Lower Healthy Eating Index-2005 dietary quality scores in older women with rheumatoid arthritis v. healthy controls

Arthritis is associated with high nutritional risk among older Canadian adults from the Canadian Longitudinal Study on Aging

This study assessed the association between arthritis, functional impairment, and nutritional risk (NR). Cross-sectional data were from the Canadian Longitudinal Study on Aging, a nationally representative sample of 45-85-year-old community-dwelling Canadians (n = 41,153). The abbreviated Seniors in the Community: Risk Evaluating for Eating and Nutrition II (SCREEN II-AB) Questionnaire determined NR scores (continuous), and high NR (score < 38); the Older American Resources and Services scale measured functional impairment. NR scores and status (low/high) were modelled using multiple linear and logistic regressions, respectively. Analyses adjusted for demographic characteristics, functional impairment, and health (body mass index, self-rated general and mental health). Additional analyses stratified the models by functional impairment. People with arthritis had poorer NR scores (B: - 0.35, CI - 0.48, - 0.22; p < 0.05) and increased risks of high NR (OR 1.11, 95% CI 1.06, 1.17). Among those with functional impairment, the likelihood of high NR was 31% higher in people with arthritis compared to those without arthritis (95% CI 1.12, 1.53). Among those with no functional impairment, the likelihood of high NR was 10% higher in people with arthritis compared to those without (95% CI 1.04, 1.16). These relationships differed based on the type of arthritis. Arthritis is associated with high NR in community-dwelling older adults, both with and without functional impairment. Findings highlight the need for further research on these relationships to inform interventions and improve clinical practices.

Diets and Joint Symptoms: A Survey of Moroccan Patients With Chronic Inflammatory Rheumatic Disease

Introduction The role of diet in the onset or aggravation of chronic diseases, especially chronic inflammatory rheumatic disease (CIRD), such as rheumatoid arthritis (RA) or spondyloarthritis (SpA), is a question frequently asked by patients. Our study aims to investigate whether Moroccan patients report a relationship between certain diets and disease symptoms and to study whether patients adopt specific dietary behaviours in order to relieve their symptoms. Methods This is a cross-sectional survey that included all patients followed for CIRD. The questionnaire has three parts, patients' sociodemographic and clinical data, patients' beliefs and attitudes regarding diet in relation to their joint symptoms, and a list of 24 foods for which patients were asked to indicate whether they aggravate, improve, or leave their joint symptoms unchanged. Results Thirty-four percent of the patients reported that the food had an effect on their symptoms, with 25% of them reporting an aggravation. Honey, garlic, and olive oil were the foods most often reported to improve joint symptoms, while red meat, fish, and legumes were most often reported to worsen symptoms. Age and type of rheumatism were factors associated with reporting that food affects joint symptoms. Twenty-three percent of the patients stated that they had already had discussions about diet with their rheumatologists, while 85.7% showed interest in such discussions. Experience with a food that improves joint symptoms was the only factor associated with discussing the diet with a rheumatologist. Conclusion Nearly one-third of the patients with CIRD reported an effect of diet on their joint symptoms.

Diet-derived circulating antioxidants and risk of knee osteoarthritis, hip osteoarthritis and rheumatoid arthritis: a two-sample Mendelian randomization study

Objective

To examine the causal associations of diet-derived circulating antioxidants with knee osteoarthritis (OA), hip OA, and rheumatoid arthritis (RA) within the two-sample Mendelian randomization (MR) framework.

Method

Independent single-nucleotide polymorphisms (SNPs) significantly associated with circulating levels of diet-derived antioxidants (retinol, β-carotene, lycopene, vitamin C and vitamin E) were extracted as genetic instruments. Summary statistics of genetic instruments associated with knee OA, hip OA, and RA were obtained from corresponding genome-wide association studies (GWASs). The inverse-variance weighted (IVW) was applied as the primary analysis method, with four sensitivity analysis approaches employed to evaluate the robustness of the primary results.

Results

Genetically determined per unit increment of absolute circulating levels of retinol was significantly associated with a reduced risk of hip OA [odds ratio (OR) = 0.45, 95% confidence interval (CI) 0.26-0.78, p = 4.43 × 10^-3], while genetically determined per unit increase in absolute circulating levels of β-carotene was suggestively associated with increased risk of RA (OR = 1.32, 95% CI 1.07-1.62, p = 9.10 × 10^-3). No other causal association was found. Significant evidence for heterogeneity and pleiotropic outlier was only identified when absolute circulating vitamin C was evaluated as the exposure, whereas all sensitive analysis provided consistently non-significant results.

Conclusion

Our results demonstrated that genetically determined lifelong higher exposure to absolute circulating levels of retinol is associated with a decreased risk of hip OA. Further MR study with more genetic instruments for absolute circulating levels of antioxidants are needed to confirm our results.

Dietary fiber intake associated with risk of rheumatoid arthritis among U.S. adults: NHANES 2010-2020

Rheumatoid arthritis (RA) is a prevalent inflammatory joint disease that imposes a significant medical burden and morbidity. Recent scientific evidence suggests that dietary components and patterns could be associated with RA risk. In this study, we aim to investigate the possible relationship between dietary fiber intake and RA risk. We included 15,114 participants from the 2010 to 2020 National Health and Nutrition Examination Survey database in our study. Participants aged 20 or above were categorized into those with and without RA. Univariate logistic regression analysis and multivariate regression models were used to test the association between dietary fiber intake, high-sensitivity C-reactive protein, and RA. Out of all the participants, 1053 were diagnosed with RA (6.97%). Multivariate logistic regression analysis indicated that fiber intake was negatively associated with high-sensitivity c-reactive protein (-0.09 [-0.18, -0.02]) and RA risk (0.99 [0.98, 0.99]). Furthermore, our sensitivity analysis suggested that individuals with higher fiber intake (>19.1 g/day) had a 25% lower risk of developing RA than those with lower fiber intake [0.75 (0.63, 0.88)]. Our findings suggest that higher dietary fiber intake is associated with a reduced risk of RA and may help reduce systemic inflammation, thereby potentially slowing down RA progression.

Mediterranean Diet and Physical Activity Nudges versus Usual Care in Women with Rheumatoid Arthritis: Results from the MADEIRA Randomized Controlled Trial

In rheumatoid arthritis (RA), diet quality and nutritional status have been shown to impact the disease activity and adherence to the Mediterranean diet (MD) has been suggested as an anti-inflammatory regime to improve disease status and reduce cardiovascular risk. The Mediterranean DiEt In Rheumatoid Arthritis (MADEIRA) was a single-blind (statistician), two-arm randomized clinical trial, investigating the effects of a 12-week lifestyle intervention, including a personalized isocaloric MD plan with the promotion of physical activity (PA), supported through a clinical decision support systems (CDSS) platform, versus usual care in women with RA. Forty adult women with RA on remission were randomly allocated (1:1 ratio) to either the intervention or the control arm. The intervention group received personalized MD plans and lifestyle consultation on improving PA levels, whereas the controls were given generic dietary and PA advice, based on the National Dietary Guidelines. The primary outcome was that the difference in the MD adherence and secondary outcomes included change in disease activity (DAS28), anthropometric indices (BodPod), dietary intake, PA, vitamin D concentrations, and blood lipid profiles after 12 weeks from the initiation of the trial. At 3 months post-baseline, participants in the MD arm exhibited greater adherence to the MD compared with the controls (p < 0.001), lower DAS28 (p < 0.001), favorable improvements in dietary intake (p = 0.001), PA (p = 0.002), body weight and body composition (p < 0.001), blood glucose (p = 0.005), and serum 1,25(OH)₂D concentrations (p < 0.001). The delivery of the MD and PA promotion through CDSS nudges in women with RA in an intensive manner improves the MD adherence and is associated with beneficial results regarding disease activity and cardiometabolic-related outcomes, compared with the usual care.

Dietary inflammatory index and healthy eating index-2015 are associated with rheumatoid arthritis

OBJECTIVE

Many arthritic patients have the belief that dietary habits can worsen or ameliorate their symptoms. Whether diet quality can modify the risk of rheumatoid arthritis (RA) is an issue of continued scientific debate and interest. Therefore, we aimed to examine the association between both overall diet quality and the overall diet inflammatory potential on the risk of RA.

DESIGN

Overall diet quality and the overall inflammatory potential of the diet were evaluated with the use of Dietary Inflammatory Index (DII) and the Healthy Eating Index (HEI)-2015, respectively. Both DII and HEI-2015 scores were calculated based on a validated semi-quantitative FFQ. Multivariable-adjusted odds of RA were calculated across tertiles of HEI, and energy-adjusted DII (E-DII) scores using binary logistic regression.

SETTING

Mashhad, Iran.

PARTICIPANTS

Fifty newly diagnosed RA cases and 100 well-matched healthy people controls.

RESULTS

Individuals in the highest tertile of DII scores, indicating the most pro-inflammatory diet, were about three times more likely to have RA than those in the lowest tertile (OR: 2·99; 95 % CI 1·08, 8·24; P-trend: 0·037), whereas individuals in the highest tertile of HEI scores, indicating more top dietary quality, had a significantly lower odds of RA than those in the lowest tertile (OR: 0·33; 95 % CI 0·12, 0·87; P-trend: 0·024).

CONCLUSIONS

Our findings show that E-DII and HEI-2015 are positively and negatively associated, respectively, with the odds of RA in a convenience sample of Iranians. These results highlight the importance of overall diet quality in modulating the risk of RA.

Diet quality and disease activity in rheumatoid arthritis

Objective:This study examined associations between diet quality and disease activity in adults with rheumatoid arthritis (RA). Perceived stress was also compared to diet and disease activity. Methods: In a cross-sectional design, 50 adults with RA were recruited. The Arizona Food Frequency Questionnaire was used to measure dietary intake (four weeks) and diet quality scores were calculated with the Healthy Eating Index - 2015. Perceived stress was measured with the Perceived Stress Scale. Disease activity was measured with the Health Assessment Questionnaire-Disability Index and Pain Scale, erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein, and Disease Activity Score Including 28 Joints-ESR. Results: Diet quality (56; SD ± 12) in participants was lower than the national mean (59). Age (p = 0.015) and gender (p = 0.003) were associated with higher diet quality. The belief that diet affects RA disease activity was reported by 44% of the participants, and these participants were significantly more likely to report dietary changes (p < 0.0001). Higher educational level (at least some college) was associated with this belief (B = -1.535, p = 0.023). Participants with lower diet quality also had significantly higher pain (B = -0.396, p = 0.022) and ESR scores (p = 0.019). Women were more likely to have higher HAQ-DI scores (B = 0.570, p = 0.001). Perceived stress was significantly associated with HAQ-DI and pain scores (B = 0.445, p = 0.001 and B = 0.289, p = 0.042, respectively). Medical cannabis was reportedly used by 8% of participants. Conclusion: In RA patients, lower diet quality may be associated with more pain and inflammation, and perceived stress may be associated with higher disability and disease activity.

Age- and sex-matched comparison of diet quality in patients with heart failure to similarly aged healthy older adults

The aims of this study were to (1) compare diet quality between patients with heart failure (HF) and age- and sex-matched community-dwelling healthy older adults and (2) determine whether having HF was associated with a lower Healthy Eating Index-2015 (HEI-2015) score and risk of micronutrient deficiency. The HEI-2015 and macro- and micronutrient intakes of patients with HF were compared with healthy older adults (N 102; 55-92 years old; 53 % female). A paired t-test or Wilcoxon singed-rank test, McNemar's test, and conditional logistic regression were used to assess the association between diet quality and HF status. Median values for HEI-2015 and the number of micronutrient deficiency were used to dichotomise into groups in the conditional logistic regression. There was no significant between-group difference in the HEI-2015 total score (P 0⋅059), whereas the whole grain component was lower in patients with HF than in healthy older adults (3⋅1 ± 3⋅5 v. 4⋅5 ± 3⋅1, P 0⋅037; respectively). Total caloric intake was lower in patients with HF than in healthy older adults (1683 ± 595 v. 2104 ± 670 kcal; P < 0⋅001). Patients with HF had a higher average number of micronutrient deficiencies than healthy older adults (4[2, 6] v. 1[0, 4], respectively, P < 0⋅001). Patients with HF had four times higher odds of being in a high micronutrient deficiency group than healthy older adults, controlling for socio-demographics and body mass index (adjusted odds ratio [95 % confidence interval]: 4⋅04[1⋅06, 15⋅41]). Our findings demonstrate that diet quality measured by nutritional intake identifies patients with HF with lower caloric intake and higher micronutrient deficiencies compared with age- and sex-matched healthy older adults.

The Relationship Between the Healthy Diet Index, Chronic Diseases, Obesity and Lifestyle Risk Factors Among Adults in Kaunas City, Lithuania

A healthy and balanced diet is an important factor contributing to overall health and wellness. The aim of this study was to develop a Healthy Diet Index (HDI) score and assess its association with various chronic diseases and lifestyle risk factors. A cross-sectional survey included 1,111 adults aged 18 years and older. Information on dietary habits was collected using a questionnaire. Additional demographic, socioeconomic and lifestyle risk factors data were also collected. Sixteen food groups were used to develop the HDI score for the residents of Kaunas city, Lithuania based on the national recommendations, World Health Organization (WHO) and other guidance on a healthy diet. We used logistic regression models to assess the association of the HDI score with chronic diseases, obesity and lifestyle risk factors. We found that both males and females were lacking the optimal consumption of the base components of a healthy diet-fruits and vegetables, starchy carbohydrates, and proteins. We also observed significant associations between the HDI score and several outcomes such as hypertension, arrhythmia, physical activity, and obesity. The suggested HDI score could serve as a valuable tool in assessing and improving dietary habits beneficial for promoting health and preventing many diseases.

Dietary Quality Associated with Self-Reported Diabetes, Osteoarthritis, and Rheumatoid Arthritis among Younger and Older US Adults: A Cross-Sectional Study Using NHANES 2011-2016

Background: To date, few studies have compared the dietary quality of US adults with diabetes mellitus (DM), osteoarthritis (OA), and rheumatoid arthritis (RA) by age groups. Methods: This study used cross-sectional data from adult participants from National Health and Nutrition Examination Survey 2011–2016 to identify dietary quality measured by Healthy Eating Index (HEI)-2015 total and component scores and self-reported disease status for DM, OA, and RA. Associations between the disease status and HEI-2015 total/component scores among younger adults aged 20–59 years (n = 7988) and older adults aged 60 years and older (n = 3780) were examined using logistic regression models. These accounted for the complex survey design and were adjusted for self-reported disease status, sex, race/ethnicity, education levels, income status, weight status, physical activity levels, and smoking status. Results: Among younger adults, 7% had DM, 7% had OA, and 3% had RA. Among older adults, 20% had DM, 32% had OA, and 6% had RA. Moderate added sugar intake was associated with diabetes in all adults. Excess sodium intake was associated with DM among younger adults. Inadequate seafood and plant protein intake was associated with RA among younger adults, while a poor overall dietary pattern was associated with RA among older adults. Conclusions: The dietary quality of US adults varied by self-reported DM, OA, and RA status, and each varied by age group.

The Relevance of Selenium Status in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease that can cause joint damage. Among the environmental risk factors, diet plays an important role because it can aggravate or attenuate inflammation. Selenium (Se) is considered an essential trace element since it is a structural component of antioxidant enzymes; however, its concentration can be affected by diet, drugs and genetic polymorphisms. Studies have reported that RA patients have a deficient diet in some food groups that is associated with parameters of disease activity. Furthermore, it has been shown that there is an alteration in serum Se levels in this population. Although some clinical trials have been conducted in the past to analyze the effect of Se supplementation in RA, no significant results were obtained. Contrastingly, experimental studies that have evaluated the effect of novel Se nanoparticles in RA-induced models have shown promising results on the restoration of antioxidant enzyme levels. In particular, glutathione peroxidase (GPx) is an important selenoprotein that could have a modulating effect on inflammation in RA. Considering that RA patients present an inflammatory and oxidative state, the aim of this review is to give an overview of the current knowledge about the relevance of Se status in RA.

Ideal food pyramid for patients with rheumatoid arthritis: A narrative review

Emerging literature suggests that diet plays an important modulatory role in rheumatoid arthritis (RA) because diet is an environmental factor that affects inflammation, antigen presentation, antioxidant defense mechanisms and gut microbiota. Patients with RA frequently ask their doctors about which diets to follow, and even in the absence of advice from their physicians, many patients are undertaking various dietary interventions. Given this background, the aim of this review is to evaluate the evidence to date regarding the ideal dietary approach for management of RA in order to reduce the counteracting inflammation, and to construct a food pyramid for patients with RA. The pyramid shows that carbohydrates should be consumed every day (3 portions of whole grains, preferably gluten free), together with fruits and vegetables (5 portions; among which fruit, berries and citrus fruit are to be preferred, and among the vegetables, green leafy ones.), light yogurt (125 ml), skim milk (200 ml), 1 glass (125 ml) of wine and extra virgin olive oil; weekly, fish (3 portions), white meat (3 portions), legumes (2 portions) eggs (2 portions), seasoned cheeses (2 portions), and red or processed meats (once a week). At the top of the pyramid, there are two pennants: one green means that subjects with RA need some personalized supplementation (vitamin D and omega 3) and one red means that there are some foods that are banned (salt and sugar). The food pyramid allows patients to easily figure out what to eat.

Association of chronic spinal pain with diet quality

INTRODUCTION

Chronic spinal pain is disabling and has high personal and societal costs. Risk factors include behavioral factors; however, little is known about the role of diet quality and its association with spinal pain. Higher diet quality and consumption of macronutrients that drive higher diet quality were hypothesized to be associated with lower odds of having spinal pain.

METHODS

An analysis of a population-based data set (NHANES cycle 2009-2010) was conducted. Diet quality was calculated using the Healthy Eating Index 2015 (score 0-100). To examine odds of pain related to dietary intake, generalized linear regressions were used adjusting for relevant covariates.

RESULTS

Of 4123 participants (mean age 43.5 ± 0.44 [SD], 2167 [52.6%] female), 800 (19.4%) reported chronic spinal pain. People with chronic spinal pain consumed similar amounts of calories to those with no spinal pain (2137 ± 44.5 vs 2159.9 ± 27.7), but had significantly poorer diet quality compared to people without spinal pain (51.97 ± 0.65 vs 54.31 ± 0.39, P = 0.007). From multivariate analyses, individuals with diet quality in the highest tertile on Healthy Eating Index-2015 were 24% less likely to report chronic spinal pain relative to those in the lowest tertile. Higher fruit, whole grain, and dairy intake were associated with 20% to 26% lower likelihood (all P for trend <0.028) of chronic spinal pain. Added sugars were associated with 49% increased odds of chronic spinal pain (P for trend = 0.002).

CONCLUSION

Although causality cannot be assumed, this study supports continued investigation into the role of nutritional quality as a factor that may impact pain.

Prevalence and Impact of Dietary Avoidance among Individuals with Hidradenitis Suppurativa

BACKGROUND

People with hidradenitis suppurativa (HS) are interested in dietary alterations to manage the condition. However, there are few data on the prevalence of this or the impact on HS activity. The objective of this study was to investigate the prevalence and impact of dietary alterations made by people with HS.

METHODS

A cross-sectional survey was sent to people with HS through multiple sources. Participants reported food alterations in the prior 6 months. -Results: Overall, 242 complete surveys were included in this analysis; the mean age was 35.8 years, and most (87.5%) were women. The majority (75.8%, n = 182) altered at least one food from their diet. Within this group, 154 (84.6%) made changes to multiple food groups. The top 5 food groups that were altered were gluten (48.8%), dairy (44.2%), refined sugars (40.0%), tomatoes (36.7%), and alcohol (37.1%). Smoking was eliminated in 27.5% of participants. Some participants (30.9%) reported the change made the HS "much better."

CONCLUSIONS

Dietary alteration to manage HS was common among participants in this study. Some people reported improvement in HS activity, but some noted worsening. Additional research is needed to evaluate the efficacy of dietary alteration to manage HS and to better understand the underlying pathomechanisms.

Identifying Barriers of Arthritis-Related Disability on Food Behaviors to Guide Nutrition Interventions

OBJECTIVE

To describe the impact of arthritis-related disability on aspects of food insecurity and to gain insight into the incentives and barriers to participating in a nutrition intervention.

DESIGN

Four focus groups were held in April to May, 2018. Participants completed questionnaires about socioeconomic status, diet, and health.

SETTING

The Perform Centre, Concordia University, Montreal, Canada.

PARTICIPANTS

A convenience sample of 27 adults diagnosed with arthritis.

PHENOMENON OF INTEREST

Perceived impact of arthritis-related disability on food behaviors as well as incentives and deterrents to participating in a nutrition intervention.

ANALYSIS

Transcriptions of the focus group discussions were coded using the constant comparative method. Basic descriptive statistics were used to analyze the questionnaire data.

RESULTS

The themes of pain, fatigue, knowledge, and social support emerged in discussions on food choices, procurement, preparation, consumption, and other lifestyle behaviors. Participants reported common barriers, although the extent to which they were affected varied. Questionnaire results revealed low disability. Timing, cost, and information quality were important incentives to participate in a nutrition intervention.

CONCLUSIONS AND IMPLICATIONS

Results highlight the need for further research among people with greater limitations related to arthritis and adapted nutrition interventions that provide both knowledge and experience to help individuals overcome the challenges of arthritis.

Diet quality indices for research in low- and middle-income countries: a systematic review

CONTEXT

Dietary intake research has increasingly focused on improving diet quality in low- and middle-income countries (LMICs). Accompanying this is the need for sound metrics to assess diet quality.

OBJECTIVE

This systematic literature review aims to describe existing diet quality indices for general populations and highlights recommendations for developing such indices for food system research in LMICs.

DATA SOURCES

Three electronic databases were searched for papers published between January 2008 and December 2017.

DATA EXTRACTION

Articles published in English and describing the development of an index to measure overall diet quality, irrespective of whether they were for high-income countries or LMICs, were included.

DATA ANALYSIS

Eighty-one indices were identified, over two thirds were based on national dietary guidelines from high-income countries. Of the 3 key diet quality dimensions, "diversity" was included in all 18 indices developed for LMICs, "moderation" was captured by most, and "nutrient adequacy" was included 4 times.

CONCLUSIONS

Indices need to be developed that include all dimensions, include foods and/or food groups rather than nutrients, use an optimal range for individual components in the score, and express the intake of healthy and unhealthy components separately. Importantly, validation of the index should be part of its development.

Poor Dietary Quality Is Associated with Increased Inflammation in Swedish Patients with Rheumatoid Arthritis

The aim was to study whether dietary quality was associated with disease activity and inflammation among patients with rheumatoid arthritis (RA). This cross-sectional analysis included 66 Swedish participants, who each completed a food frequency questionnaire (FFQ) at screening. Food intake was scored by a dietary quality index created by the Swedish National Food Agency. Disease activity was measured as Disease Activity Score 28 (DAS28), based on erythrocyte sedimentation rate (ESR), a patient administered visual analogue scale of perceived global health and the number of tender and swollen joints out of 28 examined. Inflammation was measured as ESR and C-reactive protein (hs-CRP). Associations between dietary quality, disease activity and inflammation were evaluated using multivariable linear regression analysis. High dietary quality (high intake of fish, shellfish, whole grain, fruit and vegetables and low intake of sausages and sweets) was not related to DAS28 (B = −0.02, p = 0.787). However, dietary quality was significantly negatively associated with hs-CRP (B = −0.6, p = 0.044) and ESR (B = −2.4, p = 0.002) after adjusting for body mass index, age, education, smoking and gender. Both hs-CRP and ESR decreased with increasing dietary quality. In conclusion, among patients with RA, high dietary quality was associated with reduced inflammation but not with disease activity.

Diet quality of individuals with rheumatoid arthritis using the Healthy Eating Index (HEI)-2010

BACKGROUND

Rheumatoid arthritis (RA) afflicts approximately 1.5 million American adults and is a major cause of disability. As disease severity worsens, individuals with RA may experience functional decline that can impact dietary intake.

OBJECTIVE

The objective of this study is to assess the diet quality of individuals with RA using the Healthy Eating Index (HEI)-2010 and examine associations between diet quality and disease activity and functional status.

METHODS

This cross-sectional study assessed diet quality and disease activity and functional status in adults with RA. Participants completed seven-day weighed food records, which were scored using the HEI-2010. Participants had a fasting blood draw and completed the Multidimensional Health Assessment Questionnaire to determine disease activity and functional status.

RESULTS

The mean age of individuals with RA ( N = 84) was 53 ± 14 years, and 86.9% were female. The mean HEI-2010 total score was 58.7 ± 15.9, with 7.1% of participants scoring "good", 58.3% "fair", and 34.5% "poor". Most participants did not adhere to recommended intakes of total fruit, total vegetables, whole grains, fatty acids, refined grains, sodium, and empty calories. An unadjusted multiple linear regression model found duration of morning stiffness and C-reactive protein concentration to be significant variables to inversely predict HEI-2010 total score.

CONCLUSIONS

The diet quality of many individuals with RA needs improvement and may be related to functional disability associated with RA. Healthcare providers should encourage individuals with RA to meet dietary guidelines and maintain a healthy diet. Moreover, healthcare providers should be aware of the potential impacts of functional disability on diet quality in individuals with RA.

Did the 2009 American Recovery and Reinvestment Act affect dietary intake of low-income individuals?

This paper examines the relationship between increased Supplemental Nutritional Assistance Program (SNAP) benefits following the 2009 American Recovery and Reinvestment Act (ARRA) and the diet quality of individuals from SNAP-eligible compared to ineligible (those with somewhat higher income) households using data from the 2007-2010 National Health and Nutrition Examination Survey. The ARRA increased SNAP monthly benefits by 13.6% of the maximum allotment for a given household size, equivalent to an increase of $24 to $144 for one-to-eight person households respectively. In the full sample, we find that these increases in SNAP benefits are not associated with changes in nutrient intake and diet quality. However, among those with no more than a high school education, higher SNAP benefits are associated with a 46% increase in the mean caloric share from sugar-sweetened beverages (SSBs) and a decrease in overall diet quality especially for those at the lower end of the diet quality distribution, amounting to a 9% decline at the 25th percentile.

Adherence to the 2010 Dietary Guidelines for Americans and the relationship to adiposity in young women

OBJECTIVE

To determine the relationship between adherence to the 2010 Dietary Guidelines for Americans and adiposity in young women with and without statistical adjustment for physical activity (PA).

METHODS

Participants included 324 young women (aged 17-25 years). The researchers measured dietary intake using the Dietary History Questionnaire and determined diet quality using the 2010 Healthy Eating Index (HEI-2010). BOD POD (Cosmed, Rome, Italy, 2006) and accelerometry were used to assess body fat and PA, respectively.

RESULTS

Women in the top quartile of HEI-2010 had significantly lower percent body fat than women in the lowest 3 quartiles (F = 3.36; P = .03). Controlling for objectively measured PA weakened this relationship by 20%. These young women (top quartile of HEI-2010) also had 0.37 odds (95% confidence interval, 0.16-0.85) of having body fat > 32%.

CONCLUSIONS AND IMPLICATIONS

Young women whose diets most closely meet the 2010 Dietary Guidelines for Americans have lower adiposity.

Diet quality in a sample of adults from Cuiabá (MT), Brazil: association with sociodemographic factors

OBJECTIVE: To analyze the dietary quality of adults and to identify associated factors. METHODS: Cross-sectional study carried out in a sample of adults (n=195), aged 20-50 years, of both genders, from a population-based study in Cuiabá, Mato Grosso, Brazil. Food consumption data was collected by a food frequency questionnaire. Sociodemographic, lifestyle, anthropometric, and body composition data were also collected. Diet quality was analyzed by the Brazilian Healthy Eating Index-Revised. The associations were estimated by Poisson regression. RESULTS: The mean Brazilian Healthy Eating Index-Revised score was 75.2 points (CI95%=74.2-76.1), which differed significantly between the genders (p=0.03). Women had higher scores for whole fruit and sodium (p<0.01), while men had higher scores for oils, nuts, and fish fat (p=0.02). Individuals aged >30 years had higher total Brazilian Healthy Eating Index-Revised score and higher scores for the groups whole fruit; saturated fat; and calories from solid fats, alcoholic beverages, and added sugar (p<0.01). The Poisson regression between high Brazilian Healthy Eating Index-Revised and the independent variables showed that high Brazilian Healthy Eating Index-Revised was associated with being female, being aged 30 years or more, and being from families whose household head had 8 or more years of formal education. CONCLUSION: The factors associated with high Brazilian Healthy Eating Index-Revised were age, gender, and education level of the household head.

The influence of cognitive-perceptual variables on patterns of change over time in rural midlife and older women's healthy eating

Although studies demonstrate that dietary interventions for healthy adults can result in beneficial dietary changes, few studies examine when and how people change in response to these interventions, particularly in rural populations. The purpose of this study was to examine patterns of change over time in healthy eating behaviors in midlife and older women in response to a one-year health-promoting intervention, and to examine what predictors (perceived benefits, barriers, self-efficacy, and family support for healthy eating) influence the changes during the intervention and follow-up. Data for this secondary analysis were from the Wellness for Women community-based trial. Women (N = 225) between the ages of 50-69 in rural Nebraska, U.S.A., were recruited. A repeated-measures experimental design was used with randomization of two rural counties to intervention (tailored newsletter) or comparison (standard newsletter) groups. Eating behavior was measured by the Healthy Eating Index. The predictor variables were assessed using standard measures. Data analysis was done using latent growth curve modeling. The tailored newsletter group was successful in improving their healthy eating behavior compared to the standard newsletter group during the one-year intervention, at the end of the intervention, and during the follow-up phase. Family support at the end of the intervention was positively associated with healthy eating at the end of the intervention. Perceived barriers had the strongest impact on healthy eating behavior at all time points. Compared to participants in the standard newsletter group, those in the tailored newsletter group perceived more family support and fewer barriers for healthy eating at the end of the intervention (mediation effects). Based on these findings, both family support and perceived barriers should be central components of interventions focused on healthy eating behavior in rural midlife and older women.