A systematic review of diet quality indices in relation to obesity

Association of activity-based food environment index with obesity-related cancer mortality in the US

BACKGROUND

Obesity and obesity-related cancers contribute to rising healthcare costs and declining life expectancy in the US and improving diet quality plays a crucial role in reversing such trends. Existing studies on the relationship between healthy food access and obesity-related cancer mortality present mixed findings, whereas food procurement activities are largely overlooked. The paper aims to construct a novel food environment index based on residents' food retailer visits, and then compare it with the location-based food environment index regarding the strength of associations with obesity-related cancer mortality rates.

METHODS

This cross-sectional ecologic study used business location data from InfoGroup and aggregated GPS-based food retailer visit data from SafeGraph in 2018-2019, and mortality data from the Centers for Disease Control and Prevention in 2015-2020. A total of 2925 counties or equivalents with complete information were included. Activity-based index was calculated as the percentage of visits to healthy food retailers out of total visits to all qualified food retailers for residents in each county. Location-based index was calculated as the percentage of healthy food retailers out of all qualified food retailers in each county. The main outcome is age-adjusted obesity-related cancer (13 types of cancer based on evidence from the International Agency for Research on Cancer) mortality rates, which were calculated for each county and counties were further categorized into high- and low-risk (≥ 60.2 and < 60.2 cases per 100,000 population) areas. Linear, non-linear, logistic, and spatial regression analyses were performed to examine the association between each food environment index and obesity-related cancer mortality rates.

RESULTS

The activity-based index demonstrated significant negative association with the 2015-2020 obesity-related cancer mortality rates (coefficient [95% CI]: - 0.980 [- 1.385, - 0.575], P < 0.001), and each standard deviation increase in the activity-based index was associated with an 18% decrease in the odds of being in a high-risk area (odds ratio [95% CI]: 0.821 [0.749, 0.900], P < 0.001), while the location-based index showed much weaker and non-significant effects.

CONCLUSIONS

Our findings suggest that health policies and initiatives that combat obesity and obesity-related cancers should consider incorporating food retailer visits into policy formation.

Nutrition Knowledge, Food Insecurity, and Dietary Biomarkers: Examining Fruit and Vegetable Intake Among College Students

OBJECTIVES

Food insecurity among college students, combined with limited nutrition knowledge and barriers to healthy eating, significantly impacts diet quality and fruit and vegetable intake. Efforts to address these issues are further complicated by the challenges of accurately and efficiently collecting dietary data in research settings. This study aimed to explore the relationship between nutrition knowledge and fruit/vegetable intake using skin, plasma, and dietary carotenoid levels as biomarkers.

METHODS

Undergraduate and graduate students aged 18 years and older (n = 166) from a California public university were recruited. The sample was predominately female (n = 133, 80%), with 30 males (18%) and three individuals (2%) identifying as non-binary. Food security was assessed using the USDA's 10-item Adult Food Security Survey Module and nutrition knowledge through a validated questionnaire. Biological data included blood samples and skin carotenoid measurements (Veggie Meter®). Dietary quality (HEI-2015) and carotenoid intake were assessed through Diet ID™, a photo-based assessment tool.

RESULTS

The mean nutrition knowledge scores were 36.55 ± 8.83 out of 58 points, and the mean skin carotenoid score was 307.07 ± 110.22. Higher knowledge scores were associated with increased plasma carotenoids, HEI-score, and Diet ID™ total carotenoids. Food security classification did not significantly impact nutrition knowledge but did influence HEI scores and skin carotenoid levels, with very low food security linked to poorer diet quality and lower carotenoid levels.

CONCLUSIONS

Nutrition knowledge may serve as a significant predictor of fruit and vegetable intake in university students. Despite this correlation, the impact of overall diet quality is potentially hindered by an individual's food security status. Therefore, while knowledge is critical, addressing food insecurity is essential for enhancing diet quality among college students.

The Experimental Beverage Marketplace: Feasibility and preliminary validation of a tool to experimentally study sugar-sweetened beverage taxes and beverage purchasing

Sugar sweetened-beverage (SSB) consumption contributes to poor diet quality and diet-related chronic diseases. One effective public health strategy to reduce SSB consumption is to tax SSB. Laboratory approaches can complement existing methods to improve understanding of how taxes on SSB influence purchasing. In this study we sought to develop and validate an experimental marketplace that presents participants with beverages typically available at grocery stores. Participants who drink SSB (n = 73) hypothetically shopped for beverages for their household with a 40% SSB tax and with no tax (order counterbalanced). Relative to the no tax condition, SSB purchasing was lower in the tax condition. We also found that self-reported beverage expenditures were correlated with experimental marketplace beverage expenditures. Most participants noticed the tax and agreed that the experimental marketplace was easy to use. Using an experimental marketplace is a promising way to explore SSB tax design to improve public policy. We present ideas for future studies that can include real and hypothetical outcomes.

Increased BMI is associated with an altered decision-making process during healthy food choices in males and females

Unhealthy diets (rich in calories, sugar, fat, and sodium) are a major cause of obesity. Why individuals struggle to make healthy food choices remains unclear. This study examined how body mass index, biological sex, and eating context influence food attribute perception, the food choice process, and the percentage of healthy food choices. In an online study, males and females with and without obesity (n = 910) rated food images for healthiness and tastiness and made food choices after prompts directing them to choose foods they considered healthy (healthy prompt) or to choose as they would in their daily lives (typical prompt), which aimed to model healthy and typical eating contexts. When foods were classified as healthy or unhealthy using nutritional labeling information, all participants rated healthy foods with larger healthiness ratings, but females rated healthy foods as healthier and tastier than males. Still, participants with obesity had fewer healthy choices (i.e., choosing the food with the largest healthiness rating) regardless of sex and prompt. Further, tastiness differences were more relevant than healthiness differences during healthy food choices among participants with obesity, and more so after the typical prompt. On the contrary, healthiness differences were more relevant among participants with healthy weight regardless of prompt type. Our findings highlight the importance of eating contexts in how individuals use their perception of food attributes during healthy food choices and suggest that increasing the presence of healthy prompts and perceived tastiness of healthy foods may promote healthy food choices among individuals with obesity.

Sex moderates diet quality differences in integrated collaborative care for comorbid obesity and depression: Post-hoc analysis of the RAINBOW RCT

OBJECTIVES

To investigate (1) whether an evidence-based behavioral weight loss intervention was associated with improved diet quality in adults with obesity and depression compared with usual care; and (2) whether the associations were modified by sex.

DESIGN

In the RAINBOW RCT, 409 participants were randomized in 1:1 ratio to receive a 12-month intervention integrating a Diabetes Prevention Program-based behavioral weight loss treatment with problem-solving therapy for depression (n = 204) or usual care (n = 205). Participants completed 24-h dietary recalls at baseline, 6, 12, 18, and 24 months. Dietary outcomes included the DASH score as the composite measure of diet quality and its components. Between-group differences in dietary outcomes were examined among all participants and by sex, using repeated-measures mixed-effects linear models.

RESULTS

Intervention group had mean age 50.9 (SD 12.2) years and 71% women, while control had 51.0 (11.9) years and 70% women. Changes in DASH scores did not differ between the intervention and usual care control groups through 24 months in both females and males. Compared with controls, males in the intervention group had decreased nut, seed, and legume intake at 6 (mean difference, -1.1; 95% CI, -1.9, -0.3 servings/day; P = 0.01; Pajd = 0.73) and 12 months (-1.0; -2.0, -0.0 servings/day; P = 0.048; Pajd = 0.73). Compared with controls, females in the intervention group had decreased fruit and vegetable intake at 18 (-1.8; -2.9, -0.6 servings/day; P = 0.002; Pajd = 0.08) and 24 months (-1.1; -2.2, -0.1 servings/day; P = 0.03; Pajd = 0.25), and whole grain intake at 24 months (-0.5; -0.9, -0.1 servings/day; P = 0.03; Pajd = 0.25), but increased percent calories from fat at 24 months (3.6; 0.6, 6.5; P = 0.02; Pajd = 0.25).

CONCLUSION

Diet quality not only did not improve in an effective behavioral weight loss intervention but deteriorated in females, in particular. These post-hoc findings warrant confirmation and may suggest sex-tailored behavior change techniques specifically targeting diet quality are needed in behavioral weight loss interventions aside from caloric reductions.

TRIAL REGISTRATION

ClinicalTrials.gov#NCT02246413 (https://clinicaltrials.gov/ct2/show/NCT02246413).

Early life factors that affect obesity and the need for complex solutions

The prevalence of obesity increases with age but is apparent even in early life. Early childhood is a critical period for development that is known to influence future health. Even so, the focus on obesity in this phase, and the factors that affect the development of obesity, has only emerged over the past two decades. Furthermore, there is a paucity of iterative work in this area that would move the field forward. Obesity is a complex condition involving the interplay of multiple influences at different levels: the individual and biological level, the sociocultural level, and the environmental and system levels. This Review provides a brief overview of the evidence for these factors with a focus on aspects specific to early life. By spotlighting the complex web of interactions between the broad range of influences, both causal and risk markers, we highlight the complex nature of the condition. Much work in the early life field remains observational and many of the intervention studies are limited by a focus on single influences and a disjointed approach to solutions. Yet the complexity of obesity necessitates coordinated multi-focused solutions and joined-up action across the first 2,000 days from conception, and beyond.

A systematic review of observational studies on the association between diet quality patterns and visceral adipose tissue

Beyond obesity, visceral adipose tissue (VAT) has emerged as an important predictor of chronic disease, but the role of diet quality patterns (DQP) in VAT development is not well defined. Therefore, we conducted a systematic review of how various DQP are associated with VAT via literature searches in PubMed and EMBASE. We included observational investigations in disease-free adults/adolescents that related DQP to VAT assessed by imaging methods. The studies were evaluated separately for a priori and a posteriori DQP and according to design differences. Study quality was assessed using the Risk of Bias in Non-randomised Studies of Interventions tool. Of the 1807 screened articles, thirty-five studies met the inclusion criteria. The majority of a priori indices, for example, the Healthy Eating Index, showed significant inverse associations with VAT, while only a small proportion of a posteriori patterns were related to VAT. Results did not differ substantially by the method of exposure and outcome assessment or between studies with (n 20) or without (n 15) body-size adjustment, but significant findings were more common in younger v. older individuals, USA v. other populations and investigations with moderate v. serious risk of bias. The heterogeneity of the existing literature limited the ability to quantify the magnitude of the associations across studies. These findings suggest that a high-quality diet, as assessed by a priori DQP, is generally inversely associated with VAT, but results for a posteriori DQP are less consistent. As associations persisted after adjusting for body size, diet quality may beneficially influence VAT beyond its association with obesity.

Dietary intakes differ between LGBTQ + and non-LGBTQ + college students

Objective: To compare dietary intakes between LGBTQ + and non-LGBTQ + college students. Participants: Participants were LGBTQ+ (n = 92) and non-LGBTQ+ (n = 491) college students. Methods: The 26-item Dietary Screener Questionnaire assessed intakes of added sugars, fiber, whole grains, fruits and vegetables, dairy, and calcium. Percentage of participants meeting Dietary Guidelines for Americans were also computed. Multivariate ANCOVA assessed differences in dietary intake. Chi-square analyses assessed differences in proportions of LGBTQ + and non-LGBTQ + students meeting recommendations. Results: LGBTQ + students reported lower intakes of fiber, whole grains, fruit, and fruits and vegetables both including and excluding French fries (all p < 0.05). Fewer LGBTQ + students met recommendations for fruit (5.7%) compared to their non-LGBTQ + counterparts (14.2%; p = .03). Conclusions: LGBTQ + students report poorer indices of diet quality compared to non-LGBTQ + students. Health promotion programming efforts to improve these outcomes may need to be tailored differently for students who identify as LGBTQ+.

The effects of age on associations between pre-school children's eating behaviour traits and diet quality

Child eating behaviour traits are associated with several aspects of dietary intake of pre-school children, however the associations between child eating behaviour traits and overall dietary quality in pre-school children has not been examined. Additionally, it is unknown how these relationships vary by age. This study examines the associations between child eating behaviour traits and pre-school children's dietary quality and whether children's age moderates these associations. This study utilises cross-sectional online survey data collected from mothers (n = 1367) of pre-school aged children (2-5 years) from across Australia. The survey included a validated measure of four child eating behaviour traits and a validated measure of diet quality. Multiple linear regression assessed associations between child eating behaviour traits and dietary quality, including interactions between child eating behaviour traits and child age. The average age of the children was 3.3 years, with 50.2% reported as males. Enjoyment of food was positively associated with dietary quality (B coefficient: 2.51, p < 0.001). Food fussiness and satiety responsiveness were inversely associated with dietary quality (B coefficients: 2.59 and -2.25, respectively, p < 0.001), while food responsiveness was not related to diet quality. Child age moderated associations between food fussiness and dietary quality (B coefficient: 0.38, p = 0.025). The difference in dietary quality between lower and higher food fussiness is most pronounced among 5-year-old children. In conclusion, this study demonstrates that it is important for future interventions aiming to improve dietary quality of pre-school children to target children with lower food enjoyment, higher food fussiness or satiety responsiveness as possible ways to improve child dietary quality. Future interventions should also have a particular focus on strategies to reduce food fussiness for older preschoolers.

Association between overall quality of macronutrients and incidence of overweight and obesity in the SUN (Seguimiento Universidad de Navarra) cohort

Introduction

Introduction: no previous large prospective studies have assessed the global quality of macronutrients in association with the risk of overweight/obesity. Objective: to prospectively assess the association of an overall macronutrient quality index (MQI) with weight change and the incidence of overweight/obesity in the Seguimiento Universidad de Navarra (SUN) cohort. Methods: the diet of 9,344 Spanish university graduates free of overweight/obesity (mean age: 36.5 [SD, 11.1]) was assessed through a validated 136-item food frequency questionnaire. The MQI was calculated as the sum of the Carbohydrate Quality Index, the Fat Quality Index, and the Healthy Plate Protein Quality Index. Participants were classified into groups (G) according to MQI. Incident overweight/obesity was defined if follow-up questionnaires indicated BMI was ≥ 25 kg/m2. Multiple linear regression models and Cox proportional hazard models were used to assess the average yearly weight change and the risk of overweight/obesity over follow-up time. Results: 2,465 cases of incident overweight/obesity were identified (median follow-up: 10.7 years). Increasing MQI was significantly associated with lower annual weight gain (g): ß coefficient: -99.0, (95 % CI: -173.6 to -24.5) in the G4 vs G1, p for trend = 0.007. In the fully adjusted model the incidences of overweight/obesity in G4 and G1 were 21.7 % (431 cases) and 29.3 % (954 cases), respectively. The adjusted HR was 0.87 (95 % CI, 0.77-0.98, p for trend = 0.036). When we used repeated analyses updating the MQI after 10 years of follow-up, results remained similar. Conclusions: a significant inverse association between a multidimensional MQI and the risk of overweight/obesity was found in this Mediterranean cohort of adults.

Association between protein intake, diet quality, and obesity in Australian adults: a comparison of measurement units

Previous investigations on protein associations with diet quality and obesity still have inconclusive findings, possibly due to how protein intake was expressed. This study aimed to compare how different ways of expressing total protein intake may influence its relationships with diet quality and obesity. Usual protein intake was estimated from the 2011-12 Australian National Nutrition and Physical Activity Survey (n = 7637 adults, ≥19 years), expressed in grams (g/d), percent energy (%EI), and grams per actual kilogram body weight (g/kgBW/d). Diet quality was assessed using the 2013 Dietary Guidelines Index, and obesity measures included Body Mass Index (BMI) and waist circumference (WC). Sex-stratified multiple linear and logistic regressions were performed and adjusted for potential confounders. Total protein (g/d) was directly associated with diet quality (males, β = 0.15 (95% CI 0.12, 0.19); females, β = 0.25 (0.22, 0.29)), and this association was consistent across units. Protein intake (g/d) was directly associated with BMI (males, β = 0.07% (0.04%, 0.11%); females, β = 0.09% (0.04%, 0.15%)), and WC (males, β = 0.04 (0.01, 0.06); females, β = 0.05 (0.00, 0.09)). While in males, protein as %EI was associated with higher WC, no association was found in females. Adults with higher protein intake (g/d) had higher odds of overweight/obesity (males, OR = 1.01 (1.00, 1.01); females, OR = 1.01 (1.00, 1.01)), and central overweight/obesity (females, OR = 1.01 (1.00, 1.01)), but no significant association with females odds of overweight/obesity when protein was expressed in %EI. In conclusion, protein intake was positively associated with diet quality and obesity, yet these associations were stronger for women. The effect sizes also varied by measurement unit due to the different scales of those units.

Assessing and Monitoring Nutrition Security in the United States: A Narrative Review of Current Measures and Instruments

PURPOSE OF REVIEW

Because nutrition plays a crucial role in the development of chronic diseases, ensuring nutrition security is important for promoting population health. Nutrition security is defined as having consistent and equitable access to healthy, safe, affordable foods essential to optimal health and well-being. Distinguished from food security, nutrition security consists of two constructs: healthy diets and nutritional status. The study aimed to identify population measures that reflect the important constructs of nutrition security (i.e., healthy diets and nutritional status) to inform U.S. nutrition security assessment and monitoring.

RECENT FINDINGS

Through a narrative review conducted across multiple databases, associations between subconstructs of healthy diets and nutritional status were identified. Of the six subconstructs that constitute healthy diets, nutrient adequacy and moderation were most often used to assess and monitor healthfulness of U.S. population diets and were associated with health outcomes. There is little evidence of an association between health outcomes and macronutrient balance or diversity in the U.S. Thirteen instruments were identified as potentially suitable for measuring at least one subconstruct of healthy diet in the population. This review highlights the importance of nutrition security in addressing population health challenges. It emphasizes the potential use of multiple instruments and measures to comprehensively monitor population nutrition security and inform intervention strategies. Identifying feasible and practical measures for assessing and monitoring nutrition security is imperative for advancing population health and mitigating the burden of chronic diseases.

Investigating the impact of dietary guidelines transition on cardiometabolic risk profile: a forensic analysis using diet quality metrics

Evaluating dietary guidelines using diet quality (DQ) offers valuable insights into the healthfulness of a population's diet. We conducted a forensic analysis using DQ metrics to compare the Malaysian Dietary Guidelines (MDG-2020) with its former version (MDG-2010) in relation to cardiometabolic risk (CMR) for an adult Malaysian population. A DQ analysis of cross-sectional data from the Malaysia Lipid Study (MLS) cohort (n = 577, age: 20-65yrs) was performed using the healthy eating index-2015 (HEI-2015) framework in conformation with MDG-2020 (MHEI2020) and MDG-2010 (MHEI2010). Of 13 dietary components, recommended servings for whole grain, refined grain, beans and legumes, total protein, and dairy differed between MDGs. DQ score associations with CMR, dietary patterns and sociodemographic factors were examined. Out of 100, total DQ scores of MLS participants were 'poor' for both MHEI2020 (37.1 ± 10.3) and MHEI2010 (39.1 ± 10.4), especially among young adults, males, Malays, and those frequently 'eating out' as well as those with greatest adherence to Sugar-Sweetened Beverages pattern and lowest adherence to Food Plant pattern. Both metrics shared similar correlations with CMR markers, with MHEI2020 exhibiting stronger correlations with WC, BF%, TG, insulin, HOMA2-IR, and smallLDL than MHEI2010, primarily attributed to reduced refined grain serving. Notably, participants with the highest adherence to MHEI2020 scores exhibited significantly reduced odds for elevated TG (AOR 0.44, 95% CI 0.21-0.93, p = 0.030), HOMA2-IR (AOR 0.44, 95% CI 0.21-0.88, p = 0.022), and hsCRP (AOR 0.54, 95% CI 0.31-0.96, p = 0.040, compared to those with the lowest adherence. Each 5-unit increase in MHEI2020 scores reduced odds for elevated BMI (- 14%), WC (- 9%), LDL-C (- 32%), TG (- 15%), HOMA2-IR (- 9%) and hsCRP (- 12%). While MHEI2020 scores demonstrated better calibration with CMR indicators, the overall sub-optimally 'poor' DQ scores of this population call for health promotion activities to target the public to achieve adequate intake of healthful fruits, non-starchy vegetables and whole grain, and moderate intake of refined grain, added sugar and saturated fat.

Diet Quality of Stroke Survivors Versus Neurologically Intact US Adults

Stroke is a leading cause of disability in the US, often altering one's ability to access and consume food. The aim of the present study was to characterize and evaluate predictors of stroke survivors' diet quality (DQ). A cross-sectional evaluation of 2011-2018 National Health and Nutrition Examination Survey data is presented. Stroke survivors (n = 632) were matched for age, gender, and race with neurologically intact controls (n = 913). Food group intake, key nutrient intake, and Healthy Eating Index (HEI)-2015 scores were calculated from two 24-hour recalls and evaluated in relation to history of stroke, education, presence of a partner in the home, and income. Group differences in and predictors of DQ were evaluated with weighted independent samples t-tests and linear regression. Stroke survivors had lower intakes of vegetables, dairy, seafood and plant proteins, and unsaturated fats, and lower total HEI-2015 scores (P < 0.05). Having more education, a partner in the home, and higher income were overall positive predictors of DQ. DQ factors emphasized in heart-healthy diets were low in stroke survivors. Interventions may better address barriers to healthy eating post-stroke by incorporating educational, financial, and social support components.

Health behaviors predicting risk of obesity in US adults: What does a healthy lifestyle look like?

Objective

The purpose of this study was to examine the association between lifestyle factors and body weight in a nationally representative sample of US adults and to evaluate the association between a novel "Healthy Habits Composite Score (HHCS)" and risk of obesity.

Methods

This cross-sectional study included data from 4870 adults who participated in the 2017-2018 National Health and Nutrition Examination Survey (NHANES). The HHCS was developed based on 4 factors: diet, physical activity, sedentary time, and sleep, all of which were measured during the NHANES. A "healthy lifestyle" was defined as meeting ≥3 of the 4 established criteria. Data analysis was conducted using SAS 9.4 and procedures to account for the complex survey design. All models were adjusted for age, sex, race, household income, and education.

Results

Adults with obesity had significantly lower dietary quality (48.8 ± 0.6 vs. 53.2 ± 0.9) and reported significantly more sedentary time (∼1 h more; 356.3 ± 7.0 vs. 301.4 ± 8.3 min) than lean adults, both p < 0.001. Achieving a healthy lifestyle based on the HHCS was associated with nearly double the odds of having a healthy body weight (OR 1.9, p < 0.001).

Conclusions

Following a lifestyle focused on healthy habits (diet quality, physical activity, limited sedentary time, and sleep) was strongly associated with a decreased risk of obesity: an individual who achieved three or more healthy habits had nearly twice the odds of having a healthy body weight. Therefore, comprehensive interventions that address and promote a wide range of healthy habits may be most effective for lowering obesity risk.

Gender differences in diet quality and the association between diet quality and BMI: an analysis in young Australian adults who completed the Healthy Eating Quiz

BACKGROUND

Many young adults report poor diet quality. However, research evaluating whether young adult males and females differ in diet quality is limited. Additionally, although diet quality has a known inverse association with body mass index (BMI), it is unclear whether this association is observed in young adults and whether it varies by gender. The present study aimed to evaluate gender differences in diet quality in young adults, as well as the associations between diet quality and BMI.

METHODS

Data collected via the Healthy Eating Quiz (HEQ) in respondents aged 18-35 years between July 2019 and December 2021 were analysed, including demographics, and diet quality calculated using the Australian Recommended Food Score (ARFS). Differences in characteristics were analysed using a two-sample t-test, chi-squared and one-way analysis of covariance. Linear regressions were performed to estimate associations between diet quality and BMI. An interaction term was included in the model to test differences between genders.

RESULTS

The respondents (n = 28,969) were predominantly female (70.8%) with a mean ± SD age of 25.9 ± 5.0 years and BMI of 24.6 ± 5.2 kg/m2. The mean ± SD ARFS was significantly different between females and males (33.1 ± 8.6 vs. 31.4 ± 9.3 points out of 70; p < 0.001). Diet quality had a small, significant inverse association with BMI in both genders. The interaction effect between diet quality score and gender in predicting BMI was significant (p < 0.001), suggesting the impact of diet quality on BMI varies by gender, with lower diet quality more strongly associated with higher BMI in females compared to males.

CONCLUSION

Interventions that target young adults are needed to improve diet quality and its potential contribution to BMI status. As a result of the small observed effect sizes, caution should be applied in interpreting these findings.

A Cross-Sectional Study on the Association of Walnut Consumption with Obesity and Relative Fat Mass among United States Adolescents and Young Adults in NHANES (2003-2020)

Background

Walnuts contain nutrients and phytochemicals that can promote metabolic health. However, the high energy content of walnuts along with other nuts raises the concern that consuming nuts promotes obesity.

Objectives

We sought to investigate the associations between consumption of walnuts as well as other nuts and measures of obesity in adolescents and young adults.

Methods

This study included 8874 adolescents (12-19 y) and 10,323 young adults (20-39 y) from 8 waves of National Health and Nutrition Examination Survey data (2003-2020). The associations of consumption of 1) walnuts only (WO); 2) walnuts with other nuts (WON); 3) other nuts (ON); and 4) no nuts (NN) with obesity status and relative fat mass (RFM) were assessed using logistic and linear regressions stratified by age group and sex. Sample weights were used in all statistical analyses.

Results

The mean daily intake of walnuts was not different between the 2 walnut consumption groups within each age group (adolescents: 2.18 [standard error (SE) 0.14] g; P = 0.917; young adults: 4.23 [0.37] g; P = 0.682). The WON group had the lowest prevalence of obesity (adolescents: 8.3%; young adults: 21.1%) while the NN group had the highest prevalence (adolescents: 24.1%; young adults: 35.4%). The models indicated lower odds of obesity in adolescent girls (odds ratio [OR]: 0.27; P < 0.05) and young adult women (OR: 0.58; P < 0.05) who consumed WON than in those who consumed NN. In both young women and girls, RFM was significantly lower in the WON and ON groups than the NN group (P < 0.001). In young men, WON consumption was also associated with a lower RFM (OR: -1.24; 95% confidence interval: -2.21, -0.28) compared with NN consumption.

Conclusions

For adolescents girls and young women, dietary intake of walnuts combined with other nuts has the strongest inverse association with measures of obesity.

A latent profile analysis based on diet quality and eating behaviours in participants of the PREDISE study characterized by a higher BMI

The aim of this study was to identify eating-related latent profiles based on diet quality and eating behaviours within a population characterized by a body mass index (BMI) of at least 25 kg/m2, and to compare metabolic variables between profiles. This analysis was conducted in a sample of 614 adults (45.6% women; 44.8 ± 12.9 years) from the cross-sectional PREDISE study. Participants completed the Three-Factor Eating Questionnaire, the Intuitive Eating Scale-2, the Regulation of Eating Behavior Scale, and three self-administered 24 h food recalls. Waist circumference, blood lipids, blood pressure, and fasting glucose were measured to identify carriers of the metabolic syndrome. A latent profile analysis was performed, and cases of metabolic syndrome were compared between profiles. A three-profile solution was found. Profile 1 (22.8%) was characterized by lower diet quality, lower self-determined motivation for eating, lower restraint, and higher intuitive eating. Profile 2 (44.5%) was characterized by higher diet quality, higher self-determined motivation for eating, higher restraint, lower disinhibition, and higher intuitive eating. Profile 3 (32.7%) was characterized by intermediate diet quality, higher non-self-determined motivation for eating, higher restraint and disinhibition, and lower intuitive eating. We found fewer cases of metabolic syndrome among participants in profile 2 than in the other profiles (p = 0.0001). This study suggests that a profile characterized by a lower disinhibition and higher levels of restraint, intuitive eating, self-determined motivation, and diet quality is associated with a better metabolic health among individuals with a higher BMI.

Association of diet quality and body mass index in Mexican adults: a pseudo-panel analysis

Introduction

Introduction: most studies that analyze the relationship between diet quality and obesity have a cross-sectional design; an alternative with repeated cross-sectional data is a pseudo-panel design. Objective: to estimate the association between trends in dietary patterns, defined by a diet quality index, and body mass index (BMI) of Mexican adults between 2006 and 2016. Methodology: a pseudo-panel analysis was performed using data from cross-sectional surveys: National Health and Nutrition Surveys of Mexico (ENSANUTs) 2006 and 2012 and the Midway National Health and Nutrition Survey 2016 (ENSANUTMC). Cohorts (n = 108) were constructed by grouping adults 20-59 years old by sex (men n = 6,081 and women n = 11,404), education level, and year of birth. The association between diet quality (defined with the Healthy Eating Index-2015) and BMI was estimated using a fixed effects model, adjusting for sociodemographic characteristics. Results: a one-point increase in the proportion of women with high diet quality was associated with 4.1 points lower BMI (p = 0.014) compared with women with low diet quality when excluding sub-reporters of energy, the same association is observed when physical activity is included in the model. No association was found between diet quality and BMI in men, possibly because of the existence of latent classes within sociodemographic strata, therefore diet qualiy is inversely associated with BMI only in some categories of sociodemographic strata. Conclusions: these results contribute to the evidence in the longitudinal analysis between diet and BMI, highlighting the importance of differentiating the population by sex and sociodemographic characteristics. These results are input for public policy creation that promotes improving the quality of the population's diet as part of multisectoral strategies to reduce overweight and obesity in Mexican adults.

Association of dietary total antioxidant capacity with general and abdominal obesity in type 2 diabetes mellitus patients

BACKGROUND

The dual existence of Type 2 Diabetes Mellitus (T2DM) and obesity within a single individual may describe a combined adverse health effects, including impaired quality of life and increased risk for cardiovascular diseases (CVDs). Oxidative stress is a contributing factor to the pathogenesis of obesity. Meanwhile, dietary antioxidants may improve the antioxidant defense system and thereby decrease oxidative injury. Dietary total antioxidant capacity (TAC) is usually used to investigate the potential health effects of dietary antioxidant intake on several oxidative stress induced chronic diseases. This study aimed to examine the association of dietary TAC with obesity-related features in T2DM patients.

METHODS

The present study included 254 type 2 diabetes outpatients with a mean (SD) age of 54.52 (7.21) years and mean (SD) diabetes duration of 8.2 (6.4) years. Data on dietary intake was assessed using a validated food frequency questionnaire. Dietary TAC was estimated by ferric reducing antioxidant potential (FRAP) method. Anthropometric, clinical and lifestyle characteristics were all collected.

RESULTS

In linear regression analyses, dietary antioxidant capacity was inversely associated with body mass index (β = -0,231; 95% CI, -0,419 to -0,042), waist circumference (β = -0,427; 95% CI, -0,849 to -0,006) and fat mass percentage (β = -0,328; 95% CI, -0,545 to -0,112) independently of the assessed confounding variables. Interestingly, dietary TAC showed positive and significant associations with vitamin A, vitamin C, β-carotene, magnesium, folic acid and iron intakes, after adjusting for age and daily energy intake.

CONCLUSIONS

Higher intake of dietary TAC was in association with lower indices of general and central obesity in T2DM patients. Therefore, dietary recommendations for counteracting obesity in patients with T2DM should take into account a high dietary TAC.

Association of body mass index and waist circumference with long-term mortality risk in 10,370 coronary patients and potential modification by lifestyle and health determinants

BACKGROUND AND AIMS

Body adiposity is known to affect mortality risk in patients with coronary artery disease (CAD). We examined associations of body mass index (BMI) and waist circumference (WC) with long term mortality in Dutch CAD patients, and potential and effect modification of these associations by lifestyle and health determinants.

METHODS

10,370 CAD patients (mean age ∼65 y; 20% female; >80% on cardiovascular drugs) from the prospective Alpha Omega Cohort and Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease study were included. Cox models were used to estimate categorical and continuous associations (using restricted cubic splines) of measured BMI and WC with all-cause and cardiovascular mortality risk, adjusting for age, sex, smoking, alcohol, physical activity and educational level. Analyses were repeated in subgroups of lifestyle factors (smoking, physical activity, diet quality), education and health determinants (diabetes, self-rated health).

RESULTS

During ∼10 years of follow-up (91,947 person-years), 3,553 deaths occurred, including 1,620 from cardiovascular disease. U-shaped relationships were found for BMI and mortality risk, with the lowest risk for overweight patients (BMI ∼27 kg/m2). For obesity (BMI ≥30), the HR for all-cause mortality was 1.31 (95% CI: 1.11, 1.41) in male patients and 1.10 (95% CI: 0.92, 1.30) in female patients, compared to BMI 25-30 kg/m2. WC was also non-linearly associated with mortality, and HRs were 1.18 (95%CI:1.06, 1.30) in males and 1.31 (95%CI:1.05, 1.64) in females for the highest vs. middle category of WC. Results for cardiovascular mortality were mostly in line with the results for all-cause mortality. U-shaped associations were found in most subgroups, associations were moderately modified by physical activity, smoking and educational level.

CONCLUSIONS

CAD patients with obesity and a large WC were at increased risk of long-term CVD and all-cause mortality, while mildly overweight patients had the lowest risk. These associations were consistent across subgroups of patients with different lifestyles and health status.

Living with obesity in Ireland: determinants, policy and future perspectives

Globally, the prevalence of those living with obesity (≥30 kg/m2) is rising, with this trend expected to continue if firm and decisive policy interventions are not introduced. Across Europe, despite many consecutive policies aiming to reverse rising trends in weight status over recent decades, no country is currently on track to halt and reverse current trends in the coming years. This is evident in Ireland too, whereby the reporting of nationally representative weight status data show that targets have not been achieved since reporting began. The aim of this review is to critically appraise recent evidence relating to the key determinants of obesity including weight status, diet quality and physical activity with an emphasis on socioeconomic inequalities. And to consider these in the context of respective policy measures and propose future-focused recommendations. Furthermore, as with the complex nature of obesity, multifaceted approaches that shift the focus from the individual and place responsibility at a societal level will be reviewed.

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.

Association of healthy eating index and anthropometric indices among primary school girls in southeast of Iran: a cross-sectional study

BACKGROUND

The school-age period is marked by substantial advancements in physical and cognitive development, highlighting the importance of assessing the diet quality and its impact on body weight and height. The main objective of this study was to evaluate the association between diet quality and selected anthropometric indices of primary school girls in southeast of Iran using the healthy eating index-2015 (HEI-2015).

METHODS

This cross-sectional study involved 330 students aged 6-12 years from 10 primary schools in Kerman City. Standard protocols and a dish-based food frequency questionnaire were employed to evaluate anthropometric indices and dietary intake. The HEI-2015 was utilized to assess the quality of participants' diets, with a total score ranging from zero to 100, based on thirteen food score components.

RESULTS

In the present study, older participants had higher HEI scores (p = 0.02). Additionally, participants in the highest tertile of HEI score had greaterodds of being overweight (OR: 2.13; CI = 1.17-3.85, P = 0.011) and had higher intakes of whole fruits, total fruits including fruit juice, whole grains, total protein foods, seafood and plant proteins, greens, and beans (p < 0.05). However, no significant association was found between HEI score and other anthropometric indices, obesity, and thinness.

CONCLUSIONS

The study found no significant association between HEI scores and the likelihood of being thin or obese. However, children with the highest HEI scores were more likely to beoverweight. Therefore, it is recommended to implement health programs for primary school girls in Kerman to improve their eating habits and reduce the risk of overweight and obesity.

Diet quality and its associated factors among adults with overweight and obesity: findings from the 2015-2018 National Health and Nutrition Examination Survey

The rate of adult severe obesity has been continually rising in the USA. While improving diet quality has been shown to reduce the risk of obesity, few studies have explored the differences in diet quality among adults with overweight and obesity by different weight statuses along with socio-demographic factors and physical activity using data from a nationally representative survey in the USA. The main goal of the study is to assess the diet quality of adults with overweight and obesity by examining differences in the Healthy Eating Index-2015 (HEI-2015) scores, using data from the 2015-2018 National Health and Nutrition Survey. Among 6746 adults with overweight and obesity (aged ≥ 20 years), severe obesity was prevalent (27 %), particularly among females, non-Hispanic Blacks and those with lower education and income. Compared to adults with overweight, adults with severe obesity had lower HEI-2015 total scores as well as component scores for total fruits, whole fruits, greens and beans, refined grains, sodium and saturated fats. Among adults with overweight and obesity, non-Hispanic Blacks had lower diet quality than non-Hispanic Asians; females had better diet quality than males; older adults had better diet quality than younger adults; adults with a college degree and above had better diet quality than those with less than a high school degree. Socio-demographic differences in diet quality and weight status should be considered in future obesity interventions to reduce adult severe obesity in the USA.

Longitudinal analysis of the Alternative Healthy Eating Index-2010 and incident non-communicable diseases over 15 years in the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health

In studies that contain repeated measures of variables, longitudinal analysis accounting for time-varying covariates is one of the options. We aimed to explore longitudinal association between diet quality (DQ) and non-communicable diseases (NCDs). Participants from the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) were included, if they; responded to survey 3 (S3, 2003, aged 25-30 years) and at least one survey between survey 4 (S4, 2006) and survey 8 (S8, 2018), were free of NCDs at or before S3, and provided dietary data at S3 or S5. Outcomes were coronary heart disease (CHD), hypertension (HT), asthma, cancer (except skin cancer), diabetes mellitus (DM), depression and/or anxiety, and multimorbidity (MM). Longitudinal modelling using generalised estimation equation (GEE) approach with time-invariant (S4), time-varying (S4-S8) and lagged (S3-S7) covariates were performed. The mean (± standard deviation) of Alternative Healthy Eating Index-2010 (AHEI-2010) of participants (n = 8022) was 51·6 ± 11·0 (range: 19-91). Compared to women with the lowest DQ (AHEI-2010 quintile 1), those in quintile 5 had reduced odds of NCDs in time-invariant model (asthma: OR (95 % CI): 0·77 (0·62-0·96), time-varying model (HT: 0·71 (0·50-0·99); asthma: 0·62 (0·51-0·76); and MM: 0·75 (0·58-0·97) and lagged model (HT: 0·67 (0·49-0·91); and asthma: 0·70 (0·57-0·85). Temporal associations between diet and some NCDs were more prominent in lagged GEE analyses. Evidence of diet as NCD prevention in women aged 25-45 years is evolving, and more studies that consider different longitudinal analyses are needed.

Manganese and Sleep Outcomes in United States Adults: Results from the 2017-2020 National Health and Nutrition Examination Survey (NHANES)

BACKGROUND

Manganese (Mn) is an essential micronutrient, but inadequate or excess Mn intake can have a detrimental impact on human health. Despite the essentiality, little is known about the relationship between Mn and sleep.

OBJECTIVE

This study aimed to examine the relationship between blood Mn concentrations and sleep outcomes in US adults.

METHODS

This cross-sectional study used data on blood Mn and sleep from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) (n = 8356, age ≥18 y). Multivariable logistic regression was used to examine associations between quintiles of blood Mn concentrations and subjective sleep outcomes (short sleep duration, late sleep midpoint, trouble sleeping, and obstructive sleep apnea [OSA] symptoms), adjusting for age, gender, body mass index, race/ethnicity, income, smoking, inflammation-adjusted serum ferritin concentration (iron status), caffeine, and alcohol intake. Gender-stratified models were used due to interactions with gender.

RESULTS

The mean (SE) blood Mn concentration was 9.7 (0.1) μg/L in US adults. In males, a nonlinear association was noted in the relationship between blood Mn levels and short sleep duration on weekdays and weekends. The third Mn quintile (Q3) group had lower odds of short sleep duration (<7 h) on weekdays (odds ratio [OR]=0.6, 95% confidence interval [CI]: 0.4, 0.9) than the lowest Mn quintile (Q1, reference) after adjusting for covariates in males. The second Mn quintile (Q2) group had lower odds of late sleep midpoint on weekdays than Q1 (OR=0.6, 95% CI: 0.4, 0.8). In females, Q2 group had lower odds of OSA symptoms than Q1 (OR: 0.6, 95% CI: 0.4, 0.9). No relationship was noted between Mn and trouble sleeping.

CONCLUSIONS

Gender differences exist in the association between Mn and sleep in adults. Q1 group had the poorest sleep outcomes, including higher odds of short sleep duration (in males), late sleep midpoint (in males), and OSA symptoms (in females).

Role of Endogenous Opioids in the Pathophysiology of Obesity and Eating Disorders

This second chapter in our trilogy reviews and critically appraises the scientific evidence for the role of endogenous opioid system (EOS) activity in the onset and progression of both obesity and eating disorders. Defining features of normative eating and maladaptive eating behaviors are discussed as a foundation. We review the scientific literature pertaining to the predisposing risk factors and pathophysiology for obesity and eating disorders. Research targeting the association between obesity, disordered eating, and psychiatric comorbidities is reviewed. We conclude by discussing the involvement of endogenous opioids in neurobiological and behavior traits, and the clinical evidence for the role of the EOS in obesity and eating disorders.

Comparative analysis of the duodenojejunal microbiome with the oral and fecal microbiomes reveals its stronger association with obesity and nutrition

The intestinal microbiota is increasingly recognized as a crucial player in the development and maintenance of various chronic conditions, including obesity and associated metabolic diseases. While most research focuses on the fecal microbiota due to its easier accessibility, the small intestine, as a major site for nutrient sensing and absorption, warrants further investigation to determine its microbiota composition and functions. Here, we conducted a clinical research project in 30 age- and sex-matched participants with (n = 15) and without (n = 15) obesity. Duodenojejunal fluid was obtained by aspiration during endoscopy. Phenotyping included clinical variables related to metabolic status, lifestyle, and psychosocial factors using validated questionnaires. We performed metagenomic analyses of the oral, duodenojejunal, and fecal microbiome, alongside metabolomic data from duodenojejunal fluid and feces, integrating these data with clinical and lifestyle information. Our results highlight significant associations between duodenojejunal microbiota composition and usual dietary intake, as well as clinical phenotypes, with larger effect sizes than the associations between these variables and fecal microbiota. Notably, we found that the duodenojejunal microbiota of patients with obesity exhibited higher diversity and showed distinct differences in the abundance of several duodenojejunal microbiota species compared with individuals without obesity. Our findings support the relevance of studying the role of the small intestinal microbiota in the pathogenesis of nutrition-related diseases.

Association of dietary adherence and dietary quality with weight loss success among those following low-carbohydrate and low-fat diets: a secondary analysis of the DIETFITS randomized clinical trial

BACKGROUND

Eating a high-quality diet or adhering to a given dietary strategy may influence weight loss. However, these 2 factors have not been examined concurrently for those following macronutrient-limiting diets.

OBJECTIVE

To determine whether improvement in dietary quality, change in dietary macronutrient composition, or the combination of these factors is associated with differential weight loss when following a healthy low-carbohydrate (HLC) or healthy low-fat (HLF) diet.

DESIGN

Generally healthy adults were randomly assigned to HLC or HLF diets for 12 mo (n = 609) as part of a randomized controlled weight loss study. Participants with complete 24-h dietary recall data at baseline and 12-mo were included in this secondary analysis (total N = 448; N = 224 HLC, N = 224 HLF). Participants were divided into 4 subgroups according to 12-mo change in HEI-2010 score [above median = high quality (HQ) and below median = low quality (LQ)] and 12-mo change in macronutrient intake [below median = high adherence (HA) and above median = low adherence (LA) for net carbohydrate (g) or fat (g) for HLC and HLF, respectively]. Baseline to 12-mo changes in mean BMI were compared for those in HQ/HA, HQ/LA, LQ/HA subgroups with the LQ/LA subgroup within HLC and HLF.

RESULTS

For HLC, changes (95 % confidence level [CI]) in mean BMI were -1.15 kg/m2 (-2.04, -0.26) for HQ/HA, -0.30 (-1.22, 0.61) for HQ/LA, and -0.80 (-1.74, 0.14) for LQ/HA compared with the LQ/LA subgroup. For HLF, changes (95% CI) in mean BMI were -1.11kg/m2 (-2.10, -0.11) for HQ/HA, -0.26 (-1.26, 0.75) for HQ/LA, and -0.66 (-1.74, 0.41) for LQ/HA compared with the LQ/LA subgroup.

CONCLUSION

Within both HLC and HLF diet arms, 12-mo decrease in BMI was significantly greater in HQ/HA subgroups relative to LQ/LA subgroups. Neither HQ nor HA alone were significantly different than LQ/LA subgroups. Results of this analysis support the combination of dietary adherence and high-quality diets for weight loss.

CLINICAL TRIAL REGISTRY

clinicaltrials.gov (Identifier: NCT01826591).

Menu Calorie Label Use and Diet Quality: a Cross-Sectional Study

INTRODUCTION

Menu calorie labeling has been implemented in food service businesses to promote healthy food choices; however, evidence is limited on whether label use is associated with healthier dietary intake. This study examined the association between menu calorie label use and diet quality and whether it varied by weight status.

METHODS

Adults in the National Health and Nutrition Examination Survey 2017-2018 who visited restaurants were included. Menu calorie label use was categorized as did not notice labels, noticed labels, and used labels. Diet quality was measured using the Healthy Eating Index 2015 (maximum score 100) by two 24-hour diet recalls. The association between menu calorie label use and diet quality was examined using multiple linear regression and tested for effect modification by weight status. Data were collected during 2017-2018 and analyzed during 2022-2023.

RESULTS

Of 3,312 participants (representing 195,167,928 U.S. adults), 43% did not notice labels, 30% noticed labels, and 27% used labels. Using labels was associated with 4.0 points (95% CI 2.2, 5.8) higher Healthy Eating Index 2015 scores than not noticing labels. Healthy Eating Index 2015 scores in those using labels were higher for adults with normal BMI (3.4 points; 95% CI=0.2, 6.7), overweight (6.5 points; 95% CI=3.6, 9.5), and obesity (3.0 points; 95% CI=1.0, 5.1) (p-interaction=0.0004) than those who did not notice labels.

CONCLUSIONS

Using menu calorie labels was associated with modestly healthier diet quality than not noticing labels, regardless of weight status. This suggests that providing caloric information may help some adults with food decisions.

The association between food environment, diet quality and malnutrition in low- and middle-income adult populations across the rural-Urban gradient in Vietnam

BACKGROUND

Economic reforms and trade liberalisation in Vietnam have transformed the food environment, influencing dietary patterns and malnutrition status. The present study focuses on the relationship between food environments (proximity and density of food outlets) and malnutrition (underweight, overweight, obesity) through diet quality in adult populations across urban, periurban and rural areas of Vietnam.

METHODS

We evaluated food environment by geospatial mapping of food outlets through a transect walk across the "food ecosystem" from rural to urban areas. Diet quality was assessed using the Diet Quality Index - Vietnamese (DQI-V) comprising Variety, Adequacy, Moderation and Balance components. Malnutrition status was determined using body mass index. We performed a mediation analysis utilising mixed effect models to control for neighbourhood clustering effects. Confounders included age, education, income and nutrition knowledge score.

RESULTS

Analysis of data from 595 adult participants (mean ± SD age: 31.2 ± 6.4 years; 50% female) found that longer distance to the nearest food outlet was associated with higher overall DQI-V (β = 2.0; 95% confidence interval = 0.2-3.8; p = 0.036) and the Moderation component (β = 2.6; 95% confidence interval = 1.2-4.0; p = 0.001). Outlet density shows a negative association with the odds of underweight among women (odds ratio = 0.62; 95% confidence interval = 0.37-0.96). However, we did not observe statistically significant relationships between diet quality and malnutrition. Education and nutrition knowledge scores were positively associated with diet diversity, while income was negatively associated with diet moderation.

CONCLUSIONS

The findings of the present study have important implications for nutrition and dietetics practice in Vietnam and globally. It emphasises the need to consider various dimensions of sustainable diets, including economic, health and socio-cultural/political factors. Longer distances to food outlets are associated with higher diet quality, whereas lower food outlet density increases the odds of underweight among women. This poses challenges in balancing modernisation and its adverse effects on sustainable food systems. Socio-economic status consistently correlated with diet quality and malnutrition, necessitating further research to promote healthy diets across socio-economic strata.

Associations between dietary variety, portion size and body weight: prospective evidence from UK Biobank participants

'Dietary variety' has been identified as a factor associated with food intake. Whilst this relationship may have longer-term benefits for body weight management when eating low-energy, nutrient-dense foods, it may increase the risk of overconsumption (and body adiposity) when foods are high energy density. This study sought to further explore pathways underpinning the relationship between dietary variety and body weight, by considering energy density as a moderating factor and portion size as a mediating factor in this relationship. Using prospective data from the UK Biobank, dietary variety scores (DVS), cumulative portion size and energy density were derived from 24-h dietary recall questionnaires at baseline and follow-up. BMI, whole-body fat percentage and fat-free mass were included as outcomes. Contrary to predictions, linear multiple regression models found some evidence of a negative, direct association between DVS and body weight outcomes at baseline (b = -0·13). Though dietary variety was significantly associated with larger portions across time points (b = 41·86-82·64), a moderated mediation effect was not supported at baseline or follow-up (Index ≤ 0·035). Taken together, these findings provide population-level evidence to support a positive association between variety and food intake, which in turn has potential implications for body weight management, both in terms of moderating food intake and benefitting diet quality.

Longitudinal associations between diet quality, sedentary behaviours and physical activity and risk of overweight and obesity in preschool children: The ToyBox-study

BACKGROUND

Lifestyle behaviours related to diet and physical activity are associated with increased risk of obesity and evidence suggests that associations might be stronger when a synergetic effect is examined.

OBJECTIVE

To examine the cross-sectional and longitudinal associations between diet, screen time (ST) and step recommendations and risk of overweight and obesity in European preschoolers participating in the ToyBox-study.

METHODS

In this cluster-randomized clinical trial, 718 children (51.4% boys) from six European countries participated. Parents filled out questionnaires with information on socio-demographic status, step recommendations and ST.

RESULTS

Longitudinal results indicate that participants having a low Diet Quality Index (DQI), not meeting ST and step recommendations at T0 and T1 had higher odds of having overweight/obesity at T1 (odds ratio [OR] = 1.116; 95% confidence interval [CI] = 1.104-2.562) than those children having a high DQI and meeting ST and step recommendations at T0 and T1. Similarly, participants having a high DQI, but not meeting ST and step recommendations at T0 and T1 had increased odds of having overweight/obesity (OR = 2.515; 95% CI = 1.171-3.021).

CONCLUSIONS

The proportion of participants having a low DQI, not adhering to both step and ST recommendations was very high, and it was associated with a higher probability of having overweight and obesity.

The degree of food processing can influence serum fatty acid and lipid profiles in women with severe obesity

Background

The increase in the prevalence of obesity is associated with the increase in the consumption of ultra-processed foods and may be related to the increase in the disorders involving metabolism and the transport and storage of fatty acids.

Objective

To evaluate the effect of processed food consumption according to the degree of processing on the serum fatty acid levels and lipid profile of women with severe obesity.

Methods

This was a cross-sectional study. Data were collected from anthropometric assessments, the food frequency questionnaire (FFQ), and blood tests for lipidogram studies and serum fatty acid measurements. The foods consumed were identified through the FFQ and classified according to the degree of processing based on the NOVA rating, and the frequencies of consumption were transformed into scores, as proposed by Fornés methodology. Data were analyzed using IBM SPSS Statistics, version 21. The significance level for the analysis was set at 5%.

Results

This study included 44 women with a mean age of 40.59 years and mean body mass index of 48.61 kg/m2. An inverse association was observed between the consumption of unprocessed and the occurrence of hypertriglyceridemia (p = 0.021) and levels of triglycerides (p = 0.047), total cholesterol (p = 0.030), and very low-density lipoprotein-cholesterol (p = 0.039). The consumption of processed foods was positively associated with the presence of hypertriglyceridemia (p = 0.044) and omega 6/3 ratio (p = 0.001) and negatively associated with total omega 3 levels (p = 0.011). The consumption of processed foods was positively associated with total cholesterol (p = 0.041) and negatively associated with the omega 3/6 ratio (p = 0.001). A negative correlation was found between the average consumption of ultra-processed foods (at least once a week) and serum level of high-density lipoprotein (p = 0.035).

Conclusion

The consumption of processed and ultra-processed foods was associated with unfavorable lipid profiles and fatty acid levels in women with severe obesity. These results emphasize the importance of promoting the consumption of unprocessed food to mitigate metabolic disorders linked to processed food intake.

Psychometric Analysis of the Rapid Eating Assessment for Participants-Short Form to Evaluate Dietary Quality in a Pre-Surgical Bariatric Population

Dietary quality and eating behaviors are essential to evaluating bariatric surgery candidates. The Rapid Eating Assessment for Participants-Short Form (REAP-S) is a previously validated measure of dietary quality suited for use in primary care. This study aimed to evaluate the psychometric properties of the REAP-S in a pre-surgical bariatric population. This study included data from one academic medical center from August 2020 to August 2022. Variables included socio-demographics, the REAP-S, mental health, and assessments of appetitive traits. Statistical methods included Cronbach's alpha, confirmatory factor analysis (CFA), and multivariable analyses. A total of 587 adult patients were included in this analysis. The mean score for the REAP-S was 28.32 (SD: 4.02), indicative of relatively moderate dietary quality. The internal consistency of the REAP-S was moderate, with a Cronbach's alpha of 0.65. The three-factor CFA model resulted in a comparative fit index of 0.91. Race (p = 0.01), body mass index (p = 0.01), food fussiness (p < 0.0001), food responsiveness (p = 0.005), and socially desirable responses (p = 0.003) were significantly associated with the total REAP-S score. Although the REAP-S's original purpose was to assess dietary quality within a primary care population, it shows promise for application within a bariatric surgery-seeking population.

Prospective Associations between Dietary Patterns and Abdominal Obesity in Middle-Aged and Older Korean Adults

This study aimed to identify major dietary patterns associated with abdominal obesity in middle-aged and older Korean adults. Data from the Korean Genome and Epidemiology Study were used. A total of 48,037 Korean adults aged ≥40 years without abdominal obesity at baseline were followed-up. Dietary assessment was conducted using a validated 106-item food-frequency questionnaire, and dietary patterns were identified using factor analysis. Abdominal obesity was defined as a waist circumference of ≥90 cm for men and ≥85 cm for women, according to the Korean Society for the Study of Obesity. Multivariable Cox proportional-hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the future risk of abdominal obesity for each dietary pattern after adjusting for potential covariates. After an average follow-up of 4.89 years, we reported 5878 cases (1932 men and 3946 women) of abdominal obesity. Based on factor analysis, three major dietary patterns were identified in both men and women: the "healthy", "coffee and sweets", and "multi-grain" patterns. In the fully adjusted model, the "healthy" pattern was inversely associated with the incidence of abdominal obesity (HR for fourth vs. first quartile: 0.86; 95% CI: 0.75-0.98; p for trend = 0.0358 for men; HR for fourth vs. first quartile: 0.90; 95% CI: 0.83-0.99; p for trend = 0.0188 for women), whereas the "coffee and sweets" pattern was positively associated with it (HR for fourth vs. first quartile: 1.23; 95% CI: 1.08-1.40; p for trend = 0.0495 for men; HR for fourth vs. first quartile: 1.14; 95% CI: 1.04-1.25; p for trend = 0.0096 for women). In contrast, the "multi-grain" pattern in men and women showed no significant association with the incidence of abdominal obesity. Diets rich in colorful vegetables, seaweeds, mushrooms, tubers, fruits, soy products, and fish and low in coffee, sweets, and oils/fats might be favorable for reducing the future risk of abdominal obesity, particularly in middle-aged and older Korean adults.

The correlations between food security, diet quality and weight change among working women of reproductive age during the endemic phase of COVID-19

Aim

This cross-sectional study aims to investigate the correlations between food security, diet quality and weight change among working women during the endemic phase of COVID-19 in the Klang Valley of Malaysia.

Methods

Working women aged 18-49 years were required to self-report their socio-demographics and pre-pandemic body weight (body weight during February 2020). Body height and current body weight were measured using a SECA stadiometer and TANITA weighing scale. Food security was assessed using the Food Insecurity Experience Scale (FIES); the diet quality was determined with the Diet Quality Questionnaire (DQQ) for Malaysia.

Results

The prevalence of moderate-to-severe food insecurity was 19.9%. It is noted that 64.3% of working women gained weight throughout the pandemic, with an average weight gain of 4.36 ± 3.19 kg. Concerning diet quality, the majority (82.5%) achieved the Minimum Dietary Diversity for Women (MDD-W). Findings from linear regression revealed that food security was not significantly correlated with weight change. However, working women who failed to achieve the MDD-W gained, on average, 1.853 kg more than those who did (p = 0.040). On the other hand, no significant correlation was observed between food security status and diet quality in weight change of working women.

Conclusion

The current study shall provide an impetus to develop intervention strategies for promoting healthy eating among working women.

The relationship between diet and lifestyle behaviours in a sample of higher education students; a cross-sectional study

BACKGROUND & AIMS

Transitioning into higher education (HE) impacts health behaviours. Poor dietary and lifestyle behaviours may correlate and increase risk of co-morbidities. The introduction of the Okanagan Charter detailed the important role of health promotion within a HE setting. The aim of this study was to assess the relationship between dietary quality and lifestyle behaviours of students attending HE.

METHODS

Full-time students, aged 18+, were eligible to participate in this online cross-sectional study. Self-reported questions were asked in relation to demographics, body mass index (BMI), smoking, and COVID-19. A food frequency questionnaire measured dietary quality along with tools assessing alcohol use, sleep quality, perceived stress, and physical activity. Statistical analyses were performed using chi-square, one-way ANOVA, independent sample t-tests, Pearson's correlation, and multivariate linear regression.

RESULTS

Evidence of a correlation between poor diet quality and having a higher BMI (p = 0.040), higher alcohol consumption (p = <0.001), poorer sleep quality (p = 0.003), higher stress levels (p = 0.006) and smoking (p = 0.001) was found. Low fruit and vegetable consumption were associated with higher BMI (p = 0.013), higher alcohol consumption (p = <0.001), lower physical activity levels (p = 0.006), higher stress levels (p = <0.001), smoking (p = <0.001) and being male (p = 0.002).

CONCLUSIONS

This study provides data on the association between dietary quality and lifestyle behaviours among HE students and will inform healthy campus initiatives.

Association of main meal quality index with the odds of metabolic syndrome in Iranian adults: a cross-sectional study

BACKGROUND

Metabolic syndrome (MetS) is a common global issue linked to the quality of one's eating occasions. The current cross-sectional study evaluates the association between a novel index, the Main Meal Quality Index (MMQI), and MetS among Iranian adults.

METHODS

A total of 824 men and women were recruited, and a 24-hour dietary recall assessed the dietary intake of the participants. Lunch was selected as the main meal based on energy density. The MMQI score was calculated based on ten components of dietary intake, with a higher score indicating more adherence to the index, with the final scores ranging from 0 to 100 points. The associations were assessed using binary logistic regression.

RESULTS

The mean age was 42.2 years and the range of the calculated MMQI was 22 to 86 (mean in total participants: 56.62, mean in women: 56.82, mean in men: 55.64). The total prevalence of MetS in the sample was 34%. After adjustments for potential confounders, the participants at the top quartile of MMQI had a lower odds ratio for hypertriglyceridemia and low high-density lipoprotein (HDL) level, and a higher odds ratio for hypertension, hyperglycemia, abdominal obesity, and MetS. The sex-specific analysis also did not show any significant associations between adherence to MMQI and MetS and its components.

CONCLUSION

Overall, MMQI is not associated with MetS and its components in a sample of Iranian men and women. More research is needed to examine MMQI and its possible association with current health-related problems including MetS.

Effectiveness of diet quality indices in measuring a change in diet quality over time: a systematic review and meta-analysis of randomized controlled trials

CONTEXT

Diet quality indices (DQIs) were developed to score and rank adherence to dietary patterns in observational studies, but their use to measure changes in diet quality in intervention trials is becoming common in the literature.

OBJECTIVE

This systematic review and meta-analysis aimed to assess the effectiveness of DQIs to measure change in diet quality in intervention trials.

DATA SOURCES

MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials databases were searched from January 1994 to June 2020. Two reviewers independently completed full-text screening. Eligible studies were randomized controlled trials that used validated a priori DQIs to measure change in diet quality in adults.

DATA EXTRACTION

Data were extracted by an independent reviewer and reviewed by the research team. Risk of bias was assessed by the Cochrane Collaboration's Risk of Bias 2.0 tool.

DATA ANALYSIS

The 34 included studies (52% of reviewed studies, 0.6% of initially identified studies) used 10 different DQIs, 7 of which were able to measure significant change in diet quality. Meta-analyses of pooled results demonstrated change in the Healthy Eating Index (MD 5.35; 95%CI, 2.74-7.97; P < 0.001) and the Mediterranean Dietary Adherence Screener (MD 1.61; 95%CI, 1.00-2.23; P < 0.001) scores. DQIs were more likely to measure change in diet quality if they reflected the diet pattern being implemented, if the intervention was significantly different from the baseline and control diets, and if the study was adequately powered to detect change.

CONCLUSION

DQIs are responsive to change in diet quality in intervention trials when the index used reflects the dietary changes made and the study is adequately powered. The appropriate selection of a DQI to suitably match dietary changes and study populations is important for future dietary intervention trials.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020181357.

Perceived challenges and strategies to achieve Canada's Food Guide recommendation to "Cook more often": Findings from parents of young children

Unhealthy diets are detrimental to health, but home meal preparation is associated with better diet quality. Among a sample of parents of children aged 2-12, this study aimed to 1) explore perceived challenges and strategies to meeting the 2019 Canada's Food Guide recommendation of "Cook more often". From October 2019 to January 2020, 8 focus groups were conducted with 40 parents (73% mothers; 78% white) from Southwestern Ontario, Canada. Sessions were audio-recorded and transcribed verbatim. A hybrid thematic approach with inductive and deductive data analysis was used. Reported challenges included time constraints, picky eating, lacking cooking skills, high price of some fresh ingredients, school restrictions on meals at school, and the influence of children's peers on food choices, mainly unhealthy snacks. Reported strategies to mitigate some challenges included planning and preparing meals ahead of time, using technology or services to make meal planning and grocery shopping more convenient, using devices and kitchen instruments, such as Crockpot®, to make cooking faster, receiving help from spouse or child(ren), and acknowledging that foods perceived as less healthful in moderation can be included in meal preparation. These findings can help inform interventions and educational campaigns to support cooking among families with young children.

Adaptation and Validation of the Well-Being Related to Food Questionnaire (Well-BFQ©) for the French-Speaking General Adult Population of Québec, Canada

Efforts to develop effective strategies that improve dietary intake are needed; however, this improvement in diet quality must not be at the expense of well-being. The Well-Being related to Food Questionnaire (Well-BFQ©) is a tool that has been developed in France to comprehensively measure food well-being. Even though the same language is spoken in France and in Québec, cultural and linguistic differences are present, which supports the importance of adapting and validating this tool before its use in the Québec population. This study aimed to adapt and validate the Well-BFQ© for the French-speaking general adult population of Québec, Canada. The Well-BFQ© underwent a full linguistic adaptation process, including an expert panel adaptation step, a pretest among 30 French-speaking adult (18-65 years) Quebecers, and a final proofreading. The questionnaire was thereafter administered to 203 French-speaking adult Quebecers (49.3% females, M_AGE = 34.9, SD = 13.5; 88.2% Caucasians; 54.2% with a university degree). The exploratory factor analysis showed a two-factor structure: (1) food well-being related to physical and psychological health (27 items) and (2) food well-being related to symbolic/pleasure of food (32 items). Internal consistency was adequate, with a Cronbach's α of 0.92 and 0.93, respectively, for the subscales, and 0.94 for the total scale. The total food well-being score, as well as the two subscale scores, were associated with psychological and eating-related variables in expected directions. Overall, the adapted version of the Well-BFQ© was found to be a valid instrument to measure food well-being in the French-speaking general adult population of Québec, Canada.

Holistic Framework to Contextualize Dietary Quality Assessment: A Critical Review

Numerous dietary quality indices exist to help quantify overall dietary intake and behaviors associated with positive health outcomes. Most indices focus solely on biomedical factors and nutrient or food intake, and exclude the influence of important social and environmental factors associated with dietary intake. Using the Diet Quality Index- International as one sample index to illustrate our proposed holistic conceptual framework, this critical review seeks to elucidate potential adaptations to dietary quality assessment by considering-in parallel-biomedical, environmental, and social factors. Considering these factors would add context to dietary quality assessment, influencing post-assessment recommendations for use across various populations and circumstances. Additionally, individual and population-level evidence-based practices could be informed by contextual social and environmental factors that influence dietary quality to provide more relevant, reasonable, and beneficial nutritional recommendations.

The Mediating Effect of Central Obesity on the Association between Dietary Quality, Dietary Inflammation Level and Low-Grade Inflammation-Related Serum Inflammatory Markers in Adults

To date, few studies have explored the role of central obesity on the association between diet quality, measured by the health eating index (HEI), inflammatory eating index (DII), and low-grade inflammation-related serum inflammatory markers. In this paper, we use the data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES) to explore this. Dietary intakes were measured during two 24-h dietary recall interviews and using USDA Food Pattern Equivalence Database (FPED) dietary data. Serum inflammatory markers were obtained from NHANES Laboratory Data. Generalized structural equation models (GSEMs) were used to explore the mediating relationship. Central obesity plays a significant mediating role in the association between HEI-2015 and high-sensitivity C-reactive protein (hs-CRP), mediating 26.87% of the associations between the two; it also mediates 15.24% of the associations between DII and hs-CRP. Central obesity plays a mediating role in 13.98% of the associations between HEI-2015 and white blood cells (WBC); it also mediates 10.83% of the associations between DII and WBC. Our study suggests that central obesity plays a mediating role in the association of dietary quality with low-grade inflammation-related serum inflammatory markers (hs-CRP and WBC).

The Chain-Mediating Effect of Obesity, Depressive Symptoms on the Association between Dietary Quality and Cardiovascular Disease Risk

In order to explore the relationship between the Healthy Eating Index (HEI-2015) and cardiovascular disease (CVD), and the mediating role of obesity and depressive symptoms, we used the data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) for further study. A total of 12,644 participants were included in the study. The HEI was derived using NHANES personal food data and USDA Food Pattern Equivalence Database (FPED) dietary data. The risk of cardiovascular disease was determined using the Framingham Heart Study's multifactorial calculation tool. The weighted multiple logistic regression model was used to explore the association between the HEI-2015 and CVD, and the generalized structural equation was used to explore the mediating effects of obesity and depression, respectively and jointly. Higher HEI-2015 scores were associated with a lower risk of CVD compared to lower quartiles. Obesity, depressive symptoms, and their chain effects all played significant mediating roles in the association between the HEI-2015 and CVD, with proportional mediations of 9.03%, 2.23% and 0.25%, respectively. Our results suggest that higher dietary quality is associated with a lower risk of CVD, mediated by obesity, depressive symptoms, and the chain effect of obesity and depressive symptoms.

Development of the Ethiopian Healthy Eating Index (Et-HEI) and evaluation in women of reproductive age

Ethiopia announced its first food-based dietary guidelines (FBDGs) on 15 March 2022. The present study aims to develop and evaluate the Ethiopian Healthy Eating Index (Et-HEI) based on the FBDG. Data were collected from 494 Ethiopian women of reproductive age sampled from households in five different regions. The Et-HEI consists of eleven components, and each component was scored between 0 and 10 points, the total score ranging from 0 to 110, with maximum adherence to the FBDG. The Et-HEI score was evaluated against the Minimum Dietary Diversity for Women (MDD-W) and the probability of nutrient adequacy. The average Et-HEI score for women of reproductive age was 49 out of 110. Adherence to the recommendations for grains, vegetables, legumes, fat and oils, salt, sugar and alcohol contributed the most to this score. Most women had low scores for fruits, nuts and seeds, and animal-sourced foods, indicating low intake. The Cronbach's alpha coefficient, indicating the reliability of the Et-HEI to assess its diet quality, was 0⋅53. The low mean Et-HEI score agreed with a low mean score of the MDD-W (3⋅5 out of 10). Also, low nutrient adequacies confirmed poor adherence to nutrient-dense components of the FBDG. The Et-HEI was not associated with the intake of vitamin B12, vitamin C and calcium in this study population. Women who completed secondary school and above had relatively lower Et-HEI scores. The newly developed Et-HEI is able to estimate nutrient adequacy while also assessing adherence to the Ethiopian FBDG though there is room for improvement.

Short Mediterranean diet screener detects risk of prediabetes in Taiwan, a cross-sectional study

We aimed to determine whether the 14-item Mediterranean diet adherence screener (MEDAS) is suitable in Taiwan and associate the MEDAS score with the risk of prediabetes. In this cross-sectional study 346 patients were recruited between 2014 and 2019 at Taipei Tzu Chi Hospital. The MEDAS score was obtained with a 14-item MEDAS used in the PREDIMED trial. The blood glucose level is measured by fasting glucose and HbA1c. The results of the screener were analyzed for internal consistency and compared with the blood glucose level using multivariate regression models. The MEDAS score was significantly (p = 0.001) and inversely associated with both measures of blood glucose level. Adjusted data (95% CI) showed that each additional point in the MEDAS score decreases the risk of prediabetes with abnormal fasting glucose (> 100 mg/dL) level by 60% and the risk of prediabetes with abnormal HbA1c (> 5.7%) by 22.4%. Consuming at least 3 servings of legumes each week was significantly (p = 0.007) related to a lower risk of prediabetes under logistic regression. A higher score on the 14-item MEDAS screener was significantly associated with a lower risk of prediabetes.

Healthy Eating Index-2015 in relation to risk of metabolic dysfunction-associated fatty liver disease among US population: National Health and Nutrition Examination Survey 2017-2018

Background

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a serious chronic disease in the US. Dietary patterns provide good guidance for the prevention of chronic diseases. The Healthy Eating Index (HEI-2015) is a dietary pattern based on the dietary characteristics of the US.

Objective

Since the relation between HEI-2015 and MAFLD is unclear, this study examined their associations using the US National Health and Nutrition Examination Surveys (NHAENS) during 2017-2018.

Methods

This study included data from 4,062 participants aged ≥20 years, without viral hepatitis or pregnancy. MAFLD is defined as hepatic steatosis with one or more of the following: (1) overweight or obesity (body mass index ≥25 kg/m²); (2) type 2 diabetes; or (3) two or more other metabolic risk abnormalities. HEI-2015 scores were calculated from food intake information collected by the 24-h meal review method. The relationship of HEI-2015 with MAFLD was calculated using survey-weighted logistic regression analysis after adjusting for sex, age, race, education level, smoking status, alcohol use, levels of C-reactive protein, Aspartate Aminotransferase, Alanine Aminotransferase, a body shape index, minutes of sedentary activity, levels of cholesterol and glucose, energy take, drugs use, hypertension, and diabetes.

Results

When compared to the study population with no MAFLD, the patients with MAFLD showed a lower weighted mean HEI (48.0 ± 0.6). HEI-2015 was inversely associated with MAFLD in the fully adjusted model [Q4 vs. Q1, OR = 0.567 (0.407-0.790), P = -0.002]. Among the 13 HEI-2015 components, total vegetables, greens and beans, total fruits, whole fruits, and whole grains were negatively associated with MAFLD, while added sugars were positively associated with MAFLD. This inverse association was consistent in subgroups of the participants stratified by sex, age, education level, race, body shape index, minutes of sedentary activity, hypertension, and diabetes.

Conclusion

A higher HEI-2015 is associated with a lowered risk of MAFLD which is more obvious among participations who were women, young, Mexican Americans, with higher education, and with no hypertension or diabetes.

Dietary patterns derived using principal component analysis and associations with sociodemographic characteristics and overweight and obesity: A cross-sectional analysis of Iranian adults

Introduction

This study examined the cross-sectional association between household dietary patterns and sociodemographic characteristics and BMI in a nationally representative sample of Iranian adults.

Methods

Data on 6,833 households (n = 17,824 adults) from the National Comprehensive Study on Household Food Consumption Pattern and Nutritional Status 2001-2003 were used. Principal component analysis (PCA) was used to extract dietary patterns from three household 24-h dietary recalls. Linear regression analyses were used to examine associations between dietary patterns and sociodemographic characteristics and BMI.

Results

Three dietary patterns were identified: the first was characterized by high citrus fruit intake, the second by high hydrogenated fats intake and the third by high non-leafy vegetables intake. The first and third patterns were associated with household heads with higher education and living in urban areas, while the second was associated with household heads with lower education and living in rural areas. All dietary patterns were positively associated with BMI. The strongest association was found with the first dietary pattern (β: 0.49, 95% CI: 0.43, 0.55).

Discussion

While all three dietary patterns were positively associated with BMI, the sociodemographic characteristics of Iranian adults who consumed them differed. These findings inform the design of population-level dietary interventions to address rising obesity rates in Iran.