scholarly journals Relationship between general nutrition knowledge and diet quality in Australian military personnel

2016 ◽  
Vol 115 (8) ◽  
pp. 1489-1497 ◽  
Author(s):  
Charina J. Kullen ◽  
Jamie-Lee Farrugia ◽  
Tania Prvan ◽  
Helen T. O’Connor
Keyword(s):  
Diet Quality ◽  
Military Personnel ◽  
Living Arrangement ◽  
Nutrition Knowledge ◽  
Dietary Guidelines ◽  
Dietary Intakes ◽  
Convenience Sample ◽  
Balanced Diet ◽  
Operational Readiness ◽  
Median Test

AbstractA balanced diet informed by sound nutrition knowledge is key for operational readiness and the health of military personnel. Unfortunately, research suggests that military personnel have inadequate dietary intakes. This study assessed general nutrition knowledge, diet quality and their association in Australian military personnel. A convenience sample of male military personnel (n 211) including Army soldiers and officers completed a validated general nutrition knowledge questionnaire (GNKQ) and FFQ. The GNKQ assessed knowledge of dietary guidelines (Section A), sources of nutrients (Section B), choosing everyday foods (Section C) and diet–disease relationships (Section D). The Australian Recommended Food Score (ARFS) was used to assess diet quality from FFQ data. Statistical analyses included the χ2 test, Spearman’s correlation test, t test, median test, ANCOVA and ordinal logistic regression. The mean total GNKQ score was 52·7 %. Participants performed best on Section A (58·5 %) followed by Sections B (57·3 %) and C (57·0 %) and worst on Section D (31·0 %). Overall, officers scored significantly higher than soldiers (58·7 v. 51·9 %, P=0·001). Age was weakly but positively correlated with GNKQ total scores (r 0·307; P<0·0005), with no significant effects seen for level of education (P=0·463) or living arrangement (P=0·167). Overall ARFS was 37·6 (sd 7·7) (50·8 %) with officers scoring significantly higher than soldiers (54·7 v. 50·3 %, P=0·040). No demographic variables influenced total ARFS. The total GNKQ score had a significant, positive but weak relationship with total ARFS (r 0·179; P=0·009). Given the importance of nutrition to personnel health and operational readiness, initiatives to improve nutrition knowledge and diet quality are recommended in this population, especially in soldiers.

Dietary Intakes From Ad Libitum Consumption of Canadian Armed Forces Field Rations Compared With Usual Home Dietary Intakes and Military Dietary Reference Intakes

2021 ◽  
Author(s):  
Mavra Ahmed ◽  
Iva Mandic ◽  
Wendy Lou ◽  
Len Goodman ◽  
Ira Jacobs ◽  
...  
Keyword(s):  
Military Personnel ◽  
Weight Status ◽  
Armed Forces ◽  
Dietary Reference Intake ◽  
Dietary Intakes ◽  
Convenience Sample ◽  
Canadian Armed Forces ◽  
Operational Readiness ◽  
Ad Libitum ◽  
At Home

ABSTRACT Introduction Diet has an impact on weight status, health, and physical performance. Assessing the usual at-home dietary intakes of military personnel can help ascertain their nutritional status before field training or operations. Preference for foods consumed on a routine basis can also impact the military’s preference for and consumption of field rations. Military personnel are limited by the inherent nature of the field rations and availability of calories and food types; and despite previous studies indicating a high acceptability of the field rations, it is unknown whether military personnel self-select the same number of calories when faced with a restricted list of field ration options as they would from their usual foods. Although field rations are intended to be nutritionally sufficient for standard military operations, there are limited data on the ad libitum intake of nutrients of Canadian Armed Forces (CAF) personnel from field rations in comparison to the military dietary reference intake (MDRI) recommendations, which establishes standards intended to meet the nutritional requirements of military personnel on duty. Thus, assessing the adequacy of their usual diets at home and longer-term sustenance on field rations in relation to MDRIs can provide insight on CAF personnel’s operational readiness. The objectives of this study were to describe and compare, in a convenience sample of CAF, their ad libitum nutrient intakes from the consumption of self-selected field rations at home with their usual home intakes and to compare both with MDRI recommendations. Materials and Methods Eighteen CAF participants weighed and recorded their dietary intake from the ad libitum consumption of field rations at home and their usual at-home diets. Both MDRIs and the Institute of Medicine’s dietary reference intake recommendations were used to assess the adequacy of intakes for each individual. Paired Student’s t-test or Wilcoxon-matched paired tests were used to compare nutrient intake levels between usual at-home diets and field rations consumed at home. Results Mean daily energy intakes were similar between ad libitum intakes from field rations (2,688 ± 619 kcal) and usual home diets (2,657 ± 580 kcal), although participants had significantly higher intakes of protein and fat from their home diets and higher intakes of carbohydrates from the field rations (P ≤ 0.05). Participants had less than the recommended intakes of some micronutrients (vitamins A and D, folate, calcium, magnesium, and potassium), from both their home diets and field rations, but adequate intakes of vitamin C and iron. Conclusions The results of this study showed no difference in energy intake between the consumption of field rations and home diets, with levels consistent with recommendations for individuals with average physical activity levels. The results also demonstrated less than the recommended intakes (in comparison with MDRIs) of some nutrients from both home diets and self-selected consumption of field rations, warranting further research into nutritional adequacy for operational readiness.

Abstract P360: Dietary Saturated Fats From Different Food Sources Show Inconsistent Associations With Various Indices of Diet Quality in the Canadian Population

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Stephanie Harrison ◽  
Didier Brassard ◽  
Simone Lemieux ◽  
Benoit Lamarche
Keyword(s):  
Healthy Eating ◽  
Diet Quality ◽  
Nutritive Value ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Food Sources ◽  
Dietary Intakes ◽  
Trans Fat ◽  
Quality Indices ◽  
Saturated Fats

Background: Canadian dietary guidelines include a recommendation to limit the consumption of foods high in saturated fats (SFA), regardless of their dietary source. The same guidelines also recommend consumption of lean red meat and low-fat dairy products. Yet, the association between the consumption of SFA from different food sources and diet quality is currently unknown. The objective of this study was to examine associations between SFA from various food sources and different indices of diet quality. Methods: Analyses are based on a sample of 11 106 respondents representative of Canadian adults (19-70 y) from the 2015 Canadian Community Health Survey (CCHS 2015). Dietary intakes and diet quality indices were calculated using a single interview-administered 24-hour recall. Food sources of SFA were classified according to the 2019 Canada’s Food Guide categories: 1) vegetables and whole fruits, 2) whole grain foods and 3) protein foods (including dairy and meat, among others). Foods not included in these three categories were grouped as All other foods . The 2010 alternative Healthy eating index (aHEI), the 2015 Healthy eating index (HEI-2015) and the 2007 Canadian Healthy eating index (C-HEI) were calculated. Due to the unreliability of data for trans-fat consumption in the CCHS 2015 database, the trans-fat subscore of the aHEI was removed from the original score. Results: While total SFA intake and SFA from All other foods were inversely correlated with all indices of diet quality (-0.55<r<-0.10, all p<0.001), associations with SFA from dairy and meat were inconsistent. SFA from dairy were inversely correlated (p<0.001) with the aHEI (r=-0.14) and the HEI-2015 (r=-0.16) but showed a weak positive correlation with the C-HEI (r=0.05, p<0.001). SFA from meat were negatively correlated with the aHEI (r=-0.21, p<0.001) and positively correlated with the C-HEI (r=0.11, p<0.001). Removing subscores directly related to SFA intake in diet quality indices yielded positive correlations between SFA from dairy and the HEI-2015 (r=0.13, p<0.001) and the C-HEI (r=0.19, p<0.001). Conclusion: Consumption of SFA from different food sources are inconsistently associated with different indices of overall diet quality. Unsurprisingly, SFA from All other foods , which include low nutritive value foods, showed the strongest negative correlation with all diet quality scores. These results provide further support to the notion that guidance on SFA in future health policies should focus on food sources rather than on total intake of SFA.

Relationship Between General Nutrition Knowledge and Dietary Quality in Elite Athletes

2015 ◽  
Vol 25 (3) ◽  
pp. 243-251 ◽  
Author(s):  
Inge Spronk ◽  
Susan E. Heaney ◽  
Tania Prvan ◽  
Helen T. O’Connor
Keyword(s):  
Diet Quality ◽  
Sport Participation ◽  
Team Sports ◽  
Young Male ◽  
State Level ◽  
Female Gender ◽  
Nutrition Knowledge ◽  
Dietary Quality ◽  
Linear Modeling ◽  
Convenience Sample

This study investigated the association between general nutrition knowledge and dietary quality in a convenience sample of athletes (> state level) recruited from four Australian State Sport Institutes. General nutrition knowledge was measured by the validated General Nutrition Knowledge Questionnaire and diet quality by an adapted version of the Australian Recommended Food Score (A-ARFS) calculated from food frequency questionnaire data. Analysis of variance and linear modeling were used to assess relationships between variables. Data: mean (Standard Deviation). A total of 101 athletes (Males: 37; Females: 64), 18.6 (4.6) years were recruited mainly from team sports (72.0%). Females scored higher than males for both nutrition knowledge (Females: 59.9%; Males: 55.6%; p = .017) and total A-ARFS (Females: 54.2% Males: 49.4%; p = .016). There was no significant influence of age, level of education, athletic caliber or team/individual sport participation on nutrition knowledge or total A-ARFS. However, athletes engaged in previous dietetic consultation had significantly higher nutrition knowledge (61.6% vs. 56.6%; p = .034) but not total A-ARFS (53.6% vs. 52.0%; p = .466). Nutrition knowledge was weakly but positively associated with total A-ARFS (r = .261, p= .008) and A-ARFS vegetable subgroup (r = .252, p = .024) independently explaining 6.8% and 5.1% of the variance respectively. Gender independently explained 5.6% of the variance in nutrition knowledge (p = .017) and 6.7% in total A-ARFS (p = .016). Higher nutrition knowledge and female gender were weakly but positively associated with better diet quality. Given the importance of nutrition to health and optimal sports performance, intervention to improve nutrition knowledge and healthy eating is recommended, especially for young male athletes.

scholarly journals Dietary Intake and Its Determinants Among Adults Living in the Metropolitan Area of Puerto Rico

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1598 ◽  
Author(s):  
Mattei ◽  
Tamez ◽  
Bigornia ◽  
Noel ◽  
Xiao ◽  
...  
Keyword(s):  
Puerto Rico ◽  
Dietary Intake ◽  
Metropolitan Area ◽  
Diet Quality ◽  
Lifestyle Factors ◽  
Healthy Eating Index ◽  
Dietary Intakes ◽  
Linear Regression Models ◽  
Convenience Sample ◽  
Sugary Beverages

There is scarce information regarding the dietary intake of adults living in Puerto Rico (PR). We aimed to assess intake of nutrients and foods, adherence to recommended intake of nutrients and diet quality, and sociodemographic and lifestyle factors correlated with diet quality among adults in the San Juan metropolitan area of PR. Data were obtained from participants of the cross-sectional convenience-sample Puerto Rico Assessment of Diet, Lifestyle, and Diseases (n = 248; ages 30–75 years). Diet quality was defined using the Alternate Healthy Eating Index 2010 (AHEI; range 0–110 indicating lower–higher quality). Linear regression models were used to relate AHEI to sociodemographic and lifestyle factors. Most participants met the Estimated Average Requirement (EAR) for iron, folate, and vitamins B12 and B6; 61% met the EAR for magnesium and 56% for calcium. Only 4% met the EAR for vitamin D, and 7% met the adequate intake for potassium. The main contributors to total energy intake were sugary beverages (11.8%), sweets/desserts (10.2%), dairy (8.5%), mixed dishes (7.6%), starches (6.3%), fast foods (5.5%), and rice (4.9%). The mean (SD) AHEI score was 59.8 (11.0). The lowest AHEI components for which recommended servings were met were red/processed meats, fruit, sodium, sugary beverages, and polyunsaturated fats, and the highest were nuts/legumes, omega-3 fats, and whole grains. Significantly higher AHEI scores were noted for older adults, other ethnicities (vs. Puerto Rican), being single, having some college or higher education, and never/formerly smoking. Adults living in PR report healthy and unhealthy dietary intakes, providing an opportunity to improve diet at the population level.

scholarly journals Dietary Assessment Methods in Military and Veteran Populations: A Scoping Review

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 769 ◽  
Author(s):  
Rebecca A. Collins ◽  
Bradley Baker ◽  
Daisy H. Coyle ◽  
Megan E. Rollo ◽  
Tracy L. Burrows
Keyword(s):  
Dietary Intake ◽  
Scoping Review ◽  
Military Personnel ◽  
Dietary Assessment ◽  
Assessment Method ◽  
Dietary Guidelines ◽  
Complex Nature ◽  
Dietary Intakes ◽  
Civilian Life ◽  
Country Specific

Optimal dietary intake is important for the health and physical performance of military personnel. For military veterans, the complex nature of transition into civilian life and sub-optimal dietary intake is a leading contributor to the increased burden of disease. A scoping review was undertaken to determine what is known about the assessment and reporting of dietary intakes within both military and veteran populations. In addition, this review determines if studies reporting on the dietary intake of military personnel or veterans include comparisons with dietary guidelines. Six databases were searched to identify papers published from the database inception to April 2019. Observational and intervention studies were searched to identify if they assessed and reported whole dietary intake data, reported data exclusively for a military or veteran population, and included only healthy populations. A total of 89 studies were included. The majority of studies used one dietary assessment method (n = 76, 85%) with fewer using multiple methods (n = 13, 15%). The most frequent methodology used was food frequency questionnaires (FFQ) (n = 40, 45%) followed by 24-hour recalls (n = 8, 9%) and food records (n = 8, 9%). The main dietary outcomes reported were macronutrients: carbohydrate, protein, fat, and alcohol (n = 66, 74%) with total energy intake reported in n = 59 (66%). Fifty four (61%) studies reported a comparison with country-specific dietary guidelines and 14 (16%) reported a comparison with the country-specific military guidelines. In conclusion, dietary intake in military settings is most commonly assessed via FFQs and 24-hour recalls. Dietary intake reporting is mainly focused around intakes of energy and macronutrients. Most studies compare against dietary guidelines, however, comparison to specific military dietary guidelines is minimal.

scholarly journals 1055The applicability of the Healthy Eating Index to measure Iranian diet quality

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Sara Ebrahimi ◽  
Rebecca Leech ◽  
Sarah McNaughton ◽  
Katherine Livingstone
Keyword(s):  
Vitamin C ◽  
Healthy Eating ◽  
Diet Quality ◽  
Urban Areas ◽  
Household Head ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Dietary Intakes ◽  
Nutrient Intakes ◽  
Nutrient Adequacy

Abstract Background Iranian diet quality has been evaluated using indices that are not based on Iranian dietary guidelines. This study examined the applicability of the Healthy Eating Index (HEI) by examining associations with sociodemographics, nutrient intakes and nutrient adequacy. Methods Household sociodemographics and dietary intakes (three 24-h dietary recalls) were collected in the cross-sectional National Comprehensive Study on Household Food Consumption Patterns and Nutritional Status 2001-2003. Household diet quality was calculated using the HEI. Regression analyses examined associations between diet quality and sociodemographics, nutrient intakes and nutrient adequacy. Results A total of 6584 households were included in this study. Age (β-coeff 2.11; 95% CI: 1.64, 2.44), education (β-coeff 4.58; 4.05, 5.11) and living in urban areas (β-coeff 2.87; 2.56, 3.19) (as reported by the household head) were positively associated with diet quality. Higher diet quality was associated with higher intake of protein (% energy) (β-coeff 0.08; 0.07, 0.08), calcium (mg/day) (β-coeff 12.10; 11.23, 12.98), iron (mg/day) (β-coeff 0.04; 0.02, 0.05), vitamin C (mg/day) (β-coeff 3.61; 3.45, 3.77) and fibre (g/day) (β-coeff 0.12; 0.11, 0.14), lower intake of sodium (mg/day) (β-coeff -83.45; -93.02, -73.88) and adequate intake of calcium (mg/day) (OR 1.10; 95% CI: 1.09, 1.12) and vitamin C (mg/day) (1.19; 1.18, 1.20). Conclusions Higher HEI was associated with a range of sociodemographics and better nutrient intakes and nutrient adequacy. Key messages HEI was applicable for assessing the diet quality of Iranian households.

scholarly journals Dietary Saturated Fats from Different Food Sources Show Variable Associations with the 2015 Healthy Eating Index in the Canadian Population

2020 ◽  
Vol 150 (12) ◽  
pp. 3288-3295
Author(s):  
Stéphanie Harrison ◽  
Didier Brassard ◽  
Simone Lemieux ◽  
Benoît Lamarche
Keyword(s):  
Healthy Eating ◽  
Diet Quality ◽  
Nutritive Value ◽  
Meat Products ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Food Sources ◽  
Dietary Intakes ◽  
Cross Sectional ◽  
Tier System

ABSTRACT Background Although mostly food-based, the majority of dietary guidelines also recommend limiting the consumption of foods high in SFAs. Yet, the association between the consumption of SFAs from different food sources and overall diet quality remains uncertain. Objectives The objective of this study was to examine the associations between SFAs from various food sources and the 2015 Healthy Eating Index (HEI-2015) as a proxy of overall diet quality. Methods The study sample included 11,106 respondents between 19 and 70 y of age from the 2015 Canadian Community Health Survey. Dietary intakes as well as the HEI-2015 were calculated using data from a single 24-h recall. An HEI-2015 from which the SFA subscores were subtracted was also calculated. Low nutritive value foods were defined using Health Canada's 4-Tier system. Associations were investigated using multivariable linear regressions with restricted cubic splines. Results Major sources of SFAs in this population were low nutritive value foods [4.4% of total energy intake (%E)], dairy (2.7%E), and meat products (1.9%E). The associations between SFA consumption (total and from different food sources) and the HEI-2015 were generally inverse and nonlinear (P for the nonlinearity test &lt;0.03 for all). Total SFA intake showed no association with the SFA-subtracted HEI-2015 (P = 0.29). SFAs from dairy tended to be associated with an increase in the SFA-subtracted HEI-2015 (P &lt; 0.001). Removing the SFA subscore from the HEI-2015 did not materially modify its association with SFAs from meat. SFAs from low nutritive value foods remained significantly and inversely associated with the SFA-subtracted HEI-2015 (P &lt; 0.001). Conclusions These cross-sectional data in Canadian adults suggest that intake of SFAs from low nutritive value foods, but not total SFA intake, is captured by an index of healthy eating that does not account for SFA intake.

scholarly journals Do Older Women of Reproductive Age Have Better Diet Quality than Younger Women of Reproductive Age?

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3830
Author(s):  
Nahal Habibi ◽  
Katherine M. Livingstone ◽  
Suzanne Edwards ◽  
Jessica A. Grieger
Keyword(s):  
Older Women ◽  
Diet Quality ◽  
Food Group ◽  
Dietary Guidelines ◽  
Reproductive Age ◽  
Dietary Intakes ◽  
Dietary Recommendations ◽  
Women Of Reproductive Age ◽  
Younger Women ◽  
Reproductive Aged Women

There is increasing recognition of the importance of nutrition for reproductive health, but little is known regarding the diet quality of younger vs. older reproductive aged women, and how their intakes relate to dietary recommendations. The purpose of the study was to examine the diets of younger (19–35 years old) compared to older (35–50 years old) reproductive aged women, and how they align with dietary recommendations. Women aged 19–50 years from the 2011–13 Australian National Nutrition and Physical Activity Survey were included (n = 2323). Dietary intakes were assessed by a single 24-h dietary recall and were compared to (i) Australian Dietary Guidelines; (ii) Acceptable Macronutrient Distribution for protein, carbohydrates, and fat; and (iii) Dietary Guideline Index (DGI). Regression analyses comparing younger and older women against recommendations were undertaken, with confounders determined a priori. There was no difference between older and younger women in meeting food group recommendations, with 26% of all women meeting recommendations for fruit, and meat and alternatives, and <20% meeting recommendations for vegetables and alternatives, grains, and dairy. Although there was no difference between older and younger women in total DGI score (mean (SE) 75.6 (1.7) vs. 74.5 (2.5), p > 0.05), older women had higher component scores in limiting saturated fat, consuming low-fat milk, and limiting adding salt during cooking. Continued health promotion for women of reproductive age should be a key priority to improve their own health and that of future generations.

scholarly journals Dietary Nitrate and Diet Quality: An Examination of Changing Dietary Intakes within a Representative Sample of Australian Women

Nutrients ◽  
2018 ◽  
Vol 10 (8) ◽  
pp. 1005 ◽  
Author(s):  
Jacklyn Jackson ◽  
Amanda Patterson ◽  
Lesley MacDonald-Wicks ◽  
Catherine Bondonno ◽  
Lauren Blekkenhorst ◽  
...  
Keyword(s):  
Diet Quality ◽  
Representative Sample ◽  
Primary Source ◽  
Food Group ◽  
Dietary Guidelines ◽  
Dietary Intakes ◽  
Dietary Nitrate ◽  
Nitrate Consumption ◽  
Future Work ◽  
Over Time

Dietary nitrate is increasingly linked to a variety of beneficial health outcomes. Our purpose was to estimate dietary nitrate consumption and identify key dietary changes which have occurred over time within a representative sample of Australian women. Women from the 1946–1951 cohort of the Australian Longitudinal Study on Women’s Health with complete food frequency questionnaire data for both 2001 and 2013 were included for analysis. Dietary nitrate intakes were calculated using key published nitrate databases. Diet quality scores including the Australian Recommended Food Score, the Mediterranean Diet Score and the Nutrient Rich Foods Index were calculated along with food group serves as per the Australian Dietary Guidelines. Wilcoxon matched pairs tests were used to test for change in dietary intakes and Spearman’s correlations were used to examine associations. In our sample of 8161 Australian women, dietary nitrate intakes were on average 65–70 mg/day, and we detected a significant increase in dietary nitrate consumption over time (+6.57 mg/day). Vegetables were the primary source of dietary nitrate (81–83%), in particular lettuce (26%), spinach (14–20%), beetroot (10–11%), and celery (7–8%) contributed primarily to vegetable nitrate intakes. Further, increased dietary nitrate intakes were associated with improved diet quality scores (r = 0.3, p < 0.0001). Although there is emerging evidence indicating that higher habitual dietary nitrate intakes are associated with reduced morbidity and mortality, future work in this area should consider how dietary nitrate within the context of overall diet quality can facilitate health to ensure consistent public health messages are conveyed.

scholarly journals Diabetes-related nutrition knowledge and dietary adherence in patients with Type 2 diabetes mellitus: A mixed-methods exploratory study

2020 ◽  
Vol 29 (2) ◽  
pp. 81-90 ◽  
Author(s):  
Chad Yixian Han ◽  
Cherie Geok Boon Chan ◽  
Su Lin Lim ◽  
Xiaomei Zheng ◽  
Zhing Wen Woon ◽  
...  
Keyword(s):  
Diet Quality ◽  
Tertiary Hospital ◽  
Nutrition Knowledge ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Structured Interviews ◽  
Personal Motivation ◽  
External Sources

Aim: The aim of the study is to gain insights into the relationship between diabetes-related nutrition knowledge (DRNK) and diet quality in Singapore. Methods: Forty-two participants were recruited from a tertiary hospital. DRNK and diet quality were ascertained with the DRNK questionnaire and Alternate Healthy Eating Index 2010, respectively. Twenty-one semi-structured interviews of perceived barriers and enablers to adherence to dietary guidelines were audio recorded, transcribed and analysed. Results: Participants had a poor mean percentage DRNK score of 39.7% (±17.7) and diet quality of 54.2% (±9.4). Pearson’s correlation tests revealed no correlation between DRNK and diet quality ( r –0.29; p=0.065) but suggest a moderate positive correlation between DRNK and psychosocial self-efficacy ( r 0.41; p=0.008). Thematic analysis revealed six barriers (obesogenic environment; lack of time; conflict between advice and personal values; stress from external sources; lack of personal motivation; gaps in DRNK) and four enablers (personal motivation to improve condition; fear of T2DM complications; sufficient DRNK; presence of social support) to adherence to dietary guidelines. Conclusion: DRNK may not correlate with adherence to dietary guidelines; multiple mediating factors are identified when translating DRNK to practice.

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