Mean HEI Score Research Articles

Maternal Bean Consumption during Pregnancy: Distribution and Nutritional Outcomes

(1) Background: Due to their high nutritional value, we aimed to characterize the frequency and amount of maternal consumption of beans during pregnancy and their associations with diet quality and nutrient intake. (2) Methods: We conducted a secondary data analysis of US pregnant women (n = 1444) from the Infant Feeding Practices Study II, a longitudinal study that followed mother–infant pairs from late pregnancy to 1 year postpartum. Maternal bean intake (food types [dried beans, chili, and bean soup], frequency, serving size, and amount), diet quality (Healthy Eating Index [HEI]), and nutrient intake were estimated with a Food Frequency Questionnaire taken in the third trimester of pregnancy. Associations of bean consumption with diet quality and nutrient intake were examined with analysis of variance, Fisher’s least significant difference tests, correlation coefficients, and coefficients of determination. (3) Results: In general, maternal bean consumption was low during pregnancy: 0.31 cups/week of dried beans, 0.37 cups/week of chili, and 0.10 cups/week of bean soup. Maternal bean consumption varied by socio-demographics and geographic regions. In comparison with those who never consumed dried beans, mothers who ate dried beans ≥ 1 time per week had a higher mean HEI score (67.5 vs. 63.6), intake of total fiber (24.4 vs. 17.4 g/day), and protein (93.4 vs. 79.9 g/day), but a lower percentage of energy from added sugar (12.6 vs. 15.2%). Higher dried bean consumption had weak-to-moderate correlations with intake of total fiber (correlation coefficient, 0.320), insoluble fiber (0.316), soluble fiber (0.310), and folate (0.286). Similar but less extensive correlations were observed for chili and bean soup consumption. (4) Conclusions: In this US cohort of pregnant women, bean consumption was low. Increased intake of beans (≥1 time per week) may improve maternal diet quality during pregnancy.

The association between self-reported nocturnal sleep duration, irregularity in daily energy intake and diet quality in a sample of Iranian adults.

Evidence on the relationship between sleep duration and irregularity in daily energy intake with diet quality in Iranian adults is scarce. We aimed to evaluate the association of sleep duration with diet quality and irregularity in daily energy intake. This is a cross-sectional study. The study was performed in healthcare centres in Tehran. 739 adults aged 20-59 years were recruited. Dietary intake was assessed by a FFQ and three 24-h dietary recalls. Diet quality was assessed using the Healthy Eating Index-2015 (HEI-2015). An irregularity score of daily energy intake was calculated based on the deviation from the 3-d mean energy intake. Sleep duration was estimated using self-reported nocturnal sleep duration by each person. The mean age of the study participants was 44·4 ± 10·7 years; 70 % were women. The mean nocturnal sleep duration, HEI score and irregularity score were 6·7 ± 1·22 h/d, 52·5 ± 8·55 and 22·9 + 19, respectively. After adjusting for potential confounders, sleep duration was not associated with adherence to HEI-2015 (OR: 1·16; 95 % CI 0·77, 1·74). Longer sleep duration was marginally associated with a lower odd of irregularity in daily energy intake. However, after adjustment for various confounders, this association was not significant (OR: 0·82; 95 % CI 0·50, 1·33; Ptrend = 0·45). No significant interaction was observed between sleep duration and irregularity in daily energy intake in relation to adherence to HEI-2015 (Pinteraction = 0·48). We found that sleep duration was not associated with adherence to HEI-2015 and irregularity in daily energy intake. Further prospective studies are warranted.

The Relationship between Diet and Suicide Risk and Resilience in Wildland Firefighters

Objectives1) To determine the nutrient intake and diet quality of wildland firefighters (WLFF); 2) to determine the relationship between diet quality and mental health indices (e.g., anxiety, depression, post-traumatic stress, suicidality) among WLFF. MethodsThis cross-sectional study involved a convenience sample of 37 WLFF recruited via social media from across the US. Dietary intake was assessed via 24-hour recall entered into nutrient analysis software and scored using the Healthy Eating Index 2015 (HEI) for diet quality. Mental health was assessed using several indices for suicidality, anxiety, depression, hopelessness, and alcohol use. Nutrient intake and HEI scores were compared to current US adult intake patterns from the National Health and Nutrition Examination Survey (NHANES). Relationships between HEI scores and mental health indices were determined using Pearson correlation coefficients. ResultsMean (± standard deviation) age was 40.0 ± 11.7 years and 87.1% of participants were Caucasian with body mass index of 28.1 ± 4.5 kg/m2. Mean HEI score was 52.5 ± 14.8 out of 100, 10.6% lower than the US adult population. Added sugar, refined grains, and total protein all had scores between 81–100/100, indicating adequate intake. Total HEI, saturated fat, total vegetable, and sodium scores were between 51–80/100, indicating need for improvement. Seafood/plant protein, dairy, whole grains, and total fruit scores were between 0–50/100, indicating poor intake. Relationships between HEI scores and mental health indices were significant, moderate, and inverse (beneficial) for total HEI, dark greens and legumes, and fatty acid ratio scores with Alcohol Use Disorder Identification Test, Generalized Anxiety Disorder 7-item, and Patient Health Questionnaire. ConclusionsDiet quality for the diets of WLFF is lower than the US adult population, in significant need of improvement, and potentially impacting mental health status. Funding SourcesNot applicable.

Maternal Dry Bean Consumption During Pregnancy: Distribution and Nutritional Outcomes

ObjectivesDry beans and other pulses have a high nutritional profile. We aimed to characterize the frequency and amount of maternal dry bean consumption during pregnancy and their associations with diet quality and nutrient intake.MethodsWe conducted a secondary data analysis of pregnant women (N = 1,403) from the Infant Feeding Practices Study II, a longitudinal study that followed mother-infant pairs from late pregnancy until 6 years postpartum. Maternal dry bean consumption (frequency and amount), diet quality (Healthy Eating Index [HEI]), and nutrient intake were estimated with a Food Frequency Questionnaire completed in the third trimester of pregnancy. Associations of dry bean consumption with dietary quality and nutrient intake were examined with Analysis of Variance, Tukey's HSD pairwise comparisons, and determination coefficients.ResultsMothers in the analytic sample were mainly White (83.5%), college educated (78.9%), and had middle household income (55.1% ≥ $40,000). Overall, maternal dry bean consumption was low (0.3 cups/week) during pregnancy, with 92% not meeting the current recommendation (1–3 cups/week). Maternal dry bean consumption significantly varied by race/ethnicity and geographic regions with mothers of Hispanics and Asian or living in South Central regions having relatively high consumption. Compared with never-consumers, mothers who consumed dry beans ≥ 1 time per week had a higher mean HEI score (67.5 vs 63.6), intake of total fiber (24.4 vs 17.4 g/d), and protein (93.4 vs 79.9 g/d), but a lower percentage of energy (12.6 vs 15.2%) from added sugar. Higher amount of dry bean consumption had a substantial contribution to the variation in intake of total fiber (determination coefficient, 10.3%), insoluble fiber (10.0%), soluble fiber (9.6%), and folate (8.2%).ConclusionsDry bean consumption was low during pregnancy. Consumption of dry beans ≥ 1 time per week might help to improve maternal diet quality.Funding SourcesUSDA (to XW and TR).

Impact of Recent Job Loss on Sleep, Energy Consumption and Diet.

Adequate sleep and self reported dietary recall data from the Assessing Daily Activity Patterns through Occupational Transitions (ADAPT) study was analysed. Primary sleep indices used were total sleep time, time spent in bed after final awakening, and sleep quality as measured by the Daily Sleep Diary (DSD). Mean Energy consumption (MEC) was the primary nutritional index. Secondary indices included diet quality using the Health Eating Index 2015 (HEI), and self-reported intake of protein, carbohydrates and fats. The study participants were comprised mainly of women (61%) and non-Hispanic white. The participants had at least 2 years of college education and mean body mass index of 30.2±8.08 (kg/m 2). The average time in bed was 541.8 (9.0 hrs) ±77.55 minutes and total sleep time was 461.1 (7.6 hrs) ±56.49 minutes. Mean sleep efficiency was 91±6%, self-reported sleep quality was 2.40±0.57 (0-4 scale, 4 = very good), and minutes earlier than planned morning awakening were 14.36±24.15. Mean HEI score was 47.41±10.92. Although the MEC was below national average for both men and women, male sex was associated with higher MEC. In a fully adjusted model sleep quality was positively associated with MEC. Daily overall assessments of sleep quality among recently unemployed persons were positively associated with mean energy consumption. Additionally, the diet quality of unemployed persons was found to be unhealthier than the average American and consistent with the relationship between poor socioeconomic status and lower diet quality.

Associations between advertisement-supported media exposure and dietary quality among preschool-age children

Foods of low nutritional quality are heavily marketed to children, and exposure to food ads shapes children's preferences and intake towards advertised foods. Whether food ad exposure independently relates to an overall lower diet quality among children remains unclear. We examined the association between ad-supported media use, a proxy for food ad exposure, and diet quality using the baseline data (2014–2015) from 535 3-5-year-olds in a community-based cohort study. Parents reported their child's dietary intake over 3 days via a diary, and diet quality was assessed with the Healthy Eating Index (HEI-2015) where higher scores reflect greater adherence to USDA dietary guidelines. Children's media exposure was measured through online parent surveys. Mean HEI score was 54.5 (SD = 9.4). In models adjusted for sociodemographic characteristics and metrics of parent diet quality, children's HEI scores were 0.5 points lower (adjusted beta = −0.5 [95% CI: 0.8, −0.1]; P < 0.01) for each 1-h increment in weekly viewing of ad-supported children's TV networks. Children's use of media that may have food ads (e.g., apps, online games) also related to a lower diet quality yet to a lesser extent (adjusted beta −0.2 [-0.2, −0.1]; P < 0.01). In contrast, children's ad-free media use was not associated with diet quality (P = 0.21). Findings support the premise that exposure to food advertisements via media may result in a lower quality diet among children independently of other risk factors.

Associations Between Maternal Nutrition in Pregnancy and Child Blood Pressure at 4–6 Years: A Prospective Study in a Community-Based Pregnancy Cohort

The intrauterine environment may influence offspring blood pressure, with effects possibly extending into adulthood. The associations between prenatal nutrition and offspring blood pressure, alone or in combination with other sociodemographic or behavioral factors, are unclear. To investigate the associations of maternal dietary patterns and plasma folate concentrations with blood pressure in children aged 4-6 years, and assess the potential effect modifications by child sex, maternal race, pre-pregnancy overweight or obesity, maternal smoking, and breastfeeding. Participants were 846 mother-child dyads from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study. Maternal nutrition was characterized by the Healthy Eating Index 2010 (HEI) scores and plasma folate concentrations in pregnancy. We calculated the systolic blood pressure (SBP) and diastolic blood pressure percentiles, incorporating sex, age, and height, and categorized children as either having high blood pressure (HBP; ≥90th percentile) or normal blood pressure. Linear regressions were performed to quantify the associations between maternal nutrition and continuous blood pressure percentiles, and Poisson regressions were used to estimate the incidence rate ratio (IRR) of binary HBP. We examined the effect modifications using interaction models. Mean HEI scores and folate concentrations were 60.0 (SD, 11.3) and 23.1ng/mL (SD, 11.1), respectively. Based on measurements at 1 visit, 29.6% of the children were defined as having HBP. Maternal HEI scores and plasma folate concentrations were not associated with child blood pressure percentiles or HBP in the full cohort. Among mothers self-identified as white, there was an inverse relationship between maternal HEI score and child SBP percentile (β, -0.40; 95%CI: -0.75 to -0.06). A maternal HEI score above 59 was associated with a reduced risk of HBP in girls (IRR, 0.53; 95% CI: 0.32-0.88). No modified associations by pre-pregnancy overweight or obesity, maternal smoking, or breastfeeding were indicated. We found little evidence for effects of maternal nutrition during pregnancy on childhood blood pressure, but detected sex- and race-specific associations. The study contributes to the evolving scientific inquiry regarding developmental origins of disease.

Awareness and Use of Nutrition Information Predict Measured and Self-Rated Diet Quality of Older Adults in the United States - ERRATUM.

Objectives: To examine: (1) diet quality of older adults, using the Healthy Eating Index 2010 (HEI-2010) and self-rated diet quality, (2) characteristics associated with reported awareness and use of nutrition information and (3) factors associated with HEI score and self-rated diet quality. Design: Cross-sectional study. Based on Day 1 and/or Day 2 dietary recalls, the Per-Person method was used to estimate HEI-2010 component and total scores. T-tests and ANOVA were used to compare means. Logistic and linear regressions were used to test for associations with diet quality, controlling for potential confounders. Setting: National Health and Nutrition Examination Survey, 2009–2014. Participants: Three thousand and fifty-six adults, aged 60 years and older, who completed at least one 24-h recall and answered questions on awareness and use of nutrition information. Results: Mean HEI score for men was significantly lower than for women (56·4 ± 0·6 v. 60·2 ± 0·6, P < 0·0001). Compared with men, more women were aware of (44·8 % v. 33·7 %, P < 0·05) and used (13·7 % v. 5·9 %, P < 0·05) nutrition information. In multivariable analyses, awareness and use of nutrition information were significant predictors of both HEI and self-rated diet quality for both women and men. Groups with lower nutrition awareness included men, non-Whites, participants in nutrition assistance programmes and those with lower education and socio-economic status. Conclusions: Nutrition awareness and use of nutrition information are associated with diet quality in adults 60 years and older. Gaps in awareness of dietary guidelines in certain segments of the older adult population suggest that targeted education may improve diet quality for these groups.

Association of Dietary Quality, Inflammatory Markers, and Physical Functioning among Older Female Cancer Survivors

One area within geriatric oncology that is understudied and undertreated is the dietary quality of older cancer survivors. Most older adults with cancer experience nutritional deficits due to their age and cancer treatment. Research has shown the impact of competing comorbidities, polypharmacy, and decline in functional and cognitive status on older adults’ nutritional needs. This study sought to examine the diet quality of older female cancer survivors, and its association with inflammatory markers and physical functioning. Participants completed surveys online, by mail, or phone. Additional participant information was obtained through medical records. Descriptive statistics, Pearson’s correlations, forward linear regressions were used to analyze these data. Older female cancer survivors (≥65) that had completed their initial cancer treatment in the past 5 years were recruited through cancer clinic visits and medical records. The study was conducted from November 2018 through January 2020. Self-reported physical functioning (RAND-36), diet quality (DHQ-II, HEI-2015), and BMI were obtained from surveys. Participant diagnosis, comorbidities, and inflammatory marker (c-reactive protein (CRP)) were obtained through electronic medical records; albumin was collected as a marker correlated with inflammation. The average age of participants (n = 171) was 73.6 ± 8.4 years. Mean physical functioning score was 60 ± 24 out of 100. Mean total HEI scores were 66.39 + 10.0 out of 100. Positive correlations were observed between total HEI scores and physical functioning, self-rated health, albumin, education, and income. Negative correlations were observed between physical functioning and BMI, self-rated health, albumin, and age. Regressions indicated that individuals who had higher HEI scores were more likely to report higher physical functioning (β = 0.38, P < 0.001). Identifying dietary quality and markers to overall assess inflammation is pertinent to improve the long-term health of cancer survivors. The strong correlations between physical function, HEI, and albumin demonstrates the relationship albumin has with inflammation and its subtle impact it can have on older cancer survivors. Along with CRP, serum albumin should be interpreted in the context of the patient’s overall health. Future larger cohort studies of older cancer survivors with longitudinal measurements are warranted.

Feasibility of using a computerized food frequency questionnaire (FFQ) to assess dietary patterns in patients with advanced gastrointestinal (GI) malignancies.

465 Background: Identification of poor dietary patterns is important for the optimal management of patients with metastatic GI malignancies who suffer from high rates of malnutrition and sarcopenia which are associated with increased rates of treatment-related toxicity and worsened survival. Dietary records or recall methods and FFQs are available but have high patient burden and are seldom utilized in oncology settings outside of formal nutritional consultations. Thus, we evaluated the feasibility of conducting serial assessments of dietary patterns using a novel computerized FFQ technology. Methods: Assessments of diet using the computerized FFQ, nutritional status (NUTRISCORE), QOL and anorexia/cachexia burden (FAACT), anxiety/depression (HADS) and taste burden were done at the time of initiation of first-line chemotherapy (baseline) and 3 months later. The FFQ was done independently either at home on personal computer after visit or via iPad in infusion room. Dietary quality was defined by the Healthy Eating Index 2010 (HEI) score, which was automatically calculated by the computerized FFQ software. Feasibility was defined as at least 70% of patients completing baseline and 3-month assessments. Spearman’s correlations were used to determine associations between measures. Results: 29 patients with advanced (metastatic or unresectable) GI cancers were enrolled and 23 completed the baseline FFQ (8 colorectal, 5 pancreas, 5 gastroesophageal, 5 other). Median age was 58 (20-78) with M:F ratio of 10:13. The overall completion rate of baseline and 3-month assessments was 81.8%, meeting the pre-defined feasibility criteria. The mean baseline HEI score was 65 (range 38-88). Of patients who completed both baseline and 3-month assessments, the mean HEI score remained stable at 58 with changes in specific HEI components including a 20% decline in the seafood and plant protein score and a 13% decline in the whole grain score and small improvements in other areas (e.g. empty calories, dairy). There were no significant correlations between baseline HEI score and other assessments. Conclusions: It is feasible to use a computerized FFQ to assess for longitudinal changes in eating patterns and dietary quality in patients with advanced GI cancers, particularly when patients can complete the assessments during chemotherapy infusions. Preliminary findings also suggest that the FFQ can be helpful for highlighting areas in which diet quality could be improved. Additional analysis of other computerized FFQ data (e.g. macro/micronutrient consumption) is ongoing.

Diet Quality Is Lower for Those Who Skip Lunch Among a Sample of Predominantly Black Adolescents.

To compare the dietary quality among adolescents who skip lunch and those who do not and explore associations between school-level variables, demographic variables and lunch skipping. Cross-sectional. Public schools in New Orleans, Louisiana (n = 21). 718 adolescents. Adolescents participated in a 24-hour dietary recall using the Automated Self-Administered 24-Hour (ASA24) Dietary Assessment Tool early in 2013. Data were converted into Healthy Eating Index (HEI-2010) scores. Mean scores were compared between students who skipped lunch and those who did not. A multilevel analysis was conducted to assess relationships between school environment, demographics, and lunch skipping. Of the 718 respondents, 88.3% were Black and 15.3% skipped lunch. Students who ate lunch had a mean HEI score of 46.6 compared to a mean score of 41.7 for students who skipped lunch (p < .001). Students who skipped lunch also had significantly lower intake of total vegetables (p = .02), whole fruits (p < .001), total dairy (p = .003), total protein (p < .001). Skipping lunch was associated with lower quality diet, though diet quality was low among all students. Considering over 15% of the sample did not eat lunch in a closed-campus school setting, further research should consider how to encourage students to participate in the National School Lunch Program, which has the ability to increase diet quality in adolescents.

Awareness and use of nutrition information predict measured and self-rated diet quality of older adults in the USA.

To examine: (1) diet quality of older adults, using the Healthy Eating Index 2010 (HEI-2010) and self-rated diet quality, (2) characteristics associated with reported awareness and use of nutrition information and (3) factors associated with HEI score and self-rated diet quality. Cross-sectional study. Based on Day 1 and/or Day 2 dietary recalls, the Per-Person method was used to estimate HEI-2010 component and total scores. T-tests and ANOVA were used to compare means. Logistic and linear regressions were used to test for associations with diet quality, controlling for potential confounders. National Health and Nutrition Examination Survey, 2009-2014. Three thousand and fifty-six adults, aged 60 years and older, who completed at least one 24-h recall and answered questions on awareness and use of nutrition information. Mean HEI score for men was significantly lower than for women (56·4 ± 0·6 v. 60·2 ± 0·6, P < 0·0001). Compared with men, more women were aware of (44·8 % v. 33·7 %, P < 0·05) and used (13·7 % v. 5·9 %, P < 0·05) nutrition information. In multivariable analyses, awareness and use of nutrition information were significant predictors of both HEI and self-rated diet quality for both women and men. Groups with lower nutrition awareness included men, non-Whites, participants in nutrition assistance programmes and those with lower education and socio-economic status. Nutrition awareness and use of nutrition information are associated with diet quality in adults 60 years and older. Gaps in awareness of dietary guidelines in certain segments of the older adult population suggest that targeted education may improve diet quality for these groups.

P159 Participant Characteristics in a Community-Based Diabetes Education Program for South Asians

Background Type 2 diabetes is highly prevalent among South Asians/Asian Indians (AI) in the US, but standard Diabetes Self-Management Programs (DSMP) do not address AI's cultural characteristics. There is a gap of knowledge about AI's nutrition- and healthcare-related behaviors that are likely to influence diabetes outcomes. Objective To describe nutrition and diabetes care-related characteristics of AI who participate in DSMP. Study Design, Setting, Participants Cross-sectional baseline data were collected through group-administered surveys among 40 AI adults prior to participating in community-based DSMP in New Jersey in 2019. Anthropometric data were measured by trained research staff. Measurable Outcome/Analysis DHQ III semi-quantitative food frequency questionnaire and Healthy Eating Index 2015 (HEI) were used to measure dietary quality; Asian food preference at home was also collected. Diabetes care behaviors included measures such as 10-item diabetes self-efficacy scale, 4-item health distress scale (range: 0-5), 3-item scale for communications with doctors (range: 0-5), and 4-item social role-diabetes interference scale (range: 0-4). Body weight/height (BMI) and waist circumference (WC) were used to characterize weight status. Descriptive results were calculated using IBM SPSS Statistics. Results Most (83%) of the participants’ BMIs were in overweight/obese category (mean: 27.9 ± 4.7); 80% of participants had high risk WC. Mean HEI score (37.9 ± 13.7), intake of fruits (1.1 cups ± 1.6/d), vegetables (1.5 cups ± 1.4/d), and fiber (14.9g ± 13.8/d) were below recommended levels; 80% of participants preferred mostly/exclusively Asian foods at home. Diabetes self-efficacy was moderately high (mean: 7.4 ± 1.9); means for health distress (1.5 ± 1.3) and social role interference (1.7 ± 2.6) scores were moderately low, and communication (with doctors) score was 2.9 ± 1.2. Conclusions These results indicate a need to improve weight status and dietary quality, which are potential risk factors for type 2 diabetes. Future education programming should be tailored to address Asian dietary intake preferences and include strategies to improve health distress, social role interference, and communication with healthcare providers. Results will be used for culturally appropriate curriculum development and implementation for AI.

Comparing Healthy Eating Index Scoring Methods and Different Dietary Assessment Instruments: The Interactive Diet and Activity Tracking in AARP (IDATA) Study

Abstract Objectives To compare five Healthy Eating Index-2015 (HEI-2015) scoring methods using 24-hour recalls (24HRs), 4-day food records (4DFRs), and food frequency questionnaires (FFQs). Methods Over 12 months, Interactive Diet and Activity Tracking in AARP (IDATA) study participants (N = 1021) aged 50–74 years completed up to six Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) recalls, 2 4DFRs, and 2 FFQs. Mean HEI-2015 total and component scores were estimated using five methods – two estimating usual intake: the multivariate Markov Chain Monte Carlo (MCMC) and bivariate; and three not estimating usual intake: per day, per person, and population ratio. Sums of squared differences (SSD) were calculated to compare differences among component scores. Results MCMC and bivariate methods estimated similar total mean HEI-2015 scores for men with 24HRs (60 points) and 4DFRs (61 points). The population ratio scores were comparable (63 points), but higher, and the per day was most different for both 24HRs and 4DFRs (57 points). This pattern was similar for women. With 24HR and 4DFRs, the population ratio method had higher component scores compared with MCMC and bivariate for Total Fruits, Whole Fruits, and Seafood and Plant Proteins. For example, among men, in 24HRs (comparing MCMC and population ratio), the SSD for Whole Fruit were 1.44 and those of Seafood and Plant Proteins were 0.49, compared to SSDs for other components which only ranged from 0.01 to 0.16. With FFQs, estimation of mean HEI scores is not recommended due to biases. However, when applying all methods, the total and component scores for FFQs were higher for Total Fruits, Whole Fruits, Greens and Beans, Dairy, Fatty Acids, Refined Grains, Sodium, and Saturated Fats. Conclusions Overall, the two usual intake methods (MCMC and bivariate) yield comparable total and component scores. The population ratio method adjusts for day-to-day variation by averaging data across populations, thus arrives at scores closer to the MCMC and bivariate, hence is the preferred method of estimating a population's mean usual HEI scores on the basis of a single day of data. When distributions are needed, the MCMC and bivariate methods are recommended to adjust for measurement error, consider episodic consumption and skewness, and account for correlation between each and or all constituents and energy. Funding Sources N/A.

Abstract P206: Diet Quality is Lower Among Adolescents Who Skip Lunch

Introduction: A healthy diet is key in preventing chronic diseases and black adults have higher rates of hypertension, obesity, and heart disease death rates compared to their white counterparts. Because dietary habits track from adolescence to adulthood, it is important to understand dietary habits of adolescents. This study aimed to examine the dietary quality among adolescents who skip lunch compared to those who do not. Methods: Data were collected in 2012 from 718 adolescents attending schools in New Orleans, Louisiana. Schools were high-poverty and closed-campus. Adolescents participated in a 24-hour dietary recall using the Automated Self-Administered 24-Hour (ASA24) Dietary Assessment Tool and data were converted into Healthy Eating Index (HEI-10) scores (range 0-100; higher scores reflect higher quality diet). Mean scores were compared between students who skipped lunch and those who did not. Results: Of the 718 respondents, 88.3% were black and 15.3% of students skipped lunch. Students who ate lunch had a mean HEI score of 46.6 compared to a mean score of 41.7 for students who skipped lunch (p&lt;0.001). Students who skipped lunch also had significantly lower intake of total vegetables, whole fruits, total dairy, total protein, and higher intake of empty calories (Solid fats, alcohols, and added sugars (SoFASS)). Conclusions: Skipping lunch was associated with lower quality diet, though diet quality was low among all students. Students who skip lunch are less likely to consume vegetables, whole fruits, whole grains, and proteins and have higher intake of SoFASS. Considering over 15% of the sample did not eat lunch in a closed-campus school setting, further research should consider how to encourage students to participate in the National School Lunch Program. Table 1. HEI score comparisons between those who skip and do not skip lunch.

Diet Quality of Congregate and Home-delivered Meal Recipients in the United States (P04-076-19)

Objectives1) Examine diet quality of OAANSP meals, 2) examine diet quality of complementary food consumed in addition to the CM/HDM meal, and 3) examine diet quality of daily intake by individuals who did versus did not consume a CM/HDM meal.Background: Older adults are becoming a larger proportion of the US population, a phenomenon that will continue over the next few decades. Congregate (CM) and home-delivered meals (HDM) of the Older Americans Act Nutrition Program (OAANP) have beneficial effects on the lives of older adults. Yet, data demonstrating value remains relatively limited, arguably leading to underfunding. MethodsData from the Administration for Community Living (ACL) Outcomes Evaluation Study was collected using a multistage clustered sample design. Data collection tools comprised a survey (including information on respondent’s sociodemographics, health status, self-reported weight and height, social relationships, dietary self-reliance, participation in other nutrition assistance programs, and food security) and two 24-hour recalls. HEI-2010 was used to calculate individual and mean scores using the simple HEI scoring algorithm and the population ratio method, respectively. Radar plots were used to visualize HEI comparisons, and multiple logistic regression models were built to examine associations between diet quality and OAANSP. ResultsOAANSP participation was associated with HEI (P < 0.0001 and P = 0.04 for CM and HDM, respectively) and so was number of meals/day (P = 0.007 and P = 0.03 for CM and HDM, respectively). Compared to the complementary diet, OAANSP meals had better scores for total vegetables (P < 0.0001), and greens and beans (P < 0.001). The complementing diet quality for CM participants had better scores than the meal for total fruit, whole grains, seafood and plant proteins; and whole grains for HDM participant. Meals and complementing foods exceeded the dietary guidelines for sodium, refined grains, saturated fat, added sugar and total protein. HDM participants’ mean HEI score was lower on no meal-day compared to meal-day (P < 0.0001). ConclusionsCM/HDM meals may need to be revised, especially for sodium, added sugar and refined grains. Adding another meal daily and expanding nutrition education may be important for a healthier diet. Funding SourcesNone.

Positive Change in HEI-2005 Dietary Scores of Low-Income Adults After Participation in the Expanded Food and Nutrition Education Program (EFNEP) (P16-049-19)

ObjectivesEFNEP helps low-income audiences acquire the knowledge and skills necessary to plan, procure, and prepare nutritionally sound diets. The study objective was to determine EFNEP participants’ change in HEI-2005 scores in 2013–2014. MethodsThis study was a secondary analysis of the 24 hour recall (24HR) data collected from EFNEP participants from October 2012 - September 2014. EFNEP staff entered entry/exit 24HR data into a web-based data evaluation program using the Food and Nutrient Database for Dietary Studies (version 3.0). Initial data set (n = 135,021) was cleaned (n = 122,961) and categorical variables established for demographic predictor variables of interest (n = 97,522). Statistical analysis was performed using the car and lsmeans packages. In addition, linear models including age group, education, gender, race/ethnicity and entry HEI-2005 score were used. To account for testing multiple components, a Bonferonni adjusted ANOVA F-test was calculated. ResultsThe mean (sd) HEI scores were 51.1 (13.7) at entry and 56.5 (13.7) at exit, with a change of 5.4 (16.7) after completion of the program (P < 0.05); nine of 12 component scores increased. The change in HEI-2005 scores was significantly greater as age increased, with increasing education, and in women. Thirty-two % of the HEI score increase was due to increased fruit intake, 17% from increased vegetable intake, 17% from increased intake of “milk” and 20% due to decreased intakes of solid fats, alcohol and added sugar (increase in this component score reflects a decreased intake). Three component scores slightly decreased over the program - total grains, oils, and sodium (decrease in sodium score reflects an increased sodium intake). ConclusionsThe results reported here are the first known national documentation of change in HEI dietary quality due to EFNEP participation. Results indicate that EFNEP participation improves diet quality based on change in HEI-2005. This improvement was evident in nine of 12 HEI-2005 components and across all demographic characteristics. Results suggest EFNEP improves diets of this vulnerable population, potentially reducing chronic disease risk. Funding SourcesAgriculture Experiment Station NC2169: EFNEP Related Research, Program Evaluation and Outreach. Supporting Tables, Images and/or Graphs▪▪▪▪

Sociodemographic and Psychosocial Factors Associated with Diet Quality Among Native American Adults: Baseline Data from the OPREVENT2 Study (P04-007-19)

ObjectivesTo identify sociodemographic and psychosocial factors associated with diet quality among Native American adults. MethodsCross-sectional data from the baseline assessment of a cluster-randomized obesity prevention trial (OPREVENT2) of 580 Native American adults from six tribal communities in the Midwest and Southwest. The Healthy Eating Index (HEI-2015) was used to define diet quality, calculated from a semi-quantitative food frequency questionnaire (modified Block FFQ). Sociodemographic (age, sex, education, food assistance) and psychosocial factors (nutrition knowledge, self-efficacy, health eating intentions) were assessed via questionnaires administered by trained data collectors. One-way ANOVA, linear regression models, and two-tailed t-tests assessed compared mean total HEI scores among sociodemographic categories. Bivariate linear regression models assessed the relation between psychosocial factors and diet quality. ResultsOverall diet quality was low, with a mean HEI-2015 score of 49 (SD + 8), which is 10 points lower than in the general U.S. population. The HEI scores of smokers were an average of 3 points lower than those of non-smokers (P < 0.001), and females had better diet quality (2.2 points higher) than males (P < 0.01). Those receiving commodity food assistance had mean total HEI scores 2.7 points lower than those who did not receive commodities (P < 0.005), and no other source of food assistance was associated with HEI. Self-efficacy (b = 0.66; P < 0.001) and healthy eating intentions (b = 0.72; P < 0.001) were positively associated with mean HEI. ConclusionsWhile nutrition knowledge has been a key focus of many dietary interventions, it does not appear to be associated with better diet quality among Native Americans. This finding suggests that it is necessary to focus interventions on factors other than nutrition knowledge that may impact food choice. Because higher self-efficacy and healthy eating intentions were associated with better diet quality, a social-cognitive approach to dietary interventions may be more effective in Native American populations. Funding SourcesOPREVENT2 is funded by a grant from the National Heart, Lung, and Blood Institute.

Developing Mediterranean and Western Diets for an Anti-Inflammatory Feeding Trial (P12-017-19)

ObjectivesDesign a research diet that can be used to evaluate the relationship between nutrition and inflammation in a randomized, cross-over study in adults. MethodsDietary components were established for a Mediterranean menu and a Western menu based on a literature review. Three-day menu cycles were planned using the established components. Recipes were developed and adapted to meet menu goals at the 2000 calorie level. Proportional increments of menu items at the 2000 kcal level were used to establish 2500, 3000, and 3500 daily kcal levels to allow for varying energy requirements of participants. Meal plans were analyzed using Nutrition Data System for Research 2017 (NDSR). Healthy Eating Index was calculated using NDSR data. Results100% of grains in the Mediterranean diet, none in the Western diet, were whole grains. Sweets and pastries were included in the Western diet daily but not the Intervention diet. Mean HEI score for the three-day menu cycle was 91.1 and 37.2 for the Mediterranean and Western diet, respectively. Preliminary results from three participants fed both diets for 6 days: All three participants consumed within 5% of the planned diet with the exception of one participant, who, during the Mediterranean diet cycle, consumed 64%. Mean HEI calculated for actual participant intake (n = 3, 6 days each) was: 89.7 Mediterranean, 36.4 Western ConclusionsThe Mediterranean diet had a 10-fold higher ratio of omega-6: omega-3 fat than Western. A three-day menu cycle was planned and met goals for an anti-inflammatory feeding study. Recruitment is ongoing to study the feasibility of providing a Mediterranean style and Western style diet to adults with asthma in Baltimore City. Mean HEI for the first three recruits was similar to that of the planned menu, indicating that lack of strict diet adherence did not alter HEI goal of the diet. Although diet design was successful, there were challenges to feeding study participants that must be considered in future feeding studies. Adequate freezer space is key in food preparation and delivery. Acceptability of foods in the Mediterranean diet may effect diet compliance in those who typically eat a Western diet. Dietary restrictions and allergies excluded potential study subjects. Funding SourcesThis publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number UL1 TR001079 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS or NIH. Supporting Tables, Images and/or Graphs▪

Awareness and Use of Nutrition Information Predict Measured and Self-Rated Diet Quality of Older Adults in the United States (P18-046-19)

ObjectivesThis study aimed to investigate: 1) the diet quality of older adults, using the Healthy Eating Index 2015 (HEI-2015) and self-rated diet quality, 2) characteristics associated with reported awareness and use of nutrition information, 3) factors associated with HEI-2015 score and self-rated diet quality, including the relationship with awareness and use of nutrition information. MethodsA cross-sectional analysis of 24-hour recall and questionnaire data from the National Health and Nutrition Examination Survey 2009–2014, including 4493 subjects, aged 60 years and older. The population ratio method was used in SAS 9.4 to calculate mean HEI scores. Data was stratified by gender, then t-tests and ANOVA were used to compare means and chi-squares were used to compare proportions. Logistic and linear regression were used to test for associations with diet quality, controlling for potential covariates. ResultsThe mean total HEI score for men was significantly lower than for women (63.7 ± 0.8 vs. 66.6 ± 0.8 respectively, P < 0.0001). Compared to men, more women reported nutrition awareness (53.7% vs. 41.1%, P < 0.0001), and use of nutrition information (19.3% vs. 9.2%, P < 0.0001). Nutrition awareness was also associated with race, age, education, socioeconomic status, and food security. In bivariate analyses, nutrition awareness and use of nutrition information were significantly associated with both HEI score and self-rated diet quality in both men and women. In multivariate analyses, nutrition awareness remained a significant predictor of HEI for women but not men, and remained a significant predictor of self-reported diet quality in men but not women. ConclusionsNutrition awareness and use of nutrition information are significantly related to diet quality in older adults, even when controlling for other factors. There are differences in these relationships for older adult men versus women. Gaps in awareness, indicating need for nutrition education, exist in men, non-whites, those participating in nutrition assistance programs, and those with lower education and socioeconomic status. Closing these gaps may lead to improved diet quality in segments of the older adult population. Funding SourcesAgricultural Research Service, United States Department of Agriculture.