Sociodemographic and Psychosocial Factors Associated With Diet Quality in 6 Rural Native American Communities

ObjectiveTo identify psychosocial and household environmental factors related to diet quality among Native Americans (NA).DesignAnalysis of baseline data from a community-randomized obesity prevention trial.SettingSix rural NA communities in the Midwest and the Southwestern US.ParticipantsA total of 580 tribal members, aged 18–75 years old (mean 45 years), 74% female, self-identified as the main household food purchaser.Variables MeasuredDiet quality (Healthy Eating Index–2015 [HEI]) was derived from a semiquantitative food frequency questionnaire. Sociodemographic, psychosocial, and home food environment factors were assessed via interviewer-administered questionnaires.AnalysisOne-way ANOVA, linear regression models, and 2-tailed t tests compared HEI scores among sociodemographic categories. Multiple linear regression models assessed the relationship between psychosocial factors, home food environment, and HEI.ResultsPrevalence of obesity was 59%. Mean HEI–2015 score was 49.3 (SD = 8.1). Average HEI scores were 3.0 points lower in smokers than nonsmokers (P < 0.001), and 2.2 points higher in females than males (P < 0.01). Higher self-efficacy (β = 0.97; P < 0.001) and healthier eating intentions (β = 0.78; P < 0.001) were positively associated with HEI. Healthier household food patterns score was associated with higher HEI (β = 0.48; P < 0.01).Conclusions and ImplicationsPsychosocial factors were associated with diet quality, a finding that supports the use of social-cognitive intervention approaches in rural NA communities in the Midwest and Southwest, and warrants evaluation in other locations. There remains a need to elucidate the association between the Food Distribution Program on Indian Reservations and diet quality.     

Food Skills: Associations With Diet Quality and Food Waste Among Canadian Parents

ObjectiveTo examine the association between self-reported food skills and diet quality along with measured food waste among a sample of Canadian parents.DesignCross-sectional data from surveys to assess food skills, 3-day food records to assess the Healthy Eating Index (HEI)-2015, and food waste measured by household waste audits.SettingGuelph-Wellington, Ontario.ParticipantsParents (n = 130) with children aged 2–8 years.Main Outcome MeasuresHEI-2015 scores, daily per capita avoidable and unavoidable food waste (grams).AnalysisLinear regression using generalized estimating equations to determine unstandardized β estimates of associations between food skills and dependent variables. Models were adjusted for multiple testing, gender, and level of education.ResultsFood safety knowledge for cooking hot foods (β = 4.3, P = 0.05), planning (β = 4.5, P = 0.001), and conceptualizing food (β = 4.0, P = 0.03) were positively associated with HEI-2015 scores. Knowledge related to best before dates (β = 25.3, P = 0.05; β = 12.1, P = 0.04), conceptualizing food (β = 34.1, P = 0.01; β = 13.8, P = 0.02), and mechanical techniques (β = 39.2, P = 0.01; β = 20.5, P = 0.004) were associated with more avoidable and unavoidable food waste, respectively.Conclusions and ImplicationsAddressing higher-level food skills with a focus on efficient food preparation practices that make use of all edible portions of foods could play an important role in minimizing food waste and improving diet quality. Additional research in other countries and in a larger, more socioeconomically diverse sample is needed to confirm these findings.     

Predicting Intentions to Eat a Healthful Diet by College Baseball Players: Applying the Theory of Planned Behavior

ObjectiveTo assess factors important to college baseball players regarding intention to eat a healthful diet within the Theory of Planned Behavior.DesignA survey based on the Theory of Planned Behavior was administered during the 2006 summer league season from 5 of the Northern Division teams of the Coastal Plain League.ParticipantsMale undergraduate college baseball players (mean [standard deviation (SD)] age 20.25 [1.12]).Phenomenon of InterestPrediction of behavioral intention to eat a healthful diet.AnalysisRegression analysis was used to assess how well the variables of the Theory of Planned Behavior predicted behavioral intention to eat a healthful diet.ResultsAttitude, subjective norms, and perceived behavior control variables accounted for 72% of the variance in behavioral intention to eat a healthful diet. Attitude had the greatest influence on intention (β = .383, P < .001), followed by subjective norms (β = .291, P < .001), and perceived behavioral control (β = .269, P < .001). Athletes' daily schedule and their perception of the impact of a healthful diet on their focus and concentration had the biggest impact on intention to eat healthful food.Conclusions and ImplicationsUniversity athletic administration must emphasize providing access to healthful food, especially during the season, both at home and while traveling to games.     

Healthy Food Density is Not Associated With Diet Quality Among Pregnant Women With Overweight/Obesity in South Carolina

ObjectiveExamine the association and moderating effect of residential location (urban/rural) on the relationship between neighborhood healthy food density and diet quality.DesignCross-sectional analysis of baseline data from the Health in Pregnancy and Postpartum study, a randomized trial designed to prevent excessive gestational weight gain.ParticipantsPregnant women in South Carolina with prepregnancy overweight/obesity (n = 228).Main Outcome MeasuresHealthy Eating Index–2015 (HEI) was used to measure diet quality from 2 24-hour dietary recalls. The HEI total scores and 11 binary HEI components (those that met the standard for maximum component score vs those that did not) were calculated as dependent variables.AnalysisMultiple linear and logistic regression models were used to examine the association between healthy food density and HEI total scores and meeting the standards for maximum component scores. Healthy food density × residential location tested for moderation. P < 0.05 indicated significance.ResultsParticipants’ diet quality was suboptimal (mean, 52.0; SD, 11.7; range, 27–85). Healthy food density was not significantly related to HEI total scores or components, and residential location was not a moderator.Conclusions and ImplicationsDiet quality was suboptimal, and there was no relationship between healthy food density and diet quality among Health in Pregnancy and Postpartum study participants. These data support examining behavioral factors that could influence diet quality.     

Diet Quality of Frequent Fast-Food Consumers on a Non-Fast Food Intake Day Is Similar to a Day with Fast Food,What We Eat in America,NHANES 2013-2016

BackgroundFrequent fast food (FF) consumers may make more healthful food choices at eating occasions without FF. However, it is not clear if poor diet quality of frequent FF consumers is a function of FF consumption or less healthful food choices overall.ObjectiveThe objective of this study was to compare diet quality, energy, and nutrient intakes of infrequent FF consumers (INFREQ) with that of frequent FF consumers on an intake day with FF (FREQ-FF) or without FF (FREQ_NO FF).DesignThis study is a cross-sectional analysis of 1 day dietary intake data from What We Eat in America, National Health and Nutrition Examination Survey 2013-2016, the dietary intake component of National Health and Nutrition Examination Survey.Participants/settingParticipants included adults aged 20 years and older (N = 4,012), who, during the previous 7 days, reported no consumption of FF or pizza (n = 2,142 INFREQ) or reported FF or pizza three or more times and either had FF/pizza (n = 1,455 FREQ_FF) or did not have FF/pizza (n = 415 FREQ_NO FF) on the intake day.Main outcome measuresMain outcomes were energy, nutrient density (nutrient intake per 1,000 kcal), and diet quality evaluated using Healthy Eating Index (HEI) 2015.Statistical analyses performedGroup comparisons were made using t tests. Differences were considered significant at P < 0.001.ResultsCompared with INFREQ consumers, FREQ_FF consumers had higher intakes of energy and fat per 1,000 kcal, lower scores for total HEI and most components, and lower nutrient densities of most micronutrients (P < 0.001). HEI component scores of INFREQ consumers for vegetables, fruit, whole grains, and added sugars were higher than FREQ_FF consumers (P < 0.001). Energy intake, most nutrient densities, and total HEI and component scores of FREQ_NO FF consumers were not significantly different from FREQ_FF consumers with the exception of fruit but were different from INFREQ consumers for some nutrients and HEI components.ConclusionsResults suggest diet quality and nutrient intake of frequent FF consumers on a non-FF intake day is not markedly different from a day with FF.     

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.     

Breakfast eating pattern and its association with dietary quality indices and anthropometric measurements in young women in Isfahan

ObjectiveTo assess the association between consuming or skipping breakfast and dietary quality indices such as the Healthy Eating Index (HEI), the Dietary Diversity Score (DDS), diversity scores of different food groups, and anthropometric measurements in young Isfahanian women.MethodsWomen 18 to 28 y old were selected randomly from among university students (n = 411) in Isfahan, Iran. A validated semiquantitative questionnaire was used to assess dietary intake. Five food groups of the Food Guide Pyramid were considered for calculating the DDS and diversity score of the food groups. Subjects were categorized based on consuming or skipping breakfast. The HEI was calculated based on 10 components including the five food groups, different fat and sodium intakes, and the DDS.ResultsBreakfast consumers versus skippers had higher scores for the HEI (66 ± 13 versus 47 ± 13, P = 0.001), the DDS (6.8 ± 1.2 versus 4.9 ± 0.7, P = 0.001), and the DDSs for fruits (1.3 ± 0.2 versus 0.9 ± 0.1, P = 0.001), vegetables (1.6 ± 0.2 versus 1.2 ± 0.1, P = 0.001), and whole grains (1.3 ± 0.2 versus 0.9 ± 0.1, P = 0.001). Also, eating breakfast was associated with lower values for dietary energy density (0.96 ± 0.25 versus 1.04 ± 0.40, P = 0.01), the body mass index (20.0 ± 1.8 versus 23.3 ± 2.7, P = 0.001), and waist circumference (69.2 ± 7.6 versus 72.5 ± 8.7, P = 0.001). There was a higher prevalence of breakfast consumers in the third tertiles of the HEI and DDS. However, there was a smaller percentage of breakfast consumers in the third tertiles of the body mass index and waist circumference.ConclusionsBreakfast consumption was associated with higher scores of the dietary quality indices and lower values for the body mass index and waist circumference in young Isfahanian women. Further studies should be performed to determine the relation between the kind of breakfast consumed and the dietary quality indices.     

Geographic disparities in Healthy Eating Index scores (HEI–2005 and 2010) by residential property values: Findings from Seattle Obesity Study (SOS)

BackgroundHigher socioeconomic status (SES) has been linked with higher-quality diets. New GIS methods allow for geographic mapping of diet quality at a very granular level.ObjectiveTo examine the geographic distribution of two measures of diet quality: Healthy Eating Index (HEI 2005 and HEI 2010) in relation to residential property values in Seattle-King County.MethodsThe Seattle Obesity Study (SOS) collected data from a population-based sample of King County adults in 2008–09. Socio-demographic data were obtained by 20-min telephone survey. Dietary data were obtained from food frequency questionnaires (FFQs). Home addresses were geocoded to the tax parcel and residential property values were obtained from the King County tax assessor. Multivariable regression analyses using 1116 adults tested associations between SES variables and diet quality measured (HEI scores).ResultsResidential property values, education, and incomes were associated with higher HEI scores in bivariate analyses. Property values were not collinear with either education or income. In adjusted multivariable models, education and residential property were better associated with HEI, compared to than income. Mapping of HEI–2005 and HEI–2010 at the census block level illustrated the geographic distribution of diet quality across Seattle-King County.ConclusionThe use of residential property values, an objective measure of SES, allowed for the first visual exploration of diet quality at high spatial resolution: the census block level.     

Food Insecurity Is Linked to a Food Environment Promoting Obesity in Households With Children

ObjectiveTo determine the extent to which the presence and accessibility of healthful and less healthful foods in children's homes vary with level of food security.MethodsA total of 41 parents or primary caregivers who had at least 1 child ages 2–13 and resided in a low-income area with limited food access completed a home food inventory and a validated measure assessing household food security.ResultsCompared with food-secure participants, marginal or low/very low food-secure caregivers reported significantly more obesity-promoting foods in the home, more microwavable or quick-cook frozen foods, and greater access to less healthful foods in the kitchen (all Ps < .05).Conclusions and ImplicationsGiven the greater presence and accessibility of less healthful foods, targeting home food environment may improve diet quality and health status in children of low-income, food insecure households.     

Mediterranean Diet,Healthy Eating Index 2005, and Cognitive Function in Middle-Aged and Older Puerto Rican Adults

Adherence to a Mediterranean diet has recently been shown to protect against cognitive decline and dementia. It remains unclear, however, whether such protection extends to different ethnic groups and middle-aged individuals and how it might compare with adherence to the US Department of Agriculture's 2005 Dietary Guidelines for Americans (measured with Healthy Eating Index 2005 [HEI 2005]). This study examined associations between diet quality, as assessed by the Mediterranean diet and HEI 2005, and cognitive performance in a sample of 1,269 Puerto Rican adults aged 45 to 75 years and living in the Greater Boston area of Massachusetts. Dietary intake was assessed with a food frequency questionnaire specifically designed for and validated with this population. Adherence to the Mediterranean diet was assessed with a 0- to 9-point scale, and the HEI 2005 score was calculated with a maximum score of 100. Cognitive performance was measured with a battery of seven tests and the Mini Mental State Examination was used for global cognitive function. Greater adherence to the Mediterranean diet was associated with higher Mini Mental State Examination score (P trend=0.012) and lower likelihood (odds ratio=0.87 for each additional point; 95% CI 0.80 to 0.94; P<0.001) of cognitive impairment, after adjustment for confounders. Similarly, individuals with higher HEI 2005 score had higher Mini Mental State Examination score (P trend=0.011) and lower odds of cognitive impairment (odds ratio=0.86 for each 10 points; 95% CI 0.74 to 0.99; P=0.033). In conclusion, high adherence to either the Mediterranean diet or the diet recommended by the US Department of Agriculture 2005 Dietary Guidelines for Americans can protect cognitive function in middle-aged and older adults.     

Diet- and Body Size-related Attitudes and Behaviors Associated with Vitamin Supplement Use in a Representative Sample of Fourth-grade Students in Texas

ObjectiveTo examine diet- and body size-related attitudes and behaviors associated with supplement use in a representative sample of fourth-grade students in Texas.DesignCross-sectional data from the School Physical Activity and Nutrition study, a probability-based sample of schoolchildren. Children completed a questionnaire that assessed supplement use, food choices, diet-related attitudes, and physical activity; height and weight were measured.SettingSchool classrooms.ParticipantsRepresentative sample of fourth-grade students in Texas (n = 5967; mean age = 9.7 years standard error of the mean [SEM] = .03 years, 46% Hispanic, 11% African-American).Main Outcome MeasuresPrevious day vitamin supplement consumption, diet- and body size-related attitudes, food choices, demographic factors, and physical activity.AnalysisMultivariable logistic regression models, P < .05.ResultsThe prevalence of supplement use was 29%. Supplement intake was associated with physical activity. Girls who used supplements were more likely to report positive body image and greater interest in trying new food. Relative to nonusers, supplement users were less likely to perceive that they always ate healthful food, although supplement use was associated with more healthful food choices in boys and girls (P < .001).Conclusions and ImplicationsThe widespread use of supplements and clustering of supplement use with healthful diet and greater physical activity in fourth graders suggest that supplement use be closely investigated in studies of diet–disease precursor relations and lifestyle factors in children.     

Parent Food and Eating Behavior Assessments Predict Targeted Healthy Eating Index Components

ObjectiveTo examine the ability of parent response to assessments of in-home availability of 20 fruits and vegetables (FV), self-efficacy/outcome expectancy to prepare FV that their child would eat, modeling of FV eating behavior, and eating competence to predict parents’ targeted Healthy Eating Index–2010 (HEI) scores at baseline.DesignCross-sectional survey.SettingSixty-one classrooms in 8 northern Colorado elementary schools over 4 years participating in Fuel for Fun (FFF), a school-based culinary and physical activity intervention.ParticipantsParents and guardians (n = 71) of fourth-grade youths from participating classrooms.Main Outcome Measure(s)Healthy Eating Index–2010 scores as derived from 24-hour recalls administered with the Automated Self-Administered 24-hour dietary assessment tool.AnalysisGeneralized linear regression models tested the predictive validity of survey assessments for targeted HEI components. Results were considered statistically significant at P ≤ .05.ResultsIn-home FV availability predicted total fruit (P = .01), whole fruit (P = .001), and total vegetable (P = .01) HEI, and parent modeling of FV eating behavior predicted total fruit (P = .01) and whole fruit (P = .02) HEI. However, these survey measures were not associated with other HEI components, including total HEI. Parent self-efficacy/outcome expectancy to prepare FV that their child would eat or like was not associated with total HEI or HEI components. Eating competence did not predict total HEI but was associated with seafood and plant proteins in the anticipated direction (P = .04).Conclusions and ImplicationsThe results demonstrated construct validation of some parent Fuel for Fun survey assessments with targeted HEI components. Additional assessment in larger and more diverse samples is warranted so that nutrition education and behavior researchers may use these valid and reliable, brief, low-cost, and easy-to-use survey instruments as a proxy for dietary intake.     

Determinants of Healthy Diet Among Children Exposed and Unexposed to Gestational Diabetes

ObjectivesTo evaluate the association between individual and environmental determinants of diet quality with diet quality of children exposed to gestational diabetes mellitus (GDM+) and unexposed (GDM?); to study the association between mother and child vegetables and fruit (VF) intakes.DesignCross-sectional study.ParticipantsOne hundred forty-two children (104 GDM+; 38 GDM?) aged 6.2 ± 2.5 years.VariablesCanadian Healthy Eating Index 2007 (HEI-C) and VF were obtained with 2 24-hour dietary recall questionnaires in children. Maternal VF was obtained by a validated food frequency questionnaire, and weight and height were measured. Sociodemographic determinants were obtained by questionnaires.AnalysisLinear regression models were used to evaluate the association between individual and environmental determinants and the HEI-C score with interaction for GDM status.ResultsFamily meals were associated with HEI-C among GDM? but not GDM+ children (β = 9.97, P = 0.01 and β = ?0.41, P = 0.84, respectively; P for interaction = 0.02). Children's age (β = ?1.45; 95% confidence interval, ?2.19 to ?0.72; P < 0.001) was a determinant of HEI-C among all children. Maternal VF intakes were positively associated with children's VF intake (r = 0.30, P < 0.001, r² = 0.09), with association of larger variance among GDM? children (r = 0.38, r² = 0.14, P = 0.02) than GDM+ children (r = 0.23, r² = 0.05, P = 0.02).ConclusionsThe food environment at home was associated differently with the diet quality of GDM+ and GDM? children. Whether targeting family meals and maternal diet quality is a good strategy to improve children's diet quality among GDM+ children needs to be further investigated.     

Culinary Nutrition Education Improves Home Food Availability and Psychosocial Factors Related to Healthy Meal Preparation Among Children

ObjectiveTo evaluate the effectiveness of a culinary nutrition education intervention on children's home food availability and psychosocial factors related to healthy meal preparation.DesignRandomized-controlled trial.SettingSchools in Kuala Lumpur, Malaysia.ParticipantsEighty-three school children aged 10–11 years and their parents.InterventionTwelve weeks of culinary nutrition education with 5 hands-on healthy meal preparation modules and a module with parents on home food availability (conducted every 2 weeks).Main Outcome MeasuresPsychosocial factors (knowledge, attitude, practice, and self-efficacy) related to healthy meal preparation and home food availability (fruits, vegetables, healthful foods, and less healthful foods) assessed via children and parents, respectively, using validated questionnaires at baseline, postintervention, and 3-month follow-up.AnalysisRepeated measures ANOVA.ResultsIntervention group had a higher (P < 0.001) mean knowledge score (mean difference, 1.2), attitude (mean difference, 2.6), practice (mean difference, 4.4) and self-efficacy (mean difference, 3.9) of healthy meal preparation as compared with control group across 3-time points. Improvements were seen in the availability of fruits (mean difference, 3.0; P < 0.001), vegetables (mean difference, 2.4; P < 0.001), healthful foods (mean difference, 1.5; P < 0.001) and less healthful foods (mean difference, ?0.9; P = 0.001), favoring the intervention group.Conclusion and ImplicationsCulinary nutrition education had positive impact on children's psychosocial factors and home food availability, demonstrating the potential to improve children's nutrition.     

Household Food Insecurity and Home Food Availability in Relation to Youth Diet,Body Mass Index,and Adiposity

BackgroundFood security status is related to food types available in the home, which may shape youth dietary patterns, with implications for obesity.ObjectiveInvestigate whether household food insecurity and home food availability (HFA) are associated with youth fruit and vegetable (F/V) consumption and anthropometric outcomes.DesignCross-sectional study. Youth and parents completed questionnaires during in-home visits (2013-2014). Research staff obtained anthropometric measures.Participants/settingMedical record data for 10- to 15-year-old Pennsylvania youths were used to identify 434 parent-youth dyads, with 408 evaluated after excluding missing data.Main outcome measuresParent-reported household food security was assessed with the six-item US Department of Agriculture Food Security Scale (dichotomized as high vs low). Healthy and obesogenic HFA scales assessed parent report of how frequently particular foods were present in the home. Youth self-reported daily average F/V consumption. Anthropometric outcomes included age- and sex-standardized z scores for body mass index (BMIz), waist circumference (WCz), and percent body fat (PBFz).Statistical analysesAssociations were evaluated with multivariable linear regression adjusted for youth age, sex, and race or ethnicity, and parent age and income.ResultsCompared with food secure counterparts, youth from food insecure households had higher mean (beta [standard error]) BMIz (.30 [.15]), WCz (.27 [.12]), and PBFz (.43 [.16]). Food insecure households had lower mean healthy HFA scores (?1.23 [.54]); there was no evidence obesogenic HFA differed between food secure and insecure households. Youth from lower healthy HFA or higher obesogenic HFA households reported fewer mean daily F/V servings (healthy HFA: .08 [.02]; obesogenic HFA: ?.06 [.02]). Food security status was not associated with F/V consumption, nor was there evidence HFA modified associations between food insecurity and anthropometric outcomes.ConclusionsDespite an observed association between healthy HFA and youth F/V consumption, this study did not provide evidence that HFA explained associations between food insecurity and youth anthropometric outcomes.     

Trimester-Specific Intuitive Eating in Association With Gestational Weight Gain and Diet Quality

ObjectiveTo examine the associations between intuitive eating and trimester-specific gestational weight gain (GWG), and between intuitive eating and diet quality at each trimester.DesignAt each trimester, participants completed the Intuitive Eating Scale-2 and 3 24-hour recalls from which the Healthy Eating Index was calculated. Trimester-specific GWG was calculated with interpolated weights.ParticipantsA total of 79 pregnant women.Main Outcome MeasuresIntuitive eating, GWG, and diet quality.AnalysisOne-way ANOVA was used to compare intuitive eating scores between GWG groups. Pearson correlation analyses were used to assess the association between the intuitive eating score and the Healthy Eating Index score.ResultsIn the first trimester, women within GWG recommendations had a higher total intuitive eating score compared with women above recommendations (3.9 ± 0.5 vs 3.6 ± 0.6; P = .04). The unconditional permission to eat subscale was associated with lower diet quality in the first trimester (r = –.26; P = .02) whereas the body–food choice congruence subscale was associated with better diet quality in the second and third trimesters (r = .26, P = .02 and r = .27, P = .01, respectively).Conclusions and ImplicationsThe researchers found an association between higher levels of intuitive eating and adequate first-trimester GWG. Further research might investigate whether promoting intuitive eating among pregnant women favors healthy GWG.     

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.     

Self-Efficacy for Healthy Eating Moderates the Impact of Stress on Diet Quality Among Family Child Care Home Providers

ObjectiveTo examine associations of stress and sleep with diet quality of family child care home (FCCH) providers, and whether self-efficacy for healthy eating influences these associations.DesignA cross-sectional analysis was performed using baseline data (2013–2015) from a randomized control trial with FCCH providers.ParticipantsThe study included 166 licensed FCCH providers, aged >18 years, from central North Carolina.Main Outcome Measure(s)Diet quality was assessed with a food frequency questionnaire, used to calculate a modified 2010-Healthy Eating Index score. Stress, sleep quality, and diet self-efficacy were measured via self-administered questionnaires.AnalysisUsing observations from 158 participants with complete data, multiple linear regression models were created to assess whether stress, sleep quality, and diet self-efficacy were associated with diet quality and whether diet self-efficacy moderated these associations (significance set at P < 0.05).ResultsIn the initial model, only diet self-efficacy was significantly associated with diet quality (β = 0.32; P < 0.001). Moderation analyses showed that higher stress was associated with lower diet quality, but only when diet self-efficacy was low.ConclusionsBuilding FCCH providers’ self-efficacy for healthy eating is an important component of health promotion and can buffer the impact of stress on their diet quality.     

Eating Earlier and More Frequently Is Associated With Better Diet Quality in Female Brazilian Breast Cancer Survivors Using Tamoxifen

BackgroundEmerging literature demonstrates that eating time and frequency are associated with quality and quantity of food consumption and anthropometric measurements. Considering that unhealthy dietary choices and obesity are important modifiable risk factors for breast cancer incidence and recurrence, this subject is relevant and has not been studied sufficiently in breast cancer survivors.ObjectiveThis study’s aim was to examine the association of eating time and frequency with diet quality, quantity of food consumption, anthropometric measurements, and body composition parameters in female breast cancer survivors using tamoxifen.DesignThis was a cross-sectional study.Participants/settingThis study was conducted from March 2015 to March 2016 at a Brazilian university hospital (Clinic’s Hospital, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil) and included an assessment of 84 female breast cancer survivors using tamoxifen (mean [SD] age was 53.1 [8.7] years).Main outcome measuresQuantitative dietary assessment consisted of three 24-hour dietary recalls. The Brazilian Healthy Eating Index Revised was used for the qualitative diet analysis. Participants were classified by median eating time (early or late eaters of breakfast, lunch, and dinner), as well as by considering the middle time point between the first and last meal of the day (early or late midpoint eaters). Participants were also classified by median eating frequency (<5 or ≥5 eating episodes per day). Anthropometric measurements and body fat percentage by bioelectrical impedance were obtained.Statistical analysisGeneralized linear models and generalized mixed models were used to assess the associations between variables.ResultsEarly breakfast and dinner eating and early midpoint eating were associated with better scores for specific Brazilian Healthy Eating Index Revised components (P < .05). Early breakfast and dinner eating were also associated with better scores for the total index (P = .035 and P = .017, respectively). Early dinner eaters and early midpoint eaters had significantly lower daily energy consumption (P = .007 and P = .002, respectively). Eating ≥5 episodes per day was also associated with better scores of specific Brazilian Healthy Eating Index Revised components and the total index (P < .05). No significant associations between eating time and frequency with anthropometric measurements and body composition parameters were found (P > .05). However, women in the healthy body mass index category vs women in the overweight/obesity category had higher energy consumption at breakfast (P = .046).ConclusionsEarlier food intake time was associated with better diet quality and lower daily energy consumption. Higher frequency of eating was also associated with better diet quality. Future studies, such as randomized controlled trials, are needed to evaluate interventions addressing the timing and frequency of meals and their effect on diet quality and quantity in breast cancer survivors.     

Recognition of Federal Dietary Guidance Icons Is Associated with Greater Diet Quality

Background

Although the purpose of federal dietary guidance is to improve eating habits, few studies have described awareness of guidance and concurrent diet quality.