Healthy Eating Index Scores Research Articles

Higher Chinese Healthy Eating Index Scores are Associated with a Lower Risk of Hyperuricemia: A Large Cross-Sectional Survey Based in China

Hyperuricemia (HUA) is a metabolic disease with an increasing prevalence in China and worldwide. Few studies have focused on the relationship between daily dietary quality and hyperuricemia in China. Data were obtained from the China Health and Nutrition Survey (CHNS). Adults with complete dietary survey and uric acid data were selected for the study, along with complete data on covariates about demographics, lifestyle, and history of disease. The Chinese Healthy Eating Index (CHEI) was used to reflect the quality of daily diet. The logistic regression model and weighted quantile sum (WQS) regression model were used to explore the relationship between CHEI score and risk of HUA. WQS regression models can also further assess the contribution of the various dietary components of CHEI in reducing the risk of HUA. There was a not-significant trend in protective effect between higher CHEI scores and HUA risk in the logistic regression model. In the WQS model, higher CHEI scores showed a significant protective effect on the HUA (OR: .601,0.298-.907). Fruits, tubers, and dairy were top contributor in the protective effect of CHEI (26.81%, 14.34%, and 12.95%, respectively). Higher CHEI associated with lower HUA risk in Chinese adults, and more attention should be paid to fruits, tubers, and dairy.

Abstract 15791: Higher Diet Quality Associates With Lower Inflammation in Black Adults With Heart Failure

Introduction: Heart failure (HF) is associated with a chronic inflammatory state. Diet-derived metabolites, such as trimethylamine-N-oxide (TMAO), may be associated with chronic inflammation. Most Americans consume a pro-inflammatory diet with high intakes of sugar and processed foods, but adherence to high quality diet patterns may be beneficial in HF-associated inflammation. The Healthy Eating Index (HEI) and the Alternative Healthy Eating Index (AHEI) measure adherence to the Dietary Guidelines for Americans with greater adherence associated with lower inflammation and better HF outcomes but is understudied in Black adults. Hypothesis: Higher adherences to the HEI or the AHEI is inversely associated with TMAO and inflammation measured by TNF-α. Methods: Participants included Black adults living with HF (N=36, mean age 57 years, 64% women); HEI and AHEI diet scores were derived from a food frequency questionnaire (FFQ). TMAO and TNF-α were analyzed with dried blood spots and immunoassays. A lifestyle factor (LIS) score consisting of alcohol intake, body mass index, physical activity, and smoking was measured. Analyses included correlational and regression analyses. Results: Regression models explained the variance of TMAO and TNF-α levels. HEI and related covariates (AHEI, LIS) explained 15.9% change in TMAO levels: F(3,30)=3.09, p<.042. Standardized beta coefficients were at least 0.3 and higher. HEI scores and related covariates explained 17.2% change in TNF-α levels: F(4,29)=2.71, p<.050. There was an inverse correlation between AHEI scores and TNF-α: r=-.36, p=.031. Conclusions: Higher diet quality, as measured by the HEI/AHEI, was associated with lower levels of TNF-α. The anti-inflammatory benefits of adherence to healthy eating patterns are important in the self-management of HF, yet these foods may include precursors for TMAO levels. Thus, healthy eating should be balanced with an overall dietary plan that attends to the quantity and nature of foods consumed by those with HF. Interventions which promote adherence to high quality diet patterns are needed in adults with HF, particularly in Black adults who bear an excess burden of disease. More research to understand which specific diet components decrease inflammation in HF are warranted.

Comparison of Dietary Intake and Dietary Inflammatory Index in Patients with Chronic Lymphocytic Leukemia By Treatment Status to Cohabitating Controls

Chronic lymphocytic leukemia (CLL) is an incurable disease with a varied presentation ranging from indolent and asymptomatic to morbid and life-limiting. As tumor biology insufficiently explains this variability, we hypothesized that behavioral and environmental factors including diet and the gut microbiome, where diet is a key influence, may influence CLL pathogenesis and response to therapy. We performed a cross-sectional sample and survey collection study of the gut microbiome, blood, and diet in patients with CLL treated at the University of Nebraska Medical Center between 2021-2023. Eligible subjects included 1) untreated CLL with Rai stage 2-4 disease (untreated CLL), 2) CLL treated with a Bruton's tyrosine kinase inhibitor (BTKi), and 3) individuals without cancer cohabitating with enrolled CLL subjects (control). All subjects provided stool samples for microbial analysis, and subjects with CLL provided blood for serum cytokine analysis. All subjects completed the Diet History Questionnaire version 3.0 (DHQ-3). The DHQ-3 is a self-administered food frequency questionnaire, where participants complete 135 questions on food/beverages and 26 on dietary supplements consumed in the past month. A total and component healthy eating index (HEI) score was derived from the DHQ-3 and represents how well diet intake corresponds to the dietary guidelines recommended by the United States Department of Agriculture and Health and Human Services. The HEI is based on 13 individual components (Figure 1) and scored from 0-100, where higher scores indicate healthier diets. Inflammatory capacity of the diet was assessed by the Dietary Inflammatory Index (DII) (Shivappa et al, Public Health Nutrition, 2013), a measure of dietary components associated with serum markers of inflammation. The DII has a range of scores up to 7.98 suggestive of greater systemic inflammation (median DII score 0.23), and a minimum of -8.87, suggestive of consumption of anti-inflammatory foods. The DII was calculated and compared between each cohort. Statistical analysis was performed using ANOVA. A total of 58 subjects enrolled on the study, 42 with CLL and 16 cohabitating controls. A total of 27 subjects were included in the analysis after data cleaning. Fifteen subjects (56%) were treated with a BTKi, 5 (19%) had untreated Rai stage 2 disease, and 7 (26%) were cohabitating controls. Median ages (72 vs 67 vs 71 for BTKi, untreated, control, respectively) were similar. Median absolute lymphocyte count was 3.2 cells x10^3/µL (1.3 - 131 range) in the BTKi and 55 cells x10^3/µL (13-134 range) in the untreated cohort. There were 5/15 (33%) with 17p deletion and/or p53 mutation in the BTKi cohort and 2/5 (40%) in the untreated cohort. Median time from diagnosis to study entry was 30 months (range 3-151 months) in the untreated cohort, and median time on BTKi therapy was 30 months (range 2-92 months). Within the BTKi cohort, 33% received ibrutinib, 20% received zanubrutinib, and 47% received acalabrutinib. Overall dietary habits were largely similar between the 3 cohorts (Table 1). The mean total HEI score was higher in the untreated (66) and control (66) populations compared to the BTKi cohort (59) ( p = 0.23), although not significantly different. These scores are similar to the 2020 median score of 61 for Americans 60 years and above. Added sugar intake was highest in the untreated cohort (HEI component score of 9.6, 6.3, 8.6 untreated, BTKi, control p = 0.005, respectively) (Figure 1). After calculating the DII for each cohort, no statistically significant differences were observed (Table 1). The range of DII scores across subjects was -5.2 - 4.0, within the expected range for DII calculations. DII scores were 0.44, 0.2, 0.82 p = 0.89 for BTKI, untreated CLL, and control cohorts respectively. To our knowledge, this study is the first to analyze dietary patterns in well-defined homogenous CLL populations (BTKi vs Rai stage 2+ CLL cohort) and compare them to cohabitating individuals. Although overall dietary patterns and DII were similar across cohorts, slight differences in added sugar intake was observed between the cohorts, suggestive that subtle yet important dietary differences may be observed. These data provide a baseline to study personalize dietary approaches to patients with CLL, who increasingly ask clinicians for nutritional interventions as part of their comprehensive cancer care.

Adolescent Diet Quality, Cardiometabolic Risk, and Adiposity: A Prospective Cohort

ObjectiveExamine the prospective association among diet with adolescent cardiometabolic risk (CMR) and anthropometrics. MethodsSecondary analysis of an observational study of adolescents aged 10–16 years. Twenty-four-hour food recalls were used to calculate Healthy Eating Index-2015 (HEI-2015) scores. Anthropometrics were assessed using magnetic resonance imaging, dual-energy x-ray absorptiometry, and height/weight measurements. CMR included mean arterial pressure, homeostatic model assessment for insulin resistance, high-density lipoprotein cholesterol, and triglycerides. Associations between HEI-2015 score at baseline with follow-up adiposity and CMR were examined using regression models. ResultsA total of 192 adolescents were included. Baseline HEI-2015 scores were inversely associated with follow-up total CMR z-score (P = 0.01), homeostatic model assessment for insulin resistance (P < 0.01), waist circumference z-score (P = 0.02), body mass index percentile (P = 0.01), fat mass (P = 0.04), lean mass (P = 0.02), and visceral adipose tissue mass (P = 0.01). Conclusions and ImplicationsAdolescents with lower adherence to dietary guidelines and greater CMR and anthropometry measurements at baseline continued this trajectory across the observation.

Do Household Headship and Gender Affect Diet Quality under the Supplemental Nutrition Assistance Program (SNAP)?

Examine whether the association between Supplemental Nutrition Assistance Program (SNAP) participation and diet quality is different by gender and household headship. Quantitative, cross-sectional. The 2007-2018 waves of the National Health and Nutrition Examination Survey (NHANES). 6180 individuals aged 20 to 65 with household annual income below 130% of the poverty level. The outcome of diet quality was measured using the 2015 Healthy Eating Index (HEI) based on dietary intake from 24-hour diet recall. The exposures were self-reported participation in SNAP and socio-demographic variables. Ordinary Least Square (OLS) regression models. The study found that female household heads had higher average total HEI scores relative to their male and non-head counterparts (β = 1.81, 95% CI: -.27, 3.88). However, for SNAP participants, female household heads had lower average total HEI scores (β = -3.67, 95% CI: -7.36, .11). Female household heads are more likely to experience difficulty in maintaining diet quality relative to their counterparts. The study suggests that intra-household effort allocation may play an important role in differentiating and maintaining diet quality.

Mitigating the impact of bisphenol A exposure on mortality: Is diet the key? A cohort study based on NHANES

Bisphenol A (BPA) is a widespread environmental pollutant linked to detrimental effects on human health and reduced life expectancy following chronic exposure. This prospective cohort study aimed to examine the association between BPA exposure and mortality in American adults and to explore the potential mitigating effects of dietary quality on BPA-related mortality. This study utilized data from 8761 American adults in the 2003–2016 National Health and Nutrition Examination Survey (NHANES). Urinary BPA levels were employed to assess BPA exposure, and dietary quality was evaluated using the Healthy Eating Index-2015 (HEI-2015). All-cause, cardiovascular disease (CVD), and cancer mortality statuses were determined until December 31, 2019, resulting in a cumulative follow-up of 80,564 person-years. The results showed that the highest tertile of urinary BPA levels corresponded to a 36% increase in all-cause mortality and a 62% increase in CVD mortality compared to the lowest tertile. In contrast, the highest tertile of HEI-2015 scores was associated with a 29% reduction in all-cause mortality relative to the lowest tertile. Although no significant interaction was found between HEI-2015 scores and urinary BPA levels concerning mortality, the association between HEI-2015 scores and both all-cause and CVD mortality was statistically significant at low urinary BPA levels. Continuous monitoring of BPA exposure is crucial for evaluating its long-term adverse health effects. Improving dietary quality can lower all-cause mortality and decrease the risk of all-cause and CVD mortality at low BPA exposure levels. However, due to the limited protective effect of dietary quality against BPA exposure, minimizing BPA exposure remains a vital goal.

Opportunities for Maximizing the Dietary Quality of Fad Diets

The quality of American diets, measured by the Healthy Eating Index (HEI), has remained stable and low since 2005. The Dietary Guidelines for Americans 2020–2025 call for research analyzing dietary patterns to determine how guidelines might be altered to increase healthy eating. The present paper seeks to determine the dietary quality of popular fad dietary patterns among Americans. A definition of “fad diet” was created, and Google Trends© was searched for popular diets to determine popular dietary patterns based on the fad diet definition. Finally, eight dietary patterns were identified for inclusion. One-week sample menus were created for each dietary pattern, maximizing alignment with the DGAs but staying within the dietary pattern parameters, and then scored according to the HEI 2015 to determine the dietary quality. Total HEI scores ranged from 26.7 (Carnivore) to 89.1 (Low-FODMAP); the six highest total HEI scores were in the range of 77.1–89.1 out of 100 points. This analytical approach showed that some of the included popular fad dietary patterns have the potential to attain a high dietary quality. Rather than suggesting one “best” diet or dietary pattern, there is opportunity to maximize dietary quality in the context of dietary patterns that are considered fad diets.

The association between diet quality and chronic obstructive pulmonary disease: a case-control study

BackgroundPrevious investigations have primarily examined the relationship between various dietary patterns and the risk of chronic obstructive pulmonary disease (COPD); however, there have been limited studies that have evaluated the association between diet quality presented by Healthy Eating Index 2010 (HEI-2010) and COPD. The aim of this study was to investigate this association in Iranian population.MethodsThis case-control study recruited 84 cases and 252 healthy controls who were randomly selected. Diet, smoking, and physical activity were assessed using validated questionnaires. The HEI-2010 score ranged from zero to hundred twenty, with zero indicating an unhealthy diet and hundred twenty indicating a healthy diet. Logistic regression models were utilized to analyze the association between HEI-2010 and the odds of COPD.ResultsResults from logistic regression showed that individuals with higher HEI scores had a significantly lower odds of COPD (OR: 0.34; 95% CI: 0.16–0.72). After adjusting for confounders, individuals with the highest HEI score were 82% less likely to have COPD (OR: 0.18; 95% CI: 0.03–0.96). This association remained significant after adjusting for smoking and physical activity (OR: 0.08; 95% CI: 0.01–0.93) and with additional adjustment for BMI (OR: 0.08; 95% CI: 0.01–0.92).ConclusionsThis study found a significant association between a higher HEI-2010 score and a lower odd of COPD in the Iranian population. These results suggest that a healthy diet may play a crucial role in reducing the odds of COPD and in improving the function of the lungs. However, further prospective studies are warranted to elucidate this relationship.

The association of the healthy eating index with risk of colorectal cancers (overall and by subsite) among Canadians

BackgroundHealthy dietary patterns characterized by high intake of fruits and vegetables, grains/cereals, and lean meat/fish, and low intake of red/processed meats and refined carbohydrates, have been shown to be associated with reduced risk of colorectal cancer, but evidence regarding their association with colorectal cancer subsites is limited. Hence, this study was conducted to assess the association of a healthy dietary pattern, as reflected in the Healthy Eating Index (HEI) (a composite score based on consumption of various food groups), with risk of colorectal cancer, overall and by subsite. MethodsWe conducted a case-cohort study in the Canadian Study of Diet, Lifestyle and Health (CSDLH). The study included all cases of incident colorectal cancer in the entire cohort, and an age-stratified subcohort of 3185 women and 2622 men. Cox regression models were used to estimate hazard ratios (HR) for the association between the HEI and the risk of colorectal cancer, overall and by subsite. We also assessed the association by sex and by selected metabolic factors. ResultsFor both sexes combined, the highest quintile of the HEI score was inversely associated with risk of colorectal cancer, colon cancer and proximal colon cancer (HR: 0.65; 95% CI: 0. 49–0.85, HR: 0.60, 95% CI: 0.44–0.83 and HR: 0.54, 95% CI: 0.35–0.85, respectively). However, these associations were mostly observed among men (HR: 0.56; 95% CI: 0.38–0.81, HR: 0.44, 95% CI: 0.28–0.69 and HR: 0.26; 95% CI: 0.12–0.56, for colorectal cancer, colon cancer and proximal colon cancer, respectively; p-interactions=0.029, 0.032 and 0.063, respectively). An inverse association was also observed between the HEI and risk of colorectal cancer among normal weight participants, overweight/obese participants, non-smokers, non-alcohol drinkers and participants who were physically inactive. ConclusionA healthy dietary pattern may reduce risk of colorectal cancer, particularly among men.

Behavioral Lifestyle Intervention Program Using Mobile Application Improves Diet Quality in Adults With Prediabetes (D’LITE Study): A Randomized Controlled Trial

BackgroundMobile health applications (mHealth apps) are increasingly being used in weight loss interventions. However, evidence on the effects of such interventions on diet quality and their correlation with weight loss is lacking. ObjectiveThe objective of this study was to examine whether changes in the diet quality of adults with prediabetes followed the use of an mHealth-enabled lifestyle intervention, compared with those who did not, and whether these changes correlated with weight loss. DesignA secondary analysis of a 6-month randomized controlled trial Diabetes Lifestyle Intervention using Technology Empowerment (D’LITE) was conducted, with participants recruited from October 2017 to September 2019. Participants/settingCommunity-dwelling adults (n = 148) in Singapore diagnosed with prediabetes and body mass index (BMI) ≥23 were included in this study. InterventionParticipants were randomized to receive either a 6-month mHealth-enabled lifestyle intervention program (diet and physical activity) or standard care dietary advice. Main outcome measuresDietary data were collected in the form of 2-day food records at baseline, 3, and 6 months. Changes in Alternate Healthy Eating Index-2010 (AHEI-2010) scores and food groups (servings/day), calculated from the dietary data, and correlation between changes in AHEI-2010 and weight loss at 3 and 6 months, were examined. Statistical AnalysesBetween-group comparisons of continuous variables and within-participants variation were performed using longitudinal mixed-effect models, intention-to-treat principles. The models included treatment groups, time (baseline, 3 months, and 6 months), and covariates (age, sex, and BMI), as well as the group × time interactions, as fixed variables and within-participant variation in outcome values as random variable. The random intercept for participants accounted for the dependence of repeated measures. A likelihood ratio test was also conducted to test random effect variance. Spearman correlation test was used to examine correlation between changes in AHEI-2010 scores and weight loss. ResultsThere was a significant improvement in overall diet quality as ascertained by the AHEI-2010, by 6.2 points (95% confidence interval [CI], 3.8–8.7; P < 0.001) in the intervention group as compared with the control. The participants in the intervention group had a significantly greater reduction in intake of sugar-sweetened beverages (SSB) by 0.5 servings/day (95% CI, −0.8, −0.2; P < 0.001) and sodium by 726 mg/day (95% CI, −983, −468; P < .001), compared with those receiving standard care. At 3 and 6 months, a significant decrease in SSB (0.8 servings/day; 0.7 servings/day, respectively) and sodium (297 mg/day; 296 mg/day, respectively) intakes were reported compared with baseline intakes. Small positive correlations (r = 0.2; P < 0.05) were observed between changes in AHEI-2010 scores from baseline and percentage weight loss at 3 and 6 months. ConclusionFor adults with prediabetes in Singapore, diet quality can be improved with an mHealth-enabled lifestyle intervention program. A small positive correlation exists between AHEI-2010 scores and weight loss.

Beneficial role of healthy eating Index-2015 score & physical activity on COVID-19 outcomes

BackgroundNutritional status and physical activity are essential to maintain a strong immune system. No definite pharmacological strategies for Coronavirus disease 2019 treatment are presently available, so natural enhancement of the immune system is in need. Our goal was to assess the correlation of healthy diet and physical activity on COVID-19 disease outcome.MethodsThis cohort study was conducted on 68 adult patients who contracted mild (38) or moderate [30] cases of COVID-19, recruited via a convenience sampling technique from the outpatient clinic, Kasr Al-Aini Faculty of Medicine, Cairo University Hospital. Patients’ Healthy Eating Index (HEI) and degree of physical activity as measured by the Global Physical Activity Questionnaire were evaluated and linked with several inflammatory markers.ResultsMost of patients with mild COVID-19 patients (92.1%) were physically active, compared to only 50% of moderate COVID-19. The total Metabolic Equivalent Task-min/week was positively correlated with the lymphocyte percentage. The median total HEI score was significantly higher in the patients with mild COVID-19 than with moderate COVID. Significant positive correlations observed among the lymphocyte count and total HEI-2015. There was approximately a 64% reduction in the probability of acquiring moderate COVID-19 illness for each unit rise in The HEI.ConclusionHealthier nutrition and Physical activity correlated with reduced COVID-19 disease severity.Trial registrationThe study was registered on clinical trial.gov maintained by the US National Library of Medicine (CinicalTrials.gov identifier = NCT04447144; https://clinicaltrials.gov/) (25/06/2020).

Modified-Weight Healthy Eating Index-2015 Scores Are More Strongly Associated With Mortality Risk Than Standard Scores

BackgroundVarious diet quality scores are consistently and similarly associated with mortality risk. Emerging evidence suggests that individual diet quality components are differentially associated with mortality risk, but it is unclear whether or not modified weights reflective of relative component differences would strengthen mortality associations. ObjectiveThis study examined whether Healthy Eating Index 2015 (HEI-2015) scores with modified (vs standard) component weights are differentially associated with mortality risk. DesignThis was a longitudinal analysis of the National Health and Nutrition Examination Survey III (1988-94) with 23 years of mortality follow-up. The HEI-2015 and modified-weight scores were calculated from one 24-hour recall. The a priori Key Facets HEI was a subset score equivalently weighting fruits, vegetables, whole grains, and seafood and plant proteins. In the least absolute shrinkage and selection operator regression-weighted HEI, components were assigned weights reflecting relative mortality risk associations. Participants/settingAnalyses included 10,789 US adults (aged 20 years and older) who were not pregnant and without prior diabetes, cancer, cardiovascular disease, or chronic kidney disease diagnoses. Main outcome measuresAll-cause and cardiovascular disease mortality risk were the primary outcomes examined. Statistical analyses performedThree energy-adjusted HEI scores were assigned to quintiles; covariate-adjusted sex-stratified Cox models with age as the timescale assessed associations between and trends across quintiles of HEI scores and all-cause and cardiovascular disease mortality risk. ResultsModified-weight HEI scores were associated with 23% to 38% reduced all-cause mortality risk in the highest vs lowest quintile, whereas comparisons were only significant for women (Key Facets P = 0.02 and least absolute shrinkage and selection operator regression-weighted P = 0.001; for men P = 0.06 on both scores), trends across quintiles of modified-weight scores were significant for men and women. The HEI-2015 was not significantly associated with all-cause mortality risk, and none of the scores were associated with cardiovascular disease mortality risk. ConclusionsOnly modified-weight HEI scores were associated with reduced all-cause mortality risk. Findings suggest modified diet quality weighting schemes warrant further examination to determine their replicability.

Cross-sectional measurement of adherence to a proposed sustainable and healthy dietary pattern among United States adults using the newly developed Planetary Health Diet Index for the United States

BackgroundDietary choices are an important avenue for improving food system sustainability. The Planetary Health Diet was proposed by the EAT-Lancet Commission as a reference healthy and sustainable dietary pattern. ObjectivesTo assess adherence to the Planetary Health Diet among United States adults, this study developed and evaluated the Planetary Health Diet Index for the United States (PHDI-US), adapted from the original PHDI validated in the Brazilian population. MethodsThe PHDI-US has 16 components with scores ranging between 0 and 150, and higher scores indicate better adherence to the Planetary Health Diet. Cross-sectional dietary data from 4741 participants of the National Health and Nutrition Examination Survey 2017–2018 were used to assess the validity and reliability of the PHDI-US. ResultsValidity and reliability tests were acceptable overall: principal component analysis identified 6 components; total PHDI-US and Healthy Eating Index-2015 scores were positively associated (β = 0.67, standard error = 0.03, P <0.0001; R2 = 0.39); concurrent-criterion validity analyses identified significantly lower scores among males, everyday smokers, and younger adults; and the Cronbach’s α value was 0.54. The average PHDI-US score was 46.7 out of 150, indicating that the diets of United States adults were far from meeting Planetary Health Diet recommendations. Based on component PHDI-US scores, many United States adults may be able to enhance the quality and sustainability of their diets by increasing intake of plant-based foods, including whole grains, nuts and peanuts, legumes, fruits, and vegetables, and reducing intake of animal-based foods, including red and processed meats. ConclusionsThe PHDI-US is a new tool that can assess adherence to the Planetary Health Diet and identify key aspects of United States adults’ diets that could be altered to potentially improve dietary sustainability and quality.

Higher energy consumption in the evening is associated with increased odds of obesity and metabolic syndrome: findings from the 2016-2018 Korea National Health and Nutrition Examination Survey (7th KNHANES).

Chrono-nutrition emphasizes meal timing in preventing obesity and metabolic disorders. This study explores the impact of temporal dietary patterns (TDPs) on obesity and metabolic syndrome (MetS) in Korean adults aged 20 years to 65 years. We utilized dynamic time warping method and Kernel k-means clustering to investigate diet quality and the odds ratios (ORs) of obesity and MetS with different TDPs using data from the 7th Korea National Health and Nutrition Examination Survey. Participants were divided into three groups based on relative energy intake over 24 hours. After adjusting for age and gender, Cluster 3 (with the highest proportion of energy intake in the evening) had the lowest Healthy Eating Index scores compared to other clusters. Following adjustment for key covariates, Cluster 3 showed the highest values for body mass index, waist circumference, blood pressure, total cholesterol, and triglycerides. Compared to Cluster 1 (with a lower proportion of energy intake in the evening), Cluster 2 and Cluster 3 had ORs for obesity of 1.12 (95% confidence interval [CI], 0.97 to 1.30) and 1.19 (95% CI, 1.03 to 1.37), respectively. For MetS, the ORs were 1.26 (95% CI, 1.08 to 1.48) and 1.37 (95% CI, 1.17 to 1.61) when comparing Cluster 2 and Cluster 3 to Cluster 1. This study reveals that individuals with higher energy intake in the evening have increased odds of obesity and MetS, even after adjusting for major covariates, including age and total energy intake.

Hypothetical Interventions on Diet Quality and Lifestyle Factors to Improve Breast Cancer Survival: The Pathways Study.

The number of breast cancer survivors is increasing, yet evidence to inform dietary and lifestyle guidelines is limited. This analysis included 3,658 participants from the Pathways Study, a prospective cohort of women diagnosed with invasive breast cancer. A healthy plant-based dietary index score (hPDI), an American Cancer Society (ACS) nutrition guidelines score, a 2015 Healthy Eating Index score (HEI), hours per week of moderate to vigorous physical activity (PA), and lifetime cumulative pack-years of cigarette smoking (SM) were each measured at diagnosis, 6, 24, and 72 months. Using g-computation, 5- and 10-year risk ratios (RR), risk differences, and 95% confidence intervals (CI) for all-cause mortality under hypothetical interventions on diet quality, PA, and SM, compared with the natural course (no intervention) were calculated. Hypothetical moderate to extreme interventions on hPDI, ACS, and HEI, each in combination with PA and SM, showed 11% to 56%, 9% to 38%, and 9% to 49% decreases in 5-year risks of all-cause mortality compared with no intervention, respectively [(hPDI: RRmoderate = 0.89, 95% CI: 0.82-0.94; RRextreme = 0.44, 95% CI: 0.26-0.67), (ACS: RRmoderate = 0.91, 95% CI: 0.85-0.96; RRextreme = 0.62, 95% CI: 0.43-0.82), (HEI: RRmoderate = 0.91, 95% CI: 0.84-0.95; RRextreme = 0.51, 95% CI: 0.33-0.72)]. While 10-year relative risks were slightly attenuated, absolute risk reductions were more pronounced. Interventions to improve diet quality, increase PA, or reduce SM at the time of diagnosis may improve survival among breast cancer survivors. We estimate that over 10% of deaths could be delayed by even moderate adoption of these behaviors.

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

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

Dietary approach to stop hypertension and healthy eating index 2015, modify the association between FTO polymorphisms and obesity phenotypes

This study aimed to investigate the interaction of the healthy eating index (HEI) and the dietary approach to stop hypertension (DASH) diet scores with FTO polymorphisms in relation to change in obesity traits. A total of 4480 subjects aged ≥ 18 years were selected from participants of the Tehran lipid and glucose study and followed-up 3 years. Selected polymorphisms (rs1421085, rs1121980, rs8050136) were genotyped and genetic risk score (GRS) was computed. HEI and DASH scores were computed based on dietary data. Changes in body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and visceral adiposity index (VAI) were measured. Higher adherence to both DASH and HEI scores were increased with higher ages. Individuals with high GRS had a lower change in BMI when they had higher adherence to HEI, compared to subjects with lower HEI score (P trend = 0.01). Change in WC in participants in the fourth quartile of HEI score in minor allele carriers of FTO variants was lower compared to the first quartile; conversely, higher adherence to the DASH score by this genotypic group was related to increase in WC. No significant interaction was seen between FTO polymorphisms and both diet scores regarding changes in any of obesity traits. In conclusion, in individuals with high GRS higher adherence to HEI score was associated with lower change in BMI and WC, while higher adherence to DASH diet was associated with higher change in WC, compared to individuals with lower adherence to both scores.

Assessment of Healthy Eating Index and Serum Levels of 25-hydroxyvitamin D and Zinc in Prostate Cancer Patients

Background and Objectives Prostate cancer is the most common malignant cancer in men. In this study, the healthy eating index (HEI) and serum levels of 25-hydroxyvitamin D and zinc were evaluated in prostate cancer patients compared with healthy individuals. Subjects and Methods In this study, 30 men who had recently been diagnosed with prostate cancer were compared with 30 otherwise healthy age-matched men in terms of their serum levels of 25 hydroxyvitamin D and zinc as well as HEI. The latter was evaluated in both groups using a 3-day food record. Results There was no significant difference between the two groups in terms of age, weight, BMI and waist circumference. The scores of all components of HEI were not significantly different in the two groups, and in spite of the lower total HEI score in the prostate cancer group, this difference was not statistically significant. Differences between the two groups in terms of serum zinc levels were marginally significant (P-value=0.053). However, the serum level of 25-hydroxyvitamin D in the prostate cancer group was significantly lower than that in the control group (P-value =0.046). Conclusion The results of this study showed that there are statistically significant and marginally significant differences between prostate cancer patients and their otherwise healthy aged-matched counterparts in terms of serum levels 25 hydroxyvitamin D and zinc, respectively. There was no significant difference between the two groups regarding the HEI score.

Association of Early Childhood Caries with Body Mass Index, Dietary Habits, and Socioeconomic Status among Preschool Children of Kelambakkam.

One of the most prevalent oral diseases affecting preschoolers, early childhood caries (ECC), can significantly lower a child's quality of life. The pain and discomfort that ECC causes will alter the child's eating habits, which will have an impact on both their physical and mental health, as shown by the deviation from the body mass index (BMI). Dental caries and deviation from the normal BMI are both significantly influenced by children's eating habits and socioeconomic status (SES). To determine the association of ECC with BMI, dietary habits, and SES among 3-6-year-old preschool children. A cross-sectional study was conducted among 375 preschool children of 3-6 years of age. The decayed, missing, or filled teeth (deft) index was used to determine the caries status. Measurement of height (m) and weight (kg) was done using a stadiometer and electronic weighing machine. For each child, the BMI (kg/m2) was calculated, and the child's body weight status was assessed using Centers for Disease Control and Prevention (CDC)-based classification. Questionnaires were collected with demographic details, 3 days diet diary, and the SES of parents. The dietary habit and SES were obtained from the healthy eating index-2005 (HEI-2005) score and Modified Kuppuswamy's Scale 2018. All the data were entered and analyzed using Statistical Package for the Social Sciences (SPSS) software V 20.0. The prevalence of ECC was 44.8%. On comparison of mean height, weight, and BMI scores, there was a significant difference in mean weight (p = 0.006) and BMI (p = 0.001) among the two study groups. Children with ECC had a lower HEI-2005 score and belonged to a lower social class compared to caries-free children (p = 0.001). Children with ECC are significantly associated with BMI being overweight, or risk of being overweight; lower grades of SES and lower total score of HEI-2005 with poor diet and diet that needs improvement. Suresh A, Srinivasan D, AR SE, et al. Association of Early Childhood Caries with Body Mass Index, Dietary Habits, and Socioeconomic Status among Preschool Children of Kelambakkam. Int J Clin Pediatr Dent 2023;16(4):565-571.

The diet quality of well adolescents: Do they really eat poorly?

BackgroundA common assumption is that adolescents have poor eating habits. However, there is minimal data regarding adolescents’ intake of macronutrients (i.e. protein, carbohydrate, and fats) and micronutrients (i.e. vitamins and minerals). In addition, few studies have used the Healthy Eating Index-2010 (HEI-2010) to assess diet quality of well adolescents. ObjectiveTo determine diet quality among patients presenting for well care by using NDSR (Nutrition Data Systems for Research) nutrition analysis software and by calculating HEI-2010 scores. MethodsA convenience sample of adolescents presenting to clinic for well care was recruited. Participants completed a 24 hour dietary recall using the multiple pass method, a validated interviewing technique. Results for each participant were entered into NDSR version 2014, which provides a detailed nutrition analysis, and these results were also used to calculate a HEI-2010 score, which measures how well dietary intake conforms to the Dietary Guidelines for Americans in terms of amounts consumed from each food group. ResultsData from 48 adolescents (30 female, 18 male; mean age 16.5, range 12–20 years; 18 Hispanic, 11 Black, 5 White, 14 other) were analyzed. Body-mass-index (BMI) ranged from 16.0 to 38.1. Average total calories were 2054 (but there was a wide range of 683 to 4801 calories). Average calories for females and males were 1723 and 2604, respectively. Average percentages of calories from macronutrients were 33.2% from fat, 50.5% from carbohydrate, and 16.3% from protein. Micronutrient content was very low (< 53% of recommended Daily Values) for vitamins E and D; moderately low (61–76%) for zinc, magnesium, potassium and copper; minimally low (86–97%) for calcium, iron and vitamin B12; and normal (≥100%) for thiamin, riboflavin, niacin, folic acid, phosphorus, manganese, selenium and vitamins C, K, and B6. HEI scores were <50 (“poor”) for 20 subjects and 51–79 (“needs improvement”) for 13 subjects. Calorie consumption was insufficient to calculate an HEI score for 15 subjects and no subjects had an HEI score >80 (“good”). ConclusionOn some measures (distribution of macronutrients, intake of most vitamins and minerals), the adolescents in this study had sufficient diets by NDSR calculations. However, no subject had an HEI score indicative of good diet quality. It is possible that adolescents are consuming adequate macro- and micronutrients in the setting of processed, fortified foods, but that optimal consumption from each food group is lacking, resulting in lower diet quality scores on the HEI.