Healthy Eating Index Scores Research Articles

Association between diet quality and incident cardiovascular disease stratified by body mass index

ObjectiveDiet quality is a significant contributor to cardiovascular disease (CVD) development given its substantial influence on important downstream CVD mediators such as weight. However, it is unclear if there are additional pathways between diet quality and incident CVD independent of weight. We sought to determine if higher diet quality was associated with lower CVD risk stratified by BMI categories. MethodsProspective cohort data from the Lifetime Risk Pooling Project (LRPP) was analyzed. Diet data from 6 US cohorts were harmonized. The alternative Healthy Eating Index-2010 (aHEI-2010) score was calculated for each participant. Within each cohort, participants were divided into aHEI-2010 quintiles. The primary outcome of interest was composite incident CVD event including coronary heart disease, stroke, heart failure, and CVD death. Cox regression analysis was performed separately for three BMI strata: 18.5–24.9, 25–29.9, and ≥ 30 kg/m2. ResultsA total of 30,219 participants were included. During a median follow-up of 16.2 years, there were a total of 7,021 CVD events. An inverse association between aHEI-2010 score and incident CVD was identified among participants who were normal weight (comparing highest quintile with lowest quintile: adjusted hazard ratio [95% confidence interval] 0.57 [0.50 – 0.66]) and among participants with overweight (0.69 [0.61 – 0.77]). aHEI-2010 score was not associated with CVD among participants with obesity (0.97 [0.84 – 1.13]). ConclusionsAmong adults in the United States, higher diet quality as measured by aHEI-2010 was significantly associated with lower risk of incident CVD among individuals with normal weight and overweight but not obesity.

Late Evening Eating Patterns among US Adults Vary in Their Associations With, and Impact on, Energy Intake and Diet Quality: Evidence from What We Eat in America, National Health and Nutrition Examination Survey 2013-2016

BackgroundEvening eating has been associated with higher energy intake and lower nutrient density. However, these qualities may not characterize all late evening (LE) eating patterns. ObjectiveWe sought to characterize US adults’ LE eating patterns on a given day and identify differences, if any, in pattern-specific associations with, and impact on, daily energy intake and total diet quality. DesignLE eating patterns, energy intakes, and Healthy Eating Index (HEI) scores were identified using Day-1 dietary recall data from the cross-sectional National Health and Nutrition Examination Survey 2013-2016. Participants/settingThe sample included adults aged ≥ 20 years (n = 9,861). LE reporters were respondents who consumed foods/beverages between 20:00 and 23:59 on the intake day. Main outcome measuresEnergy intake and HEI-2015 scores by LE status/pattern and the impact of LE consumption on these measures. Statistical analysesCluster analysis assigned individuals to LE eating patterns based on the LE energy contribution of food/beverage groups. Regression models estimated energy intake and HEI-2015 scores; estimates were compared between LE reporters and nonreporters. Similarly, LE’s contribution to total energy and the difference in total HEI inclusive vs exclusive of LE consumption were estimated and compared among patterns. ResultsAmong US adults, 64.4% were LE reporters. Eleven LE patterns were identified; the six most prevalent patterns (representing 89% of LE reporters) were further analyzed. Daily energy intake in all prevalent patterns except the fruit pattern exceeded that of nonreporters by ≥ 268 kcal (unadjusted; P < 0.001), varying by pattern. Conversely, total HEI score did not differ from that of nonreporters (51.0) in any pattern except the fruit pattern, where it was higher (57.4, unadjusted; P < 0.001). Generally, LE consumption’s impact on energy was high and its impact on HEI scores was low. ConclusionsLate evening food/beverage consumption is common among US adults, and LE patterns are not monolithic in their associations with, and impact on, total energy intake and dietary quality.

Diet quality comparisons in Hispanic/Latino siblings: Results from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth)

The objective of this study was to determine how well Hispanic/Latino siblings' diet quality correlate with each other and whether social and environmental factors explained potential differences. Hispanic/Latino 8–16-year-olds from the cross-sectional Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth) with at least one sibling enrolled in the study were examined (n = 740). Diet quality was assessed with the Healthy Eating Index 2010 (HEI-2010), calculated from two 24-h recalls. Mixed effects models were used with HEI-2010 score as the outcome, and correlations in siblings' diet quality were assessed with intraclass correlation coefficients (ICCs). All models were examined stratified by age and sex. Diet-related social and environmental measures were added as fixed effects in a secondary analysis. Mean (standard deviation) overall HEI-2010 score was 53.8 (13.0). The ICC for siblings' HEI-2010 score was 0.31 (95% CI: 0.25, 0.38). Siblings who were born <3 vs. ≥3 years apart had stronger correlations in overall diet quality (0.47 [95% CI: 0.37, 0.58] vs. 0.21 [95% CI: 0.13, 0.30]), but no differences were observed in overall HEI-2010 score according to sex. Greater peer support for fruit and vegetable intake (β = 1.42 [95% CI: 0.62, 2.21]) and greater away-from-home food consumption (β = −1.24 [95% CI: −2.15, −0.32]) were associated with differences in siblings' diet quality. Overall diet quality scores of Hispanic/Latino siblings in this study were slightly correlated, with stronger correlations among siblings closer in age. Differences in peer support and foods consumed outside the home may explain differences in siblings' diet quality. Future research should investigate additional determinants of differences in siblings' diets.

Abstract 12197: Rural Caregivers With Low Health Literacy Show Greater Improvements in Diet Quality From a Cardiovascular Disease Risk Reduction Intervention Designed to Address Low Health Literacy Than Those With High Health Literacy

Introduction: Rural caregivers of those with chronic illnesses have higher cardiovascular disease (CVD) risk than urban caregivers. Diet is a major lifestyle factor that contributes to CVD risk. We conducted a randomized controlled trial of a CVD risk reduction intervention called Rural Intervention for Caregivers’ Heart Health (RICHH), that was designed to promote CVD risk reduction, including healthy eating and that was designed to be accessible to those with low health literacy (HL). We tested the moderating effect of HL on the impact of the intervention on diet quality. Hypothesis: Rural caregivers with low HL would gain equal or greater benefits from the RICHH intervention on diet quality compared to those with high HL. Methods: The newest vital sign (NVS), rural-urban commuting area (RUCA) code ≥4 or living in Appalachian counties, and Healthy Eating Index-2015 (HEI-2015) were used to determine HL, rurality, and diet quality, respectively. The HEI-2015 was computed based on a food frequency questionnaire at baseline and post-intervention. The RICHH intervention was delivered using videoconference technology by nurse interventionists once a week for 12 weeks. A linear mixed effect model was used to evaluate the moderation effect of HL (NVS ≥ 4) on the impact of the intervention on diet quality. Results: A total of 296 rural caregivers (54.5 ± 13.7 years old, 76% female) completed the study. The improvement in HEI-2015 scores was greater in the low HL group than in the high HL group controlling for age and sex (beta estimate = 9.21, SE = 3.31, P = 0.0058). Conclusions: The RICHH intervention was effective in improving diet quality of rural caregivers compared to the control group. In particular, rural caregivers with low HL benefited more from the intervention aimed at increasing diet quality. Thus, addressing low HL could play an important role to improve diet quality and to reduce CVD risk among caregivers residing in rural environment.

Impact of Supplemental Nutrition Assistance Program Benefit Reduction or Loss on Food-at-Home Acquisitions and Community Food Program Use

Since Supplemental Nutrition Assistance Program (SNAP) benefits are vital for food-at-home (FAH) acquisitions among participating families, changes in participation or benefit amounts may impact FAH purchase and use of community-based food programs (CFP). The association of the loss of or a reduction in SNAP benefits with FAH acquisitions and CFP use was assessed using 2012–2013 National Household Food Acquisition and Purchase Survey data. Households with incomes equal to or below 130% of the Federal Poverty Level were categorized as (1) current SNAP households, (2) households with benefit loss in the preceding year, or (3) households with benefit loss for more than a year. Current SNAP households were classified as receiving (1) lesser-than-usual benefits or (2) usual benefits. Regression analyses examined associations of the loss of or a reduction in benefits with the Healthy Eating Index-2015 (HEI-2015) scores of FAH purchases and CFP use. Benefit loss in the preceding year was related to a lower total HEI-2015 score for FAH acquisitions, whereas benefit reduction was associated with lower green/bean and added sugar scores and increased CFP use. This study suggests that the loss of or a reduction in SNAP benefits may adversely impact the quality of FAH purchases. The findings also suggest that efforts enhancing the nutrition environment of community food sources could support healthy food acquisition by families experiencing benefit reduction.

Healthy Eating Index Scores Differ by Race/Ethnicity but Not Hypertension Awareness Status among US Adults with Hypertension: Findings from the 2011-2018 National Health and Nutrition Examination Survey

BackgroundLittle is known about whether or not diet quality is associated with race/ethnicity as well as hypertension awareness status among adults with hypertension. ObjectiveThe aim of this study was to examine associations between diet quality and race/ethnicity as well as hypertension awareness. DesignAnalysis of the 2011-2018 National Health and Nutrition Examination Survey, a cross-sectional survey representative of the US population. Participants/settingA total of 6,483 participants with hypertension who were at least 18 years old and had dietary recall data were included. Main outcome measuresDiet quality was assessed by Healthy Eating Index 2015 (HEI-2015). Statistical analysis performedWeighted χ2 tests were employed to test associations between categorical variables. Weighted linear regression was used to model the HEI-2015 score by various covariates. ResultsAmong the 6,483 participants with hypertension included in this study, the average HEI-2015 total score was 54.0 out of the best possible score of 100. In unadjusted analysis, the HEI-2015 total score was significantly different by race/ethnicity (P < 0.01), being 60.9 for non-Hispanic Asian participants, 54.4 for Hispanic, 53.8 for non-Hispanic White, and 52.7 for non-Hispanic Black participants. The HEI-2015 component scores were statistically different by race/ethnicity for all the 13 components (all P values < 0.01). In adjusted analysis, race/ethnicity was significantly associated with the total HEI-2015 score (P < 0.0001), but hypertension awareness status was not (P = 0.99), after controlling for age, sex, body mass index, marital status, education level, income level, and insurance status. ConclusionsThere were significant racial/ethnic differences in HEI-2015 scores among participants with hypertension. Hypertension awareness status was not associated with HEI-2015 scores. Further study is needed to identify reasons why there was an association between HEI-2015 scores and race/ethnicity, and a lack of association with hypertension awareness.

Longitudinal bidirectional relationship between children's appetite and diet quality: A prospective cohort study

This study explored the relationship between eating behaviours and diet quality, from 7 to 10y. The sample included 3879 children evaluated, from the Portuguese birth cohort Generation XXI, with complete information on Food Frequency Questionnaire (FFQ) and the Children Eating Behaviour Questionnaire (CEBQ). A healthy eating index (HEI) (range: 9–31) was developed to evaluate the child's diet quality. The eight CEBQ's eating behaviours were included in the analysis. Generalised linear models were used to estimate the associations. Adjusted structural equation modelling was performed to study the direction of the associations. Eating behaviours measured at age 7y tracked to age 10y. A bidirectional inverse association between the food fussiness trait and diet quality was found, with a similar magnitude (p < 0.001), thus a higher score on food fussiness predicted a lower quality of the diet. A higher HEI score at 7y was associated with lower satiety responsiveness at 10y (βstandardized = −0.039), and a higher HEI score at age 10y was associated with higher enjoyment of food at 7y (βstandardized = 0.046). Eating behaviours were linked to diet quality in children with high enjoyment of food and low food fussiness at age 7y linked to a high-quality diet at 10y. In addition, children with high-quality diets at 7y were more likely to have lower food fussiness and satiety responsiveness at 10y. Given the stability of eating behaviours and the bidirectional nature of effects between eating behaviours and dietary quality in the long term, tailored interventions may be needed to encourage the acquisition of healthy eating behaviours and habits in early life.

The resemblance of dietary intakes in three generations of parent-offspring pairs: Tehran lipid and glucose study

The degree of similarity between dietary intakes of offspring and their parents may be different across various countries. This study aimed to investigate the correlation between food group intakes and dietary quality in three younger-middle-older generations by living arrangements. Individuals who participated in the 5th survey of the Tehran Lipid and Glucose Study, 1286 families (4685 subjects) with complete data for two or three generations were entered in this cross-sectional study. Genetic data management system from Progeny Software was used to error-check family data pedigree details. Dietary data were gathered using a valid and reliable food frequency questionnaire. The healthy eating index score was computed. Data of parents with their offspring were compared using paired t-test and partial correlation. The mean ages of grandfathers and grandmothers were 69.4 ± 7.9 and 63.7 ± 8.5 respectively. Of girls and boys who lived with their parents, about 59% were 20 years or older. The correlation of parents’ dietary intake and their young offspring who lived with them was higher than that of parents and adult offspring who lived independently from their parents. The correlation of dietary quality and food group intakes in mother-offspring dyads (mother-son: 0.37, mother-daughter: 0.44) were higher than father-offspring (father-son: 0.34, father-daughter: 0.25) dyads. The dietary quality of parents was higher than that of offspring in both living statuses. The dietary intake of adult married offspring was not correlated with their parents; also there was no correlation between the dietary quality of younger and older generations. There were weak to moderate similarities between food group intakes of parent-offspring dyads that lived with their parents.

Validation of a Home Food Environment Instrument Assessing Household Food Patterning and Quality.

The home food environment (HFE) is associated with dietary intake; yet measuring HFE quality often requires burdensome collection of detailed inventories. This project evaluated the capacity of the Home Inventory to Describe Eating and Activity, version 2 (Home-IDEA2) to capture HFE quality by measuring the presence or absence of household foods. Validity was tested using a modified application of the Healthy Eating Index-2010 (HEI). Comparative data were drawn from the National Food Acquisition and Purchase Survey (FoodAPS) Food-at-Home Public Use File. HEI scores were calculated for 4202 households in FoodAPS using Home-IDEA2 inventories and full reported inventories. Paired t-tests compared: (1) estimated vs. total edible grams (EEG; TEG); (2) limited vs. all reported foods; and (3) EEG + limited foods vs. TEG + all reported foods. Sensitivity and range of scores were compared. Mean HEI scores for Home-IDEA2 were higher (p < 0.003) than FoodAPS: (1) 51.6 ± 16.1 vs. 49.6 ± 18.1 (food amounts); (2) 53.5 ± 15.8 vs. 49.8 ± 15.4 (food items); (3) 55.5 ± 15.7 vs. 49.8 ± 15.4 (full instrument); differences were small. Scores demonstrated comparable sensitivity and range. The study found that the Home-IDEA2 can capture HFE quality adequately with low data collection burden.

Changes in dietary patterns from preconception to during pregnancy and its association with socio-demographic and lifestyle factors.

To examine dietary patterns changes from preconception to during pregnancy and their associations with socio-demographic and lifestyle factors. This study used data from the Australian Longitudinal Study on Women's Health (ALSWH), a population-based prospective cohort study. Women's dietary patterns were assessed using Healthy Eating Index-2015 (HEI-2015) score and the four patterns were obtained from the factor analysis (Western diets, vegetable and grains, traditional vegetable and fruit patterns). Multi-variable linear regression and repeated measures mixed-effect models were used. A national representative survey which covers all Australian citizens and permanent residents in Australia. 621 women were included from the ALSWH. Women's scores increased on the 'HEI-2015', 'traditional vegetable' and 'fruit' patterns while the 'vegetable and grains' decreased from preconception to during pregnancy. Women with higher education were more likely to increase their HEI-2015 score and fruit consumption from preconception to during pregnancy, respectively (β = 2·31, (95 % CI 0·02, 4·60)) and (β = 23·78, (95 % CI 4·58, 42·97)), than those with lower educational status. Single women were more likely to increase the consumption of vegetables and grains compared to married women (β = 76·08, (95 % CI 20·83, 131·32)). Women with higher income had a greater increase in the HEI-2015 score than those with lower income (β = 3·02, (95 % CI 0·21, 5·83)). The findings indicate that there have been marked dietary changes from preconception to during pregnancy. Changes in healthy dietary patterns were influenced by education, marital status and income.

Socioeconomic inequities in diet quality among a nationally representative sample of adults living in Canada: an analysis of trends between 2004 and 2015

Socioeconomic inequities in diet quality are stable or widening in the United States; however, these trends have not been well characterized in other nations. Moreover, purpose-developed indices of inequities that can provide a more comprehensive and precise perspective of trends in absolute and relative dietary gaps and gradients using multiple indicators of socioeconomic position (SEP) have not yet been used, and can inform strategies to narrow dietary inequities. We quantified nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to 3 indicators of SEP among adults in Canada. Adults (≥18 y old) who participated in the nationally representative, cross-sectional Canadian Community Health Survey-Nutrition in 2004 (n=20,880) or 2015 (n=13,970) were included. SEP was classified using household income (quintiles), education (5 categories), and neighborhood deprivation (quintiles). Dietary intake data from 24-h recalls were used to derive Healthy Eating Index-2015 (HEI-2015) scores. Dietary inequities were quantified using absolute and relative gaps (between the most and least disadvantaged) and absolute [Slope Index of Inequality (SII)] and relative gradients (Relative Index of Inequality). Overall and sex-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015. Mean HEI-2015 scores improved from 55.3 to 59.0 (maximum: 100); however, these trends were not consistently equitable. Whereas inequities in HEI-2015 scores were stable in the total population and in females, the absolute gap [from 1.60 (95% CI: 0.09, 3.10) to 4.27 (95% CI: 2.20, 6.34)] and gradient [from SII=2.09 (95% CI: 0.45, 3.73) to SII=4.84 (95% CI: 2.49, 7.20)] in HEI-2015 scores for household income, and the absolute gradient for education [from SII=8.06 (95% CI: 6.41, 9.71) to SII=10.52 (95% CI: 8.73, 12.31)], increased in males. Absolute and relative gaps and gradients in overall diet quality remained stable or widened between 2004 and 2015 among adults in Canada.

Impact of Bariatric Surgery on the Healthy Eating Index, Binge Eating Behavior and Food Craving in a Middle Eastern Population: A Lebanese Experience.

Even though bariatric surgeries (BS) are on the rise in Lebanon and the Middle East, the changes in diet quality, binge eating, and food cravings in this region are poorly studied peri-operatively. This cross-sectional study aimed to assess binge eating behaviors, food craving and the Healthy Eating Index (HEI) in Lebanese patients who underwent BS in a duration that exceeds 6 months. Evaluation included a dietary assessment of usual diet preoperatively and postoperatively. It included the collection of information on sociodemographic, anthropometric and surgical variables, as well as the administration of dietary recalls and questionnaires to calculate the HEI score, the Binge Eating Scale (BES) and the Food Craving Inventory (FCI). Participants (n = 60) were mostly females (85%) who had undergone sleeve gastrectomy (90%), with a mean duration since BS of 2.4 ± 1.8 years. Despite improvements in their HEI scores, 97% of the participants remained in the worst category. The frequency of participants in the severe BES category dropped markedly postoperatively from 78% to 5% (p < 0.01). Food craving followed a similar trend, with scores dropping from 50 ± 36 pre-surgery to 30 ± 25 post surgery (p < 0.01). Weight regain, prevalent among 40% of participants, was predicted by BES. Despite the improvement in BES and FCI, HEI improvement remained shy. Future interventions should validate findings in other countries and assess means for optimizing HEI scores among BS patients in the Middle East region.

Association between children’s food insecurity and a Healthy Eating Index in Portuguese children

Abstract Background Evidence on the association between children's food insecurity (FI) and a priori-defined dietary patterns is scarce, particularly in Europe. This study assessed the association between children's FI and a diet quality index in a population-based sample of children. Methods A cross-sectional study including 2800 children from the 10-year-old follow-up of a Portuguese birth cohort, the Generation XXI study, was performed. Data on food security status, assessed by the Self-administered Food Security Survey Module for Children (SAFSSMC), dietary intake, assessed by a validated FFQ, and socio-demographic characteristics were collected. An adaptation of the Healthy Eating Index (HEI) was used, by including 7 food groups (fruit and vegetables, dairy products, fish and eggs, meat and meat products, sweet snacks, salty snacks and soft drinks) scored from 1 to 4 according to increasing quartiles of daily consumption. For the last 4 groups, a reverse score was assigned. Scores were summed up (the highest the score, the highest diet quality). Linear and logistic regression models (HEI score and its food groups divided by the sample median) were performed. Results The FI prevalence was 9.4%. The median (P25;P75) HEI score was 18.0 (15.0;21.0). Children's FI was inversely associated with diet quality (β=-0.671;95%CI:-1.129;-0.213), independently of maternal education, caregivers' unemployment and child's sex. By using the SAFSSMC raw score, FI increased the odds for lower (below the median) fruit and vegetables intake (OR = 1.069;95%CI:1.002-1.139), and higher intake (above the median) of meat and meat products (OR = 1.075;95%CI:1.011-1.144) and soft drinks (OR = 1.074;95%CI:1.008-1.145), independently of maternal education, caregivers' unemployment, child's sex and the other food groups consumption. Conclusions Food insecure children have poorer diet quality, specifically a lower fruit and vegetables consumption, and higher intake of meat and meat products, and soft drinks. Key messages FI was reported by 9.4% of children, and poorer diet quality was observed among food insecure children, when compared to food secure ones. Public health interventions targeting food insecure children should be developed to promote healthy dietary habits in the context of populations vulnerable to FI.

Maternal and paternal dietary quality, dietary inflammation status, and offspring DNA methylation

Abstract Background Altered nutritional conditions at early life stages may increase the risk of future disease in offspring. Recent evidence suggests that developmental programming may involve epigenetic mechanisms. However, few studies have evaluated the effect of parental dietary quality on offspring DNA methylation. We investigated the relationships between dietary quality and inflammatory potential of future parents and DNA methylation of their children at nine years. Methods We used data from the Lifeways Cross-Generation cohort, established between 2001 and 2003 in the Republic of Ireland. Maternal dietary intake during the first trimester and paternal diet of the 12 previous months were assessed with a food-frequency questionnaire. Dietary quality and inflammation were determined by the healthy eating index (HEI) 2015 score and the energy-adjusted dietary inflammation index (E-DII), respectively. The Illumina Infinium HumanMethylationEPIC (EPIC array) assessed methylation levels in saliva samples from 264 children. Dietary associations with DNA methylation at individual CpG sites were examined. Results After adjusting for multiple tests, maternal HEI-2015 scores were inversely associated with DNA methylation at 1 CpG site (cg21840035, p-value=5.5 × 10-8) located near the PLEKHM1 gene, whose functions involve regulation of bone development. An increase in paternal HEI score was related to lower methylation at one CpG site (cg22431767, p-value=4.1× 10-8) located near cell signaling gene LUZP1. No significant associations between maternal or paternal E-DII and DNA methylation at individual CpG sites were observed. Conclusions Parental dietary quality in the prenatal period may influence offspring childhood DNA methylation. A better understanding of the nutritional programming effects on epigenetic markers is essential to design public health strategies that could help women to achieve a healthier diet and optimize the health capital of children and future generations. Key messages Our findings suggest that both maternal and paternal dietary quality may have a long-term influence on the offspring epigenome, expand the current understanding of parental nutritional programming. Replication in other populations with contrasted dietary intake is warranted, with a view to informing public health recommendations to benefit the health of future generations.

Stress-Related Poor Diet Quality Does Not Explain Socioeconomic Inequities in Health: A Structural Equation Mediation Analysis of Gender-Specific Pathways

BackgroundPsychosocial stress and diet quality individually mediate associations between socioeconomic position (SEP) and health; however, it is not known whether they jointly mediate these associations. This is an important question because stress-related unhealthy eating is often invoked as an explanation for diet-related health inequities, particularly among women, seemingly with no empirical justification. ObjectiveThis study examined whether psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women and men. DesignMultiple mediating pathways were modeled using data from the cross-sectional International Food Policy Study. Participants and settingData were collected from 5,645 adults (aged 18 years or older) in Canada during 2018 and 2019. Main outcome measuresParticipants reported SEP using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial pathways (subjective social status), along with psychosocial stress, dietary intake (to assess overall diet quality via Healthy Eating Index-2015 scores), and self-rated health. Statistical analyses performedStructural equation modeling modeled pathways linking SEP (ie, educational attainment, perceived income adequacy, and subjective social status) with self-rated health mediated by psychosocial stress and diet quality, stratified by gender. ResultsThere was no evidence that psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women or men. Diet quality mediated associations between educational attainment and self-rated health in women and men, with some evidence that it mediated associations between subjective social status and self-rated health in men (P = 0.051). Psychosocial stress mediated associations between perceived income adequacy and self-rated health in women and men, and between subjective social status and self-rated health in women. ConclusionsAlthough often invoked as an explanation for diet-related health inequities, stress-related poor diet quality did not mediate associations between SEP and self-rated health in women or men. Psychosocial stress and diet quality individually mediated some of these associations, with some differences by gender.

Association of macronutrients and dietary patterns with risk of systemic lupus erythematosus in the Black Women’s Health Study

Systemic lupus erythematosus (SLE) affects African-American (AA) women disproportionately. The few prospective studies assessing dietary intake in relation to risk of SLE have been conducted in predominantly white populations and have been null. The present study assessed associations of macronutrients and dietary patterns with risk of SLE in AA women. Data from the Black Women's Health Study was collected prospectively via biennial questionnaires starting in 1995. Participants completed a self-administered 68-item FFQ in 1995. Self-reported SLE was verified through medical record review. We used multivariable (MV) Cox regression models to estimate HRs and 95% CIs for macronutrients, carbohydrates, proteins, total fats, PUFAs, ω-3 fatty acids, ω-6 fatty acids, MUFAs, saturated fats, trans fatty acids, Alternative Healthy Eating Index score, vegetable/fruit and meat/fried food dietary patterns, and a reduced rank regression (RRR)-derived dietary pattern in relation to SLE risk. We confirmed a total of 114 incident cases of SLE among 51,934 women during 1995-2015. MVHRs and 95% CIs for the highest quintile of intake versus the lowest were HR: 1.96, 95% CI: 1.02, 3.67 for carbohydrates; HR: 0.66, 95% CI: 0.37, 1.18 for protein; and HR: 0.54, 95% CI: 0.28, 1.01 for total fats. MUFAs, saturated fatty acids, and trans fatty acids were significantly associated with a lower risk of SLE. An RRR-derived factor, rich in fruits and sugar-sweetened drinks and low in margarines and butter, red and processed meats, fried chicken, poultry, and eggs, which explained 53.4% of the total variation of macronutrients, was the only food pattern associated with increased SLE risk (HR: 1.88, 95% CI: 1.06, 3.35). These analyses suggest that a diet high in carbohydrates and low in fats is associated with increased SLE risk in AA women.

Healthy eating index and anthropometric status in young children: A cross-sectional study.

Weight status and growth during childhood are indicative of healthy development throughout the lifespan. Thus, understanding the influence of overall quality of diet and dietary patterns on anthropometric measures during childhood is critical to inform dietary recommendations. The current study used an updated version of the healthy eating index (HEI) to evaluate the association between overall diet quality and measures of childhood development in six-year-old children. This cross-sectional study was conducted across 788 six-year-old children referred to healthcare centers in Tehran, Iran. Anthropometric indices and dietary intake were evaluated using standard protocols and food frequency questionnaires, respectively. The HEI-2015 was used to evaluate participant diet quality. The total HEI-2015 score ranged from zero to 100 using the sum of thirteen food score components. Children in the highest tertile of HEI score had higher nutrient intakes and HEI-related food groups (p<0.05). Children within the highest tertile of HEI score compared to those within the lowest tertile were more likely to be overweight (OR: 1.45; 95% CI=1.01; 2.08). Findings presented in this study showed that HEI was not associated with a greater likelihood of obesity, underweight, severe underweight, and stunting. However, children in the highest tertile of HEI score were more likely to be overweight.

Compliance with dietary guidelines and its relationship with symptoms and clinical outcomes in patients with advanced cancer in early-phase oncology clinical trials.

199 Background: We examined compliance with the Dietary Guidelines for Americans and its association with symptom burden and clinical outcomes in patients with advanced cancer in early-phase clinical trials testing novel immunotherapeutic and targeted agents. Methods: Patients starting an early-phase clinical trial (ECOG-PS = 0-1) were recruited into a prospective, longitudinal design with assessments at baseline and at the end of Cycle 1. Diet and symptom burden were assessed using the validated National Cancer Institute Diet History Questionnaire (NCI-DHQ) and the MD Anderson Symptom Inventory, respectively. Compliance with the Dietary Guidelines for Americans recommendations was measured via the Healthy Eating Index (HEI) (a measure of dietary intake per total energy), computed from NCI-DHQ food group and nutrient scores; higher HEI scores indicate greater compliance with dietary guidance recommendations (possible range = 0–100). Statistical tests included Spearman rank correlations (rho), and Cox proportional hazards models. Results: Among early-phase clinical trial patients [N = 40; 50% female; 80% Non-Hispanic White; 80% ECOG = 1; 36% on trials including an immunotherapeutic agent and 64% on targeted therapy trials; mean age = 55y; mean BMI = 28], mean HEI was 69, compared to 59 for the US general population. The proportion of phase I clinical trial patients who met adequacy guidelines were 80% for whole fruit, 73% for total protein foods, 55% for seafood and plant proteins, 55% for total fruit, 50% for greens and beans, 28% for total vegetables, 15% for fatty acids [(PUFAs + MUFAs)/SFAs ≥2.5], 13% for dairy, and 0% for whole grains. The proportion of patients who met moderation guidelines were 28% for refined grains, 28% for added sugar, 13% for saturated fat, and 0% for sodium. Female patients had higher HEI scores than male patients (73 vs. 65, P = 0.004). Patients who were normal weight (BMI &lt; 25) had higher scores for meeting the moderation in sugar intake guideline than overweight patients (BMI≥25) (7.7 vs. 5.5, P = 0.031). Higher intakes of cooked lean meat from beef, pork, veal, lamb, and game were linked to prolonged overall survival (HR = 0.5, 95%CI = 0.26, 0.96, P = 0.039). In immunotherapy patients, greater compliance with seafood and plant protein recommendations was associated with less fatigue at end of Cycle 1 (rho = -0.7, P = 0.008); in targeted therapy patients, higher glycemic load was associated with worse pain (rho = 0.7, P = 0.004). Conclusions: Diets of these early-phase clinical trial patients overall were congruent with recommendations in the Dietary Guidelines for Americans. However, increasing intakes of whole grains and reducing sodium intakes may be useful dietary goals for this population. Also, dietary factors may influence symptoms, such as fatigue and pain, in early-phase clinical trial patients with advanced cancer.

Changes in Adolescents’ Dietary Intake Following the Initiation of an 8-Week Exercise Program

Purpose: To assess changes in dietary intake of adolescents following an 8-week aerobic exercise program.Methods: Twenty-six adolescents (14-18 years) participated in an 8-week aerobic exercise program on cycle ergometer at their high school in Quebec, Canada. Twenty-four hour recalls were collected pre- and post-intervention. A two-way repeated measures ANOVA and paired sample t-tests were used to assess differences in energy and dietary intake parameters (food quantity, diet quality, eating patterns) between pre- and postintervention.Results: A decrease in total daily energy intake (-287.8kcal, P = 0.007), in meal size at lunch (-110.1 g, P = 0.02) and dinner (-143.7 g, P = 0.03), in food density at breakfast (-1.8kcal/g, P = 0.04), in daily carbohydrate intake (-56.1 g, P = 0.005), and in percentage of energy intake consumed at school (-5.1%, P = 0.04) were observed following initiation of an aerobic exercise program. No change in healthy eating index scores or percentage of energy from processed foods was observed.Conclusions: Changes in energy intake, food quantity, and eating pattern but not diet quality (Healthy Eating Index or food processing scores) were observed following the initiation of an aerobic exercise program. Nutrition interventions may be needed, in addition to an exercise program, to target diet quality and promote healthy eating habits in adolescents.

The relationship between diet quality and the severity of household food insecurity in Canada.

To examine the relationship between the dietary quality of Canadian children and adults and household food insecurity status. Dietary intake was assessed with one 24-h recall. Households were classified as food secure or marginally, moderately or severely food insecure based on their responses to the Household Food Security Survey Module. We applied multivariable analyses of variance to determine whether % energy from ultra-processed foods, fruit and vegetable intake, Healthy Eating Index (HEI) scores, macronutrient composition and micronutrient intakes per 1000 kcal differed by food insecurity status after accounting for income, education and region. Analyses were run separately for children 1-8 years and 9-18 years and men and women 19-64 years of age. Ten provinces in Canada. Respondents to the 2015 Canadian Community Health Survey-Nutrition, aged 1-64 years, with complete food insecurity data and non-zero energy intakes, N 15 909. Among adults and children, % energy from ultra-processed foods was strongly related to severity of food insecurity, but no significant trend was observed for fruit and vegetable intake or HEI score. Carbohydrate, total sugar, fat and saturated fat intake/1000 kcal did not differ by food insecurity status, but there was a significant negative trend in protein/1000 kcal among older children, a positive trend in Na/1000 kcal among younger children and inverse associations between food insecurity severity and several micronutrients/1000 kcal among adults and older children. With more severe household food insecurity, ultra-processed food consumption was higher, and diet quality was generally lower among both adults and children.