Total HEI Scores Research Articles

Diet quality as assessed by the healthy eating index-2020 among different smoking status: an analysis of national health and nutrition examination survey (NHANES) data from 2005 to 2018

BackgroundCombining smoking with poor eating habits significantly elevates the risk of chronic illnesses and early death. Understanding of how dietary quality shifts post-smoking cessation remains limited. The objective of this study is to examine dietary quality – using Healthy Eating Index (HEI – 2020) and its 13 components, among current, former, and never smokers, and particularly the impact of quitting and the duration of cessation on dietary habits.MethodsA cross-sectional analysis of 31,569 adults from the National Health and Nutrition Examination Survey (NHANES) 2005–2018 was conducted. Dietary quality was assessed using HEI-2020 scores, which were determined by NIH developed - simple HEI scoring algorithm per person. Smoking status was categorized into current, former, and never smokers, with further subdivisions for current (heavy/light smokers) and former smokers (duration post-cessation). Descriptive analysis and multiple regression models weighted to represent the US population were performed.ResultsThe current smoking rate was 19.4%, with a higher prevalence in males (22.5%) than females (17.5%). Current smokers reported statistically significantly lower HEI total score than both former and never smokers. Former smokers exhibited HEI scores similar to those of never smokers. The adjusted HEI total scores for current, former, and never smokers were 49.2, 54.0, and 53.3, respectively, with a statistically significant difference (p < 0.001). Moreover, light smokers had better total HEI score than heavy smokers (46.8 vs. 50.8, p < 0.001, respectively), but former and never smokers scored even higher. Quitting smoking immediately improved dietary quality, with former smokers reaching the dietary levels of never smokers within 5–10 years (53.8 vs. 53.3, p > 0.05, respectively). Compared to current smokers, former smokers tended to consume more beneficial foods (e.g., fruits, vegetables, greens and beans, whole grains, proteins, and fatty acids), while also consuming more sodium and less added sugar.ConclusionsCurrent smokers, particularly heavy smokers, exhibit poorer dietary habits than former and never smokers. The dietary quality of former smokers aligns with never smokers over time, highlighting the positive impact of smoking cessation on diet. This has implications for reducing chronic disease risks associated with poor diet and smoking.

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

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

Potassium and magnesium and cognitive decline in middle-aged adults

BACKGROUND: Increase in dementias globally is a burden to patients, caregivers, the healthcare system, and the communities in which they live. Understanding nutritional patterns and how they may impact the prevention of these conditions will be critical moving forward. The known impact of minerals such as potassium and magnesium on conditions such as hypertension, oxidative stress, and inflammation – all of which directly impact cognitive health – warrant further study as to their potential direct effects on cognitive function. OBJECTIVE: To determine if low potassium and magnesium blood levels and dietary intakes are associated with cognitive decline in middle-aged adults over a 6-year span. METHODS: Linear regression models were used to describe the associations between potassium and magnesium intakes and cognitive function scores of participants in the Atherosclerosis Risk in Communities Study (ARIC) dataset over 6 years of follow up. Associations with blood values were also assessed. Variables controlled for included total HEI score, a measure of dietary quality. 9,044 participants were included. All linear regression models were run with a 95% confidence interval. RESULTS: Levels of blood potassium and magnesium, in univariate as well as in multivariate analysis were found to have no significant association with cognitive decline. Likewise, intake levels of both minerals were shown to have no significant association with cognitive function. CONCLUSIONS: In 9,044 participants, ages 44 to 66, potassium and magnesium intake and blood serum levels were found to have no significant association with cognitive decline in fully controlled models over 6 years in the ARIC cohort.

The relationship between alexithymia, health literacy, and diet quality in obese adolescents

Alexithymia and low health literacy are the barriers of self-management. This study aims to examine therelationship between alexithymia, health literacy and diet quality in obese adolescents, and their effects on anthropometric and biochemical markers. The 20-item Toronto alexithymia scale (TAS-20) was used to determine the alexithymic traits of the adolescents, and "The Newest Vital Sign" (NVS) scales were used to determine their health literacy levels. Diet quality was evaluated with the Healthy Eating Index-2010 (HEI-2010). 39.7% of the obese adolescents were alexithymic, and 69.4% of alexithymics and 35.1% of non-alexithymics had metabolic syndrome. Alexithymic adolescents were lackof adequate health literacy. There were positive correlations between alexithymia scores and insulin, triglyceride, systolic and diastolic blood pressure levels, andall anthropometric values except height (p<0.05). There wasa negative correlation between alexithymia scores andhealth literacy scores (p<0.05). There were negative correlations between health literacy and alexithymia scores, insulin, total cholesterol, triglyceride, ALT, systolic, diastolic blood pressure levels and all anthropometric values except height, and positive correlation was observed between health literacy scores and diet quality (p<0.05). Total HEI score was negatively correlated with waist circumference, neck circumference, body weight, BMI, triglyceride, AST, ALT, systolic and diastolic blood pressure, and positively correlated with health literacy and HDL levels (p<0.05). As alexithymia severity increased in obese adolescents, the degree of obesity and the incidence of metabolic syndrome increased while the level of health literacy decreased. The increase in health literacy levels, on the other hand, decreased the level of alexithymia and increased the quality of the diet.

The Relationship between Diet and Suicide Risk and Resilience in Wildland Firefighters

Objectives1) To determine the nutrient intake and diet quality of wildland firefighters (WLFF); 2) to determine the relationship between diet quality and mental health indices (e.g., anxiety, depression, post-traumatic stress, suicidality) among WLFF. MethodsThis cross-sectional study involved a convenience sample of 37 WLFF recruited via social media from across the US. Dietary intake was assessed via 24-hour recall entered into nutrient analysis software and scored using the Healthy Eating Index 2015 (HEI) for diet quality. Mental health was assessed using several indices for suicidality, anxiety, depression, hopelessness, and alcohol use. Nutrient intake and HEI scores were compared to current US adult intake patterns from the National Health and Nutrition Examination Survey (NHANES). Relationships between HEI scores and mental health indices were determined using Pearson correlation coefficients. ResultsMean (± standard deviation) age was 40.0 ± 11.7 years and 87.1% of participants were Caucasian with body mass index of 28.1 ± 4.5 kg/m2. Mean HEI score was 52.5 ± 14.8 out of 100, 10.6% lower than the US adult population. Added sugar, refined grains, and total protein all had scores between 81–100/100, indicating adequate intake. Total HEI, saturated fat, total vegetable, and sodium scores were between 51–80/100, indicating need for improvement. Seafood/plant protein, dairy, whole grains, and total fruit scores were between 0–50/100, indicating poor intake. Relationships between HEI scores and mental health indices were significant, moderate, and inverse (beneficial) for total HEI, dark greens and legumes, and fatty acid ratio scores with Alcohol Use Disorder Identification Test, Generalized Anxiety Disorder 7-item, and Patient Health Questionnaire. ConclusionsDiet quality for the diets of WLFF is lower than the US adult population, in significant need of improvement, and potentially impacting mental health status. Funding SourcesNot applicable.

The Associations between Dietary Supplement Use, Diet Quality, and Health-Related Quality of Life among Older Female Cancer Survivors

Evidence-based guidelines for cancer survivorship do not recommend dietary supplementation, yet older cancer survivors report high prevalence of dietary supplement use, specifically multivitamin (MVM), calcium, and vitamin D. Female cancer survivors (≥65 years) who were ≤5 years post-cancer diagnosis completed questionnaires assessing health-related quality of life (HRQoL), diet quality, and supplement intake. Intakes of MVM, calcium, and vitamin D supplementation were 61.4%, 76.9%, and 35.3%, respectively. Women who used MVM supplements had significantly higher dietary quality mean scores for total vegetables (4.5 ± 0.9 to 4.1 ± 1.1), greens and beans (4.1 ± 1.3 to 3.6 ± 1.6), whole fruit (4.7 ± 0.8 to 4.3 ± 1.3), and whole grains (2.9 ± 1.8 to 2.3 ± 1.6) than those who did not use these supplements. After controlling for demographic and clinical variables, the odds of MVM use was 1.07 times greater among those women who had higher total HEI scores. Participants with lower HRQoL were 4% more likely to take an MVM. Understanding the prevalence of supplementation, associations with diet quality, and perceived benefits of supplementation may help healthcare providers in educating survivors and promoting adherence to the evidence-based guidelines.

Abstract 2586: Association between healthy eating index score and risk of pancreatic cancer in the prostate, lung, colorectal, and ovarian cancer screening trial (PLCO)

Abstract Pancreatic cancer is one of the deadliest malignancies in the US. Most cases are diagnosed in the late, non-resectable stages largely due to lack of effective screening tests. There is an urgent need to identify modifiable risk factors for primary prevention of this malignancy. To date, only a few risk factors (family history, smoking, and type-2 diabetes) have been identified for pancreatic cancer. Although several lines of evidence suggest that nutrition plays a role in pancreatic cancer, few nutrients have been consistently associated with its risk in epidemiologic studies. Therefore, the present study sought to investigate the association between the 2015 Healthy Eating Index (HEI-2015) score and pancreatic cancer risk among participants in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). The HEI-2015 is a measure of overall diet quality used to assess how well a diet conforms to key recommendations of the 2015-2020 Dietary Guidelines for Americans. The HEI score is made up of 13 food components, with higher scores (ranged 0-100 points) indicating better dietary quality. In the present study, the HEI-2015 scores were calculated from participant responses to two food frequency questionnaires, dietary questionnaire (DQX) and dietary history questionnaire (DHQ) administered at baseline and the three-year anniversary of enrollment, respectively. During a median follow-up of 12.2 years, 279 cases of pancreatic cancer were identified among 58,477 participants who completed the DQX, while 101,721 participants who responded to the DHQ gave rise to 380 cases of pancreatic cancer over a median follow-up of 8.9 years. Hazard ratios (HR) and 95% confidence internals (CI) were estimated using Cox proportional hazards regression for total HEI score and individual score components, classified into adequacy components (total fruit, whole fruits, total vegetables, greens and beans, whole grains, dairy, total protein foods, seafood and plant proteins, and fatty acids) and moderation components (refined grains, sodium, added sugars, and saturated fats). After adjustment for confounders, no significant association between total HEI score and pancreatic cancer was identified [HR (95% CI) for quartile (Q) 4 vs. Q1: 0.86 (0.60, 1.09) for DQX and 1.03 (0.77, 1.39) for DHQ]. The individual component scores for total vegetables and added sugar in the DHQ analysis and whole grain score in the DQX analysis were inversely associated with pancreatic cancer risk [HR (95% CI) for one-point score increase: 0.89 (0.81, 0.98), 0.95 (0.91, 0.99), and 0.94 (0.89, 0.99), respectively]. In summary, our study did not find a significant association between overall diet quality and pancreatic cancer risk but revealed significant associations with total vegetables, added sugar, and whole grains in the PLCO trial. Citation Format: Margaret L. Hoyt, Jianjun Zhang. Association between healthy eating index score and risk of pancreatic cancer in the prostate, lung, colorectal, and ovarian cancer screening trial (PLCO) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2586.

Healthy eating index patterns in adults by sex and age predict cardiometabolic risk factors in a cross-sectional study

BackgroundAssociations between diet and cardiometabolic disease (CMD) risk may vary in men and women owing to sex differences in eating habits and physiology. The current secondary analysis sought to determine the ability of sex differences in dietary patterns to discriminate groups with or without CMD risk factors (CMDrf) in the adult population and if this was influenced by age.MethodsDiet patterns and quality were evaluated using 24 h recall-based Healthy Eating Index (HEI-2015) in free-living apparently healthy men (n = 184) and women (n = 209) 18–65 y of age with BMIs of 18–44 kg/m2. Participants were stratified into low- and high-CMDrf groups based on the presence/absence of at least one CMDrf: BMI > 25 kg/m2; fasting triglycerides > 150 mg/dL; HDL cholesterol < 50 mg/dL-women or < 40 mg/dL-men; HOMA > 2; HbA1c > 5.7. Sex by age dietary patterns were stratified by multivariate analyses, with metabolic variable associations established by stepwise discriminant analysis.ResultsDiet quality increased with age in both sexes (P < 0.01), while women showed higher fruit, vegetable and saturated fat intake as a percentage of total energy (P < 0.05). The total-HEI score (i.e. diet quality) was lower in the high-CMDrf group (P = 0.01), however, diet quality parameters predicted CMDrf presence more accurately when separated by sex. Lower ‘total vegetable’ intake in the high-CMDrf group in both sexes, while high-CMDrf men also had lower ‘total vegetables’, ‘greens and beans’ intake, and high-CMDrf women had lower ‘total fruits’, ‘whole-fruits’, ‘total vegetables’, ‘seafood and plant-proteins’, ‘fatty acids’, and ‘saturated fats’ intakes (P < 0.05). Moreover, ‘dairy’ intake was higher in high-CMDrf women but not in men (sex by ‘dairy’ interaction P = 0.01). Sex by age diet pattern models predicted CMDrf with a 93 and 89% sensitivity and 84 and 92% specificity in women and men, respectively.ConclusionsSex and age differences in dietary patterns classified participants with and without accepted CMDrfs, supporting an association between specific diet components and CMD risk that differs by sex. Including sex specific dietary patterns into health assessments may provide targeted nutritional guidance to reduce the burden of cardiovascular disease.Trial registrationClinicalTrials.gov: NCT02367287. ClinicalTrials.gov: NCT02298725.

Association of Dietary Quality, Inflammatory Markers, and Physical Functioning among Older Female Cancer Survivors

One area within geriatric oncology that is understudied and undertreated is the dietary quality of older cancer survivors. Most older adults with cancer experience nutritional deficits due to their age and cancer treatment. Research has shown the impact of competing comorbidities, polypharmacy, and decline in functional and cognitive status on older adults’ nutritional needs. This study sought to examine the diet quality of older female cancer survivors, and its association with inflammatory markers and physical functioning. Participants completed surveys online, by mail, or phone. Additional participant information was obtained through medical records. Descriptive statistics, Pearson’s correlations, forward linear regressions were used to analyze these data. Older female cancer survivors (≥65) that had completed their initial cancer treatment in the past 5 years were recruited through cancer clinic visits and medical records. The study was conducted from November 2018 through January 2020. Self-reported physical functioning (RAND-36), diet quality (DHQ-II, HEI-2015), and BMI were obtained from surveys. Participant diagnosis, comorbidities, and inflammatory marker (c-reactive protein (CRP)) were obtained through electronic medical records; albumin was collected as a marker correlated with inflammation. The average age of participants (n = 171) was 73.6 ± 8.4 years. Mean physical functioning score was 60 ± 24 out of 100. Mean total HEI scores were 66.39 + 10.0 out of 100. Positive correlations were observed between total HEI scores and physical functioning, self-rated health, albumin, education, and income. Negative correlations were observed between physical functioning and BMI, self-rated health, albumin, and age. Regressions indicated that individuals who had higher HEI scores were more likely to report higher physical functioning (β = 0.38, P < 0.001). Identifying dietary quality and markers to overall assess inflammation is pertinent to improve the long-term health of cancer survivors. The strong correlations between physical function, HEI, and albumin demonstrates the relationship albumin has with inflammation and its subtle impact it can have on older cancer survivors. Along with CRP, serum albumin should be interpreted in the context of the patient’s overall health. Future larger cohort studies of older cancer survivors with longitudinal measurements are warranted.

Development and Validation of the Short Healthy Eating Index Survey with a College Population to Assess Dietary Quality and Intake.

Because diet quality (DQ) is associated with risk of chronic disease and is a common construct assessed in health-related research, validated tools to assess DQ are needed that have low respondent and researcher burden. Thus, content experts develop the Short Healthy Eating Index (sHEI) tool and an associated scoring system. The sHEI scoring system was then refined using a classification and regression tree (CRT) algorithm methodology with an iterative feedback process with expert review and input. The sHEI scoring system was then validated using a concurrent criterion validation process that included the sHEI DQ scores (calculated from responses from 50 participants) being compared to the participants’ Healthy Eating Index scores derived from 24 h recalls. The total HEI score from the CRT algorithm highly correlated with the 24 h recall HEI score (0.79). For individual food group items, the correlation between the CRT algorithm scoring and the 24 h recall data scoring ranged from 0.44 for refined grains to 0.64 for whole fruits. The sHEI appears to be a valid tool for estimating overall dietary quality and individual items (with correlations > 0.49) for fruits, vegetables, dairy, added sugar, sugar from sugar-sweetened beverages, and calcium.

Diet quality in an ethnically diverse sample of children and adolescents with autism spectrum disorder compared with nationally representative data

BackgroundChildren with developmental disabilities are at an increased risk of unhealthy eating habits, which may contribute to compromised growth and development. Children with autism spectrum disorder (ASD) exhibit unique risk factors for unhealthy dietary patterns, including sensory issues and cognitive rigidity at mealtimes. ObjectiveThis cross-sectional study examined diet quality in a sample of children with ASD in Florida compared to nationally representative National Health and Nutrition Examination Survey (NHANES) 2009–2014/2013-2014 data using the Healthy Eating Index-2015 (HEI-2015). MethodsA 24-h food record was completed by 41 parents of children with ASD aged 2–17 years, and food and beverage items consumed by each child were reported per standardized 24-h recall protocol. Two models were used to compare mean total and component HEI-2015 scores to NHANES means: (1) comparing means for our full sample to published NHANES means for children aged 2–18 years and (2) a matched model with subjects matched 1:1 by age, gender, race/ethnicity, and parent education level. ResultsHEI component scores were significantly lower (poorer) in children with ASD for whole fruit, total vegetables, dairy, total protein foods, and seafood and plant protein. Whole grains, fatty acids, added sugars, and refined grains scores were higher (better) in our sample. However, total HEI scores and HEI scores for all 13 components were similar among children with ASD and the matched cases from the NHANES data. ConclusionsThere are potential discrepancies in diet quality between children with ASD and general population. Further research with a larger sample size, reporting both total and component HEI scores, is needed.

Examining the Relationship Between Intuitive Eating and Diet Quality Among College Students

Abstract Objectives College students in the US tend to have low diet quality due to a confluence of interpersonal, intrapersonal, and environmental factors. Restrictive dieting is commonly used for weight management but often ineffective in the long term and can lead to dangerous eating behaviors. Intuitive eating is an adaptive form of eating that has gained interest as an alternative to restrictive dieting due to its successful use in eating disorder recovery and correlation with decreased body mass index in healthy populations. The objective of the current study was to identify if higher intuitive eating, as measured by the intuitive eating scale (IES-2), correlated with increased diet quality, as measured by the Healthy Eating Index 2015 (HEI-2015) in a college sample. Methods In this cross-sectional study, participants completed an online survey containing the IES-2 questionnaire which provides a total score for intuitive eating and four subscale scores representing the main behaviors of intuitive eating. The dietary intake of participants was assessed with up to three 24-hour diet recalls, which were completed over the phone. A total of 55 participants (40 females and 15 males) completed the survey and a minimum of two 24-hour diet recalls, which were used to calculate the HEI-2015. Independent sample t-test and Pearson's correlation were used for statistical analysis. Results The total IES-2 scores were higher for males than females (82.9 ± 8.1 vs. 76.3 ± 11.2, P = 0.04). The average total HEI-2015 score was 59.5 ± 15.1 and did not differ between gender (P = 0.93). The total IES-2 score was not significantly correlated with the total HEI scores (r = −0.218, P = 0.11), and one subscale of the IES-2, the Unconditional Permission to Eat subscale, was negatively correlated with the total HEI score (r = −0.418, P &amp;lt; 0.01) and BMI (r = −0.335, P &amp;lt; 0.05). Conclusions The results of the study do not support that intuitive eating is correlated with diet quality, furthermore, increased scores of the Unconditional Permission to Eat subscale of intuitive eating was correlated with a lower diet quality suggesting that intuitive eating and diet quality may be separate constructs that should be addressed individually. Funding Sources None.

Breakfast Consumption Is Associated with Increased HEI-2015 Component Scores and Consumption of Unprocessed Foods

Abstract Objectives Studies have evaluated the benefits of breakfast consumption (BC) on overall dietary quality. However, further research is warranted to determine which components of the diet, including the amount of processed foods, attribute to those findings. This study examined the associations of BC, Health Eating Index-2015 (HEI-2015) component scores, and consumption of processed foods. Methods This analysis used baseline data from TX Sprouts, a large school-based gardening, nutrition, and cooking randomized control trial implemented in 16 elementary schools in Austin, TX, targeting 3rd-5th grade students. Each child completed two 24-hour dietary recalls, from which HEI-2015 scores and NOVA Food Classification System scores were calculated, classifying each food item as unprocessed, processed, or ultra-processed. Breakfast was defined as a meal consumed before 10am and accounting for ≥15% of daily energy. BC groups (BCG) included: breakfast skippers (BS; no breakfast both days), intermittent breakfast consumers (IBC; breakfast one day), and regular breakfast consumers (RBC; breakfast both days). Analysis of covariance was used to examine associations between BCG, HEI-2015 scores, and NOVA scores, controlling for age, sex, race/ethnicity, free/reduced lunch (FRL) status, daily energy, and day of the week. Results The study included 668 children (mean age 9 y; 54% female, 59% Hispanic, 67% FRL) with a BCG composition of 17% BS, 37% IBC, and 46% RBC. RBC had higher total HEI scores compared to both IBC and BS (P = 0.03 and P = 0.02). Specifically, RBC compared to IBC and BS had higher total fruit (P &amp;lt; 0.001 and P &amp;lt; 0.001) and dairy (P &amp;lt; 0.04 and P &amp;lt; 0.001) intake and lower saturated fat intake (P &amp;lt; 0.02 and P &amp;lt; 0.04). RBC consumed a higher percentage of unprocessed foods than IBC and BS (P &amp;lt; 0.02 and P &amp;lt; 0.04). Conclusions Regular BC was associated with higher dietary quality and intake of unprocessed foods; however, studies examining interventional effects of regular BC on processed food intake and diet quality are needed. Funding Sources Supported by the National Heart, Lung, and Blood Institute.

Comparison of diet quality between celiac patients and non-celiac people in East Azerbaijan-Iran

BackgroundConsidering the lifelong dietary restriction in celiac patients, it is important to assess the diet quality in these patients. Hence, this study aimed to investigate the diet quality in adult celiac patients and compare it with that of the non-celiac people.MethodsIn the present cross-sectional study, 130 celiac patients were selected from the celiac disease (CD) registry database of East Azerbaijan province, Iran. Non-celiac people (n = 464) was selected from the major lifestyle promotion project conducted in the East Azerbaijan district. The dietary intake data was obtained by an 80-item semi-quantitative food frequency questionnaire. Diet quality was assessed using the healthy eating index-2015 (HEI-2015).ResultsThe mean total HEI score was significantly higher in the celiac group compared with the non-celiac people (P < 0.001) and 68.5% of non-celiac people and 17.4% of celiac patients had poor diet quality. After adjusting for confounding factors, the mean score of total HEI in adherents to gluten-free diet (GFD) was significantly higher compared with non-adherents (P = 0.007).ConclusionsAlthough the mean total HEI score was higher in celiac patients compared with the non-celiac people, about 17.5% of patients had poor diet quality and the scores of whole grains and dairy products group were very low in our population. Accordingly, it seems that educational programs should be held for the celiac patients and non-celiac people to increase their nutritional literacy and enable them to select healthy gluten-free alternatives.

Diet Quality in Early Care and Education Centers: A Comparison of Menu, Served, and Consumed Lunch Measures

ObjectiveAssess if diet quality (DQ) differs among 3 lunch measures commonly used to assess DQ in early care and education (ECE) centers, which include what is listed on the menu, served, and consumed. DesignThis quantitative observational study measured DQ of food and beverage items listed on the menu, what children were served, and what they consumed during one lunch meal. SettingAlabama ECE centers. ParticipantsECE centers (n = 28) with attendance of ≥10 children ages 3 to 5 years and provided lunch daily. Main Outcome Measure(s)DQ measured through Healthy Eating Index–2015 (HEI) scores, which were calculated for the menu, served, and consumed lunch measures. AnalysisMenu, served, and consumed HEI scores compared using either Kruskal-Wallis or ANOVA. Dunn Bonferroni or Duncan post hoc tests identified which group differed. ResultsTotal HEI scores were significantly higher among menus, compared with served and consumed (P = .001). Served and consumed total HEI scores were not different. Conclusions and ImplicationsMenu DQ differed from both the served and consumed lunch measures. These findings support the need for nutrition education on the importance of menu adherence in ECE centers.

Family Eating Behavior and Child Eating Patterns Differences Between Children With and Without Siblings

To examine the differences in family eating behaviors and child eating patterns in children with siblings (nonsingletons) and without siblings (singletons). Cross-sectional analysis of mother-child dyads of 5-7-year-old children, (nonsingletons with a 2-to-4-year-old sibling) was conducted. Anthropometrics were measured. Mothers completed questionnaires and a child dietary log. Healthy Eating Index 2010 (HEI) score was calculated. Linear regression models adjusting for child age, child sex, maternal body mass index, and hours-away-from-home were conducted, with a revised P < .021. Sixty-eight mother-child dyads (27 singletons, 41 nonsingletons) participated. Singletons exhibited less healthy family eating behaviors (β = -4.98, SE = 1.88, P = .003), and lower total HEI scores than did nonsingletons (average: β = -8.91, SE =2.40, P = .001). On average, singletons had lower scores in 3 HEI components compared with nonsingletons (P < .021 for all). In this sample, singleton children exhibited less healthy eating behaviors. Additional investigation into parent-level differences is warranted.

Interrelationships Between Household Chaos, Children’s ADHD Tendencies, and Diet Quality (P11-113-19)

ObjectivesHousehold environment, diet, and inattention/hyperactivity tendencies have been shown to influence children’s physical and cognitive development. However, these factors are often studied independently. Therefore, there is little knowledge on the interrelationships between household environment, diet, and children’s ADHD tendencies. This study aimed to investigate relationships between ADHD tendencies, household chaos, and diet quality among 4 and 5-year olds. MethodsFour and five-year-old children (n = 55, 22 females) were recruited from the East-Central Illinois area. Participants’ parents completed two surveys and a seven-day food record. The ADHD Rating Scale-IV Home Version questionnaire and the Confusion, Hubbub, and Order Scale (CHAOS) questionnaire were used to assess inattention/hyperactivity tendencies and household chaos, respectively. Diet records were analyzed using the Nutrition Data Systems for Research (NDSR) 2015 to estimate Healthy Eating Index 2015 scores (HEI-2015). All measures were self-reported by the child’s caregiver. ResultsUsing Spearman’s bivariate correlations, total HEI score was negatively and significantly related to hyperactivity tendencies (r = –.24, P = .04) and total raw scores (r = –.24, P = .04). CHAOS was positively and significantly related to inattention tendencies (r = .24, P = .04), hyperactivity tendencies (r = .31, P = .01), and total raw scores (r = .31, P = .01). CHAOS indicated no significant relationship with total HEI score. Using partial correlations while controlling for age, sex, income, and gender, household chaos was positively and significantly related to hyperactivity tendencies (r = .28, P = .03) and total raw scores (r = .28 P = .03). Additionally, total HEI score was no longer significantly related to inattention or hyperactivity tendencies. ConclusionsThese findings suggest that children’s tendencies of hyperactivity and inattention are associated with commotion in the household environment. Additional research is necessary to determine the potential of dietary factors in this relationship. Funding SourcesThis work was supported by the National Dairy Council and the Department of Kinesiology and Community Health.

Gender Differences in Nutrient Intake, Diet Quality, and Mealtime Behaviors Among Children with Autism Spectrum Disorder (P11-105-19)

ObjectivesAs ASD is more frequently diagnosed in males than females, research findings in ASD behaviors such as diet can be biased towards male-dominant features. Gender differences needed to be further explored to develop an intervention based on gender-specific needs, if there are any. This preliminary analysis aims to investigate gender differences in nutrient intake, diet quality, and mealtime behaviors among children with ASD. MethodsA cross-sectional analysis of dietary intake and mealtime behavior was conducted in 39 children (26 males, 13 females) aged 2 to 17 with ASD. A parent of each child completed a 24-hour recall phone call and a mealtime behavior survey. Energy and nutrient intake data were analyzed with NDSR Pilot-Pack software. Diet quality was assessed using the Healthy Eating Index-2015 (HEI-2015). Descriptive statistics were generated in SPSS for nutrient intake and mealtime behaviors and in SAS for diet quality. Independent t-tests were performed to examine gender differences for nutrient intake and diet quality data; chi-square tests were performed for mealtime behavior outcomes. ResultsThere were no gender differences in energy or nutrient intake. Males exhibited significantly higher HEI component scores for whole grains (P = 0.029), fatty acids (P = 0.039), and saturated fats (P = 0.049). Total HEI score was higher in males, but the difference was not statistically significant. There was no difference in total mealtime behavior score by gender. However, males showed greater difficulty eating at home (P = 0.028) and preference for certain food temperatures (P = 0.008), while females had greater parent-reported binge eating behavior (P = 0.048). ConclusionsBoys in this study had higher diet quality in some categories and exhibited greater prevalence of certain problematic mealtime behaviors. Further research is needed to examine gender-specific needs in children with ASD that should be considered when implementing nutrition interventions. Funding SourcesThis work was supported by the University of South Florida Research and Innovation Internal Awards Program under Grant No. 0128126.

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

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

Sociodemographic and Psychosocial Factors Associated with Diet Quality Among Native American Adults: Baseline Data from the OPREVENT2 Study (P04-007-19)

ObjectivesTo identify sociodemographic and psychosocial factors associated with diet quality among Native American adults. MethodsCross-sectional data from the baseline assessment of a cluster-randomized obesity prevention trial (OPREVENT2) of 580 Native American adults from six tribal communities in the Midwest and Southwest. The Healthy Eating Index (HEI-2015) was used to define diet quality, calculated from a semi-quantitative food frequency questionnaire (modified Block FFQ). Sociodemographic (age, sex, education, food assistance) and psychosocial factors (nutrition knowledge, self-efficacy, health eating intentions) were assessed via questionnaires administered by trained data collectors. One-way ANOVA, linear regression models, and two-tailed t-tests assessed compared mean total HEI scores among sociodemographic categories. Bivariate linear regression models assessed the relation between psychosocial factors and diet quality. ResultsOverall diet quality was low, with a mean HEI-2015 score of 49 (SD + 8), which is 10 points lower than in the general U.S. population. The HEI scores of smokers were an average of 3 points lower than those of non-smokers (P < 0.001), and females had better diet quality (2.2 points higher) than males (P < 0.01). Those receiving commodity food assistance had mean total HEI scores 2.7 points lower than those who did not receive commodities (P < 0.005), and no other source of food assistance was associated with HEI. Self-efficacy (b = 0.66; P < 0.001) and healthy eating intentions (b = 0.72; P < 0.001) were positively associated with mean HEI. ConclusionsWhile nutrition knowledge has been a key focus of many dietary interventions, it does not appear to be associated with better diet quality among Native Americans. This finding suggests that it is necessary to focus interventions on factors other than nutrition knowledge that may impact food choice. Because higher self-efficacy and healthy eating intentions were associated with better diet quality, a social-cognitive approach to dietary interventions may be more effective in Native American populations. Funding SourcesOPREVENT2 is funded by a grant from the National Heart, Lung, and Blood Institute.