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BackgroundEating a high-quality diet or adhering to a given dietary strategy may influence weight loss. However, these 2 factors have not been examined concurrently for those following macronutrient-limiting diets.ObjectiveTo determine whether improvement in dietary quality, change in dietary macronutrient composition, or the combination of these factors is associated with differential weight loss when following a healthy low-carbohydrate (HLC) or healthy low-fat (HLF) diet.DesignGenerally healthy adults were randomly assigned to HLC or HLF diets for 12 mo (n = 609) as part of a randomized controlled weight loss study. Participants with complete 24-h dietary recall data at baseline and 12-mo were included in this secondary analysis (total N = 448; N = 224 HLC, N = 224 HLF). Participants were divided into 4 subgroups according to 12-mo change in HEI-2010 score [above median = high quality (HQ) and below median = low quality (LQ)] and 12-mo change in macronutrient intake [below median = high adherence (HA) and above median = low adherence (LA) for net carbohydrate (g) or fat (g) for HLC and HLF, respectively]. Baseline to 12-mo changes in mean BMI were compared for those in HQ/HA, HQ/LA, LQ/HA subgroups with the LQ/LA subgroup within HLC and HLF.ResultsFor HLC, changes (95 % confidence level [CI]) in mean BMI were -1.15 kg/m2 (-2.04, -0.26) for HQ/HA, -0.30 (-1.22, 0.61) for HQ/LA, and -0.80 (-1.74, 0.14) for LQ/HA compared with the LQ/LA subgroup. For HLF, changes (95% CI) in mean BMI were -1.11kg/m2 (-2.10, -0.11) for HQ/HA, -0.26 (-1.26, 0.75) for HQ/LA, and -0.66 (-1.74, 0.41) for LQ/HA compared with the LQ/LA subgroup.ConclusionWithin both HLC and HLF diet arms, 12-mo decrease in BMI was significantly greater in HQ/HA subgroups relative to LQ/LA subgroups. Neither HQ nor HA alone were significantly different than LQ/LA subgroups. Results of this analysis support the combination of dietary adherence and high-quality diets for weight loss.Clinical trial registryclinicaltrials.gov (Identifier: NCT01826591).

In the United States, college students experience disproportionate food insecurity (FI) rates compared to the national prevalence. The experience of acute and chronic FI has been associated with negative physical and mental health outcomes in this population. This narrative review aims to summarize the current methodologies for assessing health outcomes associated with the experience of FI in college students in the United States. To date, assessing the health outcomes of FI has predominately consisted of subjective assessments, such as self-reported measures of dietary intake, perceived health status, stress, depression, anxiety, and sleep behaviors. This review, along with the emergence of FI as an international public health concern, establishes the need for novel, innovative, and objective biomarkers to evaluate the short- and long-term impacts of FI on physical and mental health outcomes in college students. The inclusion of objective biomarkers will further elucidate the relationship between FI and a multitude of health outcomes to better inform strategies for reducing the pervasiveness of FI in the United States college student population.

Objective: This cross-sectional study investigated associations among the Healthy Eating Index (HEI)-2015, Dietary Inflammatory Index (DII), and body composition in female collegiate athletes. Participants: Female NCAA Division I student-athletes (n = 41, 18–21 years old) were included from various sports and did not report any diagnosed chronic diseases. Methods: Demographics, dietary intake, anthropometrics, and body composition, including bone mineral density, were collected utilizing a questionnaire, three interview-based multiple-pass 24-h dietary recalls, and dual-energy X-ray absorptiometry. Results: Mean HEI-2015 and DII scores (using 39 of 45 components) were 56.2 ± 13.5 and −0.1 ± 1.9, respectively. Athletes did not meet recommended intake levels for servings of fruit, vegetables, fiber, calcium, vitamin D, omega-3, and omega-6. Saturated fat and added sugar intake exceeded the recommended intakes. Diet quality indices and body composition measures were not correlated. Conclusions: Although female collegiate athletes consumed poor-quality diets, this was not associated with body composition or bone health. [ABSTRACT FROM AUTHOR]

Objective: To explore young adult's experiences of how starting university influenced their physical activity, diet, sleep, and mental well-being, and barriers and enablers to health behavior change. Participants: University students aged 18–25 years. Methods: Three focus groups were conducted in November 2019. Inductive thematic approach was utilized to identify themes. Results: Students (female: n = 13, male: n = 2, other gender identity: n = 1, 21.2 (1.6) years) reported mental well-being, physical activity levels, diet quality and sleep health were negatively affected. Stress, study demands, university timetabling, not prioritizing physical activity, cost and availability of healthy foods, and difficulty falling asleep were key barriers. Health behavior change interventions aiming to support mental well-being need to include both information and support features. Conclusions: There is a significant opportunity to improve the transition to university for young adults. Findings highlight areas to target in future interventions to improve physical activity, diet, and sleep of university students. [ABSTRACT FROM AUTHOR]

Rationale: The change of IgG of COVID‐19 vaccine was thought to be an effect of diet quality or daily habits. Aims and Objectives: This study aimed to correlate diet quality and healthy living factors with serum IgG response in the blood. Methods: Participants were selected from volunteers who had their first vaccination and did not have COVID‐19 disease (Male = 21 Female = 40). Serum IgG levels were measured on average (avg) 28 days after the COVID‐19 vaccine. Information was obtained directly from the participants by questionnaire method (Food consumption record, frequency of food consumption, Diet Quality Index [(DQI], etc.). Results: A significant difference was observed in the IgG levels of the second measurement of age (young/middle) and gender (male/female) (p < 0.05). A significant difference was found in the first measurement of serum IgG levels and IgG avgs of those with medium diet quality and those who did not drink alcohol (p < 0.05). When the IgG2/1 ratio was examined between alcohol users and nonalcohol, a significant increase was observed about two times in non‐alcohol users (p = 0.039). There is a positive significant moderate strength relationship between the second measurements of IgG and anthropometric measurements and the first, second, and avg measurements of IgG with DQI. It was found that there was a negative significant medium‐strength relationship between individuals' amount of alcohol consumption and IgG avg (r = −0.535, p = 0.009). Conclusions: Medium diet quality has been seen to affect antibody levels positively. At the same time, it is thought that alcohol use negatively affects serum IgG antibody response in the long term. Other than that, there was shown to be a correlation between IgG levels and DQI. [ABSTRACT FROM AUTHOR]

Purpose: (i) Characterize ultra-processed food (UPF) intakes in toddlerhood and mid-childhood, including identifying principal UPF sub-groups and associations with nutrient profile; (ii) explore stability and change in UPF intake between toddlerhood and mid-childhood. Methods: Data were from children in the UK Gemini twin cohort at 21 months (n = 2,591) and 7 years (n = 592) of age. UPF intakes were estimated using diet diaries and Nova classification. Complex samples general linear or logistic regression models were used to explore associations between UPF intake, UPF sub-groups and nutrients, and changes in intake over time. Results: The contribution of UPF to total energy was 46.9% (± 14.7) at 21 months and 59.4% (± 12.5) at 7 years. Principal UPF sub-groups were yogurts, higher-fiber breakfast cereals, and wholegrain breads in toddlerhood, and puddings and sweet cereal products and white breads in mid-childhood. At both ages, mean free sugar and sodium intakes exceeded recommended maximums and higher UPF consumption was associated with consuming more of each nutrient (P < 0.001). UPF intake was negatively associated with fat, saturated fat and protein intake in toddlerhood, and fiber intake in mid-childhood (P < 0.001). Being in the highest UPF intake quintile in toddlerhood was predictive of being in the highest quintile in mid-childhood (OR 9.40, 95%CI 3.94–22.46). Conclusions: UPF accounted for nearly half of toddlers' energy, increasing to 59% in mid-childhood. Higher UPF consumers had higher intakes of free sugar and sodium. UPF intake in toddlerhood was predictive of mid-childhood intake. Effective policies are needed to reduce UPF intakes in the early years. [ABSTRACT FROM AUTHOR]

Background: A low-fat vegan diet, supplemented with soybeans, has been shown effective in reducing postmenopausal hot flashes. This secondary analysis assessed the association of a plant-based index (PDI), healthful (hPDI), and unhealthful (uPDI), with changes in hot flashes in postmenopausal women. Methods: Participants (n = 84) were randomly assigned to a low-fat vegan diet supplemented with soybeans (n = 42) or a control group (n = 42) for 12 weeks. Three-day dietary records were analyzed and PDI indices were calculated. A repeated measures analysis of variance (ANOVA) was used for statistical analysis. Results: All three scores increased in the vegan group, compared with no change in the control group; the effect sizes were: PDI + 9.8 (95% CI + 5.8 to + 13.8; p < 0.001); hPDI + 10.9 (95% CI + 6.4 to + 15.3; p < 0.001); and uPDI + 3.6 (95% CI + 0.5 to + 6.6; p = 0.02). The change in all three scores negatively correlated with change in body weight (PDI: r=-0.48; p < 0.001; hPDI: r=-0.38; p = 0.002; and uPDI: r=-0.31; p = 0.01). The changes in PDI and uPDI were negatively associated with changes in severe hot flashes (r=-0.34; p = 0.009; and r=-0.43; p < 0.001, respectively), and associations remained significant after adjustment for changes in body mass index (r=-0.31; p = 0.02; and r=-0.41; p = 0.001, respectively). Conclusions: These findings suggest that minimizing the consumption of animal products and oil may be an effective strategy to reduce hot flashes in postmenopausal women, and that categorization of plant foods as "healthful" or "unhealthful" may be unwarranted. Trial registration: ClinicalTrials.gov, NCT04587154, registered on Oct 14, 2020. [ABSTRACT FROM AUTHOR]

Background: The Non-Healthy Diet Index (NHDI) and the Pro-Healthy Diet Index (PHDI) are two novel indices that evaluate the healthiness of a diet based on the consumption of several food groups. This study aimed to evaluate the association between adherence to the PHDI and NHDI and colorectal cancer (CRC) risk in the Iranian population. Methods: The current study was conducted as a hospital-based research using a case (n = 71)- matched-controls (n = 142) design in Tehran, Iran. A semi-quantitative food frequency questionnaire was utilized to determine participants' dietary intake after confirming the diagnosis of CRC and at the time of the interview. The PHDI-10 was employed to assess the consumption of foods with positive health effects, which is linked to the frequency of consuming 10 food groups, and the NHDI-14 was used to assess the consumption of foods that have detrimental effects on health, based on the frequency of 14 food groups. Logistic regression was used to evaluate the association between continuous PHDI and NHDI scores and their tertiles with CRC. Results: The results indicated that individuals in the highest tertile of the PHDI showed a lower CRC risk compared to those in the lowest tertile (adjusted model- odds ratio (OR) = 0.25; 95% confidence interval (CI): 0.10–0.61; P = 0.002). Also, lower odds of CRC risk were seen with each unit change in the total score of PHDI in the adjusted model (OR = 0.86; 95% CI: 0.76–0.96; P = 0.009). In contrast, individuals in the highest tertile of the NHDI showed a higher risk of CRC compared to those in the lowest tertile (OR = 2.62; 95% CI: 1.09–6.27; P = 0.030) in the adjusted model. Also, higher odds of CRC risk were observed with each unit increase in the total score of NHDI in the adjusted model (OR = 1.13; 95% CI: 1.03–1.25; P = 0.008). Conclusions: The present study showed that higher adherence to PHDI and NHDI is associated with lower and higher CRC risk, respectively. These results provide valuable insights into the roles of healthy and unhealthy diets in CRC prevention. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Sample Measurements Results Conclusion This study examined the influence of nutrition literacy and neighborhood on diet quality within the Mexican‐origin population residing in the United States, addressing a gap in existing literature that lacks focus on specific Latinx subgroups.This study used a descriptive, correlational design to examine the relationships between nutrition literacy, neighborhood ranking, and diet quality.A total of 130 Mexican origin participants living in the United States completed all components of this study.Participants completed demographics, the Nutrition Literacy Assessment Instrument (NLit), Area Deprivation Index (ADI), and Diet History Questionnaire III (DHQ3).Compared to the national average of 59, participants’ average score was 63.16. When examining subgroups of diet quality, participants scored poorly compared to the national average for saturated fats, seafood, and plant proteins. Nutrition literacy was a predictor of total protein foods, seafood, and plant proteins, while the ADI was a predictor of increased refined grains score.The present study provides insights about the influencing factors of diet quality in this population. Given the essential role diet has in shaping health outcomes and preventing chronic illness, addressing dietary subgroups within the Latinx population is critical to accurately informing nursing interventions and patient education. [ABSTRACT FROM AUTHOR]

Background: Consumption of locally produced foods is generally perceived as being part of a healthy dietary pattern. Accordingly, in 2020, the provincial government of Québec (Canada) promoted the purchase of local foods for economic and health benefits. The present cross-sectional study aimed to document the association between the behavior of local food procurement and overall diet quality in a sample of adults from the province of Québec. Methods: Data were collected in a sample of 834 adults (86.6% females) from the NutriQuébec project, a web-based longitudinal population study that aims to document the lifestyle and eating habits of adults in Québec, Canada. Dietary intakes were measured using a validated web-based 24-h recall tool and diet quality was assessed using the Healthy Eating Food Index (HEFI-2019), which measures adherence to the 2019-Canada's Food Guide recommendations on healthy food choices. Local food procurement behavior was measured using the Locavore-I-SF score, which assesses the frequency of short food supply chain use as well as the geographical origin of three locally produced foods. Results: The Locavore-I-SF score was weakly correlated with the HEFI-2019 score (r = 0.08, p < 0.02). Positive correlations were observed for the Vegetables and fruits (r = 0.09, p = 0.005), Beverages (r = 0.08, p = 0.04) and Free sugars (r = 0.14, p < 0.001) components of the HEFI-2019. Associations between the Locavore-I-SF and the HEFI-2019 scores were found in specific subgroups of participants: males (r = 0.33, p < 0.001), participants aged between 50 and 70 years (r = 0.16, p = 0.003), participants with a greater education level (r = 0.13, p = 0.003) and higher income (r = 0.12, p = 0.02), non-vegetarian participants (r = 0.10, p = 0.008) and participants living in Census Metropolitan Areas (r = 0.11, p = 0.004). Conclusion: These results suggest that the behavior of local food procurement is only weakly associated with better overall diet quality among a sample of adults from Québec, raising doubts on the relevance of promoting local food procurement as an effective public health measure for improving diet quality in Québec. Study registration number: NCT04140071. [ABSTRACT FROM AUTHOR]

Food insecurity disproportionately affects smallholder farming households and within them women, who bear primary caregiving responsibilities and contend with time and resource constraints that heighten their vulnerability to adverse nutrition‐related health outcomes. This study cross‐sectionally investigates the association between food production practices, household consumer behaviour, and the experience of food insecurity with women's waist‐hip ratio (WHR), a key indicator of abdominal obesity, in a coastal community in Kenya. In total, 394 households were randomly selected from a list of farming households in Kaloleni and Rabai sub‐counties of Kilifi. Trained enumerators administered questionnaires to adult female family members who play a pivotal role in household management. Household dietary diversity scores (HDDS) were computed from 16 food groups consumed in the 7 days preceding the survey. Waist‐hip measurements focused on these females, representing vulnerable populations. Pathway‐based regression models were constructed using STATA version 13 (p < 0.05). Most households practised mixed farming (59.9%) and monocropping (73.2%) and most female respondents were widowed (75.1%) with limited education (73.1% had no formal education) and over 20 years of farming experience. Food insecurity was prevalent, affecting 80.7% of households. Limited dietary diversity was noted with an average HDDS of 9. The most commonly consumed foods were cereals, spices, condiments and beverages, while meat, eggs and fruits were infrequently eaten. An inverse association was observed between HDDS and WHR (standardised regression coefficient = −0.1328; p = 0.026) but while food insecurity was inversely associated with both HDD and WHR, these associations did not reach statistical significance (HDDS‐standardised regression coefficient −0.0294; p = 0.592: WHR‐standardised regression coefficient −0.0155; p = 0.791). Existing research has primarily addressed the undernutrition and hunger‐related impacts of food insecurity. The findings underscore the need to better understand the complex interplay between food insecurity and nutritional health, including markers of adiposity, to effectively promote health. [ABSTRACT FROM AUTHOR]

Athletes competing in weight categories (e.g., powerlifters) often restrict food intake approaching competition, which may be detrimental to health and performance. Our purpose was to assess the effect of nutrition knowledge, sex, and time (off-season versus precompetition, when athletes often cut weight) on dietary adequacy in powerlifters. Twenty-three powerlifters (10 females; 30.7 6 11.2 years) completed questionnaires to assess nutrition knowledge and dietary adequacy. Athletes with higher nutrition knowledge consumed more fruits and nuts and less vitamin B2, B3 across all time points (p< 0.05) and a greater number (73%) were above the recommended dietary allowance for vitamin D compared with athletes with lower nutrition knowledge (50%) (p< 0.05). Male powerlifters with higher nutrition knowledge consumed less alcohol and vitamin A than male powerlifters with lower nutrition knowledge (p< 0.05). Female powerlifters with higher nutrition knowledge consumed less sugar and beverage calories than female powerlifters with lower nutrition knowledge (p>0.05). Intake of alcohol and carbohydrate decreased, and meat calories increased from off-season to precompetition (p, 0.05). Male powerlifters increased B-vitamins, whereas female powerlifters decreased B-vitamin and sugar consumption approaching competition (p< 0.05). Male powerlifters increased water consumption versus female powerlifters approaching competition (sex 3 time, p< 0.05). There was no effect of nutrition knowledge on dietary changes approaching competition. Nutrition knowledge, sex, and competitive season affect dietary intake of powerlifters. A higher nutrition knowledge predicts a higher intake of some foods and nutrients important for health and performance. Female powerlifters should pay close attention to the intake of B-vitamins and water before competitions when many are trying to cut weight. [ABSTRACT FROM AUTHOR]

Objective: The study explored food items that contribute most toward increased fermentable carbohydrate (FC) intake and its association with diet quality in college students. Method: This cross-sectional study included 571 consented college students (≥18 years) with reported energy intakes (500–3500 kcal/day for women; 800–4000 kcal/day for men). FC intake and healthy eating index-2015 (HEI-2015) scores were assessed by diet history questionnaire-II. Data were analyzed by unadjusted bivariate linear regression and Pearson correlation tests. Results: The mean intakes of total FC (β = 1.24; 95% Confidence Interval: 1.02, 1.47) significantly predicted HEI-2015 scores. Positive correlations were found between FC intake and red and orange vegetables (r = 0.62), whole fruits (r = 0.63), and dark green vegetables (r = 0.58). Conclusions: Higher FC intake was associated with higher diet quality; vegetables and fruits are primary contributors to FC content. Efforts are required to promote these food items to improve diet quality and FC intake to shape eating choices in college students. [ABSTRACT FROM AUTHOR]

Aims High diet quality is related to better health outcomes in general. During pregnancy, a high-quality diet is of paramount importance to promote optimal maternal and neonatal outcomes. This is a scoping review of research available on diet quality indexes (DQIs) for use during pregnancy that summarizes the DQIs in terms of development, country of origin, population used, components, scoring and weighting of components, and evaluation. Furthermore, the DQIs are discussed narratively to inform and direct the development of improved and country-specific DQIs for pregnancy. Methods The EBSCOhost database was used to identify English-language, peer-reviewed articles published between 2000 and 2023, from which 11 publications were identified that describe the development of pregnancy-specific DQIs. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews model. Results Almost all DQIs (n = 9 of 11) were developed in high-income countries, using dietary intake data from food frequency questionnaires. Several DQIs (n = 5 of 11) used the US Healthy Eating Index as basis and modified it in various ways. Almost all DQIs included both foods and nutrients as components (n = 9 of 11), with vegetables being the most commonly included component alone (n = 8 of 11) or combined with fruit (n = 2 of 11). Conclusion Because most DQIs were developed using dietary guidelines, recommendations, and dietary intake data from high-income countries, it is recommended that pregnancy-specific DQIs be developed and validated to reflect the nutrition guidelines for lower-income and culturally diverse countries. [ABSTRACT FROM AUTHOR]

Various foods and nutrients are linked with higher or lower risk of rheumatoid arthritis (RA), yet these associations are inconsistent across studies. Limited research has been done evaluating the association between diet quality and RA in a larger-scale prospective study on postmenopausal women. The objective of this study was to evaluate the association between dietary quality and risk of incident RA in postmenopausal women. This was a prospective cohort study as part of the Women's Health Initiative (WHI), with an average follow-up time of 8.1 years. Baseline diet was measured using a food frequency questionnaire (FFQ). Diet quality was evaluated by the Healthy Eating Index (HEI)-2015 total score. In addition, intake of food groups and nutrients that align with HEI-2015 components was assessed. Postmenopausal women (N = 109 591) were included in this study, which was conducted at various clinical centers across the United States with recruitment from 1993 to 1998. Women's Health Initiative participants who were missing outcome data, had unreliable/missing FFQ data, or had RA at baseline were excluded. The primary outcome measure was incident RA. Statistical analyses performed Multivariable Cox proportional regression analysis was performed evaluating the association of diet quality with self-reported physician-diagnosed RA after adjusting for age, race, ethnicity, education status, income, and body mass index (BMI). During 857 517 person-years of follow-up, 5823 incident RA cases were identified. After adjustment for multiple comparisons, compared with quartile 1, quartiles 2, 3, and 4 of the HEI-2015 total scores were associated with lower RA risks of 1%, 10%, and 19%, respectively (P -trend <.001). Greater consumption of total fruits (P -trend =.014), whole fruits (P -trend <.0002), total vegetables (P -trend =.008), greens and beans (P -trend <.0002), whole grains (P -trend =.008), and dairy (P -trend =.018) were significantly associated with lower rates of incident RA. Conversely, higher consumption of saturated fat (P -trend =.002) was significantly associated with higher rates of incident RA. A higher-quality diet reflected by higher HEI-2015 total scores was inversely associated with incident RA in postmenopausal women. [ABSTRACT FROM AUTHOR]

Few studies have examined whether diet quality is lower in women with body weight dissatisfaction compared with women without body weight dissatisfaction. (1) Examine the association between body weight dissatisfaction and diet quality among women (18–65 years old) in the healthy weight body mass index (BMI) category, and (2) explore dietary and behavioral patterns among women with body weight dissatisfaction. Data were extracted from the cross-sectional 2014–2015 Swiss National Nutrition Survey. Population-based sample of 507 women with BMI ≥ 18.5 and < 25. Dietary intakes assessed by registered dietitians using 2 nonconsecutive computer-assisted multi-pass 24-hour dietary recalls. Diet quality was measured with a slightly modified version of the Healthy Eating Index (HEI)-2020. Multiple linear regressions were performed to test the association between body weight dissatisfaction and total HEI-2020 score. Hierarchical cluster analysis was used to identify subgroups of women with body weight dissatisfaction. Body weight dissatisfaction was not found to be associated with diet quality (β = –1.73 [–4.18; 0.71], P =.16). However, women who were dissatisfied with their body weight had lower scores for the HEI-2020 total fruits (P =.050) and whole grains (P =.014) components than women who were satisfied with their body weight. Four profiles with different dietary patterns were identified among women with body weight dissatisfaction: "Unhealthy diet with dairy," "Protein and fat," "Vegetables without protein," and "Healthier diet without dairy." Among women with a BMI in the healthy weight category, overall diet quality was not observed to differ between those with or without body weight dissatisfaction. More research is needed to explore the different profiles of dietary intake in women with body weight dissatisfaction. [ABSTRACT FROM AUTHOR]

Higher diet quality scores are associated with a lower risk for many chronic diseases and all-cause mortality; however, it is unclear if diet quality is associated with aging biology. This study aimed to examine the association between diet quality and a measure of biological aging known as epigenetic aging. A cross-sectional data analysis was used to examine the association between three diet quality scores based on self-reported food frequency questionnaire data and five measures of epigenetic aging based on DNA methylation (DNAm) data from peripheral blood. This study included 4,500 postmenopausal women recruited from multiple sites across the United States (1993-98), aged 50 to 79 years, with food frequency questionnaire and DNAm data available from the Women's Health Initiative baseline visit. Five established epigenetic aging measures were generated from HumanMethylation450 Beadchip DNAm data, including AgeAccelHannum, AgeAccelHorvath, AgeAccelPheno, AgeAccelGrim, and DunedinPACE. Linear mixed models were used to test for associations between three diet quality scores (Healthy Eating Index, Dietary Approaches to Stop Hypertension, and alternate Mediterranean diet scores) and epigenetic aging measures, adjusted for age, race and ethnicity, education, tobacco smoking, physical activity, Women's Health Initiative substudy from which DNAm data were obtained, and DNAm-based estimates of leukocyte proportions. Healthy Eating Index, Dietary Approaches to Stop Hypertension, and alternate Mediterranean diet scores were all inversely associated with AgeAccelPheno, AgeAccelGrim, and DunedinPACE (P < 0.05), with the largest effects with DunedinPACE. A one standard deviation increment in diet quality scores was associated with a decrement (β ± SE) in DunedinPACE z score of –0.097 ± 0.014 (P = 9.70 x 10-13) for Healthy Eating Index, –0.107 ± 0.014 (P = 1.53 x 10-14) for Dietary Approaches to Stop Hypertension, and –0.068 ± 0.013 (P = 2.31 x 10-07) for the alternate Mediterranean diet. In postmenopausal women, diet quality scores were inversely associated with DNAm-based measures of biological aging, particularly DunedinPACE. [ABSTRACT FROM AUTHOR]

Rural communities face unique food and nutrition challenges. Analyzing population-level survey data from 2021 to 2022 in two predominantly rural U.S. states using regression and multiple hypothesis testing procedures, we examined how well diets align with national recommendations and associations between diet, age, food security, and rurality. We found dietary intake of key foods and ingredients to differ significantly from recommendations and overall diet quality to increase with age. Food secure adults had higher diet quality than food insecure adults. Neither dietary intake nor dietary quality differed by degree of rurality. Continued action is needed to address nutrition challenges among underserved populations. [ABSTRACT FROM AUTHOR]

Background/Objectives: Food insecurity (FI) is defined as the lack of consistent access to enough food for an active and healthy life. FI affects over 30 million Americans and is associated with poor clinical outcomes and impaired quality of life and drives significant health inequities. Despite the rising prevalence of FI and the federal focus on improving access to healthy food, there is a paucity of research on FI in patients with inflammatory bowel disease (IBD). Therefore, the goal of this study was to define FI in a cohort of IBD patients and determine whether FI was associated with changes in dietary patterns, including specifically an increase in ultra-processed food (UPF) consumption in this high-risk patient population. Methods: This was a single-center, retrospective cohort study of patients with a diagnosis of IBD who were 18 years of age or older and who were seen in a nutrition focused clinic. Patients were screened for FI using the Hunger Vital Sign™, a 2-question validated FI screening tool and underwent a 24-h dietary recall. The degree of food processing was assessed using the NOVA Food Classification System. Results: Among 128 patients with IBD, we observed that FI is increasingly prevalent, with 45% of patients reporting difficulty with sufficient grocery access at least "sometimes" in the last 12 months and 10% reporting decreased food access "often" in the prior year. In addition, the patients at high-risk for FI were significantly more likely to eat NOVA 4 UPFs (54% vs. 27%, p = 0.001) and were significantly less likely to eat NOVA 1 unprocessed foods (32% vs. 61%, p = 0.001) as compared to those not at risk for FI. Finally, only a small percentage of those at highest risk for FI were enrolled in a federal food assistance program for grocery support. Conclusions: The prevalence of FI is increasing in patients with IBD and is associated with reduced dietary quality. [ABSTRACT FROM AUTHOR]

Background: Older populations are at high risk of nutritional inadequacy and monotonous diets, and assessing dietary diversity can be a practical measure to indicate groups at nutritional risk. We aimed to explore the dietary diversity of older adults enrolled in primary health care services in Brazil and to evaluate its associated factors. Methodology: In this cross-sectional study, we evaluated the dietary diversity score (DDS) of 581 participants (≥60 years) registered in primary care services. All foods mentioned in a 24 h food recall were classified into 10 groups, and factors associated with the DDS were analyzed using hierarchical linear regression models in two blocks: (1) sociodemographic and (2) health conditions and lifestyle. Results: The mean DDS was 5.07 (±1.34), and 67.5% of the sample reached the minimum dietary diversity (≥5 groups). In the final model, income, previous diagnosis of cancer, and sporadic intake of alcohol were positively associated with DDS. In contrast, cognitive decline, sedentary lifestyle, and anorexia of aging were negatively associated with DDS. Conclusions: These findings show that the entire structural, economic, and social system needs to facilitate access to quality food, adequate places and conditions for the practice of physical activity, and policies regarding tobacco and alcohol abuse, in addition to nutritional guidance. [ABSTRACT FROM AUTHOR]

Background: Diet and sleep are both established risk factors for cardiometabolic diseases. Prior evidence suggests a potential link between these behaviors, though longitudinal evidence for how diet associates with sleep is scarce. This study aimed to determine the prospective association between diet quality in young adulthood and multiple sleep outcomes at midlife in the Bogalusa Heart Study (BHS). Methods: This prospective study included 593 BHS subjects with dietary assessment at the 2001–2002 visit and sleep questionnaire responses from the 2013–2016 visit, after an average of 12.7 years (baseline mean age: 36 years, 36% male, 70%/30% White and Black persons). A culturally tailored, validated food frequency questionnaire assessed usual diet. Diet quality was measured with the Alternate Healthy Eating Index (AHEI) 2010, the Healthy Eating Index (HEI) 2015, and the alternate Mediterranean (aMed) dietary score. Robust Poisson regression with log-link function estimated risk ratios (RR) for insomnia symptoms, high sleep apnea score, and having a healthy sleep pattern by quintile and per standard deviation (SD) increase in dietary patterns. Models adjusted for potential confounders including multi-level socioeconomic factors, depression, and body mass index. Trends across quintiles and effect modification by sex, race, and education were tested. Results: Higher diet quality in young adulthood, measured by both AHEI and HEI, was associated with lower probability of having insomnia symptoms at midlife. In the adjusted model, each SD-increase in AHEI (7.8 points; 7% of score range) conferred 15% lower probability of insomnia symptoms at follow-up (RR [95% confidence interval CI]: 0.85 [0.77, 0.93]), those in Q5 of AHEI had 0.54 times the probability as those in Q1 (95% CI: 0.39, 0.75), and there was a significant trend across quintiles (trend p = 0.001). There were no significant associations between young adult diet quality and having a high sleep apnea risk or a healthy sleep pattern at follow-up. Conclusions: A healthy diet was associated with a lower probability of future insomnia symptoms. If replicated, these findings could have implications for chronic disease prevention strategies incorporating the lifestyle behaviors of sleep and diet. [ABSTRACT FROM AUTHOR]

AbstractLifestyle habits seem interconnected and extant studies suggest that a lifestyle-related modification can impact other related behaviors. For instance, interventions targeting physical activity (PA) could potentially impact dietary patterns and quality. Therefore, we hypothesized that a web-based intervention to increase PA would lead to changes in diet quality without explicit dietary guidance. Our aim was to evaluate changes in diet quality, measured by the Healthy Eating Index 2020 (HEI-2020), following a 12-week web-based PA intervention in adults with obesity. The study consisted of secondary analysis of a 12-week pilot randomized controlled trial, wherein participants (N = 82) were randomized to the Physical Activity for The Heart (PATH) intervention group, which included workout videos and virtual coaching, or a wait-list control group. Diet quality was assessed at baseline and post-intervention using the HEI-2020 based on recalls collected through the Automated Self-Administered 24-h recall (ASA-24) system. Baseline characteristics were similar across groups. Both groups showed small improvements in HEI-2020 total scores after 12 wk (PATH: 65.11 vs. Control: 62.24). Stratification by moderate to vigorous physical activities increase (<60 min. vs. ≥60 min.) revealed greater improvements in specific HEI-2020 components in the ≥60 min group, though overall changes remained modest. The PA intervention led to small improvements in certain diet quality components, suggesting potential interconnectedness between PA and dietary habits. However, overall changes in HEI-2020 scores were modest. Future research with larger samples should explore the effects of PA intervention alone vs. combined with dietary guidance on diet quality in adults with obesity. [ABSTRACT FROM AUTHOR]

Background: Previous studies have reported associations between individual nutrients or specific foods and the risk of age-related macular degeneration (AMD). However, the relationship between overall dietary quality, specifically the alternative Mediterranean diet (aMED) score, and AMD remains unclear. Therefore, this study aimed to investigate the association between the aMED score, as an indicator of overall diet quality, and AMD in the Korean population. Methods: We conducted a cross-sectional analysis using nationally representative samples of older adults aged ≥ 65 years (895 men and 1,191 women) from the Korea National Health and Nutrition Examination Survey (2017–2018). Food intake and the aMED score were estimated using 24-h recall. AMD was diagnosed by an ophthalmologist based on fundus photography. The associations of aMED score tertiles with AMD were determined using odds ratios (ORs) from multivariate logistic regressions. Results: Multiple logistic regression analysis revealed a significantly negative association between the aMED score and AMD (adjusted ORs = 0.58; 95% confidence interval = 0.39–0.88; p-trend = 0.021) in older men after adjusting for confounding factors such as age, body mass index, family monthly income, current smoking, alcohol consumption, physical activity, chronic disease status, and energy intake. Notably, this association was exclusively observed in men, and no significant association was observed between the aMED score and AMD in women (adjusted OR = 0.88; 95% CI = 0.61–1.29; p-trend = 0.691). Conclusions: This study's findings suggest that a high aMED score may be associated with a reduced risk of AMD in older men. Future studies with larger sample sizes and a prospective or interventional design are required to enhance current understanding regarding the association between diet quality and AMD. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) and diet quality have each been shown to be inversely associated with mortality but their combined impact on longevity has been less explored, particularly when considering their changes over time. This study aimed to examine the separate and combined associations of PA, diet quality and their changes over time with mortality outcomes. Methods: A prospective cohort study was performed on 9349 adults aged 40 to 79 years from the population-based European Prospective Investigation into Cancer in Norfolk Study, with repeated measurements of PA and diet (from 1993 till 2004) and subsequent follow-up till 2022 (median follow-up 18.8 years). Validated questionnaires were used to derive physical activity energy expenditure (PAEE) as a proxy of total PA and adherence to the Mediterranean diet score (MDS, range 0–15 points) as an indicator of overall diet quality, and their changes over time (∆PAEE and ∆MDS). Cox regression models adjusted for potential confounders and mediators were used to estimate hazard ratios (HRs) and 95% CIs. Results: Over 149,681 person-years of follow-up, there were 3534 deaths. In adjusted models, for each 1-SD difference in baseline PAEE (4.64 kJ/kg/day), ∆PAEE (0.65 kJ/kg/day per year), baseline MDS (1.30 points) and ∆MDS (0.32 points per year), HRs (95% CI) for all-cause mortality were 0.90 (0.86 to 0.94), 0.89 (0.85 to 0.93), 0.95 (0.91 to 0.99) and 0.93 (0.90 to 0.97), respectively. Compared with participants with sustained low PAEE (< 5 kJ/kg/day) and low MDS (< 8.5 points), those with sustained high PAEE and high MDS had lower all-cause mortality (HR 0.78; 95% CI: 0.68–0.91), as did those who improved both PAEE and MDS (0.60; 0.44–0.82). There was no evidence of interaction between PA and diet quality exposures on mortality risk. Population impact estimates suggested that if all participants had maintained high levels of PA and diet quality consistently, cumulative adjusted mortality rate would have been 8.8% (95% CI: 2.4 to 15.3%) lower. Conclusions: These findings suggest that adopting and maintaining higher levels of PA and diet quality are associated with lower mortality. Significant public health benefits could be realised by enabling active living and healthy eating through adulthood. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study investigates the relationship between diet quality and body image disturbance among young women aged 18–24, a crucial period for establishing lifelong health behaviors. Given the increasing exposure to social media, which often promotes unrealistic beauty standards, this research aims to explore associations between eating behaviors, diet quality, and body image disturbance. Methods: A mixed-methods approach was employed, combining qualitative focus group discussions with quantitative analysis. Focus groups (n = 19) explored themes of body image dissatisfaction. The Body Image Disturbance Questionnaire (BIDQ) was administered to 50 participants (young women aged 18–24) to quantitatively assess body image disturbance, while diet quality was evaluated using the Australian Recommended Food Scores (ARFS). The Three-Factor Eating Questionnaire (TFEQ-R18) was also used to assess eating behaviors, including cognitive restraint, uncontrolled eating, and emotional eating. A social influence questionnaire (SIQ) was administered to measure the effect of social influence. Pearson's correlation coefficient was used to determine the relationship between ARFS, BIDQ, and TFEQ-R18 scores. Results: Qualitative findings revealed persistent dissatisfaction with body shape, largely influenced by social media. Quantitatively, 65% of participants scored above the clinical threshold for body image disturbance (mean BIDQ score = 4.2, SD = 0.8). The correlation between ARFS and BIDQ scores was weak and not statistically significant (r = 0.057, p = 0.711). However, a significant positive correlation was observed between time spent on social media and body image disturbance (r = 0.58, p < 0.01). Additionally, TFEQ-R18 results indicated that 45% of participants displayed moderate levels of uncontrolled eating, and 36.5% demonstrated moderate levels of emotional eating. Conclusions: While social media is associated with body image concerns, its effect on eating behaviors and diet quality shows weak correlations, suggesting that other factors may mediate these outcomes. These results suggest the complexity of the associations between body image, eating behaviors, and diet quality, indicating that interventions should consider psychological drivers behind these concerns alongside social media usage. [ABSTRACT FROM AUTHOR]

Objective: This pilot cross-sectional study explored differences in dietary intake and eating behaviors between healthy adults and a group of adults taking insulin to manage diabetes. Methods: A characteristic questionnaire and up to four Automated Self-Administered 24-Hour dietary recalls were collected from 152 adults aged 18–65 years (96 healthy and 56 adults taking insulin) from Indiana and across the U.S. from 2022 to 2023. The macronutrient intake, diet quality via the Healthy Eating Index (HEI)-2015, eating frequency, and consistency of timing of eating were calculated and compared between the two groups using adjusted linear or logistic regression models. Results: The total mean HEI scores were very low, at 56 out of 100 and 49 out of 100 for the healthy and insulin-taking groups, respectively. Insulin-taking adults had significantly lower HEI total (p = 0.003) and component scores compared to the healthy group for greens and beans (2.0 vs. 3.0, p = 0.02), whole fruit (2.1 vs. 2.9, p = 0.05), seafood and plant proteins (2.1 vs. 3.3, p = 0.004), and saturated fats (3.7 vs. 5.4, p = 0.05). Eating frequency was significantly lower in the insulin-taking group than in the healthy group (3.0 vs. 3.4 eating occasions/day, p = 0.05). Conclusion: Evidence of the low diet quality and eating frequency of insulin takers may help inform and justify nutrition education to control and manage diabetes. [ABSTRACT FROM AUTHOR]

Snacking is a common dietary behaviour among adolescents contributing to more than one quarter of their total energy intake; however, the relationship between snacks and diet quality remains unclear. Hence, this study aimed to examine the characteristics of snacks among adolescents with different levels of diet quality. Dietary data collected from a nationally representative sample of Australian adolescents (12–18 years old, n = 935) using one 24-hour dietary recall in the National Nutrition and Physical Activity Survey were analysed. Snacks were defined based on participant-identified eating occasions, and diet quality was assessed using the Dietary Guideline Index for Children and Adolescents (DGI-CA). Marginal means and proportion of snack characteristics including snack frequency, snack energy density (ED), and commonly consumed foods at snack from the five food groups and discretionary foods at snack across DGI-CA tertiles (highest tertile indicating high guideline adherence) were estimated for both boys and girls using linear regression and logistic regression. Differences in means were tested using the F-test. The results showed no significant differences in the mean frequency of snacks across tertiles of DGI-CA scores. The mean ED of snacks decreased as DGI-CA scores increased in both boys (lowest tertile = 8.4, 95% CI [7.1, 10.0] kJ/g, highest tertile = 6.3 [5.4, 7.4] kJ/g) and girls (lowest tertile = 9.0 [7.8, 10.3] kJ/g, highest tertile = 5.9 [5.1, 6.9] kJ/g). As diet quality improved, the proportion of adolescents consuming discretionary (i.e., unhealthy) foods and foods from the five food group foods as snacks decreased and increased, respectively. In conclusion, adolescents with higher diet quality consumed snacks with a lower ED while lower proportion of them consume discretionary foods, and higher proportion of them consume from the five food groups. Encouraging the consumption of foods from the five food groups with lower ED as snacks presents an opportunity to enhance adolescent diet quality. [ABSTRACT FROM AUTHOR]

• Better diet quality had a direct (beneficial) effect on pain. • Higher consumption of core foods was related to less pain in women, but not men. • Adiposity did not mediate the relationship between diet quality and pain. • Strategies for pain management should consider diet quality. Dietary intake has been associated with pain and physical function, but it is unclear if these relationships are mediated by adiposity. Data were derived from the Whyalla Intergenerational Study of Health (n = 654, 57% women). Structural equation modelling tested the hypotheses that adiposity (body mass index (BMI), waist circumference (WC), or body fat (BF, dual energy x-ray absorptiometry)) would mediate the relationship between diet quality (Dietary Guideline Index (DGI) total, core, or non-core scores) and pain (Short Form-36 bodily pain scale (SF36-BPS)), or physical function (grip-strength), overall, and by gender. Adiposity did not mediate a relationship between DGI scores and pain. Direct effects were observed between DGI total scores and SF36-BPS accounting for BMI (β = 0.170, 95% CI 0.002, 0.339), and between DGI core food scores and SF36-BPS (BMI, β = 0.278, 95% CI 0.070, 0.486; WC, β = 0.266, 95% CI 0.058, 0.474; BF, β = 0.266, 95% CI 0.060, 0.473). In women, direct effects existed between DGI scores and SF36-BPS (DGI total scores, BMI, β = 0.388, 95% CI 0.162, 0.613; WC, β = 0.372, 95% CI 0.146, 0.598; BF, β = 0.382, 95% CI 0.158, 0.605, and DGI core scores, BMI, β = 0.482, 95% CI 0.208, 0.757; WC, β = 0.472, 95% CI 0.197, 0.747; BF, β = 0.467, 95% CI 0.195, 0.739), and DGI total scores and grip-strength (BMI, β = 0.075, 95% CI 0.008, 0.142; WC, β = 0.076, 95% CI 0.009, 0.143; BF, β = 0.079, 95% CI 0.011, 0.146). Better diet quality is associated with lower bodily pain, irrespective of adiposity. Findings highlight the potential role of diet quality in pain management and function, particularly in women. A cross-sectional study of 654 Australian adults (57% women) from the WISH found better diet quality, particularly the intake of core foods, assessed via the DGI, was associated with lower body pain. These findings were most pronounced in women. Mediation analyses did not show any influence of adiposity in this relationship. Abbreviations: BMI, body mass index; DGI, Dietary Guideline Index; WISH, Whyalla Intergenerational Study of Health. [Display omitted] [ABSTRACT FROM AUTHOR]

Peru is one of the most diverse countries in the world in terms of food production, but also suffers a wide range of food security challenges, including malnutrition, the impact of natural hazards, and rising food prices. People living in poverty conditions are the main victims of these problems, which trigger undernutrition, obesity, and diet‐related non‐transmittable diseases. Despite these challenges, Peru lacks historical food intake data. Therefore, in the current study, we assess the diet quality evolution in the period 2008–2021 based on apparent household purchases extracted from the National Household Survey. The results reveal significant variations in the consumption of certain food items and groups, and the consequences of these changes are discussed in environmental and human health terms. The consumption of lower environmental impact animal protein, such as chicken, eggs, and marine fish, has increased by 37%, 69%, and 29%, respectively; whereas the consumption of high environmental impact foods, such as beef and other red meat, has decreased. Moreover, consumption of less processed carbohydrate sources (e.g., legumes, fruits, and vegetables) has risen, while refined sugar and sugar‐sweetened beverages have decreased significantly (almost 45%). Regional differences were also visible; hence, cities on the Northern coast and the Amazon basin had similar consumption habits, whereas Central/Southern coastal and Andean cities had closer consumption patterns. On average, this improvement was reflected in the increase in calories (9.9%) and macronutrient intake (up to 15%), but at the socioeconomic level, food inequality persists, with consumption of many food groups below minimum thresholds in lower socioeconomic strata. This article met the requirements for a gold/gold JIE data openness badge described at http://jie.click/badges. [ABSTRACT FROM AUTHOR]

Background: The sustainability of diets consumed by African populations under socio-economic transition remains to be determined. This study developed and characterized a multi-dimensional Sustainable Diet Index (SDI) reflecting healthfulness, climate-friendliness, sociocultural benefits, and financial affordability using individual-level data of adults in rural and urban Ghana and Ghanaian migrants in Europe to identify the role of living environment in dietary sustainability. Methods: We used cross-sectional data from the multi-centre Research on Obesity and Diabetes among African Migrants Study (N = 3169; age range: 25–70 years). For the SDI construct (0–16 score points), we used the Diet Quality Index-International, food-related greenhouse gas emission, the ratio of natural to processed foods, and the proportion of food expenditure from income. In linear regression analyses, we estimated the adjusted ß-coefficients and 95% confidence intervals (CIs) for the differences in mean SDI across study sites (using rural Ghana as a reference), accounting for sociodemographic and lifestyle factors. Results: The overall mean SDI was 8.0 (95% CI: 7.9, 8.1). Participants in the highest SDI-quintile compared to lower quintiles were older, more often women, non-smokers, and alcohol abstainers. The highest mean SDI was seen in London (9.1; 95% CI: 8.9, 9.3), followed by rural Ghana (8.2; 95% CI: 8.0, 8.3), Amsterdam (7.9; 95% CI: 7.7, 8.1), Berlin (7.8; 95% CI: 7.6, 8.0), and urban Ghana (7.7; 95% CI: 7.5, 7.8). Compared to rural Ghana, the differences between study sites were attenuated after accounting for age, gender and energy intake. No further changes were observed after adjustment for lifestyle factors. Conclusion: The multi-dimensional SDI describes four dimensions of dietary sustainability in this Ghanaian population. Our findings suggest that living in Europe improved dietary sustainability, but the opposite seems true for urbanization in Ghana. [ABSTRACT FROM AUTHOR]

Background: Substantial variability in response to lifestyle interventions has been recognized for many years, and researchers have begun to disentangle sources of error from inherent differences in individual responsiveness. The objective of this secondary analysis of an intensive lifestyle intervention (diet and exercise) for metabolic syndrome (MetS) was to identify potentially important differences among study completers grouped by treatment response as measured by change in a continuous metabolic syndrome score (Gurka/MetS). Methods: All study completers from a 12-month primary care study were categorized into one of five groups according to change in the Gurka/MetS score. A change of 0.4 in z-score defined clinically relevant change in line with results of previous studies. Repeated measures analysis of variance was used to examine cardiovascular disease risk and individual clinical indicators of MetS over 12 months, looking for differences in response over time by the five groups. Results: Of 176 participants, 50% (n = 88) had stable scores, 10% (n = 18) had relevant change scores in the first 3 months only and reverted toward baseline, 20% (n = 35) achieved meaningful change over the whole study, 11% (n = 20) had a delayed response at 3–12 months, and 9% (n = 15) demonstrated worsening scores. Significant differential patterns were noted for groups over the duration of the intervention (p <.001). Improvement in diet quality and fitness scores were similar across all groups. Other available variables were tested and did not account for the differences. Conclusion: Work is needed to identify key factors that account for differences in responses to lifestyle interventions that can be used to guide treatment decisions for intensive lifestyle interventions for this common condition. Trial Registration: ClinicalTrials.gov Identifier: NCT01616563; first registered June 12, 2012. [ABSTRACT FROM AUTHOR]

Background: A sleeve gastrectomy (SG) is a lifelong treatment that improves health and better outcomes are associated with follow‐up. However, there is lack of access or high attrition to aftercare. This potentially contributes to sub‐optimal dietary intake and a lack of evidence for nutrition interventions. The present study assessed the feasibility and preliminary efficacy of a nutrition intervention to improve diet quality in Australian adults living with a SG. Methods: Adults (n = 96) post‐SG were recruited into a cross‐sectional diet quality study, with 68 eligible for randomisation to an intervention or wait‐list control group. Over 10 weeks, a Facebook group was used to post daily nutrition education. Feasibility outcomes included participant recruitment, engagement, retention and acceptability. Preliminary efficacy was assessed using change in Australian Recommended Food Score (ARFS). Linear mixed models were used to measure differences in mean outcome between the experimental groups over time. Results: Sixty‐eight participants (97% female) aged 48.2 ± 9.8 years, body mass index 33.1 ± 5.8 kg/m2, and mean ± SD ARFS 39 ± 9 points were randomised to the intervention, with 66% retention at 10 weeks. At follow‐up, diet quality increased for the intervention group (mean ARFS, 95% confidence interval = 0.2 [−1.5 to 1.9]) and decreased for the control group (mean ARFS, 95% confidence interval= −2.0 [−5.2 to 1.2]) with no between group difference (p = 0.2). Participants (n = 30) rated the intervention positively. Conclusions: Recruiting and retaining adults post‐SG into a nutrition intervention is feasible. Low‐cost recruitment attracted strong interest from women to identify greater support to know what to eat following SG. A future fully powered trial to assess intervention efficacy is warranted. Highlights: An online nutrition education intervention for Australian adults' post‐sleeve gastrectomy has been found to be effective and feasibleThe interventions attracted strong interest, especially from women, who were looking for greater support in understanding what to eat after a sleeve gastrectomy.Researchers recommend conducting a fully powered trial to assess the efficacy of this intervention further. [ABSTRACT FROM AUTHOR]

Better diet quality regardless of community food access was associated with a higher likelihood of glycemic control in early pregnancy among nulliparous individuals with pregestational diabetes. These findings highlight the need for interventions that address nutrition insecurity for pregnant individuals living with diabetes. • Better diet quality was associated with glycemic control in early pregnancy among nulliparous individuals with pregestational diabetes. • Community food access was not associated with glycemic control. • Interventions that address nutrition insecurity for pregnant individuals living with diabetes are needed. [ABSTRACT FROM AUTHOR]

Background: Vaginal Lactobacillus predominance is associated with improved vaginal health and reduced pregnancy complications. Little is known about how dietary quality may improve vaginal microbial composition or about dietary interventions that may promote Lactobacillus abundance. To understand the host factors affecting vaginal microbiota during pregnancy in a multi-ethnic cohort in Hawai'i. We hypothesize that better diet quality improves vaginal microbial composition, as represented by Lactobacillus abundance and depletion of anaerobic organisms. Methods: We compared comprehensive diet quality, as measured by the Healthy Eating Index-2015 (HEI-2015), to taxonomic classifications of bacteria present within the vagina. Participants of the four predominant ethnic groups in Hawai'i (Japanese, Filipino, Non-Hispanic White and Native Hawaiian) completed Quantitative Food Frequency Questionnaires (QFFQs) and collected vaginal swabs during each trimester. 16s rRNA amplicon sequencing (V2–V9 regions) was performed on vaginal samples. HEI-2015 scores and macro- and micronutrient intake were compared with the predominant species present using the Mann–Whitney-U test, PERMANOVA, and the Pearson correlation coefficient. A mixed-effects logistics regression model was used to predict the depletion of Lactobacillus species while accounting for confounding demographic factors. Results: Matched, longitudinal data for 40 participants demonstrated three predominant Lactobacillus species: L. crispatus, L. iners, and L. gasseri, with another subset of samples with anaerobic abundance. (Primarily, Atopobium vaginae, Prevotella, and Gardnerella vaginalis.) Non-Hispanic White participants had lower amounts of Lactobacillus iners compared to other racial and ethnic groups. HEI scores correlated with the chao index and observed species number primarily in the first trimester (r = 0.25, p < 0.05). Greater carbohydrate intake was associated with a higher abundance of L. crispatus, while lower carbohydrate intake trended towards more L. iners (0.056) and anaerobic species. Conclusions: Increased carbohydrate consumption and improved diet quality may be associated with beneficial vaginal microbial composition in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Stress has been shown to be associated with poor nutrition among young women. However, studies around the topic have major limitations in their methodologies and the role of confounding factors within this association remains unclear in the literature. Objective: To investigate the associations between stress and dietary quality/patterns in a culturally diverse population of childbearing-aged women. Methods: A secondary analysis of data from two studies conducted in UK and Lebanon was performed using Structural Equation Modelling (SEM) to explore the role of country context, socio-economic status, and physical variables. Participants were healthy women of childbearing age (n = 493). Variables measured were dietary intake, stress, physical activity, sociodemographic variables, and Body Mass Index. These were included in the SEM analysis to examine the mediating effect of stress. Results: The results showed that, among all variables, only country had a significant effect on dietary quality and patterns through the mediatory effect of stress. Participants from Lebanon were found to have higher stress levels compared to participants from the UK, and this contributed to a lower adherence to a Mediterranean diet. Conclusions: This study shows that for women of childbearing age, having a good diet quality/pattern is dependent on stress levels and country context. [ABSTRACT FROM AUTHOR]

Abstract Background The Non-Healthy Diet Index (NHDI) and the Pro-Healthy Diet Index (PHDI) are two novel indices that evaluate the healthiness of a diet based on the consumption of several food groups. This study aimed to evaluate the association between adherence to the PHDI and NHDI and colorectal cancer (CRC) risk in the Iranian population. Methods The current study was conducted as a hospital-based research using a case (n = 71)- matched-controls (n = 142) design in Tehran, Iran. A semi-quantitative food frequency questionnaire was utilized to determine participants’ dietary intake after confirming the diagnosis of CRC and at the time of the interview. The PHDI-10 was employed to assess the consumption of foods with positive health effects, which is linked to the frequency of consuming 10 food groups, and the NHDI-14 was used to assess the consumption of foods that have detrimental effects on health, based on the frequency of 14 food groups. Logistic regression was used to evaluate the association between continuous PHDI and NHDI scores and their tertiles with CRC. Results The results indicated that individuals in the highest tertile of the PHDI showed a lower CRC risk compared to those in the lowest tertile (adjusted model- odds ratio (OR) = 0.25; 95% confidence interval (CI): 0.10–0.61; P = 0.002). Also, lower odds of CRC risk were seen with each unit change in the total score of PHDI in the adjusted model (OR = 0.86; 95% CI: 0.76–0.96; P = 0.009). In contrast, individuals in the highest tertile of the NHDI showed a higher risk of CRC compared to those in the lowest tertile (OR = 2.62; 95% CI: 1.09–6.27; P = 0.030) in the adjusted model. Also, higher odds of CRC risk were observed with each unit increase in the total score of NHDI in the adjusted model (OR = 1.13; 95% CI: 1.03–1.25; P = 0.008). Conclusions The present study showed that higher adherence to PHDI and NHDI is associated with lower and higher CRC risk, respectively. These results provide valuable insights into the roles of healthy and unhealthy diets in CRC prevention.

Abstract Background A low-fat vegan diet, supplemented with soybeans, has been shown effective in reducing postmenopausal hot flashes. This secondary analysis assessed the association of a plant-based index (PDI), healthful (hPDI), and unhealthful (uPDI), with changes in hot flashes in postmenopausal women. Methods Participants (n = 84) were randomly assigned to a low-fat vegan diet supplemented with soybeans (n = 42) or a control group (n = 42) for 12 weeks. Three-day dietary records were analyzed and PDI indices were calculated. A repeated measures analysis of variance (ANOVA) was used for statistical analysis. Results All three scores increased in the vegan group, compared with no change in the control group; the effect sizes were: PDI + 9.8 (95% CI + 5.8 to + 13.8; p

Abstract Background Consumption of locally produced foods is generally perceived as being part of a healthy dietary pattern. Accordingly, in 2020, the provincial government of Québec (Canada) promoted the purchase of local foods for economic and health benefits. The present cross-sectional study aimed to document the association between the behavior of local food procurement and overall diet quality in a sample of adults from the province of Québec. Methods Data were collected in a sample of 834 adults (86.6% females) from the NutriQuébec project, a web-based longitudinal population study that aims to document the lifestyle and eating habits of adults in Québec, Canada. Dietary intakes were measured using a validated web-based 24-h recall tool and diet quality was assessed using the Healthy Eating Food Index (HEFI-2019), which measures adherence to the 2019-Canada’s Food Guide recommendations on healthy food choices. Local food procurement behavior was measured using the Locavore-I-SF score, which assesses the frequency of short food supply chain use as well as the geographical origin of three locally produced foods. Results The Locavore-I-SF score was weakly correlated with the HEFI-2019 score (r = 0.08, p

Abstract Background Diet and sleep are both established risk factors for cardiometabolic diseases. Prior evidence suggests a potential link between these behaviors, though longitudinal evidence for how diet associates with sleep is scarce. This study aimed to determine the prospective association between diet quality in young adulthood and multiple sleep outcomes at midlife in the Bogalusa Heart Study (BHS). Methods This prospective study included 593 BHS subjects with dietary assessment at the 2001–2002 visit and sleep questionnaire responses from the 2013–2016 visit, after an average of 12.7 years (baseline mean age: 36 years, 36% male, 70%/30% White and Black persons). A culturally tailored, validated food frequency questionnaire assessed usual diet. Diet quality was measured with the Alternate Healthy Eating Index (AHEI) 2010, the Healthy Eating Index (HEI) 2015, and the alternate Mediterranean (aMed) dietary score. Robust Poisson regression with log-link function estimated risk ratios (RR) for insomnia symptoms, high sleep apnea score, and having a healthy sleep pattern by quintile and per standard deviation (SD) increase in dietary patterns. Models adjusted for potential confounders including multi-level socioeconomic factors, depression, and body mass index. Trends across quintiles and effect modification by sex, race, and education were tested. Results Higher diet quality in young adulthood, measured by both AHEI and HEI, was associated with lower probability of having insomnia symptoms at midlife. In the adjusted model, each SD-increase in AHEI (7.8 points; 7% of score range) conferred 15% lower probability of insomnia symptoms at follow-up (RR [95% confidence interval CI]: 0.85 [0.77, 0.93]), those in Q5 of AHEI had 0.54 times the probability as those in Q1 (95% CI: 0.39, 0.75), and there was a significant trend across quintiles (trend p = 0.001). There were no significant associations between young adult diet quality and having a high sleep apnea risk or a healthy sleep pattern at follow-up. Conclusions A healthy diet was associated with a lower probability of future insomnia symptoms. If replicated, these findings could have implications for chronic disease prevention strategies incorporating the lifestyle behaviors of sleep and diet.

Abstract Background Physical activity (PA) and diet quality have each been shown to be inversely associated with mortality but their combined impact on longevity has been less explored, particularly when considering their changes over time. This study aimed to examine the separate and combined associations of PA, diet quality and their changes over time with mortality outcomes. Methods A prospective cohort study was performed on 9349 adults aged 40 to 79 years from the population-based European Prospective Investigation into Cancer in Norfolk Study, with repeated measurements of PA and diet (from 1993 till 2004) and subsequent follow-up till 2022 (median follow-up 18.8 years). Validated questionnaires were used to derive physical activity energy expenditure (PAEE) as a proxy of total PA and adherence to the Mediterranean diet score (MDS, range 0–15 points) as an indicator of overall diet quality, and their changes over time (∆PAEE and ∆MDS). Cox regression models adjusted for potential confounders and mediators were used to estimate hazard ratios (HRs) and 95% CIs. Results Over 149,681 person-years of follow-up, there were 3534 deaths. In adjusted models, for each 1-SD difference in baseline PAEE (4.64 kJ/kg/day), ∆PAEE (0.65 kJ/kg/day per year), baseline MDS (1.30 points) and ∆MDS (0.32 points per year), HRs (95% CI) for all-cause mortality were 0.90 (0.86 to 0.94), 0.89 (0.85 to 0.93), 0.95 (0.91 to 0.99) and 0.93 (0.90 to 0.97), respectively. Compared with participants with sustained low PAEE (

Abstract Background Previous studies have reported associations between individual nutrients or specific foods and the risk of age-related macular degeneration (AMD). However, the relationship between overall dietary quality, specifically the alternative Mediterranean diet (aMED) score, and AMD remains unclear. Therefore, this study aimed to investigate the association between the aMED score, as an indicator of overall diet quality, and AMD in the Korean population. Methods We conducted a cross-sectional analysis using nationally representative samples of older adults aged ≥ 65 years (895 men and 1,191 women) from the Korea National Health and Nutrition Examination Survey (2017–2018). Food intake and the aMED score were estimated using 24-h recall. AMD was diagnosed by an ophthalmologist based on fundus photography. The associations of aMED score tertiles with AMD were determined using odds ratios (ORs) from multivariate logistic regressions. Results Multiple logistic regression analysis revealed a significantly negative association between the aMED score and AMD (adjusted ORs = 0.58; 95% confidence interval = 0.39–0.88; p-trend = 0.021) in older men after adjusting for confounding factors such as age, body mass index, family monthly income, current smoking, alcohol consumption, physical activity, chronic disease status, and energy intake. Notably, this association was exclusively observed in men, and no significant association was observed between the aMED score and AMD in women (adjusted OR = 0.88; 95% CI = 0.61–1.29; p-trend = 0.691). Conclusions This study’s findings suggest that a high aMED score may be associated with a reduced risk of AMD in older men. Future studies with larger sample sizes and a prospective or interventional design are required to enhance current understanding regarding the association between diet quality and AMD.

Abstract Snacking is a common dietary behaviour among adolescents contributing to more than one quarter of their total energy intake; however, the relationship between snacks and diet quality remains unclear. Hence, this study aimed to examine the characteristics of snacks among adolescents with different levels of diet quality. Dietary data collected from a nationally representative sample of Australian adolescents (12–18 years old, n = 935) using one 24-hour dietary recall in the National Nutrition and Physical Activity Survey were analysed. Snacks were defined based on participant-identified eating occasions, and diet quality was assessed using the Dietary Guideline Index for Children and Adolescents (DGI-CA). Marginal means and proportion of snack characteristics including snack frequency, snack energy density (ED), and commonly consumed foods at snack from the five food groups and discretionary foods at snack across DGI-CA tertiles (highest tertile indicating high guideline adherence) were estimated for both boys and girls using linear regression and logistic regression. Differences in means were tested using the F-test. The results showed no significant differences in the mean frequency of snacks across tertiles of DGI-CA scores. The mean ED of snacks decreased as DGI-CA scores increased in both boys (lowest tertile = 8.4, 95% CI [7.1, 10.0] kJ/g, highest tertile = 6.3 [5.4, 7.4] kJ/g) and girls (lowest tertile = 9.0 [7.8, 10.3] kJ/g, highest tertile = 5.9 [5.1, 6.9] kJ/g). As diet quality improved, the proportion of adolescents consuming discretionary (i.e., unhealthy) foods and foods from the five food group foods as snacks decreased and increased, respectively. In conclusion, adolescents with higher diet quality consumed snacks with a lower ED while lower proportion of them consume discretionary foods, and higher proportion of them consume from the five food groups. Encouraging the consumption of foods from the five food groups with lower ED as snacks presents an opportunity to enhance adolescent diet quality.

Abstract Background The sustainability of diets consumed by African populations under socio-economic transition remains to be determined. This study developed and characterized a multi-dimensional Sustainable Diet Index (SDI) reflecting healthfulness, climate-friendliness, sociocultural benefits, and financial affordability using individual-level data of adults in rural and urban Ghana and Ghanaian migrants in Europe to identify the role of living environment in dietary sustainability. Methods We used cross-sectional data from the multi-centre Research on Obesity and Diabetes among African Migrants Study (N = 3169; age range: 25–70 years). For the SDI construct (0–16 score points), we used the Diet Quality Index-International, food-related greenhouse gas emission, the ratio of natural to processed foods, and the proportion of food expenditure from income. In linear regression analyses, we estimated the adjusted ß-coefficients and 95% confidence intervals (CIs) for the differences in mean SDI across study sites (using rural Ghana as a reference), accounting for sociodemographic and lifestyle factors. Results The overall mean SDI was 8.0 (95% CI: 7.9, 8.1). Participants in the highest SDI-quintile compared to lower quintiles were older, more often women, non-smokers, and alcohol abstainers. The highest mean SDI was seen in London (9.1; 95% CI: 8.9, 9.3), followed by rural Ghana (8.2; 95% CI: 8.0, 8.3), Amsterdam (7.9; 95% CI: 7.7, 8.1), Berlin (7.8; 95% CI: 7.6, 8.0), and urban Ghana (7.7; 95% CI: 7.5, 7.8). Compared to rural Ghana, the differences between study sites were attenuated after accounting for age, gender and energy intake. No further changes were observed after adjustment for lifestyle factors. Conclusion The multi-dimensional SDI describes four dimensions of dietary sustainability in this Ghanaian population. Our findings suggest that living in Europe improved dietary sustainability, but the opposite seems true for urbanization in Ghana.

Abstract Background Substantial variability in response to lifestyle interventions has been recognized for many years, and researchers have begun to disentangle sources of error from inherent differences in individual responsiveness. The objective of this secondary analysis of an intensive lifestyle intervention (diet and exercise) for metabolic syndrome (MetS) was to identify potentially important differences among study completers grouped by treatment response as measured by change in a continuous metabolic syndrome score (Gurka/MetS). Methods All study completers from a 12-month primary care study were categorized into one of five groups according to change in the Gurka/MetS score. A change of 0.4 in z-score defined clinically relevant change in line with results of previous studies. Repeated measures analysis of variance was used to examine cardiovascular disease risk and individual clinical indicators of MetS over 12 months, looking for differences in response over time by the five groups. Results Of 176 participants, 50% (n = 88) had stable scores, 10% (n = 18) had relevant change scores in the first 3 months only and reverted toward baseline, 20% (n = 35) achieved meaningful change over the whole study, 11% (n = 20) had a delayed response at 3–12 months, and 9% (n = 15) demonstrated worsening scores. Significant differential patterns were noted for groups over the duration of the intervention (p

Abstract Background Limited information exists linking food habits, diet quality, and lifestyle scores with anthropometric indices and happiness levels. Our aim was to examine the association between food habits, diet quality, and lifestyle scores with anthropometric indices and happiness levels in the Iranian population. Methods This cross-sectional study included 200 students randomly selected from a university in Iran. Dietary intakes, physical activity (PA), and happiness levels of study participants were assessed using validated questionnaires. The anthropometric indices examined in this study included the body shape index (ABSI), body roundness index (BRI), and abdominal volume index (AVI). Multiple logistic regression models were used to examine the association between food habits, diet quality, and lifestyle scores with anthropometric indices and happiness levels. Results The mean age and body mass index (BMI) of study participants were 23.5 years ± 4.52 and 23.8 kg/m2 ± 3.17, respectively. In the study population, no significant association was seen between ABSI, BRI, AVI and happiness with food habits, diet quality, and lifestyle scores respectively. After adjusting for potential confounders (age, energy intake, marital status, education, smoking, physical activity, gender, and BMI), the association remained not significant for ABSI and food habits, diet quality, and lifestyle scores respectively (OR: 0.56, 95% CI (0.25–1.34), P = 0.193; OR: 0.59, 95% CI (0.22–1.57), P = 0.413; OR:1.19, 95%CI (0.54–2.63), P = 0.652), BRI and food habits, diet quality, and lifestyle scores respectively (OR:1.98, 95% CI (0.41–9.49), P = 0.381; OR: 0.57, 95%CI (0.12–2.74), P = 0.512; OR: 1.19, 95% CI (0.3–4.71), P = 0.811), AVI and food habits, diet quality, and lifestyle scores (OR:1.15, 95% CI (0.53–2.48), P = 0.743, OR:1.01, 95% CI (0.47–2.18), P = 0.965; OR: 1.3, 95% CI (0.64–2.65), P = 0.465) and happiness and food habits, diet quality, and lifestyle scores respectively (OR:0.3, 95%CI (0.07–1.25), P = 0.972; OR: 0.77, 95%CI (0.18–3.19), P = 0.724, OR: 0.3, 95% CI (0.07–1.25), P = 0.083). Conclusions No significant association was detected between food habits, diet quality, and lifestyle scores with anthropometric indices and happiness levels. However, longitudinal studies are required to confirm these findings.

Abstract There is growing concern among policymakers and researchers about the negative health and climate impacts of meat consumption. Consumers are encouraged to re-evaluate their dietary choices to preserve our ecosystem and reduce the burden of diet-related diseases. However, limited information is available about how price changes in animal protein sources affect plant-based protein demand and the consequences for nutrient intake and/or diet quality. The goal of the present paper is to fill this gap by explaining how consumers react to price changes in animal protein types and to present the implications for nutrition or diet quality. This paper applied the exact affine stone index implicit (EASI) Marshallian demand system to 2021 home scan panel data collated by the Kantar Worldpanel to estimate both price and expenditure elasticities. Twelve food groups of seven animal-based protein products and five plant-based protein products were considered. The results revealed that dairy and eggs are daily necessities for the people of Scotland. The demand for fish and non-dairy milk are the most sensitive to price. Estimates based on expenditure elasticities show that beef is considered a luxury and a highly substitutable product in the Scottish diet. Peas are relatively basic, essential foodstuffs. In general, increasing the price of animal protein sources will shift demand towards plant protein. On the positive side, there will be a significant reduction in cholesterol and fat purchases. However, there would also be a significant reduction in the total amount of protein, carbohydrates, and healthy fats, such as unsaturated fatty acids, purchased by the average household. This shows that increases in plant-based protein are not enough to compensate for the reductions in essential macro- and micronutrient purchases from animal protein. From the climate perspective, reductions in meat purchases could reduce emissions from production and consumption.

Abstract Background Increasing dietary diversity is a sustainable solution to combat micronutrient deficiencies. Given the large slum population in urban India, double burden of malnutrition, nutritional transition among slum-dwellers, and limited studies focusing on dietary intake and diversity among pregnant slum-dwellers, this study aimed to 1) describe macro- and micronutrient intakes and compare them with guidelines, 2) describe dietary diversity and intake of unhealthy foods and, 3) investigate the sociodemographic and lifestyle determinants of adequate dietary diversity among pregnant slum-dwellers in Pune, Maharashtra, India. Methods This study presents cross-sectional data of 454 pregnant slum-dwelling women completing mid-pregnancy visit collected from a larger cohort study. Sociodemographic and lifestyle data were collected at baseline (

Abstract 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 = 28.3, SD = 4.0; p