Diet Quality Research Articles

Unhealthy Eating Habits and Determinants of Diet Quality in Primary Healthcare Professionals in Poland: A Cross-Sectional Study

Background/Objectives: The aim of this work was to understand the factors influencing the prevalence of dietary behaviors, as well as determinants of unhealthy eating and diet quality among primary care physicians and nurses in Poland. Methods: A cross-sectional study involving 161 doctors and 331 nurses was conducted in the years 2020–2022 in primary healthcare settings. Results: Unhealthy eating habits affected GPs aged 40–54 years (42.9%), females (64.3%), those of normal body weight (67.9%), representing private medical practice (67.9%), who had over 20 years of work experience (42.8%). Similarly, among the group of nurses, unhealthy eating habits were reported in subjects aged 40–54 (46.5%), individuals with normal body weights (49.5%), those with one chronic disease (38.4%), representing public medical practice (63.6%), with over 20 years of work experience (40.4%), seeing ≤100 patients during the work week (84.8%). The univariable logistic regression analyses for unhealthy dietary habits showed that overweight GPs had lower odds of unhealthy eating habits (OR = 0.35; 95% CI: 0.11–1.08; p < 0.05). Among the nurses, the odds of unhealthy eating habits increased with the number of years of work. Nurses with 10–20 years of work experience had 1.23 times greater odds of unhealthy eating habits, while people working for more than 20 years had 1.81 times greater odds of unhealthy eating habits than individuals working for a period shorter than ten years (OR = 1.23; 95% CI: 0.68–2.23; p > 0.05 vs. OR = 1.81; 95% CI: p < 0.05). The multivariable logistic regression analysis did not show statistically significant results. Conclusions: These issues should be addressed when planning educational activities aimed at supporting healthcare professionals in implementing lifestyle changes.

Examining Health Behaviors as Mechanisms Linking Earlier Pubertal Timing with Accelerated Epigenetic Aging in Late Adolescence.

Earlier pubertal timing is associated with accelerated epigenetic aging, but the underlying mechanisms are not well understood. This three-wave longitudinal study examined negative health behaviors, specifically substance use, short sleep duration, and poor diet quality in middle adolescence, as mediators of links between earlier phenotypic and perceived pubertal timing measured in early adolescence and epigenetic aging on three epigenetic clocks in late adolescence (GrimAge, DunedinPACE, and PhenoAge). Phenotypic pubertal timing measured physical pubertal maturation relative to chronological age, whereas perceived pubertal timing was based on adolescents' subjective interpretation of their pubertal timing relative to their peers. Participants included 1213 youth (51% female, 49% male; 62% Black, 34% White) who participated during early adolescence (mean age = 13.10 years), middle adolescence (mean age = 16.1 years) and late adolescence (mean age = 19.7 years). Results from a mediation model revealed a mediation effect of earlier phenotypic pubertal timing on accelerated GrimAge in late adolescence through higher substance use during middle adolescence. There was also a direct effect of earlier phenotypic pubertal timing on accelerated DunedinPACE in males. Sleep duration and diet quality did not emerge as mediators but shorter sleep duration predicted accelerated GrimAge in females. These findings suggest that higher substance use presents a mechanism through which earlier maturing youth experience faster epigenetic aging that puts them at risk for poorer health across the lifespan.

Association of dietary antioxidant indices with kidney function indicators in patients with type 2 diabetes: a cross-sectional study

This cross-sectional study investigated the relationship between dietary antioxidant indices and kidney function indicators in 240 outpatient adults with type 2 diabetes. Dietary intake was assessed using three 24-h dietary recalls. Dietary total antioxidant capacity (DTAC), dietary antioxidant index (DAI), and dietary antioxidant quality score (DAQS) were obtained. Indicators of kidney function, including serum creatinine, urea, blood urea nitrogen (BUN), and glomerular filtration rate (GFR), were extracted from medical records. After adjustment, the highest DAI tertile had lower serum creatinine (0.98 ± 0.27 vs 1.03 ± 0.32 mg/dL, P < 0.001), reduced urea (30.97 ± 8.75 vs 34.07 ± 14.45 mg/dL, P = 0.005), and higher GFR (85.16 ± 29.43 vs 74.16 ± 22.18 ml/min per 1·73 m2, P < 0.001) compared to the lowest tertile. The results of logistic regression analysis indicated a borderline significant inverse association of serum urea > 20 mg/dl with DTAC (odds ratio (OR):0.28; 95% CI: 0.07–1.09; Ptrend = 0.06). Multivariable linear regression analysis revealed a significant aligned correlation between DAQs and GFR (β: 0.20; P-value: 0.005) and a marginally significant direct relationship between DAI and GFR (β: 0.14; P-value: 0.06). However, no significant association was observed for DTAC with GFR (β:-0.02; P-value: 0.80). Diets with higher antioxidant capacity may be linked to improved kidney function in type 2 diabetes but our results did not support this strongly.

Derivation of outcome-dependent dietary patterns for low-income women obtained from survey data using a supervised weighted overfitted latent class analysis.

Poor diet quality is a key modifiable risk factor for hypertension and disproportionately impacts low-income women. Analyzing diet-driven hypertensive outcomes in this demographic is challenging due to the complexity of dietary data and selection bias when the data come from surveys, a main data source for understanding diet-disease relationships in understudied populations. Supervised Bayesian model-based clustering methods summarize dietary data into latent patterns that holistically capture relationships among foods and a known health outcome but do not sufficiently account for complex survey design. This leads to biased estimation and inference and lack of generalizability of the patterns. To address this, we propose a supervised weighted overfitted latent class analysis (SWOLCA) based on a Bayesian pseudo-likelihood approach that integrates sampling weights into an exposure-outcome model for discrete data. Our model adjusts for stratification, clustering, and informative sampling, and handles modifying effects via interaction terms within a Markov chain Monte Carlo Gibbs sampling algorithm. Simulation studies confirm that the SWOLCA model exhibits good performance in terms of bias, precision, and coverage. Using data from the National Health and Nutrition Examination Survey (2015-2018), we demonstrate the utility of our model by characterizing dietary patterns associated with hypertensive outcomes among low-income women in the United States.

Cross-context equivalence and agreement of healthy diet metrics for national and global monitoring: a multicountry analysis of cross-sectional quantitative 24-hour dietary intake studies

BackgroundDespite national and global commitments to improve nutrition, there are no universally accepted indicators for at-scale monitoring of diets. Several metrics have been proposed and used, but they vary in their comprehensiveness and validity in capturing the properties of healthy diets and, potentially, their interpretability across contexts. ObjectiveThe objective of this study was to assess the cross-context equivalence and agreement of healthy diet metrics. DesignQuantitative 24-h dietary intake data from 57,456 nonpregnant females (15–49 y) in 21 countries were used to construct the food group diversity score (FGDS) and Minimum Dietary Diversity for Women indicator; the Global Diet Quality Score (GDQS) and its submetrics: GDQS+ and GDQS−; the Global Dietary Recommendations (GDR) score and its submetrics: noncommunicable disease (NCD)-Protect and NCD-Risk scores; and the All-5 indicator. Associations between (standardized) measures and indicators were quantified by fitting linear and logistic mixed-effect models across World Bank country income classifications, respectively. The levels of agreement between measures were assessed using Bland–Altman plots of z-scores, whereas rank correlations were assessed using Spearman’s ρ. ResultsThe consumption of healthy food groups was positively associated with concurrent intakes of unhealthy food groups, in particular in high-income countries. Hence, metrics constructed using both healthy and unhealthy food groups (i.e., GDR score and GDQS) showed relatively less discriminatory capacity across country income classifications than their respective submetrics or FGDS. Standardized metrics of healthy (e.g., FGDS and GDQS+) and unhealthy food group consumption (i.e., NCD-Risk and GDQS−) exhibited strong agreement and correlations. ConclusionComposite metrics weighting both healthy and unhealthy food groups have limited cross-context equivalence, because a wide range of diets can theoretically return similar scores. Healthy food group (sub)metrics performed comparably, likely indicating strong underlying construct validity (i.e., dietary diversity and nutrient adequacy). For national and global monitoring, refinement and validation of unhealthy food group metrics (i.e., moderation) is recommended to complement healthy food group metrics.

What does it take for healthy food retail programmes to be successful? Lessons learned in New York City.

Healthy food retail programmes (HFRP) in the USA generally aim to increase healthy foods access to improve diet quality and health, yet the impact is mixed. These programmes primarily target adults, even though adolescents frequently and independently visit stores to purchase snacks. This study's aims are to explore successes and challenges of implementing HFRP (Aim 1) and examine how HFRP can be tailored to adolescents (Aim 2). One-time, virtual, semi-structured interviews with individuals who were involved in a HFRP, followed by a socio-demographic characteristics survey. Interviews were designed based on the RE-AIM framework and the Hexagon Tool and analysed using Braun and Clark's (2006) thematic analysis approach. Descriptive statistics were used to summarise participants' socio-demographic characteristics. New York City (NYC). Adults (18 years or older) who have designed, implemented and/or evaluated an HFRP in NYC and speak/understand English (n 21). Aim 1: For successes, strategies to build relationships with the community were most discussed. Regarding challenges, securing reliable funding was the hardest to overcome. Suggested solutions included designing profitable HFRP, targeting shortcomings in food distribution systems and increasing consumer demand. Aim 2: Most participants had not considered adolescents in previous HFRP but suggested involving youth in developing HFRP to encourage youth-driven solutions and promote youth advocacy. Future HFRP should focus on activities that help store owners purchase affordable healthy foods from distributors, which translates to affordability for customers. Federal and local policies can assist by funding complementary programmes. Additionally, adolescents should be considered in these efforts.

Who is consuming ultra-processed food in Canada? A cross-sectional analysis of the 2018/2019 International Food Policy Study.

High consumption of ultra-processed foods and drinks (UPF) has been linked to poor diet quality and an increased risk of non-communicable diseases. To inform public policies and interventions aimed at reducing UPF intake in Canada, updated information on UPF intake among different sociodemographic groups is needed. This study, using data from 5,872 adults aged 18 years and older from the International Food Policy Study (2018-2019), aims to estimate the dietary energy contribution of UPF and assess its variation among sociodemographic subgroups. All foods and drinks reported in a single 24-hour dietary recall were classified using the Nova system. We estimated the mean proportion of total daily energy from UPF and subcategories of UPF in the overall sample and among sociodemographic subgroups. Multivariable linear regression models evaluated the association between sociodemographic characteristics with the proportion of total daily energy from UPF. On average, adults consumed 45.2% of their total daily energy from UPF. UPF consumption was slightly higher among males than females (49.4% vs. 47.6%, p=0.039) and younger adults aged 19-30 years compared with older adults aged 51-64 years (50.0% vs. 47.2%, p=0.029), adjusting for a range of sociodemographic factors. Overall, UPF consumption was relatively high among adults in all sociodemographic subgroups, highlighting the need for policies to decrease UPF consumption in the entire population.

Adherence to the Mediterranean Diet in Association with Self-Perception of Dietary Behavior (Discrepancy between Self-Perceived and Actual Diet Quality): A Cross-Sectional Study among Spanish University Students of Both Genders.

Background/Objectives: The Mediterranean diet (MD) is one of the most studied dietary patterns to date and is associated with multiple benefits for health and sustainability. However, paradoxically, adherence to the MD (AMD) has been gradually decreasing in native regions. It is necessary to identify the factors that influence AMD to reverse this trend and to mitigate the negative outcomes (for health and the environment) associated with westernized diets. The objective of this study was to assess how self-perception of dietary behavior influences AMD. Methods: During the 28-day repeated measurement cross-sectional study, participants' dietary information was obtained from an initial form which established the self-perception of dietary behavior and the e12HR application to establish actual food consumption by individuals. Using the dietary information from both sources, the AMD index was calculated (specifically, the Mediterranean diet Serving Score (MDSS) index). Two categories of self-perception of dietary behavior were defined: Normal/underestimation: difference (MDSS index from initial form-MDSS index from e12HR application) ≤0; and Overestimation: difference >0 (with three subcategories: low (difference = 1-5), moderate (difference = 6-10), high (difference = 11-15)). Results: 139 (111, women; 28, men) Spanish university students were studied, with 98.6% (99.1%, women; 96.4%, men) falling into the overestimation category (they overestimated their dietary behavior); these students had significantly lower MDSS indexes, mean = 6.7, than students in the normal/underestimation category, mean = 12.0. Within the overestimation category, there were significant differences in the MDSS index: low (mean = 8.1), moderate (mean = 6.7), and high (mean = 4.9) subcategories and also differences that were significant in women but not in men. Conclusions: Overestimation of dietary behavior could be associated with lower AMD in all Spanish university students and women.

Healthy lifestyle and HPV infection risk: results from a cross-sectional study.

Human Papillomavirus (HPV) infection constitutes a significant global public health challenge despite the widespread implementation of vaccination programs, with infection rates persistently high. Recent studies suggest that lifestyle factors including diet quality (DQ) and physical activity (PA) could play a pivotal role in the mitigation of HPV infections. This investigation explored the influence of DQ, PA, and a healthy lifestyle on the incidence of HPV infection in adult women. Data from 5,308 women aged 20-59 from the National Health and Nutrition Examination Survey (NHANES) 2007-2016. DQ and PA were measured using the Healthy Eating Index (HEI-2015) and the Global Physical Activity Questionnaire (GPAQ), respectively, creating four lifestyle groups based on how well they matched dietary and activity guidelines. The associations between key factors and HPV infection were explored using multivariate logistic regression, trend tests, and interaction tests. Fully adjusted multivariable logistic regression models revealed an inverse association between the risk of HPV infection and higher levels of PA (OR = 0.914; 95% CI: 0.854-0.979) as well as DQ (OR = 0.993; 95% CI: 0.989-0.998). Individuals in the highest tertile of DQ displayed a reduced risk of HPV infection relative to those in the lowest tertile (OR = 0.846; 95% CI: 0.726-0.986). Belonging to the third quintile of PA was linked to a lower risk of HPV infection than the lowest quintile (OR = 0.823; 95% CI: 0.681-0.995). Subgroups adhering to a healthy DQ were linked to a lower risk of HPV infection irrespective of PA meeting guideline recommendations. Our findings underscore the importance of a healthy diet in conjunction with appropriate PA in preventing HPV infection, offering new insights for public health policies and interventions.

Effects of Risk and Time Preferences on Diet Quality: Empirical Evidence from Rural Madagascar

Malnutrition is a major concern in Madagascar. Eating a wide variety of nutritious food is necessary because Malagasy diets heavily rely on rice consumption. This study explored the barriers to dietary change towards diversification from the perspective of consumer behaviour. We analysed the impact of risk and time preferences on dietary diversity using economic experiments conducted with 539 rural lowland rice farmers in Central Highlands in Madagascar. The results showed that risk-averse or impatient individuals were more likely to have lower Household Dietary Diversity Score (HDDS), indicating poorer diet quality. Risk-averse people may not want to add different foods to meals as they perceive unfamiliar food as a ‘risk’; people who prefer immediate gratification may fail to invest in nutritious diets now to achieve better health in the future. Additionally, higher HDDS was observed among households with a female head who earned off-farm income and who had frequent market visits. These findings contribute to explaining the limited shift in nutritional transition in Madagascar and provide useful insights into nutritional policies promoting healthier food choices. Depending on the preferences, more focused support such as nutritional education, financial support, market development, and pre-commitment mechanisms could be provided to reward long-term nutritional benefits.

A Structural Equation Modelling Approach to Examine the Mediating Effect of Stress on Diet in Culturally Diverse Women of Childbearing Age

Background: Stress has been shown to be associated with poor nutrition among young women. However, studies around the topic have major limitations in their methodologies and the role of confounding factors within this association remains unclear in the literature. Objective: To investigate the associations between stress and dietary quality/patterns in a culturally diverse population of childbearing-aged women. Methods: A secondary analysis of data from two studies conducted in UK and Lebanon was performed using Structural Equation Modelling (SEM) to explore the role of country context, socio-economic status, and physical variables. Participants were healthy women of childbearing age (n = 493). Variables measured were dietary intake, stress, physical activity, sociodemographic variables, and Body Mass Index. These were included in the SEM analysis to examine the mediating effect of stress. Results: The results showed that, among all variables, only country had a significant effect on dietary quality and patterns through the mediatory effect of stress. Participants from Lebanon were found to have higher stress levels compared to participants from the UK, and this contributed to a lower adherence to a Mediterranean diet. Conclusions: This study shows that for women of childbearing age, having a good diet quality/pattern is dependent on stress levels and country context.

Patterns of dietary quality, physical activity, and sleep duration among cancer survivors and caregivers.

Fruit and vegetable intake (FVI), moderate-to-vigorous physical activity (MVPA), and sleep duration are each independently associated with cancer-related and general health outcomes among cancer survivors. Past research suggests that health behaviors cluster among cancer survivors, with caregivers demonstrating similar patterns. This analysis examined co-occurrence of FVI, MVPA, and sleep duration among cancer survivors and informal cancer caregivers and identified sociodemographic and clinical correlates of health behavior engagement. Using data from the Health Information National Trends Survey (HINTS), an exploratory latent profile analysis (LPA) was conducted among those self-reporting a history of cancer or identifying as a cancer caregiver. The LPA model was fit with daily self-reported FVI (cups/d), MPVA (minutes/d) and sleep duration (hours/d). Multinomial logistic regression models were used to predict profile membership based on sociodemographic and clinical characteristics. Four health behavior profiles were identified (Least Engaged-No MVPA, Least Engaged-Low MVPA, Moderately Engaged, and Highly Engaged). The largest profile membership was Least Engaged-No MVPA, capturing 37% of the sample. Profiles were most distinguished by MVPA, with the lowest variance in sleep duration. Participants reporting higher FVI also often reported greater MVPA and longer sleep duration. Profile membership was significantly associated with age, relationship status, education, income, rurality, alcohol use, self-efficacy, psychological distress, BMI, and cancer type. This study identified four health behaviors patterns and sociodemographic correlates that distinguished those patterns among cancer survivors and caregivers drawn from a nationally representative sample. Results may help identify for whom health behavior interventions could be of greatest benefit.

Maternal diet in pregnancy and the risk of inflammatory bowel disease in the offspring: a prospective cohort study

BackgroundDiet has been hypothesized as a risk factor for development of inflammatory bowel disease (IBD). ObjectiveTo explore associations between maternal diet diversity and quality in pregnancy and the offspring’s risk of IBD. MethodsWe used data from a nationwide cohort study on 85,129 Norwegian children followed from birth (1999–2009) with information on maternal diet in pregnancy from validated food frequency questionnaires. Hazard ratios (aHRs) for IBD, Crohn’s disease (CD), and ulcerative colitis (UC) by maternal diet diversity, quality and intake amounts of individual food groups were adjusted for maternal body mass index, parental IBD, and socio-demographic factors. Sensitivity analyses adjusted for the child's early-life diet quality and antibiotic treatment. Dietary exposures were classified into tertiles, comparing low (reference) to medium, and high levels. ResultsDuring a mean follow-up time of 16.1 years (1,367,837 person-years of follow-up), 268 children developed IBD (CD, n=119; UC, n=76; IBD-unclassified, n=73). High compared with low diet diversity in pregnancy was associated with a lower risk of UC in the offspring (aHR 0.46, 95% confidence interval 0.25-0.87), with consistent findings after further adjustment for the child's early-life diet quality and antibiotic treatment. High compared with low diet diversity in pregnancy yielded aHRs of 0.81 for CD (0.51-1.28) and 0.75 for any IBD (0.55-1.02) in the offspring. A high compared with low diet quality in pregnancy or intakes of specific food groups were not associated with the offspring’s risk of IBD or its subtypes. ConclusionsOur findings suggest that a higher maternal diet diversity in pregnancy may be associated with a lower risk of UC in the offspring.

Food insecurity and other barriers to adherence to a gluten-free diet in individuals with coeliac disease and non-coeliac gluten sensitivity in the Netherlands: a mixed-methods study

ObjectivesTo determine the prevalence of food insecurity among individuals with coeliac disease (CeD) and non-coeliac gluten sensitivity (NCGS) in the Netherlands and explore its association with diet quality and other...

Omnivore, vegan and vegetarian diet quality associations with depressive symptoms: A comparative cross-sectional analysis of the Australian Longitudinal Study on Women's Health

BackgroundDepressive symptoms are experienced by >350 million people globally. Research suggests that a diet rich in plant foods could be protective against depressive symptoms, but vegans and vegetarians who eat a predominant plant-based diet are known to have higher depressive symptoms than omnivores. MethodsThis study aims to explore a secondary analysis of the association between diet quality and depressive symptoms in women born between 1973 and 1978 who follow vegan, vegetarian, and omnivore diets from the Australian Longitudinal Study of Women's Health at baseline (1996) and at three time points (2000, 2003 and 2009). ResultsAfter controlling for covarying factors, there was a significant association between diet quality and depressive symptoms in both the plant-based and omnivore groups at both time points F(9, 4851) = 106.90, p < .001. There was no significant difference between diet quality and depressive symptoms between diet type. ConclusionsDespite diet type (plant-based or omnivore), adhering to a high-quality diet may decrease depressive symptoms and a low-quality diet may increase depressive symptoms in Australian women. LimitationsCaution should be exercised when interpreting these results due to the small sample sizes and small resulting coefficients, there is uncertainty that coefficients this small can be associated with any meaningful change in an individual being treated for depressive symptoms in a clinical setting.

Mediterranean-DASH Diet Intervention for Neurodegenerative Delay Diet and Psychological Problems in Maintenance Hemodialysis Patients by the Structural Equation Modeling Analysis of Malnutrition and Inflammation Markers Approach

ObjectiveAlthough it is known that diet quality affects psychological problems in hemodialysis patients, there is need to explain the role of modifiable risk factors in this relationship. Therefore, the aim of this study was a) to investigate the relationship between diet quality and modifiable risk factors to depression and anxiety in end-stage renal disease (ESRD) patients receiving maintenance hemodialysis; b) to explore the mediating roles of modifiable factors in the relationship with diet quality to depression and anxiety. MethodsThis cross-sectional study included 216 patients with ESRD receiving maintenance hemodialysis treatment. We assessed participants' dietary records for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND) quality, Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and Hospital Anxiety and Depression (HAD)-scale for psychological problems. Furthermore, biochemical findings and anthropometric measurements were performed to evaluate nutritional markers, metabolic risk factors and inflammation. We applied hierarchical regression analysis to estimate modifiable risk factors for depression and anxiety and Structural-Equation-Modeling analysis to determine the mediating role of modifiable risk factors between diet quality and psychological problems. ResultsDepression symptoms were observed in 59.2% (n=128) of the participants, whilst the rate was 35.1% (n=76) for anxiety. Depression and anxiety were found to be negatively correlated with MIND levels after covariate adjusting model, and the rates of explanation were found to be 16.2% and 12.2%, respectively. C-reactive protein (CRP), albumin levels and the presence of malnutrition were shown to be significant predictors of depression (ΔF=14.761 and ΔR2:0.071 for covariate-adjusted model). Albumin levels, CRP, hemodialysis duration, and malnutrition were found to be independent predictors of anxiety (ΔF=16.174 and ΔR2:0.077 for covariate-adjusted model). It was found that CRP and malnutrition partially mediated the association of MIND score with depression, and CRP mediated the association with anxiety. ConclusionIt was concluded that adherence to the MIND diet is associated with a better nutritional profile and reduced inflammation, which in turn may be linked to fewer psychological problems.These further studies are needed to validate and expand upon our findings.

Diet and Survival in Black Women With Epithelial Ovarian Cancer

Ovarian cancer survival among Black women is the lowest across all racial and ethnic groups. Poor dietary quality also disproportionately affects Black populations, but its association with ovarian cancer survival in this population remains largely unknown. To examine associations between dietary patterns and survival among Black women diagnosed with epithelial ovarian cancer (EOC). This prospective cohort study was conducted among self-identified Black women aged 20 to 79 years newly diagnosed with histologically confirmed EOC in the African American Cancer Epidemiology Study (AACES) between December 2010 and December 2015, with follow-up until October 2022. AACES is a population-based study of ovarian cancer risk and survival among Black women in 11 US regions. Data were analyzed from March 2023 to June 2024. Dietary patterns were assessed by the Healthy Eating Index-2020 (HEI-2020) and Alternative Healthy Eating Index-2010 (AHEI-2010), with scores calculated based on dietary intake in the year prior to diagnosis and collected via the validated Block 2005 Food Frequency Questionnaire. Higher scores indicate better dietary quality. Hazard ratios (HRs) and 95% CIs were estimated from multivariable Cox models for the association between adherence to dietary recommendations and overall mortality among all participants and those with high-grade serous ovarian cancer (HGSOC). Among 483 Black women with EOC (mean [SD] age, 58.1 [10.5] years), 310 deaths were recorded during a median (IQR) follow-up of 4.3 (2.0-8.2) years. No association of dietary patterns with mortality was found among women with EOC overall. However, among 325 women with HGSOC, better adherence to HEI-2020 was associated with decreased mortality in later quartiles compared with the first quartile (HR, 0.63; 95% CI, 0.44-0.92 for quartile 2; HR, 0.67; 95% CI, 0.46-0.97 for quartile 3; HR, 0.63; 95% CI, 0.44-0.91 for quartile 4 ). Similar results were observed with AHEI-2010 among women with HGSOC for the second (HR, 0.62; 95% CI, 0.43-0.89) and fourth (HR, 0.67; 95% CI, 0.45-0.98) quartiles compared with quartile 1. In this study, women with moderate and high prediagnosis dietary quality had significantly lower mortality rates from HGSOC compared with women with the lowest prediagnosis dietary quality. These findings suggest that even moderate adherence to dietary guidelines prior to diagnosis may be associated with improved survival among Black women with HGSOC, the most lethal form of ovarian cancer.

Adherence to the Healthy Nordic Food Index is associated with reduced plasma levels of inflammatory markers in patients with heterozygous familial hypercholesterolemia

Background and aimsFamilial hypercholesterolemia (FH) is an inherited disease associated with hypercholesterolemia, and dietary treatment is part of the treatment. We aimed to assess the dietary pattern in relation to the Healthy Nordic Food Index (HNFI) in adults with and without heterozygous FH (HeFH), and to examine the associations between dietary quality and biomarkers related to cardiovascular disease in adults with HeFH. MethodsWe included 205 adults (≥18 years) with HeFH who received follow-up at the Lipid Clinic in Oslo and compared them to controls (n=228). Dietary intake was assessed using a food frequency questionnaire and dietary quality was assessed using the HNFI. Blood samples were analysed for levels of blood lipids, plasma fatty acids (FAs), and markers of inflammation and platelet activation. ResultsThe HeFH patients (median 60 years; 50.2% female; 25.9% in secondary prevention) had lower intake of total and saturated fat compared to controls (32.6 energy percent (E%) vs. 34.9E%, and 9.6 E% vs 12.0 E%, respectively; p<0.001 for both). In the HeFH patients, increasing dietary quality was associated with increased plasma levels of the n-3 polyunsaturated FAs (PUFAs) eicosapentaenoic acid and docosahexaenoic acid, and the n-6 PUFA linoleic acid, and lower plasma levels of the inflammatory cytokines Tumor Necrosis Factor and interleukin-6, and of the platelet-derived inflammatory cytokines Platelet Factor 4 and Neutrophil-Activating Peptide-2. ConclusionNorwegian patients with HeFH followed up at a Lipid Clinic eat healthier than controls. Adherence to a healthy dietary pattern is associated with higher plasma levels of n-3 and n-6 PUFA, and lower levels of inflammatory markers, including platelet markers. This may suggest that adherence to an overall healthy dietary pattern might be beneficial for HeFH patients independent of the cholesterol-lowering effect of the diet.

Associations of Pregnancy Dietary Quality and Diversity with Childhood Celiac Disease

BackgroundHigh gluten and low dietary fiber in pregnancy intake is associated with an increased risk of celiac disease (CeD) in the child. Early life higher dietary quality is suggested to reduce the subsequent risk of CeD. ObjectivesThe aim was to investigate associations of pregnancy dietary quality and diversity with child risk of CeD. MethodsIn The Norwegian Mother, Father and Child Cohort Study, 85,122 mother-child pairs had available data from a validated pregnancy food frequency questionnaire. Pregnancy dietary quality and diversity were estimated by a Pregnancy Healthy Eating Index [mean 99.3, standard deviation (SD) 9.9, range 48.8–128.3], and a Diet Diversity Score (mean 7.0, SD 1.0, range 1.6–9.8), respectively. Child CeD was captured by ≥2 diagnostic codes in the Norwegian Patient Registry. Logistic regression was used to estimate associations between pregnancy dietary quality, diversity and child CeD, adjusted for socioeconomic factors, and parents CeD [adjusted odds ratio (aOR), 95% confidence intervals (CI)]. CeD-susceptible human leukocyte antigen haplotypes (DQ2/DQ8) were present in 30,718 (45.5%). ResultsUp to mean age 16.0 (SD 1.8, 12.4–19.8) y, 1363 (1.6%) children were diagnosed with CeD. Lower as well as higher pregnancy dietary quality associated with a reduced risk of CeD in the child (<5th percentile aOR = 0.67, 95% CI: 0.48, 0.93, >95th percentile aOR = 0.71, 95% CI: 0.52, 0.98, respectively, nonlinear squared term P = 0.011). Analyses on genetically susceptible children, adjustments for pregnancy iron supplementation, gluten, and dietary fiber intake, and child early life dietary quality, gluten intake and iron supplementation, supported the finding. Pregnancy dietary diversity was not associated with child CeD (aOR = 1.00, 95% CI: 0.94, 1.07/score). ConclusionsIn this population-based study, lower as well as higher pregnancy dietary quality associated with a reduced risk of CeD diagnosis in the child. In contrast, no such association was observed with maternal dietary diversity.

Development of a Concise Healthy Diet Score for Cardiovascular Disease among Japanese; The Japan Collaborative Cohort Study.

Several diet quality indicators have been developed primarily for cardiovascular disease (CVD) prevention in Western countries. However, those previous indicators are complicated and less feasible in clinical and health-promoting settings. Therefore, we aimed to develop a concise dietary risk score for CVD prevention in Japanese. Using the self-administered food frequency questionnaire with 35 food items, we developed a concise healthy diet score (cHDS) ranging from 0 to 5 points. We examined the association of cHDS with risks of all-cause and cause-specific mortality among 23,115 men and 35,557 women who were free of CVD and cancer. During 19.2 years of median follow-up, 6,291 men and 5,365 women died. In men, the multivariable hazard ratios (95% confidence intervals) for the highest cHDS (5 points) compared to the lowest (0-1 points) were 0.74 (0.60-0.91, P-trend=0.008) for CVD and 0.86 (0.77-0.95, P-trend=0.05) for all causes. No significant associations were found for stroke, coronary heart disease, and other causes in men. The corresponding hazard ratio in women was 0.65 (0.52-0.81, P-trend＜0.001) for CVD, 0.63 (0.45-0.88, P-trend＜0.001) for stroke, 0.48 (0.30-0.78, P-trend=0.008) for coronary heart disease, 0.67 (0.54-0.84, P-trend＜0.001) for other causes, and 0.75 (0.66-0.85, P-trend＜0.001) for all causes. We developed a concise diet quality score named cHDS in the Japanese population and found the inverse association of cHDS with mortality from CVD and all causes for both men and women.