Nutrition Recommendations from the US Dietary Guidelines Critical to Teach Low-Income Adults: Expert Panel Opinion

Food Skills Education and Low-Income Adults' Healthy Food Choices

BACKGROUND

The Cooking Matters food skills education program equips low-income families with the skills and knowledge to shop for and cook healthy meals within budget and time constraints.

AIMS

To explore whether participation in Cooking Matters is associated with healthier food choices using a 6-item scale, comprised of a variety of food categories.

METHODS

Cooking Matters participants (n = 332) and a comparison group (n = 336) completed surveys at baseline, 3-, and 6-month follow-up.

RESULTS

Cooking Matters participants experienced greater improvements in healthy choices overall (p < 0.0001) and for each of the six underlying items at 3 month follow-up. Improvements were sustained at 6-month follow-up overall and for all categories, except low-fat milk (p = 0.1168).

DISCUSSION

Participation in Cooking Matters was associated with improvements in overall healthy food choices across a variety of food groups and maintained at 6-month follow-up. Enabling healthy food choices is an important step toward improved diet quality.

Development of a National Dietary Behaviors Questionnaire for EFNEP Adult Participants

OBJECTIVE

Develop and establish the reliability and validity of dietary behavior evaluation questions for the Expanded Food and Nutrition Education Program (EFNEP).

DESIGN

A mixed-methods study using cognitive interviews, expert panels, test/retest reliability, and pretests/posttests.

SETTING

14 states across the US.

PARTICIPANTS

A convenience sample of low-income EFNEP or EFNEP-eligible participants for cognitive interviews (n = 111), reliability testing (n = 181), and sensitivity to change testing (n = 382).

MAIN OUTCOMES MEASURES

Indicators of face and content validity, temporal reliability, and sensitivity to change.

ANALYSIS

Questions interpreted as intended in cognitive interviews, intraclass correlation coefficient and Spearman rank-order correlation for reliability testing; paired t tests or Wilcoxon signed-rank tests for sensitivity to change; and exploratory factor analyses to identify possible scales.

RESULTS

Cognitive interviews resulted in 3 rounds of question revisions; reliability value ranges were 0.48-0.77 for intraclass correlation coefficient and 0.43-0.77 for Spearman rank-order correlation. For sensitivity to change, 9 items had evidence of change (P < 0.05) between pretests and posttests, whereas 5 items had evidence for change after removing those with little room to change. Two scales were identified: diet quality and non-cheese dairy.

CONCLUSIONS AND IMPLICATIONS

The EFNEP's new dietary behavior evaluation questions demonstrated face and content validity, moderate to strong reliability, and sensitivity to detect self-reported behavior changes among low-income, diverse populations (culturally, racially/ethnically, and level of education) across 14 states. Nutrition education programs targeting similar behaviors with English speaking clients could consider this dietary behavior questionnaire.

Best Practices in Curricula Revisions: Using the Evidence-Based Eating Smart • Being Active as an Exemplar

This article describes the processes employed to revise the widely used curriculum, Eating Smart • Being Active. Because of its popularity among nutrition education programs serving the low-income population, the curriculum developers felt it was important to share the revision process after the release of the 2015-2020 Dietary Guidelines for Americans. Extensive feedback during formative evaluation, updated content from the Dietary Guidelines for Americans, and a modern look resulted in a fully revised curriculum released in 2017. Program leaders should have confidence that their educators will be able to implement this evidence-based curriculum with fidelity. An outcome evaluation of the revised Eating Smart • Being Active curriculum is recommended.

Health Biomarkers in Adults Are More Closely Linked to Diet Quality Attributes Than to Plant-Based Diet Categorization

Although plant-based diets are promoted for healthy outcomes, these diets are not synonymous with high-quality diets. Plant-based diets can include highly processed, less healthful foods, including savory snacks, pastries, and sugary fruit drinks. This cross-sectional study examined the diet quality of vegetarian and omnivorous adults, matched for gender, age, and adiposity, and related diet quality to standard health biomarkers. Diet quality was assessed using the Rapid Eating and Activity Assessment for Participants Short Version questionnaire. Participants (17 vegetarians and 16 omnivores; 28.2 ± 8.9 years; 22.5 ± 2.7 kg/m²) were non-smokers and healthy by self-report. The median duration of adherence to the vegetarian diet was 27 months. Physical activity level and diet quality did not differ significantly between diet groups. Moreover, health biomarkers did not differ by diet groups. When participants were regrouped by low versus high diet quality, health biomarkers differed significantly between groups for fasting insulin, HOMA-IR, triglyceride (TG)/HDL ratio, and blood folate, with more favorable levels in the group with high diet quality. These data suggest that health biomarkers more closely align with diet quality attributes than with plant-based diet categorization. Thus, messaging focused on healthy diet attributes may lead to better health outcomes than the simple promotion of plant-based diets.

Interpretation and Understanding of the Dietary Guidelines for Americans Consumer Messages Among Low-Income Adults

Objective: The objective of this study was to determine the interpretation, understanding, and implementation of the Dietary Guidelines for Americans (DGA) consumer messages among low-income adults and compare findings to perceptions of the messages for consumers by community nutrition educators.Methods: In this mixed methods, cross-sectional study, a convenience sample of low-income adults (n = 98) with a child between the ages of 3 and 10 years old and nutrition educators (n = 9) were interviewed individually about the DGA messages, food-related behaviors, and barriers related to consuming fruits, vegetables, and whole grains. Interviews were audio-taped, transcribed verbatim, and analyzed using the inductive approach. Interpretation and ranking of the clarity and ease of the DGA messages by low-income adults and nutrition educators and perceptions about the messages were assessed. Descriptive statistics were conducted for demographic data and Fisher's exact tests were used to examine differences regarding the clarity and ease of the messages among low-income adults and nutrition educators.Results: According to the interview results, messages that tended to be misinterpreted most frequently were on topics such as sodium, fruit and vegetables, portions, and whole grain intake. Low-income adults and nutrition educators also differed in perceptions for the message clarity addressing whole grain servings (p = .001), avoiding oversized portions (p = .002), and comparing sodium (p < .001).Conclusions: Improvements in the DGA consumer messages are warranted to improve clarity and feasibility for low-income adults through new communication tools or strategies that complement the DGA.