The Effectiveness of the Expanded Food and Nutrition Education Program (EFNEP) on Diet Quality as Measured by the Healthy Eating Index

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Dietary approach to stop hypertension and healthy eating index 2015, modify the association between FTO polymorphisms and obesity phenotypes

This study aimed to investigate the interaction of the healthy eating index (HEI) and the dietary approach to stop hypertension (DASH) diet scores with FTO polymorphisms in relation to change in obesity traits. A total of 4480 subjects aged ≥ 18 years were selected from participants of the Tehran lipid and glucose study and followed-up 3 years. Selected polymorphisms (rs1421085, rs1121980, rs8050136) were genotyped and genetic risk score (GRS) was computed. HEI and DASH scores were computed based on dietary data. Changes in body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and visceral adiposity index (VAI) were measured. Higher adherence to both DASH and HEI scores were increased with higher ages. Individuals with high GRS had a lower change in BMI when they had higher adherence to HEI, compared to subjects with lower HEI score (P trend = 0.01). Change in WC in participants in the fourth quartile of HEI score in minor allele carriers of FTO variants was lower compared to the first quartile; conversely, higher adherence to the DASH score by this genotypic group was related to increase in WC. No significant interaction was seen between FTO polymorphisms and both diet scores regarding changes in any of obesity traits. In conclusion, in individuals with high GRS higher adherence to HEI score was associated with lower change in BMI and WC, while higher adherence to DASH diet was associated with higher change in WC, compared to individuals with lower adherence to both scores.

Diet quality and anthropometric indices of patients undergone bariatric surgery: the prospective Tehran obesity treatment study

BACKGROUND

Patients undergone bariatric surgery (BS) has long-term risks including decrease in diet quality, nutritional deficiencies and weight regain. This study focus on assessing dietary quality and food group components in patients one year after BS, the relationship between dietary quality score and anthropometric indices, and also evaluating the trend of body mass index (BMI) of these patients three years after BS.

METHODS

A total of 160 obese patients (BMI ≥ 35 kg/m²) were undergone sleeve gastrectomy (SG) (n = 108) or gastric bypass (GB) (n = 52), participated in this study. They were assessed for dietary intakes using three 24-hour dietary recalls one year after surgery. Dietary quality was assessed using food pyramid for post BS patients and healthy eating index (HEI). Anthropometric measurements were taken pre-surgery and 1, 2 and 3 years after operation.

RESULTS

The mean age of patients was 39.9 ± 11 years (79% female). The mean ± SD percentage of excess weight loss was 76.6 ± 21.0 one year after surgery. Intake patterns are generally (up to 60%) not consistent with the food pyramid. The mean total HEI score was 64 ± 12 out of 100. More than %60 of participants is exceeding the recommendations for saturated fat and sodium. The HEI score did not show significant relationship with anthropometric indices. The mean of BMI in SG group increased over three years of follow up, while in GB group, there were no significant differences in BMI during three years of follow up.

CONCLUSIONS

These findings showed that patients had not healthy pattern intake one year after BS. Diet quality did not show significant relationship with anthropometric indices. The trend of BMI three years after surgery was different based on surgery types.

Diet Quality and Nutrition Behavior of Federal Nutrition Education Program Participants before and during the COVID-19 Pandemic

Despite challenges due to the COVID-19 pandemic, reports from regional and national meetings of the Expanded Food and Nutrition Education program (EFNEP) have provided anecdotal evidence that the program has persevered, pivoted, and continued to positively impact the lives of some of the nation's most vulnerable populations. However, there have been necessary changes to program delivery, inevitable changes in the lives of participants, and changes in the food environment that may have impacted program outcomes. This study compares national EFNEP data (demographics, behavior change data, and 24 h dietary recall data) of participants from two federal fiscal years, before the COVID-19 pandemic and during the pandemic. Linear mixed model analysis of variance and covariance were used to assess the effects of year on program outcomes. Results of this study provide quantitative evidence of the resiliency of EFNEP to facilitate positive behavior changes related to diet quality, physical activity, food safety, food resource management, and food security. Amidst changes in the food environment during the COVID-19 pandemic, these results emphasize the importance and value of federal nutrition education programs in any food environment.

Strengthening US Food Policies and Programs to Promote Equity in Nutrition Security: A Policy Statement From the American Heart Association

Nutritionally inadequate dietary intake is a leading contributor to chronic cardiometabolic diseases. Differences in dietary quality contribute to socioeconomic and racial and ethnic health disparities. Food insecurity, a household-level social or economic condition of limited access to sufficient food, is a common cause of inadequate dietary intake. Although US food assistance policies and programs are designed to improve food security, there is growing consensus that they should have a broader focus on nutrition security. In this policy statement, we define nutrition security as an individual or household condition of having equitable and stable availability, access, affordability, and utilization of foods and beverages that promote well-being and prevent and treat disease. Despite existing policies and programs, significant gaps remain for achieving equity in nutrition security across the life span. We provide recommendations for expanding and improving current food assistance policies and programs to achieve nutrition security. These recommendations are guided by several overarching principles: emphasizing nutritional quality, improving reach, ensuring optimal utilization, improving coordination across programs, ensuring stability of access to programs across the life course, and ensuring equity and dignity for access and utilization. We suggest a critical next step will be to develop and implement national measures of nutrition security that can be added to the current US food security measures. Achieving equity in nutrition security will require coordinated and sustained efforts at the federal, state, and local levels. Future advocacy, innovation, and research will be needed to expand existing food assistance policies and programs and to develop and implement new policies and programs that will improve cardiovascular health and reduce disparities in chronic disease.

The role of body mass index, healthy eating-related apps and educational activities on eating motives and behaviours among women during the COVID-19 pandemic: A cross sectional study

The COVID-19 related lockdown made it much more difficult for people to control their eating behaviours and body weight with the methods and means they had used before. This is reflected in reports that show that eating behaviours deteriorated significantly during the COVID-19 pandemic (including in Poland). Therefore, it is important to determine what factors may be conducive to healthy eating behaviours among people with different BMI. As previous studies show, the use of healthy eating related-apps and training programs may be a protective factor against the development of unhealthy eating behaviours. Therefore, it is worth checking whether their action will be a protective factor during COVID-19. The aim of this cross sectional study was to analyse whether the current use of healthy eating-related apps and previous participation in training in this field (educational activities) as well as body mass index may play a role in eating motives and behaviours among women during COVID-19. Our final sample included 1,447 women (age: M = 31.34 ± 11.05). Participants completed: the Eating Motivation Survey, the Emotional Overeating Questionnaire, the Mindful Eating Questionnaire, socio-demographic survey and questions about healthy eating-related apps and training (educational activities). Referring to the selected significant results, our study shows that during COVID-19, the use of healthy eating-related apps alone, as well as the use of apps and prior training participation promote healthy eating motives and behaviours. It suggests that promoting the use of healthy eating applications and the acquisition of knowledge and skills in this field could be one way of shaping resources that can be effectively used to deal with crisis situations.

New Exponential Scoring Functions for Diet Quality Indexes Solve Problems Caused by Truncation

BACKGROUND

Diet quality indexes, including the Healthy Eating Index (HEI), assess diets based on usual dietary intakes and a scoring function. Nearly all diet quality indexes use scoring functions that have floors and ceilings, thereby truncating the scores and losing information about intakes outside the scoring range. This score truncation has two important impacts: 1) the index does not reflect all intakes; and 2) the assumption that measurement error in intake reporting has a neutral impact on the diet quality score cannot be upheld.

OBJECTIVE

The main objective was to devise new diet quality scoring functions that eliminate truncation and its attendant problems.

METHODS

Seven desirable properties of a new scoring function were identified: 1) avoid truncations in component scoring to prevent information loss and to provide scoring sensitivity in the currently truncated regions; 2) reduce dependency on the accuracy of dietary standards; 3) minimize measurement error bias and subsequent misclassification; 4) relate plausibly to biological processes; 5) possess desirable mathematical and statistical properties; 6) have simple representations which are easy to calculate and add minimum artifacts of their own; and 7) otherwise closely mimic existing scoring functions.

RESULTS

The recommended replacement for piecewise-linear scoring is a family of scoring functions based on exponentials. For components where higher intakes are better, the function is a single exponential. For components where lower intakes are better, the function is a concave-convex mirrored pair of exponentials. The proposed exponential scoring functions have all seven desired properties.

CONCLUSIONS

The proposed exponential scoring functions will improve the usefulness of dietary scoring indexes by eliminating truncations. Compared to existing scoring functions, the use of exponentials makes the scores more inclusive of very high and very low intakes, reduces measurement error bias, and is less sensitive to the exact placement of the scoring standards.

Effectiveness of Foodbank Western Australia's Food Sensations® for Adults Food Literacy Program in Regional Australia

Background: Food Sensations for Adults, funded by the Western Australian Department of Health, is a four-week nutrition education program focused on food literacy, with demonstrated success amongst Western Australians. In the last two years, 25% of programs have been in regional and remote areas and therefore the aim of this research is to explore the impact of the program in regional areas. Methods: Participants answered validated pre- and post-questionnaires to assess change in food literacy behaviours (2016–2018). Results: Regional participants (n = 451) were more likely to live in low income areas, have lower education levels, and identify as Aboriginal, than metropolitan participants (n = 1398). Regional participants had statistically significantly higher food literacy behaviours in the plan and manage and preparation domains, and lower selection behaviours at baseline than metropolitan participants. Post program, regional participants showed matched improvements with metropolitan participants in the plan and manage, and preparation domains. Food selection behaviour results increased in both groups but were significantly higher in regional participants. Conclusions: The program demonstrates effective behaviour change in all participants; however, the increased disadvantage experienced by people residing outside of major cities highlights the need for additional government support in addressing regional specific barriers, such as higher food costs, to ensure participants gain maximum benefit from future food literacy programs.

Effectiveness of Expanded Food and Nutrition Education Program in Changing Nutrition-Related Outcomes Among Adults With Low Income: A Systematic Review

OBJECTIVE

To review the effect of the Expanded Food and Nutrition Education Program (EFNEP) in changing nutrition-related outcomes.

METHODS

Relevant research conducted before December 2020 was identified using PubMed, Web of Science, Google Scholar, and the EFNEP Research Database. The methodological quality of each eligible study was assessed.

RESULTS

Of the 406 studies found, 30 were eligible; 26 studies were on EFNEP, and 4 included both EFNEP and Supplemental Nutrition Assistance Program Nutrition Education (SNAP-Ed). The sample sizes ranged from 35 to 122,961. Outcome measures included consumption of food groups, nutrients, other nutrition-related behaviors, and food security. At least 1 immediate behavior change (P < 0.05) was reported in each study, but long-term maintenance of behavior change was not evident.

DISCUSSION

This review found a consistent, immediate improvement in nutrition behaviors after program participation but poor retention over time. Overall, variation in programming and outcome measures, incomplete reporting, and generally low study quality by modern standards precluded strong conclusions.

IMPLICATIONS FOR RESEARCH AND PRACTICE

This review identified the need for control groups, improved reporting of program protocols, theory-based curriculum, and measurement of long-term outcomes.

Positive Change in Healthy Eating Scores Among Adults With Low Income After Expanded Food and Nutrition Education Program Participation

OBJECTIVE

Using 24-hour dietary recalls, compare Healthy Eating Index (HEI)-2005 scores of Expanded Food and Nutrition Education Program participants before and after 8-12 weekly lessons.

DESIGN

Analysis of preexisting 24-hour dietary recalls information collected from October, 2012 through September, 2014.

PARTICIPANTS

Participants with complete pre-post dietary data (n = 122,961); subset of those with complete demographic data (n = 97,522).

MAIN OUTCOME MEASURES

Change in HEI-2005 scores (total and components).

STATISTICAL ANALYSIS

Linear regression model fit separately for total HEI and 12 components. The response variable was changed in the HEI-2005 score; predictor variables included age, education, sex, and race/ethnicity.

RESULTS

The mean total HEI scores were 51.1 (SD, 13.7) at entry and 56.5 (SD, 13.7) at exit, with a change of 5.4 (SD, 16.2). Nine of 12 component scores increased. Changes were greater as age increased, with increasing education, and in women. Hispanics had the greatest improvement (mean ± SE) in total HEI score (8.3 ± 0.1).

CONCLUSIONS AND IMPLICATIONS

Although diet quality remained poor, participation in the Expanded Food and Nutrition Education Program resulted in improvement in dietary quality. The degree of improvements varied among demographic groups, but all groups improved.

Food Resource Management Mediates the Relationship Between Participation in a SNAP-Ed Nutrition Education Program and Diet Quality

OBJECTIVE

To examine the mediating effects of food resource management skills (FRM) on the relationship between participation in a Supplemental Nutrition Assistance Program Education (SNAP-Ed) nutrition education program and diet quality.

DESIGN

Secondary analysis of data from a propensity score-matched sample of participants (n = 396) and nonparticipants (n = 111) in a SNAP-Ed nutrition education program.

ANALYSIS

Independent-samples t tests were used to compare entry, exit, and gain scores in FRM and diet quality between participants and nonparticipants. Structural equation modeling was used to examine direct and mediated relationships among participation, FRM, and diet quality.

MAIN OUTCOME MEASURES

Food resource management was measured as a summated rating scale, and diet quality measured as Healthy Eating Index and program participation.

RESULTS

Mediated effect of FRM on the relationship between participation in a SNAP-Ed program and diet quality was statistically significant (P < 0.01). The effect size for the mediation effect indicated that about 70% of program participation on diet quality was transferred by FRM skills. The hypothesized model had acceptable fit indices as model χ² was nonsignificant (P = 0.31), all fit indices were above 0.9, and the root mean square of error approximation was low at 0.02.

CONCLUSIONS AND IMPLICATIONS

Participation in a SNAP-Ed program enhanced participants' FRM, which in turn enhanced their diet quality.

Barriers, Opportunities, and Challenges in Addressing Disparities in Diet-Related Cardiovascular Disease in the United States

In the United States, cardiovascular disease (CVD) is the leading cause of death and disability. Suboptimal diet quality is responsible for a greater percentage of CVD-related morbidity and mortality than any other modifiable risk factor. Further troubling are the stark racial/ethnic and socioeconomic disparities in diet quality. This represents a major public health concern that urgently requires a coordinated effort to better characterize the barriers to healthy dietary practices in population groups disproportionally affected by CVD and poor diet quality to inform multifaceted approaches at the government (policy), community environment, sociocultural, and individual levels. This paper reviews the barriers, opportunities, and challenges involved in shifting population behaviors, especially in underserved populations, toward healthy dietary practices. It is imperative that public health policies address the social determinants of nutrition more intensively than previously in order to significantly decrease CVD on a population-wide basis.