Population Ratio Method Research Articles

Trends in Toddler Diet Quality in the United States: 1999 to 2018.

Diet quality has improved over time for US adults and youth aged ≥2 years. Trends over time and disparities in the diet quality of toddlers 12 through 23 months old have not been documented. Our objective was to investigate the direction and magnitude of toddler diet quality trends from 1999 to 2018 overall and by household socioeconomic status. This serial cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data was performed with 2541 toddlers from 10 NHANES cycles from 1999 to 2018. Dietary intake was measured by NHANES study staff using proxy-reported 24-hour recalls. Healthy Eating Index-Toddlers-2020 total scores (0-100 points, higher scores indicate healthier diets) and component scores were calculated from the 24-hour dietary recalls using the population ratio method. Multivariable linear regression was used to evaluate the association between time in years (measured as the midpoint of each NHANES cycle) and diet quality. Toddler diet quality improved significantly from 1999 to 2018 (P < .001), from 63.7 points on average in 1999-2000 to 67.7 points in 2017-2018. A significant positive linear trend in total diet quality was observed for all socioeconomic status groups (P < .05). Several dietary component scores improved, as follows: Whole Fruits (P < .001), Whole Grains (P = .016), Fatty Acids (P = .002), Refined Grains (P = .009), and Added Sugars (P < .001). Scores did not significantly change for Total Fruit, Total Vegetables, Greens and Beans, Dairy, Total Protein Foods, Seafood and Plant Proteins, Sodium, or Saturated Fats. From 1999 to 2018, toddler diet quality improved significantly, but mean scores still fell short of dietary guidance.

Measuring Dietary Quality Among Toddlers in the Feeding Infants and Toddlers Study, 2016, Using the New Healthy Eating Index-Toddlers-2020

BackgroundChild diet can influence risk for obesity and other related noncommunicable diseases. Few studies have used the Healthy Eating Index (HEI)-Toddlers-2020 to assess diet quality among toddlers (children aged 12 to 23.9 months). ObjectiveThe aim of this study was to examine diet quality among toddlers participating in the Feeding Infants and Toddlers Study, 2016, and determine differences by sociodemographic characteristics. Caregiver perception of how their toddler’s diet aligns with HEI-Toddlers-2020 diet quality scores was also assessed. DesignThis cross-sectional study used 24-hour dietary records collected in 2016. Participants and settingData were collected on toddlers ages 12 to 23.9 months (N = 1133) participating in the Feeding Infants and Toddlers Study, 2016. Main outcome measuresDiet quality was assessed using the HEI-Toddlers-2020. Statistical analyses performedThe population ratio method was used for all analyses using weighted data to estimate HEI-Toddlers-2020 scores overall and within subgroups. To determine significant differences of the HEI-Toddlers-2020 score between subgroups, pairwise t tests were used. Statistical significance at P < .05 was used as a cutoff for all 2-sided P values. ResultsAverage HEI-Toddlers-2020 score among toddlers ages 12 to 23.9 months participating in the Feeding Infants and Toddlers Study, 2016, was 71.2 out of a possible 100. Total scores (mean, standard error) varied by race and ethnicity with Hispanic toddlers having higher scores compared with non-Hispanic White toddlers (76.4 ± 2.5 vs 69.0 ± 1.2; P = .03) and by federal poverty level with those >200% of the poverty level having higher scores compared with those <100% of the poverty level (74.7 ± 1.5 vs 67.0 ± 2.6; P = .01). ConclusionsOpportunities for improvement in dietary intake were identified using the new HEI-Toddlers-2020 to assess diet quality among children ages 12 to 23.9 months. Scores were indicative of toddlers consuming excess added sugars and lower-than-recommended amounts of seafood and plant proteins, greens and beans, whole grains, and vegetables. Interventions to improve diet quality in toddlers may benefit from focusing on foods children should eat more of along with foods to consume in moderation.

Dietary Intakes of Community-Dwelling Adults in the United States across Older Adulthood: National Health and Nutrition Examination Survey 2015–March 2020

BackgroundDietary guidance is set on the basis of age and life stage and defines older adults as ≥60 y. Yet, little is known about if and/or how diet quality differs beyond the age of 60. ObjectiveThe objective of this study was to compare the dietary intakes of 60–69 (n = 2079), 70–79 (n = 1181), and 80+ y old (n = 644) noninstitutionalized men and women in the United States using the Healthy Eating Index 2015 (HEI) and the What We Eat in America food categories. MethodsData were obtained from National Health and Nutrition Examination Survey 2015–2016 and 2017–March 2020. HEI and component scores were calculated using the population ratio method. Population estimates for dietary intake were calculated as the average reported over 2 separate nonconsecutive 24-h dietary recalls. ResultsIn men and women, the reported energy intake was lower among the 80+ y olds (kcal/d men—80+: 1884 ± 30, 70–79: 2022 ± 33, 60–69: 2142 ± 39; women—80+: 1523 ± 36; 70–79: 1525 ± 33, 60–69: 1650 ± 25; P-trend < 0.001). Total HEI scores did not differ significantly across the 3 age categories, but the 80+ y olds had significantly lower scores for the green vegetables and beans component than the 60–69 y olds [men—mean (95% confidence interval): 2.0 (1.5, 2.5) compared with 3.4 (2.6, 4.1); women—2.3 (1.8, 2.8) compared with 4.4 (3.7, 5.0)]. In women, the percentage of daily calories from protein was significantly lower in the 80+ y olds than in the 60–69 and 70–79 y olds (12.9% ± 0.6%, compared with 17.0% ± 0.9% and 15.6% ± 0.6%, respectively). Protein intake did not differ significantly among the 3 age groups in men. The 80+ y old men and women reported consuming a significantly higher percentage of calories from snacks and sweets compared with the 60–69 y olds (men—80+: 18.1% ± 0.8%, 60–69: 15.4% ± 0.7%; women—80+: 19.6% ± 0.8%, 60–69: 15.5% ± 0.7%). ConclusionThe diet of 80+ y olds differed from that of 60–69 y olds in some key components, including energy, snacks and sweets, protein, and green vegetables. Future research is needed to determine if there are health-related consequences to these differences.

A Dietary Model of Partial Meat Replacement with Walnuts Demonstrates Changes in the Nutrient Profile and Quality of the United States Population's Diet.

The purpose of the study is to assess the impact of partial meat replacement with walnuts using a dose-escalation approach on nutrient intake and diet quality in the usual US diet. Food modeling was implemented using the nationally representative 2015-2018 National Health and Examination Survey (NHANES), with a focus on non-nut consumers, which included 2707 children and adolescents and 5190 adults. Walnuts replaced meat in a dose-escalating manner (0.5, 1, 1.5, and 2 oz walnuts per day replaced 1, 2, 3, and 4 oz meat, respectively). Diet quality was estimated using the population ratio method of the 2015 Healthy Eating Index. The usual intake of nutrients was estimated using the National Cancer Institute method. Significant differences were determined using non-overlapping 95% confidence intervals. The partial replacement of meat with walnuts demonstrated significant increases in the mean intake of fiber, magnesium, and omega-3 fatty acids and significant decreases in cholesterol and vitamin B12 in the modeled diets for children, adolescents, and adults. Additionally, the partial replacement of meat with walnuts improved overall diet quality. Walnut consumption at 1-2 oz as a replacement for some meat may improve nutrient intake and diet quality across age groups.

Dairy, Meat, Seafood, and Plant Sources of Saturated Fat: United States, Ages Two Years and Over, 2017–2020

BackgroundResearch suggests that the effects of saturated fat (SF) on health differ depending on its food source. Dairy SF has been associated with lower cardiovascular disease (CVD) risk, whereas meat SF is linked to a higher CVD risk. ObjectivesTo estimate the contribution to the total intake of SF of 1) 5 food groups - dairy, meats, seafood, plants, and “other,” and 2) the top 10 specific food category sources in the United States population overall and by sociodemographic subgroup. MethodsThe analysis included data from 11,798 participants in the 2017–March 2020 National Health and Nutrition Examination Survey aged 2+ y. Grams of SF from the food sources expressed as a percentage of the total grams of SF consumed, were estimated using the population ratio method. ResultsMean daily intake of SF was 28.1 g [95% confidence interval (CI): 27.6–28.6 g], comprising 11.9% (95% CI: 11.7–12.1%) of total energy intake. Dairy contributed 28.4% of SF, followed by meats (22.1%), plant sources (7.5%), fish and seafood (1.2%), and the remaining foods (41.6%). Youth had higher SF intake from dairy than adults (P < 0.001), whereas non-Hispanic Whites had higher intake than non-Hispanic Blacks (P < 0.001) and Hispanics (P = 0.016). Adults had higher SF intake from meats than youth (P = 0.002), males more than females (P < 0.001), and non-Hispanic Blacks more than non-Hispanic Asians (P = 0.016) and Hispanics (P < 0.001). The top 10 specific sources of SF were unprocessed red meats, sweet bakery products, cured meats, milk, cheese, pizza, unprocessed poultry, Mexican mixed dishes, eggs, and combined fruits and vegetables. ConclusionsAlthough dairy contributed ∼30% of SF compared to ∼20% for total meat, the top specific food category source of SF was unprocessed red meats, which ranked in the top 2 food category sources of SF for most subgroups. These findings may be useful for further research to examine the relationship between the different sources of SF and health outcomes.

A Classification System for Defining and Estimating Dietary Intake of Live Microbes in US Adults and Children

ABSTRACTBackgroundConsuming live microbes in foods may benefit human health. Live microbe estimates have not previously been associated with individual foods in dietary databases.ObjectivesWe aimed to estimate intake of live microbes in US children (aged 2–18 y) and adults (≥19 y) (n = 74,466; 51.2% female).MethodsUsing cross-sectional data from the NHANES (2001–2018), experts assigned foods an estimated level of live microbes per gram [low (Lo), <104 CFU/g; medium (Med), 104–107 CFU/g; or high (Hi), >107 CFU/g]. Probiotic dietary supplements were also assessed. The mean intake of each live microbe category and the percentages of subjects who ate from each live microbe category were determined. Nutrients from foods with live microbes were also determined using the population ratio method. Because the Hi category comprised primarily fermented dairy foods, we also looked at aggregated data for Med or Hi (MedHi), which included an expanded range of live microbe–containing foods, including fruits and vegetables.ResultsOur analysis showed that 52%, 20%, and 59% of children/adolescents, and 61%, 26%, and 67% of adults, consumed Med, Hi, or MedHi foods, respectively. Per capita intake of Med, Hi, and MedHi foods was 69, 16, and 85 g/d for children/adolescents, and 106, 21, and 127 g/d for adults, respectively. The proportion of subjects who consumed live microbes and overall per capita intake increased significantly over the 9 cycles/18-y study period (0.9–3.1 g/d per cycle in children across categories and 1.4 g/d per cycle in adults for the Med category).ConclusionsThis study indicated that children, adolescents, and adults in the United States steadily increased their consumption of foods with live microbes between the earliest (2001–2002) and latest (2017–2018) survey cycles. Additional research is needed to determine the relations between exposure to live microbes in foods and specific health outcomes or biomarkers.

Adding Walnuts to the Diet of Children and Adolescents Improved the Diet Quality: Results of an NHANES Modeling Study

ObjectivesTo assess the impact of adding one ounce of walnuts on nutrients of public health concern and diet quality. MethodsFood modeling was implemented in the nationally representative 2015–2018 National Health and Examination Survey (NHANES) in a population of 4,756 children and adolescents of no-nut consumers. One ounce of walnuts was added to the usual dietary intake in this modeling study. The Healthy Eating Index-2015 was used as a summary measure of diet quality. Outcomes of interest were intakes of fiber, protein, potassium, folate, magnesium, and omega 3. Nutrient intake was analyzed using the National Cancer Institute method (NCI), while the HEI-2015 score was estimated using the population ratio method. Significant differences were determined using non-overlapping 95% CIs. ResultsHEI-2015 scores were significantly higher in Modeled diet compared to usual diets (58.5 ± 0.5 vs. 49.1 ± 0.6) out of 100 total points. Adding walnuts increased the energy density per 1,000 calories of the total protein, seafood and plant proteins, and polyunsaturated fatty acids, thus increasing the individual component HEI scores in these areas. Compared to usual diet, modeled diet significantly improved inadequacy for magnesium (48.3% to 34.6%), folate (28.3 to 22.0%), Copper (16.2%to 0.2%), and zinc (21.1% to 14.7%). Further, mean fiber intake significantly increased from 13.6 ± 0.2 to 15.4 ± 0.2 grams. ConclusionsPublic health messages targeted at no-nut consumers should emphasize the benefits of nut consumption, specifically walnuts, to improve diet quality. Further, adding walnuts to the diet improves the inadequacy of folate, magnesium, and trace minerals. Food pattern modeling using NHANES data can be used to assess nutritional impacts of compliance to current dietary guidance. Funding SourcesThis study was funded by the California Walnut Commission.

Impact of Replacing Meat With Walnuts: Results of an NHANES Modeling Study

ObjectivesTo assess the impact of replacing meat with walnuts in a dose escalation manner in the usual US dietary intake pattern. MethodsFood modeling was implemented in the nationally representative 2015–2018 National Health and Examination Survey (NHANES) in a population of 5,807 adults, 19 years and older of no-nut consumers. Walnuts replaced meat in a dose escalating manner (i.e., 0.5, 1, 1.5, and 2 oz equivalents per day) in the usual dietary intake in this modeling study. Diet quality was estimated using the population ratio method of the Healthy Eating Index (HEI-2015). The usual intake of nutrients was estimated using the National Cancer Institute (NCI) method. Significant differences were determined using non-overlapping 95% CIs. ResultsReplacing meat at any dose level with walnuts significantly improved the mean intake of fiber, magnesium, omega 3 while reducing the cholesterol intake. Further, vitamin B12 intake was significantly reduced while no significant decline in iron intake was observed. Diet quality in the modeled diets (after replacing meat with walnuts) was significantly higher compared to diet quality in the usual diet. Better diet quality scores were mainly driven by strong improvements in the HEI components “Seafood and Plant Protein” and “Fatty Acid Ratio.” ConclusionsThe partial replacement of meat with walnuts improved overall diet quality and increased the intake of magnesium, fiber, and omega 3 but adversely affected vitamin B12. Funding SourcesThis study was funded by the California Walnut Commission.

Association of diet quality, physical activity, and abdominal obesity with metabolic syndrome z-score in black and white adolescents in the US

Background and aimsMetabolic syndrome (MetS) affects ∼10% of adolescents and is associated with cardiometabolic disease risk. The most prevalent MetS component is abdominal obesity. Healthy diet and physical activity (PA) are inversely associated with abdominal obesity and may reduce MetS risk in youth. Our aim was to examine associations of diet, activity, and abdominal obesity with MetS z-score (MetS-z). Methods and resultsAn analysis of National Health and Nutrition Examination Survey (NHANES) 2011–2016 data in adolescents was performed. Healthy Eating Index (HEI)- 2015 scores were calculated for diet quality, PA habits were used to determine alignment with national guidelines, and abdominal obesity was assessed by sagittal abdominal diameter (SAD). MetS-z represented severity or potential risk for MetS. Multivariable regression evaluated the relationships of HEI, SAD and PA with MetS-z. Among 1214 black and white adolescents, SAD was significantly associated with MetS-z [β (95% CI) = 0.17 (0.16, 0.19); P <0.0001] while HEI-2015 components showed associations with MetS-z overall (HEI total, dairy, and sodium scores), and by sex (total, refined grains, dairy for males; added sugar, protein, whole grains for females). Mean HEI-2015 score was 47.4/100 (51.6 using the population-ratio method), and the proportion of adolescents meeting national PA guidelines was 37.6%, yet PA was not a significant predictor of MetS-z. ConclusionsUS adolescents have poor diet quality and fewer than half meet PA guidelines. Strategies for preventing MetS and related conditions in adolescence should focus on weight management – specifically, abdominal fat reduction – with individualized diet counseling.

Chronic Nutrition Impact Symptoms Are Associated with Decreased Functional Status, Quality of Life, and Diet Quality in a Pilot Study of Long-Term Post-Radiation Head and Neck Cancer Survivors.

Background: As a result of tumor location and treatment that is aggressive, head and neck cancer (HNC) survivors experience an array of symptoms impacting the ability and desire to eat termed nutrition impact symptoms (NISs). Despite increasing cancer survival time, the majority of research studies examining the impact of NISs have been based on clinical samples of HNC patients during the acute phase of treatment. NISs are often chronic and persist beyond the completion of treatment or may develop as late side effects. Therefore, our research team examined chronic NIS complications on HNC survivors’ functional status, quality of life, and diet quality. Methods: This was a cross-sectional study of 42 HNC survivors who were at least 6 months post-radiation. Self-reported data on demographics, NISs, quality of life, and usual diet over the past year were obtained. Objective measures of functional status included the short physical performance battery and InBody© 270 body composition testing. NISs were coded so a lower score indicated lower symptom burden, (range 4–17) and dichotomized as ≤10 vs. >10, the median in the dataset. Wilcoxon rank sum tests were performed between the dichotomized NIS summary score and continuous quality of life and functional status outcomes. Diet quality for HNC survivors was calculated using the Healthy Eating Index 2015 (HEI-2015). Wilcoxon rank sum tests examined the difference between the HNC HEI-2015 as compared to the National Health and Nutrition Examination Survey (NHANES) data calculated using the population ratio method. Results: A lower NIS score was statistically associated with higher posttreatment lean muscle mass (p = 0.002). A lower NIS score was associated with higher functional (p = 0.0006), physical (p = 0.0007), emotional (p = 0.007), and total (p < 0.0001) quality of life. Compared to NHANES controls, HNC survivors reported a significantly lower HEI-2015 diet quality score (p = 0.0001). Conclusions: Lower NIS burden was associated with higher lean muscle mass and functional, physical, emotional, and total quality of life in post-radiation HNC survivors. HNC survivors reported a significantly lower total HEI-2015 as compared to healthy NHANES controls, providing support for the hypothesis that chronic NIS burden impacts the desire and ability to eat. The effects of this pilot study were strong enough to be detected by straight forward statistical approaches and warrant a larger longitudinal study. For survivors most impacted by NIS burden, multidisciplinary post-radiation exercise and nutrition-based interventions to manage NISs and improve functional status, quality of life, and diet quality in this survivor population are needed.

Healthy Eating Index-2015 Scores Among Adults Based on Observed vs Recalled Dietary Intake

BackgroundThe construct and predictive validity of the Healthy Eating Index (HEI) have been demonstrated, but how error in reported dietary intake may affect scores is unclear. ObjectiveThese analyses examined concordance between HEI-2015 scores based on observed vs reported intake among adults. DesignData were from two feeding studies (Food and Eating Assessment STudy, or FEAST, I and II) in which true intake was observed for three meals on 1 day. The following day, participants completed an unannounced 24-hour dietary recall. Participants/settingFEAST I (2012) included 81 men and women, aged 20 to 70 years, living in the Washington, DC, area. FEAST II (2016) included 302 women, aged 18 years or older, with low household incomes and living in the Washington, DC, area. In FEAST I, recalls were completed independently using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24-2011) or interviewer-administered using the Automated Multiple-Pass Method. In FEAST II, recalls were completed using ASA24-2016, independently or in a small group setting with assistance. Main outcome measuresHEI-2015 scores were calculated using the population ratio method. Statistical analyses performedT-tests determined whether differences between scores based on observed and reported intake were different from zero. FEAST I data were stratified by sex, and in FEAST II, analyses were repeated by education and body mass index (BMI). ResultsDifferences in total HEI-2015 scores between observed and reported intake ranged from −1.3 to 5.8 points among those completing ASA24 independently in both studies, compared with −2.5 points in the small group setting. For interviewer-administered recalls, the differences were −1.1 for men and 2.3 for women. In FEAST II, total HEI-2015 scores derived from observed intake were lower than scores derived from reported intake among those who had completed high school or less (−3.2, SE 1.1, P<0.01) and those with BMI ≥ 30 (−2.8, SE 1.1, P = 0.01). ConclusionsHEI-2015 scores based on 24-hour dietary recall data are generally well estimated.

Forecasting Future Demand of Nursing Staff for the Oldest-Old in China by 2025 Based on Markov Model.

An aging population and an increase in the proportion of disabled elderly have brought an unprecedented global challenge, especially in China. Aside lack of professional long-term care facilities, the shortage of human resource for old-age care is also a major threat. Therefore, this study tries to forecast the demand scale of nursing staff for the oldest-old in 2025 in China servicing as a reference for the development plan of human resource for elderly nursing. Based on CLHLS (Chinese Longitudinal Healthy Longevity Survey) 2011 and 2014, Logit model was used to construct the transition probability matrix of the elderly's health status (health/mild/moderate/severe disability and death). By using the data of the elderly population aged 65 or over in the 2010 national population census, we projected the number of Chinese oldest-old population in different health status by 2025 through Markov model and projected the scale of the demand of nursing staff combined with the human population ratio method. The forecast shows that the Chinese oldest-old population is about 52.6 million, among which 46.9 million are healthy, 3.7 million are mild, 0.8 million are moderate, and 1.2 million are severely disabled in 2025. Concurrently, the demand scale of nursing staff will be 5.6 million according to the low standard and 11.5 million according to the high standard. Thus, human resource supply of long-term care is worrying. In 2025, the population size of the Chinese oldest-old will be further expanded, and the demand of care will increase accordingly, leading to a vast gap in the nursing staff. Therefore, it is urgent to build a professional nursing staff with excellent comprehensive quality and reasonable quantity, to ensure the sustainable development of China's elderly care service industry.

Changes in Maternal Diet Quality Across Pregnancy and Postpartum and Associations with Sociodemographic Characteristics

Abstract Objectives This study described diet quality across the perinatal continuum and investigated associations of sociodemographic characteristics with diet quality change from pregnancy to postpartum. Methods Pregnant women (n = 365) in a prospective cohort study completed a demographic questionnaire at recruitment and six 24-hour dietary recalls (one in each pregnancy trimester and 2, 6, and 12 months postpartum). Sample-level diet quality (Healthy Eating Index-2015, HEI total and component scores) at each of the six time points was quantified using the population ratio method and compared using bootstrapping and permutation tests. Individual-level HEI scores during the pregnancy (pooling 3 pregnancy recalls) and postpartum (pooling 3 postpartum recalls) periods were quantified using the by-person method and compared using paired t-tests. Multiple linear regression models examined independent associations of sociodemographic characteristics with change in HEI (postpartum subtracted from pregnancy score). Results Sample-level HEI total and component scores were generally consistent among time points within pregnancy and within postpartum but showed varied changes between periods. Within-person analyses indicated both positive (total protein, fatty acids, refined grains, saturated fat) and negative (total fruit, whole fruit, dairy) changes in HEI from pregnancy to postpartum. Greater improvements in HEI total score were observed in white non-Hispanic versus black non-Hispanic participants (β ± SEM: 6.7 ± 3.2), participants with at least a college degree versus less than a college degree (6.8 ± 2.7), and participants who were not working by choice versus working full time (7.0 ± 2.6). In addition to associations with change in HEI total score, race/ethnicity was associated with change in greens and beans, seafood and plant proteins, and added sugars component scores, education was associated with change in total fruit and refined grains scores, and employment was associated with change in refined grains score. Age, smoking status, and body mass index were also associated with changes in HEI component scores. Conclusions Perinatal decreases in fruit and dairy intake and sociodemographic disparities in dietary changes may represent critical intervention targets. Funding Sources This research was supported by the NICHD Intramural Research Program.

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

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

Diet quality of children in the United States by body mass index and sociodemographic characteristics.

SummaryObjectiveThe primary objective was to use the Healthy Eating Index‐2015 (HEI‐2015) to describe diet quality by categories of body mass index (BMI) and by sociodemographic characteristics within categories of BMI using a nationally representative sample of US children.MethodsDietary datasets from three cycles of the National Health and Nutrition Examination Survey (2009‐2014) were analysed for children 2 to 18 years of age (N = 8894). Using the population ratio method, mean and 95% confidence intervals for HEI‐2015 total and component scores were computed by BMI (underweight, normal weight, overweight, and obese) and by age (2‐5, 6‐11, and 12‐18 y), gender, race/ethnicity (non‐Hispanic black, non‐Hispanic white, Mexican American, other Hispanic, and other race), and family poverty to income ratio (below and at/above poverty threshold).ResultsHEI‐2015 mean total scores were 50.4, 55.2, 55.1, and 54.0 out of 100 points for children with underweight, normal weight, overweight, and obesity, respectively, and were not significantly different. Within BMI categories, significant differences in total and mean component scores were present for age and race/ethnicity groups.ConclusionsTotal and most components of diet quality did not significantly differ among child populations classified by BMI status. Within BMI categories, significant diet quality differences were found for age and race/ethnicity groups, although scores were low for all child groups. Researchers may need to address or target specific dietary components with low quality in various child populations to have the greatest effect on improving nutrition nationwide.

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

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

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

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

Diet Quality of Children in the United States by Race/Ethnicity Within Categories of Body Mass Index (P18-110-19)

ObjectivesTo use the Healthy Eating Index-2015 (HEI-2015) to describe the diet quality of children in the United States by race/ethnicity within categories of body mass index (BMI) using a nationally representative sample. MethodsDietary datasets from three cycles of the National Health and Nutrition Examination Survey (2009–2014) were used to calculate HEI-2015 total and component scores using the population ratio method for children 2–18 years of age (N = 8894). Diet quality scores were computed by race/ethnicity (non-Hispanic black, non-Hispanic white, Mexican American, other Hispanic, and other race) within BMI category (normal weight, overweight, and obese). Means and 95% confidence intervals were computed for HEI-2015 total and component scores. ResultsSignificant differences in HEI-2015 mean total scores were present in children with normal weight and overweight, but not obesity. For children with normal weight, the mean total score was significantly higher for Mexican Americans vs non-Hispanic blacks (57.1 vs 53 out of 100 points). For children with overweight, mean total scores were higher for Mexican Americans and other races vs non-Hispanic blacks (59.0 and 60.4 vs 50.3). For children with normal weight, racial/ethnic differences in mean scores were present for all 13 components except for total vegetables. For children with overweight, racial/ethnic differences in mean scores were present for seven components – total fruits, whole fruits, greens and beans, dairy, fatty acids, added sugars, and saturated fats. For children with obesity, racial/ethnic differences were present for two components – refined grains and added sugars. Due to small samples sizes resulting in unreliable estimates, results were not included for the underweight category. ConclusionsAlthough significant diet quality differences were found among races/ethnicities within BMI categories, total diet quality scores were low for all populations of children in this study. These results suggest that efforts are still needed to improve the diet quality of children in the United States, regardless of BMI status. Funding SourcesUS Department of Agriculture, Agricultural Research Service.

Diet Quality in a Nationally Representative Sample of American Adult Cancer Survivors (P05-028-19)

ObjectivesMany epidemiology studies showed diet quality before cancer diagnosis is associated with cancer survivor’s mortality, however, there is very limited information on Healthy Eating Index 2015 (HEI-2015) scores among American adult cancer survivors. This study aimed to use the HEI-2015 to evaluate the diet quality of nationally representative samples of American adult cancer survivors overall and by various sociodemographic variables. MethodsNational Health and Examination Surveys (NHANES) dietary data (2005–2016) were used to compute HEI-2015 total and component scores by use of the population ratio method for adult cancer survivors aged ≥ 20 y. Diet-quality scores were calculated overall and by age (20–29, 30–44, 45–64, and ≥65 y), gender, race or ethnicity, body mass index (BMI), family poverty-to-income ratio (below and at or above the poverty threshold), and time since the first cancer diagnosis. HEI-2015 mean total and component scores along with 95% confidence limits were reported. ResultsTotal sample consisted of 2635 adult cancer survivors with a mean age of 62.4 and a BMI of 29.0 kg/m2. The average time since cancer diagnosis was 11.5 years. The HEI-2015 mean total score for cancer survivors overall was 56.2 (range 22.2–99.5). As age increased, the total scores increased; the total score was significantly higher for survivors in the oldest age group compared with the other 3 younger age groups (58.2 vs. 50.6, 52.3, and 54.9, respectively). The total score was significantly lower for adults with BMI ≥ 30 kg/m2compared to adults with BMI < 25.0 kg/m2 (53.4 vs. 58.5). Non-Hispanic black survivors had a significantly lower total score compared with survivors of non-Hispanic White and of other races (53.4 vs. 56.3 and 57.5, respectively), but there is no significant difference compared with Mexican American survivors (53.4 vs. 54.7). Neither gender nor time since cancer diagnosis affect the total mean score, but significant differences were found between poverty threshold classes (52.2 vs. 56.6). ConclusionsThe diet quality of American adult cancer survivors remains low overall, with significant disparities across some sociodemographic populations, particularly age, race or ethnicity, BMI, and poverty level. The results can help identify at-risk populations who need more guidance in their eating to improve their survival. Funding SourcesUniversity of Central Florida.

Diet quality in a nationally representative sample of American children by sociodemographic characteristics

To date, Healthy Eating Index 2015 (HEI-2015) scores have not been published in the peer-reviewed literature for nationally representative samples of American children. The aim of this study was to use the HEI-2015 to describe the diet quality of American children overall and within various sociodemographic populations. We used 3 cycles of NHANES dietary data sets (2009-2010, 2011-2012, and 2013-2014) to calculate HEI-2015 total and component scores by use of the population ratio method for children aged 2-18 y (n=9000). Diet-quality scores were computed overall and by age (2-5, 6-11, and 12-18 y), gender, race or ethnicity (non-Hispanic black, non-Hispanic white, Mexican American, other Hispanic, and other race), and family poverty-to-income ratio (below or at or above the poverty threshold). HEI-2015 mean total and component scores were computed along with 95% CIs. The HEI-2015 total mean score for children overall was 54.9 (range: 0-100). As the age group increased, the total scores decreased; the total mean score was significantly higher for children in the youngest age group compared with the 2 older age groups (60.1 compared with 53.9 compared with 52.0, respectively). The total mean score was significantly lower for non-Hispanic black children compared with Mexican American children, other Hispanic children, and children of other races (52.6 compared with 57.0, 56.8, and 57.1, respectively). The total mean score was significantly lower for non-Hispanic white children compared with Mexican-American children (54.2 compared with 57.0). No differences in total mean scores were apparent between boys and girls or between poverty threshold classes. The total mean scores for cross-classified sociodemographic characteristics generally followed the same patterns observed for single characteristics, with notable differences occurring within age and race or ethnicity classes. The diet quality of American children remains low overall, with continued disparities across some sociodemographic populations, notably age and race or ethnicity. The results of these analyses can help guide the efforts of child nutrition researchers, practitioners, and other stakeholders.