Inverse Association between Dietary Diversity Score Calculated from the Diet Quality Questionnaire and Psychological Stress in Chinese Adults: A Prospective Study from China Health and Nutrition Survey

Isotemporal Substitution Effects of Daily Time Use on Cardiorespiratory Fitness of Children in the OptiChild Study: A Mediation Analysis with Diet Quality

(1) Background: Although daily time-use is associated with diet quality and cardiorespiratory fitness (CRF) in children, their interdependence remains unexplored. This study first examined the associations between reallocating daily movement time and diet quality and CRF, and second the mediating role of diet quality in the relationship between daily time-use and CRF. (2) Methods: This study included 1131 Chinese children (aged 8 to 10 years; median [interquartile range]: 8.5 [8.3, 8.8]) at baseline (September 2022) and 1268 children at the 9-month follow-up (June 2023) from the OptiChild study. Daily durations of moderate-to-vigorous physical activity (MVPA), sleep, and sedentary behavior (e.g., screen time) were self-reported or proxy-reported by parents. Diet quality was assessed via the Diet Quality Questionnaire (DQQ), which uses a 24 h dietary recall and is categorized according to the Global Dietary Recommendations (GDR) score and Food Group Diversity Score (FGDS). The CRF was measured using VO2max after the 20 m shuttle run test. Longitudinal associations between daily time-use, diet quality, and CRF were calculated using isotemporal substitution models. Mediation analyses were used to determine whether diet quality mediated the associations between daily time-use and CRF. (3) Results: Reallocation of 30 min from screen time to MVPA resulted in significant improvements in the GDR score (β baseline = 0.11, p = 0.024; β follow-up = 0.26, p < 0.001), FGDS (β baseline = 0.11, p = 0.006; β follow-up = 0.19, p < 0.001), and CRF (β baseline = 0.40, p < 0.001; β follow-up = 0.26, p = 0.001). Diet quality partially mediated the associations between MVPA, screen time, and CRF. Substituting 30 min of screen time for MVPA led to diet quality mediating a proportion of the association with CRF (GDR score: 11.4%, FGDS: 6.6%). (4) Conclusions: These findings underscore the importance of optimizing daily time-use of MVPA and screen time and improving diet quality to promote physical fitness in school-aged children.

Dietary diversity among women with depressive and generalized anxiety symptoms in Nepal

This study sought to determine whether there was any correlation between the dietary diversity score and symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in Nepali women who were of reproductive age. In a national cross-sectional population-based survey of women (15-49 years) (N = 7442) in Nepal, MDD was assessed with the PHQ-9 and GAD with the GAD-7, and dietary diversity with a 24 h food consumption recall of 10 food groups. Multinominal and logistic regression were used to estimate predictors of MDD and GAD symptoms. The prevalence of mild and moderate-to-severe MDD symptoms was 15.7% and 5.4%, respectively, and the prevalence of mild and moderate-to-severe GAD symptoms was 20.8% and 7.5%, respectively. The overall dietary diversity mean score was 4.66 (SD = 1.67). In the final multivariable model, adjusted for relevant confounders, dietary diversity was inversely associated with moderate-to-severe MDD symptoms (Adjusted Incidence Risk Ratios-AIRR: 0.90, 95% CI 0.84-0.97), and with moderate-to-severe GAD symptoms (AIRR: 0.86, 95% CI 0.80-0.92). Furthermore, in the fully adjusted regression model, pulses (Adjusted Odds Ratio-AOR: 0.77, 95% CI 0.60-0.98) and Vitamin A rich fruits and vegetables (AOR: 0.69, 95% CI 0.51-0.94) were inversely associated with MDD symptoms. In addition, Vitamin A rich fruits and vegetables (AOR: 0.57, 95% CI 0.43-0.75), dairy (AOR: 0.80, 95% CI 0.67-0.97), and pulses (AOR: 0.69, 95% CI 0.56-0.85) were inversely associated with GAD symptoms. Dietary diversity was inversely associated MDD and GAD symptoms.

Dietary diversity and nutritional status of adults living with HIV during the COVID-19 era

BACKGROUND

The coronavirus Disease 2019 (COVID-19) pandemic has brought about unique challenges in healthcare and nutrition, particularly for people living with HIV (PLHIV). Understanding their dietary patterns and nutritional status is crucial for developing targeted interventions and improving health outcomes. Therefore, this study assessed the dietary diversity and nutritional status of PLHIV during the COVID-19 era.

METHODS

We adopted a facility-based cross-sectional study design to enroll 220 PLHIV from two hospitals in the Central Region of Ghana. Dietary intakes were assessed using 24-hour recall. Anthropometric and body composition data were collected with a stadiometer and a body composition monitor. Dietary diversity was evaluated using the FAO's Individual Dietary Diversity Score (IDDS). Data analysis was conducted with SPSS version 20. Significance level was set p-value less than 0.05.

RESULTS

A significant proportion (33.2%) of PLHIV had low dietary diversity, with the majority (55.5%) categorized as needing dietary improvement. Approximately 2 out of every 10 of the participants were identified as underweight. Participants aged 40 to 59 years were more likely to exhibit higher dietary diversity (adjusted odds ratio (AOR) = 1.966, 95% Confidence Interval (CI): 1.045-4.987). Participants who consumed meals at least three times daily were more likely to have a high IDDS (AOR = 1.641, 95% CI: 1.221, 8.879). Employed participants (public sector and private sector) were also more likely to have a high IDDS compared to unemployed participants (AOR = 1.448, 95% CI: 1.028-3.042; AOR = 1.165, 95% CI: 1.030-9.329, respectively). Factors associated with undernutrition included being female (AOR = 1.829, 95% CI: 1.294, 3.872) and first-line antiretroviral therapy ART (AOR = 1.683, 95% CI: 1.282-2.424).

CONCLUSION

The study emphasizes the need for nutritional interventions for PLHIV, particularly during crises. It advocates for a policy collaboration to address food insecurity and promote resilient health outcomes.

Association between 29 food groups of diet quality questionnaire and perceived stress in Chinese adults: a prospective study from China health and nutrition survey

PURPOSE

Diet plays a fundamental role in promoting resilience against stress-related disorders. We aimed to examine the overall and sex-specific association between food groups and perceived stress in adults.

METHODS

We analyzed the prospective data of 7,434 adults who completed both the 2011 and 2015 surveys of the China Health and Nutrition Survey (CHNS). The Diet Quality Questionnaire (DQQ) was used to code all the food items of 2011 dietary intake into 29 food groups, and perceived stress in 2015 was measured using a 14-item perceived stress scale (PSS-14). Univariate analysis and logistic regression models were used to examine the relationship between food groups and perceived stress.

RESULTS

People who perceived a higher level of stress (PSS-14 total score > 25) made up 41.5% and 45.1% of the male and female groups, respectively (χ2 = 9.605, p = 0.002). Individuals with increased intake of food groups such as legumes, other vegetables, other fruits, yogurt, poultry, fish & seafood, fluid milk, and fruit juice were less likely to experience a higher level of psychological stress (OR range: 0.544-0.892, p < 0.05). Additionally, we found sex-specific associations between food groups and perceived stress. The difference in the proportion of food groups, such as fluid milk and fish & seafood, between the two stress groups in men was statistically significant (p < 0.025). In the female group, the distribution of eight food groups, like legumes and nuts & seeds, between the two stress groups was statistically significant (p < 0.025).

CONCLUSION

This study indicated that food groups were differentially associated with perceived stress.

Associations of diet quality and daily free sugar intake with depressive and anxiety symptoms among Chinese adolescents

BACKGROUND

Assessing diet quality has been challenging, and the associations of diet quality and daily free sugar intake with depressive and/or anxiety symptoms have shown inconsistency.

METHODS

A total of 1749 students aged 12-16 years were recruited using stratified random cluster sampling across three cities in China. The overall Global Dietary Recommendations (GDR) score, a novel indicator of diet quality, was constructed using the low-burden Diet Quality Questionnaire. Free sugar intake, including from beverages and foods, was measured using the Food Frequency Questionnaire. Daily free sugar intake was divided into low, medium, and high categories based on the latest version of the dietary guidelines for Chinese residents. Binomial and multinominal logistic regression analyses were used to examine the associations of the overall GDR score and daily free sugar intake categories or different sources of free sugar intake with depressive and/or anxiety symptoms.

RESULTS

The overall GDR score was negatively associated with depressive symptoms (adjusted odds ratio[aOR] = 0.92, 95%CI: 0.87-0.98) and anxiety symptoms (0.95, 0.90-0.99), particularly with comorbid depression and anxiety (0.90, 0.84-0.97). Conversely, daily free sugar intake was positively associated with symptoms of depression and/or anxiety, the multiple aOR for symptoms depression or anxiety were significantly increased with higher daily free sugar intake (all Ptrend < 0.05). Both free sugar from beverages and from foods were positively associated with depressive and/or anxiety symptoms. These associations were consistent between males and females.

LIMITATIONS

Cross-sectional design and self-reported symptoms.

CONCLUSIONS

Diet quality was negatively associated with symptoms of depression or anxiety, especially with comorbid symptoms among adolescents. Daily free sugar intake, regardless of its sources, was positively associated with symptoms of depression and/or anxiety.

Relationship between three dietary indices and health-related quality of life among rural elderly in China: a cross-sectional study

Purpose

This study aimed to explore the association between health-related quality of life (HRQOL) and diet quality using three evidence-based dietary indices among older people in rural China.

Methods

This cross-sectional study included 1,258 rural older people (mean age 72.32 years; 55.6% female). HRQOL was assessed using the European Five Dimension Health Scale (EQ-5D), and dietary intake was assessed using a Food Frequency Questionnaire. Three dietary scoring indices, including the Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension, and Dietary Diversity Score (DDS), were calculated to assess and analyze the relationship between these dietary indices and quality of life.

Results

The EQ-5D score was 0.95 ± 0.10, and the EQ-Visual Analog Scale (VAS) score was 76.76 ± 14.44. All three groups with higher dietary indices had higher quality of life scores. After controlling for covariates in multivariate adjusted binary logistic regression analyzes, participants in the top tertile of DDS had higher quality of life scores than those in the bottom tertile. DDS was consistently associated with EQ-5D (Model 2: OR = 1.567, p = 0.001; Model3: OR = 1.351, p = 0.044) and EQ-VAS (Model 2: OR = 1.830, p < 0.001; Model 3: OR = 1.383, p = 0.047), significantly different from the other groups.

Conclusion

Older people in rural China who adhere to various foods experience a better quality of healthy life.

How is food variety conceptualised and measured as a diet quality indicator in developed settings? Protocol for a systematic scoping review

OBJECTIVES

Dietary diversity (DD) is a pillar of healthy eating guidance and can be used to assess diet quality. Despite being an established nutrition concept, many inconsistencies in its definition and measurement exist and meanings vary across the development spectrum. This protocol outlines a research trajectory, whereby a scoping review will be undertaken to illustrate and map the methodological approaches that have been utilised to measure diversity as a marker of diet quality in the general population. It seeks to determine the most common and less used methodological approaches to measure DD in the diet of healthy adults.

METHODS AND ANALYSIS

Scoping review of peer-reviewed and grey literature from five bibliographic databases, supplemented by handsearching of reviews and reference lists. Search terms will include DD, food variety, mixed diet, balanced diet and food group variety. Eligible articles must include a measure for DD as an indicator of diet quality in the general population living in developed settings. Two independent reviewers will screen titles or abstracts, and read full-texts. Consensus will resolve any disagreements on study eligibility with a third reviewer consulted if needed. Data will be extracted using a standardised evidence table and analysed using a narrative synthesis approach. Data will be managed using Covidence.

ETHICS AND DISSEMINATION

No ethics is required for this study using public documents. Results will be disseminated through peer-reviewed papers and scientific conferences.

DISCUSSION

This scoping review will help to map, classify and assess the methodological approaches used in the nutrition literature to measure DD as a diet quality indicator. We anticipate a wide range of DD measures and expect to identify the most prevalent DD measures used to assess diet quality. Our findings will inform standardisation to improve future research on this nutritional concept.

Health-related quality of life and its association with socioeconomic status and diet diversity in Chinese older adults

Objectives

The study aimed at examining the combined association of socioeconomic status (SES) and diet diversity (DD) with health-related quality of life (HRQoL) and exploring whether DD played a mediating role in the relationship between varied SES and HRQoL among Chinese older persons.

Method

A multi-stage random sampling method was conducted in Shanxi Province of China, with 3,250 older adults participating in this cross-sectional survey. SES was divided into groups by quartiles and DD by means, and these variable groups were combined in pairs to generate a total of eight combinations. The PROCESS macro developed by Hayes was employed for the simple mediation analysis.

Results

Compared with the reference group (those with both high SES and high DD), older adults who were classified to have lower SES or DD had elevated odds of having worse HRQoL: low SES/ low DD (OR = 1.65, 95% CI 1.41-2.92); low SES/ high DD (OR = 1.45, 95% CI 1.17-1.80); middle low SES/ low DD (OR = 1.43, 95% CI 1.24-1.65); middle low SES/ high DD (OR = 1.23, 95% CI 1.03-1.47); upper high SES/ low DD (OR = 1.41, 95% CI 1.21-1.65); and high SES/ low DD (OR = 1.30, 95%CI 1.10-1.53). The mediation analysis revealed that DD mediated the relationship between SES and HRQoL (B=0.011, 95% CI 0.008-0.013), with its indirect effects accounting for 39.29% of the total effects.

Conclusions

These findings highlighted the role of DD as a mediator of the relationship between SES and HRQoL. As DD could be protective, modifiable, and easy for older adults to understand and implement, village clinics and community health stations should work collaboratively to design proper DD intervention measures for better HRQoL.

The Associations between Meeting 24-Hour Movement Guidelines (24-HMG) and Self-Rated Physical and Mental Health in Older Adults-Cross Sectional Evidence from China

BACKGROUND

This study determined the prevalence of older adults (aged 60-80 years) meeting the Canadian 24-HMG alone and in combination, and their association with the self-rated physical health and mental health of older adults.

METHODS

Participants were drawn from 4134 older adults aged 60-80 years (age, 67.37 ± 0.08 years; 46.87% male) from the China Health and Nutrition Survey (CHNS) 2015 database. Mental health and physical health scores were obtained based on self-rated mental health questionnaires and physical health of older adults. The criteria for meeting the 24-HMG were: physical activity time ≥ 150 min/week, sedentary time ≤ 480 min/day, screen time ≤ 180 min/day, sleep time 7-9 h (60-64 years) and sleep time 7-8 h (65 years and above). Logistic regression models were used to examine the association between meeting the 24-HMG guidelines number and category and older adults' self-rated mental and physical health.

RESULTS

The proportion of older people meeting three of the 24-HMG guidelines was 1.16%, the proportion meeting two guidelines was 38.19% and the proportion meeting one guideline was 49.14%. The number of people meeting 24-HMG was closely related to the self-rated physical health and mental health of older people. The category meeting 24-HMG was closely related to the self-rated physical health and mental health of older people.

CONCLUSIONS

Meeting more guidelines in the 24-HMG was strongly associated with older people's self-rated mental health and physical health. However, only a small proportion of older people met all the recommendations, highlighting the need to promote and support adherence to these movement behaviours.