Perceived and objective diet quality in US adults: a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES)

Perceived and calculated diet quality improvements in a randomized mHealth weight loss trial

The diet quality of US adults is poor and cross-sectional analyses suggest self-perception of healthful dietary intake may be overestimated. This analysis assessed the concordance between calculated and perceived diet quality and changes in diet quality among adults seeking weight loss and enrolled in a 12-month randomized behavioral trial. Healthy Eating Index-2015 diet quality (HEI) was calculated from self-administered 24-hour recalls. Perceived diet quality (PDQ) was measured on a 100-point scale. Higher scores indicate better diet quality. Concordance was assessed using the concordance correlation coefficient and Bland-Altman plots. The one hundred and five participants with complete dietary data were mostly female and white. There was good agreement between HEI and PDQ scores at 12 months for less than a third of participants. Most of the disagreement arose from PDQ scores being higher than HEI scores. Even fewer participants had good agreement between HEI changes and PDQ changes. Participants perceived greater improvement in diet quality than indicated by HEI score changes. Concordance was low at 12 months and for change in diet quality. Despite the diet quality of adults seeking weight loss being suboptimal and not improving, many perceived their diet quality and diet quality improvements as better than calculated. Future studies might explore the effect of misperceptions on weight loss outcomes.

The feasibility of an anti-inflammatory diet in endometriosis: barriers and facilitators perceived by endometriosis patients

RESEARCH QUESTION

What is the feasibility of an anti-inflammatory diet in women diagnosed with endometriosis?

DESIGN

Qualitative study using semi-structured focus groups and individual interviews among patients with endometriosis. Transcripts of the focus groups and interviews were thematically analysed using ATLAS.ti 9. To identify and structure the ideas and views from the focus groups and interviews, two behavioural change models were used. The Capability Opportunity Motivation Behaviour (COM-B) model and domains of the Theoretical Domains Framework (TDF) helped to identify factors that make adherence to an anti-inflammatory diet more or less feasible for women with endometriosis.

RESULTS

The study population consisted of 23 patients with endometriosis. Numerous perceived barriers and facilitators were identified from all COM-B components and 13 out of 15 TDF domains. Knowledge and social influences were the most prominent TDF domains. Key barriers were eating with others; disbelief in a patients' own capability regarding specific dietary guidelines; concerns about taste; lack of knowledge on how to follow the diet; lack of noticeable beneficial effect; and lack of intention to follow the diet to full extent. Key facilitators were receiving social support; general confidence in a participant's own capabilities; knowing how and why to follow the diet; noticing beneficial effect; and belief that the diet would alleviate symptoms.

CONCLUSION

Provision of knowledge, stimulating social support and enhancing self-efficacy should be emphasized. Overall, an anti-inflammatory diet in endometriosis patients, especially when identified barriers and facilitators are addressed in an intervention, is feasible.

A pilot randomized controlled trial comparing nutritious meal kits and no-prep meals to improve food security and diet quality among food pantry clients

BACKGROUND

Food pantry clients have high rates of food insecurity and greater risk for and prevalence of diet-related diseases. Many clients face time, resource, and physical constraints that limit their ability to prepare healthy meals using foods typically provided by pantries. We compared two novel approaches to alleviate those barriers and encourage healthier eating: meal kits, which bundle ingredients with a recipe on how to prepare a healthy meal, and nutritious no-prep meals, which can be eaten after thawing or microwaving.

METHODS

Participants were adult pantry clients from a large food pantry in the Southern sector of Dallas, Texas. We conducted a repeated measures between-subjects study with 70 clients randomized to receive 14-days of meal kits (n = 35) or no-prep meals (n = 35). Participants completed questionnaires at baseline and two-week follow-up on demographics, hedonic liking of study meals, perceived dietary quality, and food security. Two-way repeated measures analysis of variance was used to examine group and time effects, and group by time interactions. We also describe feasibility and satisfaction outcomes to inform future implementation.

RESULTS

Sixty-six participants completed the study (94%). Participants were predominantly Hispanic or Latino(a) (63%) and African American or Black (31%) women (90%). There was a significant interaction on hedonic liking of study meals (ηp²=0.16, F(1,64) = 11.78, p < .001), such that participants that received meal kits had greater improvements in hedonic liking over time than participants in the no-prep group. We observed significant improvements in perceived dietary quality (ηp²=0.36, F(1,64) = 36.38, p < .001) and food security (ηp²=0.36, F(1,64) = 36.38, p < .001) across both groups over time, but no between group differences or significant interactions indicating one intervention was more effective than the other. Program satisfaction was high across both groups, but higher among the meal kit group (ηp²=0.09, F(1,64) = 6.28, p = .015).

CONCLUSIONS

Results suggest nutritious meal kits and no-prep meals may be desirable nutrition intervention strategies for pantry clients and have potential to increase food security and perceived dietary quality in the short-term. Our findings are limited by a small sample and short follow-up. Future studies should continue to test both interventions, and include longer follow-up, objective measures of dietary quality, and relevant clinical outcomes.

TRIAL REGISTRATION

This trial was registered on 25/10/2022 on ClinicalTrials.gov, identifier: NCT05593510.

Effects of dietary patterns on the all-cause mortality and cardiovascular disease mortality in patients with hypertension: A cohort study based on the NHANES database

BACKGROUND

Hypertension (HTN) patients have higher risk of all-cause and cardiovascular disease (CVD)-specific mortality. Dietary patterns have been reported related to the risk of mortality, but their roles in HTN patients is unclear.

HYPOTHESIS

To explore the relationships between different dietary patterns and all-cause/CVD-specific mortality and provide dietary guidance for HTN patients' prognosis improvement.

METHODS

Data of 27 618 HTN patients were extracted from the National Health and Nutrition Examination Survey (NHANES) database in this retrospective cohort study. The associations between Healthy Eating Index (HEI)-2015, Alternate Healthy Eating Index (AHEI)-2010, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean (MED) diet and all-cause and CVD-specific mortality were explored using univariate and multivariate Cox regression analyses with hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses of age, gender, body mass index, and comorbidity were also performed.

RESULTS

The median follow-up time was 83 months. A total of 3462 patients died for all-cause and 1064 died due to CVD. After adjusting for covariates, we found that high adherence to AHEI-2010 (HR = 0.84 for all-cause; HR = 0.72 for CVD), and MED (HR = 0.84 for all-cause; HR = 0.77 for CVD) diet were associated with decreased risks of both all-cause and CVD-specific mortality. In patients who aged ≥65 years old, were normal/overweight, without complications, the relationships between different dietary patterns and risk of mortality were different.

CONCLUSION

High scores of AHEI-2010 and MED may be associated with decreased risks of all-cause and CVD-specific mortality in patients with HTN.

A pilot randomized controlled trial comparing nutritious meal kits and no-prep meals to improve food security and diet quality among food pantry clients

Background

Food pantry clients have high rates of food insecurity and greater risk for and prevalence of diet-related diseases. Many clients face time, resource, and physical constraints that limit their ability to prepare healthy meals using foods typically provided by pantries. We compared two novel approaches to alleviate those barriers and encourage healthier eating: meal kits, which bundle ingredients with a recipe on how to prepare a healthy meal, and nutritious no-prep meals, which can be eaten after thawing or microwaving.

Methods

Participants were adult pantry clients from a large food pantry in the Southern sector of Dallas, Texas. We conducted a repeated measures between-subjects study with 70 clients randomized to receive 14-days of meal kits (n=35) or no-prep meals (n=35). Participants completed questionnaires at baseline and twoweek follow-up on demographics, hedonic liking of study meals, perceived dietary quality, and food security. Two-way repeated measures analysis of variance was used to examine group and time effects, and group by time interactions. We also describe feasibility and satisfaction outcomes to inform future implementation.

Results

Sixty-six participants completed the study (94%). Participants were predominantly Hispanic or Latino(a) (63%) and African American or Black (31%) women (90%). There was a significant interaction on hedonic liking of study meals (ηp2=0.16, F(1,64)=11.78, p<.001), such that participants that received meal kits had greater improvements in hedonic liking over time than participants in the no-prep group. We observed significant improvements in perceived dietary quality (ηp2=0.36, F(1,64)=36.38, p<.001) and food security (ηp2=0.36, F(1,64)=36.38, p<.001) across both groups over time, but no between group differences or significant interactions indicating one intervention was more effective than the other. Program satisfaction was high across both groups, but higher among the meal kit group (ηp2=0.09, F(1,64)=6.28, p=.015).

Conclusions

Results suggest nutritious meal kits and no-prep meals may be desirable nutrition intervention strategies for pantry clients and have potential to increase food security and perceived dietary quality in the short-term. Our findings are limited by a small sample and short follow-up. Future studies should continue to test both interventions, and include longer follow-up, objective measures of dietary quality, and relevant clinical outcomes.

Trial Registration

This trial was registered on 25/10/2022 on Clinicaltrials.gov, identifier: NCT05593510.

Exploring patient medication adherence and data mining methods in clinical big data: A contemporary review

BACKGROUND

Increasingly, patient medication adherence data are being consolidated from claims databases and electronic health records (EHRs). Such databases offer an indirect avenue to gauge medication adherence in our data-rich healthcare milieu. The surge in data accessibility, coupled with the pressing need for its conversion to actionable insights, has spotlighted data mining, with machine learning (ML) emerging as a pivotal technique. Nonadherence poses heightened health risks and escalates medical costs. This paper elucidates the synergistic interaction between medical database mining for medication adherence and the role of ML in fostering knowledge discovery.

METHODS

We conducted a comprehensive review of EHR applications in the realm of medication adherence, leveraging ML techniques. We expounded on the evolution and structure of medical databases pertinent to medication adherence and harnessed both supervised and unsupervised ML paradigms to delve into adherence and its ramifications.

RESULTS

Our study underscores the applications of medical databases and ML, encompassing both supervised and unsupervised learning, for medication adherence in clinical big data. Databases like SEER and NHANES, often underutilized due to their intricacies, have gained prominence. Employing ML to excavate patient medication logs from these databases facilitates adherence analysis. Such findings are pivotal for clinical decision-making, risk stratification, and scholarly pursuits, aiming to elevate healthcare quality.

CONCLUSION

Advanced data mining in the era of big data has revolutionized medication adherence research, thereby enhancing patient care. Emphasizing bespoke interventions and research could herald transformative shifts in therapeutic modalities.

Similarities and Dissimilarities in Diet Quality Differences by Acculturation Level between Mexican Americans and Other Hispanic Americans: National Health and Nutrition Examination Survey 2015-2018

BACKGROUND

Evidence suggests dietary acculturation can increase obesity and chronic disease risks. However, acculturation effects on diet quality among subgroups of Hispanic Americans is not well studied.

OBJECTIVES

Estimating percentages of Hispanic Americans with low, moderate, and high acculturation using 2 proxy measures with different language variables was the first objective. Identifying similarities and dissimilarities in diet quality differences by acculturation level between Mexican Americans and other Hispanic Americans was the second objective.

METHODS

The study sample included 1733 Mexican American and 1191 other Hispanic participants aged ≥16 y from National Health and Nutrition Examination Survey 2015-2018. Proxy measures included in the 2 acculturation scales were nativity/United States residence length, immigration age, language spoken at home (home), and language of dietary recall (recall). Replicate 24-h dietary recalls were conducted, and diet quality was assessed using the 2015 Healthy Eating Index. Analyses included statistical methods for complex survey designs.

RESULTS

For Mexican Americans, 8%, 35%, and 58% had low, moderate, and high acculturation on the home scale compared with 8%, 30%, and 62% on the recall scale. For other Hispanics, 17%, 39%, and 43% had low, moderate, and high acculturation on the home scale compared with 18%, 34%, and 48% on the recall scale. Similarities between ethnicities included higher acculturation associated with lower intakes of fruits, vegetables, total protein foods, seafood and plant proteins, and saturated fats and greater intake of sodium. Dissimilarities included higher acculturation associated with more whole grains and added sugars intakes and less refined grains intake (Mexican Americans), and less total dairy and fatty acids intakes (other Hispanic Americans).

CONCLUSIONS

Higher acculturation is associated with worsening diet quality for fruits, vegetables, and protein foods in all Hispanic Americans. However, associations of higher acculturation with worsening diet quality for grains, added sugars, dairy, and fatty acids were present only in specific subgroups of Hispanic Americans.

Change in Diet Quality and Meal Sources during the COVID-19 Pandemic in a Diverse Subset of Men and Women in the Cancer Prevention Study-3

The COVID-19 pandemic resulted in restrictive measures that caused disruptions in behaviors that may have long-term consequences on diet, health, and chronic disease risk. The aim of this study was to assess longitudinal changes in diet quality from before to during the pandemic among 2335 adult participants (816 males and 1519 females; aged 36-78) of the Cancer Prevention Study-3 cohort. We compared dietary screeners conducted in 2018 and 2020 and calculated a diet quality score, which assigned higher points for recommended foods. Overall diet quality slightly improved among all participants from before to during the pandemic, particularly among males (+0.45 points, p < 0.001), White participants (+0.24 points, p < 0.001), and participants reporting weight loss (+0.66 points, p < 0.001 for 2.25 -< 4.5 kg loss; +1.04 points, p < 0.001 for ≥4.5 kg loss); change in diet quality did not differ by other sociodemographic factors. Reported consumption of most food groups decreased, especially whole grains (-0.17 servings/day, p < 0.001) and vegetables (-0.21 servings/day, p < 0.001), primarily among females, Black participants, and participants who gained ≥2.25 kg. The frequency of meals from outside the home decreased, especially in full-service restaurants (-0.47 times/week, p < 0.001) and for ready-to-eat meals (-0.37 times/week, p < 0.001). Declines in whole grain and vegetable consumption raise concerns for weight gain in these populations and increased risk of poor metabolic health and chronic disease.

Patterns of Engagement With an Application-Based Dietary Self-Monitoring Tool Within a Randomized Controlled Feasibility Trial

Introduction

The Dietary Approaches to Stop Hypertension dietary pattern is a proven way to manage hypertension, but adherence remains low. Dietary tracking applications offer a highly disseminable way to self-monitor intake on the pathway to reaching dietary goals but require consistent engagement to support behavior change. Few studies use longitudinal dietary self-monitoring data to assess trajectories and predictors of engagement. We used dietary self-monitoring data from participants in Dietary Approaches to Stop Hypertension Cloud (N=59), a feasibility trial to improve diet quality among women with hypertension, to identify trajectories of engagement and explore associations between participant characteristics.

Methods

We used latent class growth modeling to identify trajectories of engagement with a publicly available diet tracking application and used bivariate and regression analyses to assess the associations of classifications of engagement with participant characteristics.

Results

We identified 2 latent classes of engagement: consistent engagers and disengagers. Consistent engagers were more likely to be older, more educated, and married or living with a partner. Although consistent engagers exhibited slightly greater changes in Dietary Approaches to Stop Hypertension score, the difference was not significant.

Conclusions

This study highlights an important yet underutilized methodologic approach for uncovering dietary self-monitoring engagement patterns. Understanding how certain individuals engage with digital technologies is an important step toward designing cost-effective behavior change interventions.

Trial registration

This study is registered at www.clinicaltrials.gov NCT03215472.

Can United States Adults Accurately Assess Their Diet Quality?

Purpose

To estimate the percentage of United States adults who accurately assessed their diet quality (DQ).

Design

Observational, cross-sectional, nationally representative.

Setting

National Health and Nutrition Examination Survey, 2015-2018.

Sample

9757 (86%) of 11 288 adults aged ≥20 years.

Measures

Perceived DQ was assessed by asking participants, how healthy is your diet? The five responses included excellent, very good, good, fair, and poor. Measured DQ was assessed using 24-hours dietary recalls scored with 2015 Healthy Eating Index; scores were categorized using a 10-point grading scale.

Analysis

Matches between perceived and measured DQ that were classified as accurate included: excellent = A, very good = A or B, good = B or C, fair = C or D, and poor = D or F. All others were classified as inaccurate. Analyses included descriptive statistics and multivariable logistic regression for complex survey designs.

Results

63% of adults perceived their DQ as very good or good while 70% scored DQ grades of F. Overall, 15% of adults accurately assessed their DQ with 96% accuracy in the poor perception group and <23% in the other 4 groups. Overall, 75% of adults overrated their DQ. Females, adults with lower educational attainment, and those with low food security were more likely to accurately assess their DQ.

Conclusion

Adults cannot accurately assess their DQ except for those perceiving their DQ as poor, and the majority overrate their DQ.

Greater adherence to healthy dietary patterns is associated with lower diastolic blood pressure and augmentation index in healthy, young adults

More than two-thirds of cardiovascular disease (CVD) deaths worldwide are attributable to dietary factors. Blood pressure variability (BPV), endothelial dysfunction, and arterial stiffness are important CVD risk factors. Although studies show a link between consuming a healthy diet and lower BPV and stiffness and improved endothelial function, research in young, healthy adults is scarce. We hypothesized that, in young, healthy adults, diet quality would be inversely associated with BPV and arterial stiffness and positively associated with endothelial function. This cross-sectional study included 56 healthy young adults (34 women/22 men, age 26.7 ± 0.8 years, body mass index 23.4 ± 0.4 kg/m2, blood pressure [BP] 113/69 mmHg). Three-day diet records were used to calculate two Dietary Approaches to Stop Hypertension (DASH) diet scores, the alternative Mediterranean Diet (aMED) score, and the Healthy Eating Index-2015 (HEI-2015) based on the 2015-2020 Dietary Guidelines for Americans. Twenty-four-hour ambulatory BP data were used to calculate average real variability of systolic and diastolic BP. Endothelial function was assessed by flow-mediated dilation, and arterial stiffness was assessed by pulse wave velocity and augmentation index (AIx). Overall, the HEI-2015 was inversely associated with 24-hour diastolic BP (DBP) and daytime DBP, and the aMED score was inversely associated with AIx. In our exploratory analyses, the Fung DASH score was inversely associated with 24-hour DBP and daytime DBP in women, but not men. These findings suggest that consuming a diet that aligns with the DASH diet, the Mediterranean diet, and/or the 2015-2020 Dietary Guidelines for Americans is associated with cardiovascular benefits in healthy, young adults.

Associations of the Dietary Approaches to Stop Hypertension dietary pattern with cardiac structure and function

BACKGROUND AND AIMS

Various food groups have been associated with measures of left ventricular geometry and function. Whether the Dietary Approaches to Stop Hypertension (DASH) dietary pattern in mid-life is associated with a favorable cardiac structure and function later in life is unknown.

METHODS AND RESULTS

The study population consisted of the Atherosclerosis Risk in Communities study participants free of cardiovascular disease at study visit 3 in 1993-1995. Dietary intake was assessed by food frequency questionnaire at study visits 1 (1987-1989) and 3 (1993-1995). Participants who underwent transthoracic echocardiograms at the Jackson field center at visit 3 (n = 1974) and at all field centers at study visit 5 (2011-2013; n = 4651) were included in this study. General linear regression was used to evaluate associations between dietary intake and markers of cardiac structure and function adjusting for potential confounders. Higher DASH score was associated with lower left ventricle mean wall thickness and higher absolute value of longitudinal strain at visit 5 (ptrend = 0.004 and < 0.001, respectively).

CONCLUSION

The DASH dietary pattern in midlife was favorably associated with left ventricle structure and systolic function later in life. These results emphasize the importance of adhering to a healthy eating plan as one lifestyle measure to preserve cardiac structure and function.

Self-Rated Diet Quality and Cardiometabolic Health Among U.S. Adults, 2011-2018

INTRODUCTION

Self-rated health has been extensively studied, but the utility of a similarly structured question to rate diet quality is not well characterized. This study aims to assess the relative validity of self-rated diet quality, compared with that of a validated diet quality measure (Healthy Eating Index-2015) and to examine the associations with cardiometabolic risk factors.

METHODS

Analyses were conducted in 2020-2021 using cross-sectional data from the National Health and Nutrition Examination Survey, 2011-2018. Nonpregnant adults who responded to the question: How healthy is your overall diet? and provided 2 dietary recalls were eligible (n=16,913). Associations between self-rated diet quality (modeled as a 5-point continuous variable, poor=1 to excellent=5) and Healthy Eating Index-2015 scores and cardiometabolic risk factors were assessed by linear regression, accounting for the complex survey design and adjusting for demographic and lifestyle characteristics.

RESULTS

Self-rated diet quality was positively associated with total Healthy Eating Index-2015 scores (p < 0.001) and with all components except with Dairy (p=0.94) and Sodium (p=0.66). Higher self-rated diet quality was associated with lower BMI, waist circumference, glucose, insulin, triglycerides, and HbA1c and with higher high-density lipoprotein cholesterol (all p<0.01). Positive associations with total diet quality persisted across all racial/ethnic groups, although the associations with individual dietary components varied. Higher self-ratings were most consistently associated with better-scored diet quality among individuals with BMI <30 kg/m².

CONCLUSIONS

Self-rated diet quality was associated with Healthy Eating Index-2015 scores and cardiometabolic disease risk factors. This single-item assessment may be useful in time-limited settings to quickly and easily identify patients in need of dietary counseling to improve cardiometabolic health.

Diabetes Knowledge, Behaviors, and Perceptions of Risk in Rural West Virginia Counties

Introduction

A little less than half of American adults have diabetes or pre-diabetes. In 2016, West Virginia (WV) had the highest percentage (15.2%) of adults with diagnosed diabetes in the U.S.

Purpose

In partnership with the Health Sciences and Technology Academy (HSTA), a cross-sectional study was preformed to assess knowledge, behaviors, and perceptions of diabetes risk.

Methods

Data was collected by trained HSTA students and teachers who lived in rural counties in WV. Information was assessed using validated surveys, and HbA1c was obtained by utilizing professional point-of-care (Bayer) kits.

Results

Mean age and Body Mass Index (BMI) was 36.11±17.86 years and 27.80±6.09 kg/m2, respectively. More than half of the participants had a family history of diabetes (58.8%) and hypertension (60.2%), and a majority had elevated BMI (65.9%). However, only 29.2% rated their future risk for diabetes as moderate to high. Eighty percent (80%) had an inadequate amount of weekly exercise, and 36% had lower quality of diet. Overall, dietary quality and diabetes knowledge was associated with a low to moderate diabetes risk score; risk score positively correlated with higher HbA1c (r=0.439, P<.001). Participants' HbA1c, perceived future risk of diabetes and family history of diabetes emerged as significant predictors of diabetes risk in the regression model, controlling for health behavior and diabetes knowledge.

Implications

HbA1c, perceived future risk of diabetes and family history of diabetes may be the best predictors of developing diabetes in the future and, therefore, are important to assess during community screening. Perception of diabetes risk is lower than actual diabetes risk in WV.

Association of Childhood Socioeconomic Status with Leukocyte Telomere Length Among African Americans and the Mediating Role of Behavioral and Psychosocial Factors: Results from the GENE-FORECAST Study

Purpose

We examined if childhood socioeconomic status (SES) was related to adult leucocyte telomere length (TL) using the data of 361 African American (AA) participants from the GENE-FORECAST Study. We also assessed the mediating role of behavioral and psychosocial factors in the association between childhood SES and adult TL.

Methods

Childhood SES was assessed individually by using participant’s mother’s education and occupation, father’s education and occupation, parental home ownership, and family structure. TL was assessed using the quantitative polymerase chain reaction method. Information on potential confounders and mediators were collected. The associations of childhood SES with TL were assessed using multivariable linear regression models. We used path analysis to quantify and test the share of these associations that was statistically explained by each of the mediators (participant’s educational attainment, smoking status, physical activity, dietary habit, perceived stress, and depressive symptoms).

Results

Mother’s education was associated with longer average TL (β: 0.021; 95% CI: 0.001, 0.04, p=0.038) in confounder adjusted models. Once mediators were introduced in the model, the estimates were reduced and remained marginally significant (β: 0.017; 95% CI: −0.003, 0.038, p=0.061). According to path model, approximately 19% of the effect of mother’s education on TL (β: 0.004; 95% CI: −0.001, 0.01, p < 0.10) was mediated through participant’s own education level. No significant mediation effect was observed for any other mediators.

Conclusions

These data provide evidence that participant’s mother’s education was positively linked to adult TL in AA population. Participant’s own educational level partially explained this association.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40615-021-01040-5.

Relationship between diet quality scores and the risk of frailty and mortality in adults across a wide age spectrum

BACKGROUND

Beyond intakes of total energy and individual nutrient, eating patterns may influence health, and thereby the risk of adverse outcomes. How different diet measures relate to frailty-a general measure of increased vulnerability to unfavorable health outcomes-and mortality risk, and how this might vary across the life course, is not known. We investigated the associations of five dietary indices (Nutrition Index (NI), the energy-density Dietary Inflammatory Index (E-DII™), Healthy Eating Index-2015 (HEI-2015), Mediterranean Diet Score (MDS), and Dietary Approaches to Stop Hypertension (DASH)) with frailty and mortality.

METHODS

We included 15,249 participants aged ≥ 20 years from the 2007-2012 cohorts of the National Health and Nutrition Examination Survey (NHANES). The NI combined 31 nutrition-related deficits. The E-DII is a literature-derived dietary index associated with inflammation. The HEI-2015 assesses adherence to the Dietary Guidelines of Americans. The MDS represents adherence to the traditional Mediterranean diet. DASH combines macronutrients and micronutrients to prevent hypertension. Frailty was evaluated using a 36-item frailty index. Mortality status was ascertained up to December 31, 2015.

RESULTS

Participants' mean age was 47.2 ± 16.7 years and 51.7% were women. After adjusting for age, sex, race, educational level, marital and employment status, smoking, BMI, and study cohort, higher NI and E-DII scores and lower HEI-2015, MDS, and DASH scores were individually significantly associated with frailty. All dietary scores were significantly associated with 8-year mortality risk after adjusting for basic covariates and frailty: NI (hazard ratio per 0.1 point, 1.15, 95%CI 1.10-1.21), E-DII (per 1 point, 1.05, 1.01-1.08), HEI-2015 (per 10 points, 0.93, 0.89-0.97), MDS (per 1 point, 0.94, 0.90-0.97), and DASH (per 1 point, 0.96, 0.93-0.99). The associations of E-DII, HEI-2015, and MDS scores with 8-year mortality risk persisted after additionally adjusting for NI.

CONCLUSIONS

NI, E-DII, HEI-2015, MDS, and DASH scores are associated with frailty and 8-year mortality risk in adults across all ages. Nevertheless, their mechanisms and sensitivity to predict health outcomes may differ. Nutrition scores have the potential to include measures of both consumption and laboratory and physical measures of exposure.

Intention and Perceptions of Healthy Eating versus Actual Intake Among Patients with Type 1 and Type 2 Diabetes and the General Population

PURPOSE

Intention and perceptions of healthy eating may affect diet-related behavior. We assessed the intention and perceptions of eating healthily in patients with type 1 (T1D) and type 2 diabetes (T2D) compared with the general population. Secondly, differences in diet quality were assessed in patients with diabetes perceiving their dietary habits as more or less healthy.

MATERIALS AND METHODS

This cross-sectional study included data on socioeconomic status, dietary intake, and questions on healthy eating from adults with T1D (n=426), T2D (n=348) and from the general population (n=2899).

RESULTS

Patients with T2D were less likely to perceive their dietary habits as healthy compared with T1D and the general population. Patients with T1D or T2D perceiving their dietary habits as healthy reported higher intake of vegetables, fruit, fish, fibre and protein. In addition, patients with T1D with perceived healthy versus less healthy dietary habits had lower sugar intake and higher alcohol intake. Overall, adherence to dietary guidelines in patients with T1D and T2D was too low both in self-perceived healthy and less healthy eaters. In comparison with T1D patients, patients with T2D were less likely and the general population was more likely to strive to eat a healthy diet.

CONCLUSION

Patients with T2D had poorer self-perception of their dietary healthiness and less intention of eating healthily, compared with patients with T1D and the general population. Actual diet quality was higher amongst patients with T1D and T2D perceiving their dietary habits as healthy than those perceiving their dietary habits as less healthy. But inadequate intakes were found in all groups. Health care providers should address and explore the patient's intention and perceptions of healthy eating when discussing dietary changes in diabetes to improve nutritional support.

Awareness and use of nutrition information predict measured and self-rated diet quality of older adults in the USA

OBJECTIVES

To examine: (1) diet quality of older adults, using the Healthy Eating Index 2010 (HEI-2010) and self-rated diet quality, (2) characteristics associated with reported awareness and use of nutrition information and (3) factors associated with HEI score and self-rated diet quality.

DESIGN

Cross-sectional study. Based on Day 1 and/or Day 2 dietary recalls, the Per-Person method was used to estimate HEI-2010 component and total scores. T-tests and ANOVA were used to compare means. Logistic and linear regressions were used to test for associations with diet quality, controlling for potential confounders.

SETTING

National Health and Nutrition Examination Survey, 2009-2014.

PARTICIPANTS

Three thousand and fifty-six adults, aged 60 years and older, who completed at least one 24-h recall and answered questions on awareness and use of nutrition information.

RESULTS

Mean HEI score for men was significantly lower than for women (56·4 ± 0·6 v. 60·2 ± 0·6, P < 0·0001). Compared with men, more women were aware of (44·8 % v. 33·7 %, P < 0·05) and used (13·7 % v. 5·9 %, P < 0·05) nutrition information. In multivariable analyses, awareness and use of nutrition information were significant predictors of both HEI and self-rated diet quality for both women and men. Groups with lower nutrition awareness included men, non-Whites, participants in nutrition assistance programmes and those with lower education and socio-economic status.

CONCLUSIONS

Nutrition awareness and use of nutrition information are associated with diet quality in adults 60 years and older. Gaps in awareness of dietary guidelines in certain segments of the older adult population suggest that targeted education may improve diet quality for these groups.

Law enforcement personnel are willing to change, but report influencing beliefs and barriers to optimised dietary intake

BACMROUND

Law enforcement personnel have been recognized as having a high risk for several lifestyle-related health conditions which, in combination with the nature of their work (sedentary roles interspersed with intermittent high-intensity activity, shift work, and a high stress-load), can have a negative impact on their health. The aim of this study was to investigate the dietary habits and factors or barriers influencing these habits within a cohort of law enforcement personnel in the United States of America.

METHOD

Cross-sectional data were obtained via validated paper-based surveys being the Perceived Barriers to Healthy Eating, Food Choice Questionnaire and Rapid Eating Assessment for Participants, Short Version.

RESULTS

A total of 159 participants (median age = 27 [range 19-60] years; 74% males) participated. Barriers to healthy eating included being busy and irregular working hours. Overall, 91% (n = 143) placed high importance on consuming nutritious food and 80% (n = 126) on food high in vitamins and minerals. A further 80% (n = 127) emphasized high protein content and 41% (n = 62) followed a high protein diet. Barriers to healthy eating included busy lifestyle (60%, n = 94), and irregular working hours (41%, n = 64). Overall, 80% (n = 127) were very willing to make changes in eating habits to be healthier.

CONCLUSION

Law enforcement officers know what they should eat and report convenience and health the most important factors guiding their food choices. Knowing this, officers find challenges putting good dietary practices into practice due to factors like a busy lifestyle and irregular work hours. Reportedly "very willing" to make changes in their eating habits to be healthier, future interventions should focus on how to effect changes to their eating habits as opposed to focussing on what to eat.

Cooking Frequency and Perception of Diet among US Adults Are Associated with US Healthy and Healthy Mediterranean-Style Dietary Related Classes: A Latent Class Profile Analysis

Background: Meal habits are associated with overall dietary quality and favorable dietary patterns determined by the Healthy Eating Index (HEI). However, within dietary patterns, complexities of food combinations that are not apparent through composite score determination may occur. Also, explorations of these food combinations with cooking and perceived diet quality (PDQ) remain unknown. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 were utilized to determine the frequency of cooking at home and PDQ, along with sociodemographic variables. Latent class profile analysis was performed to determine person-centered data-driven analysis using the dietary index, HEI-2010, at both the daily and dinner meal-time levels. Multinomial logistic regression analysis was utilized to evaluate the association of dietary patterns with all covariates. Results: For daily HEI, five distinct dietary classes were identified. For dinner HEI, six classes were identified. In comparison to the standard American diet classes, home cooking was positively associated with daily (p < 0.05) and dinner (p < 0.001) dietary classes that had the highest amounts of total vegetable and greens/beans intake. PDQ was positively associated with these classes at the daily level (p < 0.001), but negatively associated with healthier classes at the dinner level (p < 0.001). Conclusion: The use of latent class profile analysis at the daily and dinner meal-time levels identified that food choices coalesce into diverse intakes, as shown by identified dietary classes. Home cooking frequency could be considered a positive factor associated with higher vegetable intake, particularly greens/beans, at the daily and dinner levels. At the same time, the perception of diet quality has a positive association only with daily choices.

Americans' COVID-19 Stress, Coping, and Adherence to CDC Guidelines

IMPORTANCE

Documenting Americans' stress responses to an unprecedented pandemic and their degree of adherence to CDC guidelines is essential for mental health interventions and policy-making.

OBJECTIVE

To provide the first snapshot of immediate impact of COVID-19 on Americans' stress, coping, and guideline adherence.

DESIGN

Data were collected from an online workers' platform for survey research (Amazon's Mechanical Turk) from April 7 to 9, 2020. The current data represents the baseline of a longitudinal study. Best practices for ensuring high-quality data were employed.

PARTICIPANTS

Individuals who are 18 years of age or older, living in the USA, and English-speaking were eligible for the study. Of 1086 unique responses, 1015 completed responses are included.

SETTING

Population-based.

MAIN OUTCOMES

Exposure to and stressfulness of COVID-19 stressors, coping strategies, and adherence to CDC guidelines.

RESULTS

The sample was 53.9% women (n = 547), with an average age of 38.9 years (SD = 13.50, range = 18-88), most of whom were White (n = 836, 82.4%), non-Hispanic (n = 929, 91.5%), and straight/heterosexual (n = 895, 88.2%); 40% were currently married (n = 407), and 21.6% (n = 219) were caregivers. About half (50.5%) endorsed having at least "mostly" enough money to meet their needs. Respondents' locations across the USA ranged from 18.5% in the Northeast to 37.8% in the South. The most commonly experienced stressors were reading/hearing about the severity and contagiousness of COVID-19, uncertainty about length of quarantine and social distancing requirements, and changes to social and daily personal care routines. Financial concerns were rated most stressful. Younger age, female gender, and caregiver status increased risk for stressor exposure and greater degree of stressfulness. The most frequently reported strategies to manage stress were distraction, active coping, and seeking emotional social support. CDC guideline adherence was generally high, but several key social distancing and hygiene behaviors showed suboptimal adherence, particularly for men and younger adults.

CONCLUSIONS AND RELEVANCE

Americans have high COVID-19 stress exposure and some demographic subgroups appear particularly vulnerable to stress effects. Subgroups less likely to adhere to CDC guidelines may benefit from targeted information campaigns. these findings may guide mental health interventions and inform policy-making regarding implications of specific public health measures.

Self-perception of dietary quality and adherence to food groups dietary recommendations among Mexican adults

BACKGROUND

Mexicans' adherence to food group's dietary recommendations is low and an inaccurate self-perception of dietary quality might perpetuate this low adherence. Our aim was to compare the intake and the adherence to the dietary recommendations for several food groups, subgroups, and to an overall Mexican Diet Quality Index (MxDQI), among those that perceived their diet as healthy vs. those that did not.

METHODS

We analyzed data from 989 subjects 20-59 y old from the nationally representative Mexican National Health and Nutrition Survey 2016. Dietary intake was collected with one 24-h recall and a repeated recall in 82 subjects. Self-perception of dietary quality was evaluated with the following question "Do you consider that your diet is healthy? (yes/no)". We used the National Cancer Institute method to estimate the usual intake. We compared the mean intake adjusted by sociodemographic variables and the percentage of adherence according to the self-perception of dietary quality among the whole sample and in sociodemographic subpopulations.

RESULTS

Sixty percent perceived their diet as healthy, and their adherence to recommendations was low [20% for fruits and vegetables, < 8% for legumes, seafood and SSBs, and ~ 50% for processed meats and high in saturated fat and/or added sugar (HSFAS) products]. The mean number of recommendations they met was 2.8 (out of 7) vs. 2.6 among the rest of the population (p > 0.05), and the MxDQI score was 40 vs. 37 (out of 100 points). The only food groups and subgroups with a statistically significant difference between those that perceived their diet as healthy vs. unhealthy were fruits [38 g/d (95% CI 3, 73)], fruit juices [27 g/d (95% CI 2, 52)], industrialized SSBs [- 35 kcal/d (- 70, - 1)] and salty snacks [- 40 kcal/d (- 79, - 1)]. Other differences were small or inconsistent across subgroups of the population.

CONCLUSIONS

Those that perceived their diet as healthy only had a slightly healthier diet than the rest of the population, moreover, their adherence to recommendations was very low. Hence, it is necessary to improve their nutrition knowledge.

Postpartum lifestyle modifications for women with gestational diabetes: A qualitative study

The prevalence of gestational diabetes mellitus increased to 8% in France in 2012, and the risk of developing type 2 diabetes after receiving a gestational diabetes diagnosis increases 7-fold. Education delivered during pregnancy aims to reduce this risk by reminding women to maintain dietary and lifestyle modifications after delivery.

OBJECTIVE

The primary objective of this study was to describe and analyze the feelings and daily lifestyle changes, including physical activity and dietary changes, among women who experienced gestational diabetes and the roles played by their general practitioners during follow-up.

STUDY DESIGN

We conducted a qualitative study examining women's attitudes during the 6-12 months postpartum, after receiving a gestational diabetes diagnosis and associated education. All women participated in semi-structured, individual, telephone-based interviews.

RESULTS

Out of 47 patients contacted, we interviewed 16 women. All interviewed women modified their behaviors, at least slightly, and described changes that included more balanced diets and the incorporation of mild physical activity. Lack of time, lack of awareness regarding the long-term risk of developing type 2 diabetes, resistance to long-term dietary changes, and cultural habits were identified as the primary barriers to long-term lifestyle modifications, whereas family support was found to be beneficial. The reported interactions between each woman and her physician appeared to be weak.

CONCLUSION

Our study showed that educational attitudes and preventive interventions must be reinforced, especially during the long-term, and not only during the immediate postpartum period. Raising awareness among primary care physicians regarding the need to provide continuous education for this high-risk population appears to be necessary.

Changing lifestyle for dementia risk reduction: Inductive content analysis of a national UK survey

OBJECTIVE

To explore what motivates individuals to change their behaviour to reduce their risk of dementia.

METHODS

We conducted secondary qualitative analysis of a UK-based online survey on motivation to change lifestyle and health behaviour for dementia risk reduction. Participants were recruited through social media, the Join Dementia Research network and the National Institute for Health Research Portfolio. Free-text comments from people aged ≥50 years were analysed by two researchers independently using inductive content analysis. Inter-rater agreement was measured through Cohen's Kappa coefficient.

RESULTS

Of the 3,948 participants completing the survey, 653 provided free text comments that were included in the analysis (Mean age = 64.1; SD = 8.3 years). The majority of the sample were women (n = 459; 70.3%), Caucasian (n = 625; 95.7%) and married/in partnership (n = 459; 70.3%). Three overarching themes were identified: (1) motivators to changing lifestyle; (2) barriers for lifestyle change; and, (3) quality of the information received. The inter-rater reliability of the coding was high (k = 0.7). Having a family history of dementia or feeling like they had a healthy lifestyle already were motivating factors for behaviour change. Having competing health priorities other than dementia and caring for someone acted as de-motivators as they reduced the time available to dedicate to one's own health. Evidence-based information around dementia prevention was a motivator, but commonly the information was not trusted.

DISCUSSION

Aligned with the World Health Organisation (WHO) mandate on dementia prevention, community health campaigns targeting population awareness around behaviour change and dementia risk factor reduction are urgently needed. To be successful, such campaigns will need to be accompanied by individual approaches that can overcome age-related barriers and individual differences in motivation levels, personal barriers and trust in the information received.

Differences in Nutrient Intake and Diet Quality Between Non-Hispanic Black and Non-Hispanic White Men in the United States

OBJECTIVES

Non-Hispanic black (NHB) men have higher rates of chronic disease than men in other racial/ethnic groups. Poor diet quality is one risk factor for chronic disease, but research on the diet quality and nutrient intake of NHB men is sparse. The objective of this study was to describe and compare the diet quality and nutrient intake of NHB and non-Hispanic white (NHW) men in the United States.

METHODS

We analyzed cross-sectional data on 5050 men (31.3% NHB, 68.7% NHW) who participated in the National Health and Nutrition Examination Survey (NHANES) during 2007-2012. To assess diet quality, we calculated Healthy Eating Index (HEI)-2010 scores from each participant's 24-hour recall data. We used logistic regression models to determine if NHB men had lower odds of meeting dietary recommendations for nutrient intake than NHW men. We used linear regression models to identify significant differences in HEI-2010 scores between NHB and NHW men.

RESULTS

After adjusting for sociodemographic measures, NHB and NHW men had similar diet quality (P = .59). Compared with NHW men, NHB men had lower odds of meeting recommendations for dietary fiber and cholesterol intake and higher odds of meeting recommendations for saturated fat and sodium intake.

CONCLUSION

Differences between NHB and NHW men in the intake of certain nutrients may be related to chronic disease disparities. Future research should consider racial/ethnic differences in dietary intake among men and the impact these differences have on men's health.

The Effect of a Digital Behavioral Weight Loss Intervention on Adherence to the Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern in Medically Vulnerable Primary Care Patients: Results from a Randomized Controlled Trial

BACKGROUND

Obesity treatment focuses primarily on reducing overall caloric intake with limited focus on improving diet quality. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is effective in managing hypertension and other chronic conditions, yet it is not clear whether behavioral weight control interventions improve DASH adherence. We conducted a post hoc analysis of a behavioral weight loss intervention that did not emphasize diet quality and examined whether the intervention impacted DASH adherence in medically vulnerable community health center patients.

METHODS

Participants (n=306) were enrolled in Track, a randomized controlled weight loss intervention for patients with elevated cardiovascular risk. The trial compared usual care to an intervention with weekly self-monitoring, tailored feedback on diet and exercise goals, and dietitian and provider counseling in community health centers. Dietary intake was measured using the Block Food Frequency Questionnaires collected at baseline and 12 months. DASH adherence was determined using previously validated scoring indices that assessed adherence based on recommended nutrient or food group targets. Total scores for both indices ranged from 0 to 9, with higher scores indicating greater DASH adherence.

RESULTS

The mean (and standard deviation [SD]) age of participants was 51.1 (SD=8.8) years and the mean body mass index was 35.9 (SD=3.9). Most were female (69%) and black (51%); 13% were Hispanic. Half (51%) had an annual income <$25,000 and 33% had both diabetes and hypertension. At baseline, the mean DASH nutrient score was 1.81 (SD=1.42) with 6% achieving at least a score of 4.5. Similar scores were seen for the DASH foods index. The intervention group saw significantly greater, albeit small, improvements in mean DASH nutrient score (intervention: 1.28 [SD=1.5] vs control: 0.20 [SD=1.3]; P<0.001), and there was no difference in DASH food score between study arms. There were no significant predictors of change in DASH score and no association between DASH adherence and changes in blood pressure. Within the intervention arm, improvements in DASH nutrient score were associated with greater weight loss (r=-0.28; P=0.003).

CONCLUSION

Although the intervention was not designed to increase adoption of DASH, the Track intervention produced significant weight loss and small improvements in DASH adherence. Despite these small improvements, overall adoption of DASH was poor among the medically vulnerable patients enrolled in Track. To further reduce chronic disease burden, weight loss interventions should include a focus on both caloric restriction and increasing diet quality.

Factors Associated With Underestimation of Weight Among Adults Living in Puerto Rico

The aim of this cross-sectional study was to examine the associations between underestimation of weight and sociodemographic, health, and dietary factors among adults living in a rural community in Puerto Rico. For data collection, a researcher-designed questionnaire was distributed to each household in the area. A multivariable logistic regression was conducted for data analysis. Results revealed that the prevalence of overweight and obesity was 34.4% and 38.7%, respectively. A total of 53.4% of the participants underestimated their weight, most of whom were either overweight or obese. Weight underestimation was associated with being male, age ≥35 years, living below the poverty level estimate, perceiving diet quality as excellent/very good, and consuming fast food ≥1 times/week. In conclusion, overweight/obesity rates were high in this sample, and underestimation of weight was common among people with higher body mass index levels. Future public health interventions targeting obesity in this population should consider self-perception of body weight.

Household Cooking Frequency of Dinner Among Non-Hispanic Black Adults is Associated with Income and Employment, Perceived Diet Quality and Varied Objective Diet Quality, HEI (Healthy Eating Index): NHANES Analysis 2007-2010

Home cooking is associated with improved diet quality. Non-Hispanic Blacks, a population with diet-quality related health disparities, report lower home cooking than other racial/ethnic groups. Factors and subsequent dietary outcomes associated with this cooking disparity are relatively unknown. A secondary analysis was performed using demographic and consumer behavior data from the 2007-2010 cycles of the National Health and Nutrition Examination Survey (NHANES) to identify factors associated with household cooking frequency of dinner among Non-Hispanic Blacks. Self-reported dietary data were used to calculate Healthy Eating Index-2010 (HEI-2010) to determine cooking related objective diet quality. Lower income, unemployment, and higher perceived diet quality were significantly associated with higher cooking frequency (p < 0.05). For diet quality, higher vegetable (p = 0.031), lower empty calorie intake (p = 0.002), higher dinner time protein (p = 0.004) and lower dinner time dairy intake (p = 0.003) were associated with cooking. Total HEI scores were associated with higher cooking frequency for middle income (p = 0.007), but not higher or lower income categories (p = 0.306; p = 0.384), respectively. On average, factors associated with cooking frequency were psychosocial, income, and employment related. Objective diet quality as measured by HEI was variable. Future dietary studies among Non-Hispanic Blacks should include cooking, socioeconomic status and perceived diet quality as particularly relevant factors of interest.

Significant Relationships Exist between Perceived and Objective Diet Quality in Young Adults

BACKGROUND

There is a disproportionate burden of low diet quality among young adults compared with other adult subpopulations that is not understood. Perceived and objective diet qualities are studied to understand possible barriers to change.

OBJECTIVE

To explore the association between perceived diet quality and objective diet quality in young adults in the United States.

DESIGN

This cross-sectional study used data from the 2013-2014 National Health and Nutrition Examination Survey to calculate total Healthy Eating Index-2010 (HEI-2010) score and component scores and study their relationships with perceived diet quality scores.

PARTICIPANTS/SETTING

The sample consisted of 1,261 young adults, aged 18 to 30, with 24-hour recall data.

MAIN OUTCOME MEASURES

Perceived and objective diet quality were evaluated.

STATISTICAL ANALYSES PERFORMED

Multiple regression analysis was used to test the ability to predict total HEI-2010 scores from perceived diet quality scores. Ordered logit was used to test whether HEI-2010 component scores predicted the odds of having higher perceived diet quality.

RESULTS

Excellent (b=8.442, P<0.001), very good (b=9.733, P<0.001), and good (b=5.527, P<0.001) perceived diet quality were significant predictors of total HEI-2010 score, compared with the referent category of poor perceived diet quality. The full regression model predicted 17.0% of the variance in total HEI-2010 score. Whole fruit (odds ratio [OR]=1.098, P=.017), whole grains (OR=1.046, P=.023), and empty calories (OR=1.054, P<0.001) were each significantly associated with the odds of having a higher rating of perceived diet quality (fair, good, very good, excellent) instead of a poor rating of diet quality; the difference in odds was low across categories.

CONCLUSIONS

There are significant relationships between perceived and objective diet quality, but other variables play a substantial role in explaining these two types of diet quality.

Poverty does not modify the association between perceived diet healthiness and adherence to nutritional guidelines in the Constances cohort (France)

Poor individuals have less healthy diets and seem to benefit less from nutrition information campaigns. One may wonder if they are less aware of their diets' shortcomings. The aim of this paper is to assess whether the association between perceived diet healthiness and adherence to nutritional guidelines is weaker among poor people. Data were collected from 40,000 participants from the Constances study, a large population-based observational cohort in France. Adherence to French nutritional guidelines was measured by a validated score based on a 22 item food frequency questionnaire and poverty was defined as facing material deprivation. These variables and their interaction were the variables of interest of a linear regression predicting perceived diet healthiness, with controls for confounders and 95% CI. Poor participants had lower nutrition scores and diet healthiness perceptions. Among respondents who had never faced material deprivation, for each increase in the guideline adherence score there was a +0.21 change (95% CI [0.18,0.23]) in perceived diet healthiness for men (women: +0.19 [0.17,0.22]). The coefficients were not smaller among poor respondents. Our results do not support the assumption that people facing poverty might overestimate their diet healthiness. This suggests that information campaigns are not enough: policies or interventions making healthy eating easier and more manageable are necessary.

Cancer Risk Awareness among Uninsured Primary Care Patients

OBJECTIVES

Underserved populations are at risk of low cancer risk awareness. The purpose of this study was to examine cancer risk awareness and lifestyle issues among uninsured primary care patients in the United States.

METHODS

Data were collected using a self-administered survey from May to July 2017 of adult free clinic patients (N = 506) who spoke English or Spanish.

RESULTS

The following factors were associated with higher levels of cancer risk awareness: higher educational attainment, better self-perceived health, and having a family history of cancer. More than 40% of free clinic patients reported a family history of cancer. Contradictory findings existed between perceived diet quality and perceived weight.

CONCLUSIONS

The intersection of cancer risk awareness and lifestyle issues among underserved populations is a vital topic to improve cancer prevention and promote screening uptake. Continued research is needed to understand which types of cancer underserved populations are cognizant of developing. In addition, because community-level interventions are effective in increasing cancer risk awareness, 3 research is needed to determine ways in which health education programs focused at cancer risk awareness directed to underserved populations can be effectively implemented and evaluated.

Association Between Caregiver's Perception of "Good" Dietary Habits and Food Group Intake Among Preschool Children in Tokyo, Japan

Given that parents are mainly responsible for a preschooler's dietary management, they need to understand a child's diet. However, few studies have examined the association between parental perception of a preschool child's "good" dietary habits and actual food intake. We conducted a cross-sectional study investigating whether a child's food intake would differ depending on the caregiver's perception of their child's dietary habits among 4-year-old nursery school children at Adachi City, Tokyo, Japan. Children's dietary data were collected using the brief-type self-administered diet history questionnaire for children Aged 3-6 Years (BDHQ3y), while caregivers' perceptions of their child's dietary habits (good, normal, and poor) were inquired (N = 136). The percentage of caregivers who perceived their child's dietary habit as good, normal, and poor was 41.2, 40.4, and 18.4%, respectively. Multiple linear regression analysis revealed that children whose caregivers perceived their diet as poor showed lower intakes of vegetables [β = -48.7, 95% confidence interval (CI): -86.1 to -11.2], beans (β = -13.2, 95% CI: -26.1 to -0.3), and fish and shellfish (β = -9.2, 95% CI: -17.5 to -1.0) and higher intakes of fat and oil (β = 1.7, 95% CI: 0.4 to 3.1), confectionaries (β = 11.9, 95% CI: 3.6 to 20.3), and soft drinks (β = 31.2, 95% CI: 3.5 to 59.0) compared to children whose caregivers perceived their diet as good (all measures are in g/1,000 kcal per day). No significant difference was observed in other food groups, such as dairy products, an important source of protein and calcium for children. The current study may therefore guide future nutritional education programs for parents of preschool children.

The Grocery Purchase Quality Index-2016 Performs Similarly to the Healthy Eating Index-2015 in a National Survey of Household Food Purchases

BACKGROUND

Household food purchases are potential indicators of the quality of the home food environment, and grocery purchase behavior is a main focus of US Department of Agriculture (USDA) nutrition education programs; therefore, objective measures of grocery purchases are needed.

OBJECTIVE

The objective of the study was to evaluate the Grocery Purchase Quality Index-2016 (GPQI-2016) as a tool for assessing grocery food purchase quality by using the Healthy Eating Index-2015 (HEI-2015) as the reference standard.

DESIGN

In 2012, the USDA Economic Research Service conducted the National Household Food Acquisition and Purchase Survey. Members of participating households recorded all foods acquired for a week. Foods purchased at stores were mapped to the 29 food categories used in USDA Food Plans, expenditure shares were estimated, and GPQI-2016 scores were calculated. USDA food codes, provided in the survey database, were used to calculate the HEI-2015.

PARTICIPANTS/SETTING

All households in the 48 coterminous states were eligible for the survey. The analytic sample size was 4,276 households.

MAIN OUTCOME MEASURES

GPQI-2016 and HEI-2015 scores were compared.

STATISTICAL ANALYSES PERFORMED

Correlation of scores was assessed using Spearman's correlation coefficient. Linear regression models with fixed effects were used to determine differences among various subgroups of households.

RESULTS

The correlation coefficient for the total GPQI-2016 score and the total HEI-2015 score was 0.70. For the component scores, the strongest correlations were for Total and Whole Fruit (0.89 to 0.90); the weakest were for Dairy (0.67), Refined Grains (0.66), and Sweets and Sodas/Added Sugars (0.65) (all, P<0.01). Both the GPQI-2016 and HEI-2015 were significantly different among subgroups in expected directions.

CONCLUSIONS

Overall, the GPQI-2016, estimated from a national survey of households, performed similarly to the HEI-2015. The tool has potential for evaluating nutrition education programs and retail-oriented interventions when the nutrient content and gram weights of foods purchased are not available.

Adherence to the Dietary Approaches to Stop Hypertension Dietary Pattern and Risk of Abdominal Aortic Aneurysm: Results From the ARIC Study

Background The role of a healthy dietary pattern in the prevention of abdominal aortic aneurysms ( AAA ) is unknown. We aimed to evaluate the relationship between adherence to a Dietary Approaches To Stop Hypertension-style dietary pattern and the risk of incident AAA s. Methods and Results Dietary intake was assessed via a 66-item food frequency questionnaire at baseline (1987-1989) and at visit 3 (1993-1995) in 13 496 participants enrolled in the ARIC (Atherosclerosis Risk in Communities) study without clinical AAA (mean age, 54 years). A dietary scoring index based on food times was constructed to assess self-reported adherence to a dietary approaches to stop hypertension-style dietary pattern. Participants were followed for incident clinical AAA s using hospital discharge diagnoses, Medicare inpatient and outpatient diagnoses, or death certificates through December 31, 2011. Cox proportional hazards models with covariate adjustment were used to estimate hazard ratios with 95% confidence intervals. During a median follow-up of 23 years, there were 517 incident AAA cases. Individuals with a Dietary Approaches To Stop Hypertension-style diet score in the highest quintile had a 40% lower risk of hospitalization for AAA than those in the lowest quintile (hazard ratioQ5 vs Q1: 0.60; 95% confidence intervals: 0.44, 0.83; Ptrend=0.002). In detailed analyses, higher consumption of fruits, vegetables, whole grains, low-fat dairy, and nuts and legumes was related to a lower risk for AAA . Conclusions Greater adherence to a Dietary Approaches To Stop Hypertension-style dietary pattern was associated with lower risk for AAA . Higher consumption of fruits, vegetables, whole grains, low-fat dairy as well as nuts and legumes may help to decrease the burden of AAA s.

Picky Eaters Improved Diet Quality in a Randomized Behavioral Intervention Trial in Youth with Type 1 Diabetes

BACKGROUND

Children who are picky eaters typically demonstrate persistent food refusal and poor diet quality and may be resistant to intervention.

OBJECTIVE

This study tested whether pickiness moderated the effect of a nutrition intervention on diet quality in youth with type 1 diabetes, hypothesizing that the intervention effect would be smaller among picky relative to nonpicky eaters.

DESIGN

The study was an 18-month randomized clinical trial.

PARTICIPANTS

Youth age 8.0 to 16.9 years (n=136) with type 1 diabetes duration ≥1 year, receiving care at an outpatient diabetes center in Boston, MA, and a parent, participated from 2010 to 2013.

INTERVENTION

The intervention integrated motivational interviewing, active learning, and applied problem solving to increase whole plant food intake.

MAIN OUTCOME MEASURES

Whole plant food density (WPFD, cup/oz equivalents per 1,000 kcal target food groups), Healthy Eating Index-2005 (HEI2005, measures conformance to US dietary guidelines), and dietary variety were calculated from 3-day food records completed at six different times. Parents completed the pickiness subscale of the Child Feeding Questionnaire.

STATISTICAL ANALYSES PERFORMED

Mean WPFD and HEI2005 were estimated using the population ratio method; standard errors were computed using jackknife variance-covariance estimation. Overall P value comparing groups across visits was derived using the χ2 test.

RESULTS

Baseline diet quality was lower in picky than in nonpicky eaters. No intervention effect on pickiness or dietary variety was seen. In stratified analyses, the intervention effect on diet quality was significant for picky eaters only (WPFD P=0.0003; HEI2005 P=0.04). Among picky eaters, diet quality in the treatment group improved, whereas diet quality in the control group remained low. Diet quality of nonpicky eaters in the intervention group changed to a lesser degree.

CONCLUSIONS

The intervention resulted in increased diet quality in picky eaters, whereas no intervention effect was seen in nonpicky eaters. Findings suggest that diet quality of picky eaters can be improved without changing their underlying pickiness.

Perception v. actual intakes of junk food and sugar-sweetened beverages in Australian young adults: assessed using the mobile food record

Objective

To determine perception v. actual intakes of energy-dense nutrient-poor ‘junk food’ (JF) and sugar-sweetened beverages (SSB) in young adults, using the mobile food record (mFR).

Design

Before-and-after eating images using a 4 d mFR were assessed for standardised 600 kJ (143 kcal) servings of JF and SSB (excluding diet drinks). Participants reported their concern about the health aspects of their diet, perceptions and intentions regarding JF and SSB.

Setting

Perth, Western Australia.

Subjects

Adults (n 246) aged 18–30 years.

Results

The mean (sd) intake of JF+SSB was 3·7 (2·0) servings/d. Women thinking about drinking less SSB consumed more SSB servings/d (1·5 (1·2)) than men (0·7 (0·5); P<0·05) who were thinking about drinking less. Men not thinking about cutting down JF consumed more servings/d (4·6 (2·4)) than women (2·5 (0·7); P<0·01) who were not thinking about cutting down. Those who paid a lot of attention to the health aspects of their diet consumed less JF+SSB than those who took only a bit of notice (P<0·001), were not really thinking much about it (P<0·001) or who didn’t think at all about the health aspects of food (P<0·01).

Conclusions

Perceptions and attitudes regarding JF and SSB were associated with level of consumption. Those not thinking about cutting down their intake of these foods represent an important target group as they consume more than their peers. Further research is needed to identify how amenable young adults are to changing their intake, particularly given the lack of attention paid to the health aspects of their diet.

Description of the healthy eating indices-based diet quality in Turkish adults: a cross-sectional study

OBJECTIVES

This study aims to describe the dietary status of Turkish adults using two different versions of the Healthy Eating Index (HEI).

METHODS

In this cross sectional study, 494 healthy participants (311 females) with randomly selected and living in Ankara were included between September 2013 and March 2014. A questionnaire was completed and anthropometric measurements (weight and height) were performed. The 24-h dietary recall of individuals was collected. Diet quality was measured through HEI-2005 and HEI-2010 scores.

RESULTS

The mean age, body mass index (BMI), HEI-2005 and HEI-2010 scores of individuals were 32.9 ± 10.8 years; 25.0 ± 4.8 kg/m²; 56.1 ± 13.9 and 41.5 ± 13.7 points, respectively. Significant differences were found between mean HEI-2005 and HEI-2010 scores (p < 0.05). The individual's whose diet quality needs to be improved according to mean HEI-2005 score, had poorer diet based on mean HEI-2010 scores. The highest mean HEI-2005 and HEI-2010 scores were stated in female, in subjects had low education levels, aged 51 years or older and in overweight groups (p <0.05). Both versions of healthy eating indices were correlated positively with BMI and age CONCLUSION: Diet qualities of the individuals are associated with age, gender, education and BMI. Although the components and scores in HEI-2010 version were changed from the version of HEI-2005, the changes may encourage healthy choices of some food group. HEI-2010 gives more attention to food quality than HEI-2005. Thus, in the present study it was concluded that HEI-2010 provided more precise results about diet quality.

DASH (Dietary Approaches to Stop Hypertension) Diet and Risk of Subsequent Kidney Disease

BACKGROUND

There are established guidelines for recommended dietary intake for hypertension treatment and cardiovascular disease prevention. Evidence is lacking for effective dietary patterns for kidney disease prevention.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

Atherosclerosis Risk in Communities (ARIC) Study participants with baseline estimated glomerular filtration rate (eGFR) ≥ 60mL/min/1.73m2 (N=14,882).

PREDICTOR

The Dietary Approaches to Stop Hypertension (DASH) diet score was calculated based on self-reported dietary intake of red and processed meat, sweetened beverages, sodium, fruits, vegetables, whole grains, nuts and legumes, and low-fat dairy products, averaged over 2 visits.

OUTCOMES

Cases were ascertained based on the development of eGFRs<60mL/min/1.73m2 accompanied by ≥25% eGFR decline from baseline, an International Classification of Diseases, Ninth/Tenth Revision code for a kidney disease-related hospitalization or death, or end-stage renal disease from baseline through 2012.

RESULTS

3,720 participants developed kidney disease during a median follow-up of 23 years. Participants with a DASH diet score in the lowest tertile were 16% more likely to develop kidney disease than those with the highest score tertile (HR, 1.16; 95% CI, 1.07-1.26; P for trend < 0.001), after adjusting for sociodemographics, smoking status, physical activity, total caloric intake, baseline eGFR, overweight/obese status, diabetes status, hypertension status, systolic blood pressure, and antihypertensive medication use. Of the individual components of the DASH diet score, high red and processed meat intake was adversely associated with kidney disease and high nuts, legumes, and low-fat dairy products intake was associated with reduced risk for kidney disease.

LIMITATIONS

Potential measurement error due to self-reported dietary intake and lack of data for albuminuria.

CONCLUSIONS

Consuming a DASH-style diet was associated with lower risk for kidney disease independent of demographic characteristics, established kidney risk factors, and baseline kidney function. Healthful dietary patterns such as the DASH diet may be beneficial for kidney disease prevention.

Explaining Racial/Ethnic Dietary Patterns in Relation to Type 2 Diabetes: An Analysis of NHANES 2007-2012

OBJECTIVE

The purpose of this article is to examine sociodemographic and health behavior factors associated with dietary intake as measured by the healthy eating index (HEI-2010) for persons with and without diabetes (T2D).

DESIGN

A secondary data analysis of three NHANES data cycles spanning 2007-2012. Multiple linear regression assessed racial/ethnic differences in HEI-2010 scores in those without T2D, with T2D, and with undiagnosed T2D.

PARTICIPANTS

The sample included non-pregnant adults aged ≥20 years who had two days of reliable dietary recall data.

OUTCOME MEASURES

Total scores for the HEI-2010.

RESULTS

For those without T2D, there was a significant association between race/ethnicity and HEI score, with non-Hispanic Blacks achieving significantly lower scores than their non-Hispanic White counterparts. Differences in HEI-2010 score were also associated with age, sex, smoking status and time spent in the United States. Racial/ethnic differences in dietary patterns were present, but not significant in those with undiagnosed or diagnosed T2D.

CONCLUSIONS

Racial/ethnic disparities in dietary patterns are present in individuals without T2D, but differences are not statistically significant in those with undiagnosed or diagnosed T2D. Non-Hispanic Blacks without T2D received significantly lower HEI-2010 scores than non-Hispanic Whites. Further research is necessary to determine whether or not similarities in dietary intake across racial/ethnic groups with T2D will be reflected in diabetes-related health outcomes in this population.

The association between self-rated eating habits and dietary behavior in two Latino neighborhoods: Findings from Proyecto MercadoFRESCO

OBJECTIVE

Latinos are the largest racial and ethnic minority group in the United States and bear a disproportionate burden of obesity related chronic disease. Despite national efforts to improve dietary habits and prevent obesity among Latinos, obesity rates remain high. The objective of this study is to explore the relationship between self-rated dietary quality and dietary behavior among Latinos and how this may vary by socio-demographics to help inform future public health efforts aiming to improve eating habits and obesity rates.

DESIGN

Cross-sectional study using a series of chi-square tests, the non-parametric Wilcoxon-Mann-Whitney test and logistic regression to explore self-rated eating habits.

SETTING

Two urban, low-income, predominantly Latino neighborhoods in Los Angeles County.

SUBJECTS

1000 adults who self-identified as their household's primary food purchaser and preparer were interviewed from 2012 to 2013. Households were randomly selected based on their proximity to corner stores participating in a project to improve the food environment.

RESULTS

Most respondents (59%) report "good" eating habits. Significant associations between "good" eating habits and overall health, fruit and vegetable consumption were observed (p < 0.001). Despite these promising findings, we also find high levels of regular soda and energy-dense food consumption.

CONCLUSION

This study revealed a general understanding that healthy dietary habits are associated with fruit and vegetable consumption among Latinos in two urban neighborhoods. However, there is a need for more targeted health promotion and nutrition education efforts on the risks associated with soda and energy-dense food consumption to help improve dietary habits and obesity levels in low-income Latino communities.

Dietary habits, poverty, and chronic kidney disease in an urban population

BACKGROUND

Poverty is associated with chronic kidney disease (CKD) in the United States and worldwide. Poor dietary habits may contribute to this disparity.

STUDY DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

A total of 2,058 community-dwelling adults aged 30 to 64 years residing in Baltimore City, Maryland.

PREDICTORS

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet. DASH scoring based on 9 target nutrients (total fat, saturated fat, protein, fiber, cholesterol, calcium, magnesium, sodium, and potassium); adherence defined as score ≥4.5 of maximum possible score of 9. Poverty (self-reported household income <125% of 2004 Department of Health and Human Services guideline) and nonpoverty (≥125% of guideline).

OUTCOMES AND MEASUREMENTS

CKD defined as estimated glomerular filtration rate <60 mL/minute/1.73 m(2) (CKD epidemiology collaboration equation). Multivariable logistic regression was used to calculate adjusted odds ratios (AORs) for relation of DASH score tertile and CKD, stratified by poverty status.

RESULTS

Among 2,058 participants (mean age 48 years; 57% black; 44% male; 42% with poverty), median DASH score was low, 1.5 (interquartile range, 1-2.5). Only 5.4% were adherent. Poverty, male sex, black race, and smoking were more prevalent among the lower DASH score tertiles, whereas higher education and regular health care were more prevalent among the highest DASH score tertile (P < .05 for all). Fiber, calcium, magnesium, and potassium intake were lower, and cholesterol higher, among the poverty compared with nonpoverty group (P < .05 for all), with no difference in sodium intake. A total of 5.6% of the poverty and 3.8% of the nonpoverty group had CKD (P = .05). The lowest DASH tertile (compared with the highest) was associated with more CKD among the poverty (AOR 3.15, 95% confidence interval 1.51-6.56), but not among the nonpoverty group (AOR 0.73, 95% confidence interval 0.37-1.43; P interaction = .001).

CONCLUSIONS

Poor dietary habits are strongly associated with CKD among the urban poor and may represent a target for interventions aimed at reducing disparities in CKD.