Abstract P358: Consumption of Better Quality Grain Products and Fat Sources is Associated With the Greatest Increments in Diet Quality for US Adults

Abstract

Introduction: The Healthy Eating Index (HEI)-2015 quantifies alignment with the 2015-2020 Dietary Guidelines for Americans by scoring and totaling 13 components. Higher scores have been associated with lower all-cause and cardiovascular disease (CVD) mortality. The contributions of individual components toward total diet quality and associations with health in American adults have not been determined. Hypothesis: It was hypothesized that the individual HEI-2015 components would differentially contribute to total diet quality and correlate with CVD risk factors in U.S. adults. Methods: Non-pregnant, non-lactating adult participants (age 19+ years) in the National Health and Nutrition Examination Survey (NHANES) 2001-2016 with at least one reliable 24-hour dietary recall were included in the analysis (n=39,799). Total and component HEI-2015 scores were calculated per person using a single recall. Linear regression models accounting for the complex sampling design were used to assess associations between total and component HEI-2015 scores and CVD risk factors after adjustment for potential confounders. Significance of beta coefficients was defined by p<0.01. Results: Total HEI-2015 score was positively associated with high-density lipoprotein cholesterol (HDL-C; ß±SE, 0.10±0.01 mg/dL) and inversely associated with BMI (-0.05±0 kg/m 2 ), waist circumference (WC; -0.13±0.01 cm), systolic blood pressure (SBP; -0.04±0.01 mmHg), low-density lipoprotein cholesterol (LDL-C; -0.09±0.03 mg/dL), triglycerides (-0.20±0.08 mg/dL), fasting glucose (-0.05±0.02 mg/dL), and insulin (-0.03±0.01 μU/mL). All component scores increased with total score. The Whole Grains and Fatty Acid Ratio components made the greatest contributions (both +0.12 points or 12%) to each one-unit increase in HEI-2015, followed by moderation components Refined Grains and Saturated Fat (both +0.11 or 11%). Increases in the Fatty Acid Ratio score were explained by decreasing saturated fat (-1.67 g/unit, 95% CI: -1.73 to -1.61) and increasing polyunsaturated fat (PUFA; 1.17 g/unit, 95% CI: 1.12, 1.22); increases in monounsaturated fats were relatively small (0.18 g/unit, 95% CI: 0.11 to 0.25). The predominant PUFA was linoleic acid, which increased 1.06 g/unit (95% CI: 1.02 to 1.11). Scores for grain-related components were favorably associated with BMI, WC, SBP and HDL-C; fat quality components were inversely associated with BMI, WC, HDL-C, LDL-C, and triglycerides. Conclusion: Diet quality is favorably associated with several CVD risk factors. Approximately 50% of each 1-point increase in HEI-2015 is related to the quality of grain-based products and fat sources. Choosing whole grains instead of refined grains, and PUFA in place of saturated fats, is associated with improvements in diet quality and cardiovascular health.