Usual Food Intake Research Articles

Methodology for developing and validating Bangladesh healthy eating index: A study protocol.

One of the widely used methods for evaluating the overall quality of a diet is the Healthy Eating Index. In the present study protocol, we lay out the methodological approach to the development and validation of a healthy eating index specific for the Bangladeshi population (hereinafter referred to as Bangladesh Healthy Eating Index (BD-HEI)). Bangladesh Healthy Eating Index will be developed based on the Food-based dietary guidelines (FBDG) of Bangladesh. Using a scoring system that aligns with the eleven food groups outlined in the FBDG, the index will consist of eleven eating components. A cross-sectional community nutrition survey will be carried out among 1080 reproductive-aged women. Through this survey, quantitative dietary data will be collected following multiple pass 24h dietary recall method. Repeated 24-hour dietary data (of two consecutive days) will be collected from one-third of the respondents. Evaluating usual food and nutrient intake as well as the probability of nutrient intake adequacy, the study will examine the validity of the BD-HEI. Following a suitable statistical procedure, the reliability and construct validity of BD-HEI will be evaluated. Country-specific HEI can be used to assess the dietary quality of the people of that country. The findings from this research can inform policy decisions and strategies to promote healthier eating habits and combat the rising burden of diet-related diseases in the country.

Eating Egg-Rich Diets and Modeling the Addition of One Daily Egg Reduced Risk of Nutrient Inadequacy among United States Adolescents with and without Food Insecurity

BackgroundAdolescents have the poorest dietary intake throughout their lifespan. Food insecurity worsens these nutritional risks. Eggs are a nutrient-dense strategy to increase nutrient quality. Objectives1) compare usual nutrient intakes, Dietary Reference Intake and protein compliance with recommendations and scores of micronutrient quality; and 2) analyze how adding 1 egg affects adolescents’ nutrient profiles, by food security status and egg-rich diets. MethodsDietary data of United States adolescents in the 2007–2018 National Health and Nutrition Examination Survey were analyzed (14–17 y; n = 3633). Egg-rich diet levels were categorized as 1) no eggs, 2) eggs as ingredients in dishes, or 3) primarily egg dishes. Food security status was classified using the United States Household Food Security Survey Module. The National Cancer Institute method was used to estimate usual nutrient intake and nutrient exposure scores [i.e., Food Nutrient Index (FNI) and Total Nutrient Index (TNI)]. Nutrient amounts from 1 medium egg were modeled on existing intakes. Pairwise t-tests determined significant differences. ResultsOver 60% of adolescents risked inadequate intake of calcium, choline, magnesium, vitamin D, and vitamin E regardless of food security status. Food-secure adolescents consuming primarily egg dishes had higher mean usual intakes of lutein + zeaxanthin (1544.1 μg), choline (408.4 mg), vitamin B2 (2.3 mg), selenium (128.6 μg), vitamin D (6 μg), docosahexaenoic acid (70 mg), and protein (89.1 g) than other groups (P < 0.0002). Those who were food secure and consuming eggs as ingredients in dishes demonstrated higher nutrient adequacy for magnesium (scored ∼66 out of 100), potassium (scored 81), and total scores (scored 72 and 69, respectively) for the TNI and FNI; and folate only (scored 92) for the TNI, than those who were food insecure and not consuming eggs (P < 0.0002). Adding 1 egg increased choline and vitamin D usual intakes for some groups and nutrient index scores for all groups (P < 0.0005). ConclusionsAdolescents are at substantial nutritional risk that was exacerbated by food insecurity and less egg consumption.

The ORIGINS Project: A Cross-Sectional Analysis of the Nutrition Profile of Pregnant Women in a Longitudinal Birth Cohort.

Pregnancy is an opportunistic time for dietary intake to influence future disease susceptibility in offspring later in life. The ORIGINS Project was established to identify the factors that contribute to 'a healthy start to life' through a focus supporting childhood health and preventing disease (including non-communicable diseases). We aim to describe the dietary intakes of pregnant women in this cohort and to compare these to the Nutrient Reference Values (NRVs) and Australian Recommended Food Score (ARFS). The usual food and nutrient intakes of women were collected using the Australian Eating Survey (AES), a semi-quantitative food frequency questionnaire (FFQ). A total of 374 women completed the AES FFQ at both 20 weeks and 36 weeks of gestation between December 2016 and January 2023. Macronutrient, micronutrient, and food group intake were explored using descriptive statistics. Overall, it was found that the energy contribution from carbohydrates was low, while that from fat and saturated fat was high; participants were not meeting the recommendations for several key micronutrients (calcium, iron, iodine, and folate); and they had low diet quality scores for all food groups. These findings suggest that despite the ongoing promotion of healthy eating during pregnancy, further exploration into why dietary guidelines during pregnancy are not being adhered to is warranted.

Dietary Intake of Adolescents and Alignment with Recommendations for Healthy and Sustainable Diets: Results of the SI.Menu Study.

The SI.Menu study offers the latest data on the dietary intake of Slovenian adolescents aged 10 to 17. The purpose of this study is to comprehensively assess their dietary intake (energy and nutrients) and compare their food intakes with dietary recommendations for healthy and sustainable diets. The cross-sectional epidemiological dietary study SI.Menu (March 2017-April 2018) was conducted on a representative sample of Slovenian adolescents aged 10 to 17 years (n = 468) (230 males and 238 females). Data on dietary intake were gathered through two non-consecutive 24 h recalls, in line with the European Food Safety Authority (EFSA) EU Menu methodology. The repeated 24 h Dietary Recall (HDR) and Food Propensity Questionnaire (FPQ) data were combined to determine the usual intakes of nutrients and food groups, using the Multiple Source Method (MSM) program. Adolescents' diets significantly deviate from dietary recommendations, lacking vegetables, milk and dairy products, nuts and seeds, legumes, and water, while containing excessive meat (especially red meat) and high-sugar foods. This results in insufficient intake of dietary fibre, and nutrients such as vitamin D, folate, and calcium. The dietary intake of Slovenian adolescents does not meet healthy and sustainable diet recommendations. This study provides an important insight into the dietary habits of Slovenian adolescents that could be useful for future public health strategies.

Bioavailability of Australian pre-schooler iron intakes at specific eating occasions is low

PurposePoor bioavailability may contribute to iron deficiency among children in high-resource countries, but iron bioavailability of Australian pre-schooler diets is unknown. This study aimed to estimate the bioavailability of Australian pre-schooler iron intakes across the day and by eating occasions to identify optimal timing for intervention, by using five previously developed algorithms, and to estimate the proportion of children with intakes of absorbable iron below the requirements.MethodsDietary data of children aged 2 to < 6 y (n = 812) from the 2011–12 National Nutrition and Physical Activity Survey were collected via two 24-h recalls. Usual food and nutrient intakes were estimated via Multiple Source Method. Phytate, polyphenol, and heme iron values were sourced from international databases or the literature. Five previously published algorithms were applied to observed dietary data to estimate iron bioavailability and calculate the prevalence of children with intakes of absorbable iron below requirements.ResultsPre-schooler daily iron bioavailability was low (2.7–10.5%) and corresponded to intakes of 0.18–0.75 mg/d of absorbable iron. The proportion of children with inadequate intakes of absorbable iron ranged between 32 and 98%. For all eating occasions, dinner offered iron of the greatest bioavailability (4.2–16.4%), while iron consumed at breakfast was of the lowest bioavailability (1.2–5.6%).ConclusionFuture strategies are required to improve intakes of bioavailable iron for pre-schoolers to prevent the risk of deficiency. These strategies could include the encouragement of concomitant consumption of enhancers of iron absorption with iron-rich sources, particularly at breakfast.

Computing levels of nutrient inadequacy from household consumption and expenditure surveys: A case study

This paper presents an approach to estimate the between-subject variability in nutrient intake (through the coefficient of variation [CV]) and a method to estimate the prevalence of nutrient inadequacy (PoNI) (for eight micronutrients) using household consumption and expenditure survey (HCES) data. Prevalence values are compared to individual-level estimates derived using the National-Cancer-Institute method. Data come from the 2015 Bangladesh Integrated-Household-Survey, which conducted a household-level 7-day recall (7DR) and two rounds of individual-level 24-hour recall (24HR), filled by one respondent on behalf of all members, for the same rural households. The PoNI values based on 7DR are lower than those calculated from 24HR data, due to the larger average intake estimates from 7DR data. After controlling for differences in average intake estimates and adjusting household-level data for random measurement errors, the PoNI values from 7DR and 24HR data are remarkably close. This highlights the potential use of HCES data (conducted according to international agreed standards) for estimating the level of between-subject variability in usual nutrient intake in a population. The CVs from HCES could be used to compute the PoNI using average intake estimates from individual-level data; and the inadequacy of global nutrient supply using Supply and Utilization Accounts data.

Trends in Reported Calcium and Magnesium Intake from Diet and Supplements by Demographic Factors: National Health and Nutrition Examination Survey, 2003-2018

BackgroundCalcium and magnesium are important micronutrients necessary for normal body functioning. ObjectiveThe objective of the study was to approximate usual nutrient intakes and estimate proportion of adults meeting the Estimated Average Requirement (EAR) of calcium and magnesium from diet, and diet plus supplements (total intake). Trends in the proportion of adults meeting the EAR were estimated by sex, age, and race and ethnicity. DesignThe study utilized data from the National Health and Nutrition Examination Survey, a cross-sectional survey of a nationally representative sample of the US civilian and noninstitutionalized population. Participants and settingThe continuous National Health and Nutrition Examination Survey survey data from 2003-2004 through 2017-2018 for dietary intake, and 2007-2008 through 2017-2018 for total intake were analyzed. The study sample included men and women (not lactating/pregnant) ages 19 years and older with 2 reliable 24-hour dietary recalls and energy intake >500 to <6,000 kcal/day (N = 35 037). Main outcome measuresMean daily intake and trends of proportion of adults meeting/exceeding the EAR for calcium and magnesium were estimated. Statistical analyses performedThe National Cancer Institute’s method was used to calculate daily intakes for calcium and magnesium by demographic subgroups. SAS SURVEYMEAN and SURVEYFREQ procedures were used to estimate means ± SE for continuous variables and frequencies and percentages for categorical variables, and 2-sample t test for P values. Trends were estimated with National Cancer Institute’s Joinpoint trend analysis program. ResultsMean daily dietary calcium intake and proportions of adults meeting the EAR from both diet and supplements was lowest among women (859 mg [61.9%]), adults ages 71 years and older (865 mg [60.3%]) and non-Hispanic Black individuals (782 mg [48.6%]) compared with men, younger age groups, and other races and ethnicities. Magnesium intake reported from diet was lowest in adults ages 71 years and older (276 mg), whereas total magnesium intake and proportion of meeting the EAR from both diet and supplements was lowest in women (302 mg) and men (52%), respectively, adults ages 19 to 30 years (305 mg [48.5%]), and non-Hispanic Black individuals (274 mg [35.5%]). The trends in the proportion of women and non-Hispanic White adults meeting the EAR from total calcium intake decreased significantly (P < .05) by 2.9% and 2.0%, respectively. ConclusionsWomen and adults ages 71 years and older had the lowest reported mean daily dietary calcium intake and proportion meeting the EAR for calcium from diet and supplements. Men and adults ages 19 to 30 years had the lowest proportion meeting the EAR for magnesium from diet and supplements with adults ages 19 to 30 years also having the lowest reported total magnesium intake from diet and supplements. Non-Hispanic Black individuals had the lowest proportion of meeting the EARs for calcium and magnesium from reported total intake. The trends in the proportion of women and non-Hispanic White individuals meeting the EARs for calcium through total intake decreased over time and remained stable in other subpopulations and for magnesium.

Nutrient Intake of Stunted Filipino School-age Children: Results from the 2018-2019 Expanded National Nutrition Survey

Over the last few decades, stunting has decreased worldwide, although the prevalence remains high in underdeveloped and developing countries. A child's healthy growth is a key measure of their overall well-being, and it is directly linked to his or her nutrient intake and resistance to illnesses. This study determined the nutrient intake of stunted Filipino school-age children utilizing secondary data from the 2018–2019 Expanded National Nutrition Survey conducted by the Department of Science and Technology–Food and Nutrition Research Institute. A total of 26,332 5–10-yr-old school-age children were included in the study. The data utilized were nutritional status, socio-economic status and demographic profile, and nutrient intake of school- age children. Stata version 16 was used for all statistical tests, whereas the PC-SIDE software was used for the estimation of the mean usual intake of energy and nutrients. Among stunted school-age children, mean energy, protein, iron, thiamin, riboflavin, niacin, and fat intake were significantly higher among urban households than their counterparts. The proportion of stunted school-age children meeting the recommended intake for energy (9.3%), iron (15%), vitamin A (24.8%), thiamin (27%), and riboflavin (29.8%) were significantly higher in the urban as compared to rural areas. The energy, protein, vitamin A, vitamin C, thiamin, niacin, riboflavin, iron, and calcium intake of stunted school-age children were significantly lower as compared to the non-stunted. The data show that despite the decreasing prevalence of undernutrition in the country, the problem of childhood stunting still persists. Furthermore, non-stunted children only had slightly better nutrient intakes. These urges work on the major determinants of stunting in the Philippines and the implementation of appropriate interventions such as supplementary feeding programs, food production, and nutrition education.

Do routine questions provide reliable information about the patient’s diet: the results of the survey of parents of children with brain tumors being on the 2nd rehabilitation period

Introduction. The course of central nervous system tumors in children and their therapy are associated with nutritional disorders that persist after the end of antineoplastic treatment. It is important to determine nutritional problems, which is usually carried out in the form of a survey by a physician. He also needs to be aware and understand the degree of fulfillment of appointments by patient at home.Aim. To study the problems of organizing nutritional support for children with tumors of the central nervous system after the end of antitumor treatment.Materials and methods. A cross-sectional study was conducted, which included a survey, involving the parents of 71 patients with central nervous system tumors, aged 10 to 18 years, undergoing routine rehabilitation at the Russian Field Medical and Rehabilitation Scientific center. The survey included questions that a nutritionist usually asks during a consultation, with answer options, as well as a description of the diet and usual food intake. Anthropometry data (z-score of height-on-age, BMI) are included.Results. 45% of the children had deviations in BMI. The answers to the routine questions “What is the child’s appetite” and “Are there (any) problems with nutrition” were the most uninformative, did not coincide with the actual composition of the diet and food intake. More accurately, the parents answered the questions “Are there (any) problems with diet/regimen organization” and “... associated with eating”. 21 children were prescribed diets (gentle and “low-carb”), but only 6 followed these diets. 58% noted periodic “physical exhaustion”, only 7% are engaged in physical therapy at home. Only 2 children received nutritional support at home. An analysis of the composition of the diet and diet revealed significant problems in 61% of children.Conclusion. In a routine medical survey, simple questions about appetite and “are there any problems with nutrition” are not enough. Simple anthropometry is not enough. The survey has shown its effectiveness, but an analysis of the questionnaire is needed. Not all patients can follow dietary recommendations, it is necessary to take into account the motivation and understanding of both parents and children.

Ultra-processed food consumption and increased risk of metabolic syndrome in Korean adults: A cross-sectional analysis of the KNHANES 2016–2020

ObjectiveThis study aimed to investigate the association between ultra-processed food (UPF) intake and the risk for metabolic syndrome (MetS) in Korean adults. MethodsThe study consisted of 22 688 Korean adults ≥19 y of age from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016–2020. The NOVA classification categorizes foods according to the nature, extent, and purpose of industrial processing. MetS was defined based on the National Cholesterol Education Program Adult Treatment Panel III criteria and a modified waist circumference cut-off for Korean adults. We estimated the usual percent total food intake from UPFs. We used multivariate logistic regression to assess the association between UPFs and risk for MetS, adjusted for age, sex, education level, income level, smoking status, alcohol drinking, physical activity, and total energy intake. We further analyzed the association of UPFs with each component of MetS. ResultsThe median usual percent total food intake from UPFs was 22%, and the midpoint of intake ranged from 3% (quartile 1) to 48% (quartile 4). The group with the highest UPF consumption had a 19% higher risk for developing MetS than the lowest quartile of UPF consumption (odds ratio [OR],1.19; 95% confidence interval [CI], 1.06–1.33; Ptrend = 0.006). In analysis of the relationship between UPF intake and MetS components, a higher UPF was associated with an increased risk for hypertension (OR, 1.13; 95% CI, 1.01–1.26; Ptrend = 0.037) and abdominal obesity (OR, 1.19; 95% CI, 1.07–1.33; Ptrend = 0.001), but had no significant association with other components (hyperglycemia, hypertriacylglycerolmia, and low high-density lipoprotein cholesterol, all P > 0.05). ConclusionHigher UPF contribution to total daily food intake is associated with an increased risk for MetS, particularly with a higher risk for hypertension and abdominal obesity.

Urinary Biomarkers in Screening for the Usual Intake of Fruit and Vegetables, and Sodium, Potassium, and the Sodium-to-Potassium Ratio: Required Number and Accuracy of Measurements.

Because of within-individual variation, surveys to estimate an individual's usual food intake must be conducted over many days, in general. Here, using non-invasive biomarkers, we examined the number of measurements required to screen for the usual intake of fruit and vegetables, in addition to sodium, potassium, and the sodium-to-potassium (Na/K) ratio. Participants were 202 subjects aged 40-74 years from five areas of Japan who completed weighed food records (WFR) and five 24-hour urinary collections (24-h UCs) between 2012 and 2013. The number of 24-h UCs required to screen for intake that deviated from guidelines estimated by the WFR and their accuracies were assessed by the area under the curve (AUC) in a receiver-operating characteristics (ROC) analysis. The single urinary excretion of sodium, potassium, and the Na/K ratio showed moderate performance (AUC value: >0.7) in discriminating deviations from their criteria by respective intake based on the WFR. Urinary potassium excretion also showed moderate performance (AUC value: >0.7) in estimating the intake of vegetables but could not be used to estimate fruit intake even after five collections. The non-invasive measurement of biomarkers in a single 24-h UC showed moderate performance in screening the usual intake of vegetables, as measured based on the 12-day WFR, as well as of sodium, potassium, and the Na/K ratio.

The High-Dietary Insulin Load Score Is Associated With Elevated Level of Fasting Blood Sugar in Iranian Adult Men: Results From Fasa PERSIAN Cohort Study.

Aim: The potential of different foods to induce postprandial hyperinsulinemia may be involved in the development of metabolic syndrome (MetS). We aimed to evaluate the association between dietary insulin indices and MetS in a large population of adults in Iran. Methods: A total of 6356 adults aged 35-70 years were included in the present cross-sectional study. A validated block-format 125-item semiquantitative food frequency questionnaire (FFQ) was used to obtain usual food intakes, and MetS was defined according to the International Diabetes Federation (IDF) and American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHLBI) criteria. Results: MetS was prevalent in 13.8% of participants. Mean age of the study participants was 46.58 ± 8.82 years, and mean body mass index (BMI) was 25.02 ± 4.60 kg/m2. Mean dietary insulin index (DII) and dietary insulin load (DIL) were 63.15 ± 7.57 and 168.253 ± 52.09, respectively. In the crude model, men in the highest DIL quartile were more likely to have hyperglycemia than those in the lowest quartile (OR: 1.75, 95% CI: 1.12-2.73, p trend = 0.04). This association remained significant and was even stronger after adjusting for potential confounders in model I (OR: 3.64, 95% CI: 1.57-8.47, p trend = 0.005) and further adjustment for BMI in model II (OR: 3.61, 95% CI: 1.55-8.44, p trend = 0.006). Conclusions: In healthy men, adherence to a high-DIL diet may be associated with a greater likelihood of having hyperglycemia. No statistically significant association was observed between insulin indices and the odds of having MetS.

Associations between attitudes towards and reported intakes of sugars, low/no-calorie sweeteners, and sweet-tasting foods in a UK sample

Public health initiatives are currently aiming to lower free sugar intakes for health benefits, but attitudes towards sugars, their alternatives such as low/no-calorie sweeteners (LNCS), and towards sweet-tasting foods may be hampering efforts. This work investigated associations between attitudes towards and the reported intakes of sugars, LNCS and sweet-tasting foods, and identified latent attitude profiles in subpopulations of adults in the United Kingdom. A total of 581 adults completed a questionnaire assessing their usual intake of sugars, LNCS and sweet-tasting foods, attitudes towards these foods and various demographic characteristics. Six principal components explained 39.1% of the variance in the attitude responses, named: ‘Personal Impact’, ‘Personal Management’, ‘Apathy’, ‘Negativity’, ‘Perceived Understanding’ and ‘Perceived Nonautonomy’. Personal Impact was negatively associated with reported consumption of sugar-food and sweet-tasting food groups more frequently (smallest β = −0.24, p < .01). Personal Management was positively associated with reporting adding sugar and consuming sugar-food and sweet-tasting food groups more frequently (smallest β = 0.14, p < .01). Three latent classes of participants with distinct patterns of attitudes were identified, labelled: ‘Feeling Ill-equipped’ (n = 52), ‘Actively Engaged’ (n = 162) or ‘Unopinionated’ (n = 367). Individuals who were classed as Actively Engaged reported adding LNCS more frequently than those classed as Feeling Ill-equipped (t(212) = -2.14, p<.01), who reported consuming sweet-tasting food groups more frequently than those classed as Unopinionated (t(417) = 2.65, p < .01). These findings suggest the need for personalised approaches within public health initiatives, to reduce free sugar intakes.

Usual Nutrient Intake Distribution and Prevalence of Nutrient Intake Inadequacy among Japanese Children and Adults: A Nationwide Study Based on 8-Day Dietary Records.

In this cross-sectional study, we evaluated nutrient intake adequacy in 4450 Japanese people aged 1-79 years. Dietary data was collected through non-consecutive 8-day weighed dietary records. Usual nutrient intakes from foods and beverages were estimated using the Multiple Source Method. Participant proportions with intakes below and above the Japanese Dietary Reference Intakes (2020) were calculated. Usual intakes of most nutrients were below the Estimated Average Requirement; calcium showed a high percentage of inadequacy across all sex and age groups (29-88%), and iron showed a high inadequacy among females aged 12-64 years (79-95%). The percentages of energy from protein and carbohydrates, dietary fibre, and potassium were typically below the lower limit of the Tentative Dietary Goal for Preventing Lifestyle-related Diseases (DG). Furthermore, over 20% of the participants exceeded the upper limit of the DG for the percentages of energy from total and saturated fats, and over 88% exceeded the upper limit of the DG for sodium. Japanese children and adults could improve their nutrient intake by increasing calcium, iron, dietary fibre, and potassium and reducing total and saturated fats and sodium. These findings can inform policies and interventions to improve nutrient intake in Japan.

Beef Intake Is Associated with Higher Nutrient Intake and Nutrient Adequacy in U.S. Adolescents, NHANES 2001-2018.

Nutrient adequacy among adolescents is of concern due to higher nutrient requirements for their developing bodies as well as the gap between the current nutrient intake and the recommendations. The objective of this study was to determine beef intake and assess the relationship between beef consumption and nutrient intake and nutrient adequacy in male and female adolescents, 14-18 years of age. Dietary recalls collected during the What We Eat in America (WWEIA) portion of the National Health and Nutrition Examination Survey (NHANES) cycles 2001-2018 were utilized to determine beef intake. Usual nutrient intakes were determined with the National Cancer Institute method in conjunction with day 1 and day 2 total nutrient files. Nutrient adequacy was assessed by calculating the percentage of the population below the estimated average requirement (EAR) or above the adequate intake (AI). The average beef intake of male and female adolescent beef consumers was 57.9 ± 2.4 and 46.8 ± 2.2 g with a 90th percentile of 82.3 ± 4.3 and 67.8 ± 3.5 g, respectively. Compared to non-consumers, beef consumers had a 10% or higher intake of calcium, iron, phosphorus, potassium, total choline, vitamin B12, and zinc. Over 50% of the adolescent population (regardless of beef consumption) had intakes below the EAR for calcium, magnesium, and vitamins A, C, D, and E. The percentage of the beef-consuming population below the EAR was lower for calcium, copper, folate, iron, phosphorus, zinc, and vitamins B12 and B6 as compared to non-consumers. Additionally, the portion of the population above the AI for sodium was higher in female beef consumers as compared to non-consumers. We estimate approximately 900,000 to 1,400,000, 400,000-700,000, 200,000-600,000, and 200,000-400,000 fewer adolescents to be below the EAR for zinc, phosphorus, vitamin B12, and iron, respectively if beef non-consumers were to consume beef. This study suggests beef can help increase the nutrient intake and nutrient adequacy in the diets of adolescents, helping to close important gaps for this nutritionally vulnerable population. While recommendations to reduce beef intake are widely prevalent, this could result in unintended nutritional consequences regarding under-consumed nutrients including those of public health concern important for adolescent health.

Dietary Behaviors and Social Determinants of Health Among Adults Living with Sickle Cell Disease

Background: Social determinants of health (SDoH) may impact outcomes in sickle cell disease (SCD), and recent literature reports that particular SDoH, such as food insecurity and housing insecurity, may impact diet choices for individuals with SCD. Notably, health outcomes in SCD are linked to diet choices through increased protein and caloric needs, and through nutrients, such as polyphenols, omega fatty acids and micronutrients, which are involved in SCD pathophysiology. The connection between SDoH and diet quality may occur through multiple pathways including access to food, affordability, chronic pain and psychosocial factors at the individual and family level. Importantly, the impact of this connection may relate to outcomes such as pain frequency, hospitalizations, and SCD pathophysiologic biomarkers, such as inflammation. Study Design and Methods: The Diet and SCD Study (NCT: 05170412) is an observational mixed-methods study initiated in 2021 at the National Institutes of Health Clinical Center (NIH CC) in Bethesda MD with a target sample of 75 adults living with SCD in the United States. The purpose of the study is to evaluate associations between SDoH (food insecurity, neighborhood food access, education, employment, healthcare access), dietary intake, and population health related outcomes among adults living with SCD. Study inclusion criteria consists of adults (≥18 years of age) residing within the United States at the time of screening who have a confirmed diagnosis of sickle cell disease with any genotype, and are not hospitalized at the time of enrollment. To ensure participation from adults in diverse regions of the United States, the study has a hybrid design of in-person and telehealth procedures. In-person protocol visits are conducted at the NIH CC. The CC clinical visit includes a clinical assessment, anthropometric measurements, phlebotomy, as well as monitored/proctored electronic surveys that collect SDoH and disease severity variables. The telehealth protocol visit includes a virtual clinical assessment, phlebotomy at a local laboratory center, as well as the same monitored/proctored electronic surveys completed by CC clinical visit participants. A dietary behavior semi-structured interview is conducted at both the CC clinical visit and telehealth protocol visit to garner participants' personal stories related to food choices and diet. Laboratory variables include SCD disease specific markers, amino acid levels, and measurement of inflammatory cytokine markers. All participants undergo two unannounced phone-administered 24-hour dietary recall interviews with trained NIH nutrition staff to measure recent dietary intake. Data from 24-hour recall interviews are used to determine fluid, caloric, macro and micronutrient, and polyphenol intake. Usual dietary intake of foods of potentially related to SCD pathophysiology (cruciferous vegetables and thiocyanate-rich foods) is measured through self-administered electronic 12-month food frequency questionnaires. Primary objectives are to evaluate social determinants of health related to food security and access relevant to disease severity among adults living with sickle cell disease in the U.S. Secondary outcomes are to evaluate the association of dietary quality, specific dietary nutrient intake and serum levels, including amino acids and polyphenols, with disease severity. Tertiary outcomes include evaluating inflammatory and glucometabolic biomarkers with measures of social determinants of health. When completed, the Diet and SCD study will provide important information on the associations between SDoH, dietary quality, inflammatory biomarkers and disease severity for adults living with SCD and provide initial data for future cohort and intervention studies.

A Dietary Model of Partial Meat Replacement with Walnuts Demonstrates Changes in the Nutrient Profile and Quality of the United States Population's Diet.

The purpose of the study is to assess the impact of partial meat replacement with walnuts using a dose-escalation approach on nutrient intake and diet quality in the usual US diet. Food modeling was implemented using the nationally representative 2015-2018 National Health and Examination Survey (NHANES), with a focus on non-nut consumers, which included 2707 children and adolescents and 5190 adults. Walnuts replaced meat in a dose-escalating manner (0.5, 1, 1.5, and 2 oz walnuts per day replaced 1, 2, 3, and 4 oz meat, respectively). Diet quality was estimated using the population ratio method of the 2015 Healthy Eating Index. The usual intake of nutrients was estimated using the National Cancer Institute method. Significant differences were determined using non-overlapping 95% confidence intervals. The partial replacement of meat with walnuts demonstrated significant increases in the mean intake of fiber, magnesium, and omega-3 fatty acids and significant decreases in cholesterol and vitamin B12 in the modeled diets for children, adolescents, and adults. Additionally, the partial replacement of meat with walnuts improved overall diet quality. Walnut consumption at 1-2 oz as a replacement for some meat may improve nutrient intake and diet quality across age groups.

Relationship among dietary intake of vitamin D, magnesium, and calcium, 25-hydroxyvitamin D levels, and glycemic control markers in individuals with type 2 diabetes

AimsTo investigate the associations of 25-hydroxyvitamin D (25(OH)D) concentrations, vitamin D intake, magnesium, and calcium with glycemic control in individuals with type 2 diabetes mellitus (T2DM). MethodsA total of 107 adult with T2DM, residing in the state of Sergipe/Brazil (latitude: 10°), were evaluated for serum concentrations of 25(OH)D, parathyroid hormone, fasting glucose, %HbA1c, insulin, C-peptide, total cholesterol and fractions, homeostasis of beta-cell function (HOMA-B), insulin sensitivity (HOMA-S) and resistance (HOMA-IR), anthropometry, body composition, and usual food intake. The results were analyzed according to 25(OH)D status (insufficient/deficient <30 ng/mL; adequate ≥30 ng/mL). Mann–Whitney, chi-square, and binary logistic regression tests were performed. P-value<0.05 was considered significant. ResultsThe median age and time to T2DM diagnosis were 49 and 5 years, respectively. High inadequacy was observed in the dietary intake of vitamin D, magnesium, and calcium. Higher HOMA-B values were observed in the vitamin D adequate group (p = 0.032) and higher fasting serum glucose concentrations (p = 0.012) and %body fat (p = 0.048) in the insufficient/deficient group, which had a higher chance of elevated serum glucose (odds ratio [OR]:2.937; p = 0.020) and HOMA-IR (OR:2.496; p = 0.045). ConclusionVitamin D deficiency is associated with poor glycemic control and insulin resistance, and these aspects are unrelated to inadequate dietary intake of vitamin D, magnesium, and calcium.

Dietary Intake and Quality among Stroke Survivors: NHANES 1999–2018

BackgroundNutrition is an important modifiable risk factor for prevention and treatment of stroke. However, examination of nutrient intake and diet quality in stroke survivors is limited. ObjectivesThe aim of the study was to estimate usual nutrient intake and diet quality in US adults with and without a history of self-reported stroke. MethodsUsing US National Health and Nutrition Examination Survey (NHANES) 1999-2018, we analyzed demographics, health history, and dietary intake data in 1626 individuals with a history of stroke matched for age, gender, and survey cycle to respective controls (n=1621) with no history of stroke. A minimum of one 24-h dietary recall was used to assess dietary intake. Diet quality was determined using Healthy Eating Index 2015 (HEI-2015) scores. Adult food security was assessed based on responses to the US Department of Agriculture Household Food Security Survey Module. Physical and mental limitations were assessed from responses to the NHANES Physical Functioning Questionnaire. Estimates were reported as mean (standard error). ResultsIn comparison to controls, stroke survivors were more likely to be food insecure, experience poverty, and report physical and mental limitations (P < .001, all comparisons). Stroke survivors were more likely to report excessive (% > acceptable macronutrient distribution range) intake for total fat (50.9 [2.7]% vs. 40.4 [2.2]%, P < .001) and inadequate intake (% < estimated average requirement) for calcium (54.6 [1.8]% vs. 43.5 [2.4]%, P = .001) and magnesium (66 [1.8] vs. 53.6 [1.8]%, P < .001). In addition, stroke survivors reported lower HEI-2015 total scores than controls (49.8 vs. 51.9, P < .001). Finally, HEI-2015 total scores were lower in stroke survivors who were food insecure and those with a lower income-to-poverty ratio (< 185%) (P = .001). ConclusionsDietary intake in stroke survivors was nutritionally poor, with suboptimal nutrient intake and lower overall diet quality compared with age- and gender-matched controls. Furthermore, poverty and food insecurity were more prevalent in stroke survivors and associated with worse diet quality.

Associations of Fruit and Vegetable Intake with Metabolic Health Status in Overweight and Obese Youth

Introduction: The objective of this study was to assess the relationship between fruit and vegetable intake with metabolic health status among overweight and obese Iranian youth. Methods: In total, 203 obese and overweight youth including 101 boys and 102 girls, 12–18 years, were randomly recruited through a multistage cluster sampling approach in this study. A validated Persian format of food frequency questionnaire was used to estimate participants’ usual food intake. Adolescents were categorized in accordance with the International Diabetes Federation (IDF) criteria as well as IDF plus insulin resistance (HOMA-IR) definition into metabolically healthy obese and metabolically unhealthy obese (MUO). Results: Based on IDF criteria, youth in the third tertile of vegetable and the combination of fruit and vegetable intake had 66% (odds ratio = 0.34, 95% CI: 0.12–0.95) and 73% (odds ratio = 0.27, 95% CI: 0.09–0.81) lower odds of MUO compared to those in the first tertile, in the fully-adjusted model. According to IDF plus HOMA-IR definition, inverse associations were also found between vegetable (odds ratio = 0.36, 95% CI: 0.12–1.02) and the combination of fruit and vegetable (odds ratio = 0.25, 95% CI: 0.08–0.79) intake with MUO phenotype. Stratified analysis indicated inverse associations between intake of vegetables and the combination of fruits and vegetables with MUO phenotype (based on IDF definition) in overweight, but not obese subjects. Conclusion: The current study demonstrated that greater consumption of vegetables as well as the combination of fruits and vegetables was related to a lower risk of MUO phenotype, particularly in overweight youth.