Total Healthy Eating Index Score Research Articles

Nutrition Practices of Family Child Care Home Providers and Children's Diet Quality

ObjectiveTo examine the relationship between the diet quality of children aged 2–5 years cared for in family child care homes (FCCHs) with provider adherence to nutrition best practices. DesignCross-sectional analysis. ParticipantsFamily child care home providers (n = 120, 100% female, 67.5% Latinx) and children (n = 370, 51% female, 58% Latinx) enrolled in a cluster-randomized trial. Main Outcome MeasuresData were collected over 2 days at each FCCH. The Environment and Policy Assessment and Observation tool was used to document whether providers exhibited nutrition practices on the basis of the Nutrition and Physical Activity Self-Assessment for Child Care. Each practice was scored as either present or absent. Children's food intake was observed using Diet Observation at Child Care and analyzed with the Healthy Eating Index–2015. AnalysisMultilevel linear regression models assessed the association between providers exhibiting best practices regarding nutrition and children's diet quality. The model accounted for clustering by FCCH and controlled for provider ethnicity, income level, and multiple comparisons. ResultsChildren in FCCHs in which more of the best practices were implemented had higher diet quality (B = 1.05; 95% confidence interval [CI], 0.12–1.99; P = 0.03). Specifically, children whose providers promoted autonomous feeding (B = 27.52; 95% CI, 21.02–34.02; P < 0.001) and provided nutrition education (B = 7.76; 95% CI, 3.29–12.23; P = 0.001) had higher total Healthy Eating Index scores. Conclusions and ImplicationsFuture interventions and policies could support FCCH providers in implementing important practices such as autonomy feeding practices, talking informally to children about nutrition, and providing healthful foods and beverages.

Diet quality and anthropometric indices of patients undergone bariatric surgery: the prospective Tehran obesity treatment study

BackgroundPatients undergone bariatric surgery (BS) has long-term risks including decrease in diet quality, nutritional deficiencies and weight regain. This study focus on assessing dietary quality and food group components in patients one year after BS, the relationship between dietary quality score and anthropometric indices, and also evaluating the trend of body mass index (BMI) of these patients three years after BS.MethodsA total of 160 obese patients (BMI ≥ 35 kg/m2) were undergone sleeve gastrectomy (SG) (n = 108) or gastric bypass (GB) (n = 52), participated in this study. They were assessed for dietary intakes using three 24-hour dietary recalls one year after surgery. Dietary quality was assessed using food pyramid for post BS patients and healthy eating index (HEI). Anthropometric measurements were taken pre-surgery and 1, 2 and 3 years after operation.ResultsThe mean age of patients was 39.9 ± 11 years (79% female). The mean ± SD percentage of excess weight loss was 76.6 ± 21.0 one year after surgery. Intake patterns are generally (up to 60%) not consistent with the food pyramid. The mean total HEI score was 64 ± 12 out of 100. More than %60 of participants is exceeding the recommendations for saturated fat and sodium. The HEI score did not show significant relationship with anthropometric indices. The mean of BMI in SG group increased over three years of follow up, while in GB group, there were no significant differences in BMI during three years of follow up.ConclusionsThese findings showed that patients had not healthy pattern intake one year after BS. Diet quality did not show significant relationship with anthropometric indices. The trend of BMI three years after surgery was different based on surgery types.

Dietary per- and polyfluoroalkyl substance (PFAS) exposure in adolescents: The HOME study

BackgroundDiet is the primary exposure pathway for per- and polyfluoroalkyl substances (PFAS) in non-occupationally exposed populations. Few studies have examined associations of dietary quality and macronutrient intake with PFAS exposure among US adolescents. ObjectiveTo assess relationships of self-reported dietary quality and macronutrient intake with serum PFAS concentrations in adolescents. MethodsWe used cross-sectional data from 193 Cincinnati, Ohio area adolescents (median age 12.3 years) collected from 2016 to 2019. Using 24-h food recalls completed by adolescents on three separate days, we derived Healthy Eating Index (HEI) scores, HEI components, and macronutrient intake. We measured perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA) concentrations in fasting serum samples. Using linear regression, we estimated covariate-adjusted associations between dietary variables and serum PFAS concentrations. ResultsThe median HEI score was 44 and median serum PFOA, PFOS, PFHxS, and PFNA concentrations were 1.3, 2.4, 0.7, and 0.3 ng/mL respectively. In adjusted models, higher total HEI scores, whole fruit and total fruit HEI component scores, and total dietary fiber intake were associated with lower concentrations of all four PFAS. For example, serum PFOA concentrations were 7% lower (95% CI: −15, 2) per standard deviation increase in total HEI score and 9% lower (95% CI: −18, 1) per standard deviation increase in dietary fiber. SignificanceGiven adverse health effects associated with PFAS exposure, it is crucial to understand modifiable exposure pathways. Findings from this study may inform future policy decisions aiming to limit human exposure to PFAS.

Do Locus of Control Affect Anthropometric Measurements, Food Intake and Diet Quality in Adolescent Soccer Players?

Aim: This study was conducted to examine the effect of locus of control on anthropometric measurements, nutritional status, and diet quality in adolescent soccer players. Subjects and Method: The study involved 72 male soccer players between the ages of 14 and 18. The researcher utilized the Rotter Locus of Control Scale face-to-face to the athletes to ascertain their locus of control. The 3-day food consumption records of athletes were gathered in order to assess their nutritional state. The Healthy Eating Index-2015 was used to assess the athletes’ dietary quality. Results: The average score of the athletes on Rotter’s Locus of Control Scale was determined as 10.28 ± 3.15. The athletes’ ages, total weights, skeletal muscle weights, and body mass index values were found to have a positive and statistically significant weak connection with the players’ scores on the “Locus of Control”(r: 0.268; p = 0.023; p &lt;0.05). The Total Healthy Eating Index (HEI) score was 37.16±10.14 on average, 90.3% (n=65) of the athletes had a “poor” diet, and 9.7% (n=7) had a diet quality that needed improvement. There was no statistically significant relationship between the athletes’ total HEI score and Rotter’s Locus of Control Scale score (p&gt; 0.05). Regression analysis reveals that it is connected to skeletal muscle weight as a factor in determining the degree of the locus of control (F = 5.756; p = 0.019; p &lt;0.05). Conclusion: Findings related to locus of control of athletes are interesting, however, there is a need for more comprehensive studies that can determine the relationship of locus of control with anthropometric measurements and food intake.

Treatment response to supplemental nutrients for ADHD is independent of diet quality: the MADDY Study RCT

ABSTRACT Objectives The 8-week Micronutrients for ADHD in Youth (MADDY) randomized controlled trial (N = 126, age 6–12) of broad-spectrum multinutrients for ADHD with emotional dysregulation found 3 times as many responders with multinutrients (54%) compared to placebo (18%) by Clinical Global Impression-Improvement (CGI-I). Our primary aim for this analysis tests the hypothesis that those with poor overall diet quality at baseline benefit more. The second aim is to explore whether specific components of diet quality moderate treatment response. Methods 124 children (69 multinutrients, 55 placebo) had diet quality assessed using the Healthy Eating Index-2015 (HEI-2015). For each potential moderator, the outcome CGI-I at week 8 (RCT-end), was modeled two ways: (1) as a dichotomous variable: responder/non-responder, with responders defined by a rating of 1 or 2 ‘very much’ or ‘much improved,’ all else equals non-responder using logistic regression, and (2) as a dimensional improvement outcome from 1 = very much improved to 7 = very much worse, using linear regression. Results HEI-2015 total score did not moderate treatment response [odds ratio = 1.00 (95% CI: 0.90,1.10), p = 0.984] or improvement [β = −0.01 (95% CI: −0.06,0.04), p = 0.648]. However, total vegetable intake moderated level of improvement in exploratory analysis [β = −0.48 (95% CI: −0.82, −0.13), p = 0.007]: those with higher baseline vegetable intake showed greater benefit from multinutrients compared to placebo. Conclusions Multinutrients may benefit children with ADHD and irritability regardless of overall diet quality. The finding that higher baseline vegetable intake may improve response to multinutrients deserves further exploration, including dietary effect on gut microbiota and absorption of multinutrients and parental factors.

Changes in Meal and Menu Quality at Early Care and Education Programs after Training with Food Service Staff: the FRESH Study

BackgroundPrevalence of obesity in Native American (NA) children is disproportionately high, indicating a higher risk of health disparities. Many children attend early care and education (ECE) programs, presenting an opportune environment to improve meal and menu quality as the intake of healthy foods is associated with lowered risk of childhood obesity. ObjectivesWe aimed to examine the effectiveness of food service staff training on meals and menu quality across NA ECEs. MethodsFood service staff from 9 participating ECE programs attended a 3-h training focused on Child and Adult Care Food Program (CACFP) best practices, and received a tailored, best-practice menu, and healthy recipes. Meals and menus prepared across 1 wk were examined per CACFP serving size assumptions at baseline, 4 mos, 6 mos, and 12 mos for all 9 programs. Healthy Eating Index (HEI), CACFP requirements and best practices achievement, and food substitutions quality (classified into superior, equivalent, and inferior based on the nutritional quality) were calculated. A repeated measures ANOVA model was used to determine the differences across time points. ResultsThe total meal HEI score increased significantly from baseline to 4 mos (71.1 ± 2.1; 78.6 ± 5.0; P = 0.004), but did not differ from baseline to 12 mos. Menu CACFP requirements and best practices achievement did not differ across time points, although achievement with CACFP requirements was already high at baseline. Superior nutrition quality substitutions declined from baseline to 6 mos (32.4 ± 8.9; 19.5 ± 10.9; P = 0.007); however, it did not differ from baseline to 12 mos. Equivalent and inferior quality substitutions did not differ across time points. ConclusionsImplementing a best-practice menu with healthy recipes showed immediate improvements in meal quality. Although the change did not sustain, this study showed evidence of an opportunity to educate and train food service staff. Robust efforts are needed for improving both meals and menus.This trial was registered ClinicalTrials.gov as NCT03251950 (https://clinicaltrials.gov/ct2/show/NCT03251950?cond=food+resource+equity&draw=2&rank=1).

Nosotros mismos nos estamos matando/We are the ones killing ourselves: Unraveling individual and network characteristics associated with negative dietary acculturation among Mexican Americans in New York City

BackgroundResearch on negative dietary acculturation among Mexican-Americans has mostly focused on individual-level processes and has largely ignored the role of social networks. MethodsThis mixed-method study used an egocentric network approach and derived 1620 personal ties of self-identified Mexican adults in New York. 24-hour dietary recalls were used to derive a total Healthy Eating Index (HEI) and subscores. The qualitative portion generated narratives around who helps or hinders their efforts to eat healthfully. ResultsAt the individual level, age at which participants migrated to the U.S. was negatively associated with total HEI (β = −0.39, p < .01). An annual income below $30,000 was positively associated with total HEI (β = 0.25, p < .05) and with HEI fruit subscores (β = 0.25, p < .05). Acculturative stress was negatively associated with HEI fruit (β = −0.29, p < .05) and refined grain subscores (β = −0.34, p < .01). At the network level, the proportion of network members who consumed traditional Latino diets was negatively associated with total HEI and HEI refined grains subscores (β = −0.39, p < .001; and β = −0.23, p < .05; respectively). In contrast, the proportion of alters who lived in another country was positively associated with HEI dairy subscores (β = 0.25, p < .05). Juxtaposing qualitative participants’ visual representation of their total HEI scores with their lay interpretations of healthy and unhealthy eating matched public health messages of reducing sugar, red meat intake, and processed foods. However, participants felt that this could only be achieved through restriction rather than balance. Qualitative narratives also elucidated how dietary acculturation and income could help shape dietary quality in unexpected ways. ConclusionsThis study found evidence of negative dietary acculturation and showcases the complex ways in which both individual- and network-level processes help shape dietary choices for Mexican-Americans.

Impact of a farmers’ market healthy food subsidy on the diet quality of adults with low incomes in British Columbia, Canada: a pragmatic randomized controlled trial

BackgroundAdults with low incomes have lower diet quality than their higher income counterparts. In Canada, the British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides coupons to low-income households to purchase healthy foods in farmers’ markets. ObjectiveThe objective of this study was to examine the impact of the FMNCP on the diet quality of adults with low incomes. MethodIn a pragmatic randomized controlled trial conducted in 2019, adults with low incomes (≥18 y) were randomly assigned either to an FMNCP intervention (n = 143) or a no-intervention control group (n = 142). The FMNCP group received 16 coupon sheets valued at $21 per sheet over 10–15 wk to purchase healthy foods from farmers’ markets. Participants completed a questionnaire and 2 24-h dietary recalls at baseline (0 wk), immediately post-intervention (10–15 wk), and 16-wk post-intervention (26–31 wk). Diet quality was calculated using the Healthy Eating Index-2015 (HEI-2015). Linear mixed-effects regression assessed differences in HEI-2015 total (primary outcome) and component scores (secondary outcomes) between the FMNCP and control groups at post-intervention and 16-wk post-intervention. Subgroup analyses examined program impacts by sex and age group (18–59 y, ≥60 y). ResultsThere were no significant differences in HEI-2015 total scores between the FMNCP and control groups at post-intervention (−0.07; 95% CI: −4.07, 3.93) or 16-wk post-intervention (1.22; 95% CI: −3.00, 5.44) overall or between subgroups. There were no significant between-group differences in HEI-2015 component scores at post-intervention, although there were significant differences in component scores for dairy and fatty acids at 16-wk post-intervention. ConclusionThe FMNCP did not significantly improve diet quality among adults with low incomes over the study period. Further research is needed to explore whether higher subsidy amounts or a longer intervention period is needed to meaningfully improve diet quality among adults with low incomes.This trial was registered at [clinicaltrials.gov] as [NCT03952338].

Abstract B032: Diet quality and physical activity of African American prostate cancer survivors at baseline of Men Moving Forward, a lifestyle intervention program

Abstract Background: In the United States, approximately 41,600 new cases of prostate cancer will be diagnosed in Black/African American men in 2022. Lifestyle can impact cancer survivorship, including recurrence risk, comorbidity burden and quality of life. The American Cancer Society has set physical activity and nutrition guidelines for cancer survivors that include plant-based eating and regular physical activity and strength training. However, many cancer survivors are unaware of these guidelines, and they often face challenges in adopting such behaviors. Men Moving Forward (MMF) is among the first community-based lifestyle intervention developed with and for African American Prostate Cancer Survivors (AAPCS). This study examines the diet and physical activity patterns of MMF participants at baseline. Methods: MMF is a 16-week group-based lifestyle intervention, led by local health coaches. Men complete surveys and physical assessments at baseline, post-intervention and at a 12-month follow-up. The VioScreen Food Frequency Questionnaire (FFQ) was used to obtain dietary intake and diet quality scores for participants at baseline. The Healthy Eating Index-2015 (HEI-2015) is used to assess adherence to the Dietary Guidelines for Americans (DGA) 2015-2020. Baseline HEI-2015 scores of men in the Multiethnic Cohort Study (MEC) were used to provide a population-based comparison. We also examined how many men received an HEI-2015 total score &amp;gt;80, reflecting an ideal diet for reducing premature death and chronic disease risk. Physical activity was measured using the Godin Leisure-Time Exercise Questionnaire (Godin) with an item added to query on frequency of strength training. Results: At baseline of MMF, 80 AAPCS completed the FFQ and 83 AAPCS completed the Godin. MMF participants had a mean age of 66.4 ± 6.86, 49.4% were married/living with a partner, and had varying incomes and education levels. Top comorbidities include hypertension (71%), obesity (51%), diabetes (31%), and hypercholesterolemia (48%). MMF participants had lower total HEI-2015 scores than MEC study men with average scores of 60.3 ± 11.0 and 65.6 ± 10.3, respectively. About half of the HEI-2015 component scores were similar between MMF and MEC participants. However, MMF participants reported 1 or more points higher component scores for “dairy” and “refined grains”, and 1 or more points lower scores for “seafood &amp; plant proteins”, “fatty acids”, “sodium”, and “saturated fats” than their MEC counterparts. Although AAPCS in MMF reported similar HEI-2015 scores to typical American men, only 3 of the 80 AABCS at baseline reported HEI-2015 scores &amp;gt;80, highlighting a need for diet quality improvement. At baseline, 40% of participants were considered active and 33% reported strength training at least twice weekly. Conclusion: Data reflect the value of supporting AAPCS in lifestyle changes to improve dietary quality, physical activity and strength training. Few efforts have addressed lifestyle among AAPCS, despite high prostate cancer burden. Future reports will examine the efficacy of MMF. Citation Format: Margaret Y. Tovar, Patricia Sheean, Paula Papanek, Alexis Visotcky, Lola Awoyinka, Anjishnu Banerjee, Kathryn Bylow, Deepak Kilari, Kathryn Flynn, Toni Uhrich, Sophia Aboagye, Sandra Contreras, Kathleen Jensik, Melinda Stolley. Diet quality and physical activity of African American prostate cancer survivors at baseline of Men Moving Forward, a lifestyle intervention program [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B032.

Dietary Intake of Monosaccharides from Foods is Associated with Characteristics of the Gut Microbiota and Gastrointestinal Inflammation in Healthy US Adults

BackgroundCurrent assessment of dietary carbohydrates does not adequately reflect the nutritional properties and effects on gut microbial structure and function. Deeper characterization of food carbohydrate composition can serve to strengthen the link between diet and gastrointestinal health outcomes. ObjectivesThe present study aims to characterize the monosaccharide composition of diets in a healthy US adult cohort and use these features to assess the relationship between monosaccharide intake, diet quality, characteristics of the gut microbiota, and gastrointestinal inflammation. MethodsThis observational, cross-sectional study enrolled males and females across age (18-33 y, 34–49 y, and 50–65 y) and body mass index (normal, 18.5–24.99 kg/m2; overweight, 25–29.99 kg/m2; and obese, 30–44 kg/m2) categories. Recent dietary intake was assessed by the automated self-administered 24-h dietary recall system, and gut microbiota were assessed with shotgun metagenome sequencing. Dietary recalls were mapped to the Davis Food Glycopedia to estimate monosaccharide intake. Participants with >75% of carbohydrate intake mappable to the glycopedia were included (N = 180). ResultsDiversity of monosaccharide intake was positively associated with the total Healthy Eating Index score (Pearson’s r = 0.520, P = 1.2 × 10−13) and negatively associated with fecal neopterin (Pearson’s r = -0.247, P = 3.0 × 10−3). Comparing high with low intake of specific monosaccharides revealed differentially abundant taxa (Wald test, P < 0.05), which was associated with the functional capacity to break down these monomers (Wilcoxon rank-sum test, P < 0.05). ConclusionsMonosaccharide intake was associated with diet quality, gut microbial diversity, microbial metabolism, and gastrointestinal inflammation in healthy adults. As specific food sources were rich in particular monosaccharides, it may be possible in the future to tailor diets to fine-tune the gut microbiota and gastrointestinal function. This trial is registered at www.clinicaltrials.gov as NCT02367287.

The association between healthy eating index score with semen parameters in infertile men: A cross-sectional study.

Infertility has been a major problem for young couples in recent years. One way to assay the diet quality is the healthy eating index (HEI), related to infertility. This study aims to assess the association between the HEI score with semen parameters in Iranian infertile men. Two hundred and sixty eligible men (18-55 yr), were referred to the major infertility clinic in the summer of 2018 and entered this cross-sectional study. Based on the 5 edition of the world health organization laboratory manual, semen parameters including sperm concentration, volume, motility, and morphology were analyzed, and to specify the dietary intake of individuals a 168-item questionnaire was used. Also, to calculate the total HEI score, all 13 components based on HEI-2015 components and scoring standards were summed up. Participants in the highest tertile, had no difference in mean sperm parameters with those in the lowest tertile in the crude model. No significant association was found between sperm parameters and HEI score tertiles in the crude model, even after adjustment for potential confounders, except for concentration (OR: 0.39 and CI: 0.15, 0.99, p = 0.04). Participants in the highest tertile had a lower risk of abnormal concentration and motility in the crude model. The risk of abnormal concentration decreased, and motility increased in the adjusted model. In this cross-sectional study, there was no significant relationship between HEI and sperm indexes, except for sperm concentration. Therefore, more studies need to be done in the future.

A Cross-Sectional Analysis of Food Perceptions, Food Preferences, Diet Quality, and Health in a Food Desert Campus.

The sensory properties of foods guide food choices and intake, importantly determining nutritional and health status. In communities that have inconsistent access to nutritious foods, such as food deserts, food taste perceptions and preferences have yet to be explored. The purpose of this study was to examine how taster status (supertaster vs. non-taster) and food security status (high or marginal vs. low or very low) influences food taste intensities, food preferences and perceptions, and diet quality in a cohort of students from a food desert campus in the Central Valley of California. Moreover, the complex relationship of socioeconomic status, race/ethnicity, and sex on cardiometabolic and cognitive health warrants further examination. Two hundred fifty participants (aged 18-24 years) living in a food desert campus were recruited in 2018 for this cross-sectional study where participants underwent taste tests on selected fruits, vegetables, and nuts, and clinical tests (anthropometrics, blood glucose, blood pressure, and endothelial function), cognitive function tests (memory and attention), diet quality assessment (Healthy Eating Index (HEI)), and food preference and perception assessments. Food taste intensities were influenced by sex with bitter and umami taste intensities of several foods being perceived more intensely by males. Moreover, food liking was largely influenced by ethnicity with Hispanics having higher liking ratings for several foods compared with non-Hispanics. Both, Hispanics and females, had higher total fruit HEI scores and lower attention scores than non-Hispanics and males, respectively. Females also had lower blood pressure, reactive hyperemia index, and fasting blood glucose. Food-insecure individuals rated cost and convenience as more important factors for overall food consumption and had lower attention scores than those with higher food-security status. Future research should consider the complex interactions of factors such as taste and flavor perception, sex, ethnicity, prior exposure to foods, and other environmental factors when studying food preferences and health in young adults.

Association Between Birthplace and Time in the United States With Diet Quality in US Adolescents: Findings from the National Health and Nutrition Examination Survey, 2007 to 2018

During adolescence, diet quality reaches its lowest point compared to other childhood life stages. Acculturation is associated with decreased diet quality among many groups of US immigrant adults, but research is limited among adolescents. We investigated the associations between birthplace and length of time living in the United States, 2 proxy measures of acculturation, and diet quality among adolescents (12-19 years old). Data were from the NHANES (2007-2018), which included two 24-hour dietary recalls (n = 6113) to estimate Healthy Eating Index 2015 (HEI-2015) total scores and component scores. Multivariate linear regression and generalized linear models were performed to compare HEI-2015 total scores and component scores between US-born adolescents (n = 5342) and foreign-born adolescents with <5 years (n = 244), 5 to <10 years (n = 201), and ≥10 years (n = 290) of US residency. Foreign-born adolescents with <5 years (53.3 ± 1.2), 5 to <10 years (51.4 ± 1.5), and ≥10 years of US residency (49.9 ± 0.8) had higher HEI-2015 total scores than US-born adolescents (47.0 ± 0.3; P < 0.0001) and higher component scores for total vegetables, seafood and plant proteins, and added sugars (P values ≤ 0.0001). Foreign-born adolescents with more years of US residency had higher component scores for total fruits, whole fruits, and saturated fats than those with fewer years of US residency. A sensitivity analysis revealed this pattern held for Mexican-American and other Hispanic adolescents. Being born outside the United States and living in the United States for less time (among foreign-born adolescents) are associated with higher diet quality. Culturally informed health promotion programs may help to reduce diet-related disparities related to acculturation among adolescents.

Evaluating a Food Pantry-Based Intervention to Improve Food Security, Dietary Intake, and Quality in Midwestern Food Pantries.

Voices for Food was a longitudinal community, food pantry-based intervention informed by the social ecological model, and designed to improve food security, dietary intake, and quality among clients, which was carried out in 24 rural food pantries across 6 Midwestern states. Our objective was to evaluate changes in adult food security, dietary intake, and quality from baseline (2014) to follow-up (2016), and to assess the role of adult food security on dietary outcomes. A multistate, longitudinal, quasi-experimental intervention with matched treatment and comparison design was used to evaluate treatment vs comparison group changes over time and changes in both groups over time. Adult food pantry clients (n= 617) completed a demographic food security survey, and up to three 24-hour dietary recalls at baseline (n= 590) and follow-up (n= 160). Community coaching served as the experimental component, which only "treatment" communities received, and a food council guide and food pantry toolkit were provided to both "treatment" and matched "comparison" communities. Change in adult food security status, mean usual intakes of nutrients and food groups, and Healthy Eating Index-2010 scores were the main outcome measures. Linear mixed models estimated changes in outcomes by intervention group and by adult food security status over time. Improvements in adult food security score (-0.7 ± 0.3; P= .01), Healthy Eating Index-2010 total score (4.2 ± 1.1; P &lt; .0001), and empty calories component score (3.4 ± 0.5; P &lt;.0001) from baseline to follow-up were observed in treatment and comparison groups, but no statistically significant changes were found for adult food security status, dietary quality, and usual intakes of nutrients and food groups between the 2 groups over time. The intervention effect on dietary quality and usual intake changes over time by adult food security status were also not observed. Food pantry clients in treatment and comparison groups had higher food security and dietary quality at the follow-up evaluation of the Voices for Food intervention trial compared with baseline, despite the lack of difference among the groups as a result of the experimental coaching component.

Sustained effect on diet quality of a self-care intervention to reduce cardiovascular disease risk among informal rural caregivers of people with chronic illnesses: does health literacy matter?

Abstract Background/Introduction Rural caregivers of those with chronic illnesses have higher cardiovascular disease (CVD) risk than urban caregivers. Diet is a major lifestyle factor that contributes to CVD risk. However, interventions are often not constructed with health literacy in mind. We previously found a moderation effect of health literacy on short-term (4-month) diet quality from a self-care intervention to reduce cardiovascular disease risk (RICHH) among rural caregivers. The RICHH intervention was designed to be equally effective in caregivers with marginal or adequate health literacy. Purpose To compare the impact of RICHH intervention on 12-month diet quality in rural caregivers with marginal versus adequate health literacy. Methods A total of 296 rural caregivers (54.5±13.7 years old, 76% female) of individuals with chronic illnesses participated. The newest vital sign (NVS) and Healthy Eating Index-2015 (HEI-2015) were used to determine health literacy and diet quality, respectively. The NVS was dichotomized using a cutoff score of 4. The HEI-2015 was computed based on food frequency questionnaires at baseline, 4-month, and 12-month. The RICHH intervention was delivered using video conferencing technology by nurse interventionists once a week for 12 weeks followed by bi-weekly and monthly booster sessions. A piecewise linear mixed-effect model, controlling for age, education, smoking status, and perceived stress, was used to evaluate the impact of the intervention on diet quality between the two health literacy groups. Results There was a significant difference in improvement in the HEI-2015 total scores at 4 months between control and intervention in the marginal health literacy group (beta estimate = 1.56, SE=0.74, P=0.039) but not in the adequate health literacy group (beta estimate = 0.27, SE=0.38, P=0.475). The improvement in the marginal health literacy group was sustained at 12-months (beta estimate = 8.12, SE=3.57, P=0.022). Conclusions The results of our study indicate that an intervention designed to address health literacy is effective in producing a sustained improvement in diet quality to reduce CVD risk in rural caregivers with marginal health literacy. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health National Institute of Nursing Research

Analysis of a State Police Academy Menu Cycle for Dietary Quality and Performance Nutrition Adequacy.

Law enforcement officers have high rates of overweight and obesity. With diet as a leading risk factor, training academies present an opportunity for early-career nutrition intervention. Our purpose was to determine the dietary quality (DQ) and performance nutrition adequacy of a state police academy’s cafeteria menu. This cross-sectional content analysis included six weeks (three daily meals, Monday–Friday) of a police academy menu. Nutrient content was determined by portioning menus, gathering food specifications, and performing nutrient analysis. DQ was assessed using the Healthy Eating Index (HEI) 2015. Statistical analyses included independent t-tests and Cohen’s d. The total HEI score was 54/100. Subcomponent scores indicating adequacy included added sugar (5/5), total protein (4.97/5) and whole fruits (4.77/5). Seafood/plant proteins (0.33/5), fatty acid ratio (1.31/5), and dairy scores (1.59/10) needed significant improvement. The menu met the recommended intake for 13 of 19 nutrients investigated. Nutrients that did not meet adequacy were calories (% mean difference, needs-menu = 36.7%), carbohydrates (52.3%), vitamins D (82.5%) and E (66.7%), magnesium (44.1%), and potassium (41.8%). The academy menu leaves room for improvement in DQ and shortfall nutrients. By increasing low scores, the overall DQ of the menu will increase and supplement missing nutrients.

Impact of the British Columbia Farmers’ Market Nutrition Coupon Program on the Diet Quality of Low-Income Adults: A Randomized Controlled Trial

ObjectivesImproving diet quality among low-income populations remains a public health priority. In Canada, the British Columbia (BC) Farmers’ Market Nutrition Coupon Program (FMNCP) aims to improve the diet quality of low-income households by providing coupons to purchase healthy foods from BC farmers’ markets. This randomized controlled trial, conducted in 2019, examined the impact of the FMNCP on the diet quality of low-income adults. MethodsLow-income adults ≥18 years were randomized to a FMNCP group (n = 143) that received 16 weeks’ worth of coupons valued at $21/week to purchase fruits, vegetables, dairy, meat, poultry, fish, eggs, and nuts from farmers’ markets, or to a no-intervention control group (n = 142). Participants completed data collection, including two 24-hour dietary recalls, at baseline (0 weeks), post-intervention (10–15 weeks), and 16 weeks post-intervention (26–31 weeks). Dietary intake data from the 24-hour dietary recalls were used to calculate Healthy Eating Index-2015 (HEI-2015) total scores (primary outcome) and subscores (secondary outcomes). Total scores can range from 0–100, with a higher score indicating higher diet quality. Between-group differences in HEI-2015 total scores and subscores at post-intervention and 16 weeks post-intervention were examined using linear mixed effect models. Subgroup analyses were conducted to examine differences in program impacts according to sex and age group (18–59 years, ≥60 years). ResultsMost participants were female (90.5%) and < 60 years of age (79.7%). HEI-2015 total scores did not significantly differ between the FMNCP and control groups at post-intervention (–0.07; 95% CI –4.07, 3.93) or 16 weeks post-intervention (1.22; 95% CI –3.00, 5.44). No significant between-group differences in HEI-2015 scores by sex or age group were identified. HEI-2015 subscores did not significantly differ at post-intervention; however, at 16-weeks post-intervention, the FMNCP group had significantly lower subscores for fatty acids and significantly higher subscores for dairy compared to the control group. ConclusionsParticipation in the FMNCP did not result in significant changes in overall diet quality among low-income adults. Funding SourcesCanadian Institutes of Health Research and the Maple Leaf Centre for Action on Food Security.

Association between Select Measures of Acculturation and Diet Quality in US Adolescents: Findings From the National Health and Nutrition Examination Survey, 2007 to 2018

ObjectivesAcculturation is associated with decreased diet quality among non-United States (US)-born adults, but there is limited research among non-US-born adolescents. We investigated the associations between birthplace and length of time living in the US, two measures of acculturation, with diet quality among adolescents (12–19 years old).MethodsData are from the National Health and Nutrition Examination Survey (2007–2018), which included two 24-hour dietary recalls (n = 6,113) to calculate Healthy Eating Index-2015 (HEI-2015) total scores and component scores. Multivariate linear regression and generalized linear models were performed to compare HEI-2015 total scores and component scores between US-born adolescents (n = 5342) and foreign-born adolescents with < 5 years (n = 244) and ≥5 years (n = 491) of U.S. residency.ResultsForeign-born adolescents with < 5 years (53.27 ± 0.71) and ≥5 years of US residency (50.45 + 0.71) had higher HEI-2015 total scores than US-born adolescents (46.99 ± 0.29, P < 0.0001) and higher total vegetables, greens and beans, total fruits, whole fruits, seafood and plant proteins, and added sugars scores (P < 0.0001). Foreign-born adolescents with < 5 years of US residency had higher total fruit and saturated fat scores than those with ≥5 years of US residency (P < 0.001).ConclusionsBeing born outside the US and, to a lesser extent, living in the US for less time (among foreign-born adolescents) is associated with higher diet quality. Culturally informed health promotion programs may help to reduce diet-related disparities related to acculturation among adolescents.Funding SourcesNo funding sources to report.

Dietary Restraint Constructs Are Associated With Diet Quality and Nutrient Intake

ObjectivesTo examine and compare reported food and nutrient intake in men and women who differ in cognitive restraint (CR) and disinhibition (D) scores. We hypothesize that average intake of sodium, total sugar, saturated fat, and Healthy Eating Index (HEI) scores of diet quality will differ between low and high D groups. Methods330 adults from a cross-sectional study who completed 3 dietary recalls and the three-factor eating questionnaire (TFEQ) were included in this analysis. Participants were classified into 4 groups based on TFEQ scores for CR and D: high CR + high D (CRD, n = 46); high CR + low D (CR, n = 104); low CR + high D (D, n = 42); and low CR + low D (LL, n = 138). The Automated Self-Administered 24-hour (ASA24) tool was used to obtain dietary recalls on 2 weekdays and 1 weekend day. Nutrient intakes were averaged for the 3 recalls, and HEI scores were calculated using the HEI-2015 scoring standards. Differences in average calories, sodium, total sugar, saturated fat, and HEI scores between groups were analyzed using analysis of covariance with age, sex, and BMI as covariates. ResultsThere were differences in average sodium and saturated fat intake, with CR group reporting lower sodium intake (p = 0.041) and lower saturated fat (p = 0.007) intake compared to the LL group only. There were no differences in calorie or total sugar intake between groups. Interestingly, added sugar intake based on HEI-2015 scoring showed group differences, with CR reporting lower added sugar intake than LL group (p = 0.042). HEI subscore for refined grain intake was also higher in LL group compared to CR (p = 0.002) and CRD (p = 0.023). Total HEI score was lower in LL (59.5 ± 1.0) compared to CR (65.1 ± 1.15, p = 0.002) and CRD (65.6 ± 1.75, p = 0.017). ConclusionsHigh cognitive restraint was associated with a more “healthful” diet with lower sodium and saturated fat intakes compared to groups with low restraint. While there were no associations between total sugar intake and cognitive restraint, reduced consumption of added sugar and refined grains were reported by the cognitively restrained participants, regardless of disinhibition status. Contrary to our hypothesis, high cognitive restraint was the predominant behavior associated with diet quality, not disinhibition. Funding SourcesFunding was provided through the USDA.

Diet Quality and Food Intakes samong US Adults by Level of Animal Protein Intake, What We Eat in America, NHANES 2015–2018

BackgroundDietary recommendations encourage consuming protein from a variety of plant and animal sources. Evaluating the diet of US adults by level of animal protein (AP) intake can inform dietary assessment and nutrition education. ObjectivesThe objective of this cross-sectional study was to estimate percentage of total protein intake from animal sources by US adults to compare diet quality, and intake from USDA Food Patterns (FP) groups by quintiles of AP. MethodsOne day dietary intake data from adults 20+ y (N = 9566) in What We Eat in America (WWEIA), NHANES 2015–2018 were used. Proportions of total protein intake from animal and plant sources and the USDA FP groups were estimated from the ingredients in the Food and Nutrient Database for Dietary Studies 2015–2018, then applied to the dietary intakes. The 2015 Healthy Eating Index (HEI) was used as an indicator of diet quality. The USDA FP groups were used to describe the contribution of animal and plant foods to total protein intake. Data were analyzed by quintile (Q) of AP protein intake; comparisons were made using pairwise t-tests with adjustments for covariates using survey sample weights. Results were considered significant at P <0.001. ResultsTotal mean protein intakes ranged from 62 (Q1) to 104 g (Q5) (all comparisons P <0.001). Total HEI score (possible 100) of Q1 was slightly higher (54.2) (P <0.001) compared with Q1–Q4 (range: 48.0–50.3), which did not differ significantly from each other. Contributions of plant FP components to total protein intake of Q1 to Q5, respectively, were 15% to 1% from nuts/seeds, legumes, and soy products combined; 35 to 10% from grains. The contribution of animal FP components were 19–66% from meat/poultry/seafood, 14–19% dairy, and 3–5% eggs. ConclusionsThe intake of foods considered to be good sources of plant protein was low. The overall diet quality of all adults was suboptimal regardless of plant protein intake.