Associations between Two Dietary Quality Scores and Pancreatic Cancer Risk in a US National Prospective Cohort Study

OBJECTIVE

Most previous studies investigated the associations between intake of individual nutrients and risk of disease, which failed to consider the potential interactions and correlations between various nutrients contained in food. Although dietary quality scores provide a comprehensive evaluation of the entire diet, it remains elusive whether they are associated with the risk of pancreatic cancer.

METHODS

Dietary intake data collected with the Dietary Questionnaire (DQX) and Diet History Questionnaire (DHQ) were used to calculate HEI-2015 and DQI-R scores for participants in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. A high score indicates an increased intake of adequacy components and a decreased intake of moderation components. This study included 252 cases of pancreatic cancer documented from 58,477 persons during a median follow-up of 12.2 years in the DQX cohort and 372 cases of pancreatic cancer ascertained from 101,721 persons during a median follow-up of 8.9 years in the DHQ cohort. Cox proportional hazards regression analysis was performed to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the associations between the two dietary quality scores and pancreatic cancer risk.

RESULTS

After adjustment for confounders, HEI-2015 and DQI-R scores were not significantly associated with pancreatic cancer risk. However, a significantly lower risk was observed for overweight persons with a higher HEI-2015 score in the DQX cohort (HR [95% CI] comparing the highest with lowest tertile: 0.52 [0.32, 0.85], p for trend = 0.009) and those with higher scores of some individual components.

CONCLUSION

Collectively, overall dietary quality is not associated with an altered risk of pancreatic cancer in this US population.

Diet Quality and Body Mass Index Over 20 Years in the Multiethnic Cohort

BACKGROUND

With increasing rates of overweight and obesity and disparities by ethnicity, it is important to understand the role of diet in ameliorating this health problem.

OBJECTIVE

This study examined the relation of diet quality as measured by the Healthy Eating Index 2015 with body mass index (BMI; calculated as kg/m2) and obesity among participants of the Multiethnic Cohort (MEC) in cross-sectional analyses at 3 time points (T-1, T-2, and T-3) over 20 years.

DESIGN

In a subset of 1,860 MEC participants, 3 cross-sectional analyses at cohort entry (1993 to 1996, T-1) and follow-ups in 2003 to 2008 (T-2) and 2013 to 2016 (T-3) were performed.

PARTICIPANTS/SETTING

The cohort consists of African American, Native Hawaiian, Japanese American, Latino, and White adults in Hawaii and California; mean age was 48 years at T-1.

MAIN OUTCOME MEASURE

BMI and weight status in relation to diet quality were measured.

STATISTICAL ANALYSIS

Linear and multinomial logistic regressions were applied to analyze the relation of diet quality with BMI and obesity, while adjusting for known confounders.

RESULTS

Healthy Eating Index 2015 increased by 6.1 and 5.1 units for men and women, respectively, from T-1 to T-3; the respective values for BMI were 1.5 and 2.4. Diet quality was inversely associated with BMI across time: BMI was lower by -0.47, -0.72, and -0.92 units for every 10-point increase in Healthy Eating Index 2015 scores at T-1, T-2, and T-3, respectively (P < .0001 for all). During the 20 years, the association was consistently high among Japanese American participants (-0.79, -0.87, and -1.02) and weakest in African American cohort members (-0.34, -0.37, and -0.40). Higher diet quality was related to lower odds of having obesity at all 3 time points; prevalence odds ratios were 0.72, 0.57, and 0.60.

CONCLUSIONS

These findings suggest that consuming a high-quality diet is related to lower BMI and rates of overweight and obesity but with the strongest association at an older age. To understand the ethnic differences, investigations of dietary habits and behaviors and/or fat distribution patterns will be needed in the future.

Serum Anti-Aging Protein α-Klotho Mediates the Association between Diet Quality and Kidney Function

Adherence to healthy dietary patterns is associated with a reduced risk of kidney dysfunction. Nevertheless, the age-related mechanisms that underpin the relationship between diet and kidney function remain undetermined. This study aimed to investigate the mediating role of serum α-Klotho, an anti-aging protein, in the link between a healthy diet and kidney function. A cross-sectional study was conducted on a cohort of 12,817 individuals aged between 40 and 79 years who participated in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016. For each participant, the Healthy Eating Index 2015 (HEI-2015) score was calculated as a measure of a healthy dietary pattern. Creatinine-based estimated glomerular filtration rate (eGFR) was used to assess kidney function. Multivariable regression models were used to analyze the association between the standardized HEI-2015 score and eGFR after adjusting for potential confounders. Causal mediation analysis was performed to assess whether serum α-Klotho influenced this association. The mean (±SD) eGFR of all individuals was 86.8 ± 19.8 mL/min per 1.73 m². A high standardized HEI-2015 score was associated with a high eGFR (β [95% CI], 0.94 [0.64-1.23]; p < 0.001). The mediation analysis revealed that serum α-Klotho accounted for 5.6-10.5% of the association of standardized overall HEI-2015 score, total fruits, whole fruits, greens and beans, and whole grain with eGFR in the NHANES. According to the results from the subgroup analysis, serum α-Klotho exerted a mediating effect in the participants aged 60-79 years and in males. A healthy diet may promote kidney function by up-regulating serum anti-aging α-Klotho. This novel pathway suggests important implications for dietary recommendations and kidney health.

Greenhouse gas emissions, cost, and diet quality of specific diet patterns in the United States

BACKGROUND

Major policy agendas are calling for accelerated investment in research that addresses the impact of diet patterns on multiple domains of sustainability.

OBJECTIVE

To evaluate the comparative greenhouse gas emissions, diet cost, and diet quality of plant-based, low grain, restricted carbohydrate, low fat, and time restricted diet patterns on a daily per capita basis.

DESIGN

Dietary data from the National Health and Nutrition Examination Survey (2013-2016, n=4,025) were merged with data on greenhouse gas emissions (GHGE) and food prices from multiple databases. The Healthy Eating Index-2015 was used to measure diet quality.

RESULTS

The plant-based diet pattern had the lowest GHGE (3.5 kg CO2eq, 95% CI: 3.3, 3.8 kg CO2eq) and among the lowest diet cost ($11.51, 95% CI: $10.67, $12.41), but diet quality (45.8, 95% CI: 43.3, 48.5) was similar (P>0.005) to most other diet patterns. All of the sustainability impacts of the low grain diet pattern were intermediate. The restricted carbohydrate diet pattern had the highest diet cost ($18.46, 95% CI: $17.80, $19.13) but intermediate diet quality (46.8, 95% CI: 45.7, 47.9) and moderate-to-high GHGE (5.7 kg CO2eq, 95% CI: 5.4, 5.9 kg CO2eq). The low fat diet pattern had the highest diet quality (52.0, 95% CI: 50.8, 53.1) and intermediate GHGE (4.4 kg CO2eq, 95% CI: 4.1, 4.6 kg CO2eq) and diet cost ($14.53, 95% CI: $13.73, $15.38). The time restricted diet pattern had among the lowest diet quality score (42.6, 95% CI: 40.8, 44.6), had GHGE similar to most other diet patterns (4.6 kg CO2eq, 95% CI: 4.2, 5.0 kg CO2eq), and low-to-moderate diet cost ($12.34, 95% CI: $11.38, $13.40).

CONCLUSIONS

Most diet patterns were associated with sustainability trade-offs. The nature of those trade-offs can help inform discussions on food and nutrition policy in the US, including the National Strategy on Hunger, Nutrition, and Health, and future Dietary Guidelines for Americans.

Longitudinal Analyses of Diet Quality and Maternal Depressive Symptoms During Pregnancy: The Kuopio Birth Cohort Study

BACKGROUND

Depression and diet quality appear to be associated in the general population. Nevertheless, little is known about their relationship among pregnant females.

OBJECTIVE

The aims of this study were first, to investigate longitudinally whether or not diet quality is associated with depressive symptoms during pregnancy; second, to examine whether or not variation in diet quality during pregnancy predicts variation in depressive symptoms; and third, to explore how individual dietary components are associated with depressive symptoms.

DESIGN

A longitudinal secondary analysis of the Kuopio Birth Cohort Study in eastern Finland was conducted. Data were collected from pregnant females during the first and third trimesters of pregnancy.

PARTICIPANTS/SETTING

The participants were 1,362 pregnant females who entered the study between 2012 and 2017.

MAIN OUTCOME MEASURES

Depressive symptoms, as measured with the Edinburgh Postnatal Depressive Scale during the first and third trimesters of pregnancy were used as continuous variables.

STATISTICAL ANALYSES PERFORMED

The main analyses consisted of linear mixed model analyses adjusted for potential confounders to longitudinally assess the association between diet quality as measured by the Healthy Eating Index-2015, calculated using data from a food frequency questionnaire completed during the first trimester and third trimester, and depressive symptoms during the study period. An exploratory set of linear mixed models was also used to longitudinally assess the associations between selected individual food frequency questionnaire food groups and depressive symptoms.

RESULTS

Descriptive analyses revealed that 12.3% of the participants had clinically relevant levels of depressive symptoms (ie, Edinburgh Postnatal Depressive Scale score ≥10) during either the first or third trimester. Longitudinal modeling suggested that depressive symptoms in pregnant females tend to remain stable throughout pregnancy. Females with a poorer quality diet already displayed higher levels of depressive symptoms during the first trimester of pregnancy (β = -.038 ± .016; P = 0.022). Variation in diet quality did not predict variation in depressive symptoms over the course of pregnancy (β = -9.741 × 10^-5 ± .001; P = 0.869).

CONCLUSIONS

Females entering pregnancy with a poorer quality diet also displayed higher levels of depressive symptoms compared with females with a higher quality diet at the beginning of pregnancy, and this association remained constant throughout pregnancy. Further research is needed to assess the direction and the potential causality of the observed associations between diet quality and depressive symptoms.

Validation of a Brief Dietary Questionnaire for Use in Clinical Practice: Mini-EAT (Eating Assessment Tool)

Background There is a scarcity of validated rapid dietary screening tools for patient use in the clinical setting to improve health and reduce cardiovascular risk. The Healthy Eating Index (HEI) 2015 measures compliance with the 2015 to 2020 Dietary Guidelines for Americans but requires completion of an extensive diet assessment to compute, which is time consuming and impractical. The authors hypothesize that a 19-item dietary survey assessing consumption of common food groups known to affect health will be correlated with the HEI-2015 assessed by a validated food frequency questionnaire and can be further reduced without affecting validity. Methods and Results A 19-item Eating Assessment Tool (EAT) of common food groups was created through literature review and expert consensus. A cross-sectional survey was then conducted in adult participants from a preventive cardiology clinic or cardiac rehabilitation and in healthy volunteers (n=661, mean age, 36 years; 76% women). Participants completed an online 156-item food frequency questionnaire, which was used to calculate the HEI score using standard methods. The association between each EAT question and HEI group was analyzed by Kruskal-Wallis test. Linear regression models were subsequently used to identify univariable and multivariable predictors for HEI score for further reduction in the number of items. The final 9-item model of Mini-EAT was validated by 5-fold cross validation. The 19-item EAT had a strong correlation with the HEI score (r=0.73) and was subsequently reduced to the 9 items independently predictive of the HEI score: fruits, vegetables, whole grains, refined grains, fish or seafood, legumes/nuts/seeds, low-fat dairy, high-fat dairy, and sweets consumption, without affecting the predictive ability of the tool (r=0.71). Conclusions Mini-EAT is a 9-item validated brief dietary screener that correlates well with a comprehensive food frequency questionnaire. Future studies to test the Mini-EAT's validity in diverse populations and for development of clinical decision support systems to capture changes over time are needed.

Association Between Birthplace and Time in the United States With Diet Quality in US Adolescents: Findings from the National Health and Nutrition Examination Survey, 2007 to 2018

BACKGROUND

During adolescence, diet quality reaches its lowest point compared to other childhood life stages. Acculturation is associated with decreased diet quality among many groups of US immigrant adults, but research is limited among adolescents.

OBJECTIVES

We investigated the associations between birthplace and length of time living in the United States, 2 proxy measures of acculturation, and diet quality among adolescents (12-19 years old).

METHODS

Data were from the NHANES (2007-2018), which included two 24-hour dietary recalls (n = 6113) to estimate Healthy Eating Index 2015 (HEI-2015) total scores and component scores. Multivariate linear regression and generalized linear models were performed to compare HEI-2015 total scores and component scores between US-born adolescents (n = 5342) and foreign-born adolescents with <5 years (n = 244), 5 to <10 years (n = 201), and ≥10 years (n = 290) of US residency.

RESULTS

Foreign-born adolescents with <5 years (53.3 ± 1.2), 5 to <10 years (51.4 ± 1.5), and ≥10 years of US residency (49.9 ± 0.8) had higher HEI-2015 total scores than US-born adolescents (47.0 ± 0.3; P < 0.0001) and higher component scores for total vegetables, seafood and plant proteins, and added sugars (P values ≤ 0.0001). Foreign-born adolescents with more years of US residency had higher component scores for total fruits, whole fruits, and saturated fats than those with fewer years of US residency. A sensitivity analysis revealed this pattern held for Mexican-American and other Hispanic adolescents.

CONCLUSIONS

Being born outside the United States and living in the United States for less time (among foreign-born adolescents) are associated with higher diet quality. Culturally informed health promotion programs may help to reduce diet-related disparities related to acculturation among adolescents.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Coffee Consumption among Adults in the United States by Demographic Variables and Purchase Location: Analyses of NHANES 2011-2016 Data

Coffee, obtained from various sources, is consumed by most United States adults. The present analyses of one and two 24-h dietary recalls for 14,865 persons aged ≥20 years in the 2011-2016 National Health and Nutrition Examination Survey (NHANES 2011-2016) aimed to identify socio-demographic predictors of coffee consumption and to examine whether coffee purchase locations differed by population sub-group. Given the emphasis on food and beverage consumption patterns, the relation between coffee consumption and compliance with the Dietary Guidelines of Americans was also examined. Coffee was consumed by 59% of the sample (n = 8551). Survey-adjusted mean intake among consumers was 544.7 g/day. Percent consumers and mean amounts consumed were highest among adults aged 51-70 years (p < 0.001), higher income groups (p < 0.001), and non-Hispanic Whites (p < 0.001). About 74% of coffee consumers obtained their coffee from stores, 9.8% from fast food restaurants, 4.3% from convenience stores, and 4.2% from someone else. Coffee source locations also varied by age, education, income, and race/ethnicity. Coffee consumers had significantly higher Healthy Eating Index (HEI-2015) and higher Nutrient-Rich Foods (NRF9.3) scores in energy-adjusted models and significantly higher HEI 2015 scores in multivariable models. In multivariable models, coffee consumers had diets with less added sugar (p < 0.001) but slightly more fat (of all types, including monounsaturated (MUFA), polyunsaturated (PUFA), saturated and solid fats), cholesterol, and alcohol. Their diets had more potassium and magnesium (p < 0.001) but less vitamin C (p < 0.001). Mean caffeine consumption was 233 mg/day for consumers and 72.3 mg/day for non-consumers. Coffee consumption patterns in the US vary across socio-demographic groups.

New Nutrient Rich Food Nutrient Density Models That Include Nutrients and MyPlate Food Groups

Background: Dietary guidelines have shifted emphasis from single nutrients to food patterns, food groups, and dietary ingredients. Nutrient profiling models need to do the same. Methods: Dietary intake data for 23,643 persons aged >2 years came from the 2011-2016 National Health and Examination Survey (NHANES 2011-16). Healthy Eating Index HEI-2015 was the diet quality measure. The new Nutrient Rich Food hybrid score (NRFh) was based on three subscores. The subscore based on x nutrients to encourage was defined as NRx. The subscore based on y MyPlate food groups to encourage was MPy. The negative subscore based on z nutrients to limit was LIMz. The final algorithm was NRFh(x.y.z) = NRx + MPy - LIMz. The selection of NRFh model components from among 16 nutrients and five food groups was based on regression analyses. Results: We conducted a total of 2,162,720 iterative regression analyses against HEI-2015 diet quality scores. NRF scores based on 16 nutrients accounted for up to 66% of the variance, whereas scores based on 5 MP food groups accounted for 50%. The new NRFh3:4:3 score with six nutrients and four food groups (fiber, potassium, PUFA+MUFA; whole grains, dairy, fruit, nuts and seeds; saturated fat, added sugar, sodium) explained 72%. The new NRFh4:3:3 score with seven nutrients and three food groups (protein, fiber, potassium, PUFA+MUFA; whole grain, dairy, fruit; saturated fat, added sugar, sodium;) also explained 72%. In both NRFh models, regressions remained significant for each population subgroup examined. Conclusion: The NRFh3:4:3 and NRFh4:3:3 models correlated well with HEI-2015 scores, a measure of diet quality that tracks compliance with Dietary Guidelines. Hybrid NP models based on nutrients and food groups could become part of dietary guidance.

Tea Consumption Patterns in Relation to Diet Quality among Children and Adults in the United States: Analyses of NHANES 2011-2016 Data

Flavonoid-rich tea offers an alternative to sugar-sweetened beverages. The present analyses, based on 2 24-hour dietary recalls for 17,506 persons aged ≥9 years old in the 2011–2016 National Health and Nutrition Examination Survey database (NHANES 2011–2016), explored tea consumption patterns in relation to demographics, diet quality, cardiovascular disease (CVD) biomarkers (lipids and blood pressure), and body weight. Beverage categories were unsweetened tea, other tea (herbal and presweetened tea), coffee, milk, 100% juice, water and other high-calorie (HC) and low-calorie (LC) beverages. Tea consumption (18.5% of the sample) was highest among older adults (51–70 years old), non-Hispanic Asians and Whites, and those with college education and higher incomes. The effects of age, gender, education, income, and race/ethnicity were all significant (p < 0.001 for all). Adult tea consumers had diets with more protein, fiber, potassium, iron, and magnesium, and less added sugars and alcohol. Their diets contained fewer HC beverages and coffee but had more total and citrus fruit, more total dark green and orange vegetables, and more seafood, eggs, soy and milk. Tea consumers had higher Healthy Eating Index (HEI-2015) and higher Nutrient-Rich Foods (NRF9.3) nutrient density scores. Few children drank tea and no differences in diet quality between consumers and non-consumers were observed. Adult tea consumers had slightly higher high-density lipoprotein (HDL) cholesterol and lower body mass index (BMI) values. Tea consumption was associated with higher socioeconomic status and better diets.

Association between Ready-to-Eat Cereal Consumption and Nutrient Intake, Nutritional Adequacy, and Diet Quality among Infants, Toddlers, and Children in the National Health and Nutrition Examination Survey 2015-2016

Ready-to-eat (RTE) cereal is a popular food among children. However, there are no recent data on the associations between RTE cereal consumption and dietary outcomes in the U.S. Therefore, we sought to investigate how RTE cereal was associated with nutrient and food group intakes and overall dietary quality among children aged 0.5 to 17 years using the latest data from the National Health and Nutrition Examination Survey (NHANES 2015–2016). Thirty-six percent of children reported consuming RTE cereal. RTE cereal eaters consumed the same number of calories as non-eaters but had higher intakes of total carbohydrates, total sugar, fiber, calcium, iron, magnesium, potassium, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin B₆, folate, vitamin B₁₂, and vitamin D, as well as lower intakes of total fat and saturated fat (p ≤ 0.0007). We also found that children who consumed RTE cereal had 29% higher total dairy intake (p < 0.0001) and 61% higher whole grain intake (p < 0.0001). Lastly, children who ate RTE cereal had higher diet quality than the children that did not eat RTE cereal, as shown by Healthy Eating Index 2015 total score (52.6 versus 47.7, p < 0.0001). Therefore, consumption of whole-grain fortified RTE cereals should be encouraged as part of healthy dietary patterns for children.