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Gal AM, Arhire LI, Gherasim A, Graur M, Nita O, Dumitrascu O, Soimaru RM, Popa AD, Mihalache L. Association between Diet Quality and Eating Behavior in Type 2 Diabetes Adults: A Cross-Sectional Study. Nutrients 2024; 16:2047. [PMID: 38999795 PMCID: PMC11243329 DOI: 10.3390/nu16132047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) has become a global epidemic. To effectively control T2DM, individuals must adhere to a high-quality diet that encompasses not only healthy dietary patterns but also promotes positive eating behaviors. We conducted a cross-sectional study on 314 patients with T2DM, and we evaluated the diet quality and also examined the associations between eating behavior, diet quality, and anthropometric and clinical factors in T2DM patients. We used the Diet Quality Index-International and Dutch Eating Behavior Questionnaire to assess dietary characteristics. We found that women had a significantly higher diet quality than men (61.40 vs. 58.68, p = 0.002) but were also more prone to emotional eating (2.00 vs. 1.53, p < 0.001) and restrained eating (2.39 vs. 2.05, p = 0.002). Restrained eating correlated with duration of diabetes (r = -0.169, p = 0.003), body mass index (r = 0.182, p = 0.001), and external eating with glycated hemoglobin (r = 0.114, p = 0.044). Patients with emotional eating had a higher vitamin C adequacy score (β = 0.117, p = 0.045). External eating was positively associated with grain adequacy (β = 0.208, p < 0.001) and negatively associated with empty-calorie food moderation score (β = -0.125, p = 0.032). For restrained eating, we found associations with vitamin C adequacy (β = -0.138, p = 0.017) and fruit adequacy (β = 0.125, p = 0.033). In conclusion, the results of this study provide valuable insight into dietary behavior and emphasize the importance of promoting healthy eating habits for T2DM patients.
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Affiliation(s)
- Ana Maria Gal
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania;
| | - Lidia Iuliana Arhire
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
| | - Andreea Gherasim
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
| | - Mariana Graur
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania;
| | - Otilia Nita
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
| | - Oana Dumitrascu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
| | - Raluca Meda Soimaru
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania;
| | - Alina Delia Popa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
| | - Laura Mihalache
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (A.G.); (O.N.); (O.D.); (R.M.S.); (A.D.P.); (L.M.)
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Li J, Li Y, Zhang S, Wang C, Mao Z, Huo W, Yang T, Li Y, Xing W, Li L. Association of the short-chain fatty acid levels and dietary quality with type 2 diabetes: a case-control study based on Henan Rural Cohort. Br J Nutr 2024; 131:1668-1677. [PMID: 38343180 DOI: 10.1017/s0007114524000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Evidence of the relationship between fecal short-chain fatty acids (SCFA) levels, dietary quality and type 2 diabetes mellitus (T2DM) in rural populations is limited. Here, we aimed to investigate the association between fecal SCFA levels and T2DM and the combined effects of dietar quality on T2DM in rural China. In total, 100 adults were included in the case-control study. Dietary quality was assessed by the Alternate Healthy Eating Index 2010 (AHEI-2010), and SCFA levels were analysed using the GC-MS system. Generalised linear regression was conducted to calculate the OR and 95 % CI to evaluate the effect of SCFA level and dietary quality on the risk of T2DM. Finally, an interaction was used to study the combined effect of SCFA levels and AHEI-2010 scores on T2DM. T2DM participants had lower levels of acetic and butyric acid. Generalised linear regression analysis revealed that the OR (95 % CI) of the highest acetic and butyric acid levels were 0·099 (0·022, 0·441) and 0·210 (0·057, 0·774), respectively, compared with the subjects with the lowest tertile of level. We also observed a significantly lower risk of T2DM with acetic acid levels > 1330·106 μg/g or butyric acid levels > 585·031 μg/g. Moreover, the risks of higher acetic and butyric acid levels of T2DM were 0·007 (95 % CI: 0·001, 0·148), 0·005 (95 % CI: 0·001, 0·120) compared with participants with lower AHEI-2010 scores (all P < 0·05). Acetate and butyrate levels may be important modifiable beneficial factors affecting T2DM in rural China. Improving dietary quality for body metabolism balance should be encouraged to promote good health.
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Affiliation(s)
- Jia Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan450001, People's Republic of China
| | - Yuqian Li
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shuhua Zhang
- Comprehensive Laboratory, Puyang Quality and Technical Supervision, Inspection and Testing Center, Puyang, Henan, People's Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan450001, People's Republic of China
| | - Zhenxing Mao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan450001, People's Republic of China
| | - Wenqian Huo
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan450001, People's Republic of China
| | - Tianyu Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan450001, People's Republic of China
| | - Yan Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan450001, People's Republic of China
| | - Wenguo Xing
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan450001, People's Republic of China
| | - Linlin Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan450001, People's Republic of China
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Norde MM, Bromage S, Marchioni DML, Vasques AC, Deitchler M, Arsenaut J, de Carvalho AM, Velloso L, Willett W, Giovannucci E, Geloneze B. The global diet quality score as an indicator of adequate nutrient intake and dietary quality - a nation-wide representative study. Nutr J 2024; 23:42. [PMID: 38627669 PMCID: PMC11022474 DOI: 10.1186/s12937-024-00949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The Global Diet Quality Score (GDQS) was developed to be a simple, timely and cost-effective tool to track, simultaneously, nutritional deficiency and non-communicable disease risks from diet in diverse settings. The objective was to investigate the performance of GDQS as an indicator of adequate nutrient intake and dietary quality in a national-representative sample of the Brazilian population. METHODS Nationally-representative data from 44,744 men and non-pregnant and non-lactating women aging ≥ 10 years, from the Brazilian National Dietary Survey were used. Dietary data were collected through two 24-h recalls (24HR). The GDQS was calculated and compared to a proxy indicator of nutrient adequate intake (the Minimum Dietary Diversity for Women-MDD-W) and to an indicator of high-risk diet for non-communicable diseases (caloric contribution from ultra-processed foods-UPF). To estimate the odds for overall nutrient inadequacy across MDD-W and GDQS quintiles, a multiple logistic regression was applied, and the two metrics' performances were compared using Wald's post-test. RESULTS The mean GDQS for Brazilians was 14.5 (0-49 possible range), and only 1% of the population had a low-risk diet (GDQS ≥ 23). The GDQS mean was higher in women, elderly individuals and in higher-income households. An inverse correlation was found between the GDQS and UPF (rho (95% CI) = -0.20(-0.21;-0.19)). The odds for nutrient inadequacy were lower as quintiles of GDQS and MDD-W were higher (p-trend < 0.001), and MDD-W had a slightly better performance than GDQS (p-diff < 0.001). Having a low-risk GDQS (≥ 23) lowered the odds for nutrient inadequacy by 74% (95% CI:63%-81%). CONCLUSION The GDQS is a good indicator of overall nutrient adequacy, and correlates well with UPF in a nationally representative sample of Brazil. Future studies must investigate the relationship between the GDQS and clinical endpoints, strengthening the recommendation to use this metric to surveillance dietary risks.
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Affiliation(s)
- Marina M Norde
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil.
| | - Sabri Bromage
- Institute of Nutrition, Mahidol University, Phuttamonton, Thailand
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Dirce M L Marchioni
- Department of Nutrition, School of Public Health of the University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Carolina Vasques
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil
- School of Applied Sciences, University of Campinas, Limeira, SP, Brazil
| | - Megan Deitchler
- Intake-Center for Dietary Assessment, FHI 360, Washington, DC, USA
| | - Joanne Arsenaut
- Intake-Center for Dietary Assessment, FHI 360, Washington, DC, USA
| | - Aline M de Carvalho
- Department of Nutrition, School of Public Health of the University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Lício Velloso
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil
| | - Walter Willett
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Edward Giovannucci
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Bruno Geloneze
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil
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Mitchell E, Comerford K, Knight M, McKinney K, Lawson Y. A review of dairy food intake for improving health among black adults in the US. J Natl Med Assoc 2024; 116:253-273. [PMID: 38378306 DOI: 10.1016/j.jnma.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
The adult life stage encompasses a range of new experiences, opportunities, and responsibilities that impact health and well-being. During this life stage, health disparities continue to increase for Black Americans, with Black adults having a disproportionate burden of obesity, chronic diseases, comorbidities, and worse treatment outcomes compared to their White peers. While many of the underlying factors for these disparities can be linked to longstanding sociopolitical factors such as systemic racism, food insecurity, and poor access to healthcare, there are also several modifiable risk factors that are known to significantly impact health outcomes, such as improving diet quality, increasing physical activity, and not smoking. Of all the modifiable risk factors known to impact health, improving dietary habits is the factor most consistently associated with better outcomes for body weight and chronic disease. Of the major food groups recommended by the 2020-2025 Dietary Guidelines for Americans (DGA) for achieving healthier dietary patterns, dairy foods have a nutrient profile which matches most closely to what Black Americans are inadequately consuming (e.g., vitamin A, vitamin D, calcium, magnesium). However, Black adults tend to consume less than half the recommended daily servings of dairy foods, in part, due to issues with lactose intolerance, making higher intake of dairy foods an ideal target for improving diet quality and health in this population. This review examines the current body of evidence exploring the links between dairy intake, obesity, cardiometabolic disease risk, chronic kidney disease, and the most common types of cancer, with a special focus on health and disparities among Black adults. Overall, the evidence from most systematic reviews and/or meta-analyses published in the last decade on dairy intake and health outcomes has been conducted on White populations and largely excluded research on Black populations. The findings from this extensive body of research indicate that when teamed with an energy-restricted diet, meeting or exceeding the DGA recommended 3 daily servings of dairy foods is associated with better body weight and composition outcomes and lower rates of most common chronic diseases than lower intake (<2 servings per day). In addition to the number of daily servings consumed, the specific types (e.g., milk, yogurt, cheese) and subtypes (e.g., low-fat, fermented, fortified) consumed have also been shown to play major roles in how these foods impact health. For example, higher intake of fermented dairy foods (e.g., yogurt) and vitamin D fortified dairy products appear to have the most protective effects for reducing chronic disease risk. Along with lactose-free milk and cheese, yogurt is also generally low in lactose, making it an excellent option for individuals with lactose intolerance, who are trying to meet the DGA recommendations for dairy food intake.
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Affiliation(s)
- Edith Mitchell
- Sidney Kimmel Cancer at Jefferson, Philadelphia, PA, United States
| | - Kevin Comerford
- OMNI Nutrition Science, California Dairy Research Foundation, Davis, CA, United States.
| | - Michael Knight
- The George Washington University School of Medicine and Health Sciences, Washington D.C., United States
| | - Kevin McKinney
- University of Texas Medical Branch, Department of Internal Medicine, Division of Endocrinology, Galveston, TX, United States
| | - Yolanda Lawson
- Baylor University Medical Center, Dallas, TX, United States
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Liu Z, Zhao D, Dai S, Liang Y, Zhao M, Liu M, Zhong Z, Liang L, Tian Z, Yang Y. Inverse Association between the Global Diet Quality Score and New-Onset Hypertension in Adults: A Nationwide Cohort Study. J Nutr 2024; 154:1252-1261. [PMID: 38360116 DOI: 10.1016/j.tjnut.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The Global Diet Quality Score (GDQS) is a simple and practical dietary metric associated with a number of chronic diseases. The GDQS included various foods related to blood pressure, especially diverse plant-based foods that have shown to lower blood pressure. However, studies on the role of the GDQS in reducing the risk of new-onset hypertension and whether its performance differs from that of other dietary metrics are lacking. OBJECTIVE We aimed to examine the association between the GDQS and new-onset hypertension and to compare its performance with that of other dietary patterns, including the Plant-based Diet Index (PDI), alternate Mediterranean diet (aMED) score, Alternative Healthy Eating Index-2010, and Dietary Approaches to Stop Hypertension (DASH) score in Chinese adults. METHODS We included a total of 12,002 participants (5644 males and 6358 females) aged >18 y from the China Health and Nutrition Survey (1997-2015). Dietary intake was estimated using average food intakes from 3 consecutive 24-h dietary recalls. Multivariable relative risks (RRs) were computed for hypertension using modified Poisson regression models. RESULTS With ≤18 y of follow-up (mean 8.7± 5.4 y), we ascertained 4232 incident cases of hypertension. Compared with participants with a low GDQS score (<15), the multivariable-adjusted RR of hypertension was 0.72 [95% confidence interval (CI): 0.62, 0.83] among participants with a high score (≥23). A 25% increment in the GDQS was associated with a 30% (RR, 0.70; 95% CI: 0.64, 0.76) lower risk of new-onset hypertension, which was comparable with the RRs of new-onset hypertension associated with every 25% increment in the PDI (RR, 0.84; 95% CI: 0.76, 0.93), DASH score (RR, 0.84; 95% CI: 0.78, 0.91), and aMED score (RR, 0.89; 95% CI: 0.84, 0.93). CONCLUSION A higher GDQS was associated with a lower risk of new-onset hypertension, with comparable associations of new-onset hypertension with PDI, DASH, and aMED scores in Chinese adults.
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Affiliation(s)
- Zhihao Liu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Dan Zhao
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Suming Dai
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Ying Liang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Mingzhu Zhao
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Meitong Liu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zepei Zhong
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Lihan Liang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zezhong Tian
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
| | - Yan Yang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
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Bromage S, Pongcharoen T, Prachansuwan A, Sukboon P, Srichan W, Purttiponthanee S, Deitchler M, Moursi M, Arsenault J, Ali NB, Batis C, Fawzi WW, Winichagoon P, Willett WC, Kriengsinyos W. Performance of the Global Diet Quality Score (GDQS) App in Predicting Nutrient Adequacy and Metabolic Risk Factors among Thai Adults. J Nutr 2023; 153:3576-3594. [PMID: 37844842 PMCID: PMC10739769 DOI: 10.1016/j.tjnut.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The Global Diet Quality Score (GDQS) was developed for monitoring nutrient adequacy and diet-related noncommunicable disease risk in diverse populations. A software application (GDQS app) was recently developed for the standardized collection of GDQS data. The application involves a simplified 24-h dietary recall (24HR) where foods are matched to GDQS-food groups using an onboard database, portion sizes are estimated at the food group level using cubic models, and the GDQS is computed. OBJECTIVES The study aimed to estimate associations between GDQS scores collected using the GDQS app and nutrient adequacy and metabolic risks. METHODS In this cross-sectional study of 600 Thai males and nonpregnant/nonlactating females (40-60 y), we collected 2 d of GDQS app and paper-based 24HR, food-frequency questionnaires (FFQs), anthropometry, body composition, blood pressure, and biomarkers. Associations between application scores and outcomes were estimated using multiple regression, and application performance was compared with that of metrics scored using 24HR and FFQ data: GDQS, Minimum Dietary Diversity-Women, Alternative Healthy Eating Index-2010, and Global Dietary Recommendations score. RESULTS In covariate-adjusted models, application scores were significantly (P < 0.05) associated with higher energy-adjusted mean micronutrient adequacy computed using 24HR (range in estimated mean adequacy between score quintiles 1 and 5: 36.3%-44.5%) and FFQ (Q1-Q5: 40.6%-44.2%), and probability of protein adequacy from 24HR (Q1-Q5: 63%-72.5%). Application scores were inversely associated with BMI kg/m2 (Q1-Q5: 26.3-24.9), body fat percentage (Q1-Q5: 31.7%-29.1%), diastolic blood pressure (Q1-Q5: 84-81 mm Hg), and a locally-developed sodium intake score (Q1-Q5: 27.5-24.0 points out of 100); positively associated with high-density lipoprotein cholesterol (Q1-Q5: 49-53 mg/dL) and 24-h urinary potassium (Q1-Q5: 1385-1646 mg); and inversely associated with high midupper arm circumference (Q5/Q1 odds ratio: 0.52) and abdominal obesity (Q5/Q1 odds ratio: 0.51). Significant associations for the application outnumbered those for metrics computed using 24HR or FFQ. CONCLUSIONS The GDQS app effectively assesses nutrient adequacy and metabolic risk in population surveys.
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Affiliation(s)
- Sabri Bromage
- Community Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand; Department of Global Health and Populations, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tippawan Pongcharoen
- Community Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand.
| | - Aree Prachansuwan
- Human Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Pornpan Sukboon
- Community Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Weerachat Srichan
- Community Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Sasiumphai Purttiponthanee
- Research and Innovation Service Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | | | - Mourad Moursi
- Intake Center for Dietary Assessment, Washington, DC, USA
| | | | - Nazia Binte Ali
- Department of Global Health and Populations, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carolina Batis
- Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Morelos, México
| | - Wafaie W Fawzi
- Department of Global Health and Populations, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Pattanee Winichagoon
- Community Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Wantanee Kriengsinyos
- Human Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand.
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Beigrezaei S, Darabi Z, Davies IG, Mazidi M, Ghayour-Mobarhan M, Khayyatzadeh SS. Higher global diet quality score is related to lower prevalence of depression and poor quality of life among adolescent girls. BMC Psychiatry 2023; 23:886. [PMID: 38017405 PMCID: PMC10683251 DOI: 10.1186/s12888-023-05313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/26/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Adolescence is a key time for the development of depression symptoms and the diet quality may be associated with mental health conditions. The present study examined the association between depression and quality of life (QoL) and the global diet quality score (GDQS) as a simple and standardized metric diet quality in Iranian adolescents. METHODS This cross-sectional study was conducted on 733 adolescent girls recruited using a random cluster sampling method. A 147-item food frequency questionnaire (FFQ) was used for dietary intake assessment. The GDQS is gained by summing points of all the 25 food groups, ranged from 0 to 49. Depression symptoms were assessed using a Persian version of the Beck Depression Inventory (BDI). For assessment of health-related QoL, the Short Form 12 Survey-version 2 (SF-12v2) questionnaire was employed. Multivariable logistic regression examined the association of depression and QoL with GDQS in crude and adjusted models. RESULTS Adolescent girls in the highest tertile of GDQS score compared with the lowest tertile had a 41% lower odds of depressive symptoms (OR: 0.59; 95% CI: 0.39-0.90, P = 0.01). The participants in the third tertile of GDQS score had lower odds of poor QoL compared with the first tertile (OR: 0.56; 95% CI: 0.37-0.85, P < 0.01). These associations remained significant (both P = 0.01) after adjustment for age, energy intake, body mass index (BMI), physical activity, and menstruation (depressive symptoms: OR: 0.59; 95% CI: 0.38-0.92; QoL: OR: 0.59; 95% CI: 0.38-0.91, P = 0.01). CONCLUSION We found that adolescent girls with a higher score of the GDQS had lower odds of depression and poor QoL Prospective and interventional investigations are needed to reach a clear vision.
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Affiliation(s)
- Sara Beigrezaei
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zahra Darabi
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ian G Davies
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Mohsen Mazidi
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
- Department of Twin Research and Genetic Epidemiology, King's College London, South Wing St Thomas', London, UK
| | - Majid Ghayour-Mobarhan
- International UNESCO center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sayyed Saeid Khayyatzadeh
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Shohadaye gomnam BLD. ALEM square, Yazd, Iran.
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Hollis-Hansen K, Tan S, Bargnesi S, McGovern L, Drozdowsky J, Epstein LH, Leone LA, Mak E, Masci J, Anzman-Frasca S. Feasibility and implementation of a grocery shopping intervention for adults diagnosed with or at-risk for type 2 diabetes. Public Health Nutr 2023; 26:2118-2129. [PMID: 37496394 PMCID: PMC10564597 DOI: 10.1017/s1368980023001453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 05/23/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To examine the feasibility and implementation of an optimal defaults intervention designed to align grocery purchases with a diet recommended for people with or at-risk for type 2 diabetes. DESIGN This was a 5-week pilot randomised trial with three groups: in-person grocery shopping, shopping online and shopping online with 'default' carts. Participants were asked to shop normally in Week One, according to group assignment in Weeks Two-Four (intervention period), and as preferred in Week Five. All groups received diabetes-friendly recipes via email each intervention week. SETTING Participants grocery shopped in person or online. Grocery receipt forms, enrolment information and exit surveys were collected remotely and used to assess feasibility and implementation. PARTICIPANTS Sixty-five adults with or at-risk for type 2 diabetes. RESULTS Sixty-two participants completed the exit survey and fifty-five submitted receipts all 5 weeks. Forty utilised recipes, 95 % of whom indicated recipes were somewhat or very useful. Orange chicken, quesadillas and pork with potato and apples were the most liked recipes. Most Defaults group participants accepted at least some default cart items. Recipes with the highest default acceptance were whole grain pasta and chicken, quesadillas with black beans and chicken with olives. Participants' primary concerns about the intervention were costs associated with online shopping, inability to select preferred foods and some recipes including ingredients household members would not eat. CONCLUSIONS The study had high retention, data were successfully collected remotely and the intervention was acceptable to most participants. Tailoring recipes to household preferences may be beneficial in future studies.
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Affiliation(s)
- Kelseanna Hollis-Hansen
- Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Sherey Tan
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Sarah Bargnesi
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Lily McGovern
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Julia Drozdowsky
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, USA
| | - Lucia A Leone
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, USA
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Eunice Mak
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jaclyn Masci
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, USA
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9
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Nguyen PH, Tran LM, Hoang NT, Deitchler M, Moursi M, Bergeron G. The Global Diet Quality Score is associated with nutrient adequacy and depression among Vietnamese youths. Ann N Y Acad Sci 2023; 1528:48-57. [PMID: 37566812 DOI: 10.1111/nyas.15053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
The Global Diet Quality Score (GDQS) has been recommended as a simple diet quality metric that is reflective of both nutrient adequacy and noncommunicable disease outcomes. It has been validated among women of reproductive age (15-49 years) in diverse settings but not specifically among younger women. This paper examines the relationship between the GDQS and nutrient adequacy, anthropometric outcomes, and depressive symptoms among 1001 Vietnamese young women aged 16-22 years. In energy-adjusted models, the GDQS was significantly (p < 0.05) and positively correlated with intakes of protein (ρ = 0.23), total fat (ρ = 0.06), nine micronutrients (calcium, iron, zinc, vitamin C, riboflavin, niacin, vitamin B6, folate, and vitamin A) (ρ = 0.12-0.35), and the mean probability of adequacy of micronutrients (ρ = 0.28). Compared to young women with optimal GDQS, those with low and very low GDQS were two to five times more likely to have a mean probability of nutrient adequacy less than 50% and showed two to three times higher odds for depression. No association was observed for GDQS and anthropometric outcomes. In conclusion, the GDQS performed well in capturing nutrient adequacy and depressive symptoms among Vietnamese young women. Further research is warranted to explore the relationship between diet quality and depression in other settings.
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Affiliation(s)
- Phuong Hong Nguyen
- International Food Policy Research Institute, Washington, DC, USA
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | | | | | | | - Mourad Moursi
- Intake - Center for Dietary Assessment, Washington, DC, USA
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10
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Wang P, Song M, Eliassen AH, Wang M, Giovannucci EL. Dietary patterns and risk of colorectal cancer: a comparative analysis. Int J Epidemiol 2023; 52:96-106. [PMID: 36515537 PMCID: PMC9908053 DOI: 10.1093/ije/dyac230] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although several dietary patterns have been associated with incident colorectal cancer (CRC), it is unclear which diet is optimal. METHODS Participants included 48 409 men and 169 772 women from three USA-based prospective cohort studies. We compared the associations of 18 dietary patterns with CRC risk, including two reference scores. The reference scores were derived based on the dietary recommendations for cancer prevention and CRC-specific dietary risk factors mentioned in the 2018 World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) Third Expert Report. Multivariable Cox proportional hazards models were fitted to estimate hazard ratios (HRs) and 95% CIs. RESULTS Most dietary patterns showed moderate correlations with the WCRF dietary score (absolute values of Spearman correlation coefficients: 0.45-0.63), except the Plant-based diet index, low-carbohydrate diets, the Empirical dietary index for hyperinsulinemia (EDIH) and Empirical dietary inflammation pattern (EDIP). HR for the 10th-90th percentile difference in the score was 0.86 (95% CI: 0.78-0.94) for the Dietary Approaches to Stop Hypertension score (DASH), 1.15 (1.06-1.26) for Western dietary pattern, 1.20 (1.10-1.31) for EDIH and 1.23 (1.13-1.34) for EDIP. These associations between patterns and CRC risk persisted after adjusting for the two reference scores. CONCLUSIONS Although further research is needed to improve the WCRF/AICR dietary recommendations, our comprehensive assessment of dietary patterns revealed that the DASH, Western dietary pattern, EDIH and EDIP may be the most relevant diets for preventing CRC.
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Affiliation(s)
- Peilu Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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11
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Bromage S, Andersen CT, Tadesse AW, Passarelli S, Hemler EC, Fekadu H, Sudfeld CR, Worku A, Berhane H, Batis C, Bhupathiraju SN, Fung TT, Li Y, Stampfer MJ, Deitchler M, Willett WC, Fawzi WW. The Global Diet Quality Score is Associated with Higher Nutrient Adequacy, Midupper Arm Circumference, Venous Hemoglobin, and Serum Folate Among Urban and Rural Ethiopian Adults. J Nutr 2021; 151:130S-142S. [PMID: 34689198 PMCID: PMC8564694 DOI: 10.1093/jn/nxab264] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/18/2021] [Accepted: 07/20/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising. OBJECTIVES To evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults. METHODS We scored the GDQS and a suite of comparison metrics in secondary analyses of FFQ and 24-hour recall (24HR) data from a population-based cross-sectional survey of nonpregnant, nonlactating women of reproductive age and men (15-49 years) in Addis Ababa and 5 predominately rural regions. We evaluated Spearman correlations between metrics and energy-adjusted nutrient adequacy, and associations between metrics and anthropometric/biomarker outcomes in covariate-adjusted regression models. RESULTS In the FFQ analysis, correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy were 0.32 in men and 0.26 in women. GDQS scores were inversely associated with folate deficiency in men and women (GDQS Quintile 5 compared with Quintile 1 OR in women, 0.50; 95% CI: 0.31-0.79); inversely associated with underweight (OR, 0.63; 95% CI: 0.44-0.90), low midupper arm circumference (OR, 0.61; 95% CI: 0.45-0.84), and anemia (OR, 0.59; 95% CI: 0.38-0.91) in women; and positively associated with hypertension in men (OR: 1.77, 95% CI: 1.12-2.80). For comparison, the Minimum Dietary Diversity-Women (MDD-W) was associated more positively (P < 0.05) with overall nutrient adequacy in men and women, but also associated with low ferritin in men, overweight/obesity in women, and hypertension in men and women. In the 24HR analysis (restricted to women), the MDD-W was associated more positively (P < 0.05) with nutrient adequacy than the GDQS, but also associated with low ferritin, while the GDQS was associated inversely with anemia. CONCLUSIONS The GDQS performed capably in capturing nutrient adequacy-related outcomes in Ethiopian adults. Prospective studies are warranted to assess the GDQS' performance in capturing NCD outcomes in sub-Saharan Africa.
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Affiliation(s)
| | | | - Amare W Tadesse
- London School of Hygiene and Tropical Medicine, London, UK,Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | | | - Elena C Hemler
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Hanna Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Carolina Batis
- CONACYT—Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Shilpa N Bhupathiraju
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Teresa T Fung
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Simmons University, Boston, MA, USA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Megan Deitchler
- Intake–Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Walter C Willett
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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12
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Bromage S, Batis C, Bhupathiraju SN, Fawzi WW, Fung TT, Li Y, Deitchler M, Angulo E, Birk N, Castellanos-Gutiérrez A, He Y, Fang Y, Matsuzaki M, Zhang Y, Moursi M, Kronsteiner-Gicevic S, Holmes MD, Isanaka S, Kinra S, Sachs SE, Stampfer MJ, Stern D, Willett WC. Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS). J Nutr 2021; 151:75S-92S. [PMID: 34689200 PMCID: PMC8542096 DOI: 10.1093/jn/nxab244] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups. OBJECTIVES We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings. METHODS Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics. RESULTS We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes). CONCLUSIONS The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application-based 24-h recall system developed as part of this project.
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Affiliation(s)
- Sabri Bromage
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Shilpa N Bhupathiraju
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Teresa T Fung
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Simmons University, Boston, MA, USA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Megan Deitchler
- Intake - Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Erick Angulo
- National Institute of Public Health, Cuernavaca, Mexico
| | - Nick Birk
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Yuna He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuehui Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mika Matsuzaki
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yiwen Zhang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mourad Moursi
- Intake - Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Selma Kronsteiner-Gicevic
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- London Centre for Integrative Research on Agriculture and Health, London, United Kingdom
| | - Michelle D Holmes
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sheila Isanaka
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sanjay Kinra
- London School of Hygiene and Tropical Disease, London, United Kingdom
| | - Sonia E Sachs
- Center for Sustainable Development, Columbia University, New York, NY, USA
| | - Meir J Stampfer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Dalia Stern
- National Institute of Public Health, Cuernavaca, Mexico
| | - Walter C Willett
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
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13
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Fung TT, Li Y, Bromage S, Bhupathiraju SN, Batis C, Fawzi W, Holmes MD, Stampfer M, Hu FB, Deitchler M, Willett WC. Higher Global Diet Quality Score Is Associated with Less 4-Year Weight Gain in US Women. J Nutr 2021; 151:162S-167S. [PMID: 34689192 PMCID: PMC8542092 DOI: 10.1093/jn/nxab170] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/21/2021] [Accepted: 05/05/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We have developed a simple and globally applicable tool, the Global Diet Quality Score (GDQS), to measure diet quality. OBJECTIVES To test the utility of the GDQS, we examined the associations of the GDQS with weight change and risk of obesity in US women. METHODS Health, lifestyle, and diet information were collected from women (n = 68,336) in the Nurses' Health Study II (aged 27-44 y in 1991) through repeated questionnaires (1991-2015). The GDQS has 25 food groups (maximum = 49 points) and scoring higher points reflects a healthier diet. The association between GDQS change in 4-y intervals and concurrent weight change was computed with linear models adjusted for confounders. RESULTS Mean ± SD weight gain across 4-y periods was 1.68 ± 6.26 kg. A >5-point improvement in GDQS was associated with -1.13 kg (95% CI: -1.19, -0.77 kg) weight gain compared with a score change of <±2 points. For each 5-point increase, weight gain was 0.83 kg less for age <50 y compared with 0.71 kg less for age ≥50 y (P-interaction < 0.05). A >5-point score decrease was associated with 1.13 kg (95% CI: 1.04, 1.22 kg) more weight gain in women aged <50 y and 0.81 kg more (95% CI: 0.63, 0.98 kg) in women aged ≥50 y. Compared with little change in score, obesity RR was 0.77 (95% CI: 0.74, 0.81) for a >5-point increase and 1.32 (95% CI: 1.26, 1.37) for a >5-point decrease. Risk of obesity did not differ by age. Compared with other diet quality scores, the Alternate Healthy Eating Index-2010 had somewhat stronger associations than the GDQS (P < 0.05) but the GDQS had stronger associations than the Minimum Dietary Diversity for Women score (P < 0.05). CONCLUSIONS Improvement of diet quality as measured by the GDQS was associated with less weight gain and risk of obesity in US women. The association was stronger for women aged <50 y. Associations similar in direction and magnitude were observed between the GDQS and obesity across age groups.
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Affiliation(s)
- Teresa T Fung
- Department of Nutrition, Simmons University, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Yanping Li
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Sabri Bromage
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Shilpa N Bhupathiraju
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carolina Batis
- CONACYT—Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Michelle D Holmes
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Meir Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Megan Deitchler
- Intake—Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Walter C Willett
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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14
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Bromage S, Zhang Y, Holmes MD, Sachs SE, Fanzo J, Remans R, Sachs JD, Batis C, Bhupathiraju SN, Fung TT, Li Y, Stampfer MJ, Deitchler M, Willett WC, Fawzi WW. The Global Diet Quality Score Is Inversely Associated with Nutrient Inadequacy, Low Midupper Arm Circumference, and Anemia in Rural Adults in Ten Sub-Saharan African Countries. J Nutr 2021; 151:119S-129S. [PMID: 34689197 PMCID: PMC8542095 DOI: 10.1093/jn/nxab161] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden. OBJECTIVES We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDQS) against other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults. METHODS We scored the GDQS, Minimum Dietary Diversity-Women (MDD-W), and Alternative Healthy Eating Index-2010 (AHEI-2010) using FFQ data from rural men and nonpregnant, nonlactating women of reproductive age (15-49 y) in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models. RESULTS Correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% CI: 0.30, 0.38) in men and 0.37 (95% CI: 0.32, 0.41) in women. The GDQS was associated (P < 0.05) with lower odds of low MUAC [GDQS quintile (Q) 5 compared with Q1 OR in men: 0.44, 95% CI: 0.22, 0.85; women: 0.57, 95% CI: 0.31, 1.03] and anemia (Q5/Q1 OR in men: 0.56, 95% CI: 0.32, 0.98; women: 0.60, 95% CI: 0.35, 1.01). The MDD-W correlated better with some nutrient intakes, though associated marginally with low MUAC in men (P = 0.07). The AHEI-2010 correlated better with fatty acid intakes, though associated marginally with low MUAC (P = 0.06) and anemia (P = 0.14) in women. Overweight/obesity prevalence was low, and neither the GDQS, MDD-W, nor AHEI-2010 were predictive. CONCLUSIONS The GDQS performed comparably with the MDD-W in capturing nutrient adequacy-related outcomes in rural SSA. Given limited data on NCD outcomes and the cross-sectional study design, prospective studies are warranted to assess GDQS performance in capturing NCD outcomes in SSA.
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Affiliation(s)
- Sabri Bromage
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yiwen Zhang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michelle D Holmes
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Sonia E Sachs
- The Earth Institute, Columbia University, New York, NY, USA
| | - Jessica Fanzo
- Berman Institute of Bioethics, Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA
| | - Roseline Remans
- The Alliance of Biodiversity International and the International Center for Tropical Agriculture (CIAT), Geneva, Switzerland
| | | | - Carolina Batis
- CONACYT—Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Shilpa N Bhupathiraju
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Teresa T Fung
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Simmons University, Boston, MA, USA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Megan Deitchler
- Intake – Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Walter C Willett
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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