Measure Of Diet Quality Research Articles

The quality of Indian diets: A comparison of two indices to predict risk of dietary inadequacies linked to non-communicable diseases

Nutritional inadequacies lead to various health problems among Indians. Improvements in diets can be addressed when different aspects of diet quality are known. The primary objective of the study was to assess diet quality of Indian adults belonging to the high-income group. The study also wanted to compare the suitability of two diet quality indices for use in the Indian scenario. A cross sectional study design with non-probability purposive sampling was used to collect data from 589 adults (20-40 years) in Delhi, India. Nutrient intake was assessed using the 24- hour dietary recall method. Two internationally recognized diet quality indices - Diet Quality Index- International Score (DQI-I) and the Global Diet Quality Score (GDQS) were selected to measure diet quality. 78% of the participants had poor diet quality using the DQI-I; the average score was 56.4 ± 5.6. The average DQI-I component scores for variety, adequacy, moderation and overall balance were 13.1±2.6, 27.5±2.2, 15.3±2.9, 0.43±0.9 respectively. Females were more likely (OR=2.07, 95% C.I.: 1.26 – 3.401) to have DQI-I scores in the lowest quartile (p=0.04). 88% had a moderate risk of nutritional inadequacy while 11% were at a high risk of nutritional inadequacy on the basis of their GDQS scores, the average of which was 16.9±2.1. There was a positive association between GDQS and DQI- I scores (ρ =0.316, p<0.001). The GDQS is better for assessing nutrient adequacy with healthy and unhealthy food consumption being compared. On the other hand, DQI-I gives a composite score combining the nutrient and food group intake and observes variety, adequacy, moderation and overall balance. Behaviour change communication strategies that encourage healthier food selection and promote dietary diversity may help improve nutritional quality of diets in Indian populations such as this one.

Conducting 24-Hour Dietary Recalls in Group Settings with Adults Having Low-Income: Perspectives of EFNEP Peer Educators.

The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded program that teaches nutrition education to adults and youth with low-income. EFNEP is funded throughout the United States including federal territories. The purpose of EFNEP is to provide nutrition education. Evaluation for adult programs includes pre/post surveys and pre/post 24-h diet recalls (24HDR). A validated standard of dietary measures, 24HDR are useful when collected as designed: one-on-one by a trained professional. In EFNEP, 24HDR are collected in group settings by EFNEP peer educators who often have not received a college degree or any formal education in nutrition. The purpose of this study was to explore attitudes and behaviors of EFNEP peer educators regarding how they collect diet recalls in a group setting, their perceptions of how adult participants feel about the recalls, and the benefits and challenges of using recalls. Online interviews were conducted with EFNEP peer educators across the U.S. Peer educators recognized the importance of collecting the recall data but identified several challenges such as time, resources, and participant reluctance to complete the recall. Program evaluation through methods like the 24HDR is important to measure outcomes and inform program improvements but also needs to include how evaluation can benefit participants and minimize data collection burden. Future research needs to examine the validity of collecting recalls in a group setting compared to other measures of diet quality.

Associations between social isolation and diet quality among US adults with disability participating in the National Health and Nutrition Examination Survey, 2013–2018

Social isolation and disability are established risk factors for poor nutrition. We aimed to assess whether social isolation is associated with diet quality specifically among adults with disabilities.This cross-sectional analysis used data from the National Health and Nutrition Examination Survey, 2013–2018. Adults with a disability, who were not pregnant, breastfeeding, or missing dietary intake data were included (n = 5,167). Disability was defined as a physical functioning limitation based on difficulty with any activities of daily living, instrumental activities of daily living, lower extremity mobility activities, or general physical activities. The Healthy Eating Index (HEI)-2015 measured diet quality; higher scores correspond to higher diet quality. We computed a social isolation index by summing single status, living alone, and two social engagement difficulty measures (one point for each component met; maximum 4 points). Multivariable linear regression, controlling for demographic and health covariates, estimated differences in HEI scores for dietary intake data, by social isolation score.Over half of HEI scores were < 51, corresponding to “poor” diet quality. Higher social isolation score was associated with lower vegetable and seafood/plant proteins intake. Single status and one of two social engagement measures were associated with lower scores on certain adequacy components. Differences were modest. There was little evidence of effect modification by age or gender.Adults with disabilities are not meeting national dietary standards; improving diet quality is a priority. Whether social isolation is associated with specific dietary components in this population requires further investigation. Further research is also needed among younger adults.

Dietary Assessment by Pattern Recognition: a Comparative Analysis

BackgroundDiet quality photo navigation (DQPN) is a novel dietary intake assessment tool that was developed to help address limitations of traditional tools and to easily integrate into health care delivery systems. Prevailing practice is to validate new tools against approaches that are in wide use. ObjectiveThis study aimed to assess 1) the validity of Diet ID in measuring diet quality, food group and nutrient intake against 2 traditional dietary assessment methods (i.e., food record [FR], food frequency questionnaire) and 2) the test reproducibility/reliability of Diet ID to obtain similar results with repeat assessments. MethodsUsing a participant-sourcing platform for online research, we recruited 90 participants, 58 of whom completed DQPN, a 3-d FR (via the Automated Self-Administered 24-hour Dietary Assessment Tool), and a food frequency questionnaire (FFQ, via the Dietary History Questionnaire III). We estimated mean nutrient and food group intake with all 3 instruments and generated Pearson correlations between them. ResultsMean age (SD) of participants was 38 (11) y, and more than half were male (64%). The strongest correlations for DQPN when compared with the other 2 instruments were for diet quality, as measured by the Healthy Eating Index 2015; between DQPN and the FFQ, the correlation was 0.58 (P < 0.001), and between DQPN and the FR, the correlation was 0.56 (P < 0.001). Selected nutrients and food groups also showed moderate strength correlations. Test-retest reproducibility for measuring diet quality was evaluated for DQPN and showed a correlation of 0.70 (P < 0.0001). ConclusionsThe current study offers evidence that DQPN is comparable to traditional dietary assessment tools for estimating overall diet quality. This performance, plus DQPN’s ease-of-use and scalability, may recommend it in efforts to make dietary assessment a universal part of clinical care.

Increasing Production Diversity and Diet Quality: Evidence from Bangladesh.

In the context of rural Bangladesh, we assess whether agriculture training alone, nutrition Behavior Communication Change (BCC) alone, combined agriculture training and nutrition BCC, or agriculture training and nutrition BCC combined with gender sensitization improve: (a) production diversity, either on household fields or through crop, livestock or aquaculture activities carried out near the family homestead and (b) diet diversity and the quality of household diets. All treatment arms were implemented by government employees. Implementation quality was high. No treatment increased production diversification of crops grown on fields. Treatment arms with agricultural training did increase the number of different crops grown in homestead gardens and the likelihood of any egg, dairy, or fish production but the magnitudes of these effect sizes were small. All agricultural treatment arms had, in percentage terms, large effects on measures of levels of homestead production. However, because baseline levels of production were low, the magnitude of these changes in absolute terms was modest. Nearly all treatment arms improved measures of food consumption and diet with the largest effects found when nutrition and agriculture training were combined. Relative to treatments combining agriculture and nutrition training, we find no significant impact of adding the gender sensitization on our measures of production diversity or diet quality. Interventions that combine agricultural training and nutrition BCC can improve both production diversity and diet quality, but they are not a panacea. They can, however, contribute towards better diets of rural households.

The association between adherence to alternative healthy Diet Index (AHEI) and severity, disability, duration, and frequency of migraine headache among women: a cross-sectional study

BackgroundMigraine is a common brain disorder characterized by recurrent seizures lasting between 4 and 72 h. Dietary factors can affect migraine headaches. The Alternative Healthy Diet Index (AHEI) is a measure of diet quality and adherence to healthy dietary patterns. This study aimed to assess the association of adherence to AHEI and severity, disability, duration, and frequency of migraine headaches.MethodsIn this cross-sectional study, 266 women who suffered from migraines were selected. Usual dietary intakes were assessed using a semi-quantitative, 147-item, food frequency questionnaire (FFQ). AHEI was calculated based on FFQ. The Migraine Disability Assessments (MIDAS) and Visual Analog Scale (VAS) questionnaires were used to evaluate migraine disability, severity and the pain, duration and frequency of headaches.ResultsPeople with high adherence to AHEI, compared with low adherence, had a 43% reduction in headache duration in the crude model (OR = 0.57; 95% CI 0.34, 0.97; P = 0.03), which remained significant after adjusting for potential confounders (OR = 0.56; 95% CI 0.31, 0.99; P = 0.04). No association was found between the frequency of migraine and AHEI in both crude and adjusted models (OR = 1.19; 95% CI 0.66, 2.14; P = 0.55). In addition, no significant association was found between high adherence of AHEI and odds of severe and moderate headaches (P > 0.05).ConclusionThe results of our study showed that people with high adherence of AHEI had a 43% reduction in duration of migraine. More studies are needed to evaluate and better understand this relationship.

Psychometric Analysis of the Rapid Eating Assessment for Participants-Short Form to Evaluate Dietary Quality in a Pre-Surgical Bariatric Population.

Dietary quality and eating behaviors are essential to evaluating bariatric surgery candidates. The Rapid Eating Assessment for Participants-Short Form (REAP-S) is a previously validated measure of dietary quality suited for use in primary care. This study aimed to evaluate the psychometric properties of the REAP-S in a pre-surgical bariatric population. This study included data from one academic medical center from August 2020 to August 2022. Variables included socio-demographics, the REAP-S, mental health, and assessments of appetitive traits. Statistical methods included Cronbach's alpha, confirmatory factor analysis (CFA), and multivariable analyses. A total of 587 adult patients were included in this analysis. The mean score for the REAP-S was 28.32 (SD: 4.02), indicative of relatively moderate dietary quality. The internal consistency of the REAP-S was moderate, with a Cronbach's alpha of 0.65. The three-factor CFA model resulted in a comparative fit index of 0.91. Race (p = 0.01), body mass index (p = 0.01), food fussiness (p < 0.0001), food responsiveness (p = 0.005), and socially desirable responses (p = 0.003) were significantly associated with the total REAP-S score. Although the REAP-S's original purpose was to assess dietary quality within a primary care population, it shows promise for application within a bariatric surgery-seeking population.

Cooking and food skills confidence of team sport athletes in Ireland.

Nutritional support often focuses on cooking and food skills such as food selection, recipe planning and meal preparation. Individuals with greater cooking and food skills confidence have previously displayed higher diet quality scores and lower intakes of overall calories, saturated fat and sugar. Despite this, the cooking and food skills of team sport athletes have yet to be investigated. This study aimed to evaluate the relationship between cooking and food skills confidence and athletes' demographic characteristics. A validated measure for the assessment of cooking and food skills confidence was distributed via an online survey. Participants were required to rate their confidence on a Likert scale (1 "very poor" - 7 "very good") for 14 items related to cooking skills and 19 items for food skills. Food engagement, general health interest and self-reported fruit and vegetable consumption as a measure of diet quality were also measured. The survey was completed by 266 team sport athletes (male: 150, female: 116, age: 24.8 ± 6.1 years). Group differences were explored using t-tests and ANOVA and associations were evaluated using Spearman's correlation and hierarchical multiple regressions. Athletes' total cooking and food skills confidence was 62.7 ± 17.4 (64.0 ± 17.8%) and 83.8 ± 20.1 (63.0 ± 15.1%), respectively. Females reported greater confidence in both cooking (+20.3%, p < 0.01) and food skills (+9.2%, p < 0.01). Hierarchical multiple regressions explained 48.8% of the variance in cooking skills confidence and 44% of the variance in food skills confidence with gender, previous culinary training, cooking learning stage, general health interest and food engagement all remaining significant in the cooking skills confidence model and cooking frequency, previous culinary training, general health interest and food engagement remaining significant in the food skills confidence model. Male team sport athletes may benefit the most from educational interventions designed to increase cooking and food skills confidence.

Factors Associated with Diet Quality during COVID-19 Pandemic among Undergraduate Students in Universiti Putra Malaysia

Introduction: The COVID-19 preventive and restriction measures may disrupt an individual’s daily diet quality, potentially leading to obesity and other non-communicable diseases. This study aims to assess and determine factors associated with diet quality during the COVID-19 pandemic among undergraduate students at Universiti Putra Malaysia. Methods: 130 eligible undergraduate students, who participated in this cross-sectional study were assessed using Global Physical Activity Questionnaire (GPAQ), Depression, Anxiety, Stress Scale (DASS-21), and Rapid Eating Assessment for Participants short version (REAP-S). Self-reported sociodemographic characteristics, body weight status, and nutrition knowledge were evaluated. Statistical analysis was conducted using IBM SPSS 26.0 and p&lt;0.05 was denoted as statistically significant. Results: Most of the respondents were female (76.2%), aged between 20-22 years old (64.6%), Bumiputera (80.0%), funded by loan or scholarship (73.1%), low socioeconomic status (60.0%), residing in the family household (57.7%), consumed home-cooked meals (58.5%), and used the e-hailing food services for 0-3 days/week (63.1%). There was an equal distribution in the year and program of study in every selected faculty. Most were having normal BMI status (54.6%), good nutrition knowledge (66.9%), sedentary (48.5%), less severe mental health status (85.4%), and good diet quality (62.3%). Nonetheless, throughout the study, only the anxiety subscale was associated with diet quality (r= -0.20, p&lt;0.05). Conclusion: Perceived anxiety may lead to poor diet quality. Future studies could determine the food environment and food security faced by the students as these factors vary among individuals. It is also recommended to measure diet quality differences before, during, or after the pandemic.

Development of a measure of dietary quality for the UK Biobank.

Previous studies of the UK Biobank have examined intake of single food items and their association with health outcomes. Our aim was to develop a dietary quality score and examine the relationship between this score and markers of cardiometabolic health. Principal component analysis was performed on dietary data from UK Biobank participants. Linear regression was used to analyse the relationship between diet and cardiometabolic health. The first component explained 14% of the variation in the dietary data. It was characterised by high consumption of meat and low fibre carbohydrates, and a low intake of fruit and vegetables. A higher score, indicative of healthier diet, was associated with lower systolic and diastolic blood pressure (β -0.81, 95% CI -1.0, -0.62; β-.61, 95% CI -0.72, -0.5) and a healthier lipid profile (lower levels of cholesterol β -0.05, 95% CI -0.06, -0.04, triglycerides β -0.05, 95% CI -0.06, -0.03, and higher HDL cholesterol β 0.01, 95% CI 0, 0.01). The dietary quality score was a good approximation of overall dietary quality. An unhealthy diet was associated with markers of poorer cardiometabolic health.

Red Blood Cell Membrane Fatty Acid Composition, Dietary Fatty Acid Intake and Diet Quality as Predictors of Inflammation in a Group of Australian Adults.

Evidence suggests that diet can play a role in modulating systemic inflammation. This study aims to examine the relationship between fatty acids (FAs) (self-reported dietary intake and red blood cell (RBC) membrane fatty acid concentrations), three diet quality scores, and the plasma concentrations of inflammatory markers (interleukin-6, IL-6; tumour necrosis factor alpha, TNF-α; and C-reactive protein, CRP) in a group of Australian adults (n = 92). Data were collected on their demographic characteristics, health status, supplement intake, dietary intake, RBC-FAs and plasma inflammatory markers over a nine-month period. Mixed-effects models were used to determine the relationship between RBC-FAs, dietary intake of FAs, diet quality scores and inflammatory markers to determine which variable most strongly predicted systemic inflammation. A significant association was identified between dietary saturated fat intake and TNF-α (β = 0.01, p < 0.05). An association was also identified between RBC membrane saturated fatty acids (SFA) and CRP (β = 0.55, p < 0.05). Inverse associations were identified between RBC membrane monounsaturated fatty acids (MUFAs) (β = -0.88, p < 0.01), dietary polyunsaturated fatty acids (PUFAs) (β = -0.21, p < 0.05) and CRP, and the Australian Eating Survey Modified Mediterranean Diet (AES-MED) score and IL-6 (β = -0.21, p < 0.05). In summary, using both objective and subjective measures of fat intake and diet quality, our study has confirmed a positive association between saturated fat and inflammation, while inverse associations were observed between MUFAs, PUFAs, the Mediterranean diet, and inflammation. Our results provide further evidence that manipulating diet quality, in particular fatty acid intake, may be useful for reducing chronic systemic inflammation.

Association of Above-Average Healthy Eating Index and Pregnancy Outcomes [ID: 1375493

INTRODUCTION: Nutritional health plays an important role in the intrauterine environment's effect on the developmental origins of disease. The Healthy Eating Index (HEI), a measure of dietary quality scaled 0–100 with 100 being ideal, has been shown to be poor on average in Americans. In a prospective cohort study of healthy pregnant individuals with a singleton gestation, we assessed dietary quality and its association with pregnancy outcomes. METHODS: Individuals completed their first study visit at a mean gestational age of 15 weeks, and three, 24-hour dietary recalls were obtained. Participants were dichotomized by HEI scores as above and at or below the U.S. average (&gt;58 and ≤58). We assessed outcomes including gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), and large for gestational age (LGA &gt;90th percentile). Statistical analysis was completed using two-sample t tests and Fisher's exact tests (P=.05). The study was IRB approved. RESULTS: Of the 67 participants included in the analysis, 45 (67%) had above average and 22 (33%) had below average HEI scores. The incidence of HDP was significantly lower among individuals with higher dietary quality (22.8% versus 4.4%, P=.03). Although the rates of GDM were not different between the two groups (15.6% versus 9.1%, P=.71), the proportion of LGA infants trended lower in those with higher HEI (4% versus 22%, P=.19). CONCLUSION: Our data suggest that higher dietary quality may lead to improved pregnancy outcomes and support the potential role of the HEI for further exploring these relationships in future research.

Greenhouse gas emissions, cost, and diet quality of specific diet patterns in the United States

BackgroundMajor policy agendas are calling for accelerated investment in research that addresses the impact of diet patterns on multiple domains of sustainability. ObjectivesTo evaluate the comparative greenhouse gas emissions, diet cost, and diet quality of plant-based, low-grain, restricted carbohydrate, low-fat, and time-restricted diet patterns on a daily per capita basis. MethodsDietary data from the National Health and Nutrition Examination Survey (2013–2016, n = 4025) were merged with data on greenhouse gas emissions (GHGEs) and food prices from multiple databases. The Healthy Eating Index-2015 was used to measure diet quality. ResultsThe plant-based diet pattern had the lowest GHGEs [3.5 kg carbon dioxide equivalent (CO2eq); 95% confidence interval (CI): 3.3, 3.8 kg CO2eq] and among the lowest diet cost ($11.51; 95% CI: $10.67, $12.41), but diet quality (45.8; 95% CI: 43.3, 48.5) was similar (P > 0.005) to most other diet patterns. All of the sustainability impacts of the low-grain diet pattern were intermediate. The restricted carbohydrate diet pattern had the highest diet cost ($18.46; 95% CI: $17.80, $19.13) but intermediate diet quality (46.8; 95% CI: 45.7, 47.9) and moderate-to-high GHGEs (5.7 kg CO2eq; 95% CI: 5.4, 5.9 kg CO2eq). The low-fat diet pattern had the highest diet quality (52.0; 95% CI: 50.8, 53.1) and intermediate GHGEs (4.4 kg CO2eq; 95% CI: 4.1, 4.6 kg CO2eq) and diet cost ($14.53; 95% CI: $13.73, $15.38). The time-restricted diet pattern had among the lowest diet quality score (42.6; 95% CI: 40.8, 44.6), had GHGEs similar to most other diet patterns (4.6 kg CO2eq; 95% CI: 4.2, 5.0 kg CO2eq), and low-to-moderate diet cost ($12.34; 95% CI: $11.38, $13.40). ConclusionsMost diet patterns are associated with sustainability trade-offs. The nature of these trade-offs can help inform discussions on food and nutrition policy in the United States, including the National Strategy on Hunger, Nutrition, and Health, and future Dietary Guidelines for Americans.

Associations of food choice values and food literacy with overall diet quality: a nationwide cross-sectional study in Japanese adults.

To date, a limited number of studies have examined aspects of food choice values and food literacy in relation to some aspects of dietary behaviours. The aim of this cross-sectional study was to comprehensively examine the associations of food choice values and food literacy with diet quality. In total, 2231 Japanese adults aged 19-80 years completed questionnaires asking about food choice values (accessibility, convenience, health/weight control, tradition, sensory appeal, organic, comfort and safety) and food literacy characterised by nutrition knowledge, cooking skills, food skills and eating behaviours (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness and slowness in eating). As a measure of diet quality, the Healthy Eating Index-2015 (HEI-2015) was calculated using a brief-type diet history questionnaire (BDHQ) or a food combination questionnaire (FCQ). In males, after adjustment for potential confounding factors (including age, BMI and the ratio of reported energy intake to estimated energy requirement), the HEI-2015 derived from BDHQ and that derived from FCQ were associated significantly (P ≤ 0·02) and positively with the food choice values of organic and inversely with food fussiness. In females, the HEI-2015 showed positive associations with the food choice values of health/weight control, nutrition knowledge and cooking skills and an inverse association with food fussiness, irrespective of the dietary assessment questionnaire (P ≤ 0·03). In conclusion, this study suggests that several aspects of food choice values and food literacy were associated with diet quality, and the aspects related differed between males and females.

Association between ultra-processed foods and recurrence of depressive symptoms: the Whitehall II cohort study

ABSTRACT Objectives To examine the association between high intakes of ultra-processed foods (UPF) and recurrence of depressive symptoms (DepS) in a Western non-Mediterranean country and its contribution to the overall diet-depression relationship. Methods Analyses were carried out on British participants from the Whitehall II cohort. Present analyses were restricted to white participants N = 4554 (74% men, mean age = 61; SD = 5.9). UPF consumption was estimated from a 127-item food frequency questionnaire using the NOVA classification, and cumulative average of UPF intakes (g/day) over 11 years of exposure (1991/1994–2002/2004) was computed. Recurrent DepS after measurement of UPF was defined as having two or more episodes of DepS (the Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16 or antidepressants use) during four phases of follow-up (2002/2004–2015/2016). Results Over the follow-up, 588 (12.9%) cases of recurrent DepS were observed. After adjusting for socio-demographic factors, health behaviours and health status, participants in top quintile of UPF intakes [mean 33% of total daily intakes in grams] had 31% higher odds of recurrent DepS (odds ratio 1.31; 95% CI 1.04–1.64) compared to participants in the four lowest quintiles of UPF [mean 18.1% of total daily intakes in grams]. Additional analyses showed that associations between adherence to several diet quality measures and recurrent DepS were partially attenuated (17–27%) by UPF intakes. Conclusion In this British population, high intakes of ultra-processed foods were associated with increased odds of recurrent depressive symptoms and contributed to the overall diet quality-depressive symptoms association.

Abstract P301: Diet Quality and Frailty in Israeli Adults 65 Years or Older

Background: Frailty represents a transition state between successful aging and disability. Nutrition may promote successful aging. However, only a few studies explicitly examined the association between overall diet quality and frailty in the oldest old age group. Methods: We studied an older adult (65+) cohort that participated in the Israeli National Health and Nutrition Survey of Older Adults in 2005-2006 (T1, N=1,799). Survivors of T1 were contacted, and from 2017-2019, an extensive interview and a functional assessment were conducted (T2) among 604 past participants. A 24-hour dietary recall, assessed at T1, was used to calculate the healthy eating index (HEI-2015), a measure of diet quality used to assess how well a set of foods aligns with key recommendations. A frailty index (FI) based on accumulation of deficits was developed and comprised 33 variables, including clinical, functional, and cognitive measures. A threshold of ≥ 0.26 was used to define frailty. Frail participants at T1 were excluded from the analysis (n=125). Logistic regression models were constructed to assess the association of HEI-2015 with frailty incidence. Inverse probability weighting was used to minimize attrition bias. Results: Among the 479 T2 participants analyzed (mean [SD], age 84 [5] years, 50% women), 225 (46%) were classified as frail. Frail participants were older, less educated, with a lower household income and a higher comorbidity burden at baseline than non-frail subjects. After adjustment for sociodemographic and lifestyle factors, a higher HEI-2015 score was associated with decreased odds of incident frailty [odds ratio, 0.56 (95% CI: (0.35-0.90), for the upper tertile; 0.68, (95% CI: 0.42-1.09), for the middle tertile, compared with the lower tertile ( P for trend = .005). A spline analysis supported a linear decline in frailty with increasing HEI-2015 scores (Figure). Conclusion: In this cohort study of oldest-old participants, improved diet quality was inversely associated with frailty incidence in a dose-dependent manner.

Abstract 21: Ultra-Processed Food Consumption is Associated With Higher Coronary Heart Disease Risk in United States Women From Two Large Prospective Cohorts

Introduction: Ultra-processed foods (UPF) are associated with cardiovascular disease (CVD) in European populations. Evidence is limited from U.S. populations, for specific UPF subgroups, and in the diet quality context. Hypothesis: We hypothesized that U.S. women with higher UPF intake have higher CVD risk and evaluated this association by UPF subgroup and diet quality. Methods: Women from the Nurses' Health Study (NHS; n=75,639; 30-55y) and NHSII (n=90,770; 25-42y) with complete dietary intake data and without CVD/cancer at baseline were prospectively followed (1984-2014 and 1991-2015). Diet, demographics, lifestyle, and medical history were assessed every 2-4y using validated food frequency questionnaires and follow-up questionnaires. NOVA-classified UPF (% of energy) included ten subgroups: bread and cereals; sauces, spreads, and condiments; sweet snacks and desserts; savory snacks; sugar-sweetened beverages; animal-based products; ready-to-eat/heat dishes; yogurt and dairy desserts; hard liquors, and artificially sweetened beverages. The Alternative Healthy Eating Index (AHEI) measured diet quality. Primary outcomes were non-fatal myocardial infarction, fatal coronary heart disease (CHD), and non-fatal/fatal stroke. Multivariable-adjusted Cox regression estimated the associations of cumulatively-averaged UPF and subgroup intake quintiles with CVD risk. Each cohort was analyzed separately, and data were meta-analyzed (fixed effects models). Results: We identified 7,659 CVD cases (CHD=3,889; stroke=3,855) in NHS during 2,002,986 person-years of follow-up, and 1,588 CVD cases (CHD=807; stroke=786) in NHSII during 2,308,569 person-years. Pooled multivariable-adjusted hazard ratios [HRs (95%CIs)] of CVD, CHD, and stroke for the highest quintile of UPF intake ( vs. lowest) were 1.11 (1.04, 1.19; p-trend =0.002), 1.18 (1.08, 1.30; p-trend &lt;0.001), and 1.05 (0.95, 1.15; p-trend =0.37), respectively. Positive associations remained for participants with higher diet quality (AHEI above the sample median): CVD [HR=1.15 (1.05, 1.25; p-trend =0.009)] and CHD [HR=1.24 (1.09, 1.41; p-trend =0.007)]. Values of I 2 were non-significant. For UPF subgroups, intake for the highest quintile of sugar-sweetened beverages and animal-based products was significantly associated with higher risk of CVD, CHD, and stroke. Significant inverse associations were noted for bread and cereals and yogurt and dairy dessert with CVD, CHD, and stroke, for savory snacks with CHD, and for ready-to-eat/heat dishes with stroke. Conclusion: U.S. women with long-term higher total UPF intake had a higher CHD risk, even with a high-quality diet. Sugary drinks and animal-based products were predominant for CVD risk. Some UPF subgroups may contain beneficial components, warranting more nuanced food subgroup analyses. Replication is needed in racially/ethnically-diverse populations.

Abstract P608: Dynamic Changes in Dietary Guidelines Adherence and Its Association With All-Cause Mortality Among Middle-Aged Chinese: A Longitudinal Study From the China Health and Nutrition Survey

Background: The traditional approach to evaluating dietary quality is based on the achievement of the recommended intakes for each food group, which may overlook the achievement of correct relative proportions between food groups. We propose a “Dietary Adherence Score (DAS)” to assess the degree of similarity between subjects' diets and those recommended in the Chinese Dietary Guidelines (CDG). Furthermore, it is important to incorporate the time-dependent nature of dietary quality into the mortality prediction. Aim: To investigate the association between long-term changes in adherence to the CDG and all-cause mortality. Method: The study included 4533 participants aged 30-60 from the China Health and Nutrition Survey study with a median follow-up of 6.9 years. Intakes from 10 food groups were collected in 5 survey rounds from 2004 to 2015. We calculated the Euclidean distance between the intake of each food and the CDG-recommended intake, and then summed all the foods as DAS. Mortality was assessed in 2015. The latent class trajectory modeling was used to identify 3 classes of participants with distinct longitudinal trajectories of DAS during the follow-up period. The Cox proportional hazard model was used to assess the risk of all-cause mortality in the 3 classes of people. Risk factors for death and a traditional measure of diet quality, the Alternative Healthy Eating Index (AHEI), were adjusted in the models. Result: There were 187 deaths overall. Participants in the first class identified had consistently low and decreasing DAS levels (coefficient= -0.020) over their lifetime, compared with a hazard ratio (HR) of 4.4 (95% confidence interval [CI]: 1.5, 12.7) for participants with consistently high and increasing DAS levels (coefficient= 0.008). Those with moderate DAS had an HR of 3.0 (95% CI: 1.1, 8.4). The effect of DAS was independent of AHEI. Conclusion: People with consistently high adherence to CDG-recommended dietary patterns had a significantly lower mortality risk. DAS is a promising method to assess diet quality.

Diet Quality and Liver Health in People Living with HIV in the MASH Cohort: A Multi-Omic Analysis of the Fecal Microbiome and Metabolome.

The gut-liver axis has been recognized as a potential pathway in which dietary factors may contribute to liver disease in people living with HIV (PLWH). The objective of this study was to explore associations between dietary quality, the fecal microbiome, the metabolome, and liver health in PLWH from the Miami Adult Studies on HIV (MASH) cohort. We performed a cross-sectional analysis of 50 PLWH from the MASH cohort and utilized the USDA Healthy Eating Index (HEI)-2015 to measure diet quality. A Fibrosis-4 Index (FIB-4) score < 1.45 was used as a strong indication that advanced liver fibrosis was not present. Stool samples and fasting blood plasma samples were collected. Bacterial composition was characterized using 16S rRNA sequencing. Metabolomics in plasma were determined using gas and liquid chromatography/mass spectrometry. Statistical analyses included biomarker identification using linear discriminant analysis effect size. Compared to participants with FIB-4 ≥ 1.45, participants with FIB-4 < 1.45 had higher intake of dairy (p = 0.006). Fibrosis-4 Index score was inversely correlated with seafood and plant protein HEI component score (r = -0.320, p = 0.022). The relative abundances of butyrate-producing taxa Ruminococcaceae, Roseburia, and Lachnospiraceae were higher in participants with FIB-4 < 1.45. Participants with FIB-4 < 1.45 also had higher levels of caffeine (p = 0.045) and related metabolites such as trigonelline (p = 0.008) and 1-methylurate (p = 0.023). Dietary components appear to be associated with the fecal microbiome and metabolome, and liver health in PLWH. Future studies should investigate whether targeting specific dietary components may reduce liver-related morbidity and mortality in PLWH.

The Association between Vegan, Vegetarian, and Omnivore Diet Quality and Depressive Symptoms in Adults: A Cross-Sectional Study

Dietary patterns and depressive symptoms are associated in cross-sectional and prospective-designed research. However, limited research has considered depression risk related to meat-based and plant-based dietary patterns. This study explores the association between diet quality and depressive symptoms across omnivore, vegan, and vegetarian dietary patterns. A cross-sectional online survey utilised the Dietary Screening Tool (DST) and the Centre for Epidemiological Studies of Depression Scale (CESD-20) to measure diet quality and depressive symptoms, respectively. A total of 496 participants identified as either omnivores (n = 129), vegetarians (n = 151), or vegans (n = 216). ANOVA with Bonferroni post hoc corrections indicates that dietary quality was significantly different between groups F(2, 493) = 23.61, p < 0.001 for omnivores and vegetarians and omnivores and vegans. Diet quality was highest in the vegan sample, followed by vegetarian and omnivore patterns. The results show a significant, moderately negative relationship between higher diet quality and lower depressive symptoms (r = -0.385, p < 0.001) across groups. Hierarchical regression showed that diet quality accounted for 13% of the variability in depressive symptoms for the omnivore sample, 6% for vegetarians, and 8% for vegans. This study suggests that diet quality in a meat-based or plant-based diet could be a modifiable lifestyle factor with the potential to reduce the risk of depressive symptoms. The study indicates a greater protective role of a high-quality plant-based diet and lower depressive symptoms. Further intervention research is needed to understand the bi-directional relationship between diet quality and depressive symptoms across dietary patterns.