Diet quality in the US improved during the Great Recession and deteriorated during economic recovery

Who chooses "healthy" meals? An analysis of lunchtime meal quality in a workplace cafeteria

BACKGROUND

The workplace can play an important role in shaping the eating behaviors of U.S. adults. Unfortunately, foods obtained in the workplace tend to be low in nutritional quality. Questions remain about the best way to approach the promotion of healthy food purchases among employees and to what extent health promotion activities should be tailored to the demographic characteristics of the employees. The purpose of this study was to (1) assess the nutritional quality of lunchtime meal purchases by employees in cafeterias of a large organization, (2) examine associations between lunchtime meal quality selection and the demographic characteristics of employees, and (3) determine the healthfulness of foods and beverages offered in the cafeterias of this organization.

METHODS

A cross-sectional analysis was conducted using secondary data from a food labeling study implemented in three worksite cafeterias. Demographic data was collected via surveys and meal data was collected using a photo capture system for 378 participants. The Healthy Eating Index 2015 (HEI-2015) was used to determine meal quality and a total score for the menu of options available in the cafeterias during the study period. Summary statistics were generated, and the analysis of variance (ANOVA) was used to compare the HEI-2015 scores between groups.

RESULTS

The mean HEI-2015 total score for the menu items offered (n = 1,229) in the cafeteria during the study period was 63.1 (SD = 1.83). The mean HEI-2015 score for individual lunchtime meal observations (n = 378) was 47.1 (SD = 6.8). In general, HEI-2015 total scores were higher for non-smokers, individuals who self-identified as Asian, had higher physical activity levels, scored higher on numeracy and literacy assessments, and reported higher education levels, incomes, and health status.

CONCLUSIONS

The overall HEI-2015 scores indicate that the menu of options offered in the cafeterias and individual meal selections did not align with the Dietary Guidelines for Americans, and there were significant associations between average lunchtime meal quality scores and several demographic characteristics. These results suggest that healthy eating promotion activities in workplaces may need to be tailored to the demographic characteristics of the employees, and efforts to improve the food environment in the workplace could improve meal quality for all employees.

Adherence to the Planetary Health Diet Index and correlation with nutrients of public health concern: an analysis of NHANES 2003-2018

BACKGROUND

The Planetary Health Diet Index (PHDI) is a novel measure adapted to quantify alignment with the dietary evidence presented by the EAT-Lancet Commission on Food, Planet, Health.

OBJECTIVES

To examine how population-level health and sustainability of diet as measured by the PHDI changed from 2003 to 2018, and to assess how PHDI correlated with inadequacy for nutrients of public health concern (iron, calcium, potassium, and fiber) in the United States.

METHODS

We estimated survey-weighted trends in PHDI scores and median intake of PHDI components in a nationally representative sample of 33,859 adults aged 20+ y from 8 cycles (2003-2018) of the National Health and Nutrition Examination Survey with 2 d of dietary recall data. We used the National Cancer Institute method to examine how PHDI correlated with inadequate intake of iron, calcium, potassium, and fiber.

RESULTS

Out of a theoretical range of 0-140, the median PHDI value increased by 4.2 points over the study period, from 62.7 (95% confidence interval [CI]: 62.0, 63.4) points in 2003-2004 to 66.9 (66.2, 67.7) points in 2017-2018 (P-trend < 0.001), although most of this change occurred before 2011-2012 and plateaued thereafter. For adequacy components that are encouraged for consumption, nonstarchy vegetable intake significantly decreased over time, whereas whole grains, nuts and seeds, and unsaturated oils increased. For moderation components with recommended limits for consumption, poultry and egg intake increased, but red and processed meat, added sugars, saturated fats, and starchy vegetables decreased over time. Higher PHDI values were associated with a lower probability of iron, fiber, and potassium inadequacy.

CONCLUSIONS

Although there have been positive changes over the past 20 y, there is substantial room for improving the health and sustainability of the United States diet. Shifting diets toward EAT-Lancet recommendations would improve nutrient adequacy for iron, fiber, and potassium. Policy action is needed to support healthier, more sustainable diets in the United States and globally.

Diet Quality Trajectories over Adulthood in a Biracial Urban Sample from the Healthy Aging in Neighborhoods of Diversity across the Life Span Study

Limited investigation has been done on diet quality trajectories over adulthood. The main study objectives were to determine the diet quality group trajectories (GTs) over time and to detect changes in a socio-economically and racially diverse middle-aged cohort. Data from three waves of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used to determine diet quality with group-based trajectory modeling (GBTM). Three quality indices-the Healthy Eating Index (HEI), the Dietary Inflammatory Index (DII), and the Mean Adequacy Ratio (MAR)-were explored. The rate of change in quality over time was determined by mixed-effects regression analysis. Three diet quality GTs, low, middle, and high quality, were identified for each index and confirmed with spaghetti plots. Within each GT, only small changes in diet quality scores were observed, with improvements for the HEI and DII indices and a slight decline in MAR scores. Weighted kappa values revealed that the DII had better agreement with the HEI-2010 and MAR indices compared with the agreement between the HEI-2010 and MAR. Bayesian estimates revealed that the annualized rate of change in diet quality per person across the GTs was similar. There was minimal change in diet quality over time, regardless of the diet quality index used.

Diet Quality Changes by Educational Level among Adults in Spain from 2017 to 2021

Despite increasing attention on addressing socioeconomic disparities in diet quality, longitudinal studies are scarce. Furthermore, the effects of the COVID-19 pandemic on diet-related outcomes are yet to be fully understood. We examined changes in diet quality by educational level among adults in Madrid, Spain. We used data from recruitment (in 2017) and from 2021. At baseline, our sample included 1358 adults aged 40-75 years who were free of cardiovascular disease and completed a validated diet quality screener. Of them, 931 answered the survey in the follow-up visit in 2021. We used participants' diet quality index scores (range: 18-54; higher scores indicate better diet quality) as the dependent variable. As our independent variable, we assessed participants' educational levels (low, medium, and high). We fitted a multinomial regression using the categories of educational level as the main predictor, adjusting for age, sex, country of origin, and household composition. During the study period, 78.0% of participants sustained their diet quality, 11.6% improved it, and 10.4% moved away from a healthier dietary pattern. In descriptive analyses, we observed an increase in diet quality among less-educated females. Unadjusted multinomial models showed that a lower educational level predicted both increases and decreases in diet quality over the period. Even though the median diet quality scores did not change significantly, we observed heterogeneous changes over the four years. Variability within diet, with some improving and some worsening, seems to have increased among participants with lower educational levels. Future studies should look at the determinants of change in these population subgroups.

Impact of COVID-19 on health risk behaviors in northern California: A cross-sectional survey

The COVID-19 pandemic has been disruptive, unevenly impacting health behaviors in different geographical regions and population groups. We examined how COVID-19 affected perceived changes in physical activity, sleep, and diet and the impact of socio-demographic variables on a calculated health risk behavior score. In this cross-sectional study, 505 residents of northern California completed a web-based survey from August to November of 2020. Chi-square and multivariable linear regression analyses examined the association between socio-demographic variables and the health risk behavior score. Approximately 84 % of respondents experienced at least one unfavorable behavior change after the pandemic, with 49.5 % indicating a reduction in physical activity, 29.7 % a decrease in sleep, 33.1 % an increase in sugary snack consumption, and 29.3 % a decrease in fruit and vegetable intake. Multivariate analyses indicated a higher health risk behavior score (less favorable) for females compared to males (male beta = -0.815, p < 0.0001) and Hispanics compared to Whites (Hispanics beta = 0.396, p = 0.033). The negative changes in health behavior observed in females could be attributed to a higher reduction in fruit and vegetable consumption, and a larger increase in sugary and salty snacks when compared to males. A higher reduction in exercise, sleep, and fruit and vegetable intake were the main drivers of the unfavorable results seen for Hispanics when compared to Whites. Findings highlight the detrimental behavioral changes during the COVID-19 pandemic and the disproportionate impact on Hispanics and women. These results are valuable to policymakers to identify ways to support those most affected by the pandemic and its potential long-term effects.

Rural Household Food Insecurity among Latino Immigrants during the COVID-19 Pandemic

U.S. food insecurity rates rapidly increased during the COVID-19 pandemic, with disproportionate impacts on Latino immigrant households. We conducted a qualitative study to investigate how household food environments of rural Latino immigrants were affected during the COVID-19 pandemic. Thirty-one respondents (42% from low food security households) completed interviews (July 2020-April 2021) across four rural counties in California. A rural household food security conceptual framework was used to analyze the data. Early in the pandemic, food availability was impacted by school closures and the increased consumption of meals/snacks at home; food access was impacted by reduced incomes. Barriers to access included limited transportation, excess distance, and lack of convenience. Key resources for mitigating food insecurity were the Supplemental Nutrition Assistance Program (SNAP), the Pandemic Electronic Benefits Transfer (P-EBT), school meals, charitable food programs, and social capital, although the adequacy and acceptability of charitable food distributions were noted issues. Respondents expressed concern about legal status, stigma, and the public charge rule when discussing barriers to government nutrition assistance programs. They reported that food pantries and P-EBT had fewer access barriers. Positive coping strategies included health-promoting food substitutions and the reduced consumption of meals outside the home. Results can inform the development of policy and systems interventions to decrease food insecurity and nutrition-related health disparities among rural Latino immigrants.