Healthy Eating Index Scores Research Articles

The association between healthy eating index-2015 with anthropometric, cardiometabolic and hepatic indices among patients with non-alcoholic fatty liver disease

BackgroundObesity, cardiovascular diseases, and metabolic disorders are common problems among participants with non-alcoholic fatty liver disease (NAFLD). However, the association between these problems and the healthy eating index-2015 (HEI-2015) remains unknown. Although the HEI-2015 originated from American dietary guidelines, its comprehensive evaluation of diet quality provides valuable insights for various populations, including Iranians. Therefore, the objective of this study was to investigate the association between anthropometric, hepatic, and cardio-metabolic indices with HEI-2015 scores in participants with NAFLD.MethodsWe conducted a cross-sectional analysis of data from the Hoveyzeh Cohort Study, which included adults aged 35 to 70 years between 2016 and 2018. A total of 664 participant with NAFLD (452 females and 212 males) were included in the analysis. The HEI-2015 was assessed using the Food Frequency Questionnaire (FFQ). Various indices, including the body shape index (ABSI), atherogenic index of plasma (AIP), visceral adiposity index (VAI), lipid accumulation product (LAP), cardiometabolic index (CMI), lipoprotein combine index (LCI), AST/ALT ratio, ALD/NAFLD index, and hepatic steatosis index (HSI), were calculated.ResultsNo significant differences were observed in anthropometric, cardio-metabolic, and hepatic indices across the quartiles of HEI-2015. However, among participants with NAFLD, men had significantly higher AIP and LCI levels, while women had significantly higher BMI, ABSI, VAI, LAP, and CMI levels. Additionally, women with NAFLD exhibited higher AST/ALT and HSI levels but lower ALD/NAFLD levels compared to men with NAFLD. Linear regression analysis among men with NAFLD revealed a significant negative correlation between HEI-2015 score and HSI in both the unadjusted model (β=-0.131, SE = 0.058, p = 0.024) and the adjusted model for energy intake (β=-0.129, SE = 0.058, p = 0.028).ConclusionThe present study demonstrated a correlation between lower HEI-2015 scores and an increased risk of steatosis in men with NAFLD. Moreover, our findings highlighted gender-related differences in NAFLD and cardio-metabolic disorders.

Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study

ObjectiveTo examine the association of ultra-processed food consumption with all cause mortality and cause specific mortality.DesignPopulation based cohort study.SettingFemale registered nurses from 11 US states in the Nurses’ Health Study...

Eating behaviors and dietary intake 2 to 4 years following sleeve gastrectomy: Are there any associations?

ObjectivesA lack of research exists on associations between eating behaviors and dietary intake among patients undergoing bariatric surgery. This study aimed to ascertain the association between eating behaviors and dietary quantity and quality at mid-term postsleeve gastrectomy (SG). MethodsThis cross-sectional study included 146 adults within 2 to 4 years post-SG. Dietary intake and eating behaviors were assessed using a food frequency questionnaire and the Dutch Eating Behavior Questionnaire, respectively. Energy and the proportion of macronutrients were determined. Carbohydrate quality index (CQI), fat quality index (FQI), healthy plate protein quality index (HPPQI), macronutrient quality index (MQI), and Healthy Eating Index (HEI)-2015 were computed to evaluate diet quality. Participants were categorized into high and low groups based on median scores for each eating behavior scale. Least-squared (geometric) means and 95% confidence intervals were determined for each group using the analysis of covariance, adjusted for age and sex. ResultsThe mean time since surgery for participants was 30.8 ± 6.5 months, and 77.4% were female. Participants with high emotional eating had higher energy and HPPQI. Individuals with high external eating had higher energy and percentages of fat and lower FQI and HEI scores. Individuals with high restrained eating scores demonstrated lower energy intake but a higher percentage of protein intake and higher CQI, FQI, MQI, and HEI scores. ConclusionsExternal eating showed the most unfavorable associations, while restrained eating showed the most favorable associations with quantity and quality of diet 2 to 4 years after SG. Emotional eating was minimally related to dietary characteristics.

OVERWEIGHT AND OBESITY AND ITS ASSOCIATION WITH HYPERTENSION IN COLOMBIA: PURE COHORT

Objective: To assess the association between overweight and obesity with blood pressure levels and incident hypertension in a prospective cohort with 12 years of follow-up. Design and method: Individuals aged 35 to 70 years from the Prospective Urban Rural Epidemiology Colombia cohort study were included. Participants with a history of hypertension and diabetes at baseline were excluded. Overweight and obesity was defined as a body mass index (BMI) greater or equal to 25 kg/m2. Blood pressure (BP) was measured at baseline and every 3-year follow-up. Hypertension was defined as a self-reported history of hypertension, baseline systolic BP greater or equal to 140 mmHg, diastolic BP greater or equal to 90 mmHg, or use of BP-lowering medications. Overweight and obese participants were propensity score matched using a 1:1 ratio with non-overweight participants. We used conditional logistic regression to evaluate the association between overweight, obesity, and hypertension, calculating the odds ratio and a 95% CI. Systolic BP and diastolic BP were analyzed in a linear mixed model as response variables, with matching pairs as random effects. The regression models were adjusted by sex, age, physical activity, tobacco use, alcohol use, education, waist-hip ratio, the alternative healthy eating index score, grip strength adjusted by weight, triglyceride-glucose index, and systolic BP at baseline. We established a p-value of <0.05 as significant. Results: Of 7500 participants, 1146 were matched, obtaining 573 pairs. The mean BMI was 25.2 kg/m2 (SD 4.02). The frequency of women was higher in the overweight group (68.1% vs. 60.9). The baseline SBP in overweight participants was 116.92 (SD 12.62) and 118.30 (SD 11.74) in non-overweight. 37.2% of overweight participants developed hypertension, but only 29.7% in non-overweight at follow-up. There was a 32% higher risk of hypertension in overweight participants (OR 1.32 95% CI:1.08-1.61). Being overweight and obese was associated with a higher increase in SBP of 2.53 mmHg (CI: 0.74-4.31) and DBP levels of 2.80 mmHg (CI: 1.68-3.93) at follow-up. Conclusions: Overweight and obesity, independently of other risk factors were associated with increased hypertension incidence and with higher SBP and DBP levels at 12 years of follow-up.

Adding more beans to the US typical dietary pattern can lead to greater intake of shortfall nutrients and a higher diet quality in younger and older adults

IntroductionData on nutrient and diet quality outcomes when additional beans are consumed as part of the typical American dietary pattern are scarce. The purpose of this study was to assess the effect of increased bean consumption, in the typical American dietary pattern, on the intake of shortfall nutrients and overall diet quality. MethodsUsing data from the US National Health and Nutrition Examination Survey, 2001–2018, the current analyses modeled the addition of one and two servings of canned and dried beans in all adults (N = 44,574; ≥19 y), younger adults (N = 23,554; 19–50 y) and older adults (N = 21,020; ≥51 y). The beans considered were kidney beans, black beans, chickpeas, and pinto beans. ResultsThe modeling of beans to the typical American dietary pattern resulted in significant increases in the intake of several shortfall nutrients, including dietary fiber, potassium, magnesium, iron, folate, and choline (p's < 0.0001). Modeling 1 and 2 servings of beans daily to the US typical dietary pattern significantly increased overall diet quality in all adult age groups considered. Total diet quality, as measured by Healthy Eating Index-2015 scores, was 15–16 % greater with an additional serving of beans and 19–20 % higher with 2 servings of beans relative to the US typical dietary pattern (p values<0.0001). ConclusionsDietary patterns that are rich in beans are associated with significantly higher diet quality scores and greater intake of shortfall nutrients, including nutrients of public health concern. Dietary guidance should consider the health benefits associated with the promotion of increased consumption of canned and dry beans in dietary patterns as benefits seen in younger adults continue to older adulthood.

Association of healthy eating index and self-rated health in adults living in Tehran: a cross-sectional study

BackgroundSelf-rated health (SRH) has been identified in many studies as a valid predictor of mortality and healthcare utilization. There is limited research on SRH and dietary intake. This study aimed to investigate the association between healthy eating index (HEI) and SRH in adults living in Tehran.MethodsThis cross-sectional study was carried out among 850 adult men and women aged 20–59 years who visited health centers in Tehran from 2021 to 2022. Dietary intake was assessed using a validated and reliable semiquantitative food frequency questionnaire with 168 food items, and SRH was assessed with one question: “In general, how do you rate your health?“. We categorized SRH into excellent/very good, good, and fair/poor. In the descriptive statistics part, we used mean ± standard deviation or number (ratio) for quantitative and qualitative variables, respectively. The chi-squared test and one-way analysis of variance were used to calculate the percentage and mean for demographic characteristics across tertiles of SRH. An analysis of covariance was used to compare the means of energy, macronutrients, the HEI, and its component variables across the tertiles of SRH.ResultsThe final sample included 795 participants (68.2% female; mean ± standard deviation age: 44.81 ± 10.62 years) whose 40% reported excellent/very good SRH, and 30% reported good and fair/poor SRH separately. There was no association between body mass index, physical activity, education, health status, smoking, and sleep duration with SRH. After adjustment, the total HEI score and its component scores did not differ across the tertiles of SRH status. However, participants with good SRH had a higher intake of total energy (mean difference (MD): 180.33 Kcal, P value < 0.001), total fat (MD: 8.15 gr, P value = 0.002), and total carbohydrates (MD: 20.18 gr, P value = 0.004) than those with fair/poor SRH.ConclusionAccording to our findings, fair/poor SRH was associated with a lower consumption of total energy, total fat, and total carbohydrates in Iranian adults. Additional observational studies would be necessary to clarify these findings.

Dietary Quality Evidenced by the Healthy Eating Index and Cardiovascular Disease Risk Factors in Kuwaiti Schoolchildren.

Poor dietary quality is associated with adiposity and other risks of cardiovascular disease (CVD) in children. In Kuwait, although children's food choices are a concern, no studies have evaluated dietary quality relative to the risk of CVD in Kuwaiti schoolchildren. This study hypothesized that dietary quality using the Healthy Eating Index (HEI) is associated with CVD risk factors in children and that there are associated sex differences. Our main objective was to evaluate the dietary quality of schoolchildren and investigate whether poor HEI scores are associated with CVD risk and if there are sex differences. This was a cross-sectional study of Kuwaiti fifth graders (n = 313; 53% girls; mean age = 10.4 ± 0.4 years) who completed an adapted Block Kids 2004 food frequency questionnaire. Anthropometric, blood pressure, and biochemical data were also measured. HEI-2010 and HEI-2015 scores were calculated. A general linear model and logistic regression were applied, controlling for moderate-vigorous physical activity (MVPA) and screen time (ST). The total HEI-2010 and HEI-2015 scores were 58 and 52 points, respectively; a trend analysis indicated that more girls than boys had poor (≤50 points) HEI-2015 scores (p < 0.063). The maximum scores for total vegetables (p < 0.001), dairy (p < 0.034), and fatty acids (p < 0.01) were significantly higher in girls, while the maximum scores for whole grains (p < 0.046) and protein (p < 0.006), but not sodium (p < 0.009), were higher in boys. Obesity was inversely associated with poor total HEI 2010 and HEI 2015 scores (OR: 0.347, 95% CI: 0.234 - 0.516, p < 0.001 and OR: 0.561, 95% CI: 0.391-0.805, p < 0.002, respectively). However, the correlation was lost after adjustment for possible confounding factors. Dietary quality for children overall in this study was low, and there was only a weak association between poor scores and elevated blood pressure and none between scores and obesity. These findings have public health implications and warrant further investigation and attention.

Food Insecurity and Ideal Cardiovascular Health Risk Factors Among US Adolescents.

Food insecurity, a social and economic condition of limited availability of healthy food, is a risk factor for adverse cardiovascular health outcomes among adults; few studies have been conducted in adolescents. This study explores the association between food insecurity and cardiovascular health risk factors among a nationally representative sample of US adolescents, adopting the American Heart Association's Life's Essential 8 metric. We analyzed data from 2534 adolescents aged 12 to 19 years from the 2013 to 2018 National Health and Nutrition Examination Surveys. In the sample, 24.8% of adolescents lived in food-insecure households. After multivariable adjustment, food insecurity was associated with a 3.23-unit lower total Life's Essential 8 score (95% CI, -6.32, -0.15) and lower scores on diet quality (β=-5.39 [95% CI, -8.91, -1.87]) and nicotine exposure (β=-4.85 [95% CI, -9.24, -0.45]). Regarding diet, food insecurity was associated with 5% lower Healthy Eating Index-2015 scores [95% CI, -7%, -2%], particularly lower intakes of whole grains and seafood/plant proteins and marginally higher intake of added sugar. Regarding nicotine exposure, food insecurity was associated with ever use of a tobacco product among m (odds ratio, 1.74 [95% CI, 1.20-2.53]). Compared with their food-secure counterparts, food-insecure male (odds ratio, 1.98 [95% CI, 1.07-3.65]) and female (odds ratio, 3.22 [95% CI, 1.60-6.45]) adolescents had higher odds of living with a current indoor smoker. In this nationally representative sample of adolescents, food insecurity was associated with multiple indicators of cardiovascular health risk. These findings underscore the need for public health interventions and policies to reduce food insecurity and improve cardioprotective behaviors during adolescence, with particular efforts targeting diet quality and nicotine exposure.

Dietary quality and dietary greenhouse gas emissions in the USA: a comparison of the planetary health diet index, healthy eating index-2015, and dietary approaches to stop hypertension

BackgroundThe Planetary Health Diet Index (PHDI) measures adherence to the dietary pattern presented by the EAT-Lancet Commission, which aligns health and sustainability targets. There is a need to understand how PHDI scores correlate with dietary greenhouse gas emissions (GHGE) and how this differs from the carbon footprints of scores on established dietary recommendations. The objectives of this study were to compare how the PHDI, Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH) relate to (a) dietary GHGE and (b) to examine the influence of PHDI food components on dietary GHGE.MethodsWe used life cycle assessment data from the Database of Food Recall Impacts on the Environment for Nutrition and Dietary Studies to calculate the mean dietary GHGE of 8,128 adult participants in the 2015–2016 and 2017–2018 cycles of the National Health and Nutrition Examination Survey (NHANES). Poisson regression was used to estimate the association of (a) quintiles of diet score and (b) standardized dietary index Z-scores with dietary GHGE for PHDI, HEI-2015, and DASH scores. In secondary analyses, we used Poisson regression to assess the influence of individual PHDI component scores on dietary GHGE.ResultsWe found that higher dietary quality on all three indices was correlated with lower dietary GHGE. The magnitude of the dietary quality-dietary GHGE relationship was larger for PHDI [-0.4, 95% CI (-0.5, -0.3) kg CO2 equivalents per one standard deviation change] and for DASH [-0.5, (-0.4, -0.6) kg CO2-equivalents] than for HEI-2015 [-0.2, (-0.2, -0.3) kg CO2-equivalents]. When examining PHDI component scores, we found that diet-related GHGE were driven largely by red and processed meat intake.ConclusionsImproved dietary quality has the potential to lower the emissions impacts of US diets. Future efforts to promote healthy, sustainable diets could apply the recommendations of the established DASH guidelines as well as the new guidance provided by the PHDI to increase their environmental benefits.

The Association Between Diet Quality and Glycemic Outcomes Among People with Type 1 Diabetes

BackgroundThe amount and type of food consumed impacts the glycemic response and insulin needs of people with type 1 diabetes mellitus (T1DM). Daily variability in consumption, reflected in diet quality, may acutely impact glycemic levels and insulin needs. ObjectiveType 1 Diabetes Exercise Initiative (T1DEXI) data were examined to evaluate the impact of daily diet quality on near-term glycemic control and interaction with exercise. MethodsUsing the Remote Food Photography Method, ≤8 d of dietary intake data were analyzed per participant. Diet quality was quantified with the Healthy Eating Index-2015 (HEI), where a score of 100 indicates the highest-quality diet. Each participant day was classified as low HEI (≤57) or high HEI (>57) based on the mean of nationally reported HEI data. Within participants, the relationship between diet quality and subsequent glycemia measured by continuous glucose monitoring (CGM) and total insulin dose usage was evaluated using a paired t-test and robust regression models. ResultsTwo hundred twenty-three adults (76% female) with mean ± SD age, HbA1c, and body mass index (BMI) of 37 ± 14 y, 6.6% ± 0.7%, and 25.1 ± 3.6 kg/m2, respectively, were included in these analyses. The mean HEI score was 56 across all participant days. On high HEI days (mean, 66 ± 4) compared with low HEI days (mean, 47 ± 5), total time in range (70–180 mg/dL) was greater (77.2% ± 14% compared with 75.7% ± 14%, respectively, P = 0.01), whereas time above 180 mg/dL (19% ± 14% compared with 21% ± 15%, respectively, P = 0.004), mean glucose (143 ± 22 compared with 145 ± 22 mg/dL, respectively, P = 0.02), and total daily insulin dose (0.52 ± 0.18 compared with 0.54 ± 0.18 U/kg/d, respectively, P = 0.009) were lower. The interaction between diet quality and exercise on glycemia was not significant. ConclusionsHigher HEI scores correlated with improved glycemia and lower insulin needs, although the impact of diet quality was modest and smaller than the previously reported impact of exercise.

Abstract 757: Integrating microbiome analysis and multi-modal data to identify high-risk population for esophageal adenocarcinoma

Abstract INTRODUCTION: Esophageal Adenocarcinoma (EAC) represents a pressing public health concern with a rising incidence and a staggering 5-year survival rate of less than 20%, emphasizing the critical need for early detection. Barrett's Esophagus (BE) serves as a well-established precursor to EAC, presenting an opportunity for proactive screening. The salivary microbiome provides a novel opportunity to identify a high-risk population with early-stage esophageal diseases. Here, we assessed whether the oral microbiome, in combination with lifestyle and clinical data, is associated with esophageal disease progression. METHODS: The study included n=23 esophageal adenocarcinoma patients, n=51 with Barrett's Esophagus, and n=32 healthy controls. Saliva samples were collected along with comprehensive lifestyle, dietary intake, and clinical data. Shotgun Metagenomics Sequencing was employed to investigate the microbiome composition of participants. Comprehensive microbiome analyses were performed to evaluate taxonomic profiles, including microbial abundance, microbiome diversity, and functional/metabolic insights. A multi-modal data integration strategy was used to incorporate data from the Diet Health Questionnaire (DHQ) and lifestyle and health records, aiming to utilize these multimodal features to predict esophageal disease formation and progression. RESULTS: A significant difference was observed in the salivary microbiome beta diversity between healthy controls and esophagus disease groups (p= 0.03). Clustering by microbiome taxonomic composition using the Dirichlet Multinomial Mixtures (DMM) framework indicates that some microbial signatures are associated with esophageal diseases (p=0.03). Healthy Eating Index Scores, total score (p=0.01); vegetables (p=0.003); greens, and beans score (p=0.009) were significantly different between study groups. Microbial pathways associated with diet, microbial taxa linked to lifestyle and medications, and supervised classification results reveal group characteristics and diversity variations based on key covariates such as B12 and sugar uptakes. CONCLUSION: The study presents an innovative analytic approach to identify high-risk populations for esophageal diseases by integrating microbiome analysis and multi-modal data, providing insights into early detection and prevention. The potential of this research lies in its ability to revolutionize screening strategies, offering a non-invasive and cost-effective means to identify individuals at risk of EAC at earlier, more treatable stages. Citation Format: Duygu Altinok Dindar, Madeline Krieger, Amy Palma, John Cheney, Fouad Otaki, Jessica Yu, Stephanie Wood, Thomas J. Sharpton, James McGann, Lisa Karstens, Gurkan G. Yardimci, Zhenzhen Zhang. Integrating microbiome analysis and multi-modal data to identify high-risk population for esophageal adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 757.

Abstract 6151: Relationship between polygenic risk score, lifestyle factors, and colorectal cancer risk

Abstract Although heritable factors are estimated to explain up to 35% of colorectal cancers (CRC), most are diagnosed in people without a family history of CRC suggesting that inherited genetic variants, environmental factors, or a combination of both, contribute to CRC risk. We explored the relationship between a polygenic risk score (PRS) for CRC risk and lifestyle risk factors to understand whether individuals with higher genetic risk, who do not develop CRC, engage in healthier lifestyle behaviors, or conversely, whether those with lower genetic risk, who do develop CRC, engage in riskier behaviors in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Using summary statistics obtained from a large independent GWAS meta-analysis of CRC by the GECCO consortium, we developed a genome-wide PRS for CRC using SBayesR and applied it to participants of European ancestry genotyped in the PLCO Trial (n=74,396). For all subjects, we computed an environmental (E) score based on 19 lifestyle risk factors for CRC, a WCRF/AICR score that measured adherence to the 2018 Cancer Prevention recommendations, and a 2015 healthy eating index (HEI) with higher values indicating healthier lifestyle profiles. We used t-tests to evaluate differences in lifestyle scores between CRC-free participants in the highest quartile of PRS and incident CRC cases in the lowest quartile of PRS. To examine the correlations between the PRS and lifestyle scores, we performed multivariable linear regression models regressing PRS on each lifestyle score. We used multivariable Cox hazards regression models to compute hazard ratios and 95% confidence intervals for CRC risk; multiplicative interactions between PRS and lifestyle scores were evaluated using the Wald test for the interaction terms. During the 15 years follow-up period, a total of 1,052 CRC cases were diagnosed. Individuals in the highest quartile of PRS who remained cancer-free were more likely to engage in healthier behaviors than those in the lowest quartile of PRS who were diagnosed with incident CRC (E-score: -0.01 vs. -0.18, WCRF/AICR score: -0.05 vs. -0.32, HEI score: 0.06 vs. -0.13); however, differences were not statistically significant (P value: 0.1 to 0.4). PRS and lifestyle scores were significantly (all P &amp;lt;0.0001), albeit weakly (β: -0.02 to -0.03), associated among participants who remained CRC-free but not among CRC cases (P: 0.1 to 0.3). PRS-lifestyle score interactions were not statistically significant (P: 0.2 to 0.4). Although the differences and multiplicative interaction models were not statistically significant, we found that individuals with a higher PRS who remained CRC-free were slightly more likely to engage in healthier behaviors than those at a lower genetic score who developed CRC. Additional studies with larger sample size are warranted to further explore the interplay between genetic risk and lifestyle factors related to CRC risk. Citation Format: Wen-Yi Huang, Erikka Loftfield, Rebecca Landy, Difei Wang, Hormuzd A. Katki, Jianxin Shi, Lingxiao Wang, Mitchell J. Machiela, Neal D. Freedman, Sonja I. Berndt. Relationship between polygenic risk score, lifestyle factors, and colorectal cancer risk [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6151.

Abstract P197: Dietary Quality Determined by Healthy Eating Index-2015 and Endothelial Function in Healthy Adults

The Healthy Eating Index (HEI) is a measure of diet quality based on Dietary Guidelines for Americans and developed in collaboration with the US Department of Health and Human Services and the US Department of Agriculture. Clinical interest in HEI has increased due to its association with obesity, inflammatory biomarkers and risk of coronary heart disease and stroke. Indeed, higher HEI-2015 score has been linked with reduced cardiovascular risk, morbidity, and mortality. Endothelial dysfunction, particularly impaired endothelium-dependent vasodilation, is a central etiological factor underlying cardiovascular risk and events. We and others have previously demonstrated that diets high in saturated fat and other proatherogenic diets are associated with endothelial vasodilator dysfunction. It is currently unknown whether HEI-2015 dietary score is associated with endothelial function. If so, assessing dietary quality based on HEI-2015 may provide targeted nutritional guidance for enhancing vascular health and mitigating cardiovascular risk. The aim of this study was to determine whether HEI-2015 score is associated with endothelial vasodilator function in healthy adults. Using data from 4-day dietary records, HEI-2015 scores were determined in 103 adults (65 M/38 F; age 44-68 years) free of overt cardiometabolic disease. The HEI-2015 score is based on 13 components summed to yield a total score from 0 to 100; higher score representing higher diet quality. The adults were stratified by HEI-2015 score quartiles: Q1: HEI &lt; 52.5 (n=25; 23 M/2 F); Q2: HEI 52.6-59.1 (n=26; 14 M/12 F); Q3: HEI 59.2-66.0 (n=26; 15 M/11 F); and Q4: HEI &gt; 66.0 (n=26; 13 M/13 F). Endothelium-dependent vasodilation was determined by forearm blood flow (FBF) (via plethysmography) responses to intra-arterial infusion of acetylcholine (ACh: 4.0, 8.0, and 16.0 μg/100 mL tissue/min) and sodium nitroprusside (NTP: 1.0, 2.0, and 4.0 μg/100 mL tissue/min). There were no significant differences in endothelium-dependent vasodilation across the HEI-2015 score quartiles. FBF blood responses to ACh were remarkably similar between Q1 (5.1±0.2 to 13.0±0.7 mL/100 mL tissue/min), Q2 (4.3±0.2 to 12.1±0.7 mL/100 mL tissue/min), Q3 (4.4±0.2 to 13.0±0.7 mL/100 mL tissue/min) and Q4 (4.5±0.2 to 14.4±0.6 mL/100 mL tissue/min). Moreover, HEI scores were not significantly associated with the vasodilator response to either ACh (r=0.15, P=0.13) or NTP (r=-0.04; P=0.72). In summary, although diet quality determined by HEI-2015 score has been shown to be associated with increased risk of cardiovascular disease and events, HEI-2015 was not associated endothelial function in mid-life and older adults. Given the established experimental and pathophysiological evidence linking between diet, endothelial vasodilator function and cardiovascular risk, HEI-2015 score is not a sensitive dietary indicator/biomarker of vascular function.

Food Security and Diet Quality Improvements among At-Risk, Low-Income, Older Adults following a Free Meal Pilot Program.

Older adults are at a greater risk for food insecurity compared to the general population. This study aimed to describe changes in diet quality and food insecurity following a free meal program at low-income, older adult housing complexes. Study participants were recruited from two low-income older adult public housing complexes in Kentucky. Fifty participants were enrolled and received 1-4 free weekly meals across 3 months as part of the Meals on Wings pilot program. Surveys and a 24 h dietary recall were completed at baseline and 3 months. Participants were predominately female, 69 years of age, and Black or African American race. Food security status (FSS) and dietary quality through the Healthy Eating Index (HEI) were assessed as primary measures. Participants were placed in "at-risk" categories of the (1a) lower quartile of the HEI and (1b) lower than 51% HEI, or (2) "low" or "very low" food security status based on the USDA Household Food Security Screener (FSS). Multiple linear regression (MLR) models were conducted for HEI and FSS scores to include time, group, time*group interaction, and control of meal utilization percentage (i.e., dose). The MLR for the HEI quartile had a significant time by quartile interaction that was present for an increase in the HEI in Q1 (n = 12; 32.42 ± 5.95% to n = 6; 46.10 ± 10.62%; p < 0.0001) and a decrease in the HEI for Q4 (n = 12; 70.68 ± 7.13% to n = 9; 52.36 ± 11.57%; p < 0.0001). For those low food security participants (n = 24; 48.0%), the average food insecurity score from the 6-item USDA screener improved from 4.09 ± 1.62 at baseline to 2.63 ± 2.41 at 3 months (p = 0.0064). The MLR for the FSS had a significant group*time interaction (p = 0.0071). In our population, particularly those vulnerable with lowest dietary quality and food insecurity status, we did see improvements across the free meal pilot program. However, a small sample, limited generalizability, and limited data collection measures urge caution when using these results to extrapolate for the general population. However, the current results are promising and should encourage further investigation of the effects of meal assistance programs on the health and well-being of older adults.

A Mediterranean diet plan in lactating women with obesity reduces maternal energy intake and modulates human milk composition - a feasibility study.

Maternal obesity is associated with increased concentrations of human milk (HM) obesogenic hormones, pro-inflammatory cytokines, and oligosaccharides (HMOs) that have been associated with infant growth and adiposity. The objective of this pilot study was to determine if adherence to a Mediterranean meal plan during lactation modulates macronutrients and bioactive molecules in human milk from mothers with obesity. Sixteen healthy, exclusively breastfeeding women with obesity (body mass index ≥30 kg/m2) enrolled between 4 and 5 months postpartum. The women followed a 4-week Mediterranean meal plan which was provided at no cost. Maternal and infant anthropometrics, HM composition, and infant intakes were measured at enrollment and at weeks 2 and 4 of the intervention. Thirteen mother-infant dyads completed the study. Additionally, participants from an adjacent, observational cohort who had obesity and who collected milk at 5 and 6 months postpartum were compared to this cohort. Participants' healthy eating index scores improved (+27 units, p < 0.001), fat mass index decreased (-4.7%, p < 0.001), and daily energy and fat intake were lower (-423.5 kcal/day, p < 0.001 and-32.7 g/day, p < 0.001, respectively) following the intervention. While HM macronutrient concentrations did not change, HM leptin, total human milk oligosaccharides (HMOs), HMO-bound fucose, Lacto-N-fucopentaose (LNFP)-II, LNFP-III, and difucosyllacto-N-tetrose (DFLNT) concentrations were lower following the intervention. Infant intakes of leptin, tumor necrosis factor (TNF)-α, total HMOs, HMO-bound fucose, LNFP-III and DFLNT were lower following the intervention. Specific components of the maternal diet (protein and fat) and specific measures of maternal diet quality (protein, dairy, greens and beans, fruit and vegetables) were associated with infant intakes and growth. Adherence to a Mediterranean meal plan increases dietary quality while reducing total fat and caloric intake. In effect, body composition in women with obesity improved, HM composition and infants' intakes were modulated. These findings provide, for the first time, evidence-based data that enhancing maternal dietary quality during lactation may promote both maternal and child health. Longer intervention studies examining the impact of maternal diet quality on HM composition, infant growth, and infant development are warranted.

Poor diet quality is associated with biochemical parameters of protein nutritional status after Roux-en-Y gastric bypass

ObjectiveTo assess diet quality and its association with body and biochemical parameters in patients who underwent Roux-en-Y gastric bypass (RYGB). MethodsProspective observational study with individuals of both sexes subjected to RYGB. Body composition, biochemical parameters, and diet quality were assessed before and six months after RYGB. Diet quality was assessed by the Healthy Eating Index (HEI). Data were analyzed by the paired t-test or Wilcoxon signed-rank test, with a significance level of 5%. Spearman's correlation and simple linear regression were performed between variables. ResultsThe final sample included 34 patients. Their diet was classified as poor before and 6 mo after RYGB. BMI, fat mass, fat-free mass, waist perimeter, serum total protein, transthyretin, alpha-1-acid glycoprotein, and C-reactive protein decreased significantly (P < 0.05). Variations in the HEI score and caloric intake were associated with serum albumin and transthyretin (P < 0.05). ConclusionPoor diet quality was present before and six months after RYGB, and the study data suggest that poor diet quality is associated to a risk of loss of lean body mass and visceral protein six months after RYGB.

Lower Diet Quality Associated with Subclinical Gastrointestinal Inflammation in Healthy United States Adults

BackgroundHigher diet quality has been associated with lower risk of developing inflammatory bowel disease, but associations between diet and gastrointestinal (GI) inflammation in healthy adults prior to disease onset are understudied. ObjectivesThe purpose of this project was to examine associations between reported dietary intake and markers of GI inflammation in a healthy adult human cohort. MethodsIn a cross-sectional observational trial of 358 healthy adults, participants completed ≤3 unannounced 24-h dietary recalls using the Automated Self-Administered Dietary Assessment Tool and a Block 2014 Food Frequency Questionnaire to assess recent and habitual intake, respectively. Those who provided a stool sample were included in this analysis. Inflammation markers from stool, including calprotectin, neopterin, and myeloperoxidase, were measured by ELISA along with LPS-binding protein from plasma. ResultsRecent and habitual fiber intake was negatively correlated with fecal calprotectin concentrations (n = 295, P = 0.011, 0.009). Habitual soluble fiber intake was also negatively correlated with calprotectin (P = 0.01). Recent and habitual legume and vegetable intake was negatively correlated with calprotectin (P = 0.013, 0.026, 0.01, 0.009). We observed an inverse correlation between recent Healthy Eating Index (HEI) scores and calprotectin concentrations (n = 295, P = 0.026). Dietary Inflammatory Index scores were calculated and positively correlated with neopterin for recent intake (n = 289, P = 0.015). When participants with clinically elevated calprotectin were excluded, recent and habitual fiber, legume, vegetable, and fruit intake were negatively correlated with calprotectin (n = 253, P = 0.00001, 0.0002, 0.045, 0.001, 0.009, 0.001, 0.004, 0.014). Recent total HEI score was inversely correlated with subclinical calprotectin (P = 0.003). ConclusionsHigher diet quality may be protective against GI inflammation even in healthy adults.This trial was registered at clinicaltrials.gov as NCT02367287.

The association of Healthy Eating Index and its components with levels of fasting blood sugar and lipid profile in normoglycemic and hyperglycemic individuals

PurposeThis study aims to assess the association of Healthy Eating Index (HEI) with levels of fasting blood sugar (FBS) and lipid profile in normoglycemic and elevated FBS patients.Design/methodology/approachThis case-control study was conducted on 144 participants, namely, 72 normoglycemic subjects (FBS < 100 mg/dl) and 72 high-glycemic patients (FBS ≥ 100 mg/dl) aged 20–60 years of age, who were selected from the nutrition and diet clinics in Tehran city. The dietary intake was collected by using a validated food frequency questionnaire to determine the HEI score.FindingsThe mean±SD age and body mass index of participants were 47.1 ± 12.7 years and 29.6 ± 6.0 kg/m2, respectively. The median (interquartile range) of HEI scores in the normoglycemic group and the high-glycemia group were 19.34 (15.24–24.31) and 16.53 (13.35–24.07), respectively. In the overall population, the findings of the multi-variable linear regression model indicated a positive association between the HEI score and high-density lipoprotein-cholesterol (HDL-C) (ß = 0.34; 95%CI: 0.05–0.64, P = 0.01). However, there is no significant association between HEI and HDL-C in normoglycemic (ß = 0.19; 95%CI: −0.31, 0.69, P = 0.45) and hyperglycemic subjects (ß = 0.28; 95%CI: −0.10–0.66, P = 0.15). Furthermore, the association of HEI with levels of FBS, triglycerides (TGs) and low-density lipoprotein-cholesterol (LDL-C) was not significant in any of the analyzed groups, including the total population, normoglycemic individuals and hyperglycemic subjects.Originality/valueThis study was the first study to assess the role of HEI and its components with levels of FBS and lipid profile in normoglycemic and hyperglycemic individuals in Iran. The findings suggested that higher adherence to HEI may be associated with an increase in the HDL-C level. However, HEI could not predict FBS, TGs and LDL-C levels in the adult population.

The prognostic role of diet quality in patients with MAFLD and physical activity: data from NHANES

Background and objectivesDietary control and increased physical activity (PA) are recommended for patients with metabolic (dysfunction-) associated fatty liver disease (MAFLD). However, not all patients can sustain both exercise and a healthy diet. This study explored the interaction between dietary quality, PA levels, and mortality in MAFLD patients.MethodsThe Third National Health and Nutrition Examination Survey and linked mortality data were used in this study. Diet quality was assessed with the Healthy Eating Index (HEI). PA level was calculated by multiply self-reported exercise frequency and its Metabolic Equivalent A high-quality diet was associated. A Cox proportional hazard model was used to explore risk factors for mortality in MAFLD patients.ResultsIn total, 3709 participants with MAFLD were included in the final analysis. The median follow-up time was 26.2 (interquartile range 19.3–28.1) years and 1549 (41.8%) deaths were recorded over follow-up. Cox multivariate regression was used to adjust for potential confounders of mortality. The results showed both HEI score and PA level were inversely correlated with all-cause mortality (P < 0.05). In the subgroup analysis stratified by PA level, higher diet quality decreased all-cause mortality, cardiovascular-related mortality and cancer-related mortality in PA inactive of MAFLD patients (P < 0.05), but these correlations were not present in active PA groups.ConclusionHealthy diet and physical activity may have different impact as lifestyle interventions for MAFLD. A high-quality diet is associated less mortality in inactive individuals with MAFLD but not in those with active PA levels. Sedentary individuals require healthier diet.

Longitudinal tracking of diet quality from childhood to adolescence: The Interplay of individual and sociodemographic factors

This study aimed to examine diet tracking from childhood to adolescence, using 4 time-points, and the influence of socioeconomic and individual characteristics in this transition. The sample included 6893 children from the Portuguese birth cohort Generation XXI with complete information on Food Frequency Questionnaire in at least one of the considered follow-ups. A Healthy Eating Index (HEI), previously developed to assess adherence to WHO's dietary recommendations, was applied at all ages (4, 7, 10 and 13y). The intraclass correlation coefficient (ICC) was used to analyse the tracking of diet quality. Linear mixed-effect models were performed to estimate the association of the child's socioeconomic and individual characteristics with the HEI score and respective trajectories over time. The overall diet quality decreased from childhood (22.2 ± 3.6 at 4y) to adolescence (18.2 ± 3.9 at 13y), with moderate tracking (ICC = 0.53), showing that children who start a healthy diet earlier might have a better diet quality as time goes by. Children of older mothers (β = 0.079, 95%CI = 0.061–0.097) and with higher education (β = 0.203, 95%CI = 0.178–0.229) and a higher household monthly income (β = 0.024,95%CI = 0.007–0.041) had a higher diet quality over time. Besides family characteristics, the child's sedentary activities (β = −0.009, 95%CI = −0.014–-0.003) negatively influence diet quality throughout life. In contrast, being a girl (β = −0.094, 95%CI = −0.132–-0.056) and having higher sleep duration (β = 0.039, 95%CI = 0.015–0.064) are associated with a higher diet quality over time. The presence of dietary tracking from childhood to adolescence implies that promoting healthy eating habits during the first years of life is crucial for a healthier diet quality during late childhood and early adolescence, focusing on maternal and individual child characteristics.