Self-Administered 24-Hour Dietary Assessment Tool Research Articles

Implementing a Diet Risk Score (DRS) for Spanish-Speaking Adults in a Clinical Setting: A Feasibility Study.

Tools to briefly assess diet among US Spanish-speaking adults are needed to identify individuals at risk for cardiometabolic disease (CMD) related to diet. Two registered dietitian nutritionists (RDNs) recruited bilingual medical students to translate the validated Diet Risk Score (DRS) into Spanish (DRS-S). Participants were recruited from a federally qualified health center. Students administered the DRS-S and one 24-h recall (Automated Self-Administered 24-Hour (ASA24®) Dietary Assessment Tool) on one day; a second recall was administered within 1 week. Recalls were scored using the Healthy Eating Index (HEI)-2015, a measure of adherence to the Dietary Guidelines for Americans. Spearman correlations, weighted kappa, and ANOVA were conducted using SAS 9.4 to assess the relative validity of the DRS-S. Thirty-one Spanish-speaking adults (female: n = 17, 53%; mean age: 58 (42-69)) completed assessments. The mean DRS-S was 9 (SD = 4.2) (max: 27; higher score = higher risk) and the mean HEI-2015 score was 65.7 (SD = 9.7) (max: 100; higher score = lower risk), with significant agreement between measures (r: -0.45 (p = 0.01)), weighted kappa: -0.3 (p = 0.03). The DRS-S can be used in resource-constrained settings to assess diet for intervention and referral to RDNs. The DRS-S should be tested in clinical care to assess the impact of dietary changes to reduce CMD risk.

A243 BONE MINERAL DENSITY AND DIETARY BONE NUTRIENTS DIFFER IN PATIENTS WITH CROHN'S DISEASE STRICTURES

Abstract Background Crohn’s disease (CD) phenotypes include inflammatory (non-stricture) and stricture behaviours. Strictures are bowel narrowing’s that may lead to obstructions and subsequent dietary restrictions to prevent blockages. Bone mineral density (BMD) in CD is affected by many factors including corticosteroid use, CD itself, but also dietary changes. Clinical gold standard for measuring BMD is by dual x-ray absorptiometry (DXA) scans. High-resolution peripheral quantitative computed tomography (HR-pQCT), a more precise imaging modality assesses volumetric BMD, bone geometry and bone microarchitecture. We aim to compare dietary intake, and bone quality in both stricture and non-stricture CD. Aims To identify nutritional patterns, bone quality differences and deficiencies between two subtypes of CD; including energy intake, dietary components and/or micronutrients Methods Individuals (≥55 years old) with ileal CD strictures (fixed, angulated bowel or thickened bowel with pre-stenotic dilation on diagnostic imaging), or inflammatory CD were prospectively recruited. Patients with short gut, celiac disease, dysphagia history were excluded. All patients completed DXA hip and spine scans and HR-pQCT radius and tibia scans. Dietary assessment questionnaires (Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24), and Diet History Questionnaire III for food frequency over the past year were completed. Results 56 (27 inflammatory (48% female, mean age 64.2, BMI 28.7, 16 years CD duration) and 29 strictures (45% female, mean age 65.9, BMI 27.3, 25 years CD duration, 15 (51.7%) prior bowel resection) were included. 31/56 (55.4%) patients were on biologics and 11 (19.5%) had past corticosteroid exposure. DXA-based BMD for stricture versus non-stricture CD patients was not significantly different at the hip or spine. However, HR-pQCT-based radial total BMD (p=0.03), cortical thickness (p=0.01) and cortical area (p=0.04) were lower in stricture than non-stricture patients.11 (7 stricture, 4 inflammatory) patients with past steroids consumed more dairy (p=0.01), vitamin D (p = 0.04), and calcium (p=0.03) than other CD patients. Stricture patients had significantly less consumption of vitamin K (p=0.001), vegetables (p=0.02), calcium (p=0.03), and dairy (p=0.03). Conclusions Patients with CD strictures have lower BMD and cortical bone quality at the radius than those without strictures. Patients with CD strictures also consume significantly less vitamin K, calcium, and dairy, all vital dietary components to prevent OP, compared to non-stricture patients. Overall, the skeletal fracture risk is likely much greater in CD patients with strictures than without, due to greater inherent bone fragility, and less consumption of key nutrition building blocks of bones. Funding Agencies Koopmans Memorial Research Fund

FEASIBILITY OF AN AUTOMATED SELF-ADMINISTERED 24 HOUR (ASA-24) DIETARY ASSESSMENT TOOL IN OLDER ADULTS

Abstract Background Certain dietary patterns impact trajectories of healthy aging. However, dietary assessment tools can be challenging to use. With the increased technology use in older adults, we aimed to explore the feasibility of completing an online, Automated Self-Administered 24-hour (ASA-24) dietary assessment tool. Methods We conducted a randomized, crossover study of n=20 community-dwelling older adults’ (>65 years) preference for self-administered (SA) versus research assistant-administered (RAA) ASA-24. Participants were recruited via ResearchMatch.com and randomly allocated 1:1 to each group and completed either an SA or RAA ASA-24. One week later, the alternative sequence was completed. After each session, participants completed an online 11-item feasibility survey (Likert-scale;1-5, strongly disagree to strongly agree). Mean and standard deviations were reported for each question. Results Mean age was 69±3.5 years (90% females), and no differences were observed for sex, age, race, ethnicity, education, or income. Neither group felt a need for RA assistance (p=0.34). However, both groups felt the system was easier to follow with a research assistant (RAA 4.4±1.3 vs. SA 4.6±0.5, p=0.65), particularly when self-administered first (p=0.04). When conducting an SA ASA-24 first, there was less confidence the system could be learned quickly (SA 4.5±0.5 vs RAA 3.4 ±1.0, p=0.001). Conclusion Older adults can complete dietary recall using a self-administered online assessment; however, use of a research assistant led to better accessibility. Order of administration method may impact perceived ease of use. Next steps include increasing sample diversity and using an RAA ASA-24 platform to identify dietary patterns that impact aging.

Validation of the Rapid Prime Diet Quality Score Screener (rPDQS), A Brief Dietary Assessment Tool With Simple Traffic Light Scoring.

Dietary pattern is a determinant of chronic disease, but nonregistered dietitian nutritionist (non-RDN) clinicians rarely assess diet because of barriers such as time constraints and lack of valid, brief diet quality assessment tools. The study aimed to evaluate the relative validity of a brief diet quality screener using both a numeric scoring system and a simple traffic light scoring system. A cross-sectional study was conducted using the CloudResearch online platform to compare participants' responses to the 13-item rapid Prime Diet Quality Score screener (rPDQS) and the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. The study was conducted in July and August 2021 and included 482 adults ≥18 years of age or older sampled to be representative of the US population. All participants completed the rPDQS and an ASA24; of these, 190 completed a second ASA24 and rPDQS. Responses to rPDQS items were coded using both traffic light (eg, green= healthiest intake, red= least healthy intake) and numeric (eg, consume < 1 time a week, consume ≥ 2 times per day) scoring methods and were compared with food group equivalents and Healthy Eating Index-2015 (HEI-2015) scores estimated from ASA24s. Deattenuated Pearson correlation coefficients were calculated to account for within-person variation in 24-hour diet recalls. Overall, 49% of participants were female, 62% were ≥35 years, and 66% were non-Hispanic White, 13% non-Hispanic Black, 16% Hispanic/Latino, and 5% Asian. For both food groups to encourage (eg, vegetables, whole grains) and to consume in moderation (eg, processed meats, sweets), there were statistically significant associations with intakes assessed by rPDQS, using both traffic light and numeric scoring methods. Total rPDQS scores correlated with the HEI-2015, r= 0.75 (95% confidence interval [CI]= 0.65, 0.82). The rPDQS is a valid, brief diet quality screener that identifies clinically relevant patterns of food intake. Future research is needed to test whether the simple traffic light scoring system is an effective tool that can help non-RDN clinicians provide brief dietary counseling or make referrals to registered dietitian nutritionists, as needed.

Plant-Based Dietary Indices in Relation to Nutrient and Food Group Intakes in Preschool-Aged Children.

Dietary guidance promotes plant-based foods, yet minimal research has examined intake in children. This study examined plant-based food intake in preschool-aged children using plant-based dietary index (PDI) metrics and related these metrics to nutrient and food group intakes. Dietary data were collected from preschool-aged children (n = 283, 3.45 ± 1.22 years) from the Guelph Family Health Study at baseline using the Automated Self-Administered 24-Hour Dietary Assessment Tool. Food intake servings were assigned to 16 food groups for calculation of overall PDI (oPDI), healthful PDI (hPDI), and less healthful (lhPDI) scores and summarized into tertiles for energy-adjusted comparisons. For oPDI, participants in the highest vs. lowest tertile had higher intakes of nutrients and food groups to encourage (e.g., dietary fiber, fruits) as well as lower intakes of nutrients to encourage (e.g., calcium, vitamin D). For hPDI, participants in the highest vs. lowest tertile had higher intakes of nutrients and food groups to encourage and lower intakes of those to limit (e.g., saturated fat, sweets and desserts). For lhPDI, participants in the highest vs. lowest tertile had higher intakes of nutrients and food groups to limit and lower intakes of those to encourage. These results can inform dietetic practice for dietary guidance that promotes plant-based foods in children.

Dietary Assessment by Pattern Recognition: a Comparative Analysis

BackgroundDiet quality photo navigation (DQPN) is a novel dietary intake assessment tool that was developed to help address limitations of traditional tools and to easily integrate into health care delivery systems. Prevailing practice is to validate new tools against approaches that are in wide use. ObjectiveThis study aimed to assess 1) the validity of Diet ID in measuring diet quality, food group and nutrient intake against 2 traditional dietary assessment methods (i.e., food record [FR], food frequency questionnaire) and 2) the test reproducibility/reliability of Diet ID to obtain similar results with repeat assessments. MethodsUsing a participant-sourcing platform for online research, we recruited 90 participants, 58 of whom completed DQPN, a 3-d FR (via the Automated Self-Administered 24-hour Dietary Assessment Tool), and a food frequency questionnaire (FFQ, via the Dietary History Questionnaire III). We estimated mean nutrient and food group intake with all 3 instruments and generated Pearson correlations between them. ResultsMean age (SD) of participants was 38 (11) y, and more than half were male (64%). The strongest correlations for DQPN when compared with the other 2 instruments were for diet quality, as measured by the Healthy Eating Index 2015; between DQPN and the FFQ, the correlation was 0.58 (P < 0.001), and between DQPN and the FR, the correlation was 0.56 (P < 0.001). Selected nutrients and food groups also showed moderate strength correlations. Test-retest reproducibility for measuring diet quality was evaluated for DQPN and showed a correlation of 0.70 (P < 0.0001). ConclusionsThe current study offers evidence that DQPN is comparable to traditional dietary assessment tools for estimating overall diet quality. This performance, plus DQPN’s ease-of-use and scalability, may recommend it in efforts to make dietary assessment a universal part of clinical care.

The 24-hour food frequency assessment screening tool (FAST24): Development and evaluation of a novel dietary screener to identify foods associated with weight change

Brief screening questionnaires can identify 'at risk' behaviors in clinical settings. However, there is currently no screener for dietary intake specifically developed using foods associated with body weight change and increased risk for multiple chronic conditions and diseases. We developed a novel brief dietary screener, the 24-Hour Food Frequency Assessment Screening Tool Questionnaire (FAST24), to identify intake of foods associated with weight change. University students completed the FAST24 and the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) at two time points to assess acceptability and determine preliminary criterion validity against food categories from the United States Department of Agriculture (USDA) Food Patterns Equivalents Database (FPED). 202 individuals (age 20.4±3.6 years; 65.7% females) completed the FAST24 in an average time of 2min compared to 24min for the ASA24. Over half of the food items from the FAST24 were matched to, and correlated with, standard USDA food pattern components (r's ranging from .15 to .58, p's<.05). Food items from the dietary data from the FAST24 were also highly correlated with the more intensive ASA24 application (r's ranging from .23 to .82, p's<.01), and were less time-consuming and burdensome to complete (p's<.0001). Findings support the continued refinement of the FAST24 as a rapid, valid primary care assessment tool for measuring USDA dietary intake patterns. Use of a short, simple screener such as the FAST24 has the potential for integration into large healthcare delivery settings to help establish a baseline for promoting relative behavior changes critical for long-term health and well-being.

Establishing the criterion validity of an adapted dietary screener for Asian Americans amongst Chinese American adults

ObjectiveTo assess the criterion validity of a dietary screener questionnaire adapted for Asian Americans (ADSQ) compared to Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA-24) food diary data amongst Chinese American Adults (CHAs). The ADSQ incorporated example ethnic foods from six Asian American groups. Lessons learned with respect to translating the ADSQ from English into Simplified Chinese were also documented.DesignAgreement between a two-day food diary (one weekend day and one weekday) and the ADSQ was assessed for vegetable, fruit, dairy, added sugar, fiber, calcium, and whole grain intake using paired t-tests to compare means and Spearman correlations to assess agreement between intake of food components.SettingData were collected online and via phone interviews.ParticipantsThirty-three CHAs aged 19–62 years (63.6% female).ResultsMean differences were small for fruit, dairy, fiber, calcium, and whole grain intake, but were significantly different for vegetables and added sugar intake. Spearman correlations were < 0.5 and non-significant (p > 0.05) for all components. Both the ASA-24 and the ADSQ identified the same categories where CHAs intake is misaligned with dietary recommendations: whole grains, total fruit, and dairy. Difficulties were encountered in translating 13 out of 26 questions.ConclusionsThe ADSQ may be a useful tool to identify intervention targets for improving dietary quality, but caution is warranted when interpreting vegetable and added sugar estimates. Differences in the English and Chinese languages underscore the need to take into account both literal translations and semantics in translating the ADSQ into other languages.

P24-108-23 Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) for Equitable Diet Data Collection in Primary Care

P24-108-23 Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) for Equitable Diet Data Collection in Primary Care

P29-020-23 What's New and What's Next for the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24)

P29-020-23 What's New and What's Next for the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24)

P26-011-23 Spanish Mobile User-Testing of NCI's Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24)

P26-011-23 Spanish Mobile User-Testing of NCI's Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24)

Association of Estimated Daily Lactose Consumption, Lactase Persistence Genotype (rs4988235), and Gut Microbiota in Healthy Adults in the United States

BackgroundLactase persistence (LP) is a heritable trait in which lactose can be digested throughout adulthood. Lactase nonpersistent (LNP) individuals who consume lactose may experience microbial adaptations in response to undigested lactose. ObjectivesThe objective of the study was to estimate lactose from foods reported in the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) and determine the interaction between lactose consumption, LP genotype, and gut microbiome in an observational cross-sectional study of healthy adults in the United States (US). MethodsAverage daily lactose consumption was estimated for 279 healthy US adults, genotyped for the lactase gene −13910G>A polymorphism (rs4988235) by matching ASA24-reported foods to foods in the Nutrition Coordinating Center Food and Nutrient Database. Analysis of covariance was used to identify whether the A genotype (LP) influenced lactose and total dairy consumption, with total energy intake and weight as covariates. The 16S rRNA V4/V5 region, amplified from bacterial DNA extracted from each frozen stool sample, was sequenced using Illumina MiSeq (300 bp paired-end) and analyzed using Quantitative Insights Into Microbial Ecology (QIIME)2 (version 2019.10). Differential abundances of bacterial taxa were analyzed using DESeq2 likelihood ratio tests. ResultsAcross a diverse set of ethnicities, LP subjects consumed more lactose than LNP subjects. Lactobacillaceae abundance was highest in LNP subjects who consumed more than 12.46 g/d (upper tercile). Within Caucasians and Hispanics, family Lachnospiraceae was significantly enriched in the gut microbiota of LNP individuals consuming the upper tercile of lactose across both sexes. ConclusionsElevated lactose consumption in individuals with the LNP genotype is associated with increased abundance of family Lactobacillaceae and Lachnospriaceae, taxa that contain multiple genera capable of utilizing lactose.This trial was registered on clinicaltrials.gov as NCT02367287.

Dietary intake of macro and micronutrients correspond with sleep behaviors in collegiate female soccer players

Both macro and micronutrient intakes have an impact on sleep behaviors in athletes, notably sleep onset latency and sleep efficiency. Proper nutrient intake supports daily muscle repair and synthesis of sleep regulating compounds (e.g., serotonin and melatonin). The objective of this study was to evaluate the relationship between sleep behaviors and dietary intake in elite college female athletes. It was hypothesized that dietary carbohydrates and vitamin intake would be associated with both sleep timing and consistency. Twenty-three female Division I collegiate soccer players were evaluated for their sleep and nutritional patterns. Athletes wore an OURA ring (OURA Health, Oulu, Finland) each night for 31 days during the competitive season. During the final three days, athletes recorded their dietary intake using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24). All athletes were exposed to the same travel schedule throughout the evaluation period, which did not differ by more than one time zone. Pearson’s R with Bonferonni Correction was used to assess the relationship between the average daily intake of various nutrients with average nightly sleep behaviors. Total Vitamin B12 ( r=-0.63), added Vitamin B12 ( r=-0.62), and Vitamin C ( r=-0.53) were negatively correlated with average bedtimes (P&lt;0.01) while added Vitamin B12 ( r=-0.61) and Vitamin C ( r=-0.50) were also negatively associated with wake times (P&lt;0.01). Greater dietary intake of kcals from carbohydrates, with respect to recommended consumption, was associated with earlier bedtimes ( r=0.41, P&lt;0.05). In conclusion, greater intake of carbohydrates and vitamins B12 and C are associated with ideal sleep behaviors. A potential mechanism accounting for this relationship could be the enhanced contribution of antioxidants and glycemic load on the synthesis of vital hormones for sleep regulation, including serotonin and melatonin. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Relative validity of a Diet Risk Score (DRS) for Chinese American adults

ObjectiveThe objective of this study was to evaluate the relative validity of the nine-item Diet Risk Score (DRS) among Chinese American adults using Healthy Eating Index (HEI)-2015 scores. We provide...

A225 QUANTIFICATION OF BONE DENSITY AND DIETARY RISK FACTORS FOR BONE FRAGILITY IN INFLAMMATORY BOWEL DISEASE

Abstract Background Nutrition and bone fracture risk are intimately related in inflammatory bowel disease (IBD). Crohn’s disease (CD) patients are at increased risk of low bone mineral density (BMD) and fractures. This may be due to chronic inflammation, corticosteroid exposure, inadequate consumption of nutrients and minerals such as calcium (ie. lactose intolerance), food aversion, bowel symptoms, and/or possible altered absorption. Fibrostenotic CD is characterized by debilitating strictures where patients are known to alter food intake to avoid obstructive symptoms. However, relationships between food intake patterns and BMD have not been well delineated according to CD phenotypes. Purpose Our study evaluated 1) BMD as measured by dual X-ray absorptiometry (DXA), and 2) energy intake, dietary components and/or micronutrients in CD patients with strictures versus inflammatory (non-stricture) behaviour. Method In this prospective pilot study, patients &amp;gt; 55 years old with ileal CD strictures or inflammatory behavior were recruited from the University of Calgary IBD clinic. All patients completed hip and spine DXA scans and two dietary assessment questionnaires: 1) The Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) and 2) the Diet History Questionnaire III (DHQ III). Additional data collected included past fracture history, medication (glucocorticoid exposure), smoking, and surgical history. Standard of care laboratory investigations obtained included C-reactive protein, parathyroid hormone, calcium, albumin, and 25-hydroxyvitamin D. Patients with celiac disease, cirrhosis, heart failure, kidney disease, short gut, estrogen use, and dysphagia were excluded. Independent samples t-test and multi-variable regression analyses was conducted. Result(s) Seventeen patients had stricturing and twelve had non-stricturing CD (demographics Table 1). The mean BMD for non-stricturing CD patients was not significantly different from those with a stricturing CD phenotype (p =0.140). Non-stricture patients consumed significantly more dairy, calcium, and phosphate. For all CD patients, there was a positive correlation with BMD and intake of fat (p=0.03), carbohydrates (p=0.01), fiber (p=0.01), and alcohol (p=0.01). There was no statistically significant difference in corticosteroid exposure or smoking status. 74.7% (11/17) patients with stricturing CD had past bowel resection compared to only one patient with non-stricturing CD. Image Conclusion(s) In this pilot study, there was no difference in BMD between CD patients with and without small bowel strictures despite inflammatory behaviour patients having less surgical resections and consuming more calcium rich foods known to improve BMD. Further studies may delineate the dietary differences among CD phenotypes and provide information for interventions for nutrient supplementation, and a greater understanding of their relationships with BMD. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Koopmans Memorial Research Fund Disclosure of Interest None Declared

Abstract P340: Development and Delivery of an Effective 16-week HealthEYou Program to Mitigate Metabolic Disease Risk Factors

Introduction: Metabolic syndrome (MetS) is a growing concern in the U.S and around the world. MetS is a cluster of disease risk factors including hypertension, hyperlipidemia, hyperglycemia, and obesity increasing the risk of cardiometabolic disease development. Purpose: The purpose of this study was to assess the efficacy of a 16-week nutrition and physical activity education program (HealthEYou) in mediating metabolic risk factors associated with MetS. Methods: This was a two phase study including phase 1) the use of a person-based approach and community needs assessment to develop a nutrition and physical activity education program, and 2) delivery of the 16-week workplace education program and assessment of its effectiveness. In phase 1, a survey and focus groups were used to assess the needs of the target population to develop the 16-week education program. Twenty-six participants (96% female; age: 50.1±9.2 yrs; BMI: 31.2±5.3 kg/m2) enrolled in the HealthEYou program. At baseline, 8- and 16-weeks participants completed assessments including blood pressure, body composition via Dual-energy X-ray absorptiometry (DXA) and waist circumference, 6-minute walk test, handgrip strength test, dietary intake via the Automated Self-Administered 24-hour (ASA-24) dietary assessment tool, and quality of life questionnaire. In addition, blood was drawn to assess metabolic disease risk markers (total cholesterol, glucose and hemoglobin A1c (HbA1c)). The education program consisted of 8-weeks in-person weekly interactive group (60 min) and individual goal setting (15 min) sessions and 8-weeks of weekly newsletters and two individual goal setting sessions. Results: Data was analyzed using repeated measures analysis of variance. The prevalence of MetS among the participants decreased significantly from 41.7% at baseline to 15.8% after completion of the program. There was a significant decrease from baseline compared to after 16-weeks in fat mass (36.8±10.5 kg and 34.4 ±10.47 kg, p=0.003) and HbA1c (5.36±0.40% and 5.12±0.37%, p=0.001). In addition, significant improvements in distance walked, handgrip strength, caloric intake and quality of life (p&lt;0.05) were also observed. However, no significant changes (p&gt;0.05) in total cholesterol, fasting blood glucose or systolic and diastolic blood pressure were observed at 16-weeks compared to baseline measures. Conclusion: In conclusion, the use of a person-based approach and community needs assessment was beneficial to the development of a 16-week nutrition and physical activity education program. Participants who completed the 16-week program had significant improvements in a number of metabolic risk factors. In addition, the physiological improvements corresponded with improvements in dietary intake and fitness levels, suggesting participants made positive lifestyle changes.

Abstract MP46: Higher Daytime Fruit, Vegetable, and Carbohydrate Intake is Associated With Less Fragmented Nighttime Sleep in Adults With Adequate Sleep Duration

Introduction: Population studies show an association between higher quality diets and better sleep quality. Some clinical intervention studies have supported an influence of diet on sleep but have primarily examined specific foods and not complete dietary patterns. In a previous study, we showed that higher intakes of fiber and lower intakes of sugar and saturated fat were associated with deeper, less disrupted sleep. However, this was examined over a single day and night. In this study, we used multiple days of dietary records and sleep, assessed by actigraphy, to determine the temporal associations between dietary intakes during the day and sleep on the subsequent night. Hypothesis: We hypothesized that consumption of a diet higher in fruits, vegetables, nuts and seeds, and whole grains, components of a Mediterranean diet, would predict better sleep quality. Methods: We examined habitual sleep patterns and self-reported diet in 34 adults (28 men and 6 women, 50% racial/ethnic minority, age: 28±7 years, BMI: 19.8-33.7 kg/m 2 ) who participated in 2 separate studies aimed at assessing the influence of diet and meal timing on sleep and energy balance. Diet was assessed using the Automated Self-Administered 24-hour (ASA-24) Dietary Assessment Tool. Sleep during the subsequent night was assessed using wrist actigraphy. Participants provided an average of 6.0±1.5 d of diet and accompanying sleep data. Sleep quality was estimated using the sleep fragmentation index (SFI), a measure of sleep disruption, expressed as the ratio of the number of awakenings to the total sleep time in minutes. Linear mixed effects models were used to examine the relationship between dietary intakes during the day and sleep fragmentation during the subsequent night. Models were adjusted for age, sex, BMI, and total energy intake. Results: On average, participants consumed 2085±743 kcal, 94±43 g protein, 84±38 g fat, 233±89 g carbohydrate, 21±11 g fiber, 329±154 mg magnesium, 3±2 cups fruits and vegetables, 1±2 oz nuts/seeds, and 8±7 tsp added sugar per day. Average total sleep time and sleep efficiency were 423±70 min and 89±6%, respectively; SFI was 17±9. Consumption of more fruits and vegetables (β(SE)=-0.60(0.29), P=0.04) and carbohydrates (β(SE)=-0.02(0.007), P=0.02) was associated with lower SFI, indicative of less disrupted sleep, during the subsequent night. Also, trends for inverse associations with SFI were observed for fiber (β(SE)=-0.1(0.06), P=0.08), magnesium (β(SE)=-0.007(0.004), P=0.09), and vegetable intake (β(SE)=-0.72(0.39), P=0.07). Conclusion: In adequate sleepers, consumption of a diet higher in fruits, vegetables, carbohydrates, fiber, and magnesium, was associated with less fragmented sleep. These results suggest that diets rich in these nutrients, such as the Mediterranean and DASH diets, might play a role in promoting better sleep quality. Future intervention studies are warranted.

Diet, Physical Activity, and Stress Among Wheelchair Users With Multiple Sclerosis: Examining Individual and Co-Occurring Behavioral Risk Factors

ObjectiveThis study examined individual and co-occurring behavioral risk factors (diet, exercise, and stress) in wheelchair users with multiple sclerosis (MS) and potential association with MS symptoms (ie, fatigue, depression, anxiety, pain, sleep, and health-related quality of life [HRQOL]). DesignSurvey. SettingGeneral Community. ParticipantsOne hundred twenty-three wheelchair users with MS completed this study (N=123). InterventionsNot applicable. Main Outcome MeasuresParticipants were mailed instructions for accessing online questionnaires (demographic and clinical characteristics, Godin Leisure-Time Exercise Questionnaire, Perceived Stress Scale, Automated Self-Administered 24-Hour Dietary Assessment Tool, and MS symptoms). ResultsStandard cut-points were used to categorize behavioral risk factors and then identify the extent and distribution of these behaviors both individually and co-occurring. We then analyzed the associations between behavioral risk factors and MS symptoms using bivariate correlation analyses and Mann-Whitney U tests. The mean age of participants was 60.6±10.0 years, 76% identified as women, 82% had a progressive disease course, and the mean MS duration was 23.0±9.7 years. Seven participants were classified as having 0 negative health behaviors, 41 participants had 1 negative health behavior, 49 participants had 2 negative health behaviors, and 26 participants had 3 negative health behaviors. The number of negative health behaviors was significantly correlated with HRQOL (physical, r=.30; psychological, r=.47), sleep (r=.25), depressive symptoms (r=.36), and anxiety (r=.43). Mann-Whitney U tests indicated greater fatigue, depression, and anxiety as well as lower sleep quality and HRQOL among participants who reported 2 or 3 behavioral risk factors compared with 0 or 1 behavioral risk factor. ConclusionsFuture research should examine the design and implementation of multiple health behavior change interventions targeting co-occurring behavioral risk factors among wheelchair users with MS.

Dietary changes in an acceptance-based weight loss pilot intervention study

ObjectiveTo evaluate pre-post changes in dietary intake and the possible role of emotional eating (EE) as a mediator of dietary changes in a novel behavioral weight loss intervention (Live FREE). DesignSecondary analysis of an open label pilot study. ParticipantsThirty-nine adults with overweight/obesity and EE. InterventionLive FREE is a 16-week group-based program in which participants learn emotional regulation skills from Dialectical Behavior Therapy followed by traditional behavioral weight loss techniques. Main outcome measureDietary intake and EE were measured at baseline and post-treatment with the Automated Self-Administered 24-Hour Dietary Assessment Tool and the depression subscale of the revised Emotional Eating Scale. AnalysisPaired sample t-tests and mediation for repeated measures designs. ResultsConsumption of calories (t(33) = 5.31, p < .001), saturated fat (t(33) = 5.25, p < .001), and added sugar (t(33) = 4.44, p < .001) decreased from pre-post-treatment. EE change mediated the effect of the intervention on change in saturated fat intake pre-post-treatment, B = 6.16, BootSE = 2.47, 95 % CI (1.53 to 11.37), but did not mediate change in caloric or added sugar intake. Conclusions and implicationsParticipants reported improvement in caloric, saturated fat, and added sugar intake. Improvement in EE may be closely related to decreasing saturated fat consumption. (200).

Feasibility of using the Automated Self-Administered 24-hour (ASA-24) dietary assessment tool in older adults

Background Dietary patterns can impact the trajectories of healthy aging. However, dietary assessment tools can be challenging to use. With the increased use of technology in older adults, we aimed to evaluate the feasibility of older adults completing the online, Automated Self-Administered 24-h (ASA-24) dietary assessment tool. Methods We conducted a randomized, two-period, two-sequence, crossover design of twenty community-dwelling older adults (≥65 years) comparing their preference for completing the ASA-24 alone versus with a research assistant (RA). Participants were recruited via ResearchMatch.com and randomly allocated 1:1 to a sequence of completing both an ASA-24 alone or with an RA, separated by one week. After each session, participants completed an online 11-item feasibility survey (Likert-scale range of 1–5, strongly disagree to strongly agree). Mean and standard deviations were reported for each question. Results Mean age was 69 ± 3.5 years (90% females), with no differences were observed for sex, age, race, ethnicity, education, or income. Neither group felt a need for RA assistance ( p = 0.34). However, both groups felt the system was easier to follow with the help of an RA (RA: 4.4 ± 1.3, vs. SA 4.6 ± 0.5, p = 0.65), particularly when they completed the ASA-24 alone, first ( p = 0.04). When conducting the ASA-24 alone, there was less confidence the system could be learned quickly (SA 4.5 ± 0.5→3.4 ± 1.0 vs RA 3.4 ± 1.0→3.4 ± 0.7, p = 0.001). The ASA-24 was thought to be less cumbersome after repeated exposure in those concluding with the RA. Conclusion While older adults were able to complete the ASA-24 independently, the use of an RA led to improved confidence. Enhancing the sample diversity in a larger number of participants could provide helpful data to improve the science of dietary assessment.