Measure Of Overall Diet Quality Research Articles

Evaluation of the Prime Diet Quality Score from Early Childhood Through Mid-Adolescence

BackgroundFew diet quality indices have been developed and validated for use among children and adolescents. Additionally, many available indices require completion of burdensome dietary assessments. ObjectivesWe aimed to calculate and evaluate the performance of a modified version of the food-based Prime Diet Quality Score (PDQS) derived from different diet assessment methods conducted at 4 time points in a single study population from childhood through adolescence. MethodsAmong 1460 child participants in the Project Viva cohort, we calculated the PDQS in early and mid-childhood and early and mid-adolescence using dietary data obtained from food frequency questionnaire (early childhood: parent report), PrimeScreen (mid-childhood: parent report; early adolescence: self-report) and 24-h recall (mid-adolescence: self-report). We evaluated construct and relative validity and internal reliability of the score in each life stage. ResultsThe PDQS showed a range of scores at all life stages and higher scores were associated with intake of many health-promoting macronutrients and micronutrients (e.g., protein, fiber, and vitamins) in early childhood and mid-adolescence. The PDQS performed similarly to the Youth Healthy Eating Index/Healthy Eating Index (Spearman r = 0.63–0.85) in various assessments. Higher PDQS was associated with expected characteristics including more frequent breakfast eating, family dinners, and vigorous physical activity; with less frequent TV viewing and fast food intake; and with more sleep and higher maternal diet scores during pregnancy. Cross-sectional associations of the PDQS with various anthropometric measurements and biomarkers were inconsistent but generally in the expected directions (e.g., higher PDQS associated with lower triglycerides and insulin and higher HDL cholesterol). Internal reliability was consistent with what has been found for other diet quality indices. ConclusionsThe PDQS can be calculated from data collected using different and brief dietary assessment methods and appears to be a valid and useful measure of overall diet quality in children and adolescents.Project Viva was registered at clinicaltrials.gov as NCT02820402.

Validation of a new scoring approach of a child dietary questionnaire for use in early childhood among low-income, Latino populations

BackgroundMeasuring diet quality in early childhood requires time-intensive and costly measurements (e.g., 24-hour diet recall) that are especially burdensome for low-income, minority populations. This study aimed to validate a new method for calculating overall diet quality among low-income, Latino preschoolers.MethodsThis study was an observational study using data from a randomized controlled trial. Participants included parents of Latino preschoolers who reported child diet quality at baseline, 4-month, 7-month, 12-month, and 13-month follow-up. At each timepoint parents responded to a 28-item child dietary questionnaire (CDQ), based on the National Health and Nutrition Examination Survey (NHANES) dietary module, which generated the number of times/day that a child ate each of 28 foods in the past month. These 28 items were then used to create a total standardized child diet quality index (possible range 0-100), using a percent of maximum method. Parents were asked to complete three 24-hour diet recalls at the 13-month follow-up, from which the 2015 Healthy Eating Index (HEI) was derived. Construct validity was evaluated by Spearman’s rank correlations between the new child diet quality index and the 2015 HEI at the 13-month follow-up. Test-retest reliability was assessed by intraclass correlation coefficients (ICC) for sequential pairs of time points.ResultsAmong 71 eligible parent-child pairs, mean child age was 4.2 (SD = 0.8) years, 50.7% of children were female, and mean child body mass index (BMI) was 17.8 (SD = 2.0) kg/m2. Mean Child Diet Quality Index was 45.2 (SD = 3.2) and mean HEI was 68.4 (SD = 10.5). Child Diet Quality Index and HEI total scores were significantly correlated (r = 0.37; p = 0.001). Test-retest ICCs were statistically significant between all sequential pairs of time points.ConclusionThe new approach for calculating a measure of overall diet quality from the previously-validated 28-item dietary questionnaire demonstrated modest construct validity. When time and resources are limited, this new measure of overall diet quality may be an appropriate choice among low-income, Latino preschoolers.Trial RegistrationThis reports presents observational data collected as a part of a clinical trial, which was registered on clinicaltrials.gov prior to participant enrollment (NCT03141151).

Association of Prudent, Western, and Alternate Healthy Eating Index (AHEI-2010) dietary patterns with serum testosterone and sex hormone binding globulin levels in men.

The association of dietary patterns with testosterone (T) and sex hormone binding globulin (SHBG) levels remains unclear. We investigated the associations of dietary patterns with T and SHBG levels to determine whether these associations vary by obesity status. A cross-sectional analysis was conducted in 1376 middle-aged (≥ 40years old) men of the Health Professionals Follow-up Study. Prudent (rich in whole grains and dietary fiber) and Western (rich in red meat and refined grains) diet scores were identified using principal component analysis. The Alternate Healthy Eating Index 2010 (AHEI-2010) score, a measure of overall diet quality, was defined based on foods and nutrients predictive of chronic disease risk. We identified a weak inverse association between AHEI-2010 and T levels (Ptrend = 0.07), but no associations with other dietary patterns. Null associations were observed between diet scores and SHBG. Obesity status appeared to modify the associations for the Prudent diet and AHEI-2010 with both T and SHBG (Pinteraction ≤ 0.05). T levels were lower (Q1 vs. Q4, 4.23 vs. 3.38) and SHBG higher (Q1 vs. Q4, 48.6 vs. 64.3) with adherence to a more prudent diet among obese men (Ptrends ≤ 0.05). We observed a weak inverse association between AHEI-2010 and T levels. Null associations were identified for SHBG. Obesity status seemed to modulate associations of T and SHBG levels with diet scores, especially the AHEI-2010 and prudent diets. However, this research question warrants further investigation in prospective studies.

Diet quality (adequacy, variety, moderation) in relation to biomarkers of metal exposure in school-age children

BACKGROUND AND AIM: The relationship between dietary consumption and exposure to toxic metals/metalloids is complex. Foods may be a source of toxicant exposure, but they also provide many nutrients that compete with toxicants for intestinal absorption or contribute to lowering the toxicity of toxicants. Previous studies found associations between specific foods and blood or urinary lead (ex., diary), arsenic (rice) or cadmium (grains) biomarkers in children. Basing dietary recommendations on individual foods or single toxicants could result in contradictory or potentially harmful guidance. Our objective was to relate measures of overall diet quality with biomarkers of arsenic, lead and cadmium exposure in school-age children. METHODS: We constructed measures of dietary variety (servings of meats/eggs, dairy/beans, grains, fruits, vegetables), adequacy (intake of vegetables, fruit, grains, fiber, protein, iron, calcium and vitamin C) and moderation (intake of total fat, sugar sweetened beverages, pastries, sweets and chips) based on two non-consecutive 24-hr diet recalls conducted among parents of ~7 year old children in Montevideo Uruguay. Blood lead levels (BLL) were measured using atomic absorption spectrometry and total urinary arsenic (U-As) and cadmium (U-Cd) were measured via IC-PMS. Using linear regression models, we estimated the association between dietary quality and toxicant biomarkers, adjusting for child age, sex, and household socioeconomic status. RESULTS:U-As (median [5%, 95%]: 9.9 [4.1, 27.3] μg/L), U-Cd (0.06 [0.02, 0.15] μg/L) and BLL (3.8 [0.8, 7.8] μg/dL) indicated low-to-moderate exposure. Mean variety, adequacy and moderation scores were, respectively: 9.7±3.9 (out of 20), 25.0±4.7 (out of 40) and 12.3±4.8 (out of 30). Biomarkers of lead or arsenic were not associated with diet quality. Dietary variety and moderation were inversely associated with urinary cadmium concentrations. CONCLUSIONS:Diets that are varied and provide adequate levels of nutrients do not contribute to biomarkers of children’s exposure to arsenic, cadmium and lead. KEYWORDS: diet quality, lead, cadmium, arsenic, child

Abstract 2586: Association between healthy eating index score and risk of pancreatic cancer in the prostate, lung, colorectal, and ovarian cancer screening trial (PLCO)

Abstract Pancreatic cancer is one of the deadliest malignancies in the US. Most cases are diagnosed in the late, non-resectable stages largely due to lack of effective screening tests. There is an urgent need to identify modifiable risk factors for primary prevention of this malignancy. To date, only a few risk factors (family history, smoking, and type-2 diabetes) have been identified for pancreatic cancer. Although several lines of evidence suggest that nutrition plays a role in pancreatic cancer, few nutrients have been consistently associated with its risk in epidemiologic studies. Therefore, the present study sought to investigate the association between the 2015 Healthy Eating Index (HEI-2015) score and pancreatic cancer risk among participants in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). The HEI-2015 is a measure of overall diet quality used to assess how well a diet conforms to key recommendations of the 2015-2020 Dietary Guidelines for Americans. The HEI score is made up of 13 food components, with higher scores (ranged 0-100 points) indicating better dietary quality. In the present study, the HEI-2015 scores were calculated from participant responses to two food frequency questionnaires, dietary questionnaire (DQX) and dietary history questionnaire (DHQ) administered at baseline and the three-year anniversary of enrollment, respectively. During a median follow-up of 12.2 years, 279 cases of pancreatic cancer were identified among 58,477 participants who completed the DQX, while 101,721 participants who responded to the DHQ gave rise to 380 cases of pancreatic cancer over a median follow-up of 8.9 years. Hazard ratios (HR) and 95% confidence internals (CI) were estimated using Cox proportional hazards regression for total HEI score and individual score components, classified into adequacy components (total fruit, whole fruits, total vegetables, greens and beans, whole grains, dairy, total protein foods, seafood and plant proteins, and fatty acids) and moderation components (refined grains, sodium, added sugars, and saturated fats). After adjustment for confounders, no significant association between total HEI score and pancreatic cancer was identified [HR (95% CI) for quartile (Q) 4 vs. Q1: 0.86 (0.60, 1.09) for DQX and 1.03 (0.77, 1.39) for DHQ]. The individual component scores for total vegetables and added sugar in the DHQ analysis and whole grain score in the DQX analysis were inversely associated with pancreatic cancer risk [HR (95% CI) for one-point score increase: 0.89 (0.81, 0.98), 0.95 (0.91, 0.99), and 0.94 (0.89, 0.99), respectively]. In summary, our study did not find a significant association between overall diet quality and pancreatic cancer risk but revealed significant associations with total vegetables, added sugar, and whole grains in the PLCO trial. Citation Format: Margaret L. Hoyt, Jianjun Zhang. Association between healthy eating index score and risk of pancreatic cancer in the prostate, lung, colorectal, and ovarian cancer screening trial (PLCO) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2586.

A relational approach to evaluate food environments finds that the proximate food environment matters for those who use it.

Using a relational approach, this study investigates whether shopping close to home moderates the relationship between the proximate food environment and diet. To address this question, we develop the proximate food retail quality (PFRQ) score, an inverse-distance weighted measure of all food retailers within a resident's neighborhood that incorporates audit data of each food retailer. This study relies on data collected through 24-h dietary recalls and psychosocial surveys administered to 449 adults in two socioeconomically matched neighborhoods. Food retailer audits collected data on the availability, price, and quality of healthful foods. Seventy-one percent of study participants report conducting at least 50% of their food shopping within approximately one mile of their home. Household income and education are associated with likelihood to shop close to home, while access to a personal vehicle is not. Finally, results suggest that, for residents who shop primarily close to home, a one unit increase in proximate food retail environment score is associated with a 17.2-point increase in HEI-2010 score, a measure of overall diet quality that ranges from zero to 100. This study suggests that the food environment matters for those who use it and that a low-quality proximate food environment can amplify individual disadvantage.

An Increase in SNAP Benefits Did Not Impact Food Security or Diet Quality in Youth

BackgroundLow diet quality during childhood and adolescence is associated with adverse health outcomes later in life. Diet quality is generally poor in American youth, particularly in youth of low socioeconomic status. The Supplemental Nutrition Assistance Program (SNAP) is the primary safety net to help low-income households afford a healthy diet. Yet self-selection into the program creates challenges in estimating the relationship between SNAP and diet outcomes. ObjectiveThis study examined how the increase in SNAP benefits during the American Recovery and Reinvestment Act (ARRA) affected food security and diet quality in low-income youth. DesignThis analysis used a difference-in-differences design and data from the National Health and Nutrition Examination Survey 2007-2008 to 2011-2012 waves. Participants/settingThe sample included children and adolescents aged 2 to 18 years with household income ≤250% of the Federal Poverty Line. Food security and diet outcomes in SNAP-eligible youth (n = 2,797) were examined, with children in nearly SNAP-eligible households serving as a comparison group (n = 1,169). The diet quality analysis stratified the sample by age range. Main outcome measuresThe study assessed food security and 6 dietary outcomes: 2 nutrients (sodium and fiber), 3 food categories (fruit, vegetables, and sugar-sweetened beverages), and 1 measure of overall diet quality (Healthy Eating Index 2010). Statistical analysis performedLogistic regression and linear regression were used to estimate the relationship between SNAP eligibility and child food security and diet. ResultsIn unadjusted analysis, approximately 64% of SNAP-eligible children were food secure before ARRA and 73% were food secure while ARRA was in effect. Using logistic regression in a difference-in-differences framework, the ARRA SNAP benefit increase was not significantly associated with food security (odds ratio 1.37, P = 0.43). Diet quality of SNAP-eligible children was low, scoring a 46 out of 100 on the Healthy Eating Index 2010. Measures of diet quality did not significantly change from the pre-ARRA period to the ARRA period; this did not differ by age range. ConclusionsThe increase in SNAP benefits during ARRA did not significantly impact food security or diet quality in low-income children and adolescents. Additional research to better understand how SNAP benefits impact dietary choice is warranted.

The Role of Diet Diversity and Diet Indices on Allergy Outcomes

Nutrients in foods are not eaten in isolation and food intake interacts in a complex manner, affecting health and disease outcomes. For this reason, focusing on the whole “pattern” of dietary intake instead of the single nutrients or groups of nutrients when studying diseases outcomes is increasingly appealing and growing. Diet diversity refers to the variety of foods being eaten, and the terms, diversity or variety, are often used interchangeably. When the overall diet is characterized by healthy foods, diet diversity will reflect a diversity/variety of healthy foods eaten over a period of time. The introduction of solid foods in the 1st year of life is considered a measure of increased diet diversity. Consuming a diverse range of foods and food allergens in the first year of life may increase intake of important nutrients and positively affect the gut microbiome structure and function. Intake of omega-3 fatty acids and fibers/prebiotics may be particularly important but more information is required about dose and which individuals are most likely to benefit. Increased diet diversity in the first year of life is also associated with reduced food allergy outcomes. In addition to diet diversity, diet indices are considered measures of overall diet quality and can be used as a simple assessment of dietary intake. The focus of this paper is to review and critically address the current knowledge of the association between diet diversity and diet indices and allergy outcomes. Based on the current evidence, we recommend the introduction of solid foods, including common allergenic solids, during the 1st year of life, according to the infant's neuro-developmental abilities and familial or cultural habits. For infants with severe AD and/or FA, medical assessment may be advisable before introducing common food allergens into the diet. Limited evidence exist about the role of diet indices in pregnancy and allergic disease in the offspring, and the most promising results indicate a reduction in childhood wheeze and/or asthma intake.

A 2\xa0year physical activity and dietary intervention attenuates the increase in insulin resistance in a general population of children: the PANIC study

Aims/hypothesisWe studied for the first time the long-term effects of a combined physical activity and dietary intervention on insulin resistance and fasting plasma glucose in a general population of predominantly normal-weight children.MethodsWe carried out a 2 year non-randomised controlled trial in a population sample of 504 children aged 6–9 years at baseline. The children were allocated to a combined physical activity and dietary intervention group (306 children at baseline, 261 children at 2-year follow-up) or a control group (198 children, 177 children) without blinding. We measured fasting insulin and fasting glucose, calculated HOMA-IR, assessed physical activity and sedentary time by combined heart rate and body movement monitoring, assessed dietary factors by a 4 day food record, used the Finnish Children Healthy Eating Index (FCHEI) as a measure of overall diet quality, and measured body fat percentage (BF%) and lean body mass by dual-energy x-ray absorptiometry. The intervention effects on insulin, glucose and HOMA-IR were analysed using the intention-to-treat principle and linear mixed-effects models after adjustment for sex, age at baseline, and pubertal status at baseline and 2 year follow-up. The measures of physical activity, sedentary time, diet and body composition at baseline and 2 year follow-up were entered one-by-one as covariates into the models to study whether changes in these variables might partly explain the observed intervention effects.ResultsCompared with the control group, fasting insulin increased 4.65 pmol/l less (absolute change +8.96 vs +13.61 pmol/l) and HOMA-IR increased 0.18 units less (+0.31 vs +0.49 units) over 2 years in the combined physical activity and dietary intervention group. The intervention effects on fasting insulin (regression coefficient β for intervention effect −0.33 [95% CI −0.62, −0.04], p = 0.026) and HOMA-IR (β for intervention effect −0.084 [95% CI −0.156, −0.012], p = 0.023) were statistically significant after adjustment for sex, age at baseline, and pubertal status at baseline and 2 year follow-up. The intervention had no effect on fasting glucose, BF% or lean body mass. Changes in total physical activity energy expenditure, light physical activity, moderate-to-vigorous physical activity, total sedentary time, the reported consumption of high-fat (≥60%) vegetable oil-based spreads, and FCHEI, but not a change in BF% or lean body mass, partly explained the intervention effects on fasting insulin and HOMA-IR.Conclusions/interpretationThe combined physical activity and dietary intervention attenuated the increase in insulin resistance over 2 years in a general population of predominantly normal-weight children. This beneficial effect was partly mediated by changes in physical activity, sedentary time and diet but not changes in body composition.Trial registrationClinicalTrials.gov NCT01803776Graphical abstract

Reproducibility and Relative Validity of the Healthy Eating Index-2015 and Nutrient-Rich Food Index 9.3 Estimated by Comprehensive and Brief Diet History Questionnaires in Japanese Adults.

We examined the reproducibility and relative validity of two measures of overall diet quality, the Healthy Eating Index-2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3), as estimated by well-established self-administered dietary assessment questionnaires for the Japanese, namely the comprehensive diet history questionnaire (DHQ) and the brief diet history questionnaire (BDHQ). Diet was assessed separately by two DHQs and two BDHQs at a 1-year interval and by 16-day weighed dietary records (DRs) in 121 women and 121 men aged 31–81 years. HEI-2015 and NRF9.3 were calculated from each method. The reproducibility correlation for the two questionnaires (intraclass correlation) ranged from 0.53 (HEI-2015 from BDHQ in men) to 0.77 (NRF9.3 from BDHQ in women). The validity correlation between the first questionnaires and DR (Pearson correlation) ranged from 0.37 (NRF9.3 from BDHQ in men) to 0.61 (NRF9.3 from DHQ and BDHQ in women). Bland–Altman plots showed poor agreement between the DHQ or BDHQ and DR, as well as the presence of weak proportional bias. Overall, these data indicate reasonable reproducibility and ranking ability of the DHQ and BDHQ for assessing the HEI-2015 and NRF9.3 and support their usefulness in future epidemiological research on the overall effects of Japanese diets on various health outcomes.

Methyl Donor Nutrient Intake and Risk of Type 2 Diabetes: Results from 3 Large US Cohorts (OR15-02-19)

ObjectivesDNA methylation may play a role in the development of type 2 diabetes (T2D). DNA methylation can be influenced by methyl donor nutrients such as vitamins B2, B6, B12, folate, and methionine, which are all central to one carbon metabolism. Using 3 large cohorts of US health professionals, we examined whether intake of these nutrients from food or supplements is associated with T2D risk. MethodsWe included 69,949 women from the Nurses’ Health Study (1984–2012), 90,239 women from the Nurses’ Health Study II (1991–2011), and 40,539 men from the Health Professionals Follow-Up Study (1986–2010). Dietary data were collected every 2–4 years using a validated semi-quantitative FFQ, from which dietary intakes of vitamin B2, vitamin B6, vitamin B12, folate, and methionine were calculated. We used Cox proportional hazards model with time-varying covariates and adjusted for several sociodemographic and lifestyle variables. We also adjusted for cereal fiber, animal protein, polyunsaturated and saturated fatty acids ratio. Food sources of vitamins were additionally adjusted for multivitamin use while supplemental sources of vitamins were adjusted for a measure of overall diet quality. ResultsDuring 1763,428 years of follow-up, we documented 8141 T2D cases. In pooled multivariable-adjusted analyses, compared to those in the lowest quintile, those in the highest quintile of vitamins B2 and B6 had a 10% (95% CI 3%–16%) and 11% (95% CI 3%–16%) lower T2D risk, respectively. Total vitamin B12 intake was not associated with T2D. However, when analyses were stratified by source, vitamin B12 from food sources was associated with a higher T2D risk (HR [95% CI] = 1.11 [1.02–1.19]). On the other hand, supplemental vitamin B12 was associated with lower T2D risk (HR [95% CI] for Q5 vs Q1 = 0.92 [0.85–0.98]). We found no evidence for an association between intakes of folate and methionine and T2D risk. ConclusionsOur study suggests that higher intakes of vitamin B2 and vitamin B6 are associated with a lower T2D risk. A higher vitamin B12 intake from food seems to be associated with a higher T2D risk, which may be due to consumption of animal products. Funding SourcesThe analysis was supported by grants from the National Institutes of Health.

Sociodemographic, Lifestyle, Environmental and Pregnancy-Related Determinants of Dietary Patterns during Pregnancy.

Background: Characterization of dietary patterns represents a valid and meaningful measure of overall diet quality and nutrient intake. The study aims at evaluating the sociodemographic, lifestyle, environmental, and pregnancy-related determinants of maternal dietary patterns during pregnancy. Methods: The analysis was conducted on a group of pregnant women from the Polish Mother and Child Cohort (REPRO_PL). During the second trimester of pregnancy, 1306 women filled in a modified version of the validated food frequency questionnaire (FFQ). Dietary patterns were estimated using an exploratory factor analysis. Potential dietary determinants were assessed via a questionnaire or biomarker measurements (saliva cotinine level). Results: Two dietary patterns were identified. The Prudent dietary pattern was characterized by high consumption of fruit, vegetables, legumes, whole grains, poultry, and low-fat dairy products, while the Western dietary pattern included high intake of refined grains, processed meat, potatoes, and very low intake of whole grains. Clear sociodemographic, environmental, lifestyle, and pregnancy-related determinants of diet quality were established. Older age (β = 0.2; p < 0.01), higher educational level (β = 0.3; p < 0.01), and socioeconomic status (SES) (β = 0.2; p < 0.01), overweight/obesity before (β = 0.3; p < 0.01), as well as physical activity during pregnancy (β = 0.2; p = 0.01) were positive determinants of a healthier diet (increasing Prudent–Western difference in dietary pattern scores). On the other hand, parity (β = −0.2; p = 0.04) and living in small cities (β = −0.3; p = 0.02) were significantly related to a rather Western dietary pattern. Conclusions: The current study presents evidence on specific factors influencing dietary patterns. They need to be accounted for in educational programs and interventions focused on healthy diet recommendations during pregnancy.

Diet quality and risk of multiple sclerosis in two cohorts of US women

Objective: To determine the association between measures of overall diet quality (dietary indices/patterns) and risk of multiple sclerosis (MS). Methods: Over 185,000 women in the Nurses’ Health Study (NHS) and Nurses’ Health Study II (NHSII) completed semiquantitative food frequency questionnaires every 4 years. There were 480 MS incident cases. Diet quality was assessed using the Alternative Healthy Eating Index-2010 (AHEI-2010), Alternate Mediterranean Diet (aMED) index, and Dietary Approaches to Stop Hypertension (DASH) index. Principal component analysis was used to determine major dietary patterns. We calculated the hazard ratio (HR) of MS with Cox multivariate models adjusted for age, latitude of residence at age 15, body mass index at age 18, supplemental vitamin D intake, and cigarette smoking. Results: None of the dietary indices, AHEI-2010, aMED, or DASH, at baseline was statistically significantly related to the risk of MS. The principal component analysis identified “Western” and “prudent” dietary patterns, neither of which was associated with MS risk (HR, top vs bottom quintile: Western, 0.81 (p = 0.31) and prudent, 0.96 (p = 0.94)). When the analysis was repeated using cumulative average dietary pattern scores, the results were unchanged. Conclusion: There was no evidence of an association between overall diet quality and risk of developing MS among women.

Construct Validity of a Single-Item, Self-Rated Question of Diet Quality

ObjectiveTo provide evidence of the construct validity of a single-item overall diet question with a nomological network of self-rated and biometric measures of dietary intake and outcomes. MethodsThe authors conducted a secondary analysis of survey and biometric data from a cross-sectional sample of urban-dwelling adults. In addition to self-rated diet quality, they examined dietary behaviors, biomarkers of intake, and related outcomes. Self-rated diet quality was treated as a continuous variable to calculate P for trend using regression analysis. ResultsSelf-rated diet quality was significantly associated with variation in both subjective and objective measures of dietary intake (fruit and vegetable intake, P < .001; sugar-sweetened beverage intake, P < .001; sodium to potassium ratio, P < .001), behavior (frequency of fast-food dining, P < .001), and related outcomes (systolic blood pressure, P = .010; diastolic blood pressure, P < .001; and body mass index, P < .001). Conclusions and ImplicationsEvidence supports the construct validity of a single-item measure of diet quality. This single-item question may be a useful proxy for more burdensome measures of overall diet quality.

Relationships among parent and youth healthful eating attitudes and youth dietary intake in a cross-sectional study of youth with type 1 diabetes

BackgroundConstructs based on Social Cognitive Theory have shown utility in understanding dietary behavior; however, little research has examined these relations in youth and parents concurrently. Unique demands of dietary management among families of youth with type 1 diabetes (T1D) suggest the importance of investigation in this population. The purpose of this study was to develop and evaluate youth and parent measures of self-efficacy, outcome expectations, and barriers for healthful eating, and parent modeling of healthful eating, in a sample of youth with type 1 diabetes and their parents.MethodsYouth (n=252) ages 8–18 years with diabetes duration ≥1 year and parents completed self-report measures of healthful eating attitudes including self-efficacy, perceived barriers, positive and negative outcome expectations; youth reported parent modeling of healthful eating. Youth dietary intake from 3-day diet records was used to calculate the Healthy Eating Index 2005 and the Nutrient Rich Foods 9.3 index, measures of overall diet quality. The relations among parent and youth healthful eating attitudes, parent modeling, and youth diet quality were examined using structural equation modeling.ResultsInternal consistency and test-retest reliability of the measures were acceptable. The structural equation model demonstrated acceptable fit (CFI/TLI=0.94/0.94; RMSEA=0.03), and items loaded the hypothesized factors. Parent modeling and attitudes toward healthful eating (latent variable comprised of self-efficacy, barriers, outcome expectations) had direct effects on youth diet quality. Parent modeling had a direct effect on youth attitudes ; parent attitudes had an indirect effect on youth attitudes through parent modeling . Youth attitudes were not associated with youth diet quality. Overall, the model accounted for 20% of the variance in child diet quality.ConclusionsParent diet-related behaviors demonstrated an impact on youth attitudes and diet quality, suggesting the importance of family-based clinical and public health efforts to improve diet.

Are existing measures of overall diet quality associated with peak bone mass in young premenopausal women?

Low peak bone mass in young adulthood is associated with an increased risk of osteoporosis and fracture after menopause, and an understanding of the modifiable factors that contribute to low peak bone mass is important for fracture prevention. Diet is an important modifiable factor linked to bone health and, although studies have examined the role of individual dietary components in bone health, bone growth and maintenance are complex processes, and such studies may not adequately represent the role of diet in these processes. To address this issue, a cross-sectional analysis of 226 healthy, premenopausal women aged 18-30 years was conducted to determine whether existing indices of overall diet quality are associated with bone density in premenopausal women nearing peak bone mass. Bone density was measured using dual-energy X-ray absorptiometry and diet quality was measured using two overall diet scores based on current dietary guidelines: the Recommended Food Score and the Alternate Healthy Eating Index (AHEI). In the multiple linear regression, bone density did not increase across quartiles of either diet quality score and was not associated with continuous diet quality variables. Furthermore, none of the individual AHEI components (e.g. fruit intake, vegetable intake) were associated with bone density. These findings suggest that existing diet quality scores are not appropriate for studies of peak bone mass, most likely because they do not give sufficient weight to foods and nutrients important to bone health. We recommend the development of a diet pattern index that better predicts bone mass measures.

A Culturally Adapted Telecommunication System to Improve Physical Activity, Diet Quality, and Medication Adherence Among Hypertensive African–Americans: A Randomized Controlled Trial

Hypertension is more prevalent and clinically severe among African-Americans than whites. Several health behaviors influence blood pressure (BP) control, but effective, accessible, culturally sensitive interventions that target multiple behaviors are lacking. We evaluated a culturally adapted, automated telephone system to help hypertensive, urban African-American adults improve their adherence to their antihypertensive medication regimen and to evidence-based guidelines for dietary behavior and physical activity. We randomized 337 hypertensive primary care patients to an 8-month automated, multi-behavior intervention or to an education-only control. Medication adherence, diet, physical activity, and BP were assessed at baseline and every 4months for 1year. Data were analyzed using longitudinal modeling. The intervention was associated with improvements in a measure of overall diet quality (+3.5 points, p < 0.03) and in energy expenditure (+80kcal/day, p < 0.03). A decrease in systolic BP between groups was not statistically significant (-2.3mmHg, p = 0.25). Given their convenience, scalability, and ability to deliver tailored messages, automated telecommunications systems can promote self-management of diet and energy balance in urban African-Americans.

Healthy Indexes in Public Health Practice and Research: A Review

The scientific community has long been interested in the overall quality of diets owing to the fact that it is important for each individual's health through a healthy, varied, and balanced diet. Much research has been conducted on methods used to measure dietary quality. These studies led to the determination of numerous indices, some very simple and some much more complex. Indices that examine diets for several attributes concurrently are able to provide a measure of overall diet quality that is not possible when only single nutrients or food groups are examined. Using these indices, diet quality may be evaluated in relation to nutrient adequacy, compliance with dietary guidelines, or nutrition recommendations, association with risk of chronic diseases, or mortality, and used to assess interventions. However, there are several factors that should be taken into consideration for the design of an index, like the purpose of its use, as well as its simplicity in daily practice. The general purpose of an index is to synthesize a large amount of information into a single useful indicator. The purpose of this review was to present and to critically review the most commonly used dietary indices, and how they reflect various aspects of diet quality. The majority of these indices fail to recognize the various inter-relationships between their components, as well as their accuracy for estimating specific health outcomes. Thus, the development of weighted dietary indices that adequately assess a dietary pattern and its relationship to the burden of a disease is considered essential.

Diet quality and subsequent cancer incidence and mortality in a prospective cohort of women

We have previously reported on the utility of the Recommended Foods Score (RFS), a measure of overall diet quality, in detecting associations between diet and mortality in a cohort of older women. Using additional follow-up, we have now extended our analysis to detailed studies of associations between RFS and the mortality and incidence from common cancers. The RFS, the sum of 23 recommended food items consumed at least weekly, was computed from a 62-item food frequency questionnaire completed at baseline by 42 254 women with a mean age of 61 years. Multivariate adjusted relative risk (RR) of cancer mortality and incidence of the cancers for which we were able to obtain data in relation to quartiles of RFS were examined using proportional hazards regression analyses after a median follow-up period of 9.5 years. We observed that RFS was inversely associated with total mortality (RR = 0.8; P < 0.001) cancer mortality (RR = 0.74; P < 0.001) as well as mortality from cancers of the breast (RR = 0.75; P < 0.06), colon/rectum (RR = 0.49; P < 0.01) and lung (RR = 0.54; P < 0.001). The risk of incident lung cancer (RR = 0.62; P < 0.001) was reduced in women in the highest vs the lowest quartile of RFS; for incident cancers of the breast, colorectum, endometrium, ovaries, and bladder, there was no RFS association. A dietary pattern reflecting a higher RFS was associated with decreased overall mortality in women, specifically cancers of the lung, colon/rectum, and to a lesser extent breast. Incidence was only decreased for lung cancers. These observations are consistent with the hypothesis that a high RFS dietary pattern, or associated lifestyle factors, might affect cancer progression and survival.

Measures of overall diet quality from a food frequency questionnaire: National Health Interview Survey, 1992

We developed dietary variety based measures of diet quality using food frequency questionnaire (FFQ) data from the National Health Interview Survey (NHIS), 1992. FFQs from 10,799, aged ≥ 18 years, were examined. We grouped the 68 items in the NHIS FFQ into two categories— nutrient-dense, and energy-dense, nutrient-poor. A dietary variety score (DVS), comprised of the number of food items mentioned at least once a week from the nutrientdense group (54 items), was calculated for each respondent. A dietary variety score for recommended (DVSR) foods was also computed. The DVSR counted at least weekly mentions of foods recommended in current dietary guidance (27 items). The mean±SE of DVS and DVSR were 21±0.1 and 11.6±0.1, respectively. Education, total energy, calcium, vitamin C, carotenoid intakes, and compliance with recommendation of the Food Guide Pyramid correlated positively with the DVS and DVSR. Percent energy from fat was inversely related with DVSR, but was unrelated with DVS. Nutrition knowledge correlated positively with both scores. In conclusion, the scores developed were correlated with nutrient and food group intake, and may be suitable for assessment of these attributes of diet quality when only limited dietary information is available.