Block Food Frequency Questionnaire Research Articles

Dietary Intake, D3Cr Muscle Mass, and Appendicular Lean Mass in a Cohort of Older Men.

We examined cross-sectional associations between dietary patterns, macronutrient intake, and measures of muscle mass and lean mass in older men. Participants in the Osteoporotic Fractures in Men (MrOS) cohort (n = 903; mean ± SD age 84.2 ± 4 years) completed brief Block food frequency questionnaires (May 2014-May 2016); factor analysis was used to derive dietary patterns. The D3-creatine (D3Cr) dilution method was used to measure muscle mass; dual-energy x-ray absorptiometry (DXA) was used to measure appendicular lean mass (ALM). Generalized linear models were used to report adjusted means of outcomes by dietary pattern. Multiple linear regression models were used to determine associations between macronutrients and D3Cr muscle mass and DXA ALM. Multivariable models were adjusted for age, race, clinic site, education, depression, total energy intake, height, and percent body fat. Greater adherence to a Western dietary pattern (high factor loadings for red meat, fried foods, and high-fat dairy) was associated with higher D3Cr muscle mass (p-trend = .026). Adherence to the Healthy dietary pattern (high factor loadings for fruit, vegetables, whole grains, and lean meats) was not associated with D3Cr muscle mass or DXA ALM. Total protein (β = 0.09, 95% CI = 0.03, 0.14) and nondairy animal protein (β = 0.16, 95% CI = 0.10, 0.21) were positively associated with D3Cr muscle mass. Nondairy animal protein (β = 0.06, 95% CI = 0.002, 0.11) was positively associated with DXA ALM. Associations with other macronutrients were inconsistent. Nondairy animal protein intake (within a Western dietary pattern and alone) was positively associated with D3Cr muscle mass in older men.

Higher Usual Energy Intake, Body Mass, Body Mass Index, and Fat Free Mass Index Are Associated with Lower Attrition from an Arduous Military Selection Course (P23-005-19)

ObjectivesTo determine whether usual energy intake and body composition are associated with attrition from an arduous military selection course characterized by energy deficit and strenuous physical events, including fitness tests, loaded road marches, runs, land navigation, and an obstacle course. MethodsEnergy intake and body composition were assessed in U.S. Army Soldiers (n = 776) at the start of a military assessment and selection course. Usual energy intake (kcal) over the previous year was estimated from a 127-item Block food frequency questionnaire. Body composition measures, including body mass (kg), body mass index (BMI, body mass in kg/height in m2), fat free mass index (FFMI, fat free mass in kg/height in m2), and fat mass index (FMI, fat mass in kg/height in m2) were assessed by calibrated scale and 3-site skinfold caliper measures. Associations between energy intake, body composition, and demographics were determined with analysis of variance. Logistic regression was used to determine likelihood of attrition [odds ratio (OR), 95% confidence interval (CI)] based on quartiles of energy intake and body composition. Models were adjusted for age, education, duration of aerobic exercise, duration of strength training, smoking status, and smokeless tobacco use. ResultsSoldiers that were younger (18–24 y), engaged in longer duration of aerobic exercise (≥200 min/wk) and strength training (≥400 min/wk), had more education (≥some college), and were smokeless tobacco users had higher energy intakes (P < 0.05). Higher energy intake was associated with higher body mass and FFMI (P < 0.05). After adjustment, Soldiers with higher energy intake, body mass, BMI, and FFMI were less likely to fail the strenuous course (Q1 vs. Q2, Q3, and Q4: OR range = 0.25–0.54; 95% CI lower bound range = 0.15–0.33; 95% CI upper bound range = 0.46–0.87). FMI was not associated with attrition. ConclusionsOptimization of body composition by adequate consumption of calories prior to a physically demanding military selection course may be associated with reduced attrition. Funding SourcesSupported by U.S. Army Medical Research and Materiel Command. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Army or the Department of Defense. Supporting Tables, Images and/or Graphs▪▪▪▪▪

Associations Between Sodium, Potassium, Sugar and Non-caloric Sweetener Intake and Hypertension in Native American Adults (P04-127-19)

ObjectivesNative American (NA) adults experience higher rates of hypertension than other ethnicities. Sodium and sugar consumption from processed foods and sugar sweetened beverages (SSB) have been independently linked to increased prevalence of hypertension, whereas potassium consumption is thought to be protective. We explored associations between sodium, potassium, sugar and non-caloric sweetener consumption and hypertension in NA adults. MethodsA cross-sectional survey, including an interviewer-administered modified semi-quantitative Block Food Frequency Questionnaire and anthropometric measurements, was administered for the baseline assessment of the multi-level, multi-component obesity prevention trial OPREVENT2. A subset (n = 533) was used for this analysis. Systolic and diastolic blood pressure were directly measured using a Wrist Blood Pressure Monitor. Participants with systolic ≥130 mmHg or diastolic ≥80 mmHg were categorized as having hypertension. Linear regression models assessed the association between sugar (g), sodium (mg), and potassium (mg) consumption on systolic and diastolic blood pressure (mmHg), separately. Logistic regression models assessed the association between beverage consumption (e.g., SSB, diet soft drinks) frequency (e.g., daily) on prevalence of hypertension (dichotomous). All analyzes were adjusted for sex, age, total caloric, sodium, potassium and sugar intake, and body mass index. ResultsThe sample was 73.5% female with a mean age of 45.5 years, median systolic blood pressure of 130.5 mmHg, and median diastolic blood pressure of 81.0 mmHg. The prevalence of hypertension was 64.9%, 76.6% for males and 60.7% for females. There was no association between sugar, sodium or potassium consumption on systolic or diastolic blood pressure. Participants who reported consuming at least one diet soft drink per month had 30% higher odds of hypertension than those who consumed less (P < 0.01). No significant associations were observed for other beverages. ConclusionsFrequency and type of soft drink consumption may be predictors of hypertension in NA adults and baseline prevalence of hypertension should be considered when interpreting the results. The results of this study will be used to inform future intervention trials for chronic disease prevention. Funding SourcesNational Heart, Lung, and Blood Institute R01.

Household and Individual-level Factors Associated with Fruit, Vegetable, and Fiber Intake Among Native American Adults (P04-130-19)

ObjectivesLittle is known about the multilevel determinants of dietary intake among Native American (NA) adults across multiple tribal communities. Thus, we aimed to identify the household and individual-level factors associated with daily consumption of fruits, vegetables (FV), and fiber among NA adults. MethodsA random sample of 601 adults from 6 NA communities was included in the baseline assessment of the OPREVENT2 trial. A semi-quantitative Block Food Frequency Questionnaire was used to estimate daily intakes of FV and fiber. An interviewer-administered questionnaire assessed individual (sex, age, education level, employment status, weight status, smoking status) and household (household size, federal nutrition program participation, and material standard of life score) factors. Outliers and respondents with missing data were not included (n = 61). Multiple logistic regression models assessed individual and household-level factors associated with adequate daily vegetable (2.5 cups for women, 3 cups for men) and fiber intake (women: 25 g, men: 38 g). Poisson regression was used to identify factors associated with daily consumption of at least 1 cup-equivalent of fruit. Analyses were controlled for daily caloric intake and seasonality. ResultsOn average, NA adults consumed 0.53 ± 0.42 servings of fruit and 2.48 ± 1.78 vegetables/day. Females were more likely than males to have adequate vegetable and fiber intake (OR 2.3; 95% CI 1.44–3.77 and OR 151.9; 95% CI 26.85–859.35). Adults ages >51 were twice as likely to have adequate vegetable intake (OR 2.1; 95% CI 1.22–3.62) and those ages 31–50 and > 51 had higher odds for adequate fiber intake (OR 3.4; 95% CI 1.15–10.29 and OR 12.9; 95% CI 3.88–43.26) than younger adults (ages 18–30). Employed adults were less likely to have adequate fiber consumption than unemployed (OR 0.5; 95% CI 0.25–0.98). Individual factors were not associated with fruit consumption. Household factors were not associated with FV or fiber consumption. ConclusionsIndividual factors were associated with vegetable and fiber intakes, underscoring the need for a targeted approach in improving diet quality among NA adults. Our results also suggest that future interventions should target improving FV and fiber intake among younger men who seem to be at higher risk of low diet quality. Funding SourcesNational Heart, Lung, and Blood Institute R01.

Dietary index scores and invasive breast cancer risk among women with a family history of breast cancer

Many epidemiologic studies have analyzed the relations of individual foods and nutrients and breast cancer risk with inconsistent results. Few studies have examined recommendation-based dietary indices and breast cancer risk. The aim of this study was to determine associations between recommendation-based dietary index scores and incident invasive breast cancer. The Sister Study is a prospective cohort of 50,884 US women (baseline: 2003-2009) who had a sister with breast cancer but no prior breast cancer themselves. We created scores for the Dietary Approaches to Stop Hypertension (DASH) diet, Alternative Mediterranean Diet (AMED), and Alternative Healthy Eating Index-2010 (AHEI-2010) from dietary intakes estimated by a baseline-validated Block food-frequency questionnaire (FFQ). We used Cox regression to estimate multivariable-adjusted HRs and 95% CIs for total invasive breast cancer risk and by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) status. We documented 1,700 invasive breast cancer cases through 2015 (mean follow-up, 7.6 y). Individuals in the highest quartile of DASH scores had a lower risk of invasive breast cancer compared with those in the lowest quartile (HR: 0.78; 95% CI: 0.67, 0.90; P-trend=0.001), with stronger associations for ER- (HR: 0.61; 95% CI: 0.40, 0.94; P-trend=0.006) as well as ER-/PR- and ER-/PR-/HER2- subtypes. AHEI-2010 (HR for highest compared with lowest quartile: 0.90; 95% CI: 0.78, 1.03; P-trend=0.15) and AMED (HR for highest compared with lowest quartile: 0.90; 95% CI: 0.77, 1.06; P-trend=0.07) were weakly and nonsignificantly associated with breast cancer risk, but after excluding alcohol, AHEI-2010 was inversely associated with risk of ER-/PR- (HR: 0.64; 95% CI: 0.42, 0.98; P-trend=0.04) and ER-/PR-/HER2- subtypes. We did not observe any significant interactions by menopausal status or other participant characteristics. DASH scores were inversely associated with breast cancer risk; DASH and AHEI-2010 scores excluding alcohol were particularly inversely associated with risk of ER-/PR- and ER-/PR-/HER2- breast cancers. This trial was registered at clinicaltrials.gov as NCT00047970.

Correlates of Prenatal Diet Quality in Low-Income Hispanic Women

BackgroundLow-income Hispanic women are at-risk of poor prenatal diet quality. Correlates associated with prenatal diet quality in this group of women are understudied. ObjectiveThe objective of this study was to examine the associations between financial, cultural, psychosocial, and lifestyle correlates and prenatal diet quality in low-income Hispanic women. DesignThis cross-sectional analysis used data from pregnant women enrolled in the Starting Early Trial, a randomized-controlled trial of a primary-care based child obesity prevention program beginning in pregnancy. The trial enrolled women from clinics affiliated with a large urban medical center in New York City from 2012 to 2014. Financial, cultural, psychosocial, and lifestyle variables were collected using a comprehensive baseline questionnaire. Usual dietary intakes over the past year were assessed using the Block Food Frequency Questionnaire 2005 bilingual version. ParticipantsThe study enrolled low-income Hispanic women between 28 and 32 gestational weeks (N=519). Main outcome measuresPrenatal diet quality was measured by the Healthy Eating Index 2015. Statistical analyses performedUnadjusted and adjusted multivariable linear regression analyses were performed to determine independent associations between financial, cultural, psychosocial, and lifestyle correlates and Healthy Eating Index 2015 total score. ResultsOverall prenatal diet quality was poor (mean Healthy Eating Index 2015 total score=69.0±9.4). Most women did not meet the maximum score for total vegetables (65.3%), whole grains (97.1%), dairy (74.8%), fatty acids (84.4%), refined grains (79.8%), sodium (97.5%), saturated fats (92.9%), and added sugars (66.5%). Women who reported screen time ≤2 hours/day, physical activity before and/or during pregnancy, and being born outside the United States had higher mean Healthy Eating Index 2015 total score than women with screen time >2 hours/day, no physical activity, and those born in the United States. ConclusionsPrenatal diet quality of low-income pregnant Hispanic women was suboptimal. This cross-sectional study revealed associations between cultural and lifestyle factors and prenatal diet quality in low-income Hispanic women. Longitudinal studies are needed to determine long-term influences and specific behaviors to target for effective intervention studies.

The Effect of a Digital Behavioral Weight Loss Intervention on Adherence to the Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern in Medically Vulnerable Primary Care Patients: Results from a Randomized Controlled Trial

BackgroundObesity treatment focuses primarily on reducing overall caloric intake with limited focus on improving diet quality. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is effective in managing hypertension and other chronic conditions, yet it is not clear whether behavioral weight control interventions improve DASH adherence. We conducted a post hoc analysis of a behavioral weight loss intervention that did not emphasize diet quality and examined whether the intervention impacted DASH adherence in medically vulnerable community health center patients. MethodsParticipants (n=306) were enrolled in Track, a randomized controlled weight loss intervention for patients with elevated cardiovascular risk. The trial compared usual care to an intervention with weekly self-monitoring, tailored feedback on diet and exercise goals, and dietitian and provider counseling in community health centers. Dietary intake was measured using the Block Food Frequency Questionnaires collected at baseline and 12 months. DASH adherence was determined using previously validated scoring indices that assessed adherence based on recommended nutrient or food group targets. Total scores for both indices ranged from 0 to 9, with higher scores indicating greater DASH adherence. ResultsThe mean (and standard deviation [SD]) age of participants was 51.1 (SD=8.8) years and the mean body mass index was 35.9 (SD=3.9). Most were female (69%) and black (51%); 13% were Hispanic. Half (51%) had an annual income <$25,000 and 33% had both diabetes and hypertension. At baseline, the mean DASH nutrient score was 1.81 (SD=1.42) with 6% achieving at least a score of 4.5. Similar scores were seen for the DASH foods index. The intervention group saw significantly greater, albeit small, improvements in mean DASH nutrient score (intervention: 1.28 [SD=1.5] vs control: 0.20 [SD=1.3]; P<0.001), and there was no difference in DASH food score between study arms. There were no significant predictors of change in DASH score and no association between DASH adherence and changes in blood pressure. Within the intervention arm, improvements in DASH nutrient score were associated with greater weight loss (r=−0.28; P=0.003). ConclusionAlthough the intervention was not designed to increase adoption of DASH, the Track intervention produced significant weight loss and small improvements in DASH adherence. Despite these small improvements, overall adoption of DASH was poor among the medically vulnerable patients enrolled in Track. To further reduce chronic disease burden, weight loss interventions should include a focus on both caloric restriction and increasing diet quality.

Dietary protein intake is not associated with 5-y change in mid-thigh muscle cross-sectional area by computed tomography in older adults: the Health, Aging, and Body Composition (Health ABC) Study

ABSTRACTBackgroundA higher protein intake is suggested to preserve muscle mass during aging and may therefore reduce the risk of sarcopenia.ObjectivesWe explored whether the amount and type (animal or vegetable) of protein intake were associated with 5-y change in mid-thigh muscle cross-sectional area (CSA) in older adults (n = 1561).MethodsProtein intake was assessed at year 2 by a Block food-frequency questionnaire in participants (aged 70–79 y) of the Health, Aging, and Body Composition (Health ABC) Study, a prospective cohort study. At year 1 and year 6 mid-thigh muscle CSA in square centimeters was measured by computed tomography. Multiple linear regression analysis was used to examine the association between energy-adjusted protein residuals in grams per day (total, animal, and vegetable protein) and muscle CSA at year 6, adjusted for muscle CSA at year 1 and potential confounders including prevalent health conditions, physical activity, and 5-y change in fat mass.ResultsMean (95% CI) protein intake was 0.90 (0.88, 0.92) g · kg–1 · d–1 and mean (95% CI) 5-y change in muscle CSA was −9.8 (−10.6, −8.9) cm2. No association was observed between energy-adjusted total (β = −0.00; 95% CI: −0.06, 0.06 cm2; P = 0.982), animal (β = −0.00; 95% CI: −0.06, 0.05 cm2; P = 0.923), or plant (β = +0.07; 95% CI: −0.06, 0.21 cm2; P = 0.276) protein intake and muscle CSA at year 6, adjusted for baseline mid-thigh muscle CSA and potential confounders.ConclusionsThis study suggests that a higher total, animal, or vegetable protein intake is not associated with 5-y change in mid-thigh muscle CSA in older adults. This conclusion contradicts some, but not all, previous research. This trial was registered at www.trialregister.nl as NTR6930.

Pre-diagnostic carbohydrate intake and treatment failure after radical prostatectomy for early-stage prostate cancer.

An association between dietary carbohydrate intake and prostate cancer (PCa) prognosis is biologically plausible, but data are scarce. This prospective cohort study examined the relation between pre-diagnostic carbohydrate intake and treatment failure following radical prostatectomy for clinically early-stage PCa. We identified 205 men awaiting radical prostatectomy and assessed their usual dietary intake of carbohydrates using the 110-item Block food frequency questionnaire. We also evaluated carbohydrate intake quality using a score based on the consumption of sugars relative to fiber, fat, and protein. Logistic regression analyzed their associations with the odds of treatment failure, defined as a detectable and rising serum prostate-specific antigen (PSA) or receiving androgen deprivation therapy (ADT) within 2years. Sucrose consumption was associated with a higher odds and fiber consumption with a lower odds of ADT after accounting for age, race/ethnicity, body mass index, and tumor characteristics (odds ratio [OR] (95% confidence interval [CI]) 5.68 (1.71, 18.9) for 3rd vs. 1st sucrose tertile and 0.88 (0.81, 0.96) per gram of fiber/day, respectively). Increasing carbohydrate intake quality also associated with a lower odds of ADT (OR (95% CI) 0.78 (0.66, 0.92) per unit increase in score, range 0-12). Pre-diagnostic dietary carbohydrate intake composition and quality influence the risk of primary treatment failure for early-stage PCa. Future studies incorporating molecular aspects of carbohydrate metabolism could clarify possible underlying mechanisms.

Associations of the Mediterranean diet with cognitive and neuroimaging phenotypes of dementia in healthy older adults

Accumulating evidence suggests that higher Mediterranean diet (MedDiet) adherence is associated with higher global cognitive performance and brain structural integrity as well as decreased risk of Alzheimer disease (AD) and vascular dementia (VaD). We directly examined cross-sectional associations between the MedDiet and cognitive and neuroimaging phenotypes associated with AD and VaD (separately) in a cohort of nondemented, nondepressed older adults. Community-dwelling older adults (n=82; aged ∼68.8 y; 50% female, 50% minority) underwent dietary (Block Food Frequency Questionnaire 2005) and neuropsychological assessments and neuroimaging. MedDiet scores were quantified with the use of published criteria, and participants were divided into High and Low (median split) adherence groups. We focused our neuropsychological investigation on cognitive phenotypes primarily associated with AD [i.e., learning and memory (L&M)] and VaD (i.e., information processing and executive functioning). AD neuroimaging phenotypes consisted of hippocampal and dentate gyrus volumes quantified using T1-weighted images and the FreeSurfer 6.0 segmentation pipeline (http://surfer.nmr.mgh.harvard.edu). The VaD neuroimaging phenotype consisted of total white matter hyperintensity (WMH) volumes quantified using combined T1-weighted and T2-fluid-attenuated inversion recovery images. Neuroimaging metrics were adjusted for total intracranial volume. Separate multivariable linear regression models controlling for age, sex, education, body mass index, and caloric intake examined the associations between MedDiet groups (High compared with Low) and cognitive and neuroimaging outcomes. When compared with the Low MedDiet group, the High MedDiet group was associated with better L&M performance and larger dentate gyri. MedDiet adherence was not associated with information processing, executive functioning, or WMH. Results highlight the association between increasing MedDiet adherence and specific cognitive and neuroimaging phenotypes that, when altered, are associated with AD.

1015: Changes in maternal diet across gestation by pre-pregnancy BMI

Women often report significant dietary changes during pregnancy, yet it is not known whether they actually alter their diet during gestation and if their diet is influenced by maternal pre-pregnancy BMI. We performed a cross-sectional study of healthy pregnant women at 12-16 weeks gestation at Oregon Health & Science University. Eighty-seven women (35 normal weight, 27 overweight, 25 obese) underwent body composition analysis at enrollment and 37 weeks gestation and completed Block Food Frequency Questionnaires during each trimester. Intake was assessed per trimester and a mean value calculated across trimesters. Total caloric intake or grams of fat, protein, or carbohydrate consumption during pregnancy was not different by maternal BMI category. Women who were overweight consumed a greater percent of their daily calories from fat and a lower percent from carbohydrates compared to women who were normal weight or obese (p-value 0.03 and p-value 0.02, respectively) (figure). There were no differences of maternal intake by BMI category during the first and second trimesters. During the third trimester, however, women who were normal weight consumed food with lower % fat and higher % carbohydrate compared to women with BMI ≥ 25 kg/m2 (table). Within BMI categories, during the third trimester, women who were obese increased their % fat consumption and decreased their % carbohydrate consumption compared to the first and second trimesters, and women who were overweight increased their fat intake (g) across gestation (p-value 0.03). Women of normal weight maintained consistent diets across gestation. Maternal pre-pregnancy BMI was not a primary driver of differences in maternal diet during gestation. Women who were overweight and obese had increased fat consumption in late pregnancy compared to earlier in gestation, but with no difference in total caloric intake.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Serum and Erythrocyte Biomarkers of Nutrient Status Correlate with Short-Term Α-Carotene, Β-Carotene, Folate, and Vegetable Intakes Estimated by Food Frequency Questionnaire in Military Recruits

Objective: Food frequency questionnaires (FFQs) estimate habitual dietary intake and require evaluation in populations of interest in order to determine accuracy. Thus, the purpose of this study was to determine agreement between circulating biomarkers and FFQ estimated dietary intake in a military population consuming all meals in a dining facility over 12 weeks.Methods: 2014 Block FFQs were administered and fasted blood samples were drawn to assess nutritional biomarkers at the end of a 12-week training period in male (n = 141) and female (n = 125) Marine recruits undergoing initial military training. FFQ estimates of alpha- and beta-carotene, folate, and fruit and vegetable intake and circulating concentrations of serum alpha- and beta-carotene and serum and erythrocyte folate were measured. Partial correlations were used in the full model, and weighted kappa coefficients were used to determine agreement between ranking quartiles of dietary intake estimates with corresponding biomarker status quartiles.Results: Serum and dietary intake of alpha-carotene were positively associated in males (p = 0.009) and females (p < 0.001), as was serum and intake of beta-carotene (males, p = 0.002; females, p < 0.001). Alpha-carotene was positively associated with vegetable intake in males (p = 0.02) and beta-carotene with vegetable intake in females (p = 0.003). Serum folate in males (p = 0.002) and erythrocyte folate in females (p = 0.02) were associated with dietary folate intake. In females, the relationships between biomarker and dietary estimates yielded significant kappa coefficients. In males, a significant kappa coefficient was observed for erythrocyte folate and dietary intake of folate only. The kappa coefficient for serum and estimated intake of beta-carotene was not significant in males.Conclusion: Twelve-week habitual intake of alpha-and beta-carotene and folate were correlated with circulating biomarkers in a military training population. The 2014 Block FFQ was able to accurately rank females into quartiles of nutrient status based on intake, while males were ranked less accurately than females.

Dietary Oxidative Balance Scores and Biomarkers of Inflammation among Individuals with and without Chronic Kidney Disease

Background: Oxidative stress and inflammation are proposed mechanisms of nonspecific kidney injury and progressive kidney failure. Higher dietary oxidative balance scores (OBS) are associated with lower prevalence of chronic kidney disease (CKD). Methods: We investigated the association between OBS and biomarkers of inflammation using data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Nutrient estimates from the Block Food Frequency Questionnaires were used to define tertiles of 11 pro- and antioxidant factors. Points for each OBS component were summed, with a higher score indicating predominance of antioxidant exposures. Multivariable linear regression models were used to estimate the association between OBS and biomarkers of inflammation (interleukin-6 [IL-6], interleukin-8 [IL-8], interleukin-10 [IL-10], fibrinogen, C-reactive protein [CRP], white blood cell count, and cystatin C). An interaction term was included to determine if associations between OBS and inflammatory markers differed between individuals with and without CKD. Results: Of 682 participants, 22.4% had CKD. In adjusted models, OBS was associated with CRP and IL-6. For every 5-unit increase in OBS, the CRP concentration was –15.3% lower (95% CI: –25.6, –3.6). The association of OBS with IL-6 differed by CKD status; for every 5-unit increase in OBS, IL-6 was –10.7% lower (95% CI: –16.3, –4.7) among those without CKD, but there was no association among those with CKD (p = 0.03). Conclusion: This study suggests that a higher OBS is associated with more favorable levels of IL-6 and CRP, and that the association of OBS and IL-6 may be modified by CKD status.

Dietary Intake in Relation to Military Dietary Reference Values During Army Basic Combat Training; a Multi-center, Cross-sectional Study.

The military dietary reference intakes (MDRIs), outlined in Army Regulation 40-25, OPNAVINST 10110.1/MCO10110.49, AFI 44-141, establish standards intended to meet the nutrient requirements of Warfighters. Therefore, the purpose of this study was to comprehensively compare the revised MDRIs, published in 2017, with estimated dietary intakes in U.S. military personnel. During this cross-sectional study, Block food frequency questionnaires were administered at the end of the 9-week basic combat training course to estimate dietary intake during basic combat training in male (n = 307) and female (n = 280) recruits. The cut-point method was used to determine nutrient adequacy in comparison to the MDRIs. This study was approved by the Institutional Review Board of the U.S. Army Research Institute of Environmental Medicine. Recruits consumed an adequate amount of vitamins A, C and K, as well as the B-vitamins, and phosphorus, selenium, zinc, and protein and carbohydrate as a percentage of total calories when compared with MDRI standards. Vitamin D was the short-fall nutrient affecting the greatest number of participants, as 55 and 70% of males and females, respectively, consumed less than 33% of the MDRI. In addition, less than 50% of males met the MDRI for linoleic and α-linolenic acid, fiber, vitamin E, magnesium, and potassium, and less than 50% of females met the MDRI for α-linolenic acid, fiber, vitamin E, calcium, iron, magnesium, and potassium. In contrast, fat and sodium were over-consumed by both males (78 and 87%, respectively) and females (73 and 72%, respectively). The main findings of this study were that vitamins D and E, magnesium, potassium, α-linolenic acid, and fiber were under consumed by male and female recruits while males also did not consume adequate linoleic acid and females did not consume adequate calcium and iron. Future prospective research studies are needed to determine possible health and performance impacts that may be associated with suboptimal intake of these nutrients.

Abstract 3265: Healthy eating index 2005 and the mucosa associated gut microbiome in healthy individuals

Abstract Background: Diet is a modifiable risk factor for multiple cancers. It is also known to modulate gut microbial composition and metabolic activity, and plays an important role in maintaining gut homeostasis. However, our understanding of dietary quality and mucosa-associated microbiota in the large intestine in humans is limited. We examined the association between diet quality and gut microbiota in adults underwent routine colonoscopy in a cross-sectional study. Methods: We enrolled 21 men (50-75 years old, 71% White) who were found to have grossly normal colons at colonoscopy completed between July 2013 and April 2016. We obtained 98 colonic mucosa biopsies, with microbial DNA extracted from snap frozen biopsy. The 16S rRNA V4 region was amplified and sequenced on the Illumina MiSeq platform. The UPARSE and SILVA were used for operational taxonomic unit (OTU) classification. A self-administered BLOCK Food Frequency Questionnaire was used to assess dietary intake in the past year. Dietary quality was defined using the Healthy Eating Index (HEI)-2005, and further categorized as low or high using the median of total HEI or 12 individual component scores. We compared alpha-diversity (OTU and Shannon index), beta-diversity (Weighted UniFrac principal coordinates analysis), and relative abundance of bacterial phylum and genus by total HEI and all 12 individual HEI components using Mann-Whitney test. Reported P values were adjusted for multiple testing using false discovery rate. Results: The most abundant bacterial phyla observed were Firmicutes, Bacteroidetes, Proteobacteria, Verrucomicrobia, and Fusobacteria. High-quality diet (total HEI score ≥ 63) was not associated with higher richness and evenness of gut microbiome (P = 0.12), but was significantly associated with bacterial composition (P = 0.046). Compared to men who had low-quality diet (total HEI score &amp;lt; 63), those with high-quality diet had a higher abundance of Proteobacteria (12.2% vs. 8.1%, P = 0.006), and lower abundance of Fusobacteria (0.13% vs. 3.37%, P = 0.004). At the genus level, those with high-quality diet had significantly lower abundance of Fusobacterium than those with low-quality diet (0.11% vs. 3.77%, P = 0.004). At the HEI component level, individuals with a higher consumption of solid fruits and milk had higher richness and evenness of gut microbiome (P &amp;lt; 0.05) as well as higher abundance of phylum Verrucomicrobia (P &amp;lt; 0.05) and genus Akkermansia (P &amp;lt; 0.001). Consuming more solid and saturated fat, alcohol, and added sugar were associated with a higher abundance of phylum Fusobacteria (P &amp;lt; 0.0001) and genus Fusobacterium (P = 0.0001). Conclusions: The colonic microbiome of men consuming a low-quality diet exhibited increased levels of Fusobacteria, which has been associated with colorectal cancer risk. If replicated in prospective research, our findings suggest low quality diet may contribute to colorectal cancer by modulating gut microbiome. Citation Format: Yanhong Liu, Nadim J. Ajami, Diane Hutchinson, David Graham, Sarah Plew, Ashley Johnson, Preksha Shah, Liang Chen, Kathryn Royse, Donna L. White, Jennifer Kramer, Matthew C. Wong, Rhonda Cole, Clark Hair, Jason Hou, Nisreen Husain, Maria Jarbrink-Sehgal, Fasiha Kanwal, Gyanprakash Ketwaroo, Rajesh Shah, Maria Velez, Melissa L. Bondy, Hashem B. El-Serag, Joseph F. Petrosino, Li Jiao. Healthy eating index 2005 and the mucosa associated gut microbiome in healthy individuals [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3265.

Associations between fiber intake and Body Mass Index (BMI) among African-American women participating in a randomized weight loss and maintenance trial

IntroductionAfrican-American women are at increased risk for obesity, and therefore it is important to identify dietary factors that have the potential to prevent weight gain within this population. The purpose of the current study was to examine associations between daily fiber intake and Body Mass Index (BMI) over the course of an 18-month weight loss intervention for African-American women. MethodsAnthropometric measures and the Block Food Frequency Questionnaire were administered at baseline, 6-month, and 18-month follow-up between 2008 and 2010. A mixed-effects linear regression model with random intercept and time slope was used to model associations between fiber consumption and BMI controlling for time trend. ResultsAssociations between fiber consumption and BMI were significantly different over time (β̂Fiber∗Time=−0.07,p‐value=0.003). There was no association between fiber intake and BMI at baseline; however, there was a significant inverse relation between fiber consumption and BMI at 6 months, and the association was even stronger at 18 months. ConclusionsResults from this study suggest that dietary fiber consumption may be particularly important within weight loss interventions tailored for African-American women.

Dietary patterns and longitudinal change in hip bone mineral density among older men.

This study aimed to identify baseline dietary patterns using factor analysis in a cohort of older men and to evaluate whether the dietary patterns were associated with bone mineral density change (%ΔBMD) at the total hip and femoral neck over time. Participants (n = 4379; mean age 72.9 ± 5.5years) were from the Osteoporotic Fractures in Men (MrOS) prospective cohort study and had dietary data collected at baseline (March 2000-April 2002) and BMD measured at baseline and Visit 2 (March 2005-May 2006). Dietary intake was assessed with a brief Block food frequency questionnaire (FFQ); factor analysis was used to derive dietary patterns. BMD was measured by dual-energy x-ray absorptiometry (DXA); %ΔBMD was calculated from baseline to Visit 2. We used generalized linear regression to estimate least square (LS) means of %ΔBMD in quartiles of the dietary pattern scores adjusted for potential confounding factors. Two major dietary patterns were derived: Prudent (abundant in vegetables, salad, and non-fried fish) and Western (rich in hamburger, fries, processed meats, cheese, and sweets/desserts). There was an inverse association between adherence to the Prudent pattern and total hip %ΔBMD (p-trend = 0.028 after adjusting for age and clinical site; p-trend = 0.033 after further adjustment for smoking, calcium supplement use, diabetes, hypertension, and total energy intake). No other consistent associations between dietary patterns and %ΔBMD were observed. Greater adherence to a Prudent dietary pattern may attenuate total hip BMD loss (%ΔBMD) in older men.

Prospective associations of poor diet quality with long-term incidence of protein-energy malnutrition in community-dwelling older adults: the Health, Aging, and Body Composition (Health ABC) Study

ABSTRACTBackgroundProtein-energy malnutrition (PEM) is a major problem in older adults. Whether poor diet quality is an indicator for the long-term development of PEM is unknown.ObjectiveThe aim was to determine whether poor diet quality is associated with the incidence of PEM in community-dwelling older adults.DesignWe used data on 2234 US community-dwelling older adults aged 70–79 y of the Health, Aging, and Body Composition (Health ABC) Study. In 1998–1999, dietary intake over the preceding year was measured by using a Block food-frequency questionnaire. Indicators of diet quality include the Healthy Eating Index (HEI), energy intake, and protein intake. Outcomes were determined annually by using measured weight and height and included the following: 1) incident PEM [body mass index (in kg/m2) <20, involuntary weight loss of ≥5% in the preceding year at any follow-up examination, or both] and 2) incident persistent PEM (having PEM at 2 consecutive follow-up examinations). Associations of indicators of diet quality with 4-y and 3-y incidence of PEM and persistent PEM, respectively, were examined by multivariable Cox regression analyses.ResultsThe quality of the diet, as assessed with the HEI, was rated as “poor” for 6.4% and as “needs improvement” for 73.0% of the participants. During follow-up, 24.9% of the participants developed PEM and 8.5% developed persistent PEM. A poor HEI score was not associated with incident PEM or persistent PEM. Lower baseline energy intake was associated with a lower incidence of PEM (HR per 100-kcal/d lower intake: 0.98; 95% CI: 0.97, 0.99) and persistent PEM (HR: 0.97; 95% CI: 0.95, 0.99), although lower baseline protein intake was observed to be associated with a higher incidence of persistent PEM (HR per 10-g/d lower intake: 1.15; 95% CI: 1.03, 1.29).ConclusionsThese findings do not indicate that a poor diet quality is a risk factor for the long-term development of PEM in community-dwelling older adults, although there is an indication that lower protein intake is associated with higher PEM risk.

Weight status, diet quality, perceived stress, and functional health of caregivers of children with autism spectrum disorder.

Caring for children with autism spectrum disorder (ASD) can be highly demanding and can put significant strain on caregivers. To date, little is known about the extent to which caregivers of children with ASD experience increased levels of stress which may adversely affect health outcomes. The purpose of this secondary analysis was to compare caregivers of children with ASD and caregivers of typically developing children (TDC) in weight status, diet quality, perceived stress related to the parenting role, and functional health and well-being. Caregivers of 25 children with ASD and 30 TDC completed the 2005 Block Food Frequency Questionnaire, the 36-item Short Form of the Parenting Stress Index (PSI/SF), and the Short Form Health Survey (SF-36) and had their heights and weights measured during an onsite visit. Diet quality was assessed using the Healthy Eating Index (HEI)-2010 and its dietary components and conformance to the 2010 Dietary Guidelines for Americans. ASD caregivers did not differ significantly from TDC caregivers in body mass index or overweight/obesity prevalence (p ≥ .28), even when controlling for covariates. In univariate analyses, ASD caregivers consumed significantly fewer empty calories from solid fats, alcohol, and added sugars than TDC caregivers (p=.03), but they did not differ significantly in any other dietary outcomes including nutrient adequacy (p ≥ .10) and mean total HEI scores (p=.20). ASD caregivers, when compared to TDC caregivers, reported significantly greater parenting stress for the subscales difficult child and parent-child dysfunctional interaction as well as total stress (p<.001). In addition, 56% of ASD caregivers compared with 6.7% of TDC caregivers showed clinically significant levels of stress (p<.0001); a finding which remained statistically significant when controlling for covariates. ASD and TDC caregivers did not differ significantly in any SF-36 health domains related to functional health and well-being (p ≥ .10). Despite higher reported levels of stress, ASD caregivers did not differ significantly from TDC caregivers in diet- and health-related outcomes. Nurses and other health professionals should use comprehensive screening tools to assess overall caregiver stress and levels of resilience.

Effect of mindfulness meditation on short-term weight loss and eating behaviors in overweight and obese adults: A randomized controlled trial.

Background There is a significant health crisis with rates of obesity continuing to increase despite research and clinical standard behavioral weight loss programs (SBWP). Mindfulness meditation (MM), with demonstrated benefits on physical, psychological health, and self-regulation behaviors was explored with SBWP. Methods Forty-six adults (BMI=32.5±3.7 kg/m2; age=45.2±8.2 years, 87 % female, 21.7 % African American) were randomly assigned to a 6-month SBWP only (n=24) or SBWP+MM (n=22) at a university-based physical activity and weight management research center in a northeastern US city. Participants were instructed to decrease intake (1200-1500 kcal/day), increase physical activity (300 min/wk), and attend weekly SBWP or SBWP+MM sessions. SBWP+MM had the same SBWP lessons with addition of focused MM training. Outcome measures collected at 0, 3, and 6 months included: weight, Block Food Frequency Questionnaire, Eating Behavior Inventory, Eating Inventory and Paffenbarger Physical Activity Questionnaire. Data were analyzed using linear mixed modeling for efficacy analysis of weight (primary) and eating, exercise and mindfulness (secondary outcomes). Results Retention rate was 76.1 % (n=35). A significant group by time interaction (p=0.03) was found for weight, with weight loss favoring SBWP+MM (-6.9 kg+2.9) over SBWP (-4.1 kg+2.8). Eating behaviors (p=0.02) and dietary restraint (p=0.02) improved significantly in SBWP+MM, compared to SBWP. MM enhanced weight loss by 2.8 kg potentially through greater improvements in eating behaviors and dietary restraint. Conclusions These findings support further study into the use of MM strategies with overweight and obese adults. The use of this low-cost, portable strategy with standard behavioral interventions could improve weight management outcomes.