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

Diet Quality Mediates the Relationship Between Chronic Stress and Inflammation in Patients With Metabolic Syndrome

BACKGROUND

Chronic stress is associated with promotion of inflammation and development of metabolic syndrome, as well as deterioration of diet quality. Inflammation can be modified by changes in dietary intake.

OBJECTIVE

The aim of this study was to test the hypothesis that diet quality mediates the relationship of chronic stress with inflammation in patients with metabolic syndrome.

METHODS

Participants with metabolic syndrome (n = 73, 62 ± 12 years old, 71% female) completed questionnaires on chronic stress (Perceived Stress Scale-10) and diet quality (Healthy Eating Index-2020). The Perceived Stress Scale-10 was dichotomized. The Healthy Eating Index-2020 score was used as a continuous variable, and higher scores indicate better diet quality. Inflammation was assessed using plasma high-sensitivity C-reactive protein (log-transformed). We used PROCESS in SPSS to test the hypothesis.

RESULTS

Patients in the higher stress group had lower Healthy Eating Index-2020 scores (worse diet quality) than those in the lower stress group (57 ± 13 vs 64 ± 10, P = .01). Diet quality mediated the relationship between chronic stress and inflammation (indirect effect, 0.211; 95% bootstrap confidence interval, 0.006-0.496). Higher stress was associated with lower diet quality (effect, -7.152; 95% confidence interval, -13.168 to -1.137) that was associated with increased inflammation (effect, -0.030; 95% confidence interval, -0.052 to -0.007).

CONCLUSIONS

Our findings show the important role of diet quality in the relationship of chronic stress with inflammation in patients with metabolic syndrome. Healthcare providers should encourage patients with higher stress to improve diet quality, which can decrease inflammation.

Comparing nutritional status, quality of life and physical fitness: aging in place versus nursing home residents

BACKGROUND

Quality of life (QoL) is a key indicator of well-being in older adults (OAs) and several factors, including nutrition, physical fitness, and dwelling place, can influence QoL. OA residing in institutional settings, such as nursing homes (NH), often can exhibit different QoL outcomes, nutrition status and physical fitness compared to those living independently in age-in-place (AIP) environments. This study seeks to compare the QoL, and physical activity levels of OA residing in NH with those AIP and to evaluate their dietary quality.

METHODS

This cross-sectional study included a total of 400 voluntary OAs, residing either in Narlıdere Nursing Home and Aged Care Rehabilitation Centre (n = 200) or aging in place (n = 200) in İzmir, Turkey. Participants were recruited between May 2023 and December 2023. Data collection involved face-to-face interviews using a questionnaire that covered demographic and anthropometric measurements, Mini Nutritional Assessment (MNA), Older People's Quality of Life (OPQOL-brief), Physical Fitness and Exercise Activity Levels of Older Adults Scale (PFES), and a 24-hour dietary recall. Nutritional status was further assessed using the Healthy Eating Index for Older Adults (HEI-OA).

RESULTS

Mean age of OAs was 77.8 ± 6.5 years and BMI was 25.8 ± 3.9 kg/m². HEI scores were not differed between groups (NH: 42.8 ± 8.1, AIP: 42.2 ± 11.0, p < 0.542), but AIP residents had lower poor diet quality (NH: 40.4 ± 5.9, AIP: 37.5 ± 7.9, p < 0.001). NH residence had higher OPQOL scores (NH: 54.8 ± 7.8, AIP: 47.6 ± 10.4, p < 0.001), and higher MNA scores (NH: 25.6 ± 2.7, AIP: 22.4 ± 5.5, p < 0.001). NH group had lower PFES scores, indicating reduced physical fitness compared to AIP participants (NH: 67.3 ± 6.3, AIP: 74.7 ± 7.7, p < 0.001). Nutrient intake analysis revealed that NH residents consumed more daily water, protein, and micronutrients than AIP participants, with statistically significant differences in protein, MUFA, and SFA intake (p < 0.001). A significant relationship between MNA and QoL total score in NH (r = 0.157, p = 0.027) and AIP (r = 0.619, p < 0.001) was found.

CONCLUSION

The findings of this study revealed the potential influence of nutritional status on QoL, in enhancing QoL outcomes.

Association between modified youth healthy eating index and nutritional status among Iranian children in Zabol city: a cross-sectional study

Diet quality in childhood and adolescence can affect health outcomes such as physical and cognitive growth and preventing chronic diseases in adulthood. This study aimed to evaluate the relationship between diet quality using the modified youth healthy eating index (MYHEI) with socioeconomic factors and nutrition status in 7-12-year-old children in Iran. This descriptive-cross-sectional study was performed on 580 students in Zabol, Iran, selected through multistage cluster sampling. The diet was assessed through the 168-item food frequency questionnaire (FFQ) and eating behaviors. Then, the MYHEI scoring system was used to calculate the diet quality. In addition, we used the WHO growth indices, such as weight to age, height to age, and body mass index (BMI) to age ratios, to evaluate nutrition status. The mean total MYHEI score in children was 56.3 ± 11.2. Among children with the highest MYHEI score quartile, the number of girls was significantly higher than boys (p = 0.001). The prevalence of underweight, stunting, and wasting was 25.3%, 17.4%, and 21.7%, respectively. The prevalence of underweight (OR: 2.2; 95% CI  1.26, 3.90, p = 0.001) and stunting (OR: 3.2; 95% CI   1.65, 6.14, p = 0.006) were significantly lower in the higher MYHEI score quartile compared to the lower quartile. The overall diet quality of most children should be modified. Therefore, to improve the children's health and nutrition status, it is necessary to perform nutritional interventions such as training and promotional programs, especially in schools.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Dietary Patterns in 1125 Iranian Women: Adequacy of Energy and Micronutrient Intakes and Weight Statuses

Background

Women's nutrition status includes significant effects on their children and household health. The purpose of this study was to assess energy and micronutrient intake adequacy in Iranian women.

Methods

This study was a part of the Urban HEART Study, which has jointly been developed by the World Health Organization (WHO) Centre for Health Development, Kobe, Japan. In total, anthropometric and dietary intake data were collected from 1125 women in southern Tehran municipality districts. A 24-h recall questionnaire was completed by the expert nutritionists and the participants' anthropometric statuses were assessed. Food intakes were calculated in grams per capita per day. Micronutrients and energy requirements were adapted from WHO/Food and Agriculture Organization (FAO) tables and Iran National Food Consumption Survey, respectively.

Results

Nearly 71.5% of the women were overweight or obese [body mass index (BMI) ≥25 kg/m2]. Furthermore, 1.2% of the women were underweight (BMI <18.5 kg/m2), while 27.3% had normal weight (BMI = 18.5--24.9 kg/m2). The mean bread/cereal and vegetable intakes were significantly higher in obese group, compared to that in normal/under/overweight group (375.6 g/day ± 151.4, P = 0.05; and 331.4 g/day ± 227.5, P = 0.02), respectively]. Women in the lean group significantly consumed higher quantities of cakes/pastries and had the lowest calcium and iron adequacy ratios, compared to other groups (p = 0.001, P = 0.03, and P = 0.05, respectively).

Conclusions

These findings suggest that Iranian women, especially those who reside in the southern areas of Tehran, need to change their dietary habits to maintain their health. Moreover, being under/normal weight does not necessarily mean following healthy diets.

Evaluation of Nutritional Status with Healthy Eating Index (HEI-2010) of Syrian Refugees Living Outside the Refugee Camps

Nutrition is a public health issue. Amongst populations of refugees, unmet nutritional needs have been identified. The aim of this study was to evaluate the nutritional status of Syrian refugees living outside the refugee camps in Kayseri, Turkey. Socio-demographic data and anthropometric measurements of the refugees were collected. The relationship between diet quality, which was assessed through the Healthy Eating Index (HEI-2010), and factors (including the duration of time spent outside the refugee camp, income, obesity, and waist circumference) were measured. Four hundred refugees participated in this study. The majority of refugees (77.8%) reported a 'poor' diet, with the remaining filling into the 'needs improvement' based on HEI-2010 scores. The average consumption of fruits in the study group was 101.9 g per day (g/day), while the average consumption of vegetables was 142.2 g/day. When the relationships were examined between BMI, HEI-2010 score, the time spent as a refugee, and waist circumference, statistically significant relationships were found (p < 0.001). In the linear regression analysis based on these relationships, when the results were adjusted for age and gender factors, it was observed that for every year spent as a refugee, BMI score increased by 0.17 units, and waist circumference increased by 1.14 units (p < 0.05). As a result, this study showed that refugees have low-income-related nutritional risks. In conclusion, ensuring that refugees have access to adequate nutrient-rich food is essential; therefore, analyzing and improving nutritional standards for refugees are suggested to be part of the strategies of the public and primary health care systems.

Diet-Related Inflammation is Associated with Malnutrition-Inflammation Markers in Maintenance Hemodialysis Patients: Results of a Cross-Sectional Study in China Using Dietary Inflammatory Index

Purpose

This cross-sectional study aimed to explore the association between the inflammation potential of the diet and malnutrition-inflammation status in Chinese maintenance hemodialysis (MHD) patients.

Methods

Dietary Inflammatory Index (DII) was computed based on a semi-quantitative food frequency questionnaire. Malnutrition-inflammation status was assessed by six indexes, including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), hemoglobin (HB), albumin (ALB) and malnutrition-inflammation score (MIS). Multivariable linear regression and logistic regression were employed adjusting for covariables including age, gender, body mass index and dialysis vintage.

Results

A total of 161 Chinese MHD patients with an average age of 60.0 ± 13.6 years were enrolled. The median (IQR) DII score among participants was 0.60 (−0.80, 2.32), revealing a generally pro-inflammatory diet. DII was positively associated with MIS score (β= 0.61, 95% CI: 0.51, 0.69, p < 0.0001) and CRP (β = 0.54, 95% CI: 0.46, 0.63, p < 0.0001). A negative relationship between DII and NLR (β = −0.37, 95% CI: −0.61, −0.13, p = 0.008) was found in the most anti-inflammatory diet. Multivariable logistic regression showed that each unit increase in DII was linked with 3.06 (95% CI: 1.39, 6.69, p = 0.005) times increased odds of MIS.

Conclusion

Diet with a higher DII score may act as a potential trigger contributing to the development of malnutrition-inflammation status. Further studies for verification and for developing strategies to decrease the dietary inflammation burden are warranted.

Associations between diet quality and obesity in a nationally representative sample of Iranian households: A cross-sectional study

OBJECTIVE

Research examining associations between diet quality and obesity in Iranian adults is limited by small and non-representative samples. This study examined associations between two diet quality indices and obesity risk in a nationally representative sample of Iranian adults and interactions by sex and area of residence.

METHODS

Data on 18,307 adults (mean age 37 [SD 15.2] years) were used from the Iranian National Survey 2001-2003. Two diet quality indices (Healthy Eating Index 2015, HEI-2015, and Diet Quality Index International, DQI-I) were calculated from household 24-h dietary recalls. Multi-level regression analyses were used to examine the association between household diet quality and individual-level obesity risk, with interaction terms for sex and area of residence.

RESULTS

Higher household HEI-2015 and DQI-I were associated with higher risk of obesity (HEI-2015: relative risk ratio: 1.04, 95% CI: 1.03, 1.05; DQI-I: relative risk ratio: 1.02, 95% CI: 1.01, 1.02), with stronger effect sizes in adults living in rural areas.

CONCLUSIONS

Higher diet quality (HEI-2015 and DQI-I) was associated with higher obesity risk, which was stronger in adults living in rural areas. Due to the complexity of examining these associations in a Middle Eastern country undergoing a nutrition transition, longitudinal research is needed to confirm these findings.

Development and evaluation of a diet quality screener to assess adherence to the Dutch food-based dietary guidelines

The Eetscore FFQ was developed to score the Dutch Healthy Diet index 2015 (DHD2015-index) representing the Dutch food-based dietary guidelines of 2015. This paper describes the development of the Eetscore FFQ, a short screener assessing diet quality, examines associations between diet quality and participants' characteristics, and evaluates the relative validity and reproducibility of the Eetscore FFQ in a cross-sectional study with Dutch adults. The study sample consisted of 751 participants, aged 19-91 years, recruited from the EetMeetWeet research panel. The mean DHD2015-index score based on the Eetscore FFQ of the total sample was 111 (sd 17·5) out of a maximum score of 160 points and was significantly higher in women than in men, positively associated with age and education level, and inversely associated with BMI. The Kendall's tau-b coefficient of the DHD2015-index between the Eetscore FFQ and the full-length FFQ (on average 1·7-month interval, n 565) was 0·51 (95 % CI 0·47, 0·55), indicating an acceptable ranking ability. The intraclass correlation coefficient between DHD2015-index scores derived from two repeated Eetscore FFQ (on average 3·8-month interval, n 343) was 0·91 (95 % CI 0·89, 0·93) suggesting a very good reproducibility. In conclusion, the Eetscore FFQ was considered acceptable in ranking participants according to their diet quality compared with the full-length FFQ and showed good to excellent reproducibility.

Healthy eating index and anthropometric status in young children: A cross-sectional study

BACKGROUND & AIMS

Weight status and growth during childhood are indicative of healthy development throughout the lifespan. Thus, understanding the influence of overall quality of diet and dietary patterns on anthropometric measures during childhood is critical to inform dietary recommendations. The current study used an updated version of the healthy eating index (HEI) to evaluate the association between overall diet quality and measures of childhood development in six-year-old children.

METHODS

This cross-sectional study was conducted across 788 six-year-old children referred to healthcare centers in Tehran, Iran. Anthropometric indices and dietary intake were evaluated using standard protocols and food frequency questionnaires, respectively. The HEI-2015 was used to evaluate participant diet quality. The total HEI-2015 score ranged from zero to 100 using the sum of thirteen food score components.

RESULTS

Children in the highest tertile of HEI score had higher nutrient intakes and HEI-related food groups (p < 0.05). Children within the highest tertile of HEI score compared to those within the lowest tertile were more likely to be overweight (OR: 1.45; 95% CI = 1.01; 2.08).

CONCLUSIONS

Findings presented in this study showed that HEI was not associated with a greater likelihood of obesity, underweight, severe underweight, and stunting. However, children in the highest tertile of HEI score were more likely to be overweight.

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

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

Food insecurity is associated with compromised dietary intake and quality among Lebanese mothers: findings from a national cross-sectional study

OBJECTIVE

Examine the associations between household food insecurity (HFI) with sociodemographic, anthropometric and dietary intakes of mothers.

DESIGN

Cross-sectional survey (2014-2015). In addition to a sociodemographic questionnaire, data collection included the validated Arabic version of the Household Food Insecurity Access Scale, which was used to evaluate HFI. Dietary intake was assessed using 24-h dietary recall of a single habitual day, and maternal BMI was calculated based on weight and height measurements. Associations between HFI and maternal dietary intake (food groups, energy and macronutrients' intake) were examined. Simple and multiple logistic regression analyses were conducted to explore the associations between HFI status with odds of maternal overweight and measures of diet quality and diversity (Healthy Eating Index (HEI) and Minimum Dietary Diversity for Women of Reproductive Age (MDD-W)).

SETTING

Lebanon.

PARTICIPANTS

Mothers, nationally representative sample of Lebanese households with children (n 1204).

RESULTS

HFI was experienced among almost half of the study sample. Correlates of HFI were low educational attainment, unemployment and crowding. Significant inverse associations were observed between HFI and dietary HEI (OR 0·64, 95 % CI 0·46, 0·90, P = 0·011) and MDD-W (OR 0·6, 95 % CI 0·42, 0·85, P = 0·004), even after adjusting for socioeconomic correlates. No significant association was observed between HFI and odds of maternal overweight status.

CONCLUSIONS

HFI was associated with compromised maternal dietary quality and diversity. Findings highlight the need for social welfare programmes and public health interventions to alleviate HFI and promote overall health and wellbeing of mothers.

Social determinants, lifestyle and diet quality: a population-based study from the 2015 Health Survey of São Paulo, Brazil

Objective:

To investigate the association among social determinants, lifestyle variables and diet quality in São Paulo, Brazil.

Design:

Cross-sectional study, 2015 Health Survey of São Paulo (Inquérito de Saúde de São Paulo (2015 ISA-Capital)) with Focus on Nutrition Study (2015 ISA-Nutrition).

Setting:

Population-based study, with a representative sample of adults living in São Paulo, Brazil.

Participants:

Adults (aged 20–59 years, n 643) and older adults (aged ≥60 years, n 545).

Results:

We observed differences in the Brazilian Healthy Eating Index-Revised (BHEI-R) by education, income, occupation, sex and race. Whole grains (0·63 points, 12·6 % of the maximum score), sodium (2·50 points, 25·0 %) and solid fat, alcohol and added sugars (9·28 points, 46·4 %) components had the lowest BHEI-R scores. Factors positively associated with diet quality included the presence of one disease or more (e.g. diabetes mellitus, hypertension, cancer, hypercholesterolaemia: β = 0·636, P < 0·001), income (middle income: β = 0·478, P < 0·001; high income: β = 0·966, P < 0·001) and occupation (other: β = 1·418, P < 0·001). Energy (β = –0·001, P < 0·001), alcohol consumption (β = –0·207, P = 0·027), education level (middle education: β = –0·975, P < 0·001; high education: β = –1·376, P < 0·001), races other than white (β = –0·366, P < 0·001) and being unemployed (β = –0·369, P < 0·046) were negatively associated with diet quality.

Conclusions:

Groups affected by socio-economic inequalities need better diet quality. Governmental actions should be implemented to reduce the consumption of energy-dense and sodium-rich foods, facilitate access and information on healthy eating, and conduct nutritional education.

A structural equation modeling approach for the association of a healthy eating index with metabolic syndrome and cardio-metabolic risk factors among obese individuals

Background

Numerous studies have evaluated the association between dietary factors and cardiovascular risk among patients with chronic disease. It is worthwhile to assess these associations in a combination model rather than in an isolated form. In the current study, we aimed to use structural equation modeling (SEM) to assess the association of adherence to a healthy eating index (HEI)-2015 with socio-demographic factors, psychological characteristics, metabolic syndrome (MetS) and other cardio-metabolic risk factors among obese individuals.

Methods

This cross-sectional study was conducted among 188 healthy obese adults (96 males and 92 females) aged 20–50 years in Tabriz. A validated semi-quantitative food frequency questionnaire (FFQ) was used to record dietary intake and to estimate HEI-2015. Anthropometric parameters, blood pressure and biochemical measurements were evaluated according to standard protocols. Interrelationships among socio-demographic parameters and HEI with cardio-metabolic risk factors were analyzed using SEM.

Results

The results of SEM analysis revealed that HEI mediated the association between age and several cardio-metabolic risk factors including fat mass (FM), fat free mass (FFM), systolic blood pressure (SBP) and high-density lipoprotein (HDL) (p < 0.05). Moreover, adherence to Dietary Guidelines for Americans (DGA) appears to mediate association between gender and waist circumference (B = -9.78), SBP (B = -4.83), triglyceride (B = -13.01) and HDL (B = 4.31). HEI also mediated indirect negative effects of socioeconomic status on FM (B = -0.56), FFM (B = -0.25), SBP (B = -0.55) and diastolic blood pressure (DBP) (B = -0.3). Additionally, depression and age had indirect unfavorable effects on some insulin resistance indices such as homeostasis model assessment of insulin resistance (B = 0.07; p<0.05, for age) and quantitative insulin sensitivity check index (p<0.05, for age and depression) via HEI. High adherence to HEI was found to be inversely associated with MetS risk (p<0.05).

Conclusion

Adherence to HEI-2015 seems to mediate the effect of socio-demographic parameters and mental health on cardio-metabolic risk factors as well as MetS risk. Further studies are needed to confirm these findings.

Diet Quality and Satisfaction with Life, Family Life, and Food-Related Life across Families: A Cross-Sectional Pilot Study with Mother-Father-Adolescent Triads

Family is a major determinant of children's and adolescents' eating behavior. The objectives of the present study were to assess diet quality, eating habits, satisfaction with life, family life, and food-related life in mother-father-adolescent triads, and to identify profiles of families according to family members' diet quality. Questionnaires were administered to a sample of 300 two-parent families with one child over the age of 10 in the city of Temuco (Chile), including the Adapted Healthy Eating Index (AHEI), Satisfaction with Life Scale (SWLS), Satisfaction with Food-related Life (SWFoL) scale, Satisfaction with Family Life (SWFaL) scales, and questions relating to their eating habits. Positive relationships were found between the diet quality of the family members, particularly between mothers and adolescents. Three family profiles with different diet qualities were identified: "families with an unhealthy diet" (39.3%), "families in which mothers and adolescents have healthy diets, but the fathers' diets require changes" (14.3%), and "families that require changes in their diet" (46.4%). These findings stress the key role of mothers in determining family diet quality and suggest a positive relationship between diet quality and satisfaction with life.