Healthy Diet Score Research Articles

Effect of the Pregnant+ Smartphone App on the Dietary Behavior of Women With Gestational Diabetes Mellitus: Secondary Analysis of a Randomized Controlled Trial.

BackgroundThe prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. A healthy diet and stable blood glucose levels during pregnancy can prevent adverse health outcomes for the mother and the newborn child. Mobile health may be a useful supplement to prenatal care, providing women with targeted dietary information concerning GDM.ObjectiveWe analyzed secondary data from a two-arm, multicentered, nonblinded randomized controlled trial to determine if a smartphone app with targeted dietary information and blood glucose monitoring had an effect on the dietary behavior of women with GDM.MethodsWomen with a 2-hour oral glucose tolerance test level of ≥9 mmol/L were individually randomized to either the intervention group receiving the Pregnant+ app and usual care or the control group receiving usual care only. Eligible women were enrolled from 5 diabetes outpatient clinics in the Oslo region, Norway, between October 2015 and April 2017. The Pregnant+ app promoted 10 GDM-specific dietary recommendations. A healthy dietary score for Pregnant+ (HDS-P+) was constructed from a 41-item food frequency questionnaire and used to assess the intervention effect on the dietary behavior completed at trial entry and at around gestation week 36. Dietary changes from baseline to week 36 were examined by a paired sample two-tailed t test. Between-group dietary differences after the intervention were estimated with analysis of covariance, with adjustment for baseline diet.ResultsA total of 238 women participated: 115 were allocated to the intervention group and 123 to the control group. Of the 238 women, 193 (81.1%) completed the food frequency questionnaire both at baseline and around gestational week 36. All the participants showed improvements in their HDS-P+ from baseline. However, the Pregnant+ app did not have a significant effect on their HDS-P+. The control group reported a higher weekly frequency of choosing fish meals (P=.05). No other significant differences were found between the intervention and control groups. There were no significant demographic baseline differences between the groups, except that more women in the intervention group had a non-Norwegian language as their first language (61 vs 46; P=.02).ConclusionsOur findings do not support the supplementation of face-to-face follow-up of women with GDM with a smartphone app in the presence of high-standard usual care, as the Pregnant+ app did not have a beneficial effect on pregnant women’s diet.Trial RegistrationClinicalTrials.gov NCT02588729; https://clinicaltrials.gov/ct2/show/NCT02588729

Leading dietary determinants identified using machine learning techniques and a healthy diet score for changes in cardiometabolic risk factors in children: a longitudinal analysis

BackgroundIdentifying leading dietary determinants for cardiometabolic risk (CMR) factors is urgent for prioritizing interventions in children. We aimed to identify leading dietary determinants for the change in CMR and create a healthy diet score (HDS) to predict CMR in children.MethodsWe included 5676 children aged 6–13 years in the final analysis with physical examinations, blood tests, and diets assessed at baseline and one year later. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure (SBP and DBP), fasting glucose, high-density lipoprotein cholesterol (HDL-C, multiplying by − 1), and triglycerides. Machine learning was used to identify leading dietary determinants for CMR and an HDS was then computed.ResultsThe nine leading predictors for CMRS were refined grains, seafood, fried foods, sugar-sweetened beverages, wheat, red meat other than pork, rice, fungi and algae, and roots and tubers with the contribution ranging from 3.9 to 19.6% of the total variance. Diets high in seafood, rice, and red meat other than pork but low in other six food groups were associated with a favorable change in CMRS. The HDS was computed based on these nine dietary factors. Children with HDS ≥8 had a higher decrease in CMRS (β (95% CI): − 1.02 (− 1.31, − 0.73)), BMI (− 0.08 (− 0.16, − 0.00)), SBP (− 0.46 (− 0.58, − 0.34)), DBP (− 0.46 (− 0.58, − 0.34)), mean arterial pressure (− 0.50 (− 0.62, − 0.38)), fasting glucose (− 0.22 (− 0.32, − 0.11)), insulin (− 0.52 (− 0.71, − 0.32)), and HOMA-IR (− 0.55 (− 0.73, − 0.36)) compared to those with HDS ≦3. Improved HDS during follow-up was associated with favorable changes in CMRS, BMI, percent body fat, SBP, DBP, mean arterial pressure, HDL-C, fasting glucose, insulin, and HOMA-IR.ConclusionDiets high in seafood, rice, and red meat other than pork and low in refined grains, fried foods, sugar-sweetened beverages, and wheat are leading healthy dietary factors for metabolic health in children. HDS is strongly predictive of CMR factors.

Weight Reduction Through a Digital Nutrition and Food Purchasing Platform Among Users With Obesity: Longitudinal Study

BackgroundDigital nutrition apps that monitor or provide recommendations on diet have been found to be effective in behavior change and weight reduction among individuals with obesity. However, there is less evidence on how integration of personalized nutrition recommendations and changing the food purchasing environment through online meal planning and grocery delivery, meal kits, and grocery incentives impacts weight loss among individuals with obesity.ObjectiveThe objective of this observational longitudinal study was to examine weight loss and predictors of weight loss among individuals with obesity who are users of a digital nutrition platform that integrates tools to provide nutrition recommendations and changes in the food purchasing environment grounded in behavioral theory.MethodsWe included 8977 adults with obesity who used the digital Foodsmart platform, created by Zipongo, Inc, DBA Foodsmart between January 2013 and April 2020. We retrospectively analyzed user characteristics and their associations with weight loss. Participants reported age, gender, height, at least 2 measures of weight, and usual dietary intake. Healthy Diet Score, a score to measure overall diet quality, was calculated based on responses to a food frequency questionnaire. We used paired t tests to compare differences in baseline and final weights and baseline and final Healthy Diet Scores. We used univariate and multivariate logistic regression models to estimate odds ratios and 95% CI of achieving 5% weight loss by gender, age, baseline BMI, Healthy Diet Score, change in Healthy Diet Score, and duration of enrollment. We conducted stratified analyses to examine mean percent weight change by enrollment duration and gender, age, baseline BMI, and change in Healthy Diet Score.ResultsOver a median (IQR) of 9.9 (0.03-54.7) months of enrollment, 59% of participants lost weight. Of the participants who used the Foodsmart platform for at least 24 months, 33.3% achieved 5% weight loss. In the fully adjusted logistic regression model, we found that baseline BMI (OR 1.02, 95% CI 1.02-1.03; P<.001), baseline Healthy Diet Score (OR 1.06, 95% CI 1.05-1.08; P<.001), greater change in Healthy Diet Score (OR 1.12, 95% CI 1.11-1.14; P<.001), and enrollment length (OR 1.28, 95% CI 1.23-1.32; P<.001) were all significantly associated with higher odds of achieving at least 5% weight loss.ConclusionsThis study found that a digital app that provides personalized nutrition recommendations and change in one’s food purchasing environment appears to be successful in meaningfully reducing weight among individuals with obesity.

Maternal Diet and the Serum Metabolome in Pregnancy: Robust Dietary Biomarkers Generalizable to a Multiethnic Birth Cohort.

ABSTRACTBackgroundAdvances in metabolomics are anticipated to decipher associations between dietary exposures and health. Replication biomarker studies in different populations are critical to demonstrate generalizability.ObjectivesTo identify and validate robust serum metabolites associated with diet quality and specific foods in a multiethnic cohort of pregnant women.DesignIn this cross-sectional analysis of 3 multiethnic Canadian birth cohorts, we collected semiquantitative FFQ and serum data from 900 women at the second trimester of pregnancy. We calculated a diet quality score (DQS), defined as daily servings of “healthy” minus “unhealthy” foods. Serum metabolomics was performed by multisegment injection-capillary electrophoresis-mass spectrometry, and specific serum metabolites associated with maternal DQSs were identified. We combined the results across all 3 cohorts using meta-analysis to classify robust dietary biomarkers (r > ± 0.1; P < 0.05).ResultsDiet quality was higher in the South Asian birth cohort (mean DQS = 7.1) than the 2 white Caucasian birth cohorts (mean DQS <3.2). Sixty-six metabolites were detected with high frequency (>75%) and adequate precision (CV <30%), and 47 were common to all cohorts. Hippuric acid was positively associated with healthy diet score in all cohorts, and with the overall DQS only in the primarily white Caucasian cohorts. We observed robust correlations between: 1) proline betaine—citrus foods; 2) 3-methylhistidine—red meat, chicken, and eggs; 3) hippuric acid—fruits and vegetables; 4) trimethylamine N-oxide (TMAO)—seafood, meat, and eggs; and 5) tryptophan betaine—nuts/legumes.ConclusionsSpecific serum metabolites reflect intake of citrus fruit/juice, vegetables, animal foods, and nuts/legumes in pregnant women independent of ethnicity, fasting status, and delays to storage across multiple collection centers. Robust biomarkers of overall diet quality varied by cohort. Proline betaine, 3-methylhistidine, hippuric acid, TMAO, and tryptophan betaine were robust dietary biomarkers for investigations of maternal nutrition in diverse populations.

Do Changes in the Local Food Environment Within New Residential Developments Influence the Diets of Residents? Longitudinal Results from RESIDE.

Background: There is limited longitudinal evidence supporting a link between food outlet locations and dietary outcomes to inform policy and urban planning. This study examined how longitudinal changes in the local food environment within new residential developments influenced changes in adult dietary intake. Methods: Adult participant data (n = 3223 person-observations) were sourced from the RESIDential Environments (RESIDE) project across three time points between 2004 to 2012 in Perth, Western Australia. Fixed effects regression estimated the relationship between change in spatial exposure to the local food environment, individual behaviours and perceptions of the local food environment with dietary outcome variables (healthy diet score, unhealthy diet score, diet quality score and fruit/vegetable intake). Results: An increase over time in the percentage of healthy food outlets around the home was significantly (p ≤ 0.05) associated with an increase in healthy diet scores and an increase in the distance from home to the nearest café restaurant was significantly (p ≤ 0.05) associated with an increase in diet quality scores. Conclusions: Modifying the local food environment by increasing the relative proportion of healthy food outlets around the home may support healthier dietary intake.

Cardiovascular health metrics and prevalence of cardiovascular disease in the Republic of Moldova

Abstract Background Achieving and maintaining cardiovascular health of individuals has a significant impact on reducing cardiovascular disease (CVD) and mortality at the population level. Methods We performed a cross-sectional community survey of 2,612 adult respondents in the Republic of Moldova. The American Heart Association cardiovascular health metrics score was used in total and by its two components: (1) health factors (blood pressure, total cholesterol, glucose, body mass index); (2) health behaviors (nonsmoking, physical activity, healthy diet score). The prevalence of CVD was identified as the main outcome measure. Results The prevalence of CVD was lower in study participants having all 7 cardiovascular health metrics (14.7%; 95% CI, 2.8% to 26.6%) compared to those with 0 to 1 cardiovascular health metrics (78.2%; 95% CI, 67.3% to 89.1%). Among participants who met all health factor metrics, the prevalence of CVD was lower (15.1%; 95% CI, 5.5% to 24.7%) compared to those with 0 to 1 health factor metrics (72.5 %; 95% CI, 69.9% to 75.0%). Study respondents who engaged in all health behaviors and those who engaged in 0 to 1 health behaviors had a similarly high prevalence of CVD (60.1%; 95% CI, 57.4% to 62.8% and 60.4%; 95% CI, 55.3% to 65.4%, respectively). Conclusions Lower prevalence of CVD was related to a greater total score of cardiovascular health metrics and with health factor components. While those diagnosed CVD appear willing to improve their behaviors, the population at risk is not likely to engage in health behaviors to prevent the onset of CVD. Key messages Increasing individual’s responsibility in addressing their own health implies improvement of community health. Strategies for health promotion should focus more on an individual’s motivation to assume personal responsibility for behaviors affecting their health.

Effect of Education on Promoting Healthy Lifestyle Behaviors That Prevent Breast Cancer in Middle-Aged Women: Application of Protection Motivation Theory.

BackgroundIn recent years, an increased incidence of breast cancer has made this disease the most common malignancy among Iranian women. Since education plays an important role in the implementation of preventive behaviors in breast cancer treatment, this study investigates the effect of educational interventions on the promotion of lifestyle-related behaviors that prevent breast cancer in middle-aged women.MethodsIn this randomized control study, 120 women referred to Neyshabur Health Services Centers were randomly selected and divided into two groups: an intervention group (60 subjects) and a control group (60 subjects). An educational intervention was carried out over five sessions, based on protective motivation theory constructs. Participants completed a researcher-designed questionnaire immediately and again 2 months after the intervention. The data were analyzed using IBM SPSS ver. 19.0 software (IBM Corp., Armonk, NY, USA).ResultsThe results revealed a significant difference between the mean scores of participants exposed to protective motivation theory, awareness, and physical activities immediately and also 2 months after the intervention (P<0.05). Although the healthy diet scores of the two groups differed significantly immediately after the educational intervention (P<0.05), there was no significant difference between the groups 2 months after the intervention (P<0.05).ConclusionGiven the effective role of education in protective motivation theory and the physical activity levels of the women who participated in this research, it seems clear that the women’s financial status shaped their ability to consume more fruits and vegetables. As this social element impacts the health of individuals, training programs alone cannot succeed.

Whole almond consumption is associated with better diet quality and cardiovascular disease risk factors in the UK adult population: National Diet and Nutrition Survey (NDNS) 2008\u20132017

Purpose This work aimed to estimate whole almond consumption in a nationally representative UK survey population and examine associations with diet quality and cardiovascular disease (CVD) risk.Methods Four-day food record data from the National Diet and Nutrition Survey (NDNS) 2008–2017 (n = 6802, age ≥ 19 year) were analyzed to investigate associations between whole almond consumption and diet quality, measured by the modified Mediterranean Diet Score (MDS) and modified Healthy Diet Score (HDS), and CVD risk markers, using survey-adjusted multivariable linear regression.Results Whole almond consumption was reported in 7.6% of the population. Median intake in whole almond consumers was 5.0 g/day (IQR 9.3). Consumers had higher diet quality scores relative to non-consumers; higher intakes of protein, total fat, monounsaturated, n-3 and n-6 polyunsaturated fats, fiber, folate, vitamin C, vitamin E, potassium, magnesium, phosphorus, and iron; and lower intakes of trans-fatty acids, total carbohydrate, sugar, and sodium. BMI and WC were lower in whole almond consumers compared to non-consumers: 25.5 kg/m2 (95% CI 24.9, 26.2) vs 26.3 kg/m2 (25.9, 26.7), and 88.0 cm (86.2, 89.8) vs 90.1 cm (89.1, 91.2), respectively. However, there were no dose-related fully adjusted significant associations between increasing almond intake (g per 1000 kcal energy intake) and lower CVD risk markers.Conclusions Almond intake is low in the UK population, but consumption was associated with better dietary quality and lower CVD risk factors. Habitual consumption of whole almonds should be encouraged as part of a healthy diet.

Feel4Diabetes healthy diet score: development and evaluation of clinical validity

BackgroundThe aim of this paper is to present the development of the Feel4Diabetes Healthy Diet Score and to evaluate its clinical validity.MethodsStudy population consisted of 3268 adults (63% women) from high diabetes risk families living in 6 European countries. Participants filled in questionnaires at baseline and after 1 year, reflecting the dietary goals of the Feel4Diabetes intervention. Based on these questions the Healthy Diet Score was constructed, consisting of the following components: breakfast, vegetables, fruit and berries, sugary drinks, whole-grain cereals, nuts and seeds, low-fat dairy products, oils and fats, red meat, sweet snacks, salty snacks, and family meals. Maximum score for each component was set based on its estimated relative importance regarding T2DM risk, higher score indicating better quality of diet. Clinical measurements included height, weight, waist circumference, heart rate, blood pressure, and fasting blood sampling, with analyses of glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides.Analysis of (co) variance was used to compare the Healthy Diet Score and its components between countries and sexes using baseline data, and to test differences in clinical characteristics between score categories, adjusted for age, sex and country. Pearson’s correlations were used to study the association between changes from baseline to year 1 in the Healthy Diet Score and clinical markers. To estimate reproducibility, Pearson’s correlations were studied between baseline and 1 year score, within the control group only.ResultsThe mean total score was 52.8 ± 12.8 among women and 46.6 ± 12.8 among men (p < 0.001). The total score and its components differed between countries. The change in the Healthy Diet Score was significantly correlated with changes in BMI, waist circumference, and total and LDL cholesterol. The Healthy Diet Score as well as its components at baseline were significantly correlated with the values at year 1, in the control group participants.ConclusionThe Feel4Diabetes Healthy Diet Score is a reproducible method to capture the dietary information collected with the Feel4Diabetes questionnaire and measure the level of and changes in the adherence to the dietary goals of the intervention. It gives a simple parameter that associates with clinical risk factors in a meaningful manner.Trial registrationClinicaltrials.gov NCT02393872. Registered March 20, 2015.

Dietary patterns and asthma among Peruvian children and adolescents

BackgroundAsthma is one of the conditions that contributes to the global burden of respiratory diseases and has been previously associated with diet intake. The goal of this study was to determine the relationship between diet, assessed by a developed score, and asthma in Peruvian children.MethodsThis study was a cross sectional analysis nested within an unmatched case-control study of children in two peri-urban communities of Lima, Peru. We evaluated 767 children and adolescents (573 with asthma, 194 controls) between 9 and 19 years. Diet was assessed using a food frequency questionnaire (FFQ), with food groups classified as “healthy” or “unhealthy”. Asthma control, Lung function and atopy were assessed by Asthma Control Test, Spirometry and InmunoCAP 250 test, respectively.ResultsMean age of participants was 13.8 years (SD 2.6). Mean diet score was 5 (SD 1.23; range 2–8). Healthy Diet Score was associated with asthma status [OR 0.83, 95% CI (0.72, 0.95), p = 0.009] in adjusted analysis. Thus, participants with higher HDS, had lower odds of asthma. In sensitivity analyses, when adjusting for atopy, results did not change significantly. [OR 0.85, 95% CI (0.72, 0.99); p = 0.04]. No association between the HDS and asthma control, FEV1, nor FeNO were observed. Atopy did not modify the association between diet and asthma outcomes.ConclusionsIn our study cohort, better diet quality was associated with lower odds of asthma, but was not associated with asthma control. Diet modification may be a potential intervention to impact the increasing prevalence of this disease.

Neighborhood Food Outlet Access and Dietary Intake among Adults with Chronic Kidney Disease: Results from the Chronic Renal Insufficiency Cohort Study

BackgroundHealthy diet is essential in the management of chronic kidney disease (CKD) and preventing related comorbidities. Food outlet access has been studied in the general population; however, the influence of the local food environment on dietary intake among people with CKD has not been evaluated. ObjectivesThis study examined the associations of food outlet density and type of outlets with dietary intake in a multicenter cohort of racially and ethnically diverse patients with CKD. MethodsThe Chronic Renal Insufficiency Cohort Study is a multicenter prospective study of patients with CKD that used a validated food frequency questionnaire to capture dietary intake at the baseline visit. This is a cross-sectional analysis of 2,484 participants recruited in 2003-2006 from seven Chronic Renal Insufficiency Cohort Study centers. Food outlet data were used to construct a count of the number of fast-food restaurants, convenience stores, and grocery stores per 10,000 population for each geocoded census block group. Multivariable linear and logistic regression models were used to evaluate the associations between measures of food outlet availability and dietary factors. ResultsThe proportion of participants living in zero–, low–, and high–food outlet density areas differed by gender, race or ethnicity, and income level. Among male subjects, living in areas with zero or the highest number of outlets was associated with having the highest caloric intakes in multivariable models. Male subjects living in areas with zero outlets consumed the highest levels of sodium and phosphorous. Female subjects living in areas with zero outlets had the lowest average intake of calories, sodium, and phosphorous. Among low-income female subjects, close proximity to more outlets was associated with higher calorie consumption. Among all participants, access to fast-food restaurants was not associated with an unhealthy diet score, and access to grocery stores was not associated with a healthy diet score. ConclusionsAverage caloric and nutrient intakes differed by outlet availability; however, there were no strong associations with type of food outlet. This should be considered when developing food-focused public health policies.

Abstract P101: Cardiovascular Health in US Adults Before and After Publication of the American Heart Association 2020 Impact Goals: Results From NHANES 2005-2016

Background: The dissemination of the American Heart Association (AHA) 2020 Impact Goals might promote nationwide efforts to improve cardiovascular health in the US general population. We aimed to compare cardiovascular health metrics in US adults before and after the release of the AHA 2020 Impact Goals. Methods: A total of 32,327 adults aged ≥20 years from the National Health and Nutrition Examination Surveys (NHANES) 2005-2016 were included in this analysis. Cardiovascular health comprised 7 health metrics (smoking status, body-mass index, physical activity, healthy diet score, total cholesterol, blood pressure, and fasting plasma glucose), and each metric was scored as poor (0 points), intermediate (1 point), or ideal (2 points). Cardiovascular health score (0-14) was calculated as the sum of all 7 cardiovascular health metric scores. Age-standardized proportions of cardiovascular health metrics and means of cardiovascular health scores were calculated overall and in age, sex, and race/ethnicity subgroups for NHANES 2005-2010 and 2011-2016. Results: The age-standardized mean of cardiovascular health score was not significantly different between 2005-2010 and 2011-2016 (7.86 vs. 7.99, P =0.14) in the US adult population. However, the cardiovascular health scores significantly increased in young adults aged 20-39 years (8.62 vs. 8.96, P =0.002) and non-Hispanic blacks (7.02 vs. 7.30, P =0.004). Additionally, although the cardiovascular health behaviors score was not significantly different (3.64 vs. 3.71, P= 0.24), the cardiovascular health factors score significantly improved (5.74 vs. 5.82, P =0.02). Age-standardized proportions of non-current smoking (74.1% vs. 77.0%), ideal physical activity (35.7% vs. 39.0%), and total cholesterol &lt;200 mg/dL (43.3% vs. 48.1%) significantly increased, but body-mass index &lt;25.0 kg/m 2 (32.2% vs. 29.8%) significantly decreased, from 2005-2010 to 2011-2016 in US adults. Conclusions: Since the release of the AHA 2020 Impact Goals, cardiovascular health has improved in young adults and non-Hispanic blacks. In addition, the proportions of non-current smoking, ideal physical activity, and ideal total cholesterol have increased in the entire US adult population. However, several cardiovascular health metrics have not significantly improved, or have even worsened. Further nationwide efforts are warranted to promote cardiovascular health, especially weight loss, in the US general population.

Tree nut snack consumption is associated with better diet quality and CVD risk in the UK adult population: National Diet and Nutrition Survey (NDNS) 2008-2014.

To examine associations of tree nut snack (TNS) consumption with diet quality and cardiovascular disease (CVD) risk in UK adults from National Diet and Nutrition Survey (NDNS) 2008-2014. Cross-sectional analysis using data from 4-d food diaries, blood samples and physical measurements for CVD risk markers. To estimate diet quality, modified Mediterranean Diet Score (MDS) and modified Healthy Diet Score (HDS) were applied. Associations of TNS consumption with diet quality and markers of CVD risk were investigated using survey-adjusted multivariable linear regression adjusted for sex, age, ethnicity, socio-economic and smoking status, region of residency and total energy and alcohol intake. UK free-living population. 4738 adults (≥19 years). TNS consumers had higher modified MDS and HDS relative to non-consumers. TNS consumers also had lower BMI, WC, SBP and DBP and higher HDL compared to non-consumers, although a dose-related fully adjusted significant association between increasing nut intake (g per 4184 kJ/1000 kcal energy intake) and lower marker of CVD risk was only observed for SBP. TNS consumption was also associated with higher intake of total fat, mono-, n-3 and n-6 polyunsaturated fatty acids, fibre, vitamin A, thiamin, folate, vitamin C, vitamin E, potassium, magnesium, phosphorus, selenium and iron; and lower intake of saturated fatty acids, trans fatty acids, total carbohydrate, starch, free sugar, sodium and chloride. TNS consumers report better dietary quality and consumption was associated with lower CVD risk factors. Encouraging replacement of less healthy snacks with TNS should be encouraged as part of general dietary guidelines.

Associations of lifestyle activities and a heathy diet with frailty in old age: a community-based study in Singapore.

Frailty is an age-related state characterized by a reduced physiological reserve, and is associated with adverse health outcomes in the elderly. We analyzed the data from 895 adults aged 60 years and above, and investigated the relationships between midlife and late-life social activities, intellectual activities, working hours, and dietary habits and frailty status. Participation in social or intellectual activities in late life was less prevalent among those who were frail than among those who were robust. A greater proportion of those who were frail had worked long hours in midlife. After adjustment for confounders, participating in social activities or intellectual activities in late life was associated with a reduced risk for prefrailty and frailty, while working long hours in midlife was associated with a higher risk for frailty. The risk of frailty decreased with increasing healthy diet scores in midlife and late life. When the results were stratified by gender, late-life participation in social activities and midlife or late-life participation in intellectual activities correlated negatively with prefrailty/frailty only in women. Our study suggests that social and intellectual activities are inversely associated with frailty status, but the association seems to differ based on gender.

Sleep duration is associated with healthy diet scores and meal patterns: results from the population-based EpiHealth study.

To investigate relationships between sleep duration and adherence to healthy diets, but also associations with meal patterns, in a large population-based cohort. Participants (n = 23,829, males and females, aged 45 to 75 years) from the Swedish EpiHealth cohort study were included in a cross-sectional analysis. The participants filled out an extensive Internet-based questionnaire, and also visited a test center for anthropometric measurements and blood sampling. Sleep duration was classified as short (< 6 h/night; n = 1,862), normal (6 to less fewer than 9 h/night; n = 19,907) and long sleep (≥ 9 h/night; n = 858). In addition, a combination variable of sleep duration (short/normal/long) and sleep quality (good/poor) was constructed, giving six categories. Adherence to a healthy diet was assessed using the modified Mediterranean diet (mMED) score and the Healthy Nordic Food Index (HNFI) score based on food groups from a food frequency questionnaire. A regular meal pattern was considered if the participant had breakfast, lunch and dinner on a daily basis. Compared with normal sleepers, short sleepers displayed lower adherence to a healthy diet when using both the mMED score (adjusted odds ratio = 0.70; 95% confidence interval 0.56-0.88) and the HNFI score (0.70; 0.56-0.88). When combining sleep duration and sleep quality, short sleepers with poor sleep quality showed an independent relationship with low adherence to a healthy diet (0.67; 0.52-0.86) compared with normal sleepers with good sleep quality. In addition, both short sleepers (0.71; 0.62-0.82) and long sleepers (0.75; 0.62-0.91) showed low adherence to regular meal patterns, compared with normal sleepers. Furthermore, short sleepers with poor sleep quality had reduced odds of having a regular meal pattern (0.67; 0.57-0.79) as compared with normal sleepers with good sleep quality. Short sleep duration combined with poor sleep quality is associated with low adherence to a healthy diet and regular meal patterns.

Adherence to the Norwegian dietary recommendations in a multi-ethnic pregnant population prior to being diagnosed with gestational diabetes mellitus.

Maternal diet is a modifiable risk factor for the development of gestational diabetes mellitus (GDM). Even though pregnant women are considered to be motivated to eat healthy, previous research found unhealthy eating patterns among some ethnic and lower socio‐economic status groups. This cross‐sectional study assessed adherence to national dietary recommendations prior to GDM diagnosis in a multi‐ethnic population comprising 237 pregnant women. Participants were diagnosed with GDM after performing a two‐hour oral glucose tolerance test ≥ 9 mmol/L. Participants answered a 41‐item Food Frequency Questionnaire about dietary habits prior to being diagnosed with GDM from October 2015 to March 2018. Their scores were based on adherence to the recommended intake in each food group and summed into a Healthy Diet Score (HDS). Results showed low adherence to national dietary recommendations. A significantly higher proportion of non‐native Norwegian‐speaking women had a high HDS compared with native Norwegian‐speaking women. Participants with a normal prepregnancy weight were more likely to have a high HDS compared with overweight or obese participants. Participants showed low adherence to the recommendations for whole grains, vegetables, and fruits and berries, and a relatively low proportion adhered to the recommendations for intakes of fish, red/processed meat, and ready‐made meals. However, the food group intakes varied by country of birth. Given the increase in women with GDM and the emerging evidence that maternal diet is a modifiable risk factor for GDM, effective nutrition communication strategies in antenatal care are urgently needed.

Replacing Dairy Fat With Polyunsaturated and Monounsaturated Fatty Acids: A Food-Level Modeling Study of Dietary Nutrient Density and Diet Quality Using the 2013-16 National Health and Nutrition Examination Survey.

Recent dietary guidelines have become more food-based, as opposed to purely nutrient-based. By contrast, assessing the impact of dietary changes on chronic disease risk continues to rely on single-nutrient substitutions. To assess the real-world implications of a nutrient-for-nutrient swap, this study examined dietary nutrient density and healthy diet scores following removal of food sources of dairy fat from diets of 15,260 individuals age ≥4 y in the National Health and Nutrition Examination Survey (NHANES 2013–2016). Those foods were then replaced with foods containing a comparable amount of non-dairy polyunsaturated fatty acids (PUFA) and monounsaturated fatty acids (MUFA). The present food-level substitution model was based on 576 diverse eating patterns of US population subgroups. Diet quality measures were the Nutrient Rich Food (NRF 9.3) Index and the 2015-Healthy Eating Index (HEI-2015). Removing 5% of dietary energy from dairy fat led to lower levels of multiple micronutrients and to lower NRF 9.3 scores. These deficits were not remedied by the modeled replacements. Although swapping dairy fat for foods containing non-dairy MUFA/PUFA did alter the fatty acid ratios, the resulting food patterns were still significantly lower in some key micronutrients. Nutrient-based dietary guidance is prone to ignore the complexity of food patterns and the recommended dietary change may have unintended nutritional consequences.

SUN-312 HEALTHY DIET SCORE AND KIDNEY FUNCTION: A CROSS-SECTIONAL ANALYSIS

A healthy diet is known to reduce cardiovascular disease, yet it remains uncertain whether dietary risk factors are associated with chronic kidney disease. This study aims to evaluate the association between estimated glomerular filtration rate (eGFR) and the American Heart Association’s (AHA) healthy diet score in a population-based cohort.

Abstract P144: The Effect of a Community-Based Healthy Lifestyle Behavior Change Program on Simple 7 Score Among Rural Women

Objective: The objective of this study was to evaluate the effects of a multilevel healthy lifestyle behavior change program for women living in rural areas where higher rates of cardiovascular disease are influenced by poverty, reduced access to health care and unique social and built environment challenges. Methods: In eleven medically underserved rural towns in New York, 182 overweight and obese sedentary women 40 years and older enrolled in a community-randomized trial. Communities randomized to Group 1 (intervention) participated in six months of hour-long, twice weekly experiential learning classes that included progressive strength training, aerobic exercise and skill-based nutrition education (individual level), and a civic engagement curriculum focused on healthy food and physical activity environments (social, community and policy levels); classes were facilitated by local health educators trained by the research team. Communities randomized to Group 2 (delayed intervention control) received the intervention immediately following the completion of intervention activities for Group 1. All components of the Simple 7 score were recorded at baseline (prior to randomization) and at six months (post-intervention for Group 1, pre-intervention for Group 2). Weight, height, blood pressure, blood cholesterol and blood glucose were measured directly and smoking status, diet and physical activity were self-reported. Multivariate regression analyses were used to examine change in Simple 7 score from baseline to outcome. Initial models controlled for study site, baseline Simple 7 score, education and age, and were based on the 107 participants with complete data. Results: Simple 7 scores were similar for both groups prior to randomization (7.91 for Group 1, 7.83 for Group 2). At the end of the six month intervention period for Group 1, the Simple 7 score for Group 2 was unchanged (7.85) but increased to 8.98 for Group 1 participants (p=0.02 for the difference between groups in Simple 7 change). The percentage of Group 1 participants in the optimal range of scores (10-14) rose from 14.8% to 37.0%. The Simple 7 components showing the greatest improvement were BMI, physical activity and healthy diet score. Additional analyses will assess potential bias associated with incomplete data and will examine evidence for the validity of self-reports on physical activity and diet. Conclusion: The multilevel healthy lifestyle program is feasible for implementation in rural settings with limited resources and showed promise for reducing cardiovascular disease risk in midlife and older rural overweight and obese women.

Abstract P403: Role of Modifiable and Non-modifiable Risk Factors in the Association of Kidney Function With Stroke Risk in Multi-ethnic Study of Atherosclerosis (MESA)

Introduction: Persons with chronic kidney disease have up to 8 times higher risk of stroke. A role for shared vascular risk factors, such as aging, sex, hypertension, and diabetes has been implicated in this association. We aim to explore the contribution of non-modifiable and modifiable vascular risk factors to this association. Hypothesis: We hypothesize that non-modifiable and modifiable vascular risk factors could explain part, but not all, of the association between kidney function and incidence of stroke. Methods: We included 6404 participants (mean age 62 yrs, 51% women, 38% white). Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Participants were followed for an average of 12±4 yrs for incidence of stroke. Multiple Cox regression models, adjusted for baseline non-modifiable (age, sex and race) and modifiable (BMI, smoking, SBP, diabetes, cholesterol, alcohol intake, physical activity, and healthy diet score) risk factors were used to estimate the association of kidney function with incidence of stroke. Results: During follow-up, 284 (4.4%) fatal and non-fatal stroke cases were adjudicated. Among them, 233 (3.6%) were non-fatal stroke. Non-modifiable vs. modifiable risk factors were associated with greater reduction in HRs from a crude model for association of each SD lower eGFR with risk of stroke. (25% vs. 12% for non-fatal and 33% vs. 14% for all stroke). Non-modifiable vs. modifiable risk factors were associated with a lower reduction in HRs from a crude model for association of doubling ACR with risk of stroke (6% vs. 12% for both non-fatal and all stroke) (Figure). After adjusting for all factors, worse kidney function remained associated with risk of stroke. Conclusions: Findings suggest that conventional modifiable and non-modifiable vascular risk factors do not fully explain the higher risk of stroke in relation to worse kidney function. This finding warrants exploring other potential novel mechanisms of this association.