Dietary Guidelines Adherence Research Articles

Assessing Metabolic Health and Dietary Guideline Adherence in Arkansas School-aged Children: Identifying Gaps to Inform Future Interventions

Assessing Metabolic Health and Dietary Guideline Adherence in Arkansas School-aged Children: Identifying Gaps to Inform Future Interventions

Adherence to dietary guidelines and associated factors among rural Australian cancer survivors: a cross-sectional study

PurposeThis study aimed to explore levels of adherence to dietary guidelines, and factors associated with dietary guideline adherence, among rural Australian cancer survivors.MethodsA cross-sectional study was undertaken. We recruited a convenience sample of adults with cancer who attended the chemotherapy day unit or allied health appointments at a rural hospital in Baw Baw Shire, Victoria, Australia, between August 2017 and December 2021. Dietary guideline adherence was assessed by cross-referencing participants’ responses to an adapted version of the Dietary Questionnaire for Epidemiological Studies with dietary recommendations in Australian dietary guidelines. Binary logistic regression was used to assess factors associated with dietary guideline adherence for fruits and whole red meats.ResultsThere were 107 rural cancer survivors (median age, 67 years). Dietary guideline adherence was highest for alcohol (88%) followed by whole red meats (63%), fruits (56%), processed red meats (24%), cereals/breads/grains (7%), and vegetables (4%). Relative to those aged < 65 years, 65–74-year-olds had 5.7-fold greater odds (adjusted odds ratio (aOR) = 5.74, 95% confidence interval (CI) = 1.91–17.17) of adhering to the dietary guideline for fruits. Relative to those who had completed/ceased treatment, participants who were currently receiving treatment had 78% lower odds (aOR = 0.22, 95% CI = 0.09–0.59) of adhering to the dietary guideline for fruits.ConclusionThis study contributes preliminary data on adherence to dietary guidelines and associated factors among rural Australian cancer survivors. Dietary guideline adherence varied across food groups and was mostly low, albeit not markedly worse than Australia’s national population for the fruits and vegetables groups. The mostly low adherence in our sample suggests a potential need to increase provision of dietary information, supportive care screening, and, wherever necessary, dietetics referrals, assessments, and interventions among rural cancer survivors. Larger, longitudinal studies of adherence to dietary guidelines and/or tailored, cancer-specific dietary recommendations should be undertaken in future.

Adherence to dietary guidelines associated with lower medical service utilization in preschoolers: a longitudinal study

ObjectiveWe aimed to evaluate the association between dietary guideline adherence and overall, outpatient, and emergency medical service utilization in Taiwanese preschoolers.MethodsWe selected 614 preschoolers (2–6 years) who had one day of 24-h dietary recall data from the 2013–2016 Nutrition and Health Survey in Taiwan. The Taiwanese Children Healthy Eating Index (TCHEI) was developed on the basis of Taiwanese Food-Based Dietary Guidelines; it assesses dietary adequacy and eating behavior. Data on the participants’ outpatient and emergency medical service utilization were obtained for 2013–2018 from the National Health Insurance Research Database. A multivariable generalized linear model was used to evaluate the association between the TCHEI and medical service utilization for all disease and respiratory diseases.ResultsAfter adjustment for confounding factors, children aged 2–3 years in the Tertile (T) 2 and T3 groups of the TCHEI exhibited 25% (95% CI 0.69–0.83) and 16% (95% CI 0.77–0.92) lower overall medical visits, respectively. The same pattern was noted in the outpatient and emergency visits for all diseases and respiratory diseases. The children aged 4–6 years in the T2 group exhibited 15% (95% CI 0.80–0.91) and 11% (95% CI 0.82–0.97) lower overall visits and visits for respiratory diseases, respectively. Moreover, preschoolers in the T2 group exhibited lower overall medical expenditures than did those in the T1 group.ConclusionsTCHEI score was positively correlated with better nutritional status. Optimal dietary intake associated with lower medical service utilization among Taiwan preschoolers.

Eating behavior during pregnancy mediates the association between depression and diet quality--a new strategy for intervention in pregnancy.

Depression can result in changes in eating behavior and decrease the quality of eating. It has been shown that maternal depression during pregnancy can result in malnutrition, which can have adverse effects on the pregnancy and the offspring. There is currently no clear association between depression and diet. Five hundred and forty-nine pregnant women recruited from Danyang Maternal and Child Health Hospital in Jiangsu Province participated in this study and were administered the Intuitive Eating Scale-2 (IES-2), Edinburgh Post-natal Depression Scale (EPDS), Pregnancy Stress Scale (PPS), Self-rating Anxiety Scale (SAS), and Dietary Guidelines Adherence Index for Pregnant Women during Pregnancy (CDGCI-PW). The nutritional software collected dietary records for three consecutive days in mid-pregnancy to calculate dietary intake and nutrients that support energy production. The mediation analyses were conducted using SPSS 24.0 macro PROCESS. The relationship between depressive symptoms during pregnancy and diet quality was moderated primarily by two aspects of eating behavior, "Reliance on Hunger and Satiety Cues" (RHS) and "Body-Food Choice Congruence" (BFC). Depressive symptoms (EPDS scores) showed a negative correlation with RHS, BFC, and RHS, and BFC showed a positive correlation with diet quality, yielding a significant specific indirect effect. The multiple mediation model explained 14.7% of the variance in the diet quality. This study highlights the important role of eating behaviors during pregnancy in the relationship between depressive symptoms (EPDS scores) and diet quality, and provides preliminary evidence for feasible ways pregnant women with depressive symptoms can improve diet quality, promote maternal and child health, and reduce depression.

Development of an evaluation tool for dietary guideline adherence in the elderly

Development of an evaluation tool for dietary guideline adherence in the elderly

Are behavioural risk factors clusters associated with self-reported health complaints? University students in Finland.

No previous research of university students in Finland assessed lifestyle behavioural risk factors (BRFs) and categorized students into clusters, explored the associations of the clusters with self-reported health complaints (HCs), whilst controlling for potential confounders. The current study undertook this task. Students at the University of Turku (1,177) completed an online well-being questionnaire that assessed socio-demographic variables, 5 BRFs - problematic alcohol consumption, smoking, illicit drug use, food consumption habits, moderate-to-vigorous physical activity (MVPA), and 22 HCs. A food frequency questionnaire assessed students' consumption of a range of foods, and a dietary guideline adherence score was computed based on WHO dietary recommendations for Europe. Three separate regression models appraised the associations between the cluster membership and HCs factors, adjusting for sex, income sufficiency and self-rated health. Mean age was 23 ± 5.2 years, 77% had never smoked and 79% never used illicit drug/s. Factor analysis of HCs resulted in four-factors (psychological, circulatory/breathing, gastro-intestinal, pains/aches); cluster analysis of BRFs identified two distinctive student clusters. Cluster 1 represented more healthy students who never smoked/used illicit drugs, had no problematic drinking, and undertook MVPA on 4.42 ± 3.36 days/week. As for cluster 2 students, half the cluster smoked occasionally/daily, used illicit drug/s, and > 50% had problematic drinking and students undertook MVPA on 4.02 ± 3.12 days/week. More cluster 2 students adhered to healthy eating recommendations, but the difference was not significant between clusters. Regression analysis revealed that females, those with sufficient income, and with excellent/very good self-rated general health were significantly less likely to report all four HCs. Cluster 2 students were significantly more likely to report psychological complaints, circulatory/breathing and gastro-intestinal complaints. There was no significant association between BRFs clusters and pains/aches factor. Risk taking students with less healthy lifestyles and behaviour were consistently associated with poorer psychological and somatic health.

What Differentiates Rural and Urban Patients with Type 1 Diabetes-A Pilot Study.

The effective management of diabetes is a complex issue and may be determined according to numerous patient-dependent and patient-independent factors. This study aimed to analyze the relationship between the place of residence and selected sociodemographic, psychological and diabetes-related parameters in people with type 1 diabetes (T1D). This study was conducted on 419 adults with T1D using nonprobability sampling. The following questionnaires were used: the Diabetes Dietary Guidelines Adherence Index, the Acceptance of Illness Scale, the Sense of Responsibility for Health Scale, the Diabetes Eating Problem Survey-Revised scale, the Eating Attitudes Test and questions on sociodemographic and diabetes-related parameters. People living in rural areas were characterized by a significantly lower age and level of education, a higher incidence of being overweight, a higher glycated hemoglobin concentration, a lower number of glucose measurements during the day and a higher level of acceptance of the disease compared to urban residents. The degree of adherence to dietary recommendations and the sense of responsibility for one's own health were significantly higher among urban residents. It is necessary to assess barriers to a proper diet and to increase the effectiveness in managing the disease in rural communities. Targeted actions promoting the health of type 1 diabetics need to be developed with particular emphasis on patients from rural areas.

An integrative analytical framework to identify healthy, impactful, and equitable foods: a case study on 100% orange juice

To identify healthy, impactful, and equitable foods, we combined health scores from six diverse nutrient profiling systems (NPS) into a meta-framework (meta-NPS) and paired this with dietary guideline adherence assessment via multilevel regression and poststratification. In a case-study format, a commonly debated beverage formulation – 100% orange juice (OJ) – was chosen to showcase the utility and depth of our framework, systematically scoring high across multiple food systems (i.e. a Meta-Score percentile = 93rd and Stability percentile = 75th) and leading to an expected increase of US dietary fruit guideline adherence by ∼10%. Moreover, the increased adherence varies across the 300 sociodemographic strata, with the benefit patterns being sensitive to absolute or relative quantification of the difference of adherence affected by OJ. In sum, the adaptable, integrative framework we established deepens the science of nutrient profiling and dietary guideline adherence assessment while shedding light on the nuances of defining equitable health effects.

Nitrite and nitrate intake from processed meat is associated with elevated diastolic blood pressure (DBP)

Processed meat consumption has been linked to high blood pressure (BP), a key risk factor for cardiovascular disease (CVD), but gaps remain with regards to the ingredients which contribute to this association. This study, therefore, aimed to examine the association between nitrite and nitrate intake from processed meat with diastolic (DBP) and systolic (SBP) blood pressure, while accounting for sodium intake. Dietary nitrite and nitrate intake from processed meat, assessed as total nitrite equivalent, was estimated for 1774 adult, processed meat consumers (≥18 years, 55.1% females) who had enrolled in the Hellenic National Nutrition and Health Survey (HNNHS). To avoid selection and reverse causality bias, associations with measured DBP and SBP were considered instead of self-reported data of hypertension presence. Participants were divided by tertile of dietary nitrite intake and by level of dietary guideline adherence for sodium (<1500; 1500-2300; ≥2300). Multiple regression models were used to examine associations with SBP and DBP, including an interaction term of nitrite with dietary sodium intake, for potential synergy. Overall, DBP increased by 3.05mmHg (95% CI: 0, 6.06), per tertile increase in nitrite intake and 4.41mmHg (95% CI: 0.17, 8.64) per level increase in sodium intake, when the interaction effect between nitrite and total sodium intakes was accounted for. By considering the significant synergistic effect of the two factors, DBP finally increased by 0.94 mgHg overall and 2.24 mgHg for subjects in the third tertile compared to those in the first. Also, a rise in total sodium intake of approximately 800mg, above 1500mg, caused a 2.30 mgHg increase in DBP. No significant correlations were found with SBP. Higher nitrite and nitrate intake from processed meats contributed to the increase of DBP, but the interaction effect with total sodium intake levels should be accounted for to properly interpret the findings.

Dynamic Changes in Dietary Guideline Adherence and Its Association with All-Cause Mortality among Middle-Aged Chinese: A Longitudinal Study from the China Health and Nutrition Survey.

The traditional approach to evaluating dietary quality is based on the achievement of the recommended intakes for each food group, which may overlook the achievement of correct relative proportions between food groups. We propose a "Dietary Non-Adherence Score (DNAS)" to assess the degree of similarity between subjects' diets and those recommended in the Chinese Dietary Guidelines (CDG). Furthermore, it is important to incorporate the time-dependent nature of dietary quality into mortality prediction. This study investigated the association between long-term changes in adherence to the CDG and all-cause mortality. This study included 4533 participants aged 30-60 from the China Health and Nutrition Survey study with a median follow-up of 6.9 years. Intakes from 10 food groups were collected in 5 survey rounds from 2004 to 2015. We calculated the Euclidean distance between the intake of each food and the CDG-recommended intake, and then summed all the food groups as DNAS. Mortality was assessed in 2015. Latent class trajectory modeling was used to identify three classes of participants with distinct longitudinal trajectories of DNAS during the follow-up period. The Cox proportional hazard model was used to assess the risk of all-cause mortality in the three classes of people. Risk factors for death and confounders for diets were sequentially adjusted in the models. There were 187 deaths overall. Participants in the first class identified had consistently low and decreasing DNAS levels (coefficient = -0.020) over their lifetime, compared with a hazard ratio (HR) of 4.4 (95% confidence interval [CI]: 1.5, 12.7) for participants with consistently high and increasing DNAS levels (coefficient = 0.008). Those with moderate DNAS had an HR of 3.0 (95% CI: 1.1, 8.4). In summary, we find that people with consistently high adherence to CDG-recommended dietary patterns had a significantly lower mortality risk. DNAS is a promising method to assess diet quality.

Abstract P5-08-07: Dietary patterns among women with early-stage breast cancer from the Healthy Living Program

Abstract Background: Diet is a modifiable risk factor for breast cancer risk and mortality. Current guidelines recommend a diet that provides a diverse array of nutrients, comprised predominantly of fruits/vegetables and whole grains, with limited added sugar. The Healthy Living Program (HLP) is a clinical program at Memorial Sloan Kettering Cancer Center for patients with early-stage breast cancer that offers longitudinal, personalized lifestyle management starting at the time of diagnosis. Here, we report dietary patterns among the HLP cohort and association with baseline body mass index (BMI). Methods: We included all patients enrolled in the HLP from September 2020-February 2022. At the time of enrollment, participants complete a survey containing the National Cancer Institute (NCI) Dietary Screener Questionnaire (DSQ), which consists of consumption frequency questions for 26 food items over the past month. Total daily intake equivalents are calculated for foods from every diet factor group according to standard NCI DSQ scoring as follows: 1) Total daily cup equivalents of fruits/vegetables, which includes fruit, fruit juice, salad, potatoes, beans, other vegetables, tomato sauce, salsa, and pizza; 2) Total daily ounce equivalents of whole grains, which includes cereal, whole grain bread, whole grain rice, and popcorn; 3) Total teaspoon (tsp) equivalents of added sugars from candy, doughnuts, cookies/cake/pie, cereal, ice cream, and sugar-sweetened beverages including soda, fruit drinks, and sugar/honey in coffee/tea. Adherence to recommended daily intake of fruits/vegetables, whole grains, and added sugars was assessed as per the 2020-2025 Dietary Guidelines, the American Institute for Cancer Research, and the World Health Organization guidelines. Patient and tumor characteristics were abstracted from medical records. Results: Among the 399 patients included, the median age at diagnosis was 58 and median baseline BMI was 26.1 kg/m2. 45 patients had carcinoma in situ (11.3%), 296 had stage I disease (74.2%), 51 had stage II disease (12.8%), and 7 had stage III disease (1.8%). 316 had hormone-receptor positive disease (89.3%), 24 had HER2-positive disease (6.8%), and 26 had triple-negative disease (7.3%). 106 participants (27%) met the guideline recommendation of ≥4-5 cup equivalents of fruits/vegetables daily and 3 participants (0.8%) met the guideline recommendation of ≥3 ounces equivalents of whole grains daily. All patients in the cohort met the guideline recommendation of &amp;lt; 6 tsp equivalents of added sugars daily. Only 2 patients (0.5%) met guidelines for all three diet factors. Baseline BMI was significantly higher among patients who did not meet the recommended fruit/vegetable intake than among those who did (26.9 kg/m2 vs. 24.5 kg/m2, p=0.016). There were no significant differences in BMI between those who did and did not adhere to the other diet factor guidelines and no significant association between tumor stage or histology and dietary guideline adherence. Conclusion: Most patients with early-stage breast cancer did not meet the recommended daily intake of fruits/vegetables or whole grains. Participants who did not meet the fruit and vegetable intake guideline had significantly higher BMI at diagnosis. These findings indicate that lifestyle assessment near the time of breast cancer diagnosis identifies patients that could benefit from personalized dietary interventions to optimize prognostic factors such as BMI. Citation Format: Bethina Liu, Sherry Shen, Erica Salehi, Yuan Chen, Nicolas Toumbacaris, Johnny Allsop, Cara Anselmo, Stacie Corcoran, Bridget Kelly, Rocco Magnoli, Andrea Smith, Melissa Emerzian, Julia Brockway-Marchello, Doreen Bacotti, Mark E. Robson, Neil M. Iyengar. Dietary patterns among women with early-stage breast cancer from the Healthy Living Program [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-08-07.

Abstract 53: Real-Life Effects of Nudging and Pricing Strategies in the Supermarket to Promote Healthy Diets and Cardiometabolic Health: The Supreme Nudge Parallel Cluster-Randomized Controlled Trial

Introduction: Unhealthy food intake is a major risk factor for cardiometabolic diseases. Individual-level efforts to promote heathy diets (e.g., nutrition education) have limited effect on the long term. Designing the choice context in such a way that it facilitates healthy food choices may contribute to sustainable prevention of cardiometabolic diseases. We evaluated the real-life effects of nudging and pricing strategies in supermarkets. Hypothesis: Exposure to store-level nudging and pricing will improve dietary guideline adherence, healthy food purchasing and customer satisfaction, and reduce cardiometabolic risk among Dutch adults after 12 months compared to no intervention. Methods: In this parallel cluster-randomized controlled trial, we randomized 12 Dutch supermarkets in socially disadvantaged neighborhoods to a control (n=6 supermarkets) or intervention group (n=6). Intervention supermarkets received healthy food nudges (across 13 food groups on circa 9% of supermarket products) and pricing strategies (price decreases on healthy products and increases on unhealthy products; on circa 3% of products). Eligible participants were aged 30-80 years and regular shoppers at participating supermarkets. The primary outcome was dietary guideline adherence measured via a validated index score (scale 0-150), at baseline and after 3, 6 and 12 months. Secondary outcomes included the percentage of healthy food purchases, parameters of cardiometabolic health (HbA1c (mmol/L), lipid profile (mmol/L), and waist circumference (cm)), and supermarket customer satisfaction (very unsatisfied (1) to very satisfied (7)). Implementation fidelity was regularly monitored (no implementation (1) to optimal implementation (5)). Results: Of the 361 participants included (162 intervention, 199 control), 73% were female, 42% were highly educated and the average age (sd) was 58 (11) years. Linear mixed models showed no effectiveness of the intervention compared to control on dietary guideline adherence (β -1.1, 95%CI: -3.8; 1.7), the total percentage of healthy purchases (β 0.4, 95%CI: -3.0; 3.7), HbA1c (β 0.6, 95%CI: -0.1; 1.3), lipid profile (LDL β -0.0, 95%CI: -0.2; 0.1, HDL β -0.0, 95%CI: -0.1; 0.0), and waist circumference (females β 0.7 (95%CI: -0.8; 2.2), males β 0.5, 95%CI: -2.4; 3.5) over the 12-month intervention period. Participants in the intervention clusters scored 0.3 points (95%CI: 0.1; 0.5) higher on overall customer satisfaction, compared to control clusters. Median implementation fidelity over time was 3.6 (range 2.9-4.1). Conclusions: Nudging and pricing strategies implemented in a real-life purchasing setting were not effective in promoting healthier diets and purchasing patterns nor in improving cardiometabolic health on an individual level. Sub-optimal intervention exposure due to practical implementation barriers may have contributed to these null results.

Abstract P608: Dynamic Changes in Dietary Guidelines Adherence and Its Association With All-Cause Mortality Among Middle-Aged Chinese: A Longitudinal Study From the China Health and Nutrition Survey

Background: The traditional approach to evaluating dietary quality is based on the achievement of the recommended intakes for each food group, which may overlook the achievement of correct relative proportions between food groups. We propose a “Dietary Adherence Score (DAS)” to assess the degree of similarity between subjects' diets and those recommended in the Chinese Dietary Guidelines (CDG). Furthermore, it is important to incorporate the time-dependent nature of dietary quality into the mortality prediction. Aim: To investigate the association between long-term changes in adherence to the CDG and all-cause mortality. Method: The study included 4533 participants aged 30-60 from the China Health and Nutrition Survey study with a median follow-up of 6.9 years. Intakes from 10 food groups were collected in 5 survey rounds from 2004 to 2015. We calculated the Euclidean distance between the intake of each food and the CDG-recommended intake, and then summed all the foods as DAS. Mortality was assessed in 2015. The latent class trajectory modeling was used to identify 3 classes of participants with distinct longitudinal trajectories of DAS during the follow-up period. The Cox proportional hazard model was used to assess the risk of all-cause mortality in the 3 classes of people. Risk factors for death and a traditional measure of diet quality, the Alternative Healthy Eating Index (AHEI), were adjusted in the models. Result: There were 187 deaths overall. Participants in the first class identified had consistently low and decreasing DAS levels (coefficient= -0.020) over their lifetime, compared with a hazard ratio (HR) of 4.4 (95% confidence interval [CI]: 1.5, 12.7) for participants with consistently high and increasing DAS levels (coefficient= 0.008). Those with moderate DAS had an HR of 3.0 (95% CI: 1.1, 8.4). The effect of DAS was independent of AHEI. Conclusion: People with consistently high adherence to CDG-recommended dietary patterns had a significantly lower mortality risk. DAS is a promising method to assess diet quality.

Better understanding determinants of dietary guideline adherence among Dutch adults with varying socio-economic backgrounds through a mixed-methods exploration.

Low dietary guideline adherence is persistent, but there is limited understanding of how individuals with varying socio-economic backgrounds reach a certain dietary intake. We investigated how quantitative and qualitative data on dietary guidelines adherence correspond and complement each other, to what extent determinants of guideline adherence in quantitative data reflect findings on determinants derived from qualitative data and which of these determinants emerged as interdependent in the qualitative data. This mixed-methods study used quantitative questionnaire data (n 1492) and qualitative data collected via semi-structured telephone interviews (n 24). Quantitative data on determinants and their association with total guideline adherence (scored 0-150) were assessed through linear regression. Directed content analysis was used for qualitative data. Dutch urban areas. Adults aged 18-65 years. A range of determinants emerged from both data sources, for example higher levels of cognitive restraint (β 5·6, 95 % CI 4·2, 7·1), habit strength of vegetables (β 4·0, 95 % CI 3·3, 4·7) and cooking skills (β 4·7, 95 % CI 3·5, 5·9), were associated with higher adherence. Qualitative data additionally suggested the influence of food prices, strong dietary habits and the social aspect of eating, and for the determinants cognitive restraint, habit strength related to vegetables, food prices and home cooking, some variation between interviewees with varying socio-economic backgrounds emerged in how these determinants affected guideline adherence. This mixed-methods exploration provides a richer understanding of why adults with varying socio-economic backgrounds do or do not adhere to dietary guidelines. Results can guide future interventions promoting healthy diets across populations.

Impact of Ultra-Processed Food Consumption on Quality of Diet among Brazilian Pregnant Women Assisted in Primary Health Care.

The quality of diet and nutritional status during pregnancy are crucial to optimize maternal and fetal health. Ultra-processed foods (UPFs) are increasingly prevalent in pregnancy groups despite being nutritionally unbalanced and associated with adverse perinatal outcomes. This cross-sectional study, conducted with data from 229 pregnant women, aimed to investigate the association between UPFs consumption and dietary nutrient intake of pregnant women assisted by Primary Health Care (PHC) in Federal District (DF), Brazil. Food consumption was assessed through two non-consecutive 24-h food records and categorized by the extent of processing using the NOVA classification. Multivariate linear regression models were used to analyze the association between the quintiles of UPF consumption and the total energy and nutrients intake. Mean daily energy intake was 1741 kcal, with 22.6% derived from UPFs. Greater UPF consumption was associated with reduced intake of unprocessed and minimally processed food. The highest quintile of UPFs was positively associated with higher total energy, trans fat, and sodium intake; and inversely associated with the diet content of protein, fiber, iron, magnesium, potassium, copper, zinc, selenium, and folate. Greater UPFs intake negatively impacts the nutritional quality of the diet and impoverishes the nutrient intake of pregnant women. Reducing UPF consumption may broadly improve dietary guidelines adherence in pregnant women and promote maternal and neonatal health.

Dynamic Changes in Dietary Guideline Adherence and Its Association with All-Cause Mortality among Middle-Aged Chinese: A Longitudinal Study from the China Health and Nutrition Survey

Dynamic Changes in Dietary Guideline Adherence and Its Association with All-Cause Mortality among Middle-Aged Chinese: A Longitudinal Study from the China Health and Nutrition Survey

Real-life effects of nudging and pricing strategies in the supermarket to promote healthy diets

Abstract Background Unhealthy dietary patterns pose a major public health challenge. Individual-level efforts to promote heathy diets (e.g. nutrition education) have limited effect on the long term. Context-specific interventions focussing on point-of-purchase may create opportunities for sustainable dietary changes. We evaluated real-life effects of nudging and pricing strategies in supermarkets on dietary intake. Methods In this parallel cluster-randomised controlled trial, we randomized 12 Dutch supermarkets in socially deprived neighbourhoods to a control group (n = 6), or intervention group (n = 6). Healthy food nudges were implemented in intervention stores across 13 food groups, combined with healthy product price decreases and unhealthy product price increases. Eligible participants were aged 30-80 years and regular shoppers at participating stores. The primary outcome was dietary guideline adherence measured via an index score (0-150), at baseline and after 3, 6 and 12 months. Secondary outcomes included parameters of cardiometabolic health (HbA1c, lipid profile, and waist circumference), the percentage of healthy food purchases in the supermarket, socio-cognitive factors, and supermarket customer satisfaction. Effects were analysed with linear mixed models. Results This study included 173 participants from intervention clusters and 220 from control clusters. Preliminary evaluation of the 3-month follow-up data revealed no effectiveness of the nudging and pricing strategies compared to the control supermarkets in terms of dietary guideline adherence (β -0.8, 95%CI -4.2; 2.7). Results on all outcomes will be available at time of the conference. Conclusions This novel supermarket trial is the first to evaluate real-life long-term effects of nudging and pricing strategies based on a comprehensive set of study outcomes and using a strong methodological design. Findings can direct future design of context-specific interventions focussing on the promotion of healthy diets. Key messages • Context-specific interventions focussing on point-of-purchase may create opportunities for sustainable dietary changes. • Findings from this supermarket trial testing real-life and long-term effects of nudging and pricing strategies can direct future design of context-specific interventions focussing on healthy diets.

Undertaking Healthy Nutrition Behaviors by Patients with Type 1 Diabetes as an Important Element of Self-Care.

Background: Self-control/self-care means the active participation of a diabetic patient in therapy. It involves making numerous decisions and undertaking actions independently. The primary activities under the patient’s control include adherence to medication regimens and maintenance of a health-promoting lifestyle, especially a healthy diet. However, the sense of responsibility for one’s own health, i.e., high sense of responsibility (HSR), is an important element in the treatment of diabetes and in undertaking pro-health behaviors. The study aimed at analyzing adherence to dietary recommendations in the context of HSR in patients with type 1 diabetes. Methods: The cross-sectional study was conducted on a group of 394 adults. The assessment of adherence to dietary recommendations was performed with the present authors’ Diabetes Dietary Guidelines Adherence Index (DDGA Index). The measurement of HSR was performed with the standardized Sense of Responsibility for Health Scale (HSRS). The assessment of the multifactorial influence of independent variables on the DDGA Index, including the “responsibility for health” variable, was conducted with the use of a linear regression model. Results: The mean DDGA value was 18.68 (SD = 3.97). The patients significantly more often avoided unhealthy products than included recommended products into the diet at a required frequency. A positive correlation was demonstrated between HSR and adherence to dietary recommendations (βstd. = 0.43, p < 0.001). Conclusions: The sense of responsibility for one’s health plays a main role in adherence to dietary recommendations in diabetes. Our study showed that a higher sense of responsibility for health was associated with a higher level of adherence to dietary recommendations. Patients with a high sense of responsibility for one’s health will be more involved in the therapeutic process, including adherence to dietary recommendations. Therefore, all education actions should comprise not only dietary knowledge transfer and shaping appropriate skills, but they should also strengthen the sense of responsibility for one’s health.

Poor Nutritional Literacy and Relationship to Dietary Guideline Adherence in Inner-City Dialysis Patients

ObjectivesPoor nutritional literacy may influence understanding and adherence to dietary guidelines. We examined nutritional literacy and adherence to dietary guidelines in inner-city dialysis patients. MethodsA random sample of 34 dialysis pts was interviewed regarding knowledge about dietary guidelines and 24-hr food recall was recorded and analyzed using ASA-24. Nutritional literacy was assessed using the food label questionnaire. ResultsMean age was 56 ± 17, 58% (20) male, 88% (29) identified as Black, time on dialysis 64.1 ± 17.3 mos. Mean PO4 intake was 968.2 ± 111.9 mg, sodium 2487 ± 240 mg, potassium 1983 ± 222 mg. There was no association between age, sex, income or time on dialysis and adherence to dietary guidelines. All pts received monthly nutrition counseling. 18/24 (75%) pts said they did not know daily dietary sodium allowance, none answered correctly. 2/6 (33%) who stated they knew consumed <2300 mg while 8/18 (44%) who didn’t know consumed less. Higher sodium intake in all groups correlated with fluid (r = 0.6, p = 0.002), PO4 (r = 0.8, p < 0.001), and potassium intake (r = 0.5, p = 0.007). 5/24 (21%) said they knew daily potassium allowance but 0% answered correctly. 20/24 (83%) pts didn’t know how much PO4 to consume; 13/20 (65%) ate more than 800 mg phosphorus daily and none knew the recommended phosphorus recommendation. 18/24 (75%) pts stated they knew how much fluid they should drink per day and 9 (50%) pts were correct in their answer. Higher fluid intakes were associated with higher potassium (r = 0.54, p = 0.007), phosphorous (r = 0.41, p = 0.045) and sodium intakes (r = 0.6, p = 0.002). No pt scored in the adequate health literacy range by the food label test, with 21/24 (88%) scoring 0–1 (high risk) and 3/24 (12%) scoring 2–3 (moderate risk). ConclusionsIn our population although patients report monthly nutrition counseling, the majority of could not recall the recommended dietary restrictions for sodium, potassium, PO4 or fluid. The majority of patients ate more than the recommended amounts for PO4 and sodium and those patients were less adherent to other dietary recommendations as well. All patients scored in the high to moderate risk category for nutritional literacy, which may explain inability to remember counseling recommendations and should be taken into account when designing educational programs. Funding SourcesUnfunded.

The Role of Resilience and Basic Hope in the Adherence to Dietary Recommendations in the Polish Population during the COVID-19 Pandemic.

(1) Background: The COVID-19 pandemic exerts a negative influence on dietary behaviors, which may lead to health deterioration. Dietary behaviors may be determined by psychological characteristics, such as basic hope and resilience, which facilitate the effective adjustment to new difficult conditions. The professional literature includes no research on the role of basic hope and resilience in the context of undertaken dietary behaviors in the situations of mental load associated with pandemics. The study aimed at the description of the dietary behaviors of individuals with various intensities of the discussed psychological characteristics (basic hope and resilience); (2) The observational cross-sectional online questionnaire study was conducted with the participation of 1082 adult Polish inhabitants. Three psychological scales were used: PSS-10, the Brief Resilient Coping Scale (BRCS) and BHI-12 questionnaire. The assessment of the adherence to dietary recommendations was performed with the present authors’ Dietary Guidelines Adherence Index (DGA Index); (3) Results: The value of DGA Index was variable depending on the psychological profile of study participants. The highest adherence to the principles of appropriate nutrition was observed in individuals characterized by the ability to cope with difficult situations and those who quickly adapted to new changing circumstances. The DGA Index values became poorer with the deterioration of the coping ability as regards stress and mental load; (4) Conclusions: Nutritional education during pandemics should encompass the psychological profile of the patients. It requires the implementation of a different psychodietetic approach which will facilitate a more effective introduction of a well-balanced diet.