Association of the Healthy Eating Index (HEI) Score of Children Enrolled in School Lunch and Breakfast Program and Frequency of Meals at School: NHANES 2015–2016

Abstract Objectives Nutritious and well-balanced school meals are critical to curbing the obesity epidemic in school-aged children while also providing adequate nutrition to sustain healthy growth and development. The school lunch program underwent a significant revamp in 2012 to align the menu with the US Dietary Guidelines. The Healthy Eating Index (HEI) is a metric that measures this alignment. The purpose of this study is to calculate usual HEI scores for children and compare HEI scores across frequency of school meals consumed using NHANES 2015–2016. Methods Children 18y and younger were included in the analyses and categorized into one of five groups for breakfast and lunch, each. Either consuming no school breakfast/lunch or consuming school breakfast/lunch 1–5 times daily. Usual HEI scores and standard errors were determined using the NCI method. Independent samples t-tests were computed for pairwise comparisons between no school breakfast/lunch consumption and increasing frequency of consumption. All analyses were performed using SAS version 9.4. Results Mean HEI scores for children consuming 0, 1, 2, 3, 4, 5 school breakfasts per week was 44.7 ± 0.8, 44 ± 1.9, 41.4 ± 2.4, 43.9 ± 1.4, 40.8 ± 2.3, 42.7 ± 1.0 and the mean HEI score for children consuming 0, 1, 2, 3, 4, 5 lunches per week was 44.7 ± 0.8, 46.7 ± 0.8, 42.3 ± 2.5, 45.0 ± 0.9, 46.1 ± 0.9, 43.3 ± 0.8, respectively. These results indicate that there are no significant differences across children who consumed these meals at various frequencies with those that do not consume school meals. Although there were no observed differences, overall diet quality was poor for those who do and do not consume school breakfast/lunch. Conclusions Although children and adolescents who consumed school breakfast/lunch did not appear to have greater diet quality than those who did not, overall diet quality was poor for all groups. Therefore, additional efforts are needed to improve diet quality in children and adolescents. Funding Sources Texas Woman's University.

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Modifying the healthy eating index to assess diet quality in children and adolescents

Journal of the American Dietetic Association ◽

10.1016/j.jada.2004.06.020 ◽

2004 ◽

Vol 104 (9) ◽

pp. 1375-1383 ◽

Cited By ~ 118

Author(s):

Diane Feskanich ◽

Helaine R.H. Rockett ◽

Graham A. Colditz

Keyword(s):

Children And Adolescents ◽

Healthy Eating ◽

Diet Quality ◽

Healthy Eating Index

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An Examination of Demographic and Psychosocial Factors, Barriers to Healthy Eating, and Diet Quality Among African American Adults

Nutrients ◽

10.3390/nu11030519 ◽

2019 ◽

Vol 11 (3) ◽

pp. 519 ◽

Cited By ~ 3

Author(s):

Ingrid Richards Adams ◽

Wilson Figueroa ◽

Irene Hatsu ◽

James Odei ◽

Mercedes Sotos-Prieto ◽

...

Keyword(s):

Social Support ◽

African American ◽

African Americans ◽

Psychosocial Factors ◽

Healthy Eating ◽

Diet Quality ◽

Self Efficacy ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

African American Adults

A healthy diet is associated with lower risk of chronic disease. African Americans generally have poor diet quality and experience a higher burden of many chronic diseases. We examined the associations of demographic and psychosocial factors and barriers to diet quality among African American adults. This cross-sectional study included 100 African American adults in a southeastern metropolitan area. Psychosocial factors (social support, self-efficacy), and barriers to healthy eating were assessed with validated measures. Diet quality was assessed using the Healthy Eating Index (HEI-2010). Nested linear regressions were used to examine the association between the variables of interest and HEI scores. Participants reported having social support (M (mean) = 2.0, SD (standard deviation) = 0.6, range 0–3), high levels of self-efficacy (M = 3.1, SD = 0.7, range 1–4), and low barriers (M = 1.4, SD = 0.6, range 0–4) to engage in healthy eating but total mean HEI scores needed improvement (M = 54.8, SD = 10.9, range 27.1–70.0). Participants consumed significantly higher empty calories and lower whole fruits, dairy, and total protein foods than the national average. Barriers to healthy eating (b = −12.13, p = 0.01) and the interaction between age and barriers (b = 0.25, p = 0.02) were most strongly associated with lower HEI scores. Younger African Americans with the highest barriers to healthy eating had the lowest HEI scores. Culturally appropriate interventions targeting empty calories, barriers to healthy eating, and knowledge of the Dietary Guidelines for Americans are needed for African Americans.

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Defining Diet Quality: A Review of Diet Metrics as Applied to the Double Burden of Malnutrition (OR17-01-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz039.or17-01-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Victoria Miller ◽

Patrick Webb ◽

Renata Micha ◽

Dariush Mozaffarian

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Fruits And Vegetables ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Healthy Diet ◽

Food Groups ◽

Policy Action ◽

Double Burden ◽

Meta Analyses

Abstract Objectives Meeting most of the UN Sustainable Development Goals (SGDs) will require a strong focus on tackling all forms of malnutrition─ addressing maternal and child health (MCH) as well as diet-related non-communicable diseases (NCDs). Yet, the optimal metrics to define a healthy diet remain unclear. Our aim was to comprehensively review diet metrics and assess the evidence on each metric's association with MCH and NCDs. Methods Using comprehensive searches and expert discussions, we identified metrics that i) are used in ≥3 countries to link diet to health, ii) quantify the number of foods/food groups consumed and/or iii) quantify recommended nutrient intakes. We reviewed and summarized each metric's development, components and scoring. For each identified metric, we systematically searched PubMed to identify meta-analyses or narrative reviews evaluating these metrics with nutrient adequacy and health outcomes. We assessed validity by grading the number of studies included and the consistency of the diet metric-disease relationship. Results We identified 6 MCH, 13 NCD and 0 MCH/NCD metrics. Most were developed for describing adherence to dietary guidelines or patterns, and others were developed for predicting micronutrient adequacy. On average, the metrics included 14 food groups/nutrients (range 4–45), with 10 food-group only metrics and 0 nutrient-only metrics. The most frequent metric components were grains/roots/tubers, fruits and vegetables. We identified 16 meta-analyses and 14 narrative reviews representing 102 metric-disease relationships (98 metric-NCD and 4 metric-MCH relationships, respectively). We found 5 metrics that have been consistently validated in meta-analyses and narrative reviews for NCDs, 1 metric with limited evidence for MCH, but 0 metrics for both. Of the metrics, the Alternative Healthy Eating Index (aHEI), Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index (HEI), and Mediterranean Diet Score (MED) were most commonly validated, especially for all-cause mortality and cardiovascular disease (Figure 1). Conclusions Few diet metrics have been used in multiple countries to define a healthy diet. This suggests a serious gap in global analyses of diet quality relating to malnutrition in all its forms, which hinders effective policy action. Funding Sources Gates Foundation. Supporting Tables, Images and/or Graphs

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Greater Adherence to Dietary Guidelines were Associated with Lower Risk of Cardiovascular Diseases in Chinese Patients with Type 2 Diabetes: A Case-Control Study

10.21203/rs.3.rs-100628/v1 ◽

2020 ◽

Author(s):

Shang-Ling Wu ◽

Yan-Bin Ye ◽

Long-Yun Peng ◽

Yu-Ming Chen ◽

Fang-Fang Zeng ◽

...

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Lower Risk ◽

Case Control Study ◽

Case Control ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Chinese Patients ◽

Control Study

Abstract Background The evidence regarding the impact of the healthy eating index on the risk of cardiovascular events among patients with type 2 diabetes (T2D) is limited. To examine the associations of adherence to the Chinese and American dietary guidelines and the risk of cardiovascular disease (CVD) among Chinese individuals with T2D. Methods This 1:1 matched case-control study included 419 enrolled pairs hospital-based CVD cases and controls who were matched by age and sex, in Guangdong province, China, all of whom had T2D. A structured questionnaire and a 79-item food-frequency questionnaire was used to collect general information and dietary intake information. Diet quality scores were calculated according to the Chinese Healthy Eating Index (CHEI) and the Healthy Eating Index-2015 (HEI-2015). Results After adjustment for various confounding factors, the higher diet quality scores on the CHEI and HEI-2015 showed a significant association with a lower risk of CVD. The odds ratios (95% confidence interval) per 5-score increment were 0.88(0.83,0.92) in the CHEI and 0.80(0.74,0.88) in the HEI-2015, respectively. In stratified analyses, the protective associations remained significant in the subgroups of sex, smoking status, tea-drinking, hypertension state, dyslipidemia state, BMI, and T2D duration, but not among the drinkers in CHEI. Conclusion Greater adherence to the most recent Chinese or American dietary guidelines were associated with a lower risk of CVD incidents among Chinese patients with T2D.

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Is The Healthy Eating Index-2015 Associated With Rheumatoid Arthritis?

10.21203/rs.3.rs-1061469/v1 ◽

2021 ◽

Author(s):

Atiyeh Nayebi ◽

Davood Soleimani ◽

Shayan Mostafaei ◽

Negin Elahi ◽

Homayoun Elahi ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Healthy Eating ◽

Diet Quality ◽

Linear Trend ◽

Cross Sectional Study ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

P Value ◽

Cross Sectional

Abstract Objective: Healthy Eating Index-2015 (HEI-2015) is a multidimensional criterion of diet quality utilized to evaluate how well people’s dietary behaviors align with major recommendations of the 2015–2020 Dietary Guidelines for Americans. We aim to investigate the association between the diet quality and Rheumatoid arthritis (RA) activity.Design: Cross-sectional studySetting: This study was done on 184 patients with RA in rheumatology clinic in Kermanshah city, Iran, in 2020. RA was diagnosed according to the criteria of the 2010 American College of Rheumatology/ European League against Rheumatism. The overall quality diet was extracted from a validated 168-item food frequency questioner (FFQ) to calculate the HEI-2015 score. RA disease activity was assessed using Disease Activity Score 28 (DAS28) scores. One-way ANOVA and ANCOVA were done to find the associations.Participants: RA patientsResults: Individuals in the highest HEI-2015 quartile had a lower mean Erythrocyte Sedimentation Rate (ESR) than those in the lowest quartiles of the HEI scores (P-value: 0.014). A linear trend towards decreasing waist circumference in patients was observed with increasing quartiles of the HEI-2015 scores (P-value= 0.005). After controlling for all potential confounders, patients in the highest HEI-2015 quartile had the lowest DAS28 scores than those in the lowest quartile of the HEI-2015 scores (Q1= 3.65; 95% CI= 3.29 – 4.02 vs. Q4= 2.35; 95% CI= 1.94 - 2.67; P-value<0.001).Conclusion: Our results indicated that following a high diet quality might be one of the therapeutic strategies to control or reduce the disease activity in RA patients.

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Food and nutrient intake and diet quality among older Americans

Public Health Nutrition ◽

10.1017/s1368980021000586 ◽

2021 ◽

pp. 1-10

Author(s):

Yeon Jin Choi ◽

Eileen M Crimmins ◽

Jung Ki Kim ◽

Jennifer A Ailshire

Keyword(s):

Older Adults ◽

Healthy Eating ◽

Diet Quality ◽

Healthy Eating Index ◽

Healthy Food ◽

Community Dwelling ◽

Dietary Guidelines ◽

Nutritional Deficiencies ◽

Nutrition Survey ◽

Older Americans

Abstract Objective: A suboptimal diet and nutritional deficiencies can have important influences on health with significant impact among older adults. This study aims to assess the presence of suboptimal dietary intake among older Americans and identify risk and protective factors influencing diet quality. Design: Cross-sectional secondary analysis. Setting: USA. Participants: A nationally representative sample of 5614 community-dwelling older adults over age 54 in the Health and Retirement Study – Health Care and Nutrition Survey. Results: Overall, only 10·7 % of respondents had a good quality diet (Healthy Eating Index score 81 and above); the majority had diets considered poor or needing improvement. Less than 50 % of respondents met dietary guidelines and nutritional goals for most individual food groups and nutrients. Respondents with low socio-economic status, fewer psychosocial resources and those who had limited access to healthy food outlets were more likely to have a diet of suboptimal quality. Conclusions: Efforts to remove identified barriers that put older adults at risk for poor nutrition and to provide resources that increase access to healthy food should be made to encourage healthy eating and enhance diet quality.

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Usual diet quality among 8- to 12-year-old Brazilian children

Cadernos de Saúde Pública ◽

10.1590/0102-311x00044418 ◽

2019 ◽

Vol 35 (2) ◽

Cited By ~ 1

Author(s):

Paula Martins Horta ◽

Eliseu Verly Junior ◽

Luana Caroline dos Santos

Keyword(s):

Public Schools ◽

Healthy Eating ◽

Diet Quality ◽

Mixed Model ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Nonlinear Mixed Model ◽

Dietary Recall ◽

Food And Nutrition ◽

Brazilian Children

Abstract: Nutritional surveys are important information sources for public policy in the food and nutrition field. They focus on assessing usual dietary patterns, because health outcomes result from the long-term intake. Here we aimed to evaluate diet quality adjusted for day-to-day variance among Brazilian children. Data were collected between March 2013 and August 2015. The sample included 8- to 12-year-old children (n = 1,357) from public schools from all administrative regions of a Brazilian city. One 24-h dietary recall (24HR) was collected for the whole sample and two 24HR for two non-consecutive days of the same week for a subsample. The Healthy Eating Index-2010 (HEI-2010) was adapted to Brazilian food habits and the Brazilian dietary guidelines were used to evaluate diet quality. Statistical analysis included a multipart, nonlinear mixed model with correlated random effects proposed by the U.S. National Cancer Institute to correct diet quality for day-to-day variance. The adapted HEI-2010 total score was 51.8. Children with poorer diet quality (< 10th percentile) scored less than 41.1, and children with higher diet quality (> 90th percentile) scored more than 62.4. The overall adequacy of adapted HEI-2010 components was low. Higher adequacy percentages were identified for total protein foods (94.9%), greens (62.3%), and seafood and plant proteins (52.2%). Seven components showed less than 10% of adequacy: refined grains, fatty acids, dairy, sodium, total vegetable, whole grains, and empty calories. This study identified the main inadequacies among children’s diet quality, which can guide promotion actions for healthy eating.

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The New Standardized Malaysian Healthy Eating Index

Nutrients ◽

10.3390/nu13103474 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3474

Author(s):

Marhamah Jailani ◽

Siti Masitah Elias ◽

Roslee Rajikan

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Scoring System ◽

Energy Requirement ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Quality Measure ◽

Nutrition Survey ◽

Adolescent Nutrition ◽

Index Components

Healthy Eating Index (HEI) is a diet quality measure that assesses the population’s compliance towards dietary guidelines. In Malaysia, diet quality measure, though existing, has some limitations in terms of application and relevance. This study aims to develop a new standardized Malaysian Healthy Eating Index (S-MHEI) that can measure the diet quality of all Malaysians regardless of their energy requirement level. The Malaysian Dietary Guidelines (MDG) 2010 and MDG for Children and Adolescents (MDGCA) 2013 were used as main references in developing the index components. In addition, the latest Malaysian Adults Nutrition Survey (MANS) and Adolescent Nutrition Survey (ANS) were also referred to ensure the relevance of the components selected. For adequacy components, the least restrictive method was used in setting the standard for the scoring system. Meanwhile, the scoring system for moderation components was built based on the Recommended Nutrient Intake (RNI) 2017. The new S-MHEI comprises of 11 components with a maximum total score of 100. The least restrictive method allowed the index to be used across energy requirement levels. However, the index will not be sensitive towards adhering to the specific recommended amount of intake—which in effect, made the index focus on measuring diet quality rather than diet quantity.

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

Circulation ◽

10.1161/circ.141.suppl_1.p360 ◽

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.

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Maternal night-eating and lower diet quality during pregnancy are associated with substantial postpartum weight retention

Proceedings of The Nutrition Society ◽

10.1017/s0029665120000506 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

See Ling Loy ◽

Yin Bun Cheung ◽

Colega Marjorelee ◽

Airu Chia ◽

Chad Yixian Han ◽

...

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Postpartum Weight Retention ◽

Weight Retention ◽

Eating Pattern ◽

Night Eating ◽

Postpartum Weight ◽

Fasting Duration

AbstractRecent evidence suggests that synchronizing eating-fasting schedules with body's circadian rhythms or day-night cycles is important for metabolic health. Besides food quantity and quality, food timing may contribute to weight regulation. However, it is unclear if this factor during pregnancy can influence maternal weight retention after childbirth. Using data from a prospective cohort, the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study, we examined the associations of maternal circadian eating pattern and diet quality in pregnancy with substantial postpartum weight retention (PPWR) at 18 months. We assessed 687 pregnant women for their circadian eating pattern (night-eating, night-fasting and eating episodes) and diet quality (Healthy Eating Index) based on information derived from 24-h dietary recall at 26–28 weeks’ gestation. Night-eating was defined as > 50% of total energy intake during 1900–0659 h; night-fasting duration was determined based on the longest fasting interval between consumption of a calorie-containing food or beverage during 1900–0659 h; eating episodes were defined as events that provided ≥ 210 kJ with time intervals between eating episodes of ≥ 15 min; diet quality was ascertained using the Healthy Eating Index which measures adherence to the Singapore dietary guidelines for pregnant women. PPWR was calculated by subtracting the weight at the first antenatal clinic visit from weight at 18-month postpartum. Substantial PPWR was defined as weight retention of 5 kg or more. Adjusting for maternal age, ethnicity, education, parity, night shift, mood, body mass index and total energy intake, multivariable binary logistic regression analysis was performed to estimate odds ratio (OR) of substantial PPWR in relation to circadian eating pattern and diet quality. Of 687 women, 110 (16%) had substantial PPWR. After confounders adjustment, night-eating (OR 1.95; 95% confidence interval 1.05, 3.62) and lower diet quality (1.91; 1.17, 3.10) were independently associated with higher odds of substantial PPWR. No associations with substantial PPWR were observed for night-fasting duration and number of eating episodes. During pregnancy, women with higher caloric consumption at night and lower diet quality had a greater likelihood of substantial PPWR. These findings suggest that aligning eating time with day-night cycles and adherence to dietary guidelines during pregnancy may help to alleviate overweight and obesity risk in postpartum life. There is a possibility that these eating patterns persist beyond pregnancy and pose implications for long-term obesity development. Further investigation on this area is required.

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