Block Food Frequency Questionnaire Research Articles

Serum zinc concentration and dietary zinc intake in relation to cognitive function: an analysis of the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort.

There are several pathways by which zinc may be a modifiable factor to slow age-related cognitive decline. We investigated the associations between serum and dietary zinc and cognitive impairment in a longitudinal cohort. We used data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort (n = 30,239) and the REGARDS Trace Element Study (n = 2666). Baseline serum zinc concentrations (2003-2007) were measured using inductively coupled plasma mass spectrometry. Baseline dietary zinc intake was measured via the Block food frequency questionnaire. Serum zinc concentrations and dietary zinc intake were categorized into quartiles. The outcome of interest was impairment on the Six-Item Screener (SIS), a measure of global cognitive functioning administered annually. The Enhanced Cognitive Battery (ECB), a more comprehensive series of tests assessing memory and fluency, was administered every two years and considered a secondary outcome. Associations between zinc and incident impairment were assessed using multivariable logistic regression. Among 2065 participants with serum zinc data, 184 individuals developed impairment over 10years of follow-up. In adjusted models, there was no significant association between serum zinc and impairment as assessed by the SIS or the ECB. Among 18,103 participants who had dietary data, 1424 experienced incident impairment on the SIS. Dietary zinc intake was not significantly associated with impairment as assessed by the SIS or the ECB in adjusted models. Findings from this U.S. cohort did not support the hypothesis that serum zinc concentration or dietary zinc intake is associated with the risk of cognitive impairment.

Ultra-processed and fast food consumption, exposure to phthalates during pregnancy, and socioeconomic disparities in phthalate exposures

BackgroundConsuming ultra-processed foods may increase exposure to phthalates, a group of endocrine disruptors prevalent in food contact materials. ObjectivesInvestigate associations between ultra-processed food intake and urinary phthalates during pregnancy, and evaluate whether ultra-processed foods mediate socioeconomic disparities in phthalate exposures. MethodsIn a socioeconomically diverse sample of 1031 pregnant women from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) Study in the urban South, the Block Food Frequency Questionnaire was administered and urinary phthalate metabolites were measured in the second trimester. Linear regressions modeled associations between phthalates and overall ultra-processed food consumption, individual ultra-processed foods, and exploratory factor analysis dietary patterns. Causal mediation analyses examined whether ultra-processed food intake mediates relationships between socioeconomic disparities and phthalate exposures. ResultsUltra-processed foods constituted 9.8–59.0 % (mean = 38.6 %) of participants’ diets. 10 % higher dietary proportion of ultra-processed foods was associated with 13.1 % (95 %CI: 3.4 %–22.9 %) higher molar sum concentrations of di(2-ethylhexyl) phthalate metabolites (ΣDEHP). 10 % higher consumption of minimally-processed foods was associated with lower ΣDEHP (10.8 %: 3.4 %–22.9 %). Ultra- and minimally-processed food consumption were not associated with non-DEHP metabolites. Standard deviation higher consumptions of hamburger/cheeseburger, French fries, soda, and cake were associated with 10.5 % (4.2 %-17.1 %), 9.2 % (2.6 %-16.2 %), 7.4 % (1.4 %-13.6 %), and 6.0 % (0.0 %-12.4 %), respectively, higher ΣDEHP. Exploratory factor analysis corroborated positive associations of processed food with ΣDEHP, and uncovered a healthy dietary pattern associated with lower urinary ΣDEHP, mono(2-ethyl-5-hydroxyhexyl) (MEHHP), mono(2-ethyl-5-carboxypentyl) (MECPP), mono(2-carboxymethylhexyl) (MCMHP), and mono-isononyl (MINP) phthalates. Significant indirect effects indicated that lower income and education levels were associated with 1.9 % (0.2 %-4.2 %) and 1.4 % (0.1 %-3.3 %) higher ΣDEHP, respectively, mediated via increased ultra-processed food consumption. ConclusionsConsumption of ultra-processed foods may increase exposure to phthalates. Policies to reduce dietary phthalate exposures from food packaging and processing are needed, as socioeconomic barriers can preclude dietary recommendations as a sole means to reduce phthalate exposures.

Longitudinal changes in home food availability and concurrent associations with food and nutrient intake among children at 24-48 months.

To describe changes in home food availability during early childhood, including modified, developmentally sensitive obesogenic scores, and to determine whether home food availability is associated with food and nutrient intakes of children concurrently, over time. Data were drawn from the STRONG Kids 2 longitudinal, birth cohort to achieve the study objectives. Home food availability was assessed with the Home Food Inventory (HFI) and included fifteen food groups (e.g. fruit and vegetables) and three obesogenic scores (one original and two modified). Food and nutrient intakes were measured using the Block FFQ and included twenty-seven food groups and eighteen nutrients (e.g. vitamins A and C, protein). HFI and FFQ were completed by trained researchers or mothers, respectively, at 24, 36 and 48 months. Repeated-measures ANOVA and Spearman's correlations were used to achieve the study objectives. Central Illinois, USA. Participants were 468 children at 24, 36 and 48 months of age. Availability of less nutritious foods and obesogenic foods and beverages increased as children aged, and availability of both nutritious and less nutritious foods were associated with child food and nutrient intake. The three obesogenic scores demonstrated similar, positive associations with the intake of energy, saturated fat, added sugars and kilocalories from sweets. These findings offer novel insight into changes in home food availability and associations with food and nutrient intake during early childhood. Additional attention is needed examining antecedents (e.g. built environments, purchasing behaviours) and consequences (e.g. child diet quality and weight) of home food availability.

Plasma lipidomic markers of diet quality are associated with incident coronary heart disease in American Indian adults: the Strong Heart Family Study

BackgroundIdentifying lipidomic markers of diet quality is needed to inform the development of biomarkers of diet, and to understand the mechanisms driving the diet- coronary heart disease (CHD) association. ObjectivesThis study aimed to identify lipidomic markers of diet quality and examine whether these lipids are associated with incident CHD. MethodsUsing liquid chromatography–mass spectrometry, we measured 1542 lipid species from 1694 American Indian adults (aged 18–75 years, 62% female) in the Strong Heart Family Study. Participants were followed up for development of CHD through 2020. Information on the past year diet was collected using the Block Food Frequency Questionnaire, and diet quality was assessed using the Alternative Healthy Eating Index-2010 (AHEI). Mixed-effects linear regression was used to identify individual lipids cross-sectionally associated with AHEI. In prospective analysis, Cox frailty model was used to estimate the hazard ratio (HR) of each AHEI-related lipid for incident CHD. All models were adjusted for age, sex, center, education, body mass index, smoking, alcohol drinking, level of physical activity, energy intake, diabetes, hypertension, and use of lipid-lowering drugs. Multiple testing was controlled at a false discovery rate of <0.05. ResultsAmong 1542 lipid species measured, 71 lipid species (23 known), including acylcarnitine, cholesterol esters, glycerophospholipids, sphingomyelins and triacylglycerols, were associated with AHEI. Most of the identified lipids were associated with consumption of ω-3 (n–3) fatty acids. In total, 147 participants developed CHD during a mean follow-up of 17.8 years. Among the diet-related lipids, 10 lipids [5 known: cholesterol ester (CE)(22:5)B, phosphatidylcholine (PC)(p-14:0/22:1)/PC(o-14:0/22:1), PC(p-38:3)/PC(o-38:4)B, phosphatidylethanolamine (PE)(p-18:0/20:4)/PE(o-18:0/20:4), and sphingomyelin (d36:2)A] were associated with incident CHD. On average, each standard deviation increase in the baseline level of these 5 lipids was associated with 17%–23% increased risk of CHD (from HR: 1.17; 95% CI: 1, 1.36; to HR: 1.23; 95% CI: 1.05, 1.43). ConclusionsIn this study, lipidomic markers of diet quality in American Indian adults are found. Some diet-related lipids are associated with risk of CHD beyond established risk factors.

Dietary Composition, Angiographic Coronary Disease, and Cardiovascular Outcomes in the WISE Study (Women's Ischemia Syndrome Evaluation).

Studies relating diet to angiographic coronary artery disease (CAD) and subsequent major adverse cardiac events (MACE) in women are limited. Information on diet was collected in the Women's Ischemia Syndrome Evaluation (WISE), a prospective cohort study of symptomatic women referred for coronary angiography to evaluate suspected ischemic heart disease. A consecutive subgroup (n = 201 of 936) of enrolled women completed the modified Block food frequency questionnaire (FFQ). Data on outcomes were collected and adjudicated after 8-year follow-up. A set of logistic regression models were fitted for non-obstructive versus obstructive coronary stenosis (<50% versus ≥50%). Cox proportional hazard regression models were fitted for outcomes, with each dietary composition variable adjusted for the degree of coronary stenosis. At baseline, the subgroup cohort was 58 ± 12 years old with a body mass index (BMI) of 30 ± 7 kg/m2. An increased proportion of calories consumed from protein was associated with higher levels of baseline obstructive coronary stenosis. Those individuals who ate a higher amount of protein, carotene, and servings of vegetables and meat, however, were each associated with lower subsequent adverse outcomes, respectively. Among women undergoing coronary angiography for suspected CAD, a higher percentage of protein intake was associated with higher baseline stenosis severity; however, the amount of protein intake, vegetable, meat, and carotene intake, was conversely associated with subsequent lower adverse cardiovascular outcome risk.

Dietary Patterns Among Individuals with Plasma Cell Disorders Compared to the General US Population

Background Increasingly, there is evidence supporting the benefit of healthy dietary habits during prevention, treatment, and survivorship. The median survival for patients with multiple myeloma (MM) has increased from approximately 3 to 10 years in the last decade necessitating discussions about the integration of lifestyle medicine. MM patients with healthier pre diagnosis dietary patterns have longer survival than those with less healthy diets ( Lee et al. IJC 2020). Similarly, higher adherence to the Healthy Eating Index (HEI)-2015 has been associated with reduced all-cause and cancer-specific mortality ( Shan et al. JAMA 2023). A higher HEI score has been linked to reduced risk of chronic diseases as well. However, there is a paucity of demographic data for dietary patterns in individuals with plasma cell disorders (PCDs). Therefore, we examined the dietary patterns of individuals with PCDs in comparison to the US population. Method This study used the validated Block Food Frequency Questionnaire (FFQ) to survey individuals with a known history of a PCD in HealthTree Cure Hub, a patient data portal hosted by HealthTree Foundation. The questionnaire was used to calculate HEI-2015 scores which include 13 components that reflect the recommendations in the Dietary Guidelines for Americans, 2020-2025, with higher scores indicating greater adherence to the guidelines. Fruit (cup equivalents/day), vegetable (cup equivalents/day), fiber (grams/day), and sugar (grams/day) were also calculated. Mean values were compared using the Kruskal-Wallis test across subgroups: age, sex, race, body mass index (BMI), type of PCD, and level of education. In addition, with Z-test, HEI scores from participants in this study were compared to HEI scores of the general US population from National Health and Nutrition Examination Survey (NHANES) across age, sex, and race. Results We received 152 survey responses. Older age groups, and individuals with lower BMI had higher HEI scores (p=0.003 and p=0.016, respectively). There was no difference in HEI scores based on sex, race, or type of PCD. There was a trend for higher HEI scores with higher levels of education (p=0.093). There was no significant difference when comparing fruits, vegetables, fiber, and sugar intake between different subgroups, with the following exceptions: individuals aged ≥71 years (1.85; 95% CI 1.47-2.23) had higher total fruit consumption compared to those aged 60-70 (1.41; 95% CI 1.19-1.64) and 30-59 (1.31; 95% CI 0.84-1.78) (p=0.026), and individuals with graduate or professional degrees (1.79; 95% CI 1.46-2.12) had higher total fruit consumption compared to those with bachelor's degrees (1.27; 95% CI 0.83-1.7) or below (1.36, 95% CI [1.01-1.71] ) (p=0.008). Compared to the general US population, participants with PCDs had higher HEI scores across age, sex, and race (p&amp;lt;0.0001). Discussion In this study, the differences in HEI scores between subgroups categorized by age and BMI are consistent with trends seen in the US population. We found that younger individuals and individuals with elevated BMIs have worse HEI scores, suggesting these subgroups may derive greater benefit from dietary interventions. Given the association between a higher education level and higher fruit consumption (and the trend towards higher HEI scores), dietary interventions should discuss affordable alternatives. The higher HEI scores in our survey compared to the US population may suggest individuals with PCDs are more aligned with the Dietary Guidelines for Americans, although there is still considerable room for improvement. This difference may be due to improvements in diet post PCD diagnosis ( Malik et al. BCJ 2022), or due to a selection bias with individuals interested in the role of nutrition or greater awareness of nutrition being more likely to participate. Additionally, many participants heard of this survey through talks on nutrition organized through their local support groups and the HealthTree Nutrition and Wellness Chapter. This difference may also be explained by the difference in the assessment method used by NHANES (24-hour dietary recall) compared to the FFQ used in this study. Conclusions Individuals with PCDs (especially younger individuals and those with an elevated BMI) may benefit from interventions to improve dietary patterns. Subsequent studies to correlate healthier diets with long-term outcomes in patients with MM need to be performed.

Abstract 13367: Plasma Lipidomic Markers of Diet Quality Are Associated With Risk of Coronary Heart Disease in American Indians

Background: Diet quality can affect lipid profiles and subsequent risk of coronary heart disease (CHD). Identifying lipidomic markers of diet quality is needed to inform the development of biomarkers of diet, and to understand the mechanisms driving the diet-CHD relation. Objective: To identify lipidomic markers of diet quality and examine whether these lipids are associated with incident CHD. Methods: We studied 1,694 American Indians (aged 18-75, 62% women) who were free of CHD and had lipidomic and dietary data at baseline (2001-2003). Participants were followed for development of CHD through 2020 (mean follow-up: 17.8 years; total incident cases of CHD: 147). Information on past year diet was collected using the Block Food Frequency Questionnaire, and diet quality was assessed using the Alternative Healthy Eating Index-2010 (AHEI). Mixed effects linear regression was used to identify individual lipid species associated with AHEI at baseline. Cox frailty model was used to estimate the hazard ratio of each AHEI-related lipid for CHD risk. All models adjusted for age, sex, center, education, BMI, smoking, alcohol drinking, level of physical activity, energy intake, diabetes, hypertension, and use of lipid-lowering drugs. Results: Among 1,542 lipid species measured, 71 lipid species (23 known) were associated with AHEI at FDR&lt;0.05. Of these, 10 lipids (5 known) were associated with incident CHD (Figure 1 ). The 5 known lipids associated with incident CHD were CE(22:5) B, PC(p-14:0/22:1)/PC(o-14:0/22:1), PC(p-38:3)/PC(o-38:4) B, PE(p-18:0/20:4)/PE(o-18:0/20:4), and SM(d36:2) A. On average, per standard deviation increase in the baseline level of these lipids was associated with 17%-23% increased risk of CHD. These AHEI-related lipids are enriched in glycerophospholipid metabolism. Conclusion: We identified lipidomic markers of diet quality in American Indians. Some diet-related lipids are associated with risk of CHD beyond established risk factors.

THU336 Correlation Between Dietary Advanced Glycation End-products (Ages) And Skin Ages In Adults With Longstanding T1D

Abstract Disclosure: A.B. Murthy: None. B.E. Gray: None. M. Cote: None. B. Zahedi: None. E.W. Yu: Grant Recipient; Self; Amgen Inc. Background: Advanced glycation end products (AGEs) are involved in the pathophysiology of diabetic complications, and are thought to accrue with aging, hyperglycemia, and through diet. Despite the postulated impact of dietary intake on circulating AGE levels, there is currently no validated methodology for dietary AGE (dAGE) assessment. Thus, we sought to develop a crosswalk algorithm to calculate AGE intake from the commonly utilized Block Food Frequency Questionnaire (FFQ), and to validate our algorithm by correlating dAGE to skin AGE values within a cohort of adults with Type 1 Diabetes (T1D). Methods: We performed preliminary analysis of 50 study participants from the ongoing Type 1 Diabetes Bone Health Connection (T1D BEACON) study evaluating postmenopausal women and men older than 50 years with T1D. Dietary AGE intake was quantified using a novel algorithm we developed to associate items from the 2014 Block FFQ with their AGE content as determined by ELISA in a published data set (Urribarri, et al. 2014). Mean daily dAGE intake (kU/day) was correlated with autoflourescent skin AGE values (AGE Reader, DiagnOptics Technologies) using multivariate linear regression, after adjusting for age and gender. Diabetic characteristics and complications were assessed through questionnaires, physical exams (mTCNS, DPNCheck), chart review, and urine/serum tests. Results: The average age of the T1D cohort was 62.7 ± 6.8 years, 50% were female, the average duration of diabetes was 45 ± 9.4 years, with average A1c of 7.2 ± 1.1. Regarding diabetic complications, 70% had retinopathy, 30% had microalbuminuria (urine albumin-creatinine ratio &amp;gt; 30 mcg/mg), and 33% had neuropathy (mTCNS score &amp;gt; 5). Using our novel algorithm, the mean daily dAGE intake was calculated as 13178 ± 4455 kU/day. Mean daily dAGE intake was significantly higher for men (15279 ± 6337 kU/day) compared to women (11628 ± 3699 kU/day) (p = 0.016). Importantly, dAGEs were significantly correlated with skin AGEs (r = 0.409, p = 0.004), an association that persisted after adjusting for age and gender (p = 0.005). Additionally, dAGEs were correlated with current A1c values (r=0.37, p = 0.009, adj. p = 0.042) and with BMI (r = 0.32, p = 0.024, adj. p = 0.020), even after adjusting for age and gender. No associations were found between dAGEs and retinopathy, microalbuminuria, or neuropathy. Additional analysis of the full planned cohort is ongoing, along with assessments of serum AGE levels. Conclusion: We have developed and validated a novel dietary AGE algorithm that quantifies dAGE intake using the Block FFQ and is correlated with skin AGEs and glycemic control among adults with T1D. If further validated in larger cohorts, we hope this dAGE tool will facilitate future investigation of the impact of dietary AGEs on diabetic complications. Presentation: Thursday, June 15, 2023

A Diet Pattern Characterized by Sugar-Sweetened Beverages Is Associated with Lower Decision-Making Performance in the Iowa Gambling Task, Elevated Stress Exposure, and Altered Autonomic Nervous System Reactivity in Men and Women.

The executive brain mediates and facilitates a set of cognitive functions, such as decision making, planning, self-regulation, emotional regulation, and attention. Executive dysfunction and related diseases are a rising public health concern. Evidence supports a link between nutritional factors and executive function (EF), but relatively little information exists about the relationship between diet patterns and this higher order cognitive ability. We and others have reported on the relationships between body weight regulation and affective decision making, as measured by performance in the Iowa Gambling Task (IGT). However, little is known about the relationships between performance in this decision-making task and whole diet patterns. In this study, we tested whether data-derived diet patterns based on energy-adjusted food intake data from the Block Food Frequency Questionnaire were associated with decision-making performance in the IGT. Secondarily, we examined the influence of these diet patterns on self-reported chronic stress exposure and heart rate variability, which is a marker of autonomic nervous system (ANS) activity. In prior studies, stress and ANS activity were shown to influence decision-making performance in the IGT. In this study, five distinct diet patterns were identified by cluster and factor analyses. A diet pattern best characterized by elevated sugar-sweetened beverage and added sugar consumption was associated with the lowest decision-making performance (p = 0.0049) and higher stress exposure (p = 0.0097). This same diet pattern was associated (p = 0.0374) with an IGT-affiliated decline in high-frequency HRV and an increase in low-frequency HRV, suggesting diet-induced ANS regulatory shifts in response to performing the EF task. Compared to the sugar-sweetened beverage diet pattern, diet patterns defined by more fruits/vegetables and low red meat (p = 0.0048) or higher omega-3 fatty acids and seafood (p = 0.0029) consumption were associated with lower chronic stress exposure. All outcomes were statistically adjusted for differences in BMI, age, sex, education level, and sensorimotor ability. Our findings provide new information that further supports the potential importance of whole diet patterns on cognitive disease prevention.

Diet Quality and Kidney Outcomes in Adolescent and Adult American Indians: the Strong Heart Family Study.

The burden of kidney disease is exceedingly high among American Indians (AIs). We sought to examine the relationship of diet quality, a modifiable risk factor, and kidney outcomes in AI adolescents and adults, hypothesizing that healthier diets are associated with lower odds of incident albuminuria and eGFR decline. This is an analysis from the Strong Heart Family Study, a longitudinal study of cardiovascular disease and its risk factors among AIs from Arizona, North and South Dakota, and Oklahoma (n = 1720, mean age 39 + / - 16years, 16% adolescents at baseline). Participants completed two exams (baseline: 2001-2003; follow-up: 2007-2009). The primary exposure was diet quality, expressed as the Alternative Healthy Eating Index 2010 (AHEI), on a 110-point scale (assessed using a 119-item Block food frequency questionnaire). The primary outcomes were as follows: 1) incident albuminuria (albumin to creatinine ratio 30mg/g or greater); and 2) eGFR decline of 30% or greater. Generalized estimating equations were used to examine the association of AHEI (in quartiles) with outcomes. Ten percent of participants (6% of adolescents) had incident albuminuria and 2% of participants (2% of adolescents) had eGFR decline. For those with normal fasting glucose levels, the odds ratio (OR) for incident albuminuria comparing extreme quartiles of diet quality (least healthy [reference] versus healthiest quartiles) was 0.48 (95% CI 0.28, 0.81) after adjustment for demographics and comorbidities. For American Indians with normal fasting glucose, higher diet quality decreases the odds of developing albuminuria. These findings inform future efforts to prevent CKD in American Indian adolescents and young adults.

Macular Pigment Optical Density and Skin Carotenoids in a Childhood Sample

BackgroundCarotenoids are plant pigments with light filtering and antioxidant properties that deposit in human tissues, including retina and skin. Descriptive characteristics and covariates of carotenoid status in macula and skin have been examined in adults; however, similar studies in children are limited. Thus, this study aimed to delineate how factors of age, sex, race, weight status, and dietary carotenoid intake relate to macular and skin carotenoids in children. MethodsChildren (7–13 y, N = 375) completed heterochromatic flicker photometry to assess macular pigment optical density (MPOD). Participants underwent anthropometrics to measure weight status (BMI percentile [BMI%]), and parent/guardian provided demographic information. Subsample data were available for skin carotenoids (N = 181), assessed using reflection spectroscopy, and dietary carotenoids (N = 101) using the Block Food Frequency Questionnaire. Relationships between skin and macular carotenoids were assessed using partial Pearson’s correlations controlling for age, sex, race, and BMI%. Relationships between dietary carotenoids and macular and skin carotenoids were assessed using stepwise linear regression including age, sex, race, and BMI% in the model. ResultsMean MPOD was 0.56 ± 0.22 and skin carotenoid score was 282 ± 94.6. There was no significant correlation between MPOD and skin carotenoids (r = 0.02, P = 0.76). BMI% was negatively associated with skin (stdβ = −0.42, P < 0.001), but not macular carotenoids (stdβ = −0.04, P = 0.70). Neither MPOD nor skin carotenoids were associated with age, sex, or race (all P > 0.10). MPOD was positively associated with energy-adjusted reported lutein + zeaxanthin intake (stdβ = 0.27, P = 0.01). Skin carotenoids were positively associated with energy-adjusted reported carotenoid intake (stdβ = 0.26, P = 0.01). ConclusionsThe mean MPOD values in children were higher than what has been reported in adult populations. Previous studies in adult samples report an average MPOD of 0.21. Although macular and skin carotenoids were not related, they were associated with dietary carotenoids relevant to the respective tissues; however, skin carotenoids may be more susceptible negative influence from higher weight status.

Experiences of Racial Discrimination and Periconceptional Diet Quality

BackgroundRacism is a key determinant of perinatal health disparities. Poor diet may contribute to this effect, but research on racism and dietary patterns is limited. ObjectiveWe aimed to describe the relation between experiences of racial discrimination and adherence to the 2015‒2020 Dietary Guidelines for Americans. MethodsWe used data from a prospective pregnancy cohort study conducted at 8 United States medical centers (2010‒2013). At 6‒13 weeks of gestation, 10,038 nulliparous people with singleton pregnancies were enrolled. Participants completed a Block food frequency questionnaire, assessing usual diet in the 3 mo around conception, and the Krieger Experiences of Discrimination Scale, assessing the number of situational domains (e.g., at school and on the street) in which participants ever experienced racial discrimination. Alignment of dietary intake with the 2015–2020 Dietary Guidelines for Americans was assessed using the Healthy Eating Index (HEI)-2015. ResultsThe study showed that 49%, 44%, 35%, and 17% of the Asian, Black, Hispanic, and White participants reported experiences of racial discrimination in any domain. Most participants experienced discrimination in 1 or 2 situational domains. There were no meaningful differences in HEI-2015 total or component scores in any racial or ethnic group according to count of self-reported domains in which individuals experienced discrimination. For example, mean total scores were 57‒59 among Black, 61‒66 among White, 61‒63 among Hispanic, and 66‒69 among Asian participants across the count of racial discrimination domains. ConclusionsThis null association stresses the importance of going beyond interpersonal racial discrimination to consider the institutions, systems, and practices affecting racialized people to eliminate persistent inequalities in diet and perinatal health.

Associations of Dietary Intake With Self-Reported Hearing Loss: Findings From the Survey of the Health of Wisconsin.

The purpose of this study was to evaluate associations of dietary intake components with hearing loss. Participants were from the population-based Survey of the Health of Wisconsin. The Block food frequency questionnaire measured dietary intake of carbohydrates, fiber, protein, free (added) sugars, fruits, vegetables, saturated and trans fats, and glycemic index. Intake was categorized into quintiles (Q). Hearing loss was self-reported. Logistic regression models were used to evaluate associations of dietary determinants with hearing loss. Results are presented as odds ratios (ORs) with corresponding 95% confidence intervals (95% CIs). Final models were adjusted for age, sex, total energy intake, race/ethnicity, education, smoking, and regular physical activity. There were 2,839 participants (56% women; Mage = 48.2 [SD = 14.5] years) included. Higher consumption of trans fat (Q5: OR = 1.83, 95% CI [1.27, 2.64]) and higher glycemic index (Q5: OR = 1.34, 95% CI [1.00, 1.80]) were associated with increased odds of hearing loss. Hearing loss was associated with fruit, saturated- and trans-fat intake in women, and trans-fat intake and glycemic index in men. Dietary intake was associated with self-reported hearing loss. Research on mechanistic pathways of associations and public health interventions to prevent hearing loss is needed.

Dietary Outcomes of a Multilevel, Multicomponent, Cluster Randomized Obesity Intervention in 6 Native American Communities in the Upper Midwest and Southwest United States

BackgroundImpacts of colonization on dietary intake have led to high rates of obesity and noncommunicable diseases among Native American adults. Multilevel, multicomponent (MLMC) interventions may improve dietary intake. ObjectivesTo assess the impact of a MLMC obesity intervention, OPREVENT2 (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans 2; clinicaltrials.gov NCT02803853), on dietary intake in Native American adults in Intervention versus Comparison communities. MethodsA cluster-randomized controlled trial was performed among participants in 6 communities randomized to Intervention (n = 3 and Comparison (n = 3). Adults aged 18 to 75 were recruited from tribal communities in the Southwest and upper Midwest United States from September 2016 to May 2017 (n = 601). This analysis included participants who completed baseline and follow-up surveys (82% retention), reported dietary intake between 500 and 7000 kcal/d, and had no missing data for outcomes of interest (n = 446). The intervention was implemented from May 2017, to November 2018. OPREVENT2 integrated individual, environmental, social, and structural factors and was implemented in food stores, worksites, schools, and community media outlets in Intervention communities. Activities included taste tests, cooking demonstrations, and stocking healthier items in food stores and were reinforced by a social m)edia campaign, posters, brochures, and booklets focused on nutrition. Individual-level dietary intake among participating Native American adults was assessed via modified Block food-frequency questionnaire at preintervention and postintervention. Multilevel mixed-effects linear regression, with clustering at the community level, was performed. ResultsBetween-group effects were significant (P < 0.05) for intake of carbohydrates (-23 g/d), total fat (-9 g/d), saturated fats (-3 g/d), and monounsaturated fats (-4 g/d), with greater decreases in Intervention communities. Between-group effect for total sugar (-12 g/d in Intervention communities) was not statistically significant. ConclusionsThis MLMC intervention was associated with significantly improved carbohydrate, total fat, and saturated fat intake among Native American adults. These changes are important for improving health within this population.

Adult Survivors of Childhood Cancer Have Poor Adherence to Dietary Guidelines

Background: Poor nutritional intake can exacerbate the chronic disease burden in childhood cancer survivors, whereas a healthful diet serves a protective function. Few studies have provided detailed evaluations of the diet of childhood cancer survivors.Objectives: This study aimed to evaluate diet quality and dietary intakes of key food groups and nutrients in a large cohort of childhood cancer survivors and whether cancer and treatment characteristics have an impact on survivors’ long-term intake.Methods: Diet was assessed in 2570 adult survivors of childhood cancer enrolled in the St. Jude Lifetime cohort (mean age = 32.3 y) by using the Block food-frequency questionnaire. The Healthy Eating Index–2010 (HEI-2010) was calculated to quantify diet quality. Cancer diagnosis and treatment exposure were abstracted from medical records. Differences in HEI-2010 by patient characteristics and treatment exposure were examined by using ANCOVA.Results: The mean ± SD HEI-2010 in childhood cancer survivors was 57.9 ± 12.4 of a maximum score of 100. Referenced to Dietary Reference Intakes, survivors consumed inadequate amounts of vitamin D, vitamin E, potassium, fiber, magnesium, and calcium (27%, 54%, 58%, 59%, 84%, and 90% of the recommended intakes) but excessive amounts of sodium and saturated fat (155% and 115% of the recommended intakes) from foods. Survivors diagnosed when <5 y of age had a lower diet quality than did those diagnosed when ≥5 y of age (mean HEI-2010 score: 56.9 compared with 58.2; P = 0.046). Survivors who received higher radiation doses to the abdomen had a lower diet quality than those who received lower doses (mean HEI-2010 scores = 58.9, 57.2, 56.7, and 56.1 for doses of 0, 1–19.9, 20–29.9, and ≥30 Gy, respectively; P = 0.02).Conclusions: Long-term childhood cancer survivors have poor adherence to the 2010 Dietary Guidelines for Americans. Findings reinforce the need to incorporate nutrition into cancer care to improve diet quality and to reduce morbidities.

Abstract PR014: Sugar Intake and premature aging in adult survivors of childhood cancer in the St. Jude Lifetime (SJLIFE) Cohort

Abstract Background: In the general population, sugar intake is associated with a wide range of adverse health conditions related to premature aging, including obesity, diabetes, and cardiovascular disease. Childhood cancer survivors are at increased risk of premature aging and mortality compared to their healthy peers and may be especially vulnerable to adverse consequences of excess sugar intake. Objective: To examine the association between sugar and sugar-sweetened beverage intake and premature aging in childhood cancer survivors. Method: A total of 3,322 adult survivors of childhood cancer (age range 18-65 years; mean age: 31 years) in SJLIFE self-reported their typical diet using the 110-item Block Food Frequency Questionnaire. Added sugars included all sugars added to foods during preparation or processing. Total sugar-sweetened beverages are the sum of regular and diet soda and fruit-flavored drinks. Survivors’ sociodemographics, cancer histories, and health conditions were abstracted from medical records. Premature aging was assessed using the Deficit Accumulation Index (DAI) that was a ratio of the number of age-related chronic health conditions each survivor had out of 45 conditions total. The DAI was categorized into low (&amp;lt;0.2), medium (0.2-0.34), and high (&amp;gt;0.35) aging risk groups. Multinomial logistic regressions (reference: low aging risk group) adjusting for confounders, including sociodemographics, lifestyle factors, cancer treatments, and overall diet quality, were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Survivors’ average total sugar intake was 120 g/day and added sugar intake was 71 g/day. 41% of survivors consumed sugar-sweetened beverages ≥1 time/day, and 26% consumed soda daily; 75% of soda consumed was regular (vs. diet). Survivors with higher consumption of sugar and sugar-sweetened beverages were more likely to be non-Hispanic Black and have lower educational attainment and income. Total sugar intake was associated with a significantly increased risk of premature aging (per 25 g/1,000 kcal increment, OR=1.31 [95% CI: 1.00-1.70] in the medium-risk group; OR=1.52 [95% CI: 1.03-2.25] in the high-risk group). Added sugar intake was associated with a 19% (OR=1.19, 95% CI: 1.07-1.31, per 20 g/1,000 kcal increment) and an 18% (OR=1.18, 95% CI: 1.02-1.37) increased risk of premature aging in the medium- and high-risk group, respectively. Consuming ≥2 servings/day (vs. ≤ 1/week) of total sugar-sweetened beverage was also related to an increased risk of premature aging (OR=1.54 [95% CI: 0.83-2.83] in the medium-risk group; OR=6.71 [95% CI: 2.95-15.2] in the high-risk group). Regular soda, but not diet soda, consumption was associated with premature aging risk. Conclusion: Higher consumption of sugar and sugar-sweetened beverages was associated with an increased risk of premature aging in childhood cancer survivors. Intervention efforts to reduce sugar intake among this vulnerable population are needed. Citation Format: Tuo Lan, Mei Wang, AnnaLynn M. Williams, Matthew J. Ehrhardt, Emily R. Finch, Jennifer Q. Lanctot, Shu Jiang, Kevin R. Krull, Gregory T. Armstrong, Melissa M. Hudson, Graham A. Colditz, Leslie Robison, Kirsten K. Ness, Yikyung Park. Sugar Intake and premature aging in adult survivors of childhood cancer in the St. Jude Lifetime (SJLIFE) Cohort [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr PR014.

Comprehensive Nutrition Assessment in Adults with Sickle Cell Disease Using the Dietary Inflammatory Index and Healthy Eating Index

Increasing evidence shows that nutrition plays a role in the pathogenesis and progression of many diseases. Certain diets are shown to play a role in driving systemic inflammation and consequently contribute to exacerbation of disease processes. Systematic nutrition assessment in individuals with sickle cell disease (SCD) is largely unexplored and thus it is not well understood how diet impacts SCD complications and health outcomes. Therefore, the objective of this study was to assess both the inflammatory nature and quality of diet in adults with SCD. Individuals with SCD age ≥18 years were eligible for enrollment. Consented participants completed the validated diet assessment, the Block 2014 Food Frequency Questionnaire. This questionnaire has a recall period of one year and includes questions on the intake of 127 food and beverage items. Data collected from this questionnaire are sent to the developer for secondary and tertiary analyses for quantification of nutrients and food groups and the returned quantifications were used to calculate the Dietary Inflammatory Index (DII) and the Healthy Eating Index (HEI). The DII is a validated measure that quantifies the inflammatory nature of individuals' diet based on the potential of nutrients to trigger inflammation, whereas the HEI is a metric that assesses overall diet quality and several individual dietary components. DII is calculated based on the global mean intake and standard deviation (SD), and overall inflammatory effect score for specific food parameters. A total of 30 food parameters (Figure 1) were used for DII calculation in this study. Global mean intake and SD are used to calculate a Z-score for each nutrient which is then converted to the centered percentile. It is then multiplied with the overall food parameter-specific inflammatory effect score from the DII database to get a DII for each nutrient. These individual nutrient scores are summed to create the 'overall DII score' for an individual. Possible overall DII scores range from -8.87 to +7.98, with negative scores indicating an anti-inflammatory diet and positive scores indicating a pro-inflammatory diet. The HEI reflects adherence to Dietary Guidelines for Americans (DGA) and considers density-based (amounts per 1,000 kcal) intake of the following 13 components: total fruits, whole fruits, total vegetables, greens and beans, whole grains, dairy, total protein foods, seafood and plant proteins, fatty acids, refined grains, sodium, added sugars, saturated fats. Fruits, vegetables, and proteins are assigned a maximum of 5 points each because they are represented by two components (i.e., total fruits and whole fruits) while other food groups receive a maximum of 10 points because they are represented by one component. Maximum points are assigned if the a priori set thresholds for the specific components are met (detailed in Figure 2 legend). Final HEI is a sum of scores for each component. The HEI has a range of 0 (reflecting no adherence to DGA) to 100 (reflecting complete adherence to DGA). The mean HEI for Americans aged 19-59 years old is 57. We report the range and mean for both the DII and HEI indices. A total of 28 adults with SCD completed the Block Food Frequency questionnaire. Mean age of participants was 33.7 (SD 10.5) years with range of 19-58 years and 46.4% (n=13) were female. Figure 1 represents the DII scores for our study cohort. We found 25% (n=7) of individuals had a negative DII indicating consumption of an anti-inflammatory diet, and 75% (n=21) of individuals had a positive DII indicating consumption of a pro-inflammatory diet. The DII ranged from -5.25 to 6.55, with a median DII of 2.62 (IQR -0.49, 4.45). The mean HEI score for the study cohort was 60. Individual components of the mean HEI for SCD individuals and for average adult Americans are shown in Figure 2. Numbers in the radar graph represent the percentage of maximum possible score for each component. The majority of adults with SCD in our cohort have evidence of a pro-inflammatory diet. Our cohort had a similar HEI to average Americans, but its components vary between the food groups and require further assessment. These data are the first step to systematically assessing nutrition in individuals with SCD. Further research is necessary to investigate if nutrition impacts disease expression and health outcomes in SCD and determine whether diet is a modifiable target for interventions. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Eating Habits, Risk of Breast Cancer, and Diet-Dependent Quality of Life in Postmenopausal Women after Mastectomy.

The present study examined dietary risk factors for breast cancer, their association with quality of life, and changes in eating habits in postmenopausal women after mastectomy. The study included 210 women with histologically confirmed invasive breast cancer and 225 women without a cancer diagnosis. Questionnaire data on frequency of intake of 40 different foods, the Block Food Frequency Questionnaire, and SF-36 for evaluation of quality of life were used. All questionnaire data in the patient group were collected after diagnosis. Questions about eating habits covered two time points—before breast cancer diagnosis and after completion of treatment. Logistic regression was applied to calculate the odds ratios of breast cancer risk and 95% confidence intervals. A significant positive association was found between the risk of breast cancer and more frequent intake of red meat, smoked products, offal, animal fat, white bread, potatoes, and sweets, high intake of total fat, and low consumption of dietary fibre. Foods that were inversely associated with the risk of breast cancer included fish, vegetables, fruit, wholemeal bread, and groats. The relationship between quality of life and dietary habits according to the Block Eating Frequency Questionnaire was analysed using multiple regression. It was shown that high intake of total fat reduces the quality of life in its mental components. We observed a positive change in eating habits after cancer diagnosis, albeit not always to the level in the control group. As an important lifestyle component, the diet is of great significance for primary prevention of breast cancer as well as for improving the quality of life of breast cancer patients.

Dietary Fatty Acid Intake and the Colonic Gut Microbiota in Humans.

A high-fat diet has been associated with systemic diseases in humans and alterations in gut microbiota in animal studies. However, the influence of dietary fatty acid intake on gut microbiota in humans has not been well studied. In this cross-sectional study, we examined the association between intake of total fatty acids (TFAs), saturated fatty acids (SFAs), trans fatty acids (TrFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), n3-FAs, and n6-FAs, and the community composition and structure of the adherent colonic gut microbiota. We obtained 97 colonic biopsies from 34 participants with endoscopically normal colons. Microbial DNA was used to sequence the 16S rRNA V4 region. The DADA2 and SILVA database were used for amplicon sequence variant assignment. Dietary data were collected using the Block food frequency questionnaire. The biodiversity and the relative abundance of the bacterial taxa by higher vs. lower fat intake were compared using the Mann–Whitney test followed by multivariable negative binomial regression model. False discovery rate–adjusted p-values (q value) < 0.05 indicated statistical significance. The beta diversity of gut bacteria differed significantly by intake of all types of fatty acids. The relative abundance of Sutterella was significantly higher with higher intake of TFAs, MUFAs, PUFAs, and n6-FAs. The relative abundance of Tyzzerella and Fusobacterium was significantly higher with higher intake of SFAs. Tyzzerella was also higher with higher intake of TrFA. These observations were confirmed by multivariate analyses. Dietary fat intake was associated with bacterial composition and structure. Sutterella, Fusobacterium, and Tyzzerella were associated with fatty acid intake.

Associations between diet quality and chronic health conditions (CHCs) in adult survivors of childhood cancer in the St. Jude Lifetime Cohort Study (SJLIFE).

12095 Background: Survivors of childhood cancer are at increased risk for early development of CHCs, including metabolic syndrome (MetS), low bone mineral density (LBMD), and gastrointestinal (GI) disease. Dietary modification is often recommended for prevention and/or treatment of these CHCs in non-cancer populations. However, associations between diet quality and severity of CHCs in adult survivors of childhood cancer are not well known. Methods: Adult survivors (≥10 years post-diagnosis) of childhood cancer who completed a clinical evaluation and Block Food Frequency Questionnaire were included. Diet quality was estimated using the Mediterranean diet score (aMED), with scores ranging from 0 to 9 (increased scores represent higher adherence to diet). CHCs were graded (modified CTCAE) and classified as “low” (grade ≤1 for LBMD and GI; grade ≤2 for MetS) or “high” (grade 2-4 for LBMD and GI; grade 3-4 for MetS). A multivariable linear regression model was used to estimate the mean aMED score by “low” or “high” disease category, with adjustment for age at evaluation, sex, race, education, total energy intake, adjusted BMI, physical activity, smoking, and alcohol consumption. Results: 2,822 survivors of childhood cancer (52.4% male, 83.1% non-Hispanic white) were included. The most prevalent diagnosis was acute lymphoblastic leukemia (34.1%). Time from primary diagnosis was 24.2±8.5 years and age at recruitment was 32.5±8.7 years. Lower adherence to aMED diet was associated with “high” MetS and LBMD, but not GI disease. See the Table for aMED multivariate-adjusted diet quality scores by CHC. Conclusions: In this cross-sectional analysis, MetS and LBMD were associated with poor adherence to the aMED diet. Although longitudinal investigation of associations between diet quality and CHCs in survivors of childhood cancer are needed to determine causal association between diet quality and CHCs in childhood cancer survivors, dietary interventions in early or late cancer survivors may help prevent development or progression of specific treatment related chronic conditions. [Table: see text]