Incorporating the Dietary Guidelines for Americans Vegetable Recommendations into the Diet Alters Dietary Intake Patterns of Other Foods and Improves Diet Quality in Adults with Overweight and Obesity

BackgroundUnderstanding how vegetables are incorporated into the diet, especially in the types and amounts recommended by the Dietary Guidelines for Americans, and how this alters dietary intake patterns is vital for developing targeted behavior change interventions.ObjectiveTo determine how a provision of vegetables was incorporated into the diet of adults with overweight and obesity; whether or not the provided vegetables displaced other foods; and what, if any, effect this had on diet quality and body weight and composition.DesignThis study investigated secondary outcomes from the Motivating Value of Vegetables Study, a community-based, randomized, parallel, nonblinded controlled trial. Participants were randomly assigned to a provided vegetable intervention or attention control group using a one to one allocation ratio.Participants/settingMen and women with self-reported low vegetable consumption, aged 18 to 65 years, with a body mass index ≥25 were recruited from Grand Forks, ND, between October 2015 and September 2017. Only participants randomized to the provided vegetable intervention group (n = 51; attrition = 8%) were included in this secondary analysis.InterventionDietary Guidelines for Americans recommended types and amounts of vegetables were provided weekly for 8 weeks.Main outcome measuresHow the provided vegetables were incorporated into the diet was measured using daily self-report and 24-hour dietary recalls. Diet quality was assessed via the Healthy Eating Index 2015. Body weight and composition were measured before and after the intervention.Statistical analyses performedData were assessed using generalized linear mixed models where phase (pre, post) was the within-subject factor and subject was the random effect.ResultsParticipants self-reported using 29% of the provided vegetables as substitutes for other foods. With the increase in vegetable consumption, there were decreases in total grains (mean difference ± standard deviation; –0.97 ± 3.23 oz-equivalents; P = 0.02), protein foods (–1.24 ± 3.86 oz-equivalents; P = 0.01), saturated fats (–6.44 ± 19.63 g; P = 0.02), and added sugars (–2.44 ± 6.78 tsp-equivalents; P = 0.02) consumed. Total Healthy Eating Index 2015 scores increased (+4.48 ± 9.63; P = 0.001) and dietary energy density decreased (–0.44 ± 0.52 kcal/g; P < 0.0001). There was no change in total energy intake or body weight and composition.ConclusionsIncreasing vegetable consumption to meet Dietary Guidelines for Americans recommendations alters dietary intake patterns, improving diet quality and energy density. These findings highlight the importance of characterizing how individuals incorporate Dietary Guidelines for Americans recommendations into their diet.     

Update of the Healthy Eating Index: HEI-2015

The Healthy Eating Index (HEI) is a measure for assessing whether a set of foods aligns with the Dietary Guidelines for Americans (DGA). An updated HEI is released to correspond to each new edition of the DGA, and this article introduces the latest version, which reflects the 2015-2020 DGA. The HEI-2015 components are the same as in the HEI-2010, except Saturated Fat and Added Sugars replace Empty Calories, with the result being 13 components. The 2015-2020 DGA include explicit recommendations to limit intakes of both Added Sugars and Saturated Fats to <10% of energy. HEI-2015 does not account for excessive energy from alcohol within a separate component, but continues to account for all energy from alcohol within total energy (the denominator for most components). All other components remain the same as for HEI-2010, except for a change in the allocation of legumes. Previous versions of the HEI accounted for legumes in either the two vegetable or the two protein foods components, whereas HEI-2015 counts legumes toward all four components. Weighting approaches are similar to those of previous versions, and scoring standards were maintained, refined, or developed to increase consistency across components; better ensure face validity; follow precedent; cover a range of intakes; and, when applicable, ensure the DGA level corresponds to a score >7 out of 10. HEI-2015 component scores can be examined collectively using radar graphs to reveal a pattern of diet quality and summed to represent overall diet quality.     

Diet Quality as Assessed by the Healthy Eating Index,Alternate Healthy Eating Index,Dietary Approaches to Stop Hypertension Score,and Health Outcomes: An Updated Systematic Review and Meta-Analysis of Cohort Studies

Background

Diets of the highest quality have been associated with a significantly lower risk of noncommunicable diseases.

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.

Diet Quality as Assessed by the Healthy Eating Index,Alternate Healthy Eating Index,Dietary Approaches to Stop Hypertension Score,and Health Outcomes: A Second Update of a Systematic Review and Meta-Analysis of Cohort Studies

BackgroundSuboptimal diet quality has a large impact on noncommunicable disease burden.ObjectiveThis study aimed to update the body of evidence on the associations between diet quality, as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and the Dietary Approaches to Stop Hypertension score, and health status. Moreover, results of the previous systematic reviews and meta-analyses were extended by evaluating the credibility of the evidence.MethodsPubMed, Embase, and Scopus databases were searched to identify eligible studies published between May 15, 2017 and March 14, 2020. Pooled relative risk (RR) with 95% CI for highest vs lowest category of diet quality were estimated using a random-effects model. Heterogeneity was explored using Cochran's Q test and I² statistic with 95% CI. Presence of publication bias was detected by using funnel plots and Egger's regression test. The NutriGrade tool was used to assess the credibility of evidence.ResultsThe current update identified 47 new reports, resulting in a total of 113 reports including data from 3,277,684 participants. Diets of the highest quality, as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension scores, were inversely associated with risk of all-cause mortality (RR 0.80, 95% CI 0.79 to 0.82, I² = 68%, n= 23), cardiovascular disease incidence or mortality (RR 0.80, 95% CI 0.78 to 0.82, I² = 59%, n= 45), cancer incidence or mortality (RR 0.86, 95% CI 0.84 to 0.89, I² = 73%, n= 45), incidence of type 2 diabetes (RR 0.81, 95% CI 0.78 to 0.85, I² = 76%, n= 16), and incidence of neurodegenerative diseases (RR 0.82, 95% CI 0.75 to 0.89, I² = 71%, n= 12). In cancer survivors, the highest diet quality was linked with lower risk of all-cause (RR 0.83, 95% CI 0.77 to 0.88, I² = 45%, n= 12) and cancer mortality (RR 0.82, 95% CI 0.75 to 0.89, I² = 44%, n= 12). The credibility of evidence for identified associations between overall healthy dietary patterns and included health outcomes was moderate.ConclusionThis updated systematic review and meta-analysis suggests that high diet quality (assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension) is inversely associated with risk of all-cause mortality, cardiovascular disease incidence or mortality, cancer incidence or mortality, type 2 diabetes, and neurodegenerative disease, as well as all-cause mortality and cancer mortality among cancer survivors. Moderate credibility of evidence for identified associations complements the recent 2020 Dietary Guidelines Advisory Committee report recommending healthy dietary patterns for disease prevention.     

Diet Quality and Dietary Inflammatory Index in Dutch Inflammatory Bowel Disease and Irritable Bowel Syndrome Patients

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) share common culprit foods and potential pathophysiological factors. However, how diet may contribute to disease course and whether this differs between both entities is unclear. We therefore investigated the association of dietary indices with intestinal inflammation and gastrointestinal symptoms in both IBD and IBS patients. Food frequency questionnaires from 238 IBD, 261 IBS and 195 healthy controls (HC) were available to calculate the overall diet quality by the Dutch Healthy Diet-Index 2015 (DHD-2015) and its inflammatory potential by the Adapted Dietary Inflammatory Index (ADII). Intestinal inflammation and symptoms were evaluated by faecal calprotectin and the Gastrointestinal Symptom Rating Scale, respectively. The DHD-2015 was lower in IBD and IBS versus HC (p < 0.001), being associated with calprotectin levels in IBD (b = −4.009, p = 0.006), and with abdominal pain (b = −0.012, p = 0.023) and reflux syndrome (b = −0.016, p = 0.004) in IBS. ADII scores were comparable between groups and were only associated with abdominal pain in IBD (b = 0.194, p = 0.004). In this side-by-side comparison, we found a lower diet quality that was differentially associated with disease characteristics in IBD versus IBS patients. Longitudinal studies are needed to further investigate the role of dietary factors in the development of flares and predominant symptoms.     

Diet Quality Assessment and the Relationship between Diet Quality and Cardiovascular Disease Risk

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in the U.S. and globally. Dietary risk factors contribute to over half of all CVD deaths and CVD-related disability. The aim of this narrative review is to describe methods used to assess diet quality and the current state of evidence on the relationship between diet quality and risk of CVD. The findings of the review will be discussed in the context of current population intake patterns and dietary recommendations. Several methods are used to calculate diet quality: (1) a priori indices based on dietary recommendations; (2) a priori indices based on foods or dietary patterns associated with risk of chronic disease; (3) exploratory data-driven methods. Substantial evidence from prospective cohort studies shows that higher diet quality, regardless of the a priori index used, is associated with a 14–29% lower risk of CVD and 0.5–2.2 years greater CVD-free survival time. Limited evidence is available from randomized controlled trials, although evidence shows healthy dietary patterns improve risk factors for CVD and lower CVD risk. Current dietary guidance for general health and CVD prevention and management focuses on following a healthy dietary pattern throughout the lifespan. High diet quality is a unifying component of all dietary recommendations and should be the focus of national food policies and health promotion.     

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.     

Diet Quality as Measured by the Healthy Eating Index 2015 and Oral and Pharyngeal Cancer Risk

BackgroundAlcohol and tobacco are the major risk factors for oral and pharyngeal cancer, but diet is likely to have a role, too.ObjectiveThe objective was to analyze the relationship between adherence to the 2015-2020 Dietary Guidelines for Americans (DGA), as measured by the Healthy Eating Index 2015 (HEI-2015), and oral and pharyngeal cancer risk. Moreover, this work aimed to quantify the number of avoidable cases under different scenarios of increased adherence to the DGA, with the use of the potential impact fraction. This estimates the proportion of cases that would occur if the distribution of the risk factor in the population followed an alternative distribution.DesignA multicenter, case–control study was conducted in Italy between 1991 and 2009. Participants’ usual diet for the 2 years preceding study enrolment was assessed using a food frequency questionnaire.Participants and settingCases were 946 patients admitted to major hospitals with incident, histologically confirmed oral and pharyngeal cancer. Controls were 2,492 patients admitted to the same hospitals for acute non neoplastic conditions.Main outcome measuresThe adherence to the DGA was assessed using the HEI-2015 score (range = 0 to 100), based on 13 components. The outcome was oral and pharyngeal cancer.Statistical analyses performedOdds ratios and the corresponding 95% CIs were estimated using multiple logistic regression models adjusted for tobacco, alcohol, and other relevant covariates. The potential impact fraction was estimated under different scenarios of adherence to the DGA.ResultsIn this Italian population the HEI-2015 score ranged from 33.4 to 97.5. A higher HEI-2015 score was associated with a lower risk of oral and pharyngeal cancer, with an odds ratio of 0.70 (95% CI 0.62 to 0.79) for a 10-point increment of the score. The estimated potential impact fraction was 64.8% under the maximum achievable reduction scenario, and it ranged from 9% to 27% following other more feasible scenarios.ConclusionsThe HEI-2015 score was inversely related to oral and pharyngeal cancer risk in this Italian population. This analysis allowed for the estimation of the fraction of preventable cases, under different feasible scenarios. A share of 9% to 27% of avoidable cases of oral and pharyngeal cancer might be obtained across real-world scenarios of adherence to the DGA as measured by the HEI-2015 score.     

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.     

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 Quality of Urban Older Adults Age 60 to 99 Years: The Cardiovascular Health of Seniors and Built Environment Study

There are few studies that evaluate dietary intakes and predictors of diet quality in older adults. The objectives of this study were to describe nutrient intakes and examine associations between demographic, economic, behavioral, social environment, and health status factors and diet quality. Cross-sectional data were from black, white, and Hispanic adults, age 60 to 99 years, living independently in New York City and participating in the Cardiovascular Health of Seniors and the Built Environment Study, 2009-2011 (n=1,306). Multivariable log-linear regression estimated associations between selected factors and good diet quality, defined as a Healthy Eating Index score more than 80 (based on the 2005 Dietary Guidelines for Americans [HEI-2005]). Dietary intakes were similar for men and women; intakes of energy, fiber, and the majority of micronutrients were less than recommendations, whereas intakes of fats, added sugar, and sodium were within the upper range or exceeded recommendations. Hispanic ethnicity (relative risk [RR]=1.37; 95% CI 1.07 to 1.75), energy intake <∼1,500 kcal/day (RR=1.93; 95% CI, 1.37 to 2.71), adherence to a special diet (RR=1.23; 95% CI: 1.02 to 1.50), purchasing food at supermarkets at least once/week (RR=1.34; 95% CI, 1.04 to1.74), and being married/living with a partner (RR=1.37; 95% CI, 1.10 to 1.71) were positively associated with HEI-2005 score more than 80. Consuming at least one restaurant meal/day was negatively associated with HEI-2005 score more than 80 (RR=0.69; 95%CI, 0.50-0.94). These findings identify specific groups of older adults, such as blacks or those who live alone, who may benefit from dietary interventions, as well as specific modifiable behaviors among older adults, such as eating restaurant meals or shopping at supermarkets, which may be targeted through interventions.     

A New Carbohydrate Food Quality Scoring System to Reflect Dietary Guidelines: An Expert Panel Report

Existing metrics of carbohydrate food quality have been based, for the most part, on favorable fiber- and free sugar-to-carbohydrate ratios. In these metrics, higher nutritional quality carbohydrate foods are defined as those with >10% fiber and <10% free sugar per 100 g carbohydrate. Although fiber- and sugar-based metrics may help to differentiate the nutritional quality of various types of grain products, they may not aptly capture the nutritional quality of other healthy carbohydrate foods, including beans, legumes, vegetables, and fruits. Carbohydrate food quality metrics need to be applicable across these diverse food groups. This report introduces a new carbohydrate food scoring system known as a Carbohydrate Food Quality Score (CFQS), which supplements the fiber and free sugar components of previous metrics with additional dietary components of public health concern (e.g., sodium, potassium, and whole grains) as identified by the Dietary Guidelines for Americans. Two CFQS models are developed and tested in this study: one that includes four dietary components (CFQS-4: fiber, free sugars, sodium, potassium) and one that considers five dietary components (CFQS-5: fiber, free sugars, sodium, potassium, and whole grains). These models are applied to 2596 carbohydrate foods in the Food and Nutrient Database for Dietary Studies (FNDDS) 2017–2018. Consistent with past studies, the new carbohydrate food scoring system places large percentages of beans, vegetables, and fruits among the top scoring carbohydrate foods. The whole grain component, which only applies to grain foods (N = 1561), identifies ready-to-eat cereals, oatmeal, other cooked cereals, and selected whole grain breads and crackers as higher-quality carbohydrate foods. The new carbohydrate food scoring system shows a high correlation with the Nutrient Rich Food (NRF9.3) index and the Nutri-Score. Metrics of carbohydrate food quality that incorporate whole grains, potassium, and sodium, in addition to sugar and fiber, are strategically aligned with multiple 2020–2025 dietary recommendations and may therefore help with the implementation of present and future dietary guidelines.     

Nutrition Label Use and Its Association With Dietary Quality Among Latinos: The Roles of Poverty and Acculturation

Objective

To investigate how acculturation and poverty are independently and jointly associated with the use of the Nutrition Facts panel (nutrition label) and to examine the extent to which nutrition label use moderates the association of poverty and acculturation on dietary quality among Latinos.

Consumption of Dietary Guidelines for Americans Types and Amounts of Vegetables Increases Mean Subjective Happiness Scale Scores: A Randomized Controlled Trial

BackgroundThe health benefits of diets rich in fruits and vegetables (FV) are well established. Recent observational and intervention research suggests that FV consumption may also exert a positive effect on psychological well-being.ObjectiveThis study aimed to assess changes in mean Subjective Happiness Scale (SHS) scores in response to consuming 2010-2015 Dietary Guidelines for Americans (DGA) recommended types and amounts of vegetables. It was hypothesized that increased vegetable consumption would increase mean SHS scores.DesignThis study investigated a secondary outcome of a randomized, parallel, nonblinded controlled trial with a 1:1 allocation ratio to a provided vegetable intervention or attention control group.Participants/settingMen and women (n = 75) aged 18 to 65 years, body mass index ≥ 25, with low habitual vegetable consumption were recruited from Grand Forks, North Dakota, December 2016 to January 2018, for this community-based study.InterventionThe vegetable intervention consisted of an 8-week feeding phase during which participants were provided with vegetables in DGA-recommended types and amounts. The attention control group was not provided vegetables but completed the same testing schedule as the vegetable intervention group.Main outcome measureMean SHS scores were assessed before and after the intervention.Statistical analysesMean SHS scores were analyzed using a 2-way factorial mixed linear model analysis of variance.ResultsA significant interaction between treatment and visit (P = .015) revealed greater mean SHS scores at week 8 than at baseline in the vegetable intervention group (+0.23 ± 0.11) (mean difference ± SE of the difference) but no change in the attention control group (?0.15 ± 0.11).ConclusionsGreater mean SHS scores were observed after increasing vegetable consumption to meet DGA recommendations, suggesting that adhering to DGA vegetable guidance may help promote psychological well-being.     

Intake of Potatoes Is Associated with Higher Diet Quality,and Improved Nutrient Intake and Adequacy among US Adolescents: NHANES 2001–2018 Analysis

Potatoes are nutrient rich white vegetables, however, research on their impact on public health is limited. The objective of this study was to provide updated evaluation of the cross-sectional association between potato consumption and diet quality, nutrient intake and adequacy. Twenty-four hour diet recall data from adolescents (n = 16,633; age 9–18 years) were used to assess intakes. Usual intakes of nutrients were determined using the National Cancer Institute method and diet quality was calculated using the Healthy Eating Index-2015 (HEI-2015) after adjusting for demographic factors. Consumers of potatoes (baked or boiled potatoes, mashed potatoes and potato mixtures, fried potatoes, and potato chips) had higher (p < 0.05) HEI-2015 total score and subcomponent scores for total vegetables, total protein foods, and refined grain than non-consumers. Consumers also had higher (p < 0.05) intake of energy, dietary fiber, protein, copper, magnesium, phosphorus, potassium, selenium, sodium, zinc, niacin, vitamin B₆, vitamin C, vitamin K and total choline; and higher (p < 0.05) adequacy for protein, copper, magnesium, phosphorus, potassium, zinc, thiamine, niacin, vitamin B₆, vitamin C, and vitamin K than non-consumers. In conclusion, adolescent potato consumption was associated with higher diet quality, nutrient intake, and adequacy and therefore encouraging their consumption may be an effective strategy for improving nutritional status.     

Applications of the Healthy Eating Index for Surveillance,Epidemiology, and Intervention Research: Considerations and Caveats

The Healthy Eating Index (HEI) is a measure of diet quality that can be used to examine alignment of dietary patterns with the Dietary Guidelines for Americans. The HEI is made up of multiple adequacy and moderation components, most of which are expressed relative to energy intake (ie, as densities) for the purpose of calculating scores. Due to these characteristics and the complexity of dietary intake data more broadly, calculating and using HEI scores can involve unique statistical considerations and, depending on the particular application, intensive computational methods. The objective of this article is to review potential applications of the HEI, including those relevant to surveillance, epidemiology, and intervention research, and to summarize available guidance for appropriate analysis and interpretation. Steps in calculating HEI scores are reviewed and statistical methods described. Consideration of salient issues in the calculation and interpretation of scores can help researchers avoid common pitfalls and reviewers ensure that articles reporting on the use of the HEI include sufficient details such that the work is comprehensible and replicable, with the overall goal of contributing to knowledge on dietary patterns and health among Americans.