Consuming Vegetable-Based Salad Is Associated with Higher Nutrient Intakes and Diet Quality among US Adults,What We Eat in America,National Health and Nutrition Examination Survey 2011-2014

BackgroundConsuming salad is one strategy with the potential to harmonize diets more closely with national dietary guidance. However, it is not known whether nutrient intake and diet quality differ between people who consume vegetable-based salad and those who do not.ObjectiveThe objective of this study was to compare nutrient intake and diet quality between salad reporters and nonreporters.DesignThis study is a cross-sectional analysis of 1 day of dietary intake data collected via 24-hour recall.Participants/settingAdults 20 years and older (n=9,678) in What We Eat in America, National Health and Nutrition Examination Survey 2011-2014 were included. Respondents who ate salad on the intake day were considered salad reporters.Main outcome measuresThis study estimated nutrient intake from all foods and beverages (excluding supplements) and evaluated diet quality using the Healthy Eating Index (HEI) 2015.Statistical analysesNutrient intake and HEI scores were compared between salad reporters and nonreporters using paired t tests with regression adjustment for confounding variables. Results were considered significant at P<0.001.ResultsOn the intake day, 23% of adults consumed salad. Energy, protein, and carbohydrate intakes did not differ between salad reporters and nonreporters. Salad reporters had higher intakes than nonreporters of dietary fiber, total fat, unsaturated fatty acids, vitamins A, B-6, C, E, K, folate, choline, magnesium, potassium, and sodium (P<0.001). Total HEI 2015 scores were significantly higher for reporters (56 of a possible 100 points) than nonreporters (50 points) P<0.001. Reporters also had significantly higher scores for eight of 13 HEI components: total vegetables, greens and beans, whole fruits, total protein foods, seafood and plant proteins, fatty acids, refined grains, and added sugars (P<0.001).ConclusionsIncorporating vegetable-based salad into one’s diet may be one effective way to increase nutrient intake and improve overall diet quality. Regardless of salad reporting status, HEI scores show that diets of US adults need improvement.     

Comparison of the HEI and HEI-2010 Diet Quality Measures in Association with Chronic Disease Risk among Low-Income,African American Urban Youth in Baltimore,Maryland

Objective: Overall diet patterns may be a better predictor of disease risk than specific nutrients or individual foods. The purpose of this study is to examine how overall diet patterns relate to nutritional intake, body composition, and physiological measures of chronic disease risk among low-income, urban African American adolescents.

Methods: Cross-sectional data were collected from two samples of African American adolescents (n = 317) from a low-income urban community, including dietary intake using the food frequency Youth/Adolescent Questionnaire and anthropometric measures. Serum cholesterol, serum lipoproteins, and glucose tolerance were measured in a subsample. Means testing compared differences in Healthy Eating Index (HEI) and Healthy Eating Index–2010 (HEI-2010) component and total scores. Pearson correlations examined how HEI and HEI-2010 scores related to nutrient, food intakes, and markers of disease risk, including body mass index, percent body fat, abdominal fat, serum cholesterol, serum lipoproteins, and impaired glucose tolerance. Fisher R–Z transformations compared magnitude differences between HEI and HEI-2010 correlations to nutritional intake and chronic disease risk.

Results: Both HEI and HEI-2010 scores were positively associated with micronutrient intakes. Higher HEI scores were inversely related to serum cholesterol, low-density lipoprotein, impaired glucose tolerance, percent body fat, and percent abdominal fat. HEI-2010 scores were not related to biomarkers of chronic disease risk.

Conclusions: Compared to the HEI-2010, the HEI is a better indicator of chronic disease risk among low-income, urban African American adolescents.     

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.     

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.     

Health Economic Evaluation Modeling Shows Potential Health Care Cost Savings with Increased Conformance with Healthy Dietary Patterns among Adults in the United States

Background

Many American adults have one or more chronic diseases related to a poor diet, resulting in significant direct and indirect economic impacts. The 2015-2020 Dietary Guidelines for Americans (DGA) recognized that dietary patterns may be more relevant for predicting health outcomes compared with individual diet elements and recommended three healthy patterns based on evidence of favorable associations with many chronic disease risk factors and outcomes. Health economic assessments provide a model to estimate the potential influence on costs associated with changes in chronic disease risk resulting from improved diet quality in the US adult population.

Diet quality in an ethnically diverse sample of children and adolescents with autism spectrum disorder compared with nationally representative data

BackgroundChildren with developmental disabilities are at an increased risk of unhealthy eating habits, which may contribute to compromised growth and development. Children with autism spectrum disorder (ASD) exhibit unique risk factors for unhealthy dietary patterns, including sensory issues and cognitive rigidity at mealtimes.ObjectiveThis cross-sectional study examined diet quality in a sample of children with ASD in Florida compared to nationally representative National Health and Nutrition Examination Survey (NHANES) 2009–2014/2013-2014 data using the Healthy Eating Index-2015 (HEI-2015).MethodsA 24-h food record was completed by 41 parents of children with ASD aged 2–17 years, and food and beverage items consumed by each child were reported per standardized 24-h recall protocol. Two models were used to compare mean total and component HEI-2015 scores to NHANES means: (1) comparing means for our full sample to published NHANES means for children aged 2–18 years and (2) a matched model with subjects matched 1:1 by age, gender, race/ethnicity, and parent education level.ResultsHEI component scores were significantly lower (poorer) in children with ASD for whole fruit, total vegetables, dairy, total protein foods, and seafood and plant protein. Whole grains, fatty acids, added sugars, and refined grains scores were higher (better) in our sample. However, total HEI scores and HEI scores for all 13 components were similar among children with ASD and the matched cases from the NHANES data.ConclusionsThere are potential discrepancies in diet quality between children with ASD and general population. Further research with a larger sample size, reporting both total and component HEI scores, is needed.     

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.     

Demographics,not beverage consumption,is associated with diet quality

Background Demographic characteristics and beverage choices may affect diet quality.

Objective To estimate the independent associations between consumption of food categories of the US Department of Agriculture Food Guide Pyramid, beverage consumption, gender, age, family income, and race/ethnicity with the Healthy Eating Index (HEI).

Methods Data from the Continuing Survey of Food Intake by Individuals 1994–96, 1998 were used to develop multiple regression models of demographics and food and beverage consumption regressed on the HEI.

Results After adolescence (13–19 years), males consistently had a lower diet quality than females. Young adults (20–29 years) had the poorest diet quality. Family income had a positive association with the HEI. Controlling for income, African-Americans had lower HEI scores than other race/ethnicity groups. Caucasians consumed significantly more milk products than did the other race/ethnicity groups. Consumption of beverages had a weak but positive association with the HEI.

Conclusions Family income and race/ethnicity have unique and independent associations with the HEI and dietary patterns.     

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.     

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.     

Diet and diabetes: a common approach.

Objective: To assess the impact of breakfast skipping and type of breakfast consumed on energy/nutrient intake, nutrient adequacy, and diet quality.

Design: Cross-sectional.

Setting: The National Health and Nutrition Examination Survey (NHANES), 1999–2002.

Subjects: Young adults (20–39 years, n = 2615).

Measures: A 24-hour dietary recall was used, with breakfast defined as self-reported. Covariate-adjusted sample-weighted means for the entire day's energy/nutrient intakes, mean adequacy ratio (MAR) for nutrient intakes, and diet quality (i.e., Healthy Eating Index [HEI]-2005) scores were compared using analysis of variance and Bonferroni's correction (p < 0.0167) among breakfast skippers (BS), ready-to-eat-cereal breakfast consumers (RTECC), and other breakfast consumers (OBC). Energy/nutrient intakes and food consumption at breakfast were also compared (p ≤ 0.05).

Results: Twenty-five percent of young adults were BS, 16.5% were RTECC, and 58.4% were OBC. Intakes of total energy, percent energy from carbohydrate, and dietary fiber were higher in RTECC than in BS and OBC. Percent energy intake from added sugars was higher in BS than in RTECC and OBC. Compared with BS and RTECC, OBC consumed a lower percent energy from carbohydrates and total sugars, but consumed a higher percent energy from total fat and discretionary solid fats and had a higher cholesterol intake. Intakes of several micronutrients were higher in RTECC than in BS and OBC. Both MAR and total HEI scores were the highest in RTECC and higher in OBC than in BS. The HEI scores for intakes of whole fruits, total/whole grains, milk, and percent energy from solid fat/alcohol/added sugar were the highest in RTECC and higher in OBC than in BS. Compared with OBC, RTECC had a higher HEI score for the intake of saturated fat. At breakfast, RTECC consumed higher intakes of total fruits, whole grains, dairy products, carbohydrates and total sugars, dietary fiber, and several micronutrients than OBC, who consumed higher intakes of meat/poultry/fish, eggs, total fat, discretionary oils/solid fats, cholesterol, and sodium than RTECC.

Conclusion: Thus, RTECC had more favorable nutrient intakes and better diet quality than BS and OBC.     

Alcoholic Beverage Consumption, Nutrient Intakes, and Diet Quality in the US Adult Population, 1999-2006

Background

Little is known about associations between alcoholic beverage consumption, nutrient intakes, and diet quality, although each has been independently associated with chronic disease outcomes.

Objective

This study examines cross-sectional relationships between alcoholic beverage consumption, nutrient intakes, and diet quality (Healthy Eating Index-2005 [HEI-2005] scores) in the US adult population.

Methods

Data were from four cycles of the National Health and Nutrition Examination Survey (1999-2006). Weighted multiple regression analyses, adjusted for age, race/ethnicity, education, smoking status, and body mass index included 8,155 men and 7,715 women aged ≥20 years who reported their past-year alcoholic beverage consumption and 24-hour dietary intake. Alcoholic beverage consumption was defined by drinking status (never, former, current drinker) and, among current drinkers, by drinking level (number of drinks per day, on average: men <1 to ≥5; women <1 to ≥3).

Results

Among men, there was no association between drinking status and intakes of energy, most nutrients, or total HEI-2005 score. Among women, former and current (compared to never) drinkers had significantly higher intakes of energy and several nutrients, and current drinkers had significantly lower total HEI-2005 scores (current drinkers 58.9; never drinkers 63.2). Among current drinkers of both sexes, as drinking level increased, intakes of energy and several nutrients significantly increased, whereas total HEI-2005 scores significantly decreased (from 55.9 to 41.5 in men, and from 59.5 to 51.8 in women).

Conclusions

Among men and women, increasing alcoholic beverage consumption was associated with a decline in total diet quality as measured by the HEI-2005, apparently due to higher energy intake from alcohol as well as other differences in food choices. Educational messages should focus on nutrition and chronic disease risk associated with high consumption of alcoholic beverages and poor food choices, including excessive energy intake.     

Fruit and Vegetable Healthy Eating Index Component Scores of Distributed Food Bags Were Positively Associated with Client Diet Scores in a Sample of Rural,Midwestern Food Pantries

BackgroundFood pantries have the potential to improve the quality of clients’ diets.ObjectiveThis study evaluated the relationship between the quality of the mix of foods in pantry inventories and client food bags (separately), as assessed by the Healthy Eating Index-2010 (HEI-2010), with client diet quality and how these relationships varied by food security status.DesignThis cross-sectional, secondary analysis used baseline data from the Voices for Food intervention study (Clinical Trial Registry: NCT03566095). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected. Foods available in pantry inventories and distributed in client food bags were recorded at one time point during baseline data collection.Participants and settingA convenience sample of adult food pantry clients (N = 575) from 24 rural, food pantries in the US Midwest was recruited from August to November 2014.Main outcome measuresPantry inventories, client food bags, and client diets were scored using the HEI-2010. Main outcomes were client HEI-2010 scores.Statistical analyses performedLinear regression models estimated associations between HEI-2010 total and component scores for pantry inventories and client food bags (in separate models) and the corresponding scores for client dietary intake. The interaction of client food security status, and potential pantry- and client-level confounders, was considered.ResultsClient food bag HEI-2010 scores were positively associated with client diet scores for total vegetables, greens and beans, and total fruit components, whereas pantry inventory HEI-2010 scores were negatively associated with client diet scores for total fruit, total protein foods, and seafood and plant proteins components. Client food bag whole-grains scores were more strongly associated with very low food secure compared with food secure client diet scores (all P values < 0.05).ConclusionsThe quality of client food bags, but not of pantry inventories, was positively associated with client diet quality in a rural sample in the US Midwest.     

Healthy Eating Index Scores Differ by Race/Ethnicity but Not Hypertension Awareness Status among US Adults with Hypertension: Findings from the 2011-2018 National Health and Nutrition Examination Survey

BackgroundLittle is known about whether or not diet quality is associated with race/ethnicity as well as hypertension awareness status among adults with hypertension.ObjectiveThe aim of this study was to examine associations between diet quality and race/ethnicity as well as hypertension awareness.DesignAnalysis of the 2011-2018 National Health and Nutrition Examination Survey, a cross-sectional survey representative of the US population.Participants/settingA total of 6,483 participants with hypertension who were at least 18 years old and had dietary recall data were included.Main outcome measuresDiet quality was assessed by Healthy Eating Index 2015 (HEI-2015).Statistical analysis performedWeighted χ² tests were employed to test associations between categorical variables. Weighted linear regression was used to model the HEI-2015 score by various covariates.ResultsAmong the 6,483 participants with hypertension included in this study, the average HEI-2015 total score was 54.0 out of the best possible score of 100. In unadjusted analysis, the HEI-2015 total score was significantly different by race/ethnicity (P < 0.01), being 60.9 for non-Hispanic Asian participants, 54.4 for Hispanic, 53.8 for non-Hispanic White, and 52.7 for non-Hispanic Black participants. The HEI-2015 component scores were statistically different by race/ethnicity for all the 13 components (all P values < 0.01). In adjusted analysis, race/ethnicity was significantly associated with the total HEI-2015 score (P < 0.0001), but hypertension awareness status was not (P = 0.99), after controlling for age, sex, body mass index, marital status, education level, income level, and insurance status.ConclusionsThere were significant racial/ethnic differences in HEI-2015 scores among participants with hypertension. Hypertension awareness status was not associated with HEI-2015 scores. Further study is needed to identify reasons why there was an association between HEI-2015 scores and race/ethnicity, and a lack of association with hypertension awareness.     

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.     

Diet Quality and Fruit,Vegetable, and Sugar-Sweetened Beverage Consumption by Household Food Insecurity among 8- to 12-Year-Old Children during Summer Months

BackgroundSchool-delivered nutrition assistance programs have improved dietary intake for children from food-insecure households during the school year. However, little is known about their diet quality and eating patterns during summer months.ObjectiveSchool-aged children’s summer month weekday and weekend day diet quality and eating patterns were assessed by household food insecurity.DesignSecondary analysis of cross-sectional data was employed.Participants/settingDuring the summers of 2011 through 2017, baseline data were collected from parent–child dyads participating in one of two community-based obesity prevention trials in metropolitan Minnesota (N=218). The mean age of children was 10 years; 50% were girls, 49% were nonwhite, and 25% were from food-insecure households.Main outcome measuresChildren from food-secure and food-insecure households were identified by using the short form of the US Household Food Security Survey. Healthy Eating Index 2015 and eating patterns—including energy intake and consumption of whole fruits, vegetables, 100% fruit/vegetable juice, and sugar-sweetened beverages—were estimated by means of 24-hour dietary recall interviews conducted on weekdays and weekend days.Statistical analysis performedGeneral linear modeling was used to examine diet quality and eating patterns by food insecurity, controlling for child age, child body mass index z score, and parent education.ResultsChildren from food-insecure and food-secure households had Healthy Eating Index 2015 scores less than 50. Children from food-insecure households reported less energy intake, fewer cups of whole fruit, and more sugar-sweetened beverage consumption for every 1,000 kcal consumed on a weekend day when compared with their counterparts from food-secure households (P<0.05). Similar results were not seen for weekday eating patterns.ConclusionsWhole fruit and sugar-sweetened beverage consumption varied by food insecurity on weekend days during summer months. Because children tend to gain weight during summer months, efforts to increase weekend access to whole fruits and promote water consumption may contribute to weight gain prevention and healthy development, especially for children from food-insecure households.     

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).     

Diet Quality among the Brazilian Population and Associated Socioeconomic and Demographic Factors: Analysis from the National Dietary Survey 2008-2009

BackgroundEvaluating diet quality is a way to monitor a population’s adherence to dietary guidelines.ObjectiveTo adapt the Healthy Eating Index-2015 (HEI-2015) to the Brazilian population, to evaluate the validity and reliability of the adapted HEI-2015, and to assess diet quality of Brazilian adults as well as socioeconomic and demographic factors associated with diet quality.DesignIn this cross-sectional study, two dietary records from nonconsecutive days were used to obtain food intake information. The collected socioeconomic and demographic data included sex, age, education, per capita income, and residence area.Participants/settingA representative sample (n=27,760) of the Brazilian adult population participated in the Nutrition Dietary Survey 2008-2009.Main outcome measuresTotal and component scores for the adapted HEI-2015. The validity and reliability of the index were tested.Statistical analysis performedMean total and component scores were estimated for the adapted HEI-2015. Also, the proportion of subjects that achieved the maximum score for each component was calculated. Regarding validity and reliability analysis, principal components analysis examined the number of dimensions; Pearson correlations were estimated between total score, components, and energy, and Cronbach’s coefficient α was estimated. Diet quality was compared among socioeconomic and demographic categories.ResultsThe mean total score for the adapted HEI-2015 was 45.7 (95% CI: 45.4 to 46.0). Women had higher diet quality scores (46.4; 95% CI: 46.1 to 46.7) than men (44.9; 95% CI: 44.6 to 45.3). Age, education, and per capita income were directly associated with the adapted HEI-2015 total score. Greater than or equal to 50% of subjects received the maximum adapted HEI-2015 component scores for “total protein foods,” “seafood and plant proteins,” “fatty acids,” and “sodium.” In contrast, less than 30% of subjects received the maximum component scores for “total vegetables,” “dairy,” and “saturated fats.” Higher percentages of women received the maximum component scores for “total fruits,” “whole fruits,” “total vegetables,” “greens,” “dairy,” and “sodium,” whereas higher percentages of men received the maximum component scores for “total protein foods,” “seafood and plant proteins,” “fatty acids,” “added sugars,” and “saturated fats” components. Finally, validity analysis revealed weak correlations between component scores and energy and weak to moderate correlations with total scores; six dimensions were responsible for the total variance in diet quality and the standardized Cronbach’s coefficient α was .65 (unstandardized=.64).ConclusionsBrazilian adults have suboptimal diet quality as assessed by the adapted HEI-2015. Diet quality varied by socioeconomic and demographic factors. Results support the validity and the reliability of the index.     

Dietary Quality Assessed by the HEI-2010 and Biomarkers of Cardiometabolic Disease: An Exploratory Analysis

Abstract

Objectives: This study explores relationships between cardiometabolic measures of antioxidant capacity or inflammation and diet quality assessed by the Healthy Eating Index (HEI)-2010 which measures conformity to Dietary Guidelines for Americans. This cross-sectional study was an ancillary analysis of baseline data for a randomized controlled trial with older adults at risk for cardiometabolic disease (ClinicalTrials.gov #NCT00955903).

Methods: Community-dwelling older adults (n?=?133, 49% male, 70.4?±?4.8?years) with a body mass index of 30–40?kg/m² provided a fasted blood sample for measurement of antioxidant capacity, high-sensitivity C-reactive protein, tumor necrosis factor-alpha, and interleukin-6. Dietary data were generated from the mean of three 24-hour recalls.

Results: After adjustment for potential confounders, HEI-2010 composite scores were not significantly associated with decreased inflammation or greater antioxidant capacity. In analysis of the 12 components composing the HEI-2010, significant positive association was observed between total dairy and total serum antioxidant capacity (0.043; 95% CI, 0.008–0.069). Significant associations observed in inflammatory markers were between total vegetable and tumor necrosis factor-alpha (?0.078; 95% CI, ?0.151 to ?0.005), sodium and interleukin-6 (0.091; 95% CI, 0.023–0.158), and scores for combined calories from solid fats, alcoholic beverages, and added sugars and interleukin-6 (0.139; 95% CI, 0.027–0.252). In models adjusting for HEI-2010 composite score when significant associations were observed between component scores and biomarkers, two of six associations were strengthened by adding the composite score as a potential confounder.

Conclusions: Largely null findings along with those inconsistent with scientific expectations suggest caution in extrapolating adherence to the HEI-2010 with an individual’s inflammatory or antioxidant status. Results merit additional investigation with other biomarkers of chronic disease and emphasis on dietary patterns given potential synergy within food combinations.