Evaluation of Diet Quality Among American Adult Cancer Survivors: Results From 2005-2016 National Health and Nutrition Examination Survey

BackgroundDiet quality among adult cancer survivors is low, and there is minimal information on the Healthy Eating Index (HEI)-2015 score, a measure of diet quality and adherence to the 2015-2020 Dietary Guidelines for Americans, in this population.ObjectiveThis study aimed to examine HEI-2015 total and component scores and associated factors among adult cancer survivors. Also, this study examined which dietary components needed the most change to improve diet quality in this population.DesignThe National Health and Nutrition Examination Survey (NHANES) is an ongoing nationally representative population-based cross-sectional study that is conducted annually.Participants/settingIn all, 1971 adults with a self-reported cancer diagnosis in their lifetime (both individuals with cancer currently and those that are cancer-free) from NHANES 2005-2016 were included in this study.Main outcome measuresHEI-2015 total and 13 component scores were calculated using the simple scoring algorithm method from the average of 2 24-hour recalls.Statistical analysesThe associations of the HEI-2015 total score with sociodemographic, lifestyle, and health-related factors were analyzed using the least square means comparisons. A multivariable survey regression model was used to identify associations with the HEI-2015 total score after adjustment for potential confounders. The 13 component scores were also compared by participant characteristics to identify target food groups for subgroup-specific nutrition intervention.ResultsThe average HEI-2015 total score was 55.6 (95% confidence interval = 54.8-56.4). Factors associated with the HEI-2015 total score included age, race/ethnicity, education, smoking status, body mass index, and oral health status. Overall, poor adherence to the 2015-2020 Dietary Guidelines for Americans was found for most HEI-2015 components, with Whole Grains, Greens and Beans, Sodium, and Fatty Acids components having less than 50% of the maximum possible scores.ConclusionsResults indicate poor diet quality among American adult cancer survivors, with significant disparities observed across sociodemographic and lifestyle factors, particularly education levels, body mass index, and smoking status. Nutrition interventions for cancer survivors should consider focusing on improving diet quality by increasing intakes of whole grains and greens and beans, lowering sodium consumption, and achieving a healthy balance of fatty acids (ie, a favorable ratio of unsaturated fats to saturated fats).     

Differences in Dietary Quality by Sexual Orientation and Sex in the United States: NHANES 2011-2016

BackgroundThere are persistent disparities in weight- and diet-related diseases by sexual orientation. Lesbian and bisexual females have a higher risk of obesity and cardiovascular disease compared with heterosexual females. Gay and bisexual males have a higher risk of diabetes and cardiovascular disease compared with heterosexual males. However, it remains unknown how sexual orientation groups differ in their dietary quality.ObjectiveThis study aimed to determine whether dietary quality differs by sexual orientation and sex among US adults.DesignThis was a cross-sectional study of 24-hour dietary recall data from a nationally representative sample of adults aged 20 through 65 years participating in the 2011-2016 National Health and Nutrition Examination Survey.Participants/settingStudy participants were adults (n = 8,851) with complete information on dietary intake, sexual orientation, and sex.Main outcome measuresThe main outcome measures were daily energy intake from 20 specific food and beverage groups and Healthy Eating Index-2015 (HEI-2015) scores for sexual orientation groups (heterosexual vs gay/lesbian/bisexual).Statistical analyses performedOrdinary least squares regressions were used to calculate adjusted means for each food and beverage group and HEI-2015, stratified by sex and controlling for covariates (eg, age and race/ethnicity) and survey cycles (2011-2012, 2013-2014, and 2015-2016).ResultsAmong males, red and processed meat/poultry/seafood (P = .01) and sandwiches (P = .02) were smaller contributors to energy intake for gay/bisexual males compared with heterosexual males. Among females, cereals (P =.04) and mixed dishes (P = .02) were smaller contributors to energy intake for lesbian/bisexual females compared with heterosexual females. Gay/bisexual males had significantly higher total HEI-2015 scores than heterosexual males (mean ± standard deviation 53.40 ± 1.36 vs 49.29 ± 0.32, difference = 4.14; P = .004). Lesbian/bisexual females did not differ in total or component HEI-2015 scores from heterosexual females.ConclusionsAlthough gay/lesbian/bisexual groups were similar for a variety of dietary outcomes compared with heterosexual groups, gay and bisexual men displayed healthier dietary quality for processed meat (by consuming smaller amounts) and overall dietary quality (according to HEI-2015) compared with heterosexual males.     

The Diet Quality of a Sample of Predominantly Racial Minority Children From Low-Income Households Is Lower During the Summer vs School Year: Results From the Project Summer Weight and Environmental Assessment Trial Substudy

BackgroundLittle is known about the diet quality of racial minority children during the summertime when school is out of session and there is risk of accelerated weight gain. Project Summer Weight and Environmental Assessment Trial was an observational, prospective study exploring child weight status and health trends during the summer.ObjectiveThe objective of this substudy of Project Summer Weight and Environmental Assessment Trial was to examine the diet quality of elementary-aged racial minority children during the summertime vs school year.DesignThis observational, prospective substudy was conducted from June to September 2017.Participants/settingStudents in prekindergarten through fifth grade were recruited from 2 schools located in low-income urban neighborhoods of Columbus, OH, with a predominantly Black population. Sixty-two children (39 families) enrolled.Main outcome measuresTwenty-four-hour dietary recalls (2 weekdays, 1 weekend day) were collected at 3 time points: (1) beginning of summer (T0); (2) midsummer (T1); and (3) beginning of subsequent school year (T2). Healthy Eating Index (HEI)-2015 total and component scores were calculated to assess diet quality. Daily calories (kilocalories) and servings of types of foods within food groups were also assessed.Statistical analysesRepeated measures analysis of variance and Tukey’s post hoc analyses were performed.ResultsRetention was 76% (n = 47). Mean age was 7.0 ± 0.3 years, 79% (n = 37) were African American, and 58% of participants (n = 26) reported annual household incomes ≤$20,000. HEI-2015 total score was significantly lower during the summertime vs school year (P = .02). HEI-2015 component score for whole fruits (P = .04) was also lower in the summer vs school year, along with total vegetables (P < .001), greens and beans (P < .001) specifically, and legumes (P < .001). The HEI-2015 component score for added sugars (P = .04) was significantly lower in the summer vs the school year as well, indicating a higher intake of added sugars during the summer. On the other hand, whole grains were higher during the summer vs school year (P < .01), specifically snack chips (P = .03) and popcorn (P < .01). Total daily calories did not differ between the summertime vs school year.ConclusionsIn a small sample of predominantly racial minority school-aged children from low-income households, child diet quality is better during the school year vs summer. Future research is needed to determine if and to what extent summer vs school year diet quality may be associated with differences in weight status.     

Positive Change in Healthy Eating Scores Among Adults With Low Income After Expanded Food and Nutrition Education Program Participation

ObjectiveUsing 24-hour dietary recalls, compare Healthy Eating Index (HEI)-2005 scores of Expanded Food and Nutrition Education Program participants before and after 8–12 weekly lessons.DesignAnalysis of preexisting 24-hour dietary recalls information collected from October, 2012 through September, 2014.ParticipantsParticipants with complete pre-post dietary data (n = 122,961); subset of those with complete demographic data (n = 97,522).Main Outcome MeasuresChange in HEI-2005 scores (total and components).Statistical AnalysisLinear regression model fit separately for total HEI and 12 components. The response variable was changed in the HEI-2005 score; predictor variables included age, education, sex, and race/ethnicity.ResultsThe mean total HEI scores were 51.1 (SD, 13.7) at entry and 56.5 (SD, 13.7) at exit, with a change of 5.4 (SD, 16.2). Nine of 12 component scores increased. Changes were greater as age increased, with increasing education, and in women. Hispanics had the greatest improvement (mean ± SE) in total HEI score (8.3 ± 0.1).Conclusions and ImplicationsAlthough diet quality remained poor, participation in the Expanded Food and Nutrition Education Program resulted in improvement in dietary quality. The degree of improvements varied among demographic groups, but all groups improved.     

Weight Management Efforts,But Not Weight Perceptions,Are Associated with Dietary Quality among Youth and Young Adults in Canada

BackgroundEfforts to lose, gain, or maintain weight are prevalent among youth and young adults, but little is known about the relationship between weight management efforts and dietary quality. Attempts to manage weight are typically driven by weight perceptions, which may also uniquely affect overall diet.ObjectiveThe objective was to explore sex-stratified associations between weight management efforts and perceptions with dietary quality among youth and young adults.DesignCross-sectional online survey data were drawn from Wave 1 (2016) of the Canada Food Study.Participants/settingYouth and young adults (n = 3,000), aged 16 to 30 years, were recruited from community settings in five Canadian cities and completed the online survey. The analytic sample consisted of 2,040 participants.Main outcome measuresThe Healthy Eating Index-2015 (HEI-2015) was used to characterize dietary quality among participants who completed a 24-hour recall. Respondents reported their weight change efforts over the past year and their weight perception.Statistical analyses performedSex-stratified multiple linear regression analyses were conducted to investigate relationships between each of weight management efforts and perceptions, separately, and dietary quality, controlling for known covariates.ResultsThe HEI-2015 mean score was 52 of 100 possible points. Nearly one quarter of male and female respondents reported not trying to do anything about their weight, whereas 16% reported trying to maintain, 28% and 5% trying to gain, and 33% and 55% trying to lose weight, respectively. Most respondents (63% of males and 66% of females) perceived their weight as just about right. Among males, trying to gain or maintain weight were each significantly associated with higher HEI-2015 mean scores compared with not trying to manage weight (P < .01 and <.001, respectively), whereas this relationship existed only for weight maintenance among female respondents (P < .01). Weight perceptions and HEI-2015 mean scores were not significantly related.ConclusionsEfforts to manage weight, which are commonplace among youth and young adults, are associated with dietary quality. Future behavioral research may provide insights into strategies used by youth to manage weight, guiding interventions that recognize links among weight-related behaviors, dietary quality, and other determinants of health.     

Differences in Diet Quality between School Lunch Participants and Nonparticipants in the United States by Income and Race

Prior research has shown that participation in the United States’ National School Lunch Program (NSLP) is associated with consuming higher-quality lunches and diets overall, but little is known about differences by income and race/ethnicity. This analysis used 24 h dietary recall data from the School Nutrition and Meal Cost Study to examine how NSLP participation affects the diet quality of students in different income and racial/ethnic subgroups. Diet quality at lunch and over 24 h was assessed using the Healthy Eating Index (HEI)-2010, where higher scores indicate higher-quality intakes. HEI-2010 scores for NSLP participants and nonparticipants in each subgroup were estimated, and two-tailed t-tests were conducted to determine whether participant–nonparticipant differences in scores within each subgroup were statistically significant. NSLP participants’ lunches received significantly higher total HEI-2010 scores than those of nonparticipants for lower-income, higher-income, non-Hispanic White, and non-Hispanic Black students, suggesting that participating in the NSLP helps most students consume healthier lunches. These significantly higher total scores for participants’ lunch intakes persisted over 24 h for higher-income students and non-Hispanic White students but not for lower-income students or students of other races/ethnicities. For NSLP participants in all subgroups, the nutritional quality of their 24 h intakes was much lower than at lunch, suggesting that the positive influence of the NSLP on their overall diet quality was negatively influenced by foods consumed the rest of the day (outside of lunch).     

Eating in the Absence of Hunger Is Related to Worse Diet Quality throughout Pregnancy

BackgroundScant research has examined whether laboratory assessments of eating in the absence of hunger (EAH) relates to long-term diet quality.ObjectiveThis study investigates the association of EAH with diet quality during pregnancy.DesignPregnancy diet quality was assessed using 24-hour diet recalls collected in each pregnancy trimester. EAH was assessed in a counterbalanced, crossover laboratory feeding substudy in which participants completed two free access eating occasions following a standardized meal during their second pregnancy trimester.Participants/settingData were collected from March 2015 to December 2016 from a subsample of participants (n = 46) enrolled at ≤12 weeks’ gestation in an observational, prospective cohort study (the Pregnancy Eating Attributes Study) in North Carolina.InterventionParticipants were presented with highly processed (HP) and minimally processed (MP) foods in two separate assessments.Main outcome measuresScores for total Healthy Eating Index-2015 (HEI-2015) and adherence to adequacy and moderation components were calculated from the diet recalls. Higher scores reflect better diet quality.Statistical analyses performedLinear regressions estimated associations of pregnancy diet quality with EAH (energy, EAH-kcal; and percent offered, EAH-%) in each condition for all foods, and separately for sweet and savory foods.ResultsLower pregnancy diet quality (all indicators) was associated with greater EAH (EAH-kcal and EAH-%) of all foods and sweet foods in the HP condition. Each 100-kcal increase in EAH of HP foods was associated with a 2- to 3-point decrease (standard error = 0.7 to 0.8) in HEI-2015 (P < 0.01); each 10% increase in EAH of HP foods was associated with a 5- to 7-point decrease (standard error = 2.0) in HEI-2015 (P < 0.01). Greater EAH (energy and percent offered) of savory food intake in the HP condition was associated with a lower HEI-2015 adequacy component score, but was not associated with the HEI-2015 or HEI-2015 moderation component scores. EAH in the MP condition was not associated with pregnancy diet quality.ConclusionsGreater EAH of HP, especially sweet, foods was related to worse pregnancy diet quality. Consuming HP sweets after meal termination may reflect a tendency for eating beyond satiation and may be a useful intervention target for improving maternal diet quality.     

Limited Association between the Total Healthy Eating Index-2015 Score and Cardiovascular Risk Factors in Individuals with Long-Standing Spinal Cord Injury: An Exploratory Study: An Exploratory Study

BackgroundThe healthy eating index-2015 (HEI-2015) reflects diet quality in reference to the 2015-2020 Dietary Guidelines for Americans (DGA). Little is known regarding its application in individuals with chronic spinal cord injury (SCI).ObjectiveTo explore the relationship between diet quality as assessed by the HEI-2015 and cardiovascular risk factors among individuals with chronic SCI.DesignThis is a cross-sectional analysis of baseline data collected from August 2017 through November 2019 for an interventional study that evaluates the effects of a high-protein/low-carbohydrate diet on cardiovascular risk factors in individuals with chronic SCI at the University of Alabama at Birmingham.Participants/settingTwenty-four free-living adults with SCI (mean age, 45 ± 12 y; 8F/16M, level of injury: nine cervical, 15 thoracic; mean duration of injury: 20 ± 13 y) were included.Main outcome measuresParticipants underwent a 2-hour oral glucose tolerance test (OGTT) and a dual-energy x-ray absorptiometry scan. Dietary intake was assessed by three, 24-hour multiple-pass dietary recalls to calculate the HEI-2015 using the simple HEI scoring algorithm method.Data analysisMultiple linear regression analyses were performed to predict indices of lipid metabolism and glucose homeostasis and C-reactive protein (CRP) from the HEI-2015. Principal component analysis was used to reduce the number of covariates (level of injury, sex, and body fat percentage).ResultsOn average, participants’ diets were of low quality (HEI-2015, 47.2 ± 10.8). The regression models for fasting glucose (FG), cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and CRP had moderate to large effect sizes (adjusted R² ≥ 13%), suggesting good explanatory abilities of the predictors. Small or limited effect sizes were observed for glucose tolerance, fasting insulin, triglycerides, and Matsuda index (adjusted R² < 13%). The HEI-2015 accounted for a moderate amount of variation in FG (partial omega-squared, ω_P² = 13%). Each 10-point HEI-2015 score increase was associated with a 3.3-mg/dL decrease in FG concentrations. The HEI-2015 accounted for a limited amount of variation in other indices (ω_P² < 5%).ConclusionsAmong participants with SCI, higher conformance to the 2015-2020 DGA was 1) moderately associated with better FG homeostasis; and 2) trivially associated with other cardiovascular risk factors. Because of the small sample size, these conclusions cannot be extrapolated beyond the study sample. Future larger studies are warranted to better understand the relationship between diet quality and cardiovascular disease risks in this population.     

Earlier Introduction to Sugar-Sweetened Beverages Associated With Lower Diet Quality Among WIC Children at Age 3 Years

ObjectiveExamine the association between the timing of sugar-sweetened beverages (SSBs) and 100% juice introduction with subsequent diet quality at age 3 years.DesignSecondary analysis of a publicly available, national longitudinal dataset.ParticipantsA total of 2,218 children from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).Main Outcome MeasureDietary intakes were assessed using a 24-hour dietary recall completed by caregivers of children aged 3 years. Diet quality was assessed using the Healthy Eating Index Score-2015 (HEI-2015).AnalysisLinear regression was used to assess the relationship between the timing of introduction to 100% juice and SSBs with HEI-2015. Adjustments were made for child- and maternal-related factors.ResultsDelayed introduction of SSBs during the first 2 years of life was associated with an increased HEI-2015 score. In adjusted analyses, for every 1-month delay in the introduction, there was a 0.09-point increase (95% confidence interval, 0.04–0.13) in the HEI-2015 score at 3 years.Conclusions and ImplicationsEarlier introduction to SSBs may be associated with subsequent lower diet quality in WIC participants. This association may be driven by total fruit, whole grains, and added sugars HEI component scores. Further research is needed to support changes to existing WIC nutrition practices regarding SSBs and 100% juice.     

Sex Differences in Healthy Eating: Investigating the Moderating Effect of Self-Efficacy

ObjectivesThis study aimed to evaluate sex differences in dietary habits and the moderating effect of self-efficacy on the adoption of a healthy diet.DesignCross-sectional study.SettingThe healthy population of Tehran, Iran.ParticipantsA total of 262 participants from the general population with normal health status.Main Outcome MeasureThe adoption of a healthy diet was based on the Healthy Eating Index-2015 (HEI-2015) scores and the moderating effect of self-efficacy on eating behaviors.AnalysisLogistic regression analysis and multiple linear regression (moderation) analysis were conducted using PROCESS macro (version 3.5).ResultsThe sex-based analysis revealed that females were more likely to adopt a healthy diet vs males (adjusted odds ratio, 1.85; 95% confidence interval, 1.02–3.35). The moderation analysis showed that eating behavior self-efficacy significantly moderated the relationship between sex differences and HEI-2015 scores (ΔR² = 0.01; P = 0.033). Males with low self-efficacy scores had the highest difference in HEI-2015 with females with low self-efficacy scores, whereas the difference in HEI-2015 was very small in males and females with high self-efficacy scores.Conclusions and ImplicationsEating behavior self-efficacy had a significantly decreasing moderating effect on sex differences in the adoption of a healthy diet. Future research needs to clarify the impact of eating`` behavior self-efficacy in the adoption of a healthy diet, particularly in males, and to confirm the study's findings.     

The Association between Food Insecurity and Diet Quality Varies by Race/Ethnicity: An Analysis of National Health and Nutrition Examination Survey 2011-2014 Results

BackgroundFood insecurity is believed to influence the quality and quantity of foods consumed; however, studies examining food insecurity and diet quality have been inconclusive and few studies have explored variability in these associations by sex and race/ethnicity.ObjectiveThis study examined associations between food insecurity and diet quality, and variations by sex and race/ethnicity.DesignCross-sectional analysis of data from the 2011-2014 National Health and Nutrition Examination Surveys.ParticipantsThe study population was composed of 4,393 adults (aged 20 to 65 years) with family incomes ≤300% of the federal poverty level with complete data on household food security and dietary intake via two 24-hour dietary recalls.Main outcome measuresDiet quality was assessed using the Healthy Eating Index-2015.Statistical analyses performedAssociations between food insecurity and Healthy Eating Index-2015 total and component scores were examined using linear regression models and generalized linear models. Models adjusted for sociodemographic and health covariates.ResultsCompared with food-secure adults, food-insecure adults reported a 2.22-unit lower Healthy Eating Index-2015 score (95% CI –3.35 to –1.08). This association was most pronounced among non-Hispanic whites and adults of Asian or other races/ethnicities. There were no associations among non-Hispanic black or Hispanic adults, and no differences by sex. Among non-Hispanic whites, food insecurity was associated with lower scores for total protein foods, seafood and plant proteins, and added sugar. Among Asians, food insecurity was associated with lower scores for whole fruit.ConclusionsFood insecurity was associated with lower diet quality primarily among non-Hispanic whites; Asians; and other adults, a group composed of American Indian or Alaska Natives, Native Hawaiian or Other Pacific Islanders, and multiracial adults. Further research is needed to better understand the nature of this association among understudied racial/ethnic groups.     

Healthy Eating Index-2015 Scores Among Adults Based on Observed vs Recalled Dietary Intake

BackgroundThe construct and predictive validity of the Healthy Eating Index (HEI) have been demonstrated, but how error in reported dietary intake may affect scores is unclear.ObjectiveThese analyses examined concordance between HEI-2015 scores based on observed vs reported intake among adults.DesignData were from two feeding studies (Food and Eating Assessment STudy, or FEAST, I and II) in which true intake was observed for three meals on 1 day. The following day, participants completed an unannounced 24-hour dietary recall.Participants/settingFEAST I (2012) included 81 men and women, aged 20 to 70 years, living in the Washington, DC, area. FEAST II (2016) included 302 women, aged 18 years or older, with low household incomes and living in the Washington, DC, area. In FEAST I, recalls were completed independently using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24-2011) or interviewer-administered using the Automated Multiple-Pass Method. In FEAST II, recalls were completed using ASA24-2016, independently or in a small group setting with assistance.Main outcome measuresHEI-2015 scores were calculated using the population ratio method.Statistical analyses performedT-tests determined whether differences between scores based on observed and reported intake were different from zero. FEAST I data were stratified by sex, and in FEAST II, analyses were repeated by education and body mass index (BMI).ResultsDifferences in total HEI-2015 scores between observed and reported intake ranged from −1.3 to 5.8 points among those completing ASA24 independently in both studies, compared with −2.5 points in the small group setting. For interviewer-administered recalls, the differences were −1.1 for men and 2.3 for women. In FEAST II, total HEI-2015 scores derived from observed intake were lower than scores derived from reported intake among those who had completed high school or less (−3.2, SE 1.1, P<0.01) and those with BMI ≥ 30 (−2.8, SE 1.1, P = 0.01).ConclusionsHEI-2015 scores based on 24-hour dietary recall data are generally well estimated.     

Significant Relationships Exist between Perceived and Objective Diet Quality in Young Adults

BackgroundThere is a disproportionate burden of low diet quality among young adults compared with other adult subpopulations that is not understood. Perceived and objective diet qualities are studied to understand possible barriers to change.ObjectiveTo explore the association between perceived diet quality and objective diet quality in young adults in the United States.DesignThis cross-sectional study used data from the 2013-2014 National Health and Nutrition Examination Survey to calculate total Healthy Eating Index-2010 (HEI-2010) score and component scores and study their relationships with perceived diet quality scores.Participants/settingThe sample consisted of 1,261 young adults, aged 18 to 30, with 24-hour recall data.Main outcome measuresPerceived and objective diet quality were evaluated.Statistical analyses performedMultiple regression analysis was used to test the ability to predict total HEI-2010 scores from perceived diet quality scores. Ordered logit was used to test whether HEI-2010 component scores predicted the odds of having higher perceived diet quality.ResultsExcellent (b=8.442, P<0.001), very good (b=9.733, P<0.001), and good (b=5.527, P<0.001) perceived diet quality were significant predictors of total HEI-2010 score, compared with the referent category of poor perceived diet quality. The full regression model predicted 17.0% of the variance in total HEI-2010 score. Whole fruit (odds ratio [OR]=1.098, P=.017), whole grains (OR=1.046, P=.023), and empty calories (OR=1.054, P<0.001) were each significantly associated with the odds of having a higher rating of perceived diet quality (fair, good, very good, excellent) instead of a poor rating of diet quality; the difference in odds was low across categories.ConclusionsThere are significant relationships between perceived and objective diet quality, but other variables play a substantial role in explaining these two types of diet quality.     

Stress and Depressive Symptoms Are Not Associated with Overall Diet Quality,But Are Associated with Aspects of Diet Quality in Pregnant Women in South Carolina

BackgroundPoor mental health may hinder diet quality in pregnancy.ObjectiveThis study 1) examined whether stress and depressive symptoms are associated with diet quality (via Healthy Eating Index [HEI] 2015 total scores and dietary intake of food groups/nutrients that align with HEI-2015 components) and 2) tested race as a moderator in the relationship between mental health and diet quality.DesignThis was a cross-sectional analysis of baseline data from a randomized controlled trial collected January 2015 through January 2019 in Columbia, South Carolina. Trained staff administered demographic and psychosocial questionnaires and conducted anthropometric measures. Participants completed two 24-hour dietary recalls, which were self-administered (one on-site, one at home).ParticipantsThe Health in Pregnancy and Postpartum study was a randomized controlled trial targeting excessive gestational weight gain among pregnant women with overweight/obesity (N = 228).Main outcome measuresThe HEI-2015 total scores and food groups/nutrients that align with HEI-2015 were calculated.Statistical analyses performedMultiple linear regression models were used to estimate the relationship between mental health and HEI-2015 total scores and dietary intake of food groups or nutrients that align with HEI-2015 components. Multiplicative interaction terms of stress or depressive symptoms with race were used to determine moderation.ResultsParticipants’ diet quality was suboptimal (M = 52.0 ± 11.7; range, 27–85). Stress was negatively associated with HEI-2015 total scores (crude but not adjusted model). Stress scores were positively associated with consumption of dairy, refined grains, and added sugars and negatively associated with total protein foods. Depressive symptoms were positively associated with consumption of dairy, refined grains, and saturated fats. Race was not a moderator.ConclusionsDiet quality was poor overall, but stress and depressive symptoms were not associated with HEI-2015 total scores in adjusted models. Excluding dairy, stress and depressive symptoms were associated with the consumption of food groups or nutrients related to worse diet quality. These relationships should be examined longitudinally to help establish causality and inform future interventions.     

Socioecological Path Analytic Model of Diet Quality among Residents in Two Urban Food Deserts

BackgroundDiet is critical to chronic disease prevention, yet there are persistent disparities in diet quality among Americans. The socioecological model suggests multiple factors, operating at multiple levels, influence diet quality.ObjectiveThe goal was to model direct and indirect relationships among healthy eating identity, perceived control of healthy eating, social support for healthy eating, food retail choice block scores, perceptions of healthy food availability, and food shopping behaviors and diet quality measured using Healthy Eating Index-2010 scores (HEI-2010) for residents living in two urban communities defined as food deserts.DesignA cross-sectional design was used including data collected via self-reported surveys, 24-dietary recalls, and through objective observations of food retail environments.Participants/settingData collection occurred in 2015-2016 in two low-income communities in Cleveland (n=243) and Columbus (n=244), OH.Main outcome measureHEI-2010 scores were calculated based on the average of three 24-hour dietary recalls using the Nutrition Data System for Research.AnalysisSeparate path models, controlled for income, were run for each community. Analysis was guided by a conceptual model with 15 hypothesized direct and indirect effects on HEI-2010 scores. Associations were considered statistically significant at P<0.05 and P<0.10 because of modest sample sizes in each community.ResultsAcross both models, significant direct effects on HEI-2010 scores included healthy eating identity (β=.295, Cleveland; β=.297, Columbus, P<0.05) and distance traveled to primary food store (β=.111, Cleveland, P<0.10; β=.175, Columbus, P<0.05). Perceptions of healthy food availability had a significant, inverse effect in the Columbus model (β=−.125, P<0.05). The models explained greater variance in HEI-2010 scores for the Columbus community compared with Cleveland (R²=.282 and R²=.152, respectively).ConclusionsFindings highlight the need for tailored dietary intervention approaches even within demographically comparable communities. Interventions aimed at improving diet quality among residents living in food deserts may need to focus on enhancing healthy eating identity using culturally relevant approaches while at the same time addressing the need for transportation supports to access healthy food retailers located farther away.     

Dietary Quality Associated with Self-Reported Diabetes,Osteoarthritis, and Rheumatoid Arthritis among Younger and Older US Adults: A Cross-Sectional Study Using NHANES 2011–2016

Background: To date, few studies have compared the dietary quality of US adults with diabetes mellitus (DM), osteoarthritis (OA), and rheumatoid arthritis (RA) by age groups. Methods: This study used cross-sectional data from adult participants from National Health and Nutrition Examination Survey 2011–2016 to identify dietary quality measured by Healthy Eating Index (HEI)-2015 total and component scores and self-reported disease status for DM, OA, and RA. Associations between the disease status and HEI-2015 total/component scores among younger adults aged 20–59 years (n = 7988) and older adults aged 60 years and older (n = 3780) were examined using logistic regression models. These accounted for the complex survey design and were adjusted for self-reported disease status, sex, race/ethnicity, education levels, income status, weight status, physical activity levels, and smoking status. Results: Among younger adults, 7% had DM, 7% had OA, and 3% had RA. Among older adults, 20% had DM, 32% had OA, and 6% had RA. Moderate added sugar intake was associated with diabetes in all adults. Excess sodium intake was associated with DM among younger adults. Inadequate seafood and plant protein intake was associated with RA among younger adults, while a poor overall dietary pattern was associated with RA among older adults. Conclusions: The dietary quality of US adults varied by self-reported DM, OA, and RA status, and each varied by age group.     

Late Evening Eating Patterns among US Adults Vary in Their Associations With,and Impact on,Energy Intake and Diet Quality: Evidence from What We Eat in America,National Health and Nutrition Examination Survey 2013-2016

BackgroundEvening eating has been associated with higher energy intake and lower nutrient density. However, these qualities may not characterize all late evening (LE) eating patterns.ObjectiveWe sought to characterize US adults’ LE eating patterns on a given day and identify differences, if any, in pattern-specific associations with, and impact on, daily energy intake and total diet quality.DesignLE eating patterns, energy intakes, and Healthy Eating Index (HEI) scores were identified using Day-1 dietary recall data from the cross-sectional National Health and Nutrition Examination Survey 2013-2016.Participants/settingThe sample included adults aged ≥ 20 years (n = 9,861). LE reporters were respondents who consumed foods/beverages between 20:00 and 23:59 on the intake day.Main outcome measuresEnergy intake and HEI-2015 scores by LE status/pattern and the impact of LE consumption on these measures.Statistical analysesCluster analysis assigned individuals to LE eating patterns based on the LE energy contribution of food/beverage groups. Regression models estimated energy intake and HEI-2015 scores; estimates were compared between LE reporters and nonreporters. Similarly, LE’s contribution to total energy and the difference in total HEI inclusive vs exclusive of LE consumption were estimated and compared among patterns.ResultsAmong US adults, 64.4% were LE reporters. Eleven LE patterns were identified; the six most prevalent patterns (representing 89% of LE reporters) were further analyzed. Daily energy intake in all prevalent patterns except the fruit pattern exceeded that of nonreporters by ≥ 268 kcal (unadjusted; P < 0.001), varying by pattern. Conversely, total HEI score did not differ from that of nonreporters (51.0) in any pattern except the fruit pattern, where it was higher (57.4, unadjusted; P < 0.001). Generally, LE consumption’s impact on energy was high and its impact on HEI scores was low.ConclusionsLate evening food/beverage consumption is common among US adults, and LE patterns are not monolithic in their associations with, and impact on, total energy intake and dietary quality.