Update of the Healthy Eating Index: HEI-2010

Fit and Strong! Plus: design of a comparative effectiveness evaluation of a weight management program for older adults with osteoarthritis

Osteoarthritis (OA) is the most common chronic condition and principal cause of disability among older adults. The current obesity epidemic has contributed to this high prevalence rate. Fortunately both OA symptoms and obesity can be ameliorated through lifestyle modifications. Physical activity (PA) combined with weight management improves physical function among obese persons with knee OA but evidence-based interventions that combine PA and weight management are limited for this population. This paper describes a comparative effectiveness trial testing an evidence-based PA program for adults with lower extremity (LE) OA, Fit and Strong!, against an enhanced version that also addresses weight management based on the evidence-based Obesity Reduction Black Intervention Trial (ORBIT). Adult participants (n=400) with LE OA, age 60+, overweight/obese, and not meeting PA requirements of ≥ 150 min per week, are randomized to one of the two programs. Both 8-week interventions meet 3 times per week and include 60 min of strength, flexibility, and aerobic exercise instruction followed by 30 min of education/group discussion. The Fit and Strong! education sessions focus on using PA to manage OA; whereas Fit and Strong! Plus addresses PA and weight loss management strategies. Maintenance of behavior change is reinforced in both groups during months 3-24 through telephone calls and mailed newsletters. Outcomes are assessed at baseline, and 2, 6, 12, 18, and 24 months. Primary outcomes are dietary change at 2 months followed by weight loss at 6 months that is maintained at 24 months. Secondary outcomes assess PA, physical performance, and anxiety/depression.

Diet quality index for healthy food choices

OBJECTIVE: To present a Diet Quality Index proper for dietary intake studies of Brazilian adults. METHODS: A diet quality index to analyze the incorporation of healthy food choices was associated with a digital food guide. This index includes moderation components, destined to indicate foods that may represent a risk when in excess, and adequacy components that include sources of nutrients and bioactive compounds in order to help individuals meet their nutritional requirements. The diet quality index-digital food guide performance was measured by determining its psychometric properties, namely content and construct validity, as well as internal consistency. RESULTS: The moderation and adequacy components correlated weakly with dietary energy (-0.16 to 0.09). The strongest correlation (0.52) occurred between the component 'sugars and sweets' and the total score. The Cronbach's coefficient alpha for reliability was 0.36. CONCLUSION: Given that diet quality is a complex and multidimensional construct, the Diet Quality Index-Digital Food Guide, whose validity is comparable to those of other indices, is a useful resource for Brazilian dietary studies. However, new studies can provide additional information to improve its reliability.

Childhood dietary patterns and later obesity: a review of the evidence

A range of individual nutrients and foods have been suggested to increase obesity risk in childhood, but the evidence is inconsistent. Dietary patterns that summarise the whole diet may, however, be more informative. The aim of the present paper was to systematically review the current evidence pertaining to overall dietary patterns in childhood and later obesity risk. Studies eligible for review identified childhood dietary patterns using an empirical method, i.e. principal components analysis, factor analysis or reduced rank regression, and reported their prospective associations with an obesity-related outcome. Literature searches identified 166 studies and of these, seven met the eligibility criteria. Despite differences between studies, a common dietary pattern was identified in all seven studies that was high in energy-dense, high-fat and low-fibre foods. The quality of studies varied, however; the four studies reporting positive associations between this type of dietary pattern and later obesity risk were of consistently higher quality than those reporting null associations. The balance of evidence from this systematic review indicates that dietary patterns that are high in energy-dense, high-fat and low-fibre foods predispose young people to later overweight and obesity. It also highlights that examining multiple dietary factors within a dietary pattern may better explain obesity risk than individual nutrients or foods. However, more prospective studies are needed and dietary pattern research requires greater rigour and focus, to further clarify the role of dietary factors in the aetiology of obesity and inform future interventions.

Toward a life cycle-based, diet-level framework for food environmental impact and nutritional quality assessment: a critical review

Supplying adequate human nutrition within ecosystem carrying capacities is a key element in the global environmental sustainability challenge. Life cycle assessment (LCA) has been used effectively to evaluate the environmental impacts of food production value chains and to identify opportunities for targeted improvement strategies. Dietary choices and resulting consumption patterns are the drivers of production, however, and a consumption-oriented life cycle perspective is useful in understanding the environmental implications of diet choices. This review identifies 32 studies that use an LCA framework to evaluate the environmental impact of diets or meals. It highlights the state of the art, emerging methodological trends and current challenges and limitations to such diet-level LCA studies. A wide range of bases for analysis and comparison (i.e., functional units) have been employed in LCAs of foods and diet; we conceptually map appropriate functional unit choices to research aims and scope and argue for a need to move in the direction of a more sophisticated and comprehensive nutritional basis in order to link nutritional health and environmental objectives. Nutritional quality indices are reviewed as potential approaches, but refinement through ongoing collaborative research between environmental and nutritional sciences is necessary. Additional research needs include development of regionally specific life cycle inventory databases for food and agriculture and expansion of the scope of assessments beyond the current focus on greenhouse gas emissions.

Diet quality of urban older adults age 60 to 99 years: the Cardiovascular Health of Seniors and Built Environment Study

There are few studies that evaluate dietary intakes and predictors of diet quality in older adults. The objectives of this study were to describe nutrient intakes and examine associations between demographic, economic, behavioral, social environment, and health status factors and diet quality. Cross-sectional data were from black, white, and Hispanic adults, age 60 to 99 years, living independently in New York City and participating in the Cardiovascular Health of Seniors and the Built Environment Study, 2009-2011 (n=1,306). Multivariable log-linear regression estimated associations between selected factors and good diet quality, defined as a Healthy Eating Index score more than 80 (based on the 2005 Dietary Guidelines for Americans [HEI-2005]). Dietary intakes were similar for men and women; intakes of energy, fiber, and the majority of micronutrients were less than recommendations, whereas intakes of fats, added sugar, and sodium were within the upper range or exceeded recommendations. Hispanic ethnicity (relative risk [RR]=1.37; 95% CI 1.07 to 1.75), energy intake <∼ 1,500 kcal/day (RR=1.93; 95% CI, 1.37 to 2.71), adherence to a special diet (RR=1.23; 95% CI: 1.02 to 1.50), purchasing food at supermarkets at least once/week (RR=1.34; 95% CI, 1.04 to 1.74), and being married/living with a partner (RR=1.37; 95% CI, 1.10 to 1.71) were positively associated with HEI-2005 score more than 80. Consuming at least one restaurant meal/day was negatively associated with HEI-2005 score more than 80 (RR=0.69; 95%CI, 0.50-0.94). These findings identify specific groups of older adults, such as blacks or those who live alone, who may benefit from dietary interventions, as well as specific modifiable behaviors among older adults, such as eating restaurant meals or shopping at supermarkets, which may be targeted through interventions.

Evidence for a role of proteins, lipids, and phytochemicals in the prevention of polycystic kidney disease progression and severity

Polycystic kidney disease (PKD) is a heritable disease characterized by renal cysts and is a leading cause of end-stage renal disease. Dietary intervention offers a potentially efficacious, cost-effective, and safe therapeutic option for PKD. The aim of this article was to review studies investigating the effect of dietary components on PKD and potential mechanisms of action. Low-protein diets are commonly recommended for PKD patients, but inconsistent findings in human and animal PKD studies suggest that the type rather the amount of protein may be of greater importance. Dietary soy protein has been shown to have renal protective effects in various animal models of PKD. Other than dietary proteins, studies investigating the role of the amount and type of dietary lipids on PKD progression are increasing. The omega-3 polyunsaturated fatty acids can alter multiple steps in PKD pathogenesis. Phytoestrogens and phytochemicals are other dietary compounds shown to attenuate cyst pathogenesis in animal studies. A better understanding of the role of nutrition in PKD can contribute to the development of dietary recommendations and diet-based therapies to reduce PKD progression and severity.

qDIET: toward an automated, self-sustaining knowledge base to facilitate linking point-of-sale grocery items to nutritional content

The United States, indeed the world, struggles with a serious obesity epidemic. The costs of this epidemic in terms of healthcare dollar expenditures and human morbidity/mortality are staggering. Surprisingly, clinicians are ill-equipped in general to advise patients on effective, longitudinal weight loss strategies. We argue that one factor hindering clinicians and patients in effective shared decision-making about weight loss is the absence of a metric that can be reasoned about and monitored over time, as clinicians do routinely with, say, serum lipid levels or HgA1C. We propose that a dietary quality measure championed by the USDA and NCI, the HEI-2005/2010, is an ideal metric for this purpose. We describe a new tool, the quality Dietary Information Extraction Tool (qDIET), which is a step toward an automated, self-sustaining process that can link retail grocery purchase data to the appropriate USDA databases to permit the calculation of the HEI-2005/2010.

Monitoring and benchmarking population diet quality globally: a step-wise approach

INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support) aims to monitor and benchmark the healthiness of food environments globally. In order to assess the impact of food environments on population diets, it is necessary to monitor population diet quality between countries and over time. This paper reviews existing data sources suitable for monitoring population diet quality, and assesses their strengths and limitations. A step-wise framework is then proposed for monitoring population diet quality. Food balance sheets (FBaS), household budget and expenditure surveys (HBES) and food intake surveys are all suitable methods for assessing population diet quality. In the proposed 'minimal' approach, national trends of food and energy availability can be explored using FBaS. In the 'expanded' and 'optimal' approaches, the dietary share of ultra-processed products is measured as an indicator of energy-dense, nutrient-poor diets using HBES and food intake surveys, respectively. In addition, it is proposed that pre-defined diet quality indices are used to score diets, and some of those have been designed for application within all three monitoring approaches. However, in order to enhance the value of global efforts to monitor diet quality, data collection methods and diet quality indicators need further development work.

Assessing foods offered to children at child-care centers using the Healthy Eating Index-2005

The Healthy Eating Index-2005 (HEI-2005) has been applied primarily to assess the quality of individual-level diets but has recently been applied to environmental-level data as well. Currently, no studies have applied the HEI-2005 to foods offered in child-care settings. This cross-sectional study used the HEI-2005 to assess the quality of foods and beverages offered to preschool children (3 to 5 years old) in child-care centers. Two days of dietary observations were conducted and 120 children (six children per center) were observed at 20 child-care centers in North Carolina between July 2005 and January 2006. Data were analyzed between July 2011 and January 2012 using t tests. Mean total HEI-2005 score (59.12) was significantly (P<0.01) lower than the optimal score of 100, indicating the need to improve the quality of foods offered to children. All centers met the maximum score for milk. A majority also met the maximum scores for total fruit (17 of 20 centers), whole fruit (15 of 20 centers), and sodium (19 of 20 centers). Mean scores for total vegetable (mean=2.26±1.09), dark green/orange vegetables and legumes (mean=0.20±0.43), total grain (mean=1.09±1.25), whole grain (mean=1.29±1.65), oils (mean=0.44±0.25), and meat/beans (mean=0.44±0.25) were significantly lower than the maximum scores recommended (P<0.01). Mean scores for saturated fat (mean=3.32±3.41; P<0.01) and calories from solid fats and added sugars (mean=14.76±4.08; P<0.01) suggest the need to decrease the provision of foods high in these components. These findings indicate the need to improve the quality of foods offered to children at the centers to ensure that the foods provided contribute to children's daily nutrition requirements.

Dietary pattern analysis: a comparison between matched vegetarian and omnivorous subjects

Background

Dietary pattern analysis, based on the concept that foods eaten together are as important as a reductive methodology characterized by a single food or nutrient analysis, has emerged as an alternative approach to study the relation between nutrition and disease. The aim of the present study was to compare nutritional intake and the results of dietary pattern analysis in properly matched vegetarian and omnivorous subjects.

Methods

Vegetarians (n = 69) were recruited via purposeful sampling and matched non-vegetarians (n = 69) with same age, gender, health and lifestyle characteristics were searched for via convenience sampling. Two dietary pattern analysis methods, the Healthy Eating Index-2010 (HEI-2010) and the Mediterranean Diet Score (MDS) were calculated and analysed in function of the nutrient intake.

Results

Mean total energy intake was comparable between vegetarians and omnivorous subjects (p > 0.05). Macronutrient analysis revealed significant differences between the mean values for vegetarians and omnivorous subjects (absolute and relative protein and total fat intake were significantly lower in vegetarians, while carbohydrate and fibre intakes were significantly higher in vegetarians than in omnivorous subjects). The HEI and MDS were significantly higher for the vegetarians (HEI = 53.8.1 ± 11.2; MDS = 4.3 ± 1.3) compared to the omnivorous subjects (HEI = 46.4 ± 15.3; MDS = 3.8 ± 1.4).

Conclusions

Our results indicate a more nutrient dense pattern, closer to the current dietary recommendations for the vegetarians compared to the omnivorous subjects. Both indexing systems were able to discriminate between the vegetarians and the non-vegetarians with higher scores for the vegetarian subjects.