Low-quality Diet Research Articles

Abstract P422: Diminished Returns: Racial/Ethnic Differences in Diet Quality Vary by Education Level

Introduction: Poor diet is a major modifiable risk factor for cardiovascular disease. Educational attainment is highly correlated with healthy dietary behavior; as education level increases, diet quality also increases. Nevertheless, a recent study reported that Black adults with a high education level consume lower amounts of healthy foods (e.g., fruits, vegetables, whole grains) compared to White adults with a high education level. These findings are concerning because they suggest that certain individual or structural factors may produce diminished returns on educational investment among Black-identifying people. The literature on this topic is scarce. To address this gap, this study examined racial/ethnic differences in diet quality by education level among U.S. adults. Hypothesis: Black adults with ≥ bachelor’s degree will have lower diet quality than White adults with the same education level. Methods: We analyzed cross-sectional data on 19,591 adults (age ≥ 20) who participated in the National Health & Nutrition Examination Survey from 2011-2018. We calculated Healthy Eating Index (HEI)-2015 total scores using the participant’s 24-hour recall data. HEI-2015 (scale: 0-100) reflects how well an individual’s food and beverage intake aligns with the 2015-2020 Dietary Guidelines for Americans . We ran stratified linear regression models to identify racial/ethnic differences in HEI-2015 total score within each category of educational attainment: < high school, high school or equivalent, some college/associate’s degree, ≥ bachelor’s degree. All models were adjusted for age, sex, marital status, poverty level, and household size. Results: Regression models revealed that Asian adults, on average, had significantly higher HEI-2015 total scores compared to White adults at every education level (p<0.0001 in all models). Hispanic adults had significantly higher scores than White adults in every educational category except ≥ bachelor’s degree where there was no difference. There was no difference in HEI-2015 total score between Black and White adults at every education level except ≥ bachelor’s degree. Black adults with a bachelor’s degree, on average, had a lower HEI-2015 total score (β = -1.69; SE: 0.79; p=0.03) compared to White adults with the same education level. Additional sex-specific analyses revealed that this disparity existed mainly between Black and White women with ≥ bachelor’s degree (β = -2.26; SE: 1.11; p=0.04). Conclusion: This study found that racial/ethnic differences in diet quality do vary by education level. As hypothesized, there is a Black-White disparity in diet quality among adults with higher education levels. Additional research is need to explore the individual and structural factors associated with this disparity.

Abstract P533: Consumption of Foods Away From Home and Cardiometabolic Risk Among Adults in Puerto Rico

Consuming foods away from home (FAFH) is prevalent in the United States and contributes to high food spending and daily energy intake. We recently showed that adults in Puerto Rico (PR) who frequently consume FAFH had lower diet quality and adherence to dietary recommendations. It remains unknown if these associations translate into poor cardiometabolic health. We aimed to determine the association between the consumption of FAFH and cardiometabolic risk factors among adults in PR. Data were obtained from 1,246 adults (30-75 years) in the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic disease Trends (PROSPECT). Participants self-reported the frequency of consuming FAFH for any meal as "rarely" (<2 times/week), "sometimes" (2-4 times/week), or "frequently" (>4 times/week) at various commercial or noncommercial venues. A food frequency questionnaire assessed usual diet, and the Alternate Healthy Eating Index (AHEI) was calculated to capture diet quality. Clinical and laboratory markers from fasting blood samples were measured using standardized protocols. Generalized linear regression models were used to obtain means (SE) of cardiometabolic markers by FAFH category adjusted for sociodemographic and lifestyle behavioral factors. A second model was adjusted for AHEI. Frequently consuming commercial FAFH (cFAFH) was reported by 15.8% (192 of 1,218) and noncommercial FAFH (ncFAFH) by 4.4% (54 of 1,217), while cFAFH sometimes was reported by 31.8% (387 of 1,218) and ncFAFH by 19.0% (231 of 1,217). Participants who reported consuming cFAFH frequently (vs. rarely) had significantly higher waist circumference (107 (1.6) vs. 103 (1.3) cm; P= 0.003), BMI (31.5 (0.82) vs. 29.9 (0.64) kg/m 2 ; P= 0.032), and insulin (geometric mean 9.4 (2.1) vs. 7.8 (2.0) μIU/mL; p<0.001), and lower HDL-C (geometric mean 42.9 (1.0) vs. 45.6 (1.0) mg/dL; P= 0.012). Participants who reported consuming cFAFH sometimes (vs. rarely) had significantly higher plasma triglycerides (geometric mean 126.1 (1.5) vs. 102.1 (1.4) mg/dL; P= 0.012). Plasma glucose ( P= 0.004) and insulin ( P= 0.041) were higher in individuals frequently reporting (vs. rarely) consuming ncFAFH. Adjusting for AHEI did not appreciably change the models, except to nullify the association with BMI. Consuming FAFH, especially >4 times/week, was associated with adverse adiposity, lipids, and glucose markers and generally independent of overall diet quality. Future studies should identify the directionality of these associations and the potential mechanisms connecting them to cardiometabolic markers. Policymakers and food producers should enhance the quality of FAFH for commercial and at-home consumption for better cardiometabolic health.

Abstract P126: Sociodemographic Predictors of Diet Quality During Adolescence

Introduction: Optimal nutrition is critical for near-term health, during periods of growth in childhood, and long-term health in adulthood (e.g., heart disease). The Healthy Eating Index (HEI) is an indicator of diet quality that is aligned with the Dietary Guidelines for Americans, which declines in U.S. children aged 2-18 years. Effective nutrition interventions are needed to address this decline in diet quality. Understanding sociodemographic determinants of diet quality in adolescents will help to inform such interventions. We aimed to describe changes in diet quality and to determine if sociodemographic factors associated with diet quality in adolescence. Methods: Participants of the Sleep and Growth Study (S-Grow) completed three 24-hour diet recalls in 8 th and 9 th grade. The diet data were processed using Nutrient Data System for Research software to calculate HEI-2015 score (range: 0-100, with a higher score indicating greater diet quality) using 13 food group components. Linear mixed effect models were used to assess: 1) changes in HEI-2015 score (and individual components) from 8 th to 9 th grade, 2) sociodemographic associations with HEI-2015 score (sex, race, body mass index [BMI], and household income), and 3) sociodemographic factor-by-grade interactions to determine if any associations differed in 8 th and 9 th grades. Results: The HEI-2015 score was stable from 8 th (44.6) to 9 th grade (45.3). Similarly, HEI component scores were stable from 8 th to 9 th grade, except for an increase in green vegetables (beta=0.37, P<0.05) and a decline in added sugars (beta=-0.50, P<0.05). Black (compared to White) adolescents and those living in households with <$40K (compared to >$99K) annual income were associated with lower overall diet quality (beta=-3.28, P<0.05; beta=-4.90, P<0.05; respectively). Male (compared to female) sex was associated with higher total dairy intake (beta=1.74, P<0.001); those with obesity (compared to normal weight) were more likely to have lower seafood intake (beta=-1.00, P<0.001) and higher refined grains intake (beta=1.26, P<0.05). The interaction analyses revealed that some household income and BMI associations with changes in HEI outcomes from 8 th and 9 th grades were distinct. For example, total fruit intake declined from 8 th to 9 th grade, but specifically among adolescents living in households with incomes of $40-69K (beta=-0.77, P=0.02) and for adolescents with obesity (beta=-1.03, P=0.003). Conclusion: Diet quality was consistently suboptimal in 8 th and 9 th grades (i.e., 45/100). Further, we detected sex, race, and household income disparities in diet quality. Overall, these data will help to inform future intervention efforts to improve and prevent reductions in diet quality in adolescents.

Abstract P118: Association Between Shift-and-Persist and Cardiovascular Health Among Young Adults in Puerto Rico

Background: Shift-and-persist (SP), defined as the ability to adapt the self to stressors while preserving focus in the future, is associated with favorable cardiometabolic outcomes. SP may be of great importance to individuals in Puerto Rico (PR) given their disproportionate exposure to social and environmental stressors. However, there is a scarcity of data on SP and cardiovascular health (CVH), and none in PR. This study examined the association between SP and CVH, as measured by the Life’s Essential 8 metric, among young adults in PR. Hypothesis: We hypothesize that greater SP will be associated with higher CVH scores. Methods: Baseline data from the PR-OUTLOOK study were used for this cross-sectional analysis. Young adults (18-29y, 64% women) completed baseline and clinic assessments between September 2020 and September 2022. Those with complete data on CVH were included (n=962). SP was measured with the Chen & Miller scale, with higher scores indicative of greater SP, and categorized in quartiles (SP Q1-Q4). Because dietary data are not yet available, we used questionnaires, anthropometric measurements, and fasting blood samples to calculate an adapted Life’s Essential 8 metric including physical activity, nicotine exposure, sleep health, BMI, blood lipids, blood glucose, and blood pressure; thus, actual CVH scores may be lower due to potentially low diet quality scores. Relationships between CVH and SP scores were assessed with multivariable linear regression models. Results: SP was significantly associated with CVH and its components. After adjustment for confounders, individuals in SP Q2-Q4, vs. Q1, had significantly higher total CVH (b=2.81, 95%CI=0.60, 5.03; b=4.68, 95%CI=2.54, 6.82; and b=7.34, 95%CI=4.85, 9.83, respectively) and physical activity CVH-score (b=-11.5, 95%CI=3.96, 19.1; b=11.6, 95%CI=4.27, 18.9; and b=18.6, 95%CI=10.1, 27.1, respectively). Individuals in SP Q3-Q4 also had higher BMI CVH-score (b=8.89, 95%CI=3.10, 14.7; and b=10.4, 95%CI=3.61, 17.1, respectively) than those in Q1. Additionally, those in the SP Q4, vs. Q1, had higher blood lipids (b=7.10, 95%CI=2.24, 12.0), blood glucose (B=3.91, 95%CI=0.41, 7.41), and blood pressure (b=6.23, 95%CI=1.93, 10.5) CVH-scores. Estimates were similar by sex and socioeconomic status. Conclusion: Higher SP scores were associated with higher CVH among young adults in PR. Longitudinal analyses are needed to confirm our results. We need to further understand the potential benefits of SP for CVH and identify strategies to improve SP and promote CVH in underserved populations.

Abstract P605: Neo-Traditional Diets Are Associated With Lower Odds of Metabolic Syndrome Among Adults in Puerto Rico

Prolonged marginalization of traditional food cultures has diminished local food production and increased dependence on highly processed imports in Puerto Rico (PR), contributing to low-quality diets and cardiometabolic disease. Recent efforts have been made to decolonize diets by increasing local food intake; however, what dietary patterns (DPs) exist and how they are associated with cardiometabolic disease risk remain unknown. This study aimed to 1 ) identify food-system-specific DPs and 2 ) determine associations with metabolic syndrome (MetS), a multicomponent cardiometabolic risk factor, among adults in PR. We hypothesized that a neo-traditional DP would emerge, characterized by use of minimally processed local foods and associated with lower odds of MetS. Data were obtained from adults (30-75 y) in the PR Observational Study of Psychosocial, Environmental, and Chronic Disease Trends ( n = 989). DPs were derived using partial least squares analysis on food frequency questionnaire data, with nutrients significantly associated with local food purchasing (fiber, magnesium [Mg], saturated fat) as response variables. MetS was classified using harmonized criteria from clinical and laboratory measures (waist circumference, fasting glucose, systolic/diastolic blood pressure, triglycerides, HDL cholesterol) and medication use. Fully adjusted generalized linear models tested associations between tertiles of DPs and MetS. Approximately half (52%) of participants were classified with MetS. Four DPs were extracted, described as neo-traditional (local plants and seafood), transitioning (beans and coffee), industrial: meat-centric (red/processed meats and fast foods), and industrial: sugar-centric (rice and sugary beverages). Individuals in the highest (vs. lowest) tertile of the neo-traditional DP were more likely to purchase local (not imported) fruits, vegetables, and seafood; those in the transitioning DP were more likely to reside in rural areas; those in the meat-centric DP were more likely to purchase local meats; and those in the sugar-centric DP had lower educational attainment and household income. Individuals in the highest (vs. lowest) tertile of the neo-traditional DP were 0.69 (0.49, 0.97) times less likely to have MetS ( P = 0.035); they also had 4.1 (1.3) cm lower mean (SE) waist circumference ( P = 0.002). In contrast, individuals in the highest (vs. lowest) tertile of the meat-centric DP had higher mean waist circumference (102 vs. 99 cm, P = 0.01), fasting glucose (106 vs. 98 mg/dL, P = 0.019), and systolic blood pressure (123 vs. 119 mmHg, P = 0.022). The sugar-centric and transitioning DPs were not significantly associated with MetS or its components. A neo-traditional diet in PR holds promise in supporting local food production and augmenting cardiometabolic health. Results can guide local food promotion as a healthful, decolonizing approach in island settings.

Does Better Diet Quality Offset the Association between Depression and Metabolic Syndrome?

Several studies have shown that depression increases the risk of metabolic syndrome (MetS), which is often exacerbated by the fact that both exist concurrently. People with depression are more likely to have unhealthy eating habits, which can eventually trigger the development of MetS. This study was to investigate whether diet quality modifies the association between depression and MetS in a total of 13,539 Korean adults aged 19 to 80 from 2014, 2016 and 2018 Korean National Health and Nutrition Examination Surveys. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9) and subjects were divided into subgroups according to the PHQ-9 scores: normal (<5), mild (5-9), and moderate-to-severe (≥10) groups. Diet quality was measured by the Korean Healthy Eating Index (KHEI). A complex sample multiple logistic regression stratified by tertiles of KHEI scores was used to explore whether diet quality modifies an association between depression severity and metabolic syndrome. Depression severity was positively associated with the risk of MetS (p trend = 0.006) after adjustment for potential confounders. Only the lowest diet quality, moderately-to-severely depressed group, showed a higher risk of MetS (OR: 1.72, 95% CI: 1.24-2.40) compared to the normal group. Our results suggest that healthy diet quality could offset the positive relationship between depression and MetS in the general Korean adult population. Encouraging a healthy diet regime can improve not only physical health but also the mental state of the general public.

Association Between Dietary Quality and Serum Cystatin C in Kidney Transplant Recipients Based on Chinese Diet Balance Index 2016 (DBI-16).

BACKGROUND Cystatin C (Cys) is considered to be a better marker than serum creatinine in assessing kidney function, predicting cardiovascular events, and all-cause mortality. It seems to be associated with nutritional status in the general population, but little is known about kidney transplant recipients (KTRs). This study aimed to explore the relationship between dietary balance index and serum Cys in KTRs. MATERIAL AND METHODS In a cross-sectional study, 215 KTRs completed an FFQ questionnaire and information on serum Cys. Dietary intake was assessed using the Food Frequency Questionnaire (FFQ). Dietary Balance Index 2016 (DBI-16) edition scores were calculated as an indicator of dietary quality. Data on the patient's serum Cys were obtained through the hospital information system. RESULTS The majority of KTRs were male (75.34%), 76.74% were aged 18-44 years, and 79.53% were abnormal serum Cys. Dairy (z=-2.161, P<0.05), meat (z=-2.578, P<0.05), and dietary diversity (z=-3.393, P<0.05) in the normal group were higher than those in the abnormal group, and the dietary quality distance (DQD) score (t=-2.264, P<0.05) was lower than that in the abnormal group. After adjusting for confounders, a low-quality diet was a risk factor for maintaining the normal level of serum Cys (OR 3.022, 95% CI 1.263-7.231, P<0.05). CONCLUSIONS The present study suggested that KTRs with a high dietary quality might be associated with normal serum Cys levels. Dairy, meat, and varied diet seems to impact the serum Cys levels of KTRs. Dietary imbalances were prevalent among KTRs.

Associations Between Household Frequency of Cooking Dinner and Ultraprocessed Food Consumption and Dietary Quality Among US Children and Adolescents.

Introduction: Dietary quality is poor and intake of ultraprocessed foods (UPFs) is high among children and adolescents in the United States. Low dietary quality and high UPF intake are associated with obesity and higher risk of diet-related chronic diseases. It is unknown whether household cooking behavior is related to improved dietary quality and lower consumption of UPFs among US children and adolescents. Methods: Nationally representative data from the 2007-2010 National Health and Nutrition Examination Survey (n = 6032 children and adolescents ≤19 years of age) were used to examine the relationships between household cooking frequency of evening meals and children's dietary quality and UPF intake using multivariate linear regression models adjusted for sociodemographics. Two 24-hour diet recalls were used to assess UPF intake and dietary quality [Healthy Eating Index-2015 (HEI-2015)]. Food items were categorized according to Nova classification to obtain the UPF percent of total energy intake. Results: A higher household frequency of cooking dinner was associated with lower UPF intake and higher overall dietary quality. Compared to children in households cooking dinner 0-2 times per week, children in households cooking dinner 7 times/week had lower intake of UPFs [β = -6.30, 95% confidence interval (CI) -8.81 to -3.78, p < 0.001] and marginally higher HEI-2015 scores (β = 1.92, 95% CI -0.04 to 3.87, p = 0.054). The trends toward lower UPF intake (p-trend <0.001) and higher HEI-2015 scores (p-trend = 0.001) with increasing cooking frequency were significant. Conclusions: In this nationally representative sample of children and adolescents, more frequent cooking at home was associated with lower intake of UPFs and higher HEI-2015 scores.

Media use, dietary intake, and diet quality of adolescents in Saudi Arabia.

Excessive media use can affect diet of adolescents, but relevant data in Saudi Arabia are lacking. The present study aimed to explore the association between media use, dietary intake, and diet quality among adolescents. This cross-sectional study included data of 631 adolescents (ages 11-18 years) who were randomly recruited from 16 schools located in two main cities in the Western region of Saudi Arabia (Madinah and Jeddah). Envelopes including a questionnaire were sent home to collect sociodemographic data. Students then completed the short-form food frequency questionnaire to assess diet quality. Data on media use, anthropometrics, and 24-h dietary recalls were also collected. A high proportion of adolescents (86.2%) exceeded media use recommendations of ≤2 h per day. Significantly higher proportions of younger adolescents, males, and non-Saudis reported media use within the recommendation compared to their peers. Media use predicted lower diet quality score (B = -0.67 [95% CI: -1.09 to -0.28]) and lower intake of calcium, zinc, vitamin D, and vitamin C (B = -104 [95% CI: -203 to -5.24], B = -2.13 [95% CI: -4.15 to -0.11], B = -23.5 [95% CI: -41.3 to -5.65], B = -24.0 [95% CI: -45.1 to -2.96], respectively). Interventions to limit media use are urgently needed for adolescents in Saudi Arabia to improve diet quality and overall nutritional health. Excessive media use can affect diet of adolescents, but relevant data are lacking in Saudi Arabia. The majority of adolescents exceed the recommendations for media use. Media use was negatively associated with diet quality and intake of calcium, zinc, vitamin D, and vitamin C. This study will inform public health entities and policy makers to draw evidence-based, culturally tailored recommendations and develop nutrition interventions to enhance diet quality and nutritional status of adolescents. Findings of this study highlight the urgency to develop intervention programs and policies that aim to limit media use among adolescents.

Diet Quality Variation among Polish Older Adults: Association with Selected Metabolic Diseases, Demographic Characteristics and Socioeconomic Status.

A lot of civilization diseases are related to a low-quality diet, which is often determined by environmental factors. The aim of the present study was to assess the relationship between the quality of diet and the selected metabolic diseases, as well as demographic characteristics and socioeconomic status among Polish seniors. The study was conducted on the basis of the KomPAN questionnaire (Questionnaire for Dietary Views and Habits). The research sample was chosen arbitrarily. In addition, in order to diversify the research sample, the use of the snowball method was used. The study was conducted from June to September 2019 in a group of 437 people aged 60 or more years in two regions of Poland. Two diet quality indices with a potentially beneficial (pHDI-10) and adverse impact on health (pHDI-14) were selected based on data on the frequency of consumption of 24 food groups using the KomPAN questionnaire data development procedure. Based on the intensities (low, moderate, high) and combinations of these indices, three diet quality index profiles were developed with potentially different influences on health: lower (lowest), middle (intermediate) and upper (highest). Logistic regression was used to evaluate the relationship between diet quality indices, some metabolic diseases (obesity, arterial hypertension, diabetes type 2), demographic characteristics (gender, age, place of residence), and socioeconomic status (low, moderate, high). It was shown that in the examined seniors with selected metabolic diseases, the higher quality diet was more common among women, urban inhabitants and subjects with higher socioeconomic status. In turn, among the elderly with obesity, a high-quality diet was observed more often in people aged 60-74 years and those with type II diabetes at ages 75 years or more. The relationships between diet quality, demographic characteristics and socioeconomic status were demonstrated, but it was not possible to obtain unambiguous results on the relationship of these variables with the occurrence of metabolic diseases. Further extended studies should assess the importance of diet quality in reducing the risk of metabolic diseases in the elderly, taking into account the variability resulting from the environmental characteristics of the study population.

An updated validation of the Dietary Quality Score: associations with risk factors for cardiometabolic diseases in a Danish population.

This study assessed the validity of the Dietary Quality Score (DQS) and investigated the association between the DQS and risk factors for cardiometabolic diseases. The DQS was calculated based on an updated 23-item FFQ and validated against a 376-item FFQ. A sub-sample of 450 men and women aged 18-73years, from the Danish Diet, Cancer and Health-Next generations (DCH-NG) cohort, completed the updated 23-item FFQ. We investigated the associations between the DQS and risk factors for cardiometabolic diseases (lipids, haemoglobin A1c (HbA1c), high-sensitive C-reactive protein (hs-CRP), blood pressure (BP), waist circumference (WC), visceral and total fat mass) using linear regression models. A high DQS, i.e. healthy dietary habits, was significantly associated with a higher intake of fruits, vegetables, fish, fibre, several vitamins and minerals and a lower intake of saturated fat. Moreover, a high DQS was significantly associated with lower levels of LDL cholesterol (P = 0.0133), Hs-CRP (P = 0.0449), WC (P = 0.0161), visceral fat (P = 0.0003), total fat mass (P = 0.0106) and total fat percentage (P = 0.0030) and significantly associated with a higher HDL cholesterol (P = 0.0379) level, when adjusting for education, smoking habits and physical activity. There was no association with total cholesterol, triglycerides, HbA1c, BP and BMI. The DQS, based on the updated 23-item FFQ, is a valid tool to classify individuals into groups with low, average and high dietary quality in the Danish population. Furthermore, a high DQS is significantly associated with lower levels of several risk factors for cardiometabolic diseases.

Abstract 145: Dietary Intake And Quality Among Stroke Survivors Compared To Matched Controls Who Participated In The National Health And Nutrition Examination Survey: 1999 - 2018

Introduction: Nutrition is an important modifiable risk factor for the prevention and treatment of stroke. However, the examination of nutrient intake and diet quality in stroke survivors is limited. The purpose of this study was to estimate usual nutrient intake and diet quality in a nationally representative sample of US adults who have a history of stroke and compare to controls. Methods: National Health and Nutrition Examination Survey 1999-2018 data were used to examine 1,626 stroke survivors matched for age, gender, and survey cycle to their respective controls (n=1,621), with no history of stroke. Data were collected on demographics and dietary intake and quality (assessed by Healthy Eating Index [HEI] 2015) from at least one reliable 24-h dietary recall. Estimates were reported as mean[SE]. Differences in continuous and categorical variables were assessed using independent-samples t-tests and Rao-Scott Chi-Squared tests, respectively. Results: In comparison to controls, stroke survivors were more likely to report excessive (% &gt; Acceptable Macronutrient Distribution Range) intake for total fat (50.9%[2.7] vs. 40.4%[2.2], p&lt;.001), and inadequate intake (% &lt; Estimated Average Requirement) for calcium (54.6%[1.8] vs. 43.5%[2.4], p=.001) and magnesium (66%[1.8] vs. 53.6%[1.8], p&lt;.001). In addition, stroke survivors were less likely to report adequate intakes (% &gt; Adequate Intake) for fiber (6.8%[0.9] vs. 11.9%[1.3]) and potassium (0.8%[0.3] vs. 1.0%[0.4]) (p&lt;.001, all comparisons). Finally, stroke survivors reported lower HEI scores than controls (49.8 vs. 51.9, p&lt;.001) which indicates lower diet quality, and were more likely to be food insecure, and report physical and mental limitations including difficulty preparing and eating meals compared to controls (p&lt;.001, all comparisons). Conclusions: Stroke survivors had lower overall diet quality and greater prevalence of inadequate nutrient intake profiles typically associated with increased risk of cardiovascular diseases including higher total fat intake and lower intake of key micronutrients and fiber compared to matched controls. Stroke survivors were also more likely to experience food insecurity and have physical and mental limitations that may directly impact dietary intake.

Impact of a farmers’ market healthy food subsidy on the diet quality of adults with low incomes in British Columbia, Canada: a pragmatic randomized controlled trial

BackgroundAdults with low incomes have lower diet quality than their higher income counterparts. In Canada, the British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides coupons to low-income households to purchase healthy foods in farmers’ markets. ObjectiveThe objective of this study was to examine the impact of the FMNCP on the diet quality of adults with low incomes. MethodIn a pragmatic randomized controlled trial conducted in 2019, adults with low incomes (≥18 y) were randomly assigned either to an FMNCP intervention (n = 143) or a no-intervention control group (n = 142). The FMNCP group received 16 coupon sheets valued at $21 per sheet over 10–15 wk to purchase healthy foods from farmers’ markets. Participants completed a questionnaire and 2 24-h dietary recalls at baseline (0 wk), immediately post-intervention (10–15 wk), and 16-wk post-intervention (26–31 wk). Diet quality was calculated using the Healthy Eating Index-2015 (HEI-2015). Linear mixed-effects regression assessed differences in HEI-2015 total (primary outcome) and component scores (secondary outcomes) between the FMNCP and control groups at post-intervention and 16-wk post-intervention. Subgroup analyses examined program impacts by sex and age group (18–59 y, ≥60 y). ResultsThere were no significant differences in HEI-2015 total scores between the FMNCP and control groups at post-intervention (−0.07; 95% CI: −4.07, 3.93) or 16-wk post-intervention (1.22; 95% CI: −3.00, 5.44) overall or between subgroups. There were no significant between-group differences in HEI-2015 component scores at post-intervention, although there were significant differences in component scores for dairy and fatty acids at 16-wk post-intervention. ConclusionThe FMNCP did not significantly improve diet quality among adults with low incomes over the study period. Further research is needed to explore whether higher subsidy amounts or a longer intervention period is needed to meaningfully improve diet quality among adults with low incomes.This trial was registered at [clinicaltrials.gov] as [NCT03952338].

Dietary Diversity and Associated Factors among Adolescent Girls in Rural Community of Doyogena District, Kembata Tembaro Zone, Southern Ethiopia, 2020

Background: Optimal nutrition for adolescent girls is critical for growth, development, and long-term health. Dietary diversity is a crucial component of feeding strategies. In resourcepoor countries, undiversified diets and low-quality monotonous diet feeding habits are frequent. This leads to poor nutritional status, particularly micronutrient deficiencies, which has an impact on adolescent females' current and future lives, as well as their kids. However, data on the magnitude of dietary diversity and associated determinants among adolescent girls in resource-poor settings such as Ethiopia, which include the research area, is sparse. Methods: A community-based cross-sectional study design was conducted among 603 adolescent girls from randomly selected adolescent girls in Ethiopia using a multistage sampling method. The data were collected through face-to-face interviews by using a pretested structured questionnaire and entered into Epi-data 4.2.0.0 version and exported to SPSS version 20 for analyses. Multicollinearity between independent variables and model goodness fit test was checked. Bivariable and multivariable logistic regression analysis were used to determine the degree of relationship between independent and dependent variables. At a p-value of less than 0.05, the odds ratio was declared, along with the 95 percent confidence interval and the level of statistical significance. Results: The prevalence of dietary diversity among adolescent girls was 43.8% (95% CI: 39.7%- 48.0%). having secondary and above level of education and primary education, [AOR = 4.0, 95% CI: (1.89-8.32)], being in food secure households [AOR = 6.99, 95% CI: (4.34-11.23)], skipping practice of meals [AOR = 0.54, 95% CI: (0.33-0.88)], currently being on the menstruation [AOR = 0.42, 95% CI: (0.26-0.66)] and having good knowledge about nutrition [AOR = 2.20, 95% CI: (1.32-3.56)] were significantly associated with dietary diversity among adolescent girls. Conclusion: The prevalence of dietary diversity among adolescent girls was low in the study area. Therefore, attention should be given to fathers with no formal education, and efforts should be made to improve household food security, adolescent girls knowledge about nutrition, and minimize skipping of meals to increase adolescent girls dietary diversity and to break the vicious cycles of malnutrition.

Diet Quality and Cardiometabolic Risk Factors in Adolescents with Down Syndrome.

Youth with Down syndrome (DS) have a high prevalence of obesity and dyslipidemia. Diet quality may influence cardiometabolic risk (CMR) in youth. The aim of this secondary analysis was to investigate the relationship between diet quality (Healthy Eating Index [HEI-2015]) with CMR factors in youth with DS compared with age, sex, race, ethnicity, and body mass index percentile matched, typically developing controls. Adolescents (aged 10 to 20 years) with DS and controls of comparable age, sex, race, ethnicity, and body mass index percentile were recruited from 2012 to 2017 for a cross-sectional study from two large children's hospitals (Children's Hospital of Philadelphia and the Children's National Health System in Washington, DC). CMRs in 143 adolescents with DS were compared with 100 controls. Exclusion criteria consisted of major organ-system illnesses. The average of three 24-hour dietary recalls was used to calculate the HEI-2015. Anthropometrics, blood pressure, and fasting labs were collected. Group differences were tested using Wilcoxon rank-sum tests. Relationships of CMR factors with HEI-2015 score within DS and controls were tested using linear regression models adjusted for sex, age, race, and body mass index z score. Compared with controls (n= 100, median age= 14.8 years [interquartile range= 12.2 to 17.3 years]; 41% male; 24% African American; 65% with body mass index ≥85th percentile), adolescents with DS (n= 143, median age= 14.7 years [interquartile range= 11.4 to 17.4 years]; 44% male; 18% African American; 62% with body mass index ≥85th percentile) had higher scores (more aligned with dietary recommendations) for total HEI-2015 (DS: 52.7 [interquartile range= 46.8 to 58.6] vs controls: 45.1 [interquartile range= 39.5 to 55.0]; P < 0.0001). Youth with DS also had higher HEI-2015 component scores for fruits, greens/beans, dairy, refined grains, and saturated fats, but lower whole grains and sodium scores. Within the group with DS, total HEI-2015 was not significantly associated with CMR measures. Whereas HEI-2015 in the DS group was negatively associated with fasting glucose levels, the difference did not meet the set level of statistical significance (-0.14, 95% CI -0.29 to 0.00; P= 0.053). Adolescents in both the control and DS groups reported low-quality diets, although the DS group had HEI-2015 scores more closely aligned with recommendations. In the DS group, diet quality was not significantly associated with CMR factors. Although further research is needed, these results suggest that dyslipidemia in youth with DS may not be related to dietary intake.

Predicting age and mass at maturity from feeding behavior and diet in Manduca sexta: An empirical test of a life history model.

Feeding for most animals involves bouts of active ingestion alternating with bouts of no ingestion. In insects, the temporal patterning of bouts varies widely with resource quality and is known to affect growth, development time, and fitness. However, the precise impacts of resource quality and feeding behavior on insect life history traits are poorly understood. To explore and better understand the connections between feeding behavior, resource quality, and insect life history traits, we combined laboratory experiments with a recently proposed mechanistic model of insect growth and development for a larval herbivore, Manduca sexta. We ran feeding trials for 4th and 5th instar larvae across different diet types (two hostplants and artificial diet) and used these data to parameterize a joint model of age and mass at maturity that incorporates both insect feeding behavior and hormonal activity. We found that the estimated durations of both feeding and nonfeeding bouts were significantly shorter on low-quality than on high-quality diets. We then explored how well the fitted model predicted historical out-of-sample data on age and mass of M. sexta. We found that the model accurately described qualitative outcomes for the out-of-sample data, notably that a low-quality diet results in reduced mass and later age at maturity compared with high-quality diets. Our results clearly demonstrate the importance of diet quality on multiple components of insect feeding behavior (feeding and nonfeeding) and partially validate a joint model of insect life history. We discuss the implications of these findings with respect to insect herbivory and discuss ways in which our model could be improved or extended to other systems.

Adult Survivors of Childhood Cancer Have Poor Adherence to Dietary Guidelines

Background: Poor nutritional intake can exacerbate the chronic disease burden in childhood cancer survivors, whereas a healthful diet serves a protective function. Few studies have provided detailed evaluations of the diet of childhood cancer survivors.Objectives: This study aimed to evaluate diet quality and dietary intakes of key food groups and nutrients in a large cohort of childhood cancer survivors and whether cancer and treatment characteristics have an impact on survivors’ long-term intake.Methods: Diet was assessed in 2570 adult survivors of childhood cancer enrolled in the St. Jude Lifetime cohort (mean age = 32.3 y) by using the Block food-frequency questionnaire. The Healthy Eating Index–2010 (HEI-2010) was calculated to quantify diet quality. Cancer diagnosis and treatment exposure were abstracted from medical records. Differences in HEI-2010 by patient characteristics and treatment exposure were examined by using ANCOVA.Results: The mean ± SD HEI-2010 in childhood cancer survivors was 57.9 ± 12.4 of a maximum score of 100. Referenced to Dietary Reference Intakes, survivors consumed inadequate amounts of vitamin D, vitamin E, potassium, fiber, magnesium, and calcium (27%, 54%, 58%, 59%, 84%, and 90% of the recommended intakes) but excessive amounts of sodium and saturated fat (155% and 115% of the recommended intakes) from foods. Survivors diagnosed when <5 y of age had a lower diet quality than did those diagnosed when ≥5 y of age (mean HEI-2010 score: 56.9 compared with 58.2; P = 0.046). Survivors who received higher radiation doses to the abdomen had a lower diet quality than those who received lower doses (mean HEI-2010 scores = 58.9, 57.2, 56.7, and 56.1 for doses of 0, 1–19.9, 20–29.9, and ≥30 Gy, respectively; P = 0.02).Conclusions: Long-term childhood cancer survivors have poor adherence to the 2010 Dietary Guidelines for Americans. Findings reinforce the need to incorporate nutrition into cancer care to improve diet quality and to reduce morbidities.

Nutrition Literacy Is Not Sufficient to Induce Needed Dietary Changes in Nonalcoholic Fatty Liver Disease.

Dietary and lifestyle changes are the first line of therapy for nonalcoholic fatty liver disease (NAFLD), the most prevalent liver disease in the western world. Nutrition literacy is the ability to understand nutrition information and implement that knowledge. We aimed to compare indicators of nutrition literacy in subjects with and without NAFLD in a representative US cohort. In a cross-sectional study using data from the National Health and Nutrition Examination Survey 2017-2018 cycle, we included 2,938 adult subjects with complete dietary and vibration-controlled transient elastography data and no alternative reason for hepatic steatosis. Nutrition literacy was assessed using questionnaires. Diet perception accuracy was assessed by comparing self-reported diet quality with objective diet quality scores-the Healthy Eating Index and alternative Mediterranean diet score-to assess real-world application of nutrition knowledge. Nutrition literacy was not different between subjects with or without NAFLD ( P = 0.17): more than 90% of subjects reported using nutrition labels, and most of them correctly identified the meaning of daily value. Subjects with NAFLD had a lower-quality diet (Healthy Eating Index, P = 0.018; alternative Mediterranean diet, P = 0.013) and rated their diet as poorer ( P < 0.001). On self-assessment, only 27.8% of subjects overestimated their diet quality, while 37.5% consumed more calories than their self-assessed needs. Both accuracy measures were similar between subjects with NAFLD and those without ( P = 0.71 and 0.63, respectively). Subjects with NAFLD were more likely to report being advised to lose weight (42.1% vs 16.5%, P < 0.001) or to attempt losing weight (71.9% vs 60.9%, P < 0.001). Diet quality was not better in subjects with NAFLD who received dietary recommendations. Subjects with NAFLD have poor diet quality despite receiving medical recommendations to lose weight and having nutrition literacy and perception that are comparable with subjects without NAFLD. Educational approaches may not be sufficient to promote weight loss and improve diet quality in NAFLD.

Variation in diet of desert bighorn sheep (Ovis canadensis nelsoni): Tradeoffs associated with parturition

Selection of forage and habitats is driven by nutritional needs of individuals. Some species may sacrifice nutritional quality of forage for the mother in favor of safety of offspring (risk-averse strategy), immediately following parturition. We studied diet quality and forage selection by bighorn sheep before and following parturition to determine how nutritional demands associated with rearing offspring influenced forage acquisition. We used desert bighorn sheep, Ovis canadensis nelsoni, to investigate that potential tradeoff. We captured and radio-collared female bighorn sheep from 2016 to 2018. We used vaginal implant transmitters (VIT)s in pregnant females to identify parturition and to capture and radio-collar neonates to monitor survival of young. We collected fecal samples throughout the breeding season and throughout the year to understand diet quality and composition throughout those temporal periods. We determined diet quality and composition for pre-parturient females, females provisioning offspring, females that lost offspring, and non-pregnant individuals using fecal nitrogen and DNA metabarcoding analyses. Additionally, we compared the diet quality and composition of offspring and adult females during the spring, as well as summer and winter months. Our results indicated differences in diet quality between individuals provisioning offspring and those whose offspring had died. Females that were provisioning dependent young had lower quality diets than those that lost their offspring. Diet composition among those groups was also markedly different; females that had lost an offspring had a more diverse diet than did females with dependent young. Diet quality differed among seasons, wherein offspring and adult females had higher quality diets during the spring months, with decreasing quality as the year progressed. Diet diversity was similar across seasons, although spring months tended to be most diverse. Our results support tradeoffs associated with risk-averse strategies made by adult females associated with parturition. Nutritional quality of forage was linked to provisioning status, indicating that females were trading diet quality for safety of offspring, but those females whose offspring had died selected high quality forages. Those results help explain habitat selection observed in mountain ungulates around parturition and provide further insight into the evolutionary processes and adaptive significance exhibited by those specialized artiodactyls.

Limited Health Literacy and Its Associated Health Outcomes Among Adults With at Least 2 Atopic Diseases

Health literacy (HL) is essential for patients with multiple atopic diseases to improve their health, given the complexity of their disease and treatment regimens. To estimate the proportion of adults with multiple atopic diseases (at least 2 of atopic dermatitis, asthma, allergic rhinitis, and food allergy) in the Dutch general population and to evaluate the prevalence of limited HL, and its association with socioeconomic status (SES), lifestyle factors, and health-related quality of life (HR-QoL) in this patient population. This cross-sectional study was conducted within the Lifelines Cohort Study via sending an add-on digital questionnaire, including (among others) questions on atopic dermatitis, to all adult participants (n= 135,950) between February and May 2020. Data on asthma, allergic rhinitis, lifestyle factors, HR-QoL, and SES were extracted from baseline assessment between 2006 and 2013. Functional, communicative, and critical HL were measured by validated items from Chew and the Dutch Functional Communicative and Critical Health Literacy questionnaires between 2012 and 2016. Food allergy was measured by the Food Allergy Questionnaire between 2014 and2016. In total, 11.8% of the overall study population reported ever having multiple atopic diseases; of those, 23.6% reported having limited functional HL, with a higher prevalence among those with a low SES. Limited functional HL showed positive associations with smoking, obesity, chronic stress, a low diet quality, and decreased HR-QoL among subjects with multiple atopic diseases. We identified an HL deficit, and its association with a low SES and poor health outcomes among patients with multiple atopic diseases. Further research is warranted to utilize a more extensive assessment to measure HL and include more health outcomes, such as treatment adherence and disease control.