with “unhealthy brands” on actual food intake.     

Change in Food Choices Following a Glycemic Load Intervention in Adults with Type 2 Diabetes

The glycemic index (GI) reflects the postprandial glucose response of carbohydrate-containing foods, and adoption of a lower-GI diet may be beneficial in diabetes management. The purpose of this study was to evaluate change in food-group intake by participants after completing an intervention that included instruction about carbohydrate and the GI using a quasi-experimental design. Recruitment occurred from February to August 2005 and September to December 2006. Individuals 40 to 70 years old with type 2 diabetes for 1 year or longer were randomly assigned to an immediate (n=55) or delayed (n=48) treatment group. A 9-week group-based intervention regarding the quantity and type of carbohydrate for diabetes management was provided. Three sets of 24-hour dietary recalls were used to assess food-group intake. Foods were divided into nine main food groups and 166 subgroups based on the Dietary Guidelines for Americans 2005 and the United States Department of Agriculture's Food Guide Pyramid. Analysis of variance was used to examine between-group differences and paired t test compared maintenance of change for the immediate group. Change in dietary GI was significantly different between groups upon completion of the intervention by the immediate group (P<0.05). Participants consumed significantly more servings of whole fruit and nonfat dairy products following the intervention and fewer servings of vegetable fats (all P<0.05). Only whole-fruit consumption significantly declined in the immediate group during the maintenance period (P<0.05). Nutrition education can facilitate adoption of a lower-GI diet among free-living people with diabetes. Maintaining dietary change likely requires further intervention and support.     

Home Food Environment in Relation to Children’s Diet Quality and Weight Status

The objective of this cohort study was to explore relationships among the home food environment (HFE), child/parent characteristics, diet quality, and measured weight status among 699 child-parent pairs from King County, WA, and San Diego County, CA. HFE variables included parenting style/feeding practices, food rules, frequency of eating out, home food availability, and parents’ perceptions of food costs. Child dietary intake was measured by 3-day recall and diet quality indicators included fruits and vegetables, sweet/savory snacks, high-calorie beverages, and Dietary Approaches to Stop Hypertension (DASH) score. Individual linear regression models were run in which child BMI z score and child diet quality indicators were dependent variables and HFE variables and child/parent characteristics were independent variables of interest. Fruit and vegetable consumption was associated with parental encouragement/modeling (β=.68, P<0.001) and unhealthful food availability (−0.27, P<0.05); DASH score with food availability (healthful: 1.3, P<0.01; unhealthful: −2.25, P<0.001), food rules (0.45, P<0.01), and permissive feeding style (−1.04, P<0.05); high-calorie beverages with permissive feeding style (0.14, P<0.01) and unhealthful food availability (0.21, P<0.001); and sweet/savory snacks with healthful food availability (0.26, P<0.05; unexpectedly positive). Children's BMI z score was positively associated with parent's use of food restriction (0.21, P<0.001), permissive feeding style (0.16, P<0.05), and concern for healthy food costs (0.10, P<0.01), but negatively with verbal encouragement/modeling (−0.17, P<0.05), and pressure to eat (−0.34, P<0.001). Various HFE factors associated with parenting around eating and food availability are related to child diet quality and weight status. These factors should be considered when designing interventions for improving child health.