Measure Of Diet Quality Research Articles

The association between food insecurity, diet quality, and untreated caries among US children

BackgroundThe aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship. MethodsThe authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach. ResultsFood-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries. ConclusionsFood insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries. Practical ImplicationsSocial factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health.

Association Between Food Insecurity and Diet Quality Among Early Care and Education Providers in the Pennsylvania Head Start Program.

IntroductionFood insecurity affects dietary behaviors and diet quality in adults. This relationship is not widely studied among early care and education (ECE) providers, a unique population with important influences on children’s dietary habits. Our study’s objective was to explore how food insecurity affected diet quality and dietary behaviors among ECE providers.MethodsWe used baseline data from a cluster-randomized controlled trial (January 2019−December 2020) on 216 ECE providers under the Pennsylvania Head Start Association. We used radar plots to graph scores for the Healthy Eating Index 2015 and the Alternative Healthy Eating Index (AHEI) 2010 and fitted a multivariate regression model for diet quality measures, adjusting for covariates.ResultsAmong the 216 participants, 31.5% were food insecure. ECE providers who were food insecure had a lower AHEI-2010 mean score (mean difference for food insecure vs food secure = −4.8; 95% CI, −7.8 to −1.7; P = .002). After adjusting for covariates, associations remained significant (mean difference = −3.9; 95% CI, −7.5 to −0.4; P = .03). Food insecure ECE providers were less likely to use nutrition labels (22.8% vs 39.1%; P = .046) and more likely to report cost as a perceived barrier to eating fruits and vegetables.ConclusionWe found a significant inverse association between food insecurity and the AHEI-2010 diet quality score among ECE providers after adjusting for covariates. More studies are needed to examine the effects of food insecurity on dietary behaviors of ECE providers and their response to nutrition education programs targeting their health.

Associations between Diet Quality and Anthropometric Measures in White Postmenopausal Women.

The purpose of this cross-sectional study was to examine the relationship between diet and anthropometric measures in postmenopausal women. Data collected from 937 women enrolled in the Minnesota Green Tea Trial (NTC00917735) were used for this analysis. Dietary intake and health-related data were collected via questionnaires. Body weight, height, and waist circumference (WC) were measured by the study staff. The mean age of participants was 59.8 years and mean WC was 83 cm. Approximately 30% of the participants had WC greater than 88 cm. Healthy Eating Index-2015 score was 72.6 and the Dietary Inflammatory Index score was 0. Intakes of whole grains, dairy, protein, sodium, and saturated fat did not meet the dietary guidelines. Only 12.5% consumed the recommended daily amount of calcium (mean intake = 765 mg/day). When calcium supplements were considered, only 35.2% of the participants had adequate intakes, even though 68.9% reported taking a calcium supplement. We found that age and number of medications taken were significantly associated with waist circumference (p = 0.005). Women who reported taking two or more medications had greater WC (85 cm) compared to women who reported not taking any medications (82.2 cm), p = 0.002. Our findings suggest that achieving adequate calcium and vitamin D intake may be challenging to postmenopausal women.

Applying the Healthy Eating Index-2015 in a Sample of Choice-Based Minnesota Food Pantries to Test Associations Between Food Pantry Inventory, Client Food Selection, and Client Diet

BackgroundFood pantry clients are at a high risk for diet-related chronic disease and suboptimal diet. Relatively little research has examined diet quality measures in choice-based food pantries where clients can choose their own food. ObjectiveThis study tested whether the diet quality scores for food at the pantry were associated with client food selection scores, and whether client food selection scores at the pantry were associated with client diet intake scores. DesignThis cross-sectional regression analysis, part of a larger evaluation study (SuperShelf), used baseline data from client and food pantry surveys, food pantry inventories, assessments of client food selections (“client carts”), and single 24-hour client dietary recalls. Participants/settingThe analysis includes 316 clients who completed a survey (282 of whom completed a dietary recall measure) from one of 16 choice-based Minnesota food pantries during 2018-2019. Adult English, Spanish, or Somali-speaking clients were eligible in the case that they had selected food on the day of recruitment at their food pantry visit. Main outcome measuresA Healthy Eating Index-2015 (HEI-2015) Total score and 13 subcomponent scores were calculated for: pantry food inventories of food available on the shelf, client carts, and a 24-hour client dietary recall. Statistical analysisDescriptive statistics were generated for client and food pantry characteristics, and for HEI-2015 Total score and subcomponent scores. Linear regression models tested the association between HEI-2015 Total score and subcomponent scores for food pantry inventory and client carts, and for client carts and dietary recalls, adjusted for covariates. ResultsFood pantry inventory HEI-2015 Total score averaged 65.1, client cart Total score averaged 60.8, and dietary recall Total score averaged 50.9. The diet quality scores for inventory were not associated with client cart scores, except for Added Sugars (P = .005). Client cart HEI-2015 Total score was positively associated with client diet HEI-2015 Total score (P = .002) and associations for Total Fruits, Whole Fruits, Total Vegetables, Greens and Beans, Whole Grains, Seafood and Plant Proteins, and Added Sugars subcomponents were statistically significant. ConclusionsIn choice-based Minnesota food pantries, the diet quality of food selected by clients was positively associated with client diet quality.

Healthy Eating Index Protocol: Review, Update, and Development Process to Reflect Dietary Guidance Across the Lifespan

Abstract Objectives The Healthy Eating Index (HEI) is a measure of diet quality, independent of quantity, that can be used to assess alignment with the Dietary Guidelines for Americans (DGAs), which are the basis of nutrition policy for the United States (US) government and the foundation of all federal nutrition guidance. The recently released 2020–2025 DGAs include recommendations for infants and toddlers for the first time, and necessitate a review, update, and development process of the HEI to reflect healthy eating across the lifespan. Methods Since 2005, researchers at the HHS National Cancer Institute (NCI) and the USDA Center for Nutrition Policy and Promotion have collaborated to revise the HEI based on updates to the DGAs, and the HEI-2015 is the most recent iteration. The process includes: 1) gathering information from dietary guidelines, experts, and federal stakeholders; 2) considering substantive changes and needs for new development; and 3) completing validation analyses. Results Updates to the HEI have aimed to maintain stability, reflecting the consistency of recommendations over time. A guiding principle is to only make changes to the HEI that have a strong rationale. With no significant changes in the USDA Dietary Patterns, few changes are anticipated for the HEI for 2 years and older; instead, the emphasis for the update process is focusing on considerations for an index for infants and toddlers under 2 years. Additionally, the Scientific Report of the 2020 Dietary Guidelines Advisory Committee identified the development of a scoring system (such as the HEI) for infants and toddlers as a research recommendation, because comparisons of diet quality using the HEI have thus far only been possible for Americans 2 years and older. The HEI review, update, and development process aims to consider analyses with distributions of HEI scores across the lifespan with nationally representative data and diverse cohorts. Conclusions The HEI is a valuable tool for research that can be used in nutrition interventions, epidemiology, and consumer nutrition education programs. The timely release of a new HEI will enable application across the lifespan and support additional methodological research to examine needs specific to each life stage and how to model optimal trajectories of healthy dietary patterns. Funding Sources None.

A Mediterranean Meal Plan Modulates Human Milk Composition in Women With Obesity

ObjectivesHuman milk (HM) is impacted by both maternal obesity and diet. HM from women with obesity has higher fat, leptin and insulin concentrations. Additionally, maternal dietary fat intake is associated with increased HM fat content. The objective of this study was to determine the impact of a Mediterranean meal plan on the composition of HM from women with obesity. MethodsIn this pilot study, thirteen women with obesity (body mass index (BMI) ≥ 30 kg/m2) enrolled at five months post-partum and followed a provided Mediterranean meal plan focused on reducing fat intake and increasing unsaturated fat and fiber intake for four weeks. Participants’ diet was assessed using Nutrition Data System for Research. HM was collected at baseline and after the 4-week intervention and the concentrations of metabolites, hormones and cytokines were assayed. Wilcoxon signed-rank tests and analysis of variance were used to assess changes in participant diet and HM composition. Summary statistics are presented as mean ± standard deviation. ResultsThe participants’ Healthy Eating Index Score, a measure of diet quality, significantly improved (38.3 ± 5.13 vs. 78.2 ± 6.75, p < 0.001) and total fat intake was significantly lower (99.6 ± 23.3 g vs. 66.9 ± 12.0 g/day, p < 0.001) after the intervention. Human milk leptin (694 ± 464 pg/ml vs. 437 ± 324 pg/ml, p = 0.007) and tumor necrosis factor α (0.515 ± 0.267 pg/ml vs. 0.310 ± 0.127 pg/ml, p = 0.010) concentrations were lower post intervention, whereas HM macronutrient composition was unchanged. The concentrations of several individual human milk oligosaccharides (HMO) and total HMOs (7720 ± 797 nmol/ml vs. 6986 ± 940 nmol/ml, p = 0.049), as well as HM tyrosine concentration (18.2 ± 6.16 nmol/ml vs. 14.5 ± 4.69 nmol/ml, p = 0.005) were significantly lower post intervention. ConclusionsThe composition of HM from women with obesity can be modulated by short-term adherence to a Mediterranean meal pattern. These findings merit further studies that use longer interventions and examine the impact of any changes in HM composition on infant growth and development. Modifying HM composition via a dietary intervention may provide a novel strategy to promote child development and health. Funding SourcesUSDA ARS #6026-51,000-010-05S and #6026-51,000-012-06S, NIH/NIDDK R01DK107516, Arkansas Children’s Research Institute/Arkansas Biosciences Institute GR037121.

Association Between Microbe Accessible Carbohydrates (MACs) Intake and Healthy Eating Index (HEI-2015) in the College Students

ObjectivesYoung adults tend to consume western diets with low microbe-accessible carbohydrates (MACs), which are fermentable carbohydrates that may reduce the risk of developing non-communicable diseases. The importance of dietary fiber (only one type of MAC) in the prevention of chronic diseases led to recommendations for increasing fiber intake. However, a reference to other MACs such as resistant starches, non-starch polysaccharides, polyols (lactitol, sorbitol, etc.), and oligosaccharides (fructo-oligosaccharides, etc.) is still lacking and their relationship with diet quality is far less understood. The healthy eating index (HEI) score is a measure of diet quality, independent of quantity, and is useful to assess compliance with U.S. Dietary Guidelines for Americans. The primary aim of this study was to determine the MACs consumption in healthy US college students and their association with dietary quality as indicated by the HEI-2015. MethodsFor this cross-sectional study, data were collected from consenting students (≥ 18years old) in an introductory nutrition course (n = 592, age (mean ± standard deviation) 19.5 ± 3.5; 83.7% white; 78.4% female). Dietary intake was measured via a web-based dietary history questionnaire (DHQ-II), which is able to quantify the consumption of MAC’s and subclasses such as polyols and soluble dietary fibers. DHQ website provided step by step instructions to calculate HEI in SAS (SAS enterprise guide 7.4). Linear regression was run to determine the association between the average daily intake of MACs and the HEI-2015 score. ResultsAverage MAC intake was 7.7 ± 4.4 grams with most of the amounts coming from soluble dietary fibers (6.6 ± 3.8). The mean HEI-score of this population was 64.9 ± 10.8. Average daily consumption of MAC was significantly associated with HEI score, F(1,590) = 65.22, P = 0.000, accounting for 10% of the variation in HEI-score with adjusted R2 = 9.8%, a medium-size effect according to Cohen (1988). An extra gram of daily average intake of MAC led to a 0.78 (95% CI, 0.59 to 0.97) increase in HEI-score. ConclusionsMAC intake was associated with an increase in HEI-2015 score; however, the total MAC intake was low in this population of college students. Therefore, more efforts are needed to increase the consumption of MACs not just dietary fibers in college students. Funding SourcesNone.

Dietary Practices Among US Immigrants: Energy Density as a Marker for Acculturation and Diet Quality

Abstract Objectives The Dietary Guidelines Advisory Committee (DGAC) 2020 report indicates a need for examining the association between acculturation, dietary behaviors and disease risk. Dietary energy density (ED, kcal/g) is an established indicator of diet quality and a risk factor for chronic disease. Because ED is calculated using the whole diet, it is culturally relevant for use in a variety of populations. Past research on acculturation and diet indicates a need for more research using indicators that measure diet quality. The objective of the present study was to examine the relationship between acculturation, dietary intake, and dietary energy density. Methods Dietary data was collected using 24hour-recall in a nationally representative sample of 10 622 adults who participated in the 2013–2016 NHANES. Specific questions about acculturation were asked of participants. All data were analyzed using SAS 9.4 survey procedures to account for the complex survey design of the NHANES. Results A linear relationship between dietary ED and length of time in the US was observed (p-trend &amp;lt; 0.0001). Individuals who were in the US for &amp;lt; 5 years had the lowest dietary ED compared to those who had been in the US for the longest (1.39 vs. 1.84 kcal/g, P &amp;lt; 0.0004) representing ∼450 kcal/day difference after adjusting for relevant cofactors. Despite this difference, there was no difference in the amount of money spent on food compared with length of time in the US. Conclusions This study is consistent with other studies that examine changes in dietary patterns among those who have immigrated to the US. Findings from this study, specifically using ED as an indicator of diet quality, may provide recommendations to developing culturally inclusive efforts to encourage healthy diets. Funding Sources None.

Which Predicts Incident Cardiovascular Disease Better: A Plant-Centered Diet or a Low-Saturated Fat Diet? The Coronary Artery Risk Development in Young Adults (CARDIA) Study

ObjectivesA low-saturated fat diet has been suggested to reduce serum cholesterol and thereby presumably lower the risk of atherosclerotic cardiovascular disease (CVD). We compared associations of a low-saturated fat diet vs a plant-centered diet with lower serum low-density lipoprotein cholesterol (LDL-C) concentration and risk of incident CVD, coronary heart disease (CHD), and stroke. MethodsWe followed 4,887 Black and White men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, ages 18–30 years and free of CVD at baseline from 1985–86 (exam year 0) to 2018 (year 32). The A Priori Diet Quality Score (APDQS), a measure of plant-centered diet quality, was assessed in an interviewer-administered diet history at years 0, 7, and 20. Higher APDQS implies higher intake of nutritionally-rich plant foods with less high-fat meats and unhealthy plant foods. Low-saturated fat diet was judged by lower the Keys score, based on saturated fat, polyunsaturated fat, and dietary cholesterol intake. Linear and proportional hazards regression models were used, the latter with time-varying average APDQS and CVD outcomes, both adjusted for age, sex, race, education, energy intake, physical activity, smoking, and parental history of CVD (CVD outcome only). ResultsHigher APDQS had higher dietary fiber and lower total and saturated fat. Keys score and APDQS 7-year changes correlated similarly with lower concurrent LDL-C change. During the 32 year follow-up, we documented 280,135, and 92 incident cases of CVD, CHD, and stroke, respectively. LDL-C predicted CVD and CHD, but not stroke. APDQS, but not Keys score, was associated with a lower risk of each CVD outcome. Multivariable-adjusted HRs per 1-SD increment for the APDQS were 0.81 (95% CI: 0.68 – 0.96) for CVD, 0.78 (95% CI: 0.61 – 1.00) for CHD, and 0.71 (95% CI: 0.52 – 0.98) for stroke. The primary results for APDQS and for LDL-C were not substantially altered in mutually adjusted models. ConclusionsBoth a plant-centered and a low-saturated fat diet were associated with lower LDL-C. A plant-centered diet and LDL-C, but not a low-saturated fat diet, were associated with long-term CVD risk. Our findings imply that dietary strategies aimed solely to lower saturated fat may be less effective in reducing CVD burden than recommendations for a plant-centered diet. Funding SourcesHFHL, MnDRIVE, NHLBI.

Examining the Validity of the Total Nutrient Index for Assessing Intakes of Nutrients From Foods, Beverages, and Dietary Supplements

ObjectivesTo develop and validate the total nutrient index (TNI), a nutrient-based scoring system that assesses nutrient exposures from foods/beverages and dietary supplements (DS). MethodsThe TNI includes 8 shortfall micronutrients identified in the Dietary Guidelines for Americans: calcium, magnesium, potassium, choline, and vitamins A, C, D, E. Predicted usual intake is expressed as a percentage of the appropriate Recommended Dietary Allowance or Adequate Intake and truncated at 100 to compute component scores. The average of the component scores yields the total TNI score (range 0–100). Usual intakes from foods/beverages and DS of U.S. adults (≥19y) were estimated using a multivariate extension of the National Cancer Institute method. Data sources were two 24-hour recalls and a questionnaire/in-home inventory on DS use, collected in the 2011–2014 National Health and Nutrition Examination Survey (NHANES) (n = 9,954). Concurrent criterion validity was evaluated by comparing TNI scores between subpopulations with known differences in diet quality and by correlating component scores for vitamins A, C, D, and E with biomarker data. Due to data availability, biomarker analysis for vitamins A, C, and E used data from 2003–2006 NHANES (N = 8,861). Convergent validity was determined by correlating the TNI with the Healthy Eating Index (HEI-2015). ResultsThe estimated mean total TNI score was 75.4; the same index calculated using foods/beverages only was 69.0. The TNI scores were significantly different (p < 0.001) for DS-users (83.5) vs. non-users (67.1), non-smokers (76.8) vs. smokers (70.3), and by food security status (food-secure: 76.6 vs. food-insecure: 69.1). The Pearson correlation of the TNI and HEI-2015 total score was 0.48, suggesting that the TNI captures dimensions of nutrient intake that are correlated with but distinct from those captured with the HEI-2015. Correlations of component scores with the available biomarkers ranged from 0.12 (α-tocopherol) to 0.36 (25(OH)D) and were all < 0.10 when DS were not included. ConclusionsThe TNI identifies total usual intake of shortfall nutrients and extends existing measures of diet quality by including nutrients obtained from DS. Tests of validity suggest the TNI is an effective tool in assessing total nutrient exposures of shortfall nutrients among U.S. adults. Funding SourcesNational Institutes of Health.

Comparison of measures of diet quality using 24-hour recall data of First Nations adults living on reserves in Canada

ObjectiveAssess the diet quality of First Nations adults in Canada using percentage energy from traditional foods (TF) and ultra-processed products (UPP), food portions from the 2007 Eating Well with Canada’s Food Guide - First Nations, Inuit and Métis (EWCFG-FNIM) and a Healthy Eating Index (HEI).MethodsData collection for this participatory research occurred in 92 First Nations reserves across Canada from 2008 to 2016. Percent daily energy intakes were estimated from 24-hour recalls for TF and NOVA food categories. Portions of food groups from the 2007 EWCFG-FNIM were compared to recommendations. A Canadian-adapted HEI was calculated for each participant.ResultsThe percent energy from TF was 3% for all participants and 18% for consumers. Meat and alternatives were above the EWCFG-FNIM recommendations and all other food groups were below these. HEI was “low” with only older individuals attaining “average” scores. HEI was above “average” in 4 regions. UPP represented 55% of energy, the largest proportion from a NOVA category.ConclusionThe diet quality of First Nations adults in Canada is nutritionally poor. The nutrition, food security and health of First Nations would be improved by better access to TF and healthy store-bought food. However, poor diet is only one aspect of the difficulties facing First Nations in Canada. Researchers and policy makers must strive to better understand the multiple challenges facing First Nations Peoples in order to foster empowerment and self-determination to develop First Nations living conditions and lifestyles that are more culturally sound and more conducive to health.

Higher Protein Intake During Energy Restriction Alters Dietary Patterns and Maintains Diet Quality

Abstract Objectives A higher protein diet can be a successful approach to weight loss and improved health outcomes. However, the effect of a higher protein diet on other foods in the diet is not known. Evidence suggests diet quality scores provide a comprehensive representation of dietary intake and the complex interconnected nature of nutrient intake. In this study, the objective was to examine the effect of protein intake during moderate weight loss using four diet quality scores in overweight and obese adults. Methods Overweight and obese adults (n = 235) were counseled, bimonthly, to reduce energy intake over 6 months following the ADA food lists. The diets were individualized so range of macronutrient intake varied, but all individuals were encouraged to consume &amp;gt; 0.8 g/kg protein. Dietary intake was assessed and validated at baseline and ≥ 6 days during the intervention. In addition to the Healthy Eating Index (HEI), the Alternative Healthy Eating Index (AHEI), Mediterranean Diet Quality Score (MDS), and Dietary Approaches to Stop Hypertension diet quality score (DASH) were adjusted for energy intake and used to calculate diet quality. Results Subjects (55 ± 11 years) were overweight and obese (BMI 28.9 ± 4.0 kg/m2) and consumed 17.5 ± 5.3% energy from protein at baseline. During the intervention, subjects lost 4.5 ± 5.4% body weight, with a 333 ± 605 kcal deficit and 18.7 ± 3.5% protein intake. During the intervention, only the HEI score correlated with protein intake (r = 0.240, P &amp;lt; 0.001); however, all scoring methods (HEI AHEI, MDS, DASH) showed consistent patterns of food groups changing with higher protein intake. As expected, there was greater intake of meat, but also intake of vegetables. In addition, diet quality scores that measured dairy (HEI, DASH, MDS), unsaturated fatty acids (AHEI, MDS) and sodium (HEI, AHEI) showed an increase with higher protein intake. Conclusions In individuals following a weight loss diet, higher protein intake consistently altered dietary patterns of low-protein food components including higher intake of vegetables, unsaturated fat, and sodium. In an overweight and obese population with no comorbidities, HEI, AHEI, MDS, and DASH diet scores are effective methods of measuring diet quality and food patterns during moderate weight loss. Funding Sources Financial support by North American Branch-ILSI and National Institute of Health-NIA is appreciated.

A metabolome and microbiome wide association study of healthy eating index points to the mechanisms linking dietary pattern and metabolic status.

Healthy eating index (HEI), a measure of diet quality, associates with metabolic health outcomes; however, the molecular basis is unclear. Weconducted a multi-omic study to examine whether HEI associates with the circulatory and gut metabolome and investigated the gut microbiome-HEI interaction on circulating and gut metabolites. Through a cross-sectional study, we evaluated diet quality in healthy individuals [the ABO Glycoproteomics in Platelets and Endothelial Cells (ABO) Study, n = 73], metabolites (measured at Metabolon Inc.) in plasma (n = 800) and gut (n = 767) and the gut microbiome at enterotype and microbial taxa (n = 296) levels. Pathway analysis was conducted using Metaboanalyst 4.0. We performed multi-variable linear regression to explore both the HEI-metabolites and HEI-microbiome associations and how metabolites were affected by the HEI-microbiome interaction. In the Fish oils and Adipose Inflammation Reduction (FAIR) Study (n = 25), analyses on HEI and plasma metabolites were replicated. Estimates of findings from both studies were pooled in random-effects meta-analysis. The HEI-2015 was associated with 74 plasma and 73 gut metabolites (mostly lipids) and with 47 metabolites in the meta-analysis of the ABO and FAIR Studies. Compared to Enterotype-1 participants, those with Enterotype-2 had higher diet quality (p = 0.01). We also identified 9 microbial genera associated with HEI, and 35 plasma and 40 gut metabolites linked to the HEI-gut microbiome interaction. Pathways involved in the metabolism of polar lipids, amino acids and caffeine strongly associated with diet quality. However, the HEI-microbiome interaction not only influenced the pathways involved in the metabolism of branch-chain amino acids, it also affected upstream pathways including nucleotide metabolism and amino acids biosynthesis. Our multi-omic analysis demonstrated that changes in metabolism, measured by either circulatory/gut metabolites or metabolic pathways, are influenced by not only diet quality but also gut microbiome alterations shaped by the quality of diet consumed. Future work is needed to explore the causality in the interplay between HEI and gut-microbiome composition in metabolism.

Association Between Chemosensory Dysfunction and Diet Quality in United States Adults.

Evidence suggests chemosensory dysfunction (CSD) patients have altered diet, but population-level evidence assessing diet quality in CSD patients is lacking. We examined the association between CSD and diet quality in a representative sample of United States adults. This cross-sectional study included 2831 adults aged greater than 40 years from the 2013-2014 National Health and Nutrition Examination Survey who completed the taste/smell questionnaire and examination. Mean nutrient intake in subjects with self-reported olfactory/gustatory dysfunction (sOD/sGD) and measured olfactory/gustatory dysfunction (mOD/mGD) were compared to those without CSD using univariate Wilcoxon rank-sum tests. The Healthy Eating Index (HEI), a validated measure of diet quality, was calculated. The proportion of subjects with CSD with bottom-quartile HEI was compared to those without CSD using multivariate logistic regression, adjusting for demographic and socioeconomic covariates. The population-weighted prevalence of sOD, sGD, mOD, and mGD was 20.1%, 14.4%, 15.9% and 25.6%, respectively. Subjects with mOD had lower mean intake of total calories, total fat, protein, sodium, and potassium compared to normal subjects (1873.4 ± 49.6 vs 2010.2 ± 24.2 kcal, 72.3 ± 2.7 vs 78.6 ± 1.0 gm, 74.0 ± 2.5 vs 80.4 ± 0.6 gm, 3122 ± 97.2 vs 3353.2 ± 37.0 mg, 2509.8 ± 69.8 vs 2684.7 ± 26.1 mg, P < 0.05 respectively). When controlling for sociodemographic factors and comorbidities, subjects with sOD were more likely to have bottom-quartile HEI compared to normal subjects (OR 1.33, 95% CI 1.04-1.70). This population-level study suggests an association between poor diet quality and variation in dietary intake in patients with CSD, which warrants further investigation and suggests the possible need for nutritional counseling for CSD patients.

Associations Between Diet Quality and Dental Caries in Low-Income Women

BackgroundThe Healthy Eating Index 2015 (HEI-2015) is a diet quality measure of conformity of diet to the 2015-2020 Dietary Guidelines for Americans. This tool is being used increasingly to assess relationships between diet quality and health outcomes. ObjectiveThe objective of this research was to investigate the relationships between diet quality as measured by HEI-2015 total and component scores and Decayed, Missing, Filled Teeth Index (DMFT) scores in low-income women. DesignIn this cross-sectional study, low-income women were administered questionnaires and dental examinations on 1 occasion. The questionnaires included demographics, food frequency, and oral health questionnaires, and the US Adult Food Security Survey Module. Participants/settingsParticipants in this study were part of a larger research project—Impact of Diet and Nutrition on Dental Caries in Low-Income Women. For the larger research project, a total of 255 women aged 18 to 50 years with annual income <250% of the Federal Poverty Line were recruited from low-income housing units in Central Texas from June 1, 2018 to December 30, 2018. Of the 255 women, 28 underwent dental screenings but did not complete the questionnaires. Seven women were excluded because energy intakes exceeded 4,000 kcal/d. The final sample for the current analysis was 220 women who had completed their dental examinations and provided complete data. Main outcome measuresThe exposure was diet quality and the main outcome measure was DMFT score. Statistical analysisDental caries scores were calculated by addition of decayed, missing, and filled teeth. Descriptive statistics were conducted on the variables of age, race and ethnicity, education, annual household income, food security status, and frequency of brushing and flossing. Linear regression analysis was used to discern relationships between diet quality—as assessed by HEI-2015 total and component scores—and dental caries experience, adjusting for the covariates. ResultsCaries in permanent teeth was present in 95.6% of participants. HEI-2015 total scores were inversely associated with dental caries. An increase of 1 point in total HEI-2015 score was accompanied by a decrease in DMFT score by 0.569 (P = .001). In addition, component scores for total vegetables (P = .001), greens and beans (P = .002), dairy (P = .004), refined grains (P = .001), and added sugars (P = .001) were inversely related to DMFT scores. ConclusionsThis research suggests that diet quality, as measured by the HEI-2015, is inversely associated with DMFT scores in low-income women. Future research is needed to investigate the influence of diet and nutrition on the integrity of oral health.

Association of a Single-Item Self-Rated Diet Construct With Diet Quality Measured With the Alternate Healthy Eating Index.

Background: A single-item self-rated diet measure (SRD) may provide a quick, low-burden screener. However, assessment of its validity is limited. This study aimed to evaluate the association of an SRD construct with measured diet quality among adults in Puerto Rico (PR).Methodology: Participants (30–75 years old; n = 247) of the PR Assessment of Diet, Lifestyle, and Diseases (PRADLAD) cross-sectional study reported SRD with a single question (“How would you describe your current dietary habits and diet quality?”) with a five-point scale: excellent to poor. More complete diet quality was calculated using the Alternate Healthy Eating Index-2010 (AHEI), with 11 food and nutrient components assessed by the food frequency questionnaire. Multivariable general linear models were used to test associations between SRD with AHEI and its components. Associations were also tested between recall SRD in youth and current AHEI.Results: Most participants (35.2%) self-rated diet as “good,” 13.8% as “excellent,” and 4.1% as “poor,” with the remainder split between middle scale points. SRD was not significantly associated with AHEI, although participants with “excellent” vs. “poor” SRD had marginally higher AHEI (P = 0.07). SRD was significantly associated with higher fruit intake (P = 0.02) and marginally associated with intakes of vegetables (P = 0.07) and long-chain fatty acids (P = 0.07). Unexpectedly, AHEI was significantly higher among those reporting “poor” SRD in young adulthood (P = 0.01) or childhood (P = 0.05).Conclusions: SRD may capture current diet quality at extreme intakes. Larger studies should confirm these findings and replicate them in other underrepresented populations. Further research should clarify the inverse associations between adult AHEI and earlier reported SRD.

Academy of Nutrition and Dietetics Nutrition Research Network: The Saqmolo' Project Rationale and Study Protocol for a Randomized Controlled Trial Examining the Influence of Daily Complementary Feeding of Eggs on Infant Development and Growth in Guatemala

Adequate nutrition during the complementary feeding period is critical for optimal child growth and development and for promoting long-term educational attainment and economic potential. To prioritize limited public health resources, there is a need for studies that rigorously assess the influence of multicomponent integrated nutrition interventions in children younger than age 2 years in different contexts. This study aimed to describe the rationale and protocol for the Saqmolo’ Project using the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. The Saqmolo’ (ie, “egg” in the Mayan language, Kaqchiquel) Project is an individually randomized, partially blinded, controlled comparative effectiveness trial to evaluate the influence of adding delivery of a single whole egg per day to local standard nutrition care (ie, growth monitoring, medical care, deworming medication, multiple micronutrient powders for point-of-use food fortification [chispitas], and individualized complementary and responsive feeding education for caregivers) for 6 months, compared with the local standard nutrition care package alone, on child development, growth, and diet quality measures in rural indigenous Mayan infants aged 6 to 9 months at baseline (N = 1,200). The study is being executed in partnership with the Wuqu’ Kawoq/Maya Health Alliance, a primary health care organization located in central Guatemala. Primary outcomes for this study are changes in global development scores, assessed using the Guide for Monitoring Global Development and the Caregiver Reported Child Development Instruments. Secondary outcomes include changes in infant hemoglobin, anthropometric measures (including z scores for weight for age, length for age, weight for length, and head circumference for age), and diet quality as measured using the World Health Organization’s infant and young child feeding indicators. The results of the Saqmolo’ Project may help to inform public health decision making regarding resource allocation for effective nutrition interventions during the complementary feeding period.

Dietary Energy Density and Fertility: Results from the Lifestyle and Fertility Study

ABSTRACTBackgroundDiet is a modifiable lifestyle factor linked with fertility in a growing number of studies.ObjectiveThe objective of this study was to evaluate the association between dietary energy density (ED), a summary measure of diet quality that estimates the amount of energy per unit food (kcal/g) consumed, and conception and pregnancy outcomes.MethodsA prospective cohort study of couples planning their first pregnancy was conducted in the Northeast region of the USA. Dietary data were collected prior to conception via 3 unannounced interviewer-administered 24-h dietary recalls. Multivariable-adjusted logistic regression (ORs and Cox proportional hazards models [RR] and 95% CIs) were estimated for continuous and categorical (tertile [T]) variables of dietary ED.ResultsThe majority of women (n = 80; 61%) achieved clinical pregnancy. Median time to conception of a clincal pregnancy(TTC) for those who conceived was 4.64 mo with an IQR of 4.37 mo. ED modeled as a continuous variable was not associated with clinical pregnancy, live birth, or TTC after controlling for race, physical activity, and male partner's ED. When ED was categorized to consider nonlinear associations, 60%, 73%, and 50% of the participants in the tertiles (from lowest ED to highest) achieved clinical pregnancy. In multivariable logistic analyses with the middle group as the referent (ED = 1.37–1.60), membership in the highest ED group (ED >1.60) was associated with lower odds of clinical pregnancy (OR = 0.30; 95% CI: 0.11, 0.81, P = 0.02). In Cox proportional hazards analyses, membership in the highest ED group was associated with significantly longer TTC compared with the middle category (HR = 0.41; 95% CI: 0.21,0.82, P = 0.01).ConclusionsThese results suggest that high dietary ED is associated with reduced fertility.This study evaluated associations between dietary energy density and the probability of conceiving clinical pregnancy, having a live birth, and the time to conception among couples planning pregnancy.

Effects of At‐Risk and Recent Alcohol Use on Diet Quality among People Living with HIV (PLWH)

People living with HIV (PLWH) have increased rates of alcohol use, increased survival rates with the use of ARTs and are at an increased risk for the development of metabolic comorbidities, including obesity and insulin resistance. Alcohol use is associated with decreased diet quality and individuals consuming large quantities of alcohol often have the poorest diet quality and overconsume calories. The goal of this study was to test the hypothesis that at-risk alcohol use, as well as recent alcohol use, is associated with poor diet quality in PLWH. Diet quality was determined in a subset of adult, in-care PLWH enrolled in the New Orleans Alcohol Use in HIV (NOAH) Study (n=222). Participants completed a single 24-hour dietary recall using the Automated Self-Administered 24-hour (ASA-24) Dietary Recall Tool and values were compared to the U.S. Dietary Guidelines and Dietary Reference Intakes. At-risk alcohol use was determined by the Alcohol Use Disorders Identification Test (AUDIT). An AUDIT score ≥ 8 was defined as at-risk alcohol use (n=67) and an AUDIT score of < 8 (n=155) was considered low-risk. Recent alcohol use was determined by Timeline Followback (TLFB), which assessed the previous 30-day alcohol intake. PLWH with at-risk alcohol use had lower body mass index (BMI), consumed a lower percentage of calories from carbohydrates, consumed more total calories, more calories from protein, more cholesterol and sodium and had a higher total calorie/body weight (kg) than PLWH with low-risk alcohol use. PLWH with at-risk alcohol use also consumed more calories from alcohol than PLWH with low-risk alcohol use. Calories from alcohol accounted for the difference in total caloric intake between the two groups. Cured meat intake (oz. equivalent) was higher in PLWH with at-risk alcohol use, which likely contributed to the increased sodium, cholesterol and protein intake in this group. AUDIT score and recent alcohol use (TLFB) were positively correlated with each other and total caloric consumption and calories from alcohol. Additionally, recent alcohol use (TLFB) was positively correlated with calories consumed from protein, fat, and carbohydrates. Both AUDIT score and recent alcohol use (TLFB) were negatively correlated with BMI and waist circumference. Overall, PLWH consumed lower than recommended dietary amounts of carbohydrates (43.6% ± 11.2) and higher than recommended amounts of fat (36.0% ± 9.1). The Healthy Eating Index (HEI), a measure of diet quality based on Dietary Guidelines for Americans was not affected by alcohol use in PLWH, however average HEI in PLWH was 44.5/100, compared to the national average in adults, 59/100. These preliminary analyses suggest that at-risk and recent alcohol use significantly affect diet quality in PLWH and that overall, PLWH in this South Louisiana cohort are not meeting U.S Dietary Guidelines. The development and implementation of nutritional and alcohol-reducing interventions may be appropriate strategies to improve food selection and diet quality and decrease the risk of developing metabolic comorbidities in PLWH.

Effects of nutrition intervention strategies in the primary prevention of overweight and obesity in school settings: a protocol for a systematic review and network meta-analysis

BackgroundOverweight and obesity in children and adolescents are major public health challenges affecting quality of life and representing important risk factors in the development of non-communicable diseases. School environments provide great possibilities for the primary prevention of overweight and obesity and different school-based nutrition interventions are available. However, existing research on school-based nutrition interventions has important limitations and no network meta-analysis (NMA) has been performed yet to compare all available interventions. Therefore, the present research project aims to investigate the impact of different nutrition interventions in the school setting by comparing and ranking them using NMA methodology.Methods/designA systematic literature search will be performed in 11 electronic databases (PubMed, the Cochrane Library, Web of Science, ERIC, PsycINFO, CAB s, Campbell Library, BiblioMap EPPI, Australian Education Index, Joanna Briggs Institute Evidence-Based Practice Database and Practice-based Evidence in Nutrition Database). Parallel or cluster randomized controlled trials (RCTs) meeting the following criteria will be included: (1) generally healthy school students aged 4–18 years, (2) school-based intervention with ≥ 1 nutrition component, and (3) assessed anthropometric (overweight/obesity risk, body weight change, weight Z-score, [standardized] body mass index, body fat, waist circumference) and/or diet-quality measures (daily intake of fruits and vegetables, fat, and sugar-sweetened beverages). Random effects pairwise and NMA will be performed for these outcomes and surface under the cumulative ranking curve (SUCRA) estimated (P-score). Where possible, component NMA (CNMA) will be used additionally. Subgroup analyses are carried out for intervention duration, gender, age of school students, socioeconomic status, and geographical location, and sensitivity analyses by excluding high risk of bias RCTs.DiscussionThis systematic review and NMA will be the first to both directly and indirectly compare and rank different school-based nutrition interventions for the primary prevention of overweight and obesity in childhood and adolescence. Our analyses will provide important insights about the effects of the different interventions and show which are the most promising. The results of our study can help inform the design of new studies and will be of value to anyone interested in developing successful, evidence-based nutrition interventions in school settings.Systematic review registrationPROSPERO: CRD42020220451.