Diet quality indices and their associations with health-related outcomes in children and adolescents: an updated systematic review

School Meal Nutrition Standards Reduce Disparities Across Income and Race/Ethnicity

INTRODUCTION

Children's diets in the U.S. typically fail to meet dietary recommendations, contributing to associated adverse health outcomes. The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 required the U.S. government to update nutrition standards for school meals to align with the Dietary Guidelines for Americans (DGAs). This study estimates the evolving impact of substituting school-prepared food for home-prepared food on overall daily diet quality and by subcomponents of diet quality. Subgroup analyses are performed by race/ethnicity and income.

METHODS

Two, nonconsecutive days of dietary recall data from the National Health and Nutrition Examination Survey (2005-March 2020) are used to calculate schoolchildren's Healthy Eating Index (HEI)-2020 scores. The study includes children with complete two-day dietary intakes who attend kindergarten through twelfth grade in a school offering lunch. An individual-level fixed effects regression is employed to examine the relationship of school food consumption on HEI-2020 scores before and after HHFKA-mandated changes in nutrition standards. Analyses were conducted on September 23, 2023.

RESULTS

Prior to changes in standards (2005-2008), school food did not impact diet quality within the overall group of children. In 2009-2012, positive associations between school food and diet quality emerged for low-income students and for non-Hispanic Black students. By 2013-2020, improvements were seen across all groups. The association between school food and diet quality was most attributable to more favorable consumption of dairy, fruit, whole grains, refined grains, added sugars and saturated fats.

CONCLUSIONS

HHFKA-based nutrition standards were associated with beneficial dietary changes and reduced dietary disparities for children across diverse backgrounds.

What is the link between the dietary inflammatory index and the gut microbiome? A systematic review

PURPOSE

One highlighted pathogenesis mechanism of diseases is the negative impact of pro-inflammatory diets (PD) on the gut microbiome. This systematic review aimed to study the link between dietary inflammatory index (DII), as an indicator of PD, and gut microbiome.

METHODS

A systematic search was done in PubMed and Scopus, adhering to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The assessment of the included studies' quality was performed using the critical appraisal checklist from the Joanna Briggs Institute.

RESULTS

Ten articles were included eight cross-sectional, one case-control, and, one cohort study. Seven and three included articles reported a weak and moderate relationship between gut microbiome and DII scores, respectively. DII scores were linked to variety in microbiome composition and diversity/richness. More importantly, anti-inflammatory diets as measured by lower DII scores were linked to a more desirable gut microbiome profile. Prevotella stercorea, Veillonella rogosae, Morganella morganii, Ruminococcus torques, Eubacterium nodatum, Alistipes intestine, Clostridium leptum, Morganellaceae family, Enterobacteriaceae family, and, Bacteroides thetaiotaomicron were related to higher DII scores. While, Butyrate-producing bacteria such as Ruminococcaceae and Lachnospiraceae families, Faecalibacterium prausnitzii, and Akkermansia muciniphila were related to lower DII scores.

CONCLUSION

An anti-inflammatory diet, as measured by a lower DII score, might be linked to variations in the composition and variety of the microbiome. Therefore, the DII score could be useful in microbiota research, however, this possibility needs to be investigated more precisely in future studies.

Diet quality in medical trainees: a cross-sectional assessment comparing medical students and primary care residents using the Rapid Eating Assessment for Participants-shortened version

BACKGROUND

The diet quality of the US population is significantly unhealthy, with critical long-term implications for the nation's health. A few studies have explored diet quality in the future primary care workforce. This cross-sectional study quantifies the diet quality of medical students and primary care residents at a Midwestern college of medicine in the United States.

METHODS

250 medical students and 148 primary care residents were surveyed electronically utilizing the Rapid Eating Assessment for Participants-Shortened Version (REAP-S). The survey consists of 13 questions that can be scored on a scale from 1 to 3, along with 3 questions that are not scored. The average REAP-S score for a US omnivorous diet is 32 (range 13 to 39) with higher scores indicating a higher quality diet. We obtained average REAP-S scores for all respondents and descriptive summary statistics for individual REAP-S items. Students' REAP-S total scores were compared to those of residents and the interaction between student/resident status and BMI category on REAP-S total scores were analyzed using analyses of variance. Differences between students and residents on BMI categories and other outcomes (individual REAP-S items, pandemic dietary and weight changes) were analyzed using Chi-Square Tests of Independence or Fisher's Exact Tests.

RESULTS

Medical students (n = 99; 39.6% response rate) had a significantly higher mean REAP-S score (30.5, SD = 3.9) than primary care residents (n = 72; 49% response rate) (mean = 28.6, SD = 3.9; p = 0.006). Total mean REAP-S scores were significantly higher for those with BMI < 25 (mean = 30.8, SD = 3.7) than for those with BMI > = 25 (mean = 28.3, SD = 4.0; p < 0.001). There was not a statistically significant interaction between role (student vs. resident) and BMI category on total REAP-S scores (p = 0.39). Most respondents (89.3%) indicated that they were willing to improve their diet.

CONCLUSION

Our data suggest that the diet quality of surveyed medical students and primary care residents, as quantified by the REAP-S, is suboptimal. Early detection and improvement of diet quality may be necessary for our medical profession trainees to avert potential long-term adverse cardiometabolic health outcomes, and to optimize the health of our future primary care workforce.

Dietary habits across the primary-secondary school transition: A systematic review

INTRODUCTION

The transition to secondary school involves significant changes in children's social and physical environment, which are often accompanied by changes in dietary habits. However, evidence around how dietary habits change during this life-stage transition is variable.

OBJECTIVE

This review aimed to identify, critically appraise, and summarise the wide-ranging evidence on changes in dietary habits across the primary-secondary school transition.

METHODS

Four electronic databases (PubMed, Embase, Web of Science, and Scopus) were searched for relevant studies published in English or Spanish from inception to February 2024. Longitudinal studies with a baseline quantitative assessment of dietary habits when children were in their last year or two of primary/elementary school with at least one follow-up assessment of dietary habits when children were in their first or second year of secondary/middle/junior-high school were eligible for inclusion.

RESULTS

Seven studies (10 independent samples) were eligible for inclusion, and fourteen different dietary habits outcomes were reported across the seven studies. The frequency of consuming breakfast, fruit, vegetables, and milk decreased across the primary-secondary school transition. Inconsistent results were found regarding changes in the frequency of consumption of sugar-sweetened beverages, fruit juice, snacks, and fast-foods. Many dietary habits were only evaluated in single studies.

CONCLUSIONS

There is moderate evidence for a decrease in the frequency of consumption of breakfast, fruit, vegetables, and milk in children across the transition from primary to secondary school. This highlights this timeframe as a valuable period for intervention to promote the continuation of positive dietary habits. More high-quality longitudinal studies using homogeneous methodologies to evaluate changes in dietary habits across the school transition are needed to fully understand the implications of this transition on children's diet and health behaviours.

Baseline Association between Healthy Eating Index-2015 and Health-Related Quality of Life in Breast Cancer Patients Enrolled in a Randomized Trial

Health-related quality of life (HRQoL) represents one of the most concerning aspects for cancer patients. The Healthy Eating Index (HEI) is an a priori diet quality index directly associated with health outcomes and HRQoL in cancer survivors in North American populations. We evaluated, in a Mediterranean population, the baseline associations between HEI-2015 and HRQoL in 492 women with breast cancer recruited in a DEDiCa lifestyle trial. Dietary data were obtained from 7-day food records; HRQoL was assessed through the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30) and the C30 Summary Score (SumSc). Analysis of variance and multivariable linear and log-gamma regression models were performed. Mean and standard deviation for HEI-2015 score was 68.8 ± 11.2; SumSc was 81.5 ± 12.9. Women with lower HEI-2015 score had higher BMI, were more frequently exposed to tobacco smoke and had fewer years of education. Patients with a HEI-2015 score greater than 68.7 (median value) showed a significant increase in SumSc of 4% (p = 0.02). HEI-2015 components also associated with SumSc were beans and greens (β = 1.04; p = 0.02). Weak associations were found for total vegetables and saturated fats. Higher diet quality in breast cancer survivors was associated with higher overall HRQoL in this cross-sectional analysis.

Associations of Appetitive Traits and Parental Feeding Style With Diet Quality During Early Childhood

BACKGROUND

Appetitive traits and parent feeding styles are associated with body mass index in children, yet their associations with child diet quality are unclear.

OBJECTIVE

The objective was to examine relations of appetitive traits and parental feeding style with diet quality in 3.5-year-old children.

DESIGN

The study was a secondary, cross-sectional analysis of data from Sprouts, a follow-up study of the Pregnancy Eating Attributes Study (PEAS). Birthing parents completed the Child Eating Behavior Questionnaire, Caregiver's Feeding Styles Questionnaire, and proxy 24-hour dietary recalls for their children from February 2019 to December 2020.

PARTICIPANTS/SETTING

Participants were 162 birthing parents (early pregnancy BMI ≥ 18.5 and absence of preexisting diabetes, any medical condition contraindicating study participation, self-reported eating disorder, or medications that could affect diet or weight) and their children living in North Carolina.

MAIN OUTCOME MEASURES

Healthy Eating Index-2015 (HEI-2015) total scores were calculated.

STATISTICAL ANALYSES PERFORMED

Path modeling was conducted using PROC CALIS with full information maximum likelihood (FIML) to account for missing data (< 2% of all data in dataset). Associations of child appetitive traits and parental feeding style with child HEI-2015 scores, adjusting for exclusive breastfeeding duration and household income-poverty ratio, were examined. Tests of simple effects were conducted in subsamples split by parental feeding style. Hypotheses were formulated during data collection.

RESULTS

A 1-standard deviation (SD) greater food fussiness was associated with a 2.4-point lower HEI-2015 total score (P = .02; 95% confidence interval [CI] [-4.32, -0.48]) in children. When parental feeding style was authoritarian, a 1-SD greater food responsiveness was associated with a 4.1-point higher HEI-2015 total score (P = .007; 95% CI [1.12, 7.01]) in children. When parental feeding style was authoritative, a 1-SD greater slowness in eating was associated with a 5.8-point lower HEI-2015 total score (P = .01; 95% CI [-10.26, -1.33]) in children.

CONCLUSIONS

Parental feeding style may modify the association of appetitive traits with diet quality in young children. Future research could determine whether matching parent feeding styles to child appetitive trait profiles improves child diet quality.

Evaluation of the Prime Diet Quality Score from Early Childhood Through Mid-Adolescence

BACKGROUND

Few diet quality indices have been developed and validated for use among children and adolescents. Additionally, many available indices require completion of burdensome dietary assessments.

OBJECTIVES

We aimed to calculate and evaluate the performance of a modified version of the food-based Prime Diet Quality Score (PDQS) derived from different diet assessment methods conducted at 4 time points in a single study population from childhood through adolescence.

METHODS

Among 1460 child participants in the Project Viva cohort, we calculated the PDQS in early and mid-childhood and early and mid-adolescence using dietary data obtained from food frequency questionnaire (early childhood: parent report), PrimeScreen (mid-childhood: parent report; early adolescence: self-report) and 24-h recall (mid-adolescence: self-report). We evaluated construct and relative validity and internal reliability of the score in each life stage.

RESULTS

The PDQS showed a range of scores at all life stages and higher scores were associated with intake of many health-promoting macronutrients and micronutrients (e.g., protein, fiber, and vitamins) in early childhood and mid-adolescence. The PDQS performed similarly to the Youth Healthy Eating Index/Healthy Eating Index (Spearman r = 0.63-0.85) in various assessments. Higher PDQS was associated with expected characteristics including more frequent breakfast eating, family dinners, and vigorous physical activity; with less frequent TV viewing and fast food intake; and with more sleep and higher maternal diet scores during pregnancy. Cross-sectional associations of the PDQS with various anthropometric measurements and biomarkers were inconsistent but generally in the expected directions (e.g., higher PDQS associated with lower triglycerides and insulin and higher HDL cholesterol). Internal reliability was consistent with what has been found for other diet quality indices.

CONCLUSIONS

The PDQS can be calculated from data collected using different and brief dietary assessment methods and appears to be a valid and useful measure of overall diet quality in children and adolescents. Project Viva was registered at clinicaltrials.gov as NCT02820402.

Measurement of diet quality among First Nations peoples in Canada and associations with health: a scoping review

BACKGROUND

Given the increasing number and the diversity of dietary quality indices used for research, and the differences between settings, there is a need to identify valid indices of dietary quality in different contexts and populations and to identify their associations with health-related outcomes.

OBJECTIVES

The primary objective of this scoping review is to identify the tools used in determining dietary quality among First Nations and to describe the changes in diet. The second objective is to describe the associations identified in studies that have measured the relationship between health and dietary quality among First Nations; and the third objective is to identify factors associated with diet quality.

METHODS

PubMed, Embase, CINAHL, Global Health, and Web of Science were searched from inception to June 2021 and updated in February 2022. Articles were included if the research subjects were First Nations, or if articles reported disaggregated subset data for First Nations. Eligible studies focused on nutrition and diet and were published in English or French.

RESULTS

A total of 151 articles were included in the analysis. Studies used several indicators to measure if individuals adhered to dietary guidelines. Traditional food consumption was frequently used as an indicator of diet quality (n = 96). The consumption of store-bought foods was used as an indicator in 28 studies. Some studies used other diet quality indicators such as the Healthy Eating Index (n = 5) and ultra-processed food "NOVA" classification (n = 6). A trend for decreasing traditional food intake over time was apparent, alongside an increase in store-bought food intake. This trend was accompanied with declining health status, including the increased prevalence of overweight and obesity, diabetes, metabolic diseases, and dental caries.

CONCLUSION

This scoping review showed that diet quality among First Nations is improved when traditional foods are consumed. Reduced diet quality was associated with increased risk of noncommunicable diseases.

Quality evaluation of nutrition policies in early childhood education and care services in Nerang, QLD

ISSUE ADDRESSED

Food environments in early childhood, such as early childhood education and care services, influence the development of dietary patterns and behaviours that traverse into adulthood, where they affect health and longevity. Nutrition policies are mandatory in early childhood education and care services in Australia and can positively or negatively shape the food environment. However, the quality of such nutrition policies is unknown. This study aimed to evaluate the comprehensiveness and strength of nutrition policies of early childhood education and care services among services participating in a university-community alliance in South East Queensland.

METHODS

Early childhood education and care services (n = 12) in Nerang, Queensland, Australia, participated in a cross-sectional study evaluating the comprehensiveness and strength of nutrition policies across four domains (Nutrition Education, Nutrition Standards, Promoting Healthy Eating and Communication and Evaluation) of the Wellness in Child Care Assessment Tool.

RESULTS

Nutrition policies evaluated in this study had median total comprehensiveness scores of 55 (out of 100) and median total strength scores of 19 (out of 100). 'Nutrition Education' had the highest median scores for comprehensiveness (67 out of 100) and strength (33 out of 100), while 'Nutrition Standards' had the lowest comprehensiveness score (41 out of 100), and 'Communication and Evaluation' had the lowest strength score (0 out of 100).

CONCLUSIONS

All services have a nutrition policy, but there are opportunities to enhance both the content and linguistic strength of statements within policies related to nutrition domains. SO WHAT?: There is a clear need to improve the comprehensiveness and strength of written statements in nutrition policies across all four domains, particularly 'Nutrition Standards' and 'Communication and Evaluation'.

The food and beverage cues in digital marketing model: special considerations of social media, gaming, and livestreaming environments for food marketing and eating behavior research

Digital marketing to children, teens, and adults contributes to substantial exposure to cues and persuasive messages that drive the overconsumption of energy dense foods and sugary beverages. Previous food marketing research has focused on traditional media, but less is known about how marketing techniques translate within digital platforms, such as social media, livestreaming, and gaming. Building upon previous theories and models, we propose a new model entitled food and beverage cues in digital marketing (FBCDM). The FBCDM model specifies key marking elements and marketing integration strategies that are common on digital platforms and are hypothesized to enhance the effects of advertising and incentive sensitization process. FBCDM also categorizes measurable outcomes into three domains that include brand, food, and social outcomes. Additionally, repeated marketing exposure and the resulting outcomes are hypothesized to have long term consequences related to consumer markets, consumption behavior, culture, and health. We include a discussion of what is currently known about digital marketing exposure within the outcome domains, and we highlight gaps in research including the long-term consequences of digital marketing exposure. The FBCDM model provides a conceptual framework to guide future research to examine the digital marketing of food and beverages to children and adolescents in order to inform government and industry policies that restrict the aggressive marketing of products associated with obesity and adverse diet related outcomes.

Dietary Inflammatory Potential in Pediatric Diseases: A Narrative Review

Inflammatory status is one of the main drivers in the development of non-communicable diseases (NCDs). Specific unhealthy dietary patterns and the growing consumption of ultra-processed foods (UPFs) may influence the inflammation process, which negatively modulates the gut microbiota and increases the risk of NCDs. Moreover, several chronic health conditions require special long-term dietary treatment, characterized by altered ratios of the intake of nutrients or by the consumption of disease-specific foods. In this narrative review, we aimed to collect the latest evidence on the pro-inflammatory potential of dietary patterns, foods, and nutrients in children affected by multifactorial diseases but also on the dietetic approaches used as treatment for specific diseases. Considering multifactorial diet-related diseases, the triggering effect of pro-inflammatory diets has been addressed for metabolic syndrome and inflammatory bowel diseases, and the latter for adults only. Future research is required on multiple sclerosis, type 1 diabetes, and pediatric cancer, in which the role of inflammation is emerging. For diseases requiring special diets, the role of single or multiple foods, possibly associated with inflammation, was assessed, but more studies are needed. The evidence collected highlighted the need for health professionals to consider the entire dietary pattern, providing balanced and healthy diets not only to permit the metabolic control of the disease itself, but also to prevent the development of NCDs in adolescence and adulthood. Personalized nutritional approaches, in close collaboration between the hospital, country, and families, must always be promoted together with the development of new methods for the assessment of pro-inflammatory dietary habits in pediatric age and the implementation of telemedicine.

Effects of in-store marketing on food and beverage purchases: a longitudinal study of households with children

OBJECTIVE

Most food retailers display foods in prominent locations as a marketing strategy (i.e. 'placement promotions'). We examined the extent to which households with children change their food and beverage purchases in response to these promotions.

DESIGN

We analysed a novel dataset of all products promoted in two supermarkets from 2016 to 2017, including promotion dates and locations (e.g. aisle endcaps and front registers). We linked promotions to all purchases from the supermarkets from 2016 to 2017 by a cohort of households with children. We calculated the number of weekly promotions in each of thirteen food and beverage groups (e.g. bread; candy) and used fixed effects regressions to estimate associations between number of weekly promotions and households' weekly food purchases, overall and by Supplemental Nutrition Assistance Program (SNAP) participation.

SETTING

Two large supermarkets in Maine, USA.

PARTICIPANTS

Eight hundred and twenty-one households with children.

RESULTS

Most promotions (74 %) were for less healthy foods. The most promoted food groups were sweet and salty snacks (mean = 131·0 promotions/week), baked goods (mean = 68·2) and sugar-sweetened beverages (mean = 41·6). Households generally did not change their food group purchases during weeks when they were exposed to more promotions for those groups, except that a 1-sd increase in endcap candy promotions (about 1 promotion/week) was associated with $0·19/week (about 14·5 %) increase in candy purchases among SNAP nonparticipants (adjusted P < 0·001).

CONCLUSIONS

In-store placement promotions for food groups were generally not associated with purchases of promoted food groups, perhaps because exposure to unhealthy food marketing was consistently high. Substantial changes to in-store food marketing may be needed to promote healthier purchases.

Prospective association between adherence to UK dietary guidelines in school-age children and cardiometabolic risk markers in adolescence/early adulthood in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort

Research into how alignment to UK dietary guidelines during childhood affects cardiometabolic health is limited. The association between adherence to UK dietary guidelines during childhood and overall cardiometabolic risk (CMR) in adolescence/early adulthood was explored using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). ALSPAC children with diet diaries completed at 7, 10 and 13 years of age, and data on CMR markers at 17 years (n 1940) and 24 years (n 1957) were included. A children's Eatwell Guide (C-EWG) score was created by comparing dietary intakes at each age to UK dietary guidelines for nine foods/nutrients. Cardiometabolic health at 17 and 24 years was assessed using a composite CMR score. Multivariable linear regression models examined associations between C-EWG scores at 7, 10 and 13 years and the CMR score at 17 and 24 years, adjusting for confounders. C-EWG scores were generally low. However, a higher score (adherence to more dietary guidelines) at 7 years old was associated with a lower CMR score at 17 and 24 years: β -0·13 (95 % CI -0·25, -0·01) and β -0·25 (95 % CI -0·38, -0·13) for a 1-point increase in C-EWG score, respectively. A higher C-EWG score at 10 years was also associated with a lower CMR z-score at 24 years. No clear associations were evident at other ages. Greater adherence to UK dietary guidelines during mid-childhood was associated with a better overall cardiometabolic profile, suggesting that encouraging children to eat in this way has long-term benefits to health.

Nutrition Knowledge Is Associated With Diet Quality Among US Army Soldiers

OBJECTIVE

Examine the relationship between nutrition knowledge, diet quality, and eating behavior among active-duty US Army Soldiers.

METHODS

Cross-sectional study with data collection in February 2018 via paper surveys during the validation of the Military Eating Behavior Survey.

RESULTS

Among 440 US Army Soldiers, nutrition knowledge was positively and significantly associated with diet quality (b = 0.29, P < 0.001). For every 1-point increase in nutrition knowledge, the Healthy Eating Index-2015 score was expected to increase by 0.29 points. Nutrition knowledge was not significantly associated with skipping breakfast (odds ratio, 1.01; 95% confidence interval, 0.98-1.04) or dining out (odds ratio, 1.01; 95% confidence interval, 0.98-1.03).

CONCLUSIONS AND IMPLICATIONS

The outcomes of this study warrant further investigation to determine what interventions provide the strongest outcomes for improving nutrition knowledge and diet quality, as well as create and support an environment that enhances healthy behaviors regarding nutrition that lead to improved diet quality among active-duty Soldiers.

Addressing schoolteacher food and nutrition-related health and wellbeing: a scoping review of the food and nutrition constructs used across current research

BACKGROUND

Teachers form a large and essential workforce globally. Their wellbeing impacts personal health-related outcomes with flow on effects for the health, and wellbeing of their students. However, food and nutrition (FN) interventions that include teachers, typically neglect the impact of personal FN factors on a teachers' ability to achieve optimal nutrition-related health and wellbeing, and successfully fulfil their professional FN roles as health promoters, gate keepers, educators', and role models. The aim of this review was to scope FN constructs that have been studied internationally regarding teacher FN-related health and wellbeing.

METHODS

Six databases were searched, and papers extracted in June/July 2021. Eligibility criteria guided by the population, concept, context mnemonic included studies published after 2000, in English language, with an aspect of personal FN-related health and wellbeing, among in-service (practising) and pre-service (training), primary, and secondary teachers. Screening studies for inclusion was completed by two independent researchers with data extraction piloted with the same reviewers and completed by lead author, along with complete descriptive and thematic analysis.

RESULTS

Ten thousand six hundred seventy-seven unique articles were identified with 368 eligible for full text review and 105 included in final extraction and analysis. Sixty-nine descriptive studies were included, followed by 35 intervention studies, with the main data collection method used to assess both personal and professional FN constructs being questionnaires (n = 99 papers), with nutrition knowledge and dietary assessment among the most commonly assessed.

CONCLUSION

FN constructs are used within interventions and studies that include teachers, with diversity in constructs included and how these terms are defined. The evidence from this scoping review can be used to inform data collection and evaluation in future epidemiological and interventional research that addresses teacher FN-related health and wellbeing.

Adherence to UK dietary guidelines in school-aged children from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort

Compliance to UK dietary recommendations was assessed in school-aged children from a population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). A Children's Eatwell Guide (C-EWG) score was developed to assess socio-demographic predictors of meeting dietary recommendations. ALSPAC children with plausible diet diary data at 7 years (n 5373), 10 years (n 4450) and 13 years (n 2223) were included in the study. Their dietary intakes (recorded between 1998 and 2006) were compared with dietary guidelines for total and saturated fats, free sugars, salt, fibre, protein, carbohydrates, fruit and vegetables, non-oily and oily fish and red/processed meat. The C-EWG score (0-9 points) indicated the number of recommendations met at each age. Cross-sectional associations between socio-demographic characteristics and C-EWG scores were assessed using multivariable regression. The lowest adherence to guidelines at 7 years was for sugar (0·1 % meeting recommendations), followed by fibre (7·7 %), oily fish (9·5 %), saturated fat (9·7 %) and fruit and vegetables (15·2 %). Highest adherence was for limiting red/processed meat (67·3 %) and meeting carbohydrate recommendations (77·3 %). At 7 years, 12·1 % of participants failed to meet any of the nine recommendations, 26·9 % met one and 28·2 % met two. Similar patterns were seen at 10 and 13 years. A lower social class and maternal educational attainment and higher maternal BMI were associated with meeting fewer recommendations. Most school-aged children in this cohort did not meet UK dietary recommendations, particularly children from lower socio-economic backgrounds. Additional public health initiatives are needed to improve the quality of UK children's diets, particularly targeting lower socio-economic groups.

The 7-day Beverage Intake Questionnaire for Latino Children: Validation of a Culturally Tailored Tool

OBJECTIVE

To validate a culturally tailored 7-day beverage intake questionnaire for Latino children (BIQ-L).

DESIGN

Cross-sectional.

SETTING

Federally qualified health center in San Francisco, CA.

PARTICIPANTS

Latino parents and their children aged 1-5 years (n = 105).

VARIABLES MEASURED

Parents completed the BIQ-L for each child and three 24-hour dietary recalls. Participants' height and weight were measured.

ANALYSIS

Correlations between the mean intake of beverages in 4 categories as determined by the BIQ-L and three 24-hour dietary recalls were assessed. Multivariable linear regression examined the association between sugar-sweetened beverages (SSB) servings as determined by the BIQ-L and child body mass index z-score.

RESULTS

Mean daily intake of SSB (r = 0.52, P < 0.001), 100% fruit juice (r = 0.45, P < 0.001), flavored milk (r = 0.7, P < 0.001), and unflavored milk (r = 0.7, P < 0.001) from the BIQ-L were correlated with intake assessed via three 24-hour dietary recalls. In the multivariable model, weekly servings of SSBs were associated with child body mass index z-score (β = 0.15, P = 0.02). Culturally specific beverages comprised 38% of the SSB intake reported on the BIQ-L.

CONCLUSIONS AND IMPLICATIONS

The BIQ-L is a valid tool for assessing beverage intake among Latino children aged 1-5 years. The inclusion of culturally specific beverages is critical for accurately assessing beverage intake among Latino children.

Diet Quality among Pre-Adolescent African American Girls in a Randomized Controlled Obesity Prevention Intervention Trial

Consuming an unhealthy diet increases health risks. This study assessed the impact of a culturally adapted behaviorally innovative obesity prevention intervention (The Butterfly Girls and the Quest for Founder's Rock) on diet quality in pre-adolescent non-Hispanic Black/African American girls. The RCT consisted of three groups (experimental, comparison, and waitlist control); block randomization allocated participants to each group. The two treatment groups varied in terms of whether or not they set goals. Data were collected at baseline (prior to receiving the intervention), post 1 (3 months post-baseline), and post 2 (6 months post-baseline). Two dietitian-assisted 24 h dietary recalls were collected at each timepoint. Healthy Eating Index 2015 (HEI-2015) was used to determine diet quality. A total of 361 families were recruited; 342 completed baseline data collection. No significant differences in overall HEI score or component scores were observed. To attain more equitable health outcomes, future efforts to promote dietary intake change among at-risk children should explore other behavior change procedures and employ more child-friendly dietary assessment methods.

Does Self-Perceived Diet Quality Align with Nutrient Intake? A Cross-Sectional Study Using the Food Nutrient Index and Diet Quality Score

A reliable diet quality (DQ) assessment is critical to empower individuals to improve their dietary choices. Controversies persist as to whether self-perceived DQ is accurate and correlated with actual DQ as assessed by validated nutrient intake indexes. We used National Health and Nutrition Examination Surveys data to examine whether a higher self-perceived DQ was positively associated with a more optimal nutrient intake as reflected by the Food Nutrient Index (FNI) and Diet Quality Score (DQS). Comparative analyses were performed for three self-perceived DQ groups: (I) "excellent or very good" DQ, (II) "good or fair" DQ, and (III) "poor" DQ. The FNI and DQS differed substantially across groups and sexes. FNI scores ranged from 65 to 69 in participants with a self-reported excellent or very good DQ, whereas participants with a self-perceived poor DQ scored significantly lower (53-59). We also observed age- and sex-specific patterns, with the lowest overall FNI scores found in males aged 18-30 years and females aged 31-50 years. DQ intergroup differences were more pronounced in females than in males. Our findings suggest that higher self-perceived DQ is associated with a more optimal nutrient intake and indicate potential helpfulness of self-perceived DQ as a quick and still underexplored indicator with intrinsic limitations.

Trends in Adherence to the Mediterranean Diet in Spanish Children and Adolescents across Two Decades

Unhealthy dietary habits determined during childhood may represent a risk factor to many of the chronic non-communicable diseases (NCDs) in adulthood. Mediterranean Diet (MD) adherence in children and adolescents (8-16 years) living in Spain was investigated using the KIDMED questionnaire in a comparative analysis of two cross-sectional nationwide representative studies: enKid (1998-2000, n = 1001) and PASOS (2019-2020, n = 3540). Taking into account the educational level of pupils, as well as the characteristics of the place of living, a significant association was found between a KIDMED score ≥ 8 (optimal MD adherence) and primary education as well as residency in an area of <50,000 inhabitants, while living in the southern regions was associated with non-optimal MD adherence (p < 0.001). Participants of the 2019-2020 study showed an increase in the consumption of dairy products (31.1% increase), pasta/rice (15.4% increase), olive oil (16.9% increase), and nuts (9.7% increase), as well as a decreased sweets and candies intake (12.6% reduction). In contrast, a significantly lower MD adherence was found when comparing the 2019-2020 (mean ± SE: 6.9 ± 0.04) and the 1998-2000 study (7.37 ± 0.08); p < 0.001), due to less consumption of fish (20.3% reduction), pulse (19.4% reduction), and fruits (14.9% reduction), and an increased intake of commercial goods/pastries or fast-food intake (both 19.4% increase). The lowest adherence was recorded for adolescents also in the most recent study, where 10.9% of them presented a KIDMED score ≤ 3. This study shows that eating habits are deteriorating among Spanish children and adolescents. Such findings point out the urgency of undertaking strong measures to promote the consumption of healthy, sustainable, and non-ultra-processed food, such as those available in an MD, not only at a scientific and academic level, but also at a governmental one.

Prevalence of Obesity and the Factors Associated with Low Obesity Awareness among Urban Adolescents in Harare, Zimbabwe

Obesity is a global health problem. In developing countries such as Zimbabwe, obesity is both an emerging health problem and a grey area, particularly among adolescents. This study assessed the prevalence of obesity and factors associated with low obesity awareness among adolescents.

METHOD

A cross-sectional survey was performed using an interviewer-administered questionnaire. The participants were 423 adolescents aged 14-19 years recruited from 10 schools in Harare using a stratified random sampling technique. Data were analyzed using SPSS software (version 23) and binary logistics regression was used to examine the factors associated with low obesity awareness. The level of significance was set at p < 0.05.

RESULTS

The median± IQR age was 16 (14-18) years, and overweight and obesity affected 15.8% of the participants with higher proportions among girls (73.1%, p = 0.002). Low obesity awareness was observed in 27.1% of the adolescents with a higher proportion among girls (67.0%, p = 0.001), 14-16-year-olds (51.3%, p = 0.317), and obese adolescents (56.7%, p = 0.001). Significant factors associated with low obesity awareness were household heads lacking formal education [OR = 9.41 (2.20-40.36), p = 0.003] and inadequate (poor) food habits [OR = 2.58 (1.33-5.01), p = 0.005].

CONCLUSIONS

Our study showed that adolescents had different obesity awareness levels and diverse perceptions in terms of obesity causes, and a range of potential solutions. Obesity awareness and nutrition education should address adolescents' poor eating habits while taking cognizance of the different education levels of household heads.

Diet quality of preparatory school students in Awi Zone, Ethiopia: a cross-sectional study

OBJECTIVE

The study aimed to assess diet quality and associated factors among preparatory school students in Awi Zone, Ethiopia.

DESIGN

A school-based cross-sectional study design was used in this study.

SETTING

The study was carried out in Awi Zone, Amhara Region, Ethiopia.

PARTICIPANTS

A total of 834 preparatory school students participated in the study.

OUTCOME MEASURES

Diet quality was the outcome variable, and it was computed using the dietary diversity score, food variety score and consumption of animal-source foods. Students with high dietary diversity scores, appropriate animal-source food consumption and adequate food variety scores were labelled as having good-quality diets. Data were collected using a pretested structured self-administered questionnaire. Bivariate and multivariable logistic regressions were employed to analyse the data. Variables with p≤0.2 in the bivariate logistic regression analysis were included in the multivariable logistic regression model. Multivariable logistic regression analysis was done to determine the strength of the association. Statistical significance was determined at p value less than 0.05.

RESULTS

Only 24.7% (95% CI: 21.7%, 27.7%) of preparatory school students had good-quality diets. Being female (adjusted OR (AOR)=2.88, 95% CI: 2.0, 4.1), residing in an urban setting (AOR=1.90, 95% CI: 1.1, 3.2), having an educated mother (AOR=1.78, 95% CI: 1.1, 2.7), having pocket money (AOR=1.83, 95% CI: 1.2, 2.6) and nutrition information (AOR=1.90, 95% CI: 1.2, 3.1), and family monthly income >8000 Ethiopian birrs (AOR=3.90, 95% CI: 2.2, 7.1) were factors significantly associated with having good-quality diet.

CONCLUSION

The majority of the preparatory school students had poor-quality diets. These findings highlight the necessity of nutrition education that considers the sociodemographic characteristics of the students and their families. Implementing income-generating interventions for low-income households was also recommended by the findings.

Association of main meal quality index with the odds of metabolic syndrome in Iranian adults: a cross-sectional study

BACKGROUND

Metabolic syndrome (MetS) is a common global issue linked to the quality of one's eating occasions. The current cross-sectional study evaluates the association between a novel index, the Main Meal Quality Index (MMQI), and MetS among Iranian adults.

METHODS

A total of 824 men and women were recruited, and a 24-hour dietary recall assessed the dietary intake of the participants. Lunch was selected as the main meal based on energy density. The MMQI score was calculated based on ten components of dietary intake, with a higher score indicating more adherence to the index, with the final scores ranging from 0 to 100 points. The associations were assessed using binary logistic regression.

RESULTS

The mean age was 42.2 years and the range of the calculated MMQI was 22 to 86 (mean in total participants: 56.62, mean in women: 56.82, mean in men: 55.64). The total prevalence of MetS in the sample was 34%. After adjustments for potential confounders, the participants at the top quartile of MMQI had a lower odds ratio for hypertriglyceridemia and low high-density lipoprotein (HDL) level, and a higher odds ratio for hypertension, hyperglycemia, abdominal obesity, and MetS. The sex-specific analysis also did not show any significant associations between adherence to MMQI and MetS and its components.

CONCLUSION

Overall, MMQI is not associated with MetS and its components in a sample of Iranian men and women. More research is needed to examine MMQI and its possible association with current health-related problems including MetS.

Diet Quality as a Mediator in the Relationship Between Perceived Stress and Depression Among Family Caregivers of Patients with Chronic Illness in Saudi Arabia

OBJECTIVE

The aim of this research was to investigate the correlation between caregivers' perceived stress and depression and examine the mediating role of quality of diet on this relationship.

METHODS

A cross-sectional survey was performed in Medical City from January to August 2022 in the Kingdom of Saudi Arabia. Utilizing the Stress Scale, Anxiety and Depression, the Health Promoting Lifestyle Profile-II questionnaire, and the Patient Health Questionnaire-9, researchers assessed levels of perceived stress, diet quality, and depression. The bootstrap approach and the SPSS PROCESS macro were used to assess the importance of the mediation effect. The target population was family caregivers of patients with chronic illness at Medical City in Saudi Arabia. The researcher conveniently sampled 127 patients, with 119 responding, a response rate of 93.7%. A significant correlation between depression and perceived stress was observed (β = 0.438, p < 0.001). Diet quality mediated the relationship between depression and perceived stress (β = -0.187, p = 0.018). The importance of the indirect effect of perceived stress through diet quality was supported by the outcomes of the non-parametric bootstrapping method (95% bootstrap CI = 0.010, 0.080). The findings revealed that the indirect influence of diet quality explained 15.8% of the overall variation in depression.

CONCLUSIONS

These findings help clarify the mediating effects of diet quality on the relationship between perceived stress and depression.

Estimation of the Quality of the Diet of Mexican University Students Using DQI-I

The quality of diet can be measured using diet quality indices, based on knowledge of associations between diet and health. The objective of this work was to evaluate whether the International Diet Quality Index is suitable for use as a diet quality index in populations of Mexican university girls. A cross-sectional nutritional survey was conducted at the University of Chihuahua (Mexico), collecting semi-quantitative nutritional information and socio-economic and lifestyle data from a representative sample of 400 women. Mean (Standard Deviation (SD)) age was 21.43 years (SD: 3.72); 59.1% were normal weight, 26.6% overweight, 15.3% obesity. The Diet Quality Index-International (DQI-I) was developed according to the method of Kim et al. (2003) and focused on major aspects of a high-quality diet (variety, adequacy, moderation and overall balance). The total score of Diet Quality Index-International reached 53.86% (SD: 11.43), indicating that the general diet of Mexican women a poor-quality diet. Adequacy scored highest, followed by moderation and variety. Overall balance scored the lowest. Variety: 26.3 % consumed less than 4 food groups daily, only 12.8% take more than 1 serving from each food group, and 50.6% consumed only one source of protein daily. Regarding adequacy, a large proportion of the population reported an intake of proteins, vitamin C, calcium, iron, and fruit greater than 50% of recommendation; the vegetables, fiber and grain groups were less 50%. Poor scores were obtained for total fat and SFA consumption (moderation). No statistically significant differences are observed for any of the variables under study and score of the Diet Quality Index-International: body mass index, weight, physical activity level, education level of father and mother, location of lunch, breakfast considered important, knowledge of nutrition, which allows us to consider a relatively uniform population in its eating habits. These people are close to a Westernized diet, and an intervention in nutritional education would be advisable to improve the intake of unprocessed foods, consume a greater variety of protein sources and significantly reduce consumption of sugary foods and soft drinks. Due to different methodological and cultural factors, the proposed Diet Quality Index-International dietary assessment method does not seem to be useful in the assessment of diet quality in the Mexican university population, so further research is needed to develop a diet quality index adapted to the Mexican population.

Prospective associations of lifestyle patterns in early childhood with socio-emotional and behavioural development and BMI: An outcome-wide analysis of the EDEN mother-child cohort

BACKGROUND

Children's energy balance-related behaviours (EBRB), comprising diet, screen time, physical activity, and sleep, combine into "lifestyle patterns", which may exert a synergistic effect on health. To date, studies investigating this synergy have primarily focused on obesity risk, without addressing other facets of health.

OBJECTIVES

To examine the prospective associations of preschoolers' lifestyle patterns with socio-emotional, behavioural, and body mass index (BMI) outcomes at 8 years.

METHODS

Participants were 876 children from the EDEN mother-child cohort. Three lifestyle patterns (unhealthy, healthy, and mixed) were previously identified at age 5, separately in boys and girls. At age 8, height and weight measures generated BMI z-scores while social-emotional and behavioural development was assessed by parents using the Strengths and Difficulties Questionnaire (SDQ). Drawing from the outcome-wide approach, sex- and outcome-specific adjusted linear regressions were fitted.

RESULTS

Boys' adherence to a healthy lifestyle pattern (combining a nutrient-dense diet and limited screen time) at 5 years was positively associated with prosocial behaviours (β = 0.14; 95% confidence interval [CI] 0.01, 0.26) and inversely related to hyperactivity-inattention symptoms (β = -0.12; 95% CI -0.23, -0.01) at 8 years. Girls' mixed lifestyle pattern (sugar or artificially sweetened beverages, high screen, physical activity and low sleep times) was associated with prosocial behaviours (β = 0.12; 95% CI 0.01, 0.23). There was no evidence of associations between lifestyle patterns and BMI z-scores.

CONCLUSIONS

Findings suggest synergistic benefits of engaging in a combination of optimal EBRBs, especially in boys, and support intervention efforts at preschool age to enhance some dimensions of their later socio-emotional and behavioural development.

Stunting and thinness in school-attending adolescents in Addis Ababa

BACKGROUND

Adolescent population Global Diet Quality Score (GDQS) is uncommon in low-income settings. Though Global Diet Quality Score is a good measure of dietary diversity, it has not been used in assessing nutritional outcomes among adolescents. Therefore, the aim of this study is to assess school-attending adolescents stunting and thinness status and associations with global diet quality scores in Addis Ababa.

METHODS

A school-based cross-sectional study was conducted among school-attending adolescents in the age group of 10-14 years in urban settings in Ethiopia. A multi-stage stratified random sampling procedure was used to select schools and students. A total of 1200 adolescents were included in the study. Binary and Multinomial logistic regression analyses were used to determine the predictors of stunting and thinness respectively.

RESULTS

The proportion of school-attending adolescents stunting was 8.17% (95% CI: 6.74%,9.85%) and their thinness status 12.66% (95% CI: 10.89%, 14.67%). The overall mean GDQS food groups for Seven days period consumed were 19.99 + 2.81 SD. Male adolescents were 1.95 times more likely to be stunted compared to female adolescents (1.95; 95%CI: 1.11,3.39). Frequent consumption of low-fat dairy increased the risk of thinness, while frequent consumption of citrus fruits and white root tubers decreased the risk of school-attending adolescents' thinness.

CONCLUSION

The proportion of thin or stunted adolescents attending school was high still, about 1 in 10. Stunting and thinness have no association with the overall GDQS. Nutritional interventions need to consider frequent consumption of citrus fruits, low-fat dairy, and white roots and tubers in school adolescents' nutritional programs. Further studies should validate the GDQS for stunting and thinness of school adolescents.

The Role of Dietary Patterns and Dietary Quality on Body Composition of Adolescents in Chinese College

There is limited evidence regarding the effects of dietary pattern and dietary quality on the risk of unhealthy weight status and related body composition in Chinese adolescence. In particular, studies using bioelectrical impedance analyzer (BIA) in these subjects are rare. The aim of this study was to evaluate the role of diet in body composition, to find a healthy dietary pattern for Chinese youth, and to promote the application of BIA among this population. A total of 498 participants aged from 18 to 22 years old were included. Dietary patterns were identified by principal components analysis. Energy-adjusted dietary inflammatory index (DII) and diet balance index (DBI) were calculated based on semi-quantitative food frequency questionnaire. Multivariate linear regression and logistic regression analysis were used to examine the relationship of dietary patterns, dietary quality with body mass index (BMI), fat mass index (FMI), fat-free mass index (FFMI), and the effect of dietary factors on BMI levels. The majority of participants with overweight and obesity had abdominal obesity, and there was 3.7% abdominal obesity in normal BMI individuals. Four dietary patterns were detected in the subjects. The pattern with the higher energy intake, which was close to the Western diet, was positively correlated with BMI (β = 0.326, p = 0.018) and FMI (β = 0.201, p = 0.043), while being negatively correlated with FFMI (β = −0.183, p = 0.021). Individuals who followed the pattern similar to the Mediterranean diet had a higher basal metabolic rate (BMR), and the highest fat free mass, soft lean mass, and skeletal muscle mass (p < 0.05) but the lowest FMI, visceral fat area (VFA), waist−hip ratio, and FMI/FFMI ratio (p < 0.05). Higher energy-adjusted DII was associated with high BMI. Higher bound score (HBS) (β = −0.018, p = 0.010) and diet quality distance (DQD) (β = −0.012, p = 0.015) were both negatively correlated with FFMI. In conclusion, fat or muscle indexes, such as BMR, FMI, and FFMI, had an important role in predicting overweight and obesity, which suggested the importance of applying BIA among Chinese college students. Students who followed healthful dietary patterns or the high-quality diet that is similar to the Mediterranean diet but not close to the Western diet were more likely to have a healthy BMI and normal body composition.

Impacts of Self-Efficacy on Food and Dietary Choices during the First COVID-19 Lockdown in China

The COVID-19 pandemic has caused a global public health emergency, increasing the prevalence of emotional distress, and potentially leading to altered diet behavior. Self-efficacy measures various aspects of perceiving and understanding emotions. The present study was carried out with the objective of understanding the effect of emotional self-efficacy on dietary behavior and quality. It also shed light on which elements contributed to the link between food-related behavior and perceived dietary quality during the first lockdown of the COVID-19 pandemic. Based on the factor analysis of nineteen food groups, choices, consumption, and socioeconomic status were examined in a sample of 441 Chinese participants. Multiple linear regression examined the association between food consumption, dietary quality, and self-efficacy. Contrary to prior research, the intake of salty snacks and alcoholic beverages dropped by 3.3% and 2.8%, respectively, during the first lockdown. Emotional self-efficacy negatively mediated the relationship between socioeconomic status and dietary quality. In conclusion, emotional self-efficacy is a well-established tool for evaluating how Chinese people cope with negative emotions. As an individual’s dietary quality was affected during the imposed lockdown, the present study offers valuable insight into psychosocial factors that may contribute to health disparities by advocating for organized nutritional support in future epidemic-related quarantines.

Global dietary quality in 185 countries from 1990 to 2018 show wide differences by nation, age, education, and urbanicity

Evidence on what people eat globally is limited in scope and rigour, especially as it relates to children and adolescents. This impairs target setting and investment in evidence-based actions to support healthy sustainable diets. Here we quantified global, regional and national dietary patterns among children and adults, by age group, sex, education and urbanicity, across 185 countries between 1990 and 2018, on the basis of data from the Global Dietary Database project. Our primary measure was the Alternative Healthy Eating Index, a validated score of diet quality; Dietary Approaches to Stop Hypertension and Mediterranean Diet Score patterns were secondarily assessed. Dietary quality is generally modest worldwide. In 2018, the mean global Alternative Healthy Eating Index score was 40.3, ranging from 0 (least healthy) to 100 (most healthy), with regional means ranging from 30.3 in Latin America and the Caribbean to 45.7 in South Asia. Scores among children versus adults were generally similar across regions, except in Central/Eastern Europe and Central Asia, high-income countries, and the Middle East and Northern Africa, where children had lower diet quality. Globally, diet quality scores were higher among women versus men, and more versus less educated individuals. Diet quality increased modestly between 1990 and 2018 globally and in all world regions except in South Asia and Sub-Saharan Africa, where it did not improve.

Adaptation of a Modified Diet Quality Index to Quantify Healthfulness of Food-Related Toy Sets

The objective of this cross-sectional study was to examine the construct validity of an adapted modified Diet Quality Index (aDQI) as a measure of the healthfulness of food-related toy sets for young children (3-8 years). A standardized online search was used to identify toy sets (n = 50) from 10 retailers. An aDQI score (aDQI score, range 0-50) was determined for each toy set, mean (standard deviation) = 28.7 (6.1). Regression analyses demonstrated a positive association between aDQI score and percentage of dairy, refined grains, protein, vegetables, and fruit and inverse association with percentage of desserts, sugar-sweetened beverages, and total number of servings. Sets contained more protein and fewer fruits than recommended. The aDQI score demonstrates construct validity to objectively assess the healthfulness of food-related toy sets. There is opportunity for toy manufacturers to make changes to improve the healthfulness in toy sets for young children, and future research can explore the impact of food-related toy sets on nutrition behaviors.

Validation of the Diet Quality Questionnaire in Chinese Children and Adolescents and Relationship with Pediatric Overweight and Obesity

The low-burden Diet Quality Questionnaire (DQQ) has been developed to rapidly assess diet quality globally. Poor diet is often correlated with body size, and certain dietary risk factors can result in overweight and obesity. We aimed to examine the extent to which the DQQ captured food group consumption among children and adolescents in China, and to understand the association of several new indicators of diet quality scores derived from the DQQ with overweight and obesity, using the 2011 wave of the China Health and Nutrition Survey. The DQQ questions are constructed using sentinel foods—that is, food items that are intended to capture a large proportion of the population consuming the food groups. The overall Global Dietary Recommendations (GDR) score, GDR-Healthy score, and GDR-Limit score are novel indicators of diet quality that reflect dietary risk factors for non-communicable diseases derived from the DQQ questions. Multivariable logistic regression analysis was used to examine the associations of the GDR scores with overweight and obesity in the sample. The DQQ questions captured over 95% of children who consumed the food groups. Additionally, we found that the GDR-Limit score was positively associated with general obesity (odds ratio (OR) = 1.43, 95% confidence interval (CI): 1.17–1.74) and abdominal obesity (OR = 1.22, 95% CI: 1.05–1.43), whereas the overall GDR score was negatively related to general obesity (OR = 0.85, 95% CI: 0.74–0.97). The low-burden DQQ could be a valid tool to assess diet quality for the Chinese pediatric population aged 7–18 years. Poor diet quality, as determined by the GDR-Limit score, is associated with the increased risk of obesity in Chinese children and adolescents.

Association between dietary quality and executive functions in school-aged children with autism spectrum disorder

Background

It is well known that children with autism spectrum disorder (ASD) had executive functions deficit. However, it is still unclear whether the poor dietary quality is related to the impairment of executive functions. The current study aimed to explore the association between dietary quality and executive functions in children with ASD.

Methods

A total of 106 children with ASD (7.7 ± 1.3 years) and 207 typically developing (TD) children (7.8 ± 1.3 years) were enrolled from Guangzhou, China. The Chinese version of Behavior Rating Scale of Executive function (BRIEF), the working memory subscales of the Chinese version of Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), and the Stroop Color-Word Test (SCWT) were used to measure the participant's executive functions. The food frequency questionnaire (FFQ) was used to collect the dietary intake information, and the Chinese Diet Balance Index (DBI_16) was used to evaluate the dietary quality. Generalized linear models were used to estimate the association between dietary quality and executive functions.

Results

In children with ASD, Low Bound Score (LBS) was positively correlated with the working memory subscale score of BRIEF (β = 0.23, 95% CI: 0.02–0.44, P < 0.05), while High Bound Score (HBS) and LBS were positively correlated with the organizable subscale score of BRIEF (β = 0.44, 95% CI: 0.11–0.77, P < 0.01; β = 0.19, 95% CI: 0.01–0.37, P < 0.05). Compared to TD children, children with ASD had a higher proportion of moderate and high levels of insufficient dietary intake (moderate level, 37.7% vs. 23.2%, high level, 4.7% vs. 1.4%) and moderate level of unbalanced dietary intake (36.8% vs.21.3%), higher scores on all subscales of BRIEF (P < 0.01), and lower score on the working memory (81.3 ± 32.3 vs. 104.6 ± 12.5, P < 0.01), while there was no difference on the SCWT.

Conclusion

Poor dietary quality was associated with the impairment of working memory and organizational capacity in children with ASD. This study emphasized the importance of dietary quality in executive functions among children with ASD, and attention should be paid to improving their dietary quality.

Diet and development among children aged 36-59 months in low-income countries

OBJECTIVE

To assess the associations between diet, stimulation and development among children 36-59 months of age in low-income and middle-income countries (LMICs).

DESIGN

We pooled Demographic and Health Survey data on 12 126 children aged 36-59 months from 15 LMICs. Child diet indicators included dietary diversity score (DDS, range 0-7), minimum dietary diversity (MDD, defined as DDS ≥4) and animal source foods (ASFs) consumption. Child development was assessed using the Early Childhood Development Index and stimulation by the number of stimulation activities (range 0-6). Associations were assessed using generalised linear models.

RESULTS

In our sample, 18% of children met MDD and 50% received ≥4 stimulation activities. The prevalence of suboptimal cognitive, socioemotional, literacy-numeracy and physical development was 24%, 32%, 87% and 11%, respectively. Higher DDS, meeting MDD and consuming ASFs were associated with 8%-13% more stimulation activities. Children who met MDD were slightly less likely to have suboptimal literacy-numeracy development compared with children who did not meet MDD: relative risk 0.97 (95% CI 0.95 to 1.00). DDS, meeting MDD and ASFs consumption were not associated with cognitive, socioemotional or physical development. However, there was evidence of positive associations between MDD and cognitive and literacy-numeracy development among subgroups of children, including those who received ≥4 stimulation activities or attended an early childhood care and education programme.

CONCLUSIONS

Child diet was associated with more stimulation activities. However, independent of stimulation, socioeconomic status and other factors, child diet appeared to be a prominent determinant only of literacy-numeracy development among children 36-59 months of age.

Association between Diet Quality and Health Outcomes among Children in Rural Areas of Northwest China

This study aims to examine the relationship between diet quality and health outcomes among children in rural remote areas of China. We draw on a cross-sectional dataset of 1216 children from two counties in the Gansu Province in Northwest China. Child health outcomes were assessed with both anthropometric measurements and reports by primary caregivers of the children. Child diet quality was assessed with the diet quality score (DQS) using information from a food frequency questionnaire (FFQ). Our data show the prevalence of stunting and underweight among sample children were 12% and 11%, respectively; 27% of children were reported by their caregivers as unhealthy, and 60% of children had at least one of the seventeen selected non-communicable diseases (NCDs) over the past 14 days. Overall, 780 (72%) children have at least one of the four above-mentioned health problems. Results from logistic regression models show that a higher DQS was significantly associated with a lower likelihood of being stunted and a higher likelihood of being reported healthy after adjusting for confounders. These findings imply that improving child diet quality might be an option when designing interventions to improve child health.

Should We ‘Eat a Rainbow’? An Umbrella Review of the Health Effects of Colorful Bioactive Pigments in Fruits and Vegetables

Health promotion campaigns have advocated for individuals to ‘eat a rainbow’ of fruits and vegetables (FV). However, the literature has only focused on individual color pigments or individual health outcomes. This umbrella review synthesized the evidence on the health effects of a variety of color-associated bioactive pigments found in FV (carotenoids, flavonoids, betalains and chlorophylls), compared to placebo or low intakes. A systematic search of PubMed, EMBASE, CINAHL and CENTRAL was conducted on 20 October 2021, without date limits. Meta-analyzed outcomes were evaluated for certainty via the GRADE system. Risk of bias was assessed using the Centre for Evidence-Based Medicine critical appraisal tools. A total of 86 studies were included, 449 meta-analyzed health outcomes, and data from over 37 million participants were identified. A total of 42% of health outcomes were improved by color-associated pigments (91% GRADE rating very low to low). Unique health effects were identified: n = 6 red, n = 10 orange, n = 3 yellow, n = 6 pale yellow, n = 3 white, n = 8 purple/blue and n = 1 green. Health outcomes associated with multiple color pigments were body weight, lipid profile, inflammation, cardiovascular disease, mortality, type 2 diabetes and cancer. Findings show that color-associated FV variety may confer additional benefits to population health beyond total FV intake.

Adherence to Mediterranean diet associated with health-related quality of life in children and adolescents: a systematic review

BACKGROUND

Health-related quality of life (HRQoL) has become a significant outcome in assessing interventions in the pediatric population and could be influenced by diet patterns. The Mediterranean diet (MD) pattern has been related to multiple positive health outcomes, including decreased cardiovascular risk and better mental health. We aimed to evaluate the association between MD adherence and HRQoL in children and adolescents.

METHODS

The literature search was conducted in PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Ovid-MEDLINE databases from inception to May 2022. Two researchers independently checked titles and abstracts, evaluated full-text studies, extracted data, and appraised the risk of bias using the Newcastle-Ottawa Scale (NOS).

RESULTS

Eleven studies (1 longitudinal and 10 cross-sectional), totaling 6,796 subjects, were included. Ten studies assessed MD adherence with KIDMED index, and one assessed MD adherence with Krece Plus test, while all included studies assessed HRQoL with a KIDSCREEN test. All studies analyzed the association between MD adherence and HRQoL with linear regression, and eight used adjusted models. Five studies found a significant positive association of MD adherence with HRQoL, with β-values ranging from 0.13 to 0.26. Two found a nonsignificant positive relationship, while one found a negative association. According to the NOS criteria, the risk of bias assessment showed four studies with a low risk of bias and seven with a high risk of bias.

CONCLUSION

Our findings suggest a positive correlation of MD adherence with HRQoL in children and adolescents. However, future research is needed to strengthen the evidence of this relationship.

TRIAL REGISTRATION

CRD42021236188 (PROSPERO).

Mediterranean Diet in Developmental Age: A Narrative Review of Current Evidences and Research Gaps

Numerous studies in recent decades have shown that Mediterranean diet (MD) can reduce the risk of developing obesity in pediatric patients. The current narrative review summarizes recent evidence regarding the impact of MD across the different stages of child development, starting from fetal development, analyzing breastfeeding and weaning, through childhood up to adolescence, highlighting the gaps in knowledge for each age group. A literature search covering evidence published between 1 January 2000 and 1 March 2022 and concerning children only was conducted using multiple keywords and standardized terminology in PubMed database. A lack of scientific evidence about MD adherence concerns the age group undergoing weaning, thus between 6 months and one year of life. In the other age groups, adherence to MD and its beneficial effects in terms of obesity prevention has been extensively investigated, however, there are still few studies that correlate this dietary style with the incidence of non-communicable diseases. Furthermore, research on multi-intervention strategy should be implemented, especially regarding the role of education of children and families in taking up this healthy dietary style.

Investigation of the Associations between Diet Quality and Health-Related Quality of Life in a Sample of Swedish Adolescents

Most adolescents do not consume a high-quality diet, while self-reported mental health problems within this group are increasing. This study aimed to investigate the association between diet quality and health-related quality of life, and to explore the differences in diet quality and health-related quality of life between gender and parental education status. In this cross-sectional study, a detailed web-based recall method was implemented to determine dietary intake, which was analysed using the newly developed Swedish Healthy Eating Index for Adolescents 2015 (SHEIA15) and the Riksmaten Adolescents Diet Diversity Score (RADDS), to determine diet quality. The KIDSCREEN-10 questionnaire was used to measure health-related quality of life, and parental education was self-reported through questionnaires. Parental education was divided into two groups: ≤12 years or >12 years. The study included 1139 adolescents from grade 7 (13−14 years old), 51% were girls. The results showed that girls had higher scores for healthy eating and diet diversity but lower scores for health-related quality of life. A positive association was found between diet diversity and health-related quality of life (Adj R2 = 0.072, p = 0.001), between vegetable/fruit consumption and health-related quality of life (Adj R2 = 0.071, p = 0.002), and between healthy eating and diet diversity (Adj R2 = 0.214, p < 0.001). No association was found between healthy eating and health-related quality of life for all participants. The mean scores for healthy eating and diet diversity were significantly higher in the higher education parental group. In conclusion, higher diet diversity and increased fruit and vegetable consumption could be a strategy to improve health-related quality of life among adolescents. There is a need to promote better diet quality, especially in households of low parental education. In addition, there is a further need to investigate the potential benefits of improved diet quality on mental health and overall well-being.

Healthy Eating Index Scores, Body Mass Index and Abdominal Obesity Among Asian Americans: NHANES 2011-2018

Objective

Obesity rates are increasing among Asian Americans so, the objective of this study was to examine associations between Healthy Eating Index scores (a measure of adherence to the Dietary Guidelines for Americans (DGAs)) and body mass index (BMI) and waist circumference (measure of abdominal obesity) among Asian American adults.

Methods

Included in these analyses were Asian Americans ≥20 years from the National Health and Nutrition Examination Survey (2011-18) who had: (1) two 24 h diet recalls to calculate HEI and HEI subcomponent scores, (2) height and weight data to calculate BMI overweight ≥25 kg/m2 and obese ≥ 30kg/m (2), and (3) waist circumference data (high risk ≥ 80 cm for women and ≥ 90 cm for men; n = 1024 women and n = 904 men). Multinomial logistic regression models were run with BMI as the outcome and logistic regression models were run with waist circumference as the outcome, controlling for age, income, marital status, education, and physical activity.

Results

Among women, a diet with greater adherence to the DGAs for total fruit, fatty acids and total protein was associated with lower likelihood of developing obesity, but a diet with greater adherence to the DGAs in terms of whole grains and sodium (i.e., lower sodium intake) was associated with a higher likelihood of obesity. Among men, greater adherence to the DGAs for fatty acids was associated with a lower likelihood of obesity but greater adherence to the DGAs in terms of whole grains and sodium (i.e., lower sodium intake) was associated with a greater likelihood of obesity.

Conclusions

Future research is needed to examine associations between consumption of specific foods and beverages and how they are associated with BMI and waist circumference among Asian American adults. Furthermore, there is a need culturally relevant obesity prevention interventions for Asian American adults, especially interventions that take into consideration cultural food norms of specific Asian American subgroups.

An Evaluation of Probability of Adequate Nutrient Intake (PANDiet) Scores as a Diet Quality Metric in Irish National Food Consumption Data

Identifying reliable metrics which measure the quality of a diet to promote nutrient adequacy and long-term health is an important step in the development of a sustainable food system. The Probability of Adequate Nutrient Intake (PANDiet) scoring system has been used as a measure of dietary quality in interdisciplinary research in recent years. The aim of the current study is to apply the PANDiet scoring system, and to assess the validity of the score as a metric of nutritional adequacy, within the Irish population. The Irish National Adult Nutrition Survey is a representative database with detailed data on nutrient intakes (18−90 years; n = 1051 valid-reporters; 2008−2010) and biofluid analytes (blood n = 786; urine n = 778). The PANDiet scoring system was expanded to include seven macronutrients, twelve micronutrients, nine minerals, and total energy using an established methodology. PANDiet scores were assessed against the Alternate Healthy Eating Index (AHEI) and Alternate Mediterranean Diet (aMED) food-based scores. The average score for the population (μ) was 63.69 ± 0.23 and ranged from 38.27 to 89.74. Higher PANDiet scores were significantly associated with males, higher educated participants, non-smokers, and low-energy-dense diets (p < 0.001). Females between the ages of 18 and 35 had a significantly lower nutrient adequacy score (μ 59.17). PANDiet scores were significantly correlated with serum folate, riboflavin status, serum vitamin D (p < 0.05) and with AHEI and aMED scores (Rs 0.45 and 0.43, p < 0.0001). The nutritional contribution of food groups varied between genders and low, moderate, and high nutritional adequacy groups. The PANDiet scoring system facilitated a detailed analysis of nutritional adequacy across sub-groups of the population, and is a comprehensive and valid diet quality metric in Irish databases.

Home Food Environment Changes and Dietary Intake during an Adolescent Behavioral Weight Loss Intervention Differ by Food Security Status

Behavioral weight loss (BWL) for pediatric obesity includes guidance on improving the home food environment and dietary quality; yet food insecurity presents barriers to making these changes. This study examined if home food environment, dietary quality, energy intake, and body weight changes during adolescent obesity treatment differed by food security status, and if changes in the home food environment were associated with changes in dietary quality and energy intake by food security status. Adolescents (n = 82; 13.7 ± 1.2 years) with obesity participated in a 4-month BWL treatment. Food insecurity, home food environment (Home Food Inventory [HFI]), dietary quality (Healthy Eating Index [HEI]), energy intake, and body mass index (BMI) were assessed at baseline and post-treatment. A reduced obesogenic home food environment and improved dietary quality were observed for food secure (ps < 0.01), but not insecure households (ps > 0.05) (mean difference, HFI: −6.6 ± 6.4 vs. −2.4 ± 7.4; HEI: 5.1 ± 14.4 vs. 2.7 ± 17.7). Energy intake and BMI decreased for adolescents in food secure and insecure households (ps < 0.03) (mean difference; energy intake: −287 ± 417 vs. −309 ± 434 kcal/day; BMI: −1.0 ± 1.4 vs. −0.7 ± 1.4). BWL yielded similar reductions in energy intake and body weight yet did not offer the same benefits for improved dietary quality and the home food environment for adolescents with food insecurity.

Adherence to the Chinese Dietary Guidelines and Metabolic Syndrome among Children aged 6-14 years

The role of diet in the development of childhood metabolic syndrome (MetS) has not been clearly elucidated. This study aims to investigate the association between the adherence to the Chinese...

Diet quality of Norwegian children at 3 and 7 years: changes, predictors and longitudinal association with weight

BACKGROUND/OBJECTIVES

Poor diet quality in early life can have long-term health effects, but the evidence is largely from cross-sectional studies. Our objective was to examine diet quality of Norwegian children by applying a-priori diet quality indices, identify early life determinants and examine prospective associations with overweight.

SUBJECTS/METHODS

We included 34,074 preschoolers (3-year-olds) and 18,350 school-aged children (7-years-olds) from the prospective, population-based Norwegian Mother, Father and Child Cohort Study. Diet quality was assessed as (i) adherence to a Mediterranean diet, estimated by the food frequency-based Mediterranean Diet Score (fMDS, score range: 0-6) and (ii) by the diet quality index (DQI, score range: -33% to 100%), reflecting compliance to food-based dietary guidelines. In multivariate analyses we explored perinatal and childhood characteristics as potential determinants of diet quality. We used logistic regression to examine the associations between diet quality at 3 years and BMI status at 8 years, adjusting for relevant confounders and diet quality at 7 years.

RESULTS

One in three children had high MD adherence at 3 and 8 years, and DQI (mean 60%) at 3 and 7 years was strongly correlated (r = 0.48, p < 0.001). Short breastfeeding duration, physical activity and sleep duration and long screentime at 18 months were associated with 2-3% lower DQI at 3 years. At both ages, maternal diet quality was the strongest prospective predictor of DQI (beta = 5%, 95% CI = 4.7, 5.2 and beta = 3.1%, 95% CI = 2.8, 3.4), and screentime was the strongest cross-sectional predictor (beta = -5.2%, 95% CI = -5.9, -4.5 and beta = -4.1%, 95% CI = -5.0, -3.2). High DQI score at 3 years, but not MD adherence, was associated with a lower risk for overweight (including obesity) at 8 years, compared to low DQI (lower tertile) (adjusted OR = 0.77, 95% CI = 0.62, 0.96).

CONCLUSIONS

Our study provides evidences that high diet quality in early childhood may reduce the risk for overweight in later childhood, independent of the current dietary behaviors.

Development and validation of a food frequency questionnaire for children aged 7 to 10 years

ABSTRACT Objective Food and nutritional evaluation of children can support public policies to combat early overweight and obesity. This study developed and validated a quantitative food frequency questionnaire for assessing the dietary intake of children. Methods This is a cross-sectional study of the development of a food frequency questionnaire for 130 children of both genders aged 7 to 10 years old. For the food frequency questionnaire list, 81 food items were selected. The validity of the food frequency questionnaire was evaluated by comparison with 24-hour recalls and reproducibility was performed by comparing two food frequency questionnaires. Results Most of the foods with 95% relative contribution were ultra-processed, such as packaged snacks and powdered juice. In validation, correlation coefficients were found between 0.45 (p<0.000) for lipids and 0.37 (p<0.000) for carbohydrates. An adjustment for energy reduced the correlations, but there was an increase in the correlation in calcium (r=0.75) and retinol (r=0.20). In terms of reproducibility, all macronutrients and calcium showed a satisfactory intraclass correlation coefficient (>0.400) and moderate correlations [proteins (0.54; p<0.000) and lipids (0.41; p<0.000)]. Conclusion The food frequency questionnaire developed was valid and able to assess the local food consumption by children from northeastern Brazil.

Child Autistic Traits, Food Selectivity, and Diet Quality: A Population-Based Study

BACKGROUND

Children with Autism Spectrum Disorders (ASDs) tend to be selective in their food intake, which may compromise their diet quality. While ASD diagnoses capture severe levels of impairment, autistic traits vary on a continuum throughout the population. Yet, little is known about how autistic traits relate to diet quality at the population level.

OBJECTIVES

This study examines the association between autistic traits in early childhood and diet quality in mid-childhood and explores the mediating role of food selectivity.

METHODS

Participants were children (n = 4092) from the population-based Generation R Study. Parents reported their child's autistic traits at 1.5, 3, and 6 years; food selectivity at 4 years; and food intake at 8 years, from which a diet quality score was derived. Associations of autistic traits and the autistic trait trajectory (identified using Latent Class Growth Modelling) with diet quality were examined using multiple linear regression models. The indirect effect of food selectivity in the association between autistic traits at 1.5 years and diet quality was examined using mediation analysis.

RESULTS

Autistic traits were associated with diet quality (e.g., 1.5 years: β = -0.09; 95% CI: -0.13 to -0.06). Two classes captured the autistic trait trajectories from 1.5 to 6 years: children with "low and stable" (95%) and "high and increasing" (5%) mean scores. Children in the high and increasing group had poorer diet quality than those in the low and stable group (β = -0.28; 95% CI: -0.44 to -0.11). Food selectivity mediated the association between autistic traits at 1.5 years and diet quality at 8 years (βindirect = -0.03; 95% CI: -0.03 to -0.02).

CONCLUSIONS

Autistic traits in early childhood are associated with poorer diet quality in mid-childhood, and food selectivity appears to mediate this association. Interventions intended to optimize nutrition in children with elevated autistic traits may integrate behavioral strategies to support parents' responding to their child's food selectivity.

Methodological Aspects of Diet Quality Indicators in Childhood: A Mapping Review

Diet quality indicators (DQIns) are tools that aim to assess an individual's overall diet quality. Previous reviews focused mainly on health-related outcomes but did not provide detailed information about components, assessment variables, or important methodological issues for the development and application of DQIns in the pediatric age. The current mapping review aims to provide comprehensive guidance regarding DQIns developed through a priori methodology in children aged ≤14 y that have been applied worldwide. A mapping review was conducted, whereby 1665 original articles describing the development, modifications, and updates of DQIns, published up to June 26, 2020, in English and Spanish, were retrieved. A total of 139 articles were identified and classified into 13 subgroups. There were 10 overall DQIns: Healthy Eating Indexes (n = 25), Dietary Diversity Scores (n = 20), Diet Quality Indexes (n = 16), Food Variety Scores (n = 11), Healthy and Unhealthy Scores (n = 11), Feeding and Eating Indexes (n = 10), Diet Quality Scores (n = 5), Nutritional Adequacy and Micronutrients Indexes (n = 5), Dietary Guidelines Indexes (n = 5), and Other Healthy Diet Indexes (n = 13). Three additional subgroups of dietary and lifestyle indicators found were Mediterranean Diet Indexes (n = 10), Diet-Lifestyle Indexes (n = 5), and Breakfast Quality Indexes (n = 3). This compilation of DQIns will help researchers select the most appropriate tool for future epidemiological studies by considering a careful selection of information about the assessment components, scoring methods, and key methodological issues. The main limitations of this review are that, due to its nature, a risk-of-bias assessment was not performed and the article screening was completed in 2 databases (PubMed/MEDLINE and Scopus). More research is needed to identify health-related outcomes associated with DQIns in the pediatric population, using clearer and more standardized methodological criteria.

Healthy and Sustainable Dietary Patterns in Children and Adolescents: A Systematic Review

The need for adherence to a healthy and sustainable dietary pattern in the pediatric stage is discussed worldwide, being linked to a progressive incidence of noncommunicable diseases in adulthood. The aims of this systematic review were to summarize the healthy and/or sustainable dietary patterns, defined a priori, described in the literature for use during the pediatric stage; to evaluate the adherence to these dietary patterns; and identify the health-related benefits associated with adherence to these patterns. A literature search was carried out on Medline, Scopus, and Web of Science from 2010 up to 2021, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 128 articles were included according to the following criteria: participants 2-17 y old, healthy and/or sustainable dietary patterns defined by an a priori methodology; articles written in English or Portuguese; and published since 2010. Fifty instruments with 14 adaptations that measure adherence to healthy and/or sustainable dietary patterns in children and adolescents were found. The Mediterranean Diet was the most studied dietary pattern. Adherence to healthy and/or sustainable dietary patterns has wide variations worldwide. Most of the instruments described have been little studied at pediatric ages, reducing the ability to extrapolate results. Higher adherence to these dietary patterns was associated with lower body fat, waist circumference, blood pressure, and metabolic risk. There is no consensus regarding the association with BMI. No studies have proofs of the sustainability characteristics of these instruments, it being necessary to produce a new sustainable instrument or test the association of the previous ones with, for example, the ecological footprint. Further validations of these instruments in each country and more prospective studies are needed to establish temporal relations with health-related outcomes. This systematic review was registered at www.crd.york.ac.uk/prospero/ as CRD42020221788.