Healthy Food Diversity Research Articles

Dietary variety score and risk of metabolic syndrome incidence: Tehran Lipid and Glucose Study

PurposeThere are contradictions in the association between dietary variety and metabolic syndrome (MetS). The concept of dietary variety should be merged with other dietary recommendations including diet quality and proportion....

Distribution and determinants of glycosylated hemoglobin in adolescents - Results from a nationwide population-based survey in Germany.

The role of glycosylated hemoglobin (HbA1c) in youth is largely unclear. The aims of this study are to investigate the distribution and potential determinants of HbA1c among a population-based sample of adolescents. The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) Wave 2 includes a nationwide representative sample of 0-17-year-old participants. For this evaluation, data from a randomly selected subgroup aged 14-17 years and without diagnosed diabetes was included (n = 857). Percentile-based HbA1c values (measured at laboratory in whole blood samples by high performance liquid chromatography) were calculated to examine HbA1c distribution. Multivariable linear regression analyses were performed to investigate factors (age, sex, parental socioeconomic status, body mass index (BMI), birth weight, smoking, alcohol consumption, healthy food diversity, sport activity, oral contraceptive use) associated with HbA1c. The mean HbA1c level was 5.2% (minimum: 3.9%, P10: 4.8%, P50: 5.1%, P90: 5.5%, maximum: 6.7%). Overall, 2.8% of adolescents had an HbA1c value in the prediabetic range (5.7-6.4%) and 0.1% had an undiagnosed diabetes (≥6.5%). Multivariable regression analysis showed an inverse association of age with HbA1c (17 vs. 14 years: ß: -1.18; 95% CI -2.05, -0.31). Higher HbA1c values were observed for higher BMI-standard deviation scores (SDS) (ß: 0.24; 95% CI -0.04, 0.52) and smoking (ß: 0.73; 95% CI -0.12, 1.57), but these tendencies were non-significant. In sex-stratified analysis, smoking and birth weight were significantly associated with HbA1c in boys. Among adolescents without diagnosed diabetes in Germany, HbA1c values ranged from 3.9% to 6.7%. To ensure health in adulthood, the influence of determinants on HbA1c levels in younger age should be further investigated.

The association of the healthy food diversity index with the risk of non-alcoholic fatty liver disease among the adult population

Dietary diversity index is a useful evaluation index for examining the role of dietary pattern in predicting chronic diseases risk, including non-alcoholic fatty liver disease(NAFLD). In the present study, we aimed to examine the possible association of dietary diversity using US Healthy Food Diversity(US HFD) index and the NAFLD risk in Iranian adults. A total of 675 individuals (225 patients with NAFLD and 450 controls) aged 20-60 years were recruited for the current case-control study. Data on dietary intakes were determined using a validated food frequency questionnaire, and dietary diversity was calculated using the US HFD index. In patients with NAFLD, an ultrasound scan of the liver was used to detect NAFLD. Logistic regression models were used to estimate the odds ratios(ORs) and 95% confidence interval(CI) of NAFLD across tertiles of the US HFD index. Mean±SD age of the study population were 38.13±8.85 years. The median (interquartile) score of the US HFD index in patients with NAFLD and healthy subjects was 0.08(0.07-0.09) and 0.09(0.08-0.10), respectively. In the age and sex-adjusted model, the odds of NAFLD were considerably reduced across tertiles of the US HFD index (OR:0.48; 95%CI:0.32-0.72, Ptrend<0.001). Also, in the final model, after adjusting for age, sex, waist-to-hip ratio, smoking, physical activity, marital status, socioeconomic status, and energy intake, the odds of NAFLD were significantly reduced across tertiles US HFD index (OR:0.55; 95%CI:0.31-0.97, Ptrend<0.001). Furthermore, for each SD increase in the US HFD index, the odds of NAFLD are reduced by 23% (OR:0.77;95%CI:0.60-0.97,P-Value<0.001). Our findings revealed that greater adherence to dietary pattern with a high US HFD score, defined by higher intakes of fruits, vegetables, whole grains, legumes, nuts, low-fat dairy, seeds, soya products, and plant oils may be related to reducing the odds of NAFLD.

Association between all aspects of dietary diversity and risk of depressive symptoms in US adults.

The impact of dietary diversity on depressive symptoms remains one-sided. We aim to explore the associations between all aspects of dietary diversity and the risk of depressive symptoms in US adults and their dose-response relationships. We selected 16 820 adults from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. Depressive symptoms were assessed using patient health questionnaire-9 (PHQ-9). Dietary diversity contains four indexes: count (dietary diversity score, DDS), evenness (Healthy Food Diversity Index, HFDI), dissimilarity (Jaccard distance, JD), and quality (Healthy Eating Index, HEI). Binary logistic regression was conducted to assess relationships between the four aspects of dietary diversity and depressive symptoms in whole and subgrouped populations. A restricted cubic spline was performed to explore the dose-response relationships. We revealed that DDS [0.20 (0.05, 0.73)], HFDI [0.51 (0.28, 0.94)], and HEI [0.46 (0.26, 0.80)] were inversely associated with the risk of depressive symptoms for the highest VS lowest quintile, especially in females and elders. Analysis of dose-response relationships determined linear relationships of DDS, HEI and depressive symptoms, while an "L" shaped relationship of HFDI and depressive symptoms. Adequate dietary diversity showed a significant effect on decreasing the risk of depressive symptoms at a score of 4 in DDS, 0.3 in HFDI, and a score of 51 in HEI. In conclusion, this study found that higher levels of dietary diversity, including count, evenness, and quality, might be protective factors against depressive symptoms, especially in females and elders. The DDS, HFDI, and HEI scores are recommended as 4, 0.3, and 51, respectively. Further investigation is needed to validate our results.

Unraveling the Role of Objective Food Environment in Chinese Elderly's Diet-Related Diseases Epidemic: Considering Both Healthy Food Accessibility and Diversity.

The essential role of the objective food environment in achieving healthy aging has been widely recognized worldwide. However, the existing empirical evidence is mostly based on Western cases, and how the objective food environment associates with health outcomes among Chinese elderly remains poorly understood. By merging nationally representative micro survey data with Baidu-based spatial data on the location of food outlets, this study develops accessibility and diversity indicators to explore the relationship between food environment and diet-related diseases among Chinese elderly and investigates how healthy lifestyles moderate this relationship. The results show that improvement in healthy food accessibility and diversity decreases both the probability and the number of diet-related diseases that the elderly suffer. Having more healthy lifestyle factors is associated with a lower risk of suffering from diet-related diseases and strengthens the negative effect of healthy food environment on suffered diet-related diseases. Heterogeneity effect analysis suggests that the relationship between objective food environment and diet-related diseases differs by city scale and income level. The findings of this study shed light on designing tailor-made policies for non-Western countries to promote healthy aging.

Comparison of diet quality tools to assess nutritional adequacy for adults living with kidney disease.

There is no specific diet quality tool recommended for adults living with chronic kidney disease (CKD). Identifying how diet quality tools assess nutritional adequacy and correlate with potassium and phosphorus (nutrients of interest in CKD) is warranted. Our aim was to compare Mediterranean Diet Scores (MDS), Healthy Eating Index (HEI), and Healthy Food Diversity (HFD) to determine their correlation with nutrient intake in adults living with diabetes and CKD. Using data from a longitudinal study of 50 participants with diabetes and CKD, diet quality was assessed at baseline and 1 or more times at annual visits up to 5years (complete diet records n=178). Diet quality was investigated for correlation with nutrient intake. Compared with HEI and HFD, MDS was poorly correlated with nutrient intake (all r values <0.40). HFD and HEI were moderately correlated with potassium (r=0.66, P<0.01 and r=0.57, P<0.01, respectively). HEI was weakly correlated with phosphorus (r=0.365, P<0.01). MDS recommends moderation of dairy and meat, this may have specific benefits for CKD as these are both sources of phosphorus, as such high MDS were associated with lower phosphorus intake. This study suggests that development of a renal specific diet quality assessment tool may be useful; however, further studies are needed.

Analyzing the Drivers of Household Dietary Diversity: Evidence from Burkina Faso.

Background:The diets of millions of poor individuals lack adequate amount of essential nutrients.Objective:To examine the determinants of household dietary diversity in Burkina Faso and assess whether the choice of a diversity metric matters.Methods:Using survey data from 2014, we construct 3 metrics—Household Dietary Diversity Score (HDDS), Berry Index (BI), and Healthy Food Diversity Index (HFDI). Unlike the oft-used HDDS, the BI captures the quantity distribution of food items while the HFDI captures all 3 aspects of a healthy diet—count, quantity distribution, and health value. We fit linear (for BI and HFDI) and Poisson (for HDDS) models controlling for several socioeconomic and climatic covariates.Results:Some parameter estimates are sensitive to the diversity metric with fewer significant covariates observed in the HFDI model. Overall, diets are more diverse for households in urban areas, with female or better educated heads, with higher asset-based wealth and with more diverse on-farm production, while remoteness reduces dietary diversity. Higher precipitation seems to reduce diversity, potentially driven by the spatial heterogeneity in precipitation and on-farm production diversity.Conclusions:The sensitivity of estimates to the metric used underscores potentially more complex interactions that determine the quantity distribution of food items consumed. Policies that enhance on-farm production diversity, market access, and women’s empowerment may help improve dietary diversity and subsequent nutritional benefits. Efforts should be made to compile health value data that are relevant to developing countries facing nutrition transition.

Strategies and Future Opportunities for the Prevention, Diagnosis, and Management of Cow Milk Allergy.

The prevalence of food allergy has increased over the last 20-30 years, including cow milk allergy (CMA) which is one of the most common causes of infant food allergy. International allergy experts met in 2019 to discuss broad topics in allergy prevention and management of CMA including current challenges and future opportunities. The highlights of the meeting combined with recently published developments are presented here. Primary prevention of CMA should start from pre-pregnancy with a focus on a healthy lifestyle and food diversity to ensure adequate transfer of inhibitory IgG- allergen immune complexes across the placenta especially in mothers with a history of allergic diseases and planned c-section delivery. For non-breastfed infants, there is controversy about the preventive role of partially hydrolyzed formulae (pHF) despite some evidence of health economic benefits among those with a family history of allergy. Clinical management of CMA consists of secondary prevention with a focus on the development of early oral tolerance. The use of extensive Hydrolysate Formulae (eHF) is the nutrition of choice for the majority of non-breastfed infants with CMA; potentially with pre-, probiotics and LCPUFA to support early oral tolerance induction. Future opportunities are, among others, pre- and probiotics supplementation for mothers and high-risk infants for the primary prevention of CMA. A controlled prospective study implementing a step-down milk formulae ladder with various degrees of hydrolysate is proposed for food challenges and early development of oral tolerance. This provides a more precise gradation of milk protein exposure than those currently recommended.

Microbiome Signatures of Nutrients, Foods and Dietary Patterns: Potential for Personalized Nutrition from The PREDICT 1 Study

Abstract Objectives The human gut microbiome has been linked to risk and severity of a multitude of chronic diseases, but large-scale, high-resolution studies linking it to host diet are lacking. The PREDICT 1 study (NCT03479866) enrolled 1,102 healthy US and UK adults to examine the genetic, metabolic, microbial, and meal composition/context contributions to metabolic responses to food. Here, we identify microbial features (species, genes, pathways) linked with diet and assess their potential to predict personalized food responses. Methods Dietary intake was assessed using validated EPIC (UK) and Harvard (US) semi-quantitative food frequency questionnaires (FFQs) to capture habitual intake (1 yr). Nutrient and food consumption (adjusted for energy intake) were calculated, and dietary patterns and diversity of intake were estimated. Shotgun metagenomic profiling was performed on fecal samples collected at baseline from 1,001 UK and 97 US individuals. Results We observed strong associations between overall microbial structure, as well as feature-level associations with nutrients, foods, food groups, and established dietary indices. Strongest associations were with daily intake of coffee, meat, and dairy foods, and saturated fatty acids; Spearman's r = 0.45, 0.29, 0.27 and 0.46, respectively. The Healthy Food Diversity Index and the Plant Dietary Index (PDI; comprised of healthy vs. unhealthy PDI, h-PDI, u-PDI) were strongly associated with community structure (r = 0.36, 0.34, and 0.34), highlighting the synergistic impact of dietary diversity, food quality, and microbial outcomes. We identified two clusters of microbial species with consistent, opposed correlations with ‘healthy’ and ‘unhealthy’ nutrients, food groups, and dietary indices with clear segregation between the h-PDI vs. u-PDI. These clusters were also coupled to cardiometabolic biomarkers. The associations observed in the UK cohort were reproducible in the independent US cohort. Conclusions The relationship between a healthy diet, resultant microbial signatures, and cardiometabolic outcomes strongly support the interactions between the foods we eat, the bacteria they enrich, and chronic disease outcomes, highlighting the importance of diet quality and diversity in personalized precision nutrition. Funding Sources NIHR, Wellcome Trust, Zoe Global Ltd.

The predictors of different measures of dietary diversity among one-year-olds in South Africa

Objectives: A study was undertaken to compare a range of dietary diversity indicators and their predictors among one-year-olds. Design: Multivariate regression analysis was employed, where dietary diversity indicators are the outcome variables and the main predictor variables are access to resources and maternal education. Three different dietary diversity indicators are analysed: a count of food items, a count of food groups and a Healthy Food Diversity Index. Subjects and setting: The study included participants of Birth to Twenty Plus, a longitudinal cohort study of children born in 1990 in Johannesburg, South Africa (n = 1 030). Results: There is a low correlation between measures of dietary diversity based on simple counts of food items/groups and the Healthy Food Diversity Index. Further, the predictors differ depending on which type of indicator is used. Access to resources (measured by an asset index) was found to be associated with an increase in counts of food items/groups but at a decreasing rate, while the opposite was found for the Healthy Food Diversity Index. There was no significant association between maternal education and the counts of food items/groups, while maternal education was positively associated with the Healthy Food Diversity Index. Conclusions: More sophisticated measures of dietary diversity that also capture the healthiness of foods and their distribution in the diet, rather than just the number or variety, may be useful in understanding dietary patterns among children and what influences them. Maternal education appears to be particularly important for healthy food consumption among young children, while access to resources has a more complex association, with differential results at low and high levels.

Healthy food diversity and supermarket interventions: Evidence from the Seacroft Intervention Study

Supermarket interventions have been a commonly used treatment for problems of fresh fruit accessibility in areas of previously limited availability, their wide ranges of healthy products and lower-prices making them seemingly perfect for promoting better diets. Empirical studies likewise fall in favour. However, this diversity also serves to give consumers opportunity to entrench bad habits and simply purchase more of the unhealthy foods they enjoy. In this paper we develop a new health index based upon UK government guidelines and look to the Seacroft Intervention Study for empirical evidence of supermarket impact thereupon. Using fixed effects unconditional quantile regression to provide robustness to our parameter estimates against covariate specification, we reinforce the message that supermarkets are not a panacea for dietary improvement. Whilst diversity increases post-intervention it is unlikely to be healthful, entrenching poor dietary habits rather than delivering improvement as intended. Careful consideration of planning policy, health education and sector regulation is needed.

Using an introduced index to assess the association between food diversity and metabolic syndrome and its components in Chinese adults

BackgroundIt is reported that an increase in food diversity would lower the risk of cardiac–cerebral vascular diseases.MethodsA new index was introduced to develop a Chinese healthy food diversity (HFD) index, exploring the association with metabolic syndrome (MetS) and its components among Chinese adults. Two sets of data were used. The primary data were from a cross-sectional survey conducted in 2016 called the Chinese Urban Adults Diet and Health Study (CUADHS); the verification data were from the China Health and Nutrition Survey (CHNS) of 2009. The Chinese HFD index was developed according to the Chinese Dietary Guideline, with food consumption information from 24-h dietary recalls. The association between the index and MetS and its components was explored in logistic regression models.ResultsAmong 1520 participants in the CUADHS, the crude prevalence of MetS was 36.4%, which was 29.0% after the standardisation of age and gender by the 2010 Chinese national census. In the CUADHS, the HFD index ranged from 0.04 to 0.63. The value of the index among participants who are male, young, poorly educated, drinking or smoking, and with high energy intakes was significantly lower than that of their counterparts. In the verification dataset of the CHNS, there were 2398 participants, and the distribution of different genders and age groups was more balanced. The crude prevalence of MetS in the CHNS was 27.3% and the standardised prevalence was 19.5%. The Chinese HFD index ranged from 0.02 to 0.62. In the CUADHS, the Chinese HFD index was not significantly associated with MetS in covariate-adjusted models or with its components. In the CHNS, the Chinese HFD index had a significantly negative correlation with MetS and its components (i.e., elevated fasting glucose and elevated waist circumference) in covariate-adjusted models.ConclusionsIncreased food diversity may decrease the risk of MetS, which is important in dietary interventions of cardiac–cerebral vascular disease. This underscores the necessity of continued investigation into the role of HFD in the prevention of MetS and provides an integral framework for ongoing research.

Use of dietary indices to control for diet in human gut microbiota studies

BackgroundEnvironmental factors have a large influence on the composition of the human gut microbiota. One of the most influential and well-studied is host diet. To assess and interpret the impact of non-dietary factors on the gut microbiota, we endeavoured to determine the most appropriate method to summarise community variation attributable to dietary effects. Dietary habits are multidimensional with internal correlations. This complexity can be simplified by using dietary indices that quantify dietary variance in a single measure and offer a means of controlling for diet in microbiota studies. However, to date, the applicability of different dietary indices to gut microbiota studies has not been assessed. Here, we use food frequency questionnaire (FFQ) data from members of the TwinsUK cohort to create three different dietary measures applicable in western-diet populations: The Healthy Eating Index (HEI), the Mediterranean Diet Score (MDS) and the Healthy Food Diversity index (HFD-Index). We validate and compare these three indices to determine which best summarises dietary influences on gut microbiota composition.ResultsAll three indices were independently validated using established measures of health, and all were significantly associated with microbiota measures; the HEI had the highest t values in models of alpha diversity measures, and had the highest number of associations with microbial taxa. Beta diversity analyses showed the HEI explained the greatest variance of microbiota composition. In paired tests between twins discordant for dietary index score, the HEI was associated with the greatest variation of taxa and twin dissimilarity.ConclusionsWe find that the HEI explains the most variance in, and has the strongest association with, gut microbiota composition in a western (UK) population, suggesting that it may be the best summary measure to capture gut microbiota variance attributable to habitual diet in comparable populations.

Rethinking household demand for food diversity

PurposeThe purpose of this paper is to develop a group-based food diversity index, which represents diversity in household expenditures across food subgroups. The index is compared to a product code-based index and applied to reassess determinants of food diversity demand.Design/methodology/approachA group-based food diversity index is developed by adapting the US Healthy Food Diversity Index. Using Food Acquisition and Purchase Survey data on 4,341 US households, correlation coefficients, descriptive statistics and linear regressions are estimated to compare and reassess the determinants of group and product code-based food diversity demand.FindingsResults show that the group and product code indices capture different forms of food diversity. The indices are only moderately correlated and have varying means and skewness. Education, gender, age, household size, race, SNAP and food expenditures are found to significantly affect food diversity. However, the magnitude and direction of the effects vary between group and product code indices. Given these differences, it is essential that studies select a diversity index that corresponds to their objective. Results suggest that group-based indices are appropriate for informing food and nutrition policy, while product code-based indices are ideal for guiding food industry management’s decision making.Originality/valueA group-based food diversity index representative of household expenditures across food subgroups is developed.

Greater Healthful Dietary Variety Is Associated with Greater 2-Year Changes in Weight and Adiposity in the Preventing Overweight Using Novel Dietary Strategies (POUNDS Lost) Trial

Background: Greater healthful dietary variety has been inversely associated with body adiposity cross-sectionally; however, it remains unknown whether it can improve long-term weight loss.Objective: This study prospectively examined associations between healthful dietary variety and short-term (6 mo) and long-term (2 y) changes in adiposity in the Preventing Overweight Using Novel Dietary Strategies (POUNDS Lost) weight-loss trial completed in 2007.Methods: Healthful dietary variety was assessed from 24-h recalls with the use of the US Healthy Food Diversity index among participants aged 30–70 y with overweight/obesity (n = 367). Changes in the index between baseline and 6 mo were divided into tertiles representing reduced (T1), stable (T2), or increased variety (T3). Body weight and waist circumference (WC) were measured every 6 mo, and the percentage of body fat and trunk fat were measured at 6 mo and 2 y. Associations between changes in variety and short-term and long-term changes in adiposity were analyzed by use of multivariable-adjusted generalized linear models and repeated-measures ANOVA.Results: Regardless of dietary arm, T3 compared with T2 was associated with greater reduction in weight (−8.6 compared with −6.7 kg), WC (−9.1 compared with −6.1 cm), and body fat at 6 mo (β = −4.61 kg, P < 0.05). At 2 y, individuals in T3 compared with those in T2 or T1 maintained greater weight loss [−4.0 (T3) compared with −1.8 kg (T2 and T1), P = 0.02 and WC reduction [−5.4 (T3) compared with −3.0 (T2) and −2.9 cm (T1), P = 0.01. Total body fat and trunk fat reductions were similarly greater in T3 than in T2.Conclusions: Increasing healthful food variety in energy-restricted diets may improve sustained reductions in weight and adiposity among adults with overweight or obesity on weight-loss regimens. This trial is registered at clinicaltrials.gov as NCT00072995.

Erratum for Vadiveloo et al. Greater healthful food variety as measured by the US Healthy Food Diversity Index is associated with lower odds of metabolic syndrome and its components in US adults. J Nutr 2015;145:564–71.

Erratum for Vadiveloo et al. Greater healthful food variety as measured by the US Healthy Food Diversity Index is associated with lower odds of metabolic syndrome and its components in US adults. J Nutr 2015;145:564–71.

Increasing Healthful Food Variety is Associated with Reduced Total and Food‐specific Cravings among Men in the POUNDS Lost Weight‐loss Trial

Increasing healthful variety may reduce adiposity, but the underlying psychological mechanisms are unknown. We aimed to examine if reducing, maintaining, or increasing healthful food variety affected changes in food cravings among men (n=155) and women (n=195) participating in the POUNDS Lost weight‐loss trial with dietary data at baseline and 6‐months. Healthful dietary variety was quantified with the validated US Healthy Food Diversity (US HFD) index, which measures variety, proportionality, and food quality. Six‐month changes in the US HFD index were divided into tertiles (T); T1=reduced, T2=stable, T3=increased variety. The 33‐item Food Craving Inventory‐II assessed cravings of specific foods from 1 (never) to 5 (always) at 0 and 6‐months. A significant interaction between the US HFD index and food cravings by sex was observed. Generalized linear models were stratified by sex, and adjusted for age, diet arm, and changes in fullness, restraint, hunger, general cravings, and body weight to determine if 6‐month changes in food craving scores varied by tertile of US HFD index change. Increased (T3) versus reduced (T1) variety was associated with reduced cravings for high‐fat foods (‐0.27 vs. 0.07, p=0.007), sweets (‐0.33 vs. ‐0.07, p=0.04), carbohydrates (‐0.17 vs. 0.17, p=0.02), and total cravings (‐0.21 vs. 0.07, p=0.006) in men. Increased variety was not associated with cravings in women, except non‐significantly for fruit and vegetables (0.15 vs. ‐0.17, p=0.07; T3 vs. T1). Our results suggest that increasing healthful variety may help men trying to lose weight reduce food cravings and may be a novel strategy to promote dietary adherence.

Abstract P243: Greater Healthful Dietary Variety and Changes in Adiposity Indicators During a Weight-Loss Intervention: The POUNDS Lost Trial

Background: Adhering to a healthy lower energy diet is essential for sustained weight loss. Greater variety within energy-poor, nutrient-dense foods may improve adherence by making the diet less monotonous, and therefore more enjoyable. Greater healthful dietary variety has been inversely associated with adiposity in cross-sectional studies, but it is unclear if it predicts longitudinal changes in body weight. Objective: To examine the longitudinal associations between initial changes in healthful dietary variety (0-6 months) and long-term changes in adiposity over 24-months in a weight-loss trial. Methods: Participants in the POUNDS Lost trial were advised to follow energy-restricted diets. Data for participants with complete dietary assessments at baseline and 6-months were analyzed (n=367). Healthful dietary variety was quantified using the validated US Healthy Food Diversity (US HFD) index, which measures the number of foods consumed and consistency of dietary selections and amounts with recommendations from the 2010 Dietary Guidelines for Americans. Changes in the US HFD index between baseline and 6-months were divided into tertiles (T); adults in T1 had reductions in the US HFD index, T2 maintained stable index values, and T3 had increased index values. Body weight and waist circumference (WC) were measured at 6, 12, 18, and 24-months and percent body fat and trunk fat were measured at 6 and 24-months using DEXA. Repeated measures ANOVA was used to test whether US HFD index change tertiles were significantly associated with adiposity over 24-months. Models were adjusted for age, sex, race, smoking, education, income, diet arm, changes in physical activity and energy intake, baseline adiposity indicator, and the interaction between the US HFD index change tertile and time. Results: Reductions in energy intake were equivalent across US HFD index change tertiles in multivariable models (-425 vs.-265 kcal in T1 vs.T3, p=0.08). An improved variety (T3) as compared to stable variety (T2) was associated with greater weight loss at 24-months (-4.75 vs. -2.63kg, p=0.03; linear p-trend=0.04) and greater decrease in total body fat in T3 vs. T2 (-1.10% vs. -0.006%, p=0.03; p-trend=0.04) and trunk fat (-1.29% vs. 0.08%, p=0.03; p-trend=0.04). An improved variety (T3) as compared to stable variety (T2) or reduced variety (T1) was associated with greater reduction in WC (-6.48cm (T3) vs. -3.98cm (T2), p=0.01; and -4.14cm (T1), p=0.04; linear p-trend=0.01). Reducing variety (T1) did not reduce or increase other adiposity indicators compared to stable or increased variety. Conclusions: Increasing healthful dietary variety while restricting energy intake may improve sustained reductions in adiposity among adults trying to lose weight.

Greater Healthful Food Variety as Measured by the US Healthy Food Diversity Index Is Associated with Lower Odds of Metabolic Syndrome and its Components in US Adults1–3

Consuming a wider variety of nutrient-dense foods may promote adherence to healthful dietary patterns, leading to improved dietary quality and enhanced metabolic health. We used the US Healthy Food Diversity (HFD) index to simultaneously measure dietary variety, quality, and proportionality, hypothesizing a priori that race/ethnicity may moderate associations between diet and health. A representative sample of adults (n = 7470) aged 20+ y with two 24-h recalls and complete outcome data from the cross-sectional NHANES 2003-2006 were selected. US HFD values were generated using a previously validated equation with a theoretical range from 0 to nearly 1, with higher scores indicative of more varied diets with a higher proportion of healthful food groups. Metabolic syndrome (MetS) was defined using the most recent harmonized definition. Survey-weighted multivariable linear and logistic regression, adjusted for demographic factors, smoking, energy, screen time, and leisure activity, were used to compute means and ORs (95% CIs). Adults in the third vs. first US HFD tertile had 21% lower odds of MetS [OR (95% CI): 0.79 (0.64, 0.98)] as well as lower odds of hypertension [0.83 (0.70, 0.995] and elevated waist circumference [0.75 (0.66, 0.86] after multivariable adjustment (P-trend < 0.05). The age- and sex-adjusted odds of low serum HDL cholesterol and impaired fasting plasma glucose (P-trend < 0.05) were lower in the highest vs. lowest US HFD tertile but attenuated with multivariable adjustment (P = 0.06 and 0.22, respectively). Notably, the US HFD index was only protective against adiposity among non-Hispanic white (NHW) and non-Hispanic black (NHB) adults, and MetS associations were driven by NHW adults. No associations were observed among Hispanic adults for any MetS components. Greater healthful food variety was associated with lower odds of MetS and some MetS components in the total population, NHW adults, and NHB adults. This study provides preliminary evidence that healthful food diversity may protect against MetS and highlights the need for longitudinal and experimental research.

Dietary Variety Is Inversely Associated with Body Adiposity among US Adults Using a Novel Food Diversity Index1–3

Background: Consuming a variety (vs. monotony) of energy-poor, nutrient-dense foods may help individuals adhere to dietary patterns favorably associated with weight control.Objective: The objective of this study was to examine whether greater healthful food variety quantified using the US Healthy Food Diversity (HFD) index favorably influenced body adiposity.Methods: Men and nonpregnant, nonlactating women aged ≥20 y with two 24-h recalls from the cross-sectional NHANES 2003–2006 (n = 7470) were included in this study. Dietary recalls were merged with the MyPyramid Equivalent database to generate the US HFD index, which ranges from 0 to ∼1, with higher scores indicative of diets with a higher number and proportion of healthful foods. Multiple indicators of adiposity including BMI, waist-to-height ratio, android-to-gynoid fat ratio, fat mass index (FMI), and percentage body fat were assessed across US HFD index quintiles. ORs and 95% CIs were computed with use of multivariable logistic regression (SAS v. 9.3).Results: The US HFD index was inversely associated with most adiposity indicators in both sexes. After multivariable adjustment, the odds of obesity, android-to-gynoid ratio >1, and high FMI were 31–55% lower (P-trend < 0.01) among women in quintile 5 vs. quintile 1 of the US HFD index. Among men, the odds of obesity, waist-to-height ratio ≥0.5, and android-to-gynoid ratio >1 were 40–48% lower (P-trend ≤ 0.01) in quintile 5 vs. quintile 1 of the US HFD index.Conclusions: Higher US HFD index values were inversely associated with indicators of body adiposity in both sexes, indicating that greater healthful food variety may protect against excess adiposity. This study explicitly recognizes the potential benefits of dietary variety in obesity management and provides the foundation to support its ongoing evaluation.