A Novel Diet-Health Index Reveals Worsening Trends and Widening Disparities in the Health Impacts of Diet in the United States

Abstract Objectives Poor diets are associated with poor health outcomes, but existing metrics of diet quality do not directly include the health effects of diet. Using a novel international diet-health index (IDHI), we can measure diet-related health impacts from multiple dietary factors simultaneously, given a population's health status and most prevalent causes of death and disability. Methods We obtained individual-level data on intake of 12 dietary factors and exposure to 2 metabolic risk factors from the National Health and Nutrition Examination Survey (NHANES), 2003–2014, and computed the IDHI for 12 cardio-metabolic diseases and 15 cancers in the U.S. by sex, race, education, and income. We then compared IDHI to a modified Alternative Healthy Eating Index (mAHEI) using 10 of the 12 dietary factors and validated the indices using the National Center for Health Statistics (NCHS) linked dataset for total mortality through 2015. Results IDHI declined from −0.314 (95% CI: −0.323, −0.305) in 2003/04 to −0.325 (−0.334, −0.316) in 2013/14 (P = 0.007 for trend). Non-Hispanic Black Americans have persistently lower IDHI than other groups, and disparities in IDHI have widened over time by level of income (P = 0.004 for interaction), and education (P = 0.047 for interaction). IDHI was more closely correlated with the mAHEI at higher levels of diet quality, and both indices were strongly associated with total mortality. Conclusions The IDHI is a valid tool for measuring diet-related health impacts in the context of a population's most prevalent diseases, potentially offering tailored guidance regarding how best to reduce diet-related health disparities. Funding Sources No funding.

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Yogurt Consumption Is Associated with Better Dietary Intake and Diet Quality in School-aged Children (P18-112-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz039.p18-112-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Yong Zhu ◽

Jessica Smith ◽

Valerie Benoit ◽

Neha Jain ◽

Vipra Vanage ◽

...

Keyword(s):

Dietary Intake ◽

Diet Quality ◽

The United States ◽

Healthy Eating Index ◽

Health Concern ◽

School Aged Children ◽

Funding Sources ◽

Health And Nutrition ◽

Calcium Magnesium ◽

Total Fat

Abstract Objectives To assess associations between yogurt consumption and dietary intake as well as diet quality in school-aged children in the United States. Methods A total of 3709 children aged 6–12 years from the National Health and Nutrition Examination Survey 2011–2012, 2013–2014 and 2015–2016 were included in the study. Day 1 dietary data were used to determine yogurt consumption status, energy and nutrient intake. Healthy Eating Index 2015 (HEI-2015) was used as a measure of diet quality. Multiple linear regression analyses for surveys were conducted to estimate associations between yogurt consumption and dietary intake, as well as diet quality, adjusting for sociodemographic characteristics. Results About 9% of children aged 6–12 years were yogurt eaters. Compared to non-eaters, children who reported yogurt consumption had significantly higher intake of calcium, magnesium, phosphorus, potassium, total sugar and carbohydrate, as well as significantly less intake of total fat and sodium (P < 0.05 for all). There were no significant differences on intake of added sugar and total energy intake. HEI-2015 total score, as well as sub scores for greens and beans, whole fruit, dairy, and sodium were significantly higher in yogurt eaters than non-eaters (P < 0.05 for all). Conclusions Consumption of yogurt is associated with increased intake of several key vitamins and minerals, including nutrients of public health concern such as calcium and potassium, in school-aged children. Yogurt consumption is also associated with better diet quality in this population. Funding Sources The study was funded by General Mills, Inc.

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The International Diet-Health Index: a novel tool to evaluate diet quality for cardiometabolic health across countries

BMJ Global Health ◽

10.1136/bmjgh-2019-002120 ◽

2020 ◽

Vol 5 (7) ◽

pp. e002120 ◽

Cited By ~ 1

Author(s):

Jifan Wang ◽

William A Masters ◽

Yan Bai ◽

Dariush Mozaffarian ◽

Elena N Naumova ◽

...

Keyword(s):

Dietary Intake ◽

Health Effects ◽

Diet Quality ◽

Dietary Factors ◽

Health Impacts ◽

Cardiometabolic Disease ◽

Cardiometabolic Health ◽

Dietary Intakes ◽

Health Index ◽

Cardiometabolic Diseases

IntroductionDiet is a major modifiable risk factor for cardiometabolic disease; however, interpretable measures capturing impacts of overall diet on health that can be easily used by policymakers at the global/national levels are not readily available.MethodsWe developed the International Diet-Health Index (IDHI) to measure health impacts of dietary intake across 186 countries in 2010, using age-specific and sex-specific data on country-level dietary intake, effects of dietary factors on cardiometabolic diseases and country-specific cardiometabolic disease profiles. The index encompasses the impact of 11 foods/nutrients on 12 cardiometabolic diseases, the mediation of health effects of specific dietary intakes through blood pressure and body mass index and background disease prevalence in each country–age–sex group. We decomposed the index into IDHIbeneficial for risk-reducing factors, and IDHIadverse for risk-increasing factors. The flexible functional form of the IDHI allows inclusion of additional risk factors and diseases as data become available.ResultsBy sex, women experienced smaller detrimental cardiometabolic effects of diet than men: (females IDHIadverse range: −0.480 (5th percentile, 95th percentile: −0.932, –0.300) to −0.314 (−0.543, –0.213); males IDHIadverse range: (−0.617 (−1.054, –0.384) to −0.346 (−0.624, –0.222)). By age, middle-aged adults had highest IDHIbeneficial (females: 0.392 (0.235, 0.763); males: 0.415 (0.243, 0.949)) and younger adults had most extreme IDHIadverse (females: −0.480 (−0.932, –0.300); males: −0.617 (−1.054, –0.384)). Regionally, Central Latin America had the lowest IDHIoverall (−0.466 (−0.892, –0.159)), while Southeast Asia had the highest IDHIoverall (0.272 (−0.224, 0.903)). IDHIoverall was highest in low-income countries and lowest in upper middle-income countries (−0.039 (−0.317, 0.227) and −0.146 (−0.605, 0.303), respectively). Among 186 countries, Honduras had lowest IDHIoverall (−0.721 (−0.916, –0.207)), while Malaysia had highest IDHIoverall (0.904 (0.435, 1.190)).ConclusionIDHI encompasses dietary intakes, health effects and country disease profiles into a single index, allowing policymakers a useful means of assessing/comparing health impacts of diet quality between populations.

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The utility of household Grocery Purchase Quality Index scores as an individual diet quality metric

British Journal Of Nutrition ◽

10.1017/s0007114520004833 ◽

2020 ◽

pp. 1-28

Author(s):

Haley Wynne Parker ◽

Carolina de Araujo ◽

Anne N. Thorndike ◽

Maya Vadiveloo

Keyword(s):

Diet Quality ◽

Quality Index ◽

Secondary Analysis ◽

Weighted Kappa ◽

Healthy Eating Index ◽

Bachelor's Degree ◽

Dietary Recommendations ◽

Household Level ◽

Individual Level ◽

Grocery Purchase

Abstract The validated Grocery Purchase Quality Index (GPQI) reflects concordance between household grocery purchases and US dietary recommendations. However, it is unclear whether GPQI scores calculated from partial purchasing records validly reflect individual-level diet quality. Within the 9-month randomized controlled Smart Cart study examining the effect of targeted coupons on grocery purchase quality (n=209), this secondary analysis examined concordance between the GPQI (range 0-75, scaled to 100) calculated from 3-months of loyalty-card linked partial (≥50%) household grocery purchasing data and individual-level Healthy Eating Index (HEI) scores at baseline and 3-months calculated from food frequency questionnaires. HEI and GPQI concordance was assessed with overall and demographic-stratified partially-adjusted correlations; covariate-adjusted percent score differences, cross-classification, and weighted kappa coefficients assessed concordance across GPQI tertiles (T). Participants were mostly middle-aged (55.4(13.9) years), female (90.3%), from non-smoking households (96.4%), without children (70.7%). Mean GPQI (54.8(9.1)%) scores were lower than HEI scores (baseline: 73.2(9.1)%, 3-months: 72.4(9.4)%), and moderately correlated (baseline r=0.41 vs. 3-month r=0.31, p<0.001). Correlations were stronger among participants with ≤ bachelor’s degree, obesity, and children. Concordance was highest in T3. Participants with high (T3) vs. low (T1) GPQI scores had 7.3-10.6 higher odds of having HEI scores >80% at both timepoints. Weighted kappas (k=0.25) indicated moderate agreement between scores. Household-level GPQI derived from partial grocery purchasing data were moderately correlated with self-reported intake, indicating their promise for evaluating diet quality. Partial purchasing data appears to moderately reflect individual diet quality and may be useful in interventions monitoring changes in diet quality.

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

Nutrients ◽

10.3390/nu11122952 ◽

2019 ◽

Vol 11 (12) ◽

pp. 2952

Author(s):

Yong Zhu ◽

Neha Jain ◽

Vipra Vanage ◽

Norton Holschuh ◽

Anne Hermetet Agler ◽

...

Keyword(s):

United States ◽

Dietary Intake ◽

National Health ◽

Diet Quality ◽

The United States ◽

Healthy Eating Index ◽

Nutrition Examination Survey ◽

Food Groups ◽

Dietary Recall ◽

Health And Nutrition

This study examined differences in dietary intake between ready-to-eat cereal eaters and non-eaters in adults from the United States. Participants (n = 5163) from the National Health and Nutrition Examination Survey 2015–2016 were included. One-day dietary recall was used to define ready-to-eat cereal consumption status and estimate dietary intake in eaters and non-eaters. Data from Food Patterns Equivalent Database 2015–2016 were used to compare intakes of food groups by consumption status. Diet quality was assessed by Healthy Eating Index 2015. Nineteen percent of US adults were ready-to-eat cereal eaters; they had a similar level of energy intake as non-eaters, but they had significantly higher intake of dietary fiber, and several vitamins and minerals, such as calcium, iron, magnesium, potassium, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, and vitamin D. They were also more likely to meet nutrient recommendations. Compared to non-eaters, ready-to-eat cereal eaters had the same level of added sugar intake but they had significantly higher intake of whole grains, total fruits, and dairy products. The diet quality of ready-to-eat cereal eaters was significantly higher than that of non-eaters. The study supports that ready-to-eat cereal eaters have better dietary intake with a healthier dietary pattern than non-eaters in the United States.

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Dietary intake and diet quality by weight category among a racially diverse sample of women in Birmingham, Alabama, USA

Journal of Nutritional Science ◽

10.1017/jns.2020.51 ◽

2020 ◽

Vol 9 ◽

Author(s):

Rebecca B. Little ◽

Renee Desmond ◽

Tiffany L. Carson

Keyword(s):

Diet Quality ◽

Weight Status ◽

Vegetable Intake ◽

The United States ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Rank Test ◽

Deep South ◽

Weight Category ◽

Maximum Score

Abstract Diet is a modifiable contributor to health. The lack of adherence to recommended dietary guidelines may contribute to the disproportionate burden of obesity and other chronic conditions observed in the Deep South region of the United States. The objective of this cross-sectional study was to describe food group intake and diet quality by race and weight status of women in the Deep South. Study participants were eighty-nine healthy female volunteers (56 % black, 44 % white, mean age 39⋅7 ± 1⋅4 years) recruited from Birmingham, AL, USA. Body Mass Index (BMI) determined weight status (non-obese/obese). Healthy Eating Index-2010 (HEI-2010) calculated from dietary recalls assessed diet quality. Wilcoxon sum-rank test compared HEI-2010 scores by race and weight status. χ2 analysis compared the percentage of women who achieved maximum points for HEI-2010 index food components by subgroup. Caloric and macronutrient intake did not differ by race or weight status (mean kcal 1863⋅0 ± 62⋅0). Median Total HEI-2010 Score for the sample was 51⋅9 (IQR: 39⋅1–63⋅4). Although there was no statistical difference in diet quality by race, more whites achieved the maximum score for vegetable intake compared to blacks, while blacks reported higher total fruit intake. Non-obese women reported better diet quality (56⋅9 v. 46⋅1; P = 0⋅04) and eating more whole fruits, and more achieved the maximum score for protein from plant and seafood sources. In summary, differences in diet quality were observed by weight status, but not race among this sample. These results point to tailored dietary interventions for women in metropolitan areas of Alabama, USA.

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Quality of diet related to food insecurity and food stamps use among older people

Ageing Research ◽

10.4081/ar.2011.e3 ◽

2011 ◽

Vol 2 (1) ◽

pp. 3 ◽

Cited By ~ 3

Author(s):

Maria F Montoya ◽

Andre W Hite ◽

Patricia Rohrbeck ◽

Binky Bawa ◽

Oladayo O Akinwolemiwa ◽

...

Keyword(s):

Food Security ◽

Food Insecurity ◽

Diet Quality ◽

The United States ◽

Healthy Eating Index ◽

Food Stamps ◽

Older Individuals ◽

Cross Sectional Survey ◽

Food Security Status

We explore the association between quality of diet and food security status among older persons. Cross-sectional survey of large national samples, from the National Health & Nutrition Examination Surveys (1988-1994 & 2001-2002), in the United States. A total of 5,039 and 2,040 men and women aged 60 and older, respectively. The dependent variable was the healthy eating index (HEI; 2000 and 2005) as a measure of diet quality. The independent variable of interest was food security status and was categorized as food secure, food insecurity receiving food stamps and food insecurity not receiving food stamps. In multivariate analyses, food insecure individuals not receiving food stamps had lower total HEI-2000 scores compared to food secure individuals (b=-3.91, SE=1.81, P=0.0310). Factors independently associated with high HEI (2000 or 2005) scores were female gender, being married, highly educated or wealthy, with very good/ excellent perceived health, or without functional limitations. Food secure individuals had better quality of diet than food insecure individuals. Among food insecure individuals, receiving food stamps was not associated with diet quality. Food insecure families with older individuals may need new methods of dissemination of food and nutrition programs – methods that yield positive and promising changes in the health status of this special population group.

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Associations between frequency of food shopping at different store types and diet and weight outcomes: findings from the NEWPATH study

Public Health Nutrition ◽

10.1017/s1368980016000355 ◽

2016 ◽

Vol 19 (12) ◽

pp. 2268-2277 ◽

Cited By ~ 19

Author(s):

Leia M Minaker ◽

Dana L Olstad ◽

Mary E Thompson ◽

Kim D Raine ◽

Pat Fisher ◽

...

Keyword(s):

Diet Quality ◽

Saturated Fat ◽

Healthy Eating Index ◽

Farmers Markets ◽

Food Store ◽

Individual Level ◽

Food Shopping ◽

Different Types ◽

Weight Outcomes ◽

Purchasing Patterns

AbstractObjectiveThe present study aimed to: (i) examine associations between food store patronage and diet and weight-related outcomes; and (ii) explore consumer motivations for visiting different types of food store.DesignA stratified probability sample of residents completed household and individual-level surveys in 2009/2010 on food purchasing patterns and motivations, dietary intake, waist circumference (WC), weight and height. Diet quality was calculated using the Healthy Eating Index for Canada from a subset of participants (n 1362). Generalized estimating equations were created in 2015 to examine how frequency of patronizing different types of food store was associated with diet quality, intake of fruits and vegetable, mean intake of energy (kcal) sodium and saturated fat, WC and BMI.SettingThree mid-sized urban municipalities in Ontario, Canada.SubjectsA representative sample of residents (n 4574).ResultsParticipants who shopped frequently at food co-ops had significantly better diet quality (β=5·3; 99 % CI 0·3, 10·2) than those who did not. BMI and WC were significantly lower among those who frequently shopped at specialty shops (BMI, β=−2·1; 99 % CI −3·0, −1·1; WC, β=−4·8; 99 % CI −7·0, −2·5) and farmers’ markets (BMI, β=−1·4; 99 % CI −2·3, −0·5; WC, β=−3·8; 99 % CI −6·0, −1·6) compared with those who did not. Relative importance of reasons for food outlet selection differed by large (price, food quality) v. small (proximity, convenient hours) shopping trip and by outlet type.ConclusionsFindings contribute to our understanding of food store selection and have implications for potentially relevant retail food intervention settings.

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Soup consumption is associated with a lower dietary energy density and a better diet quality in US adults

British Journal Of Nutrition ◽

10.1017/s0007114513003954 ◽

2014 ◽

Vol 111 (8) ◽

pp. 1474-1480 ◽

Cited By ~ 9

Author(s):

Yong Zhu ◽

James H. Hollis

Keyword(s):

Body Weight ◽

Energy Density ◽

Energy Intake ◽

Diet Quality ◽

The United States ◽

Healthy Eating Index ◽

Food Type ◽

United States Department ◽

Dietary Energy ◽

Dietary Energy Density

Epidemiological studies have revealed that soup consumption is associated with a lower risk of obesity. Moreover, intervention studies have reported that soup consumption aids in body-weight management. However, little is known about mechanisms that can explain these findings. The objective of the present study was to investigate associations between soup consumption and daily energy intake, dietary energy density (ED), nutrient intake and diet quality. Adults aged 19–64 years who participated in the National Health and Nutrition Examination Surveys during 2003–8 were included in the study. Soup consumers were identified from the first dietary recall using the United States Department of Agriculture food codes and combination food type from the dietary data. Compared with non-consumers (n9307), soup consumers (n1291) had a lower body weight (P= 0·002), a lower waist circumference (P= 0·001) and a trend towards a lower total energy intake (P= 0·087). Soup consumption was associated with a lower dietary ED (P< 0·001); this was independent of whether data on beverage or water consumption were included. Diet quality, as measured by the Healthy Eating Index 2005, was significantly better in soup consumers (P= 0·008). Soup consumption was also associated with a reduced intake of total fat and an increased intake of protein, carbohydrate and dietary fibre, as well as several vitamins and minerals (P< 0·05 for all). However, it was also associated with a higher intake of Na (P< 0·001). The relationship between soup consumption and body weight could be due to a reduced dietary ED and an improved diet quality. Consumers need to pay attention to their Na intake and choose low-Na products for a healthier diet.

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Diet Quality of First Semester Southeastern College Students and the Impact of COVID-19

Current Developments in Nutrition ◽

10.1093/cdn/nzab029_059 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 258-258

Author(s):

Zhiping Yu ◽

Paul Fuglestad ◽

Veruska Gonzalez

Keyword(s):

College Students ◽

Diet Quality ◽

Eating Behaviors ◽

Healthy Eating Index ◽

National Average ◽

First Semester ◽

Funding Sources ◽

Unhealthy Eating ◽

The Impact

Abstract Objectives Studies have reported poor food choices and unhealthy eating behaviors among college students. The purpose of this study was to assess the diet quality of college freshmen and the impact of the COVID-19 pandemic. Methods Freshman students 18 years or older in all majors in a southeastern university were invited to take the Diet History Questionnaire III (DHQ III) in fall 2019 and in fall 2020. The Healthy Eating Index (HEI) scores from the participants were obtained and compared to the HEI-2015 national averages through one-sample t-tests. Results Thirty students in fall 2019 cohort (86.7% female, 46.7% white) and 55 students in fall 2020 cohort (78.2% female, 63.5% white) completed the survey. Compared to national average data, participants in the current study had higher total HEI scores (60.9 vs. 58.3, P < 0.05), higher total fruits scores (3.8 vs. 2.6, P < 0.001), higher dairy scores (6.4 vs. 5.4, P < 0.001), but lower total protein scores (4.1 vs. 5.0, P < 0.001), lower seafood and plant protein scores (3.6 vs. 5.0, P < 0.001), higher refined grains scores (8.0 vs. 6.7, P < 0.001), and higher sodium scores (4.7 vs. 3.4, P < 0.001). Just examining the 2020 cohort of students, after the onset of the COVID-19 pandemic, the overall HEI scores were lower and not significantly different from the national average (P > 0.05) and HEI fatty acids scores were lower (3.7 vs. 4.5, P < 0.05). Conclusions The diet quality of freshman college students remains inadequate and interventions are needed to prevent or postpone the health problems especially during the COVID-19 pandemic. Funding Sources Brooks College of Health, University of North Florida

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A Prospective Study of the Relationship of Infant Adiposity with Maternal Prenatal and Postnatal Diet Quality

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_101 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1029-1029

Author(s):

Leah Lipsky ◽

Anna Maria Siega-Riz ◽

Myles Faith ◽

Tonja Nansel

Keyword(s):

Energy Intake ◽

Diet Quality ◽

Gestational Age ◽

Healthy Eating Index ◽

Sensitivity Analyses ◽

Large For Gestational Age ◽

Delivery Mode ◽

Funding Sources ◽

A Prospective Study ◽

Infant Birth

Abstract Objectives This study examines relationships of maternal prenatal and postnatal diet quality with infant birth size and growth, which are known risk factors for child obesity. Methods Women completed six 24-hour diet recalls (1 per pregnancy trimester and at 6 weeks, 6 months, and 12 months postpartum); infant anthropometrics were obtained at birth (n = 331 mother-child dyads), 6 weeks, 6 months and 12 months of age. Prenatal and postnatal Healthy Eating Index 2015 total (HEI), adequacy (HEI-adq) and moderation (HEI-mod) scores were calculated by combining recalls across pregnancy and across postpartum. Linear mixed models estimated associations of infant weight-for-length z-scores (WFLz) with prenatal and postnatal diet quality. Logistic regressions estimated odds of small-for-gestational age (SGA, <10th percentile) and large-for-gestational age (LGA, >90th percentile) associated with maternal prenatal diet quality. Covariates included maternal height, demographics, delivery mode, child sex, and gestational age at delivery. Sensitivity analyses examined whether associations were robust to inclusion of maternal total energy intake or early pregnancy BMI. Results WFLz was inversely associated with prenatal HEI (β±SE = −0.02 ± 0.005, P = 0.004) and HEI-mod (β ± SE = −0.04 ± 0.01, P < 0.001), and with postnatal HEI (β ± SE = −0.01 ± 0.005, P = 0.01) and HEI-adq (β ± SE = −0.02 ± 0.007, P = 0.005). SGA and LGA occurred for 92 (7%) and 172 (12%) babies, respectively. LGA was inversely associated with prenatal HEI (OR = 0.94, 95% CI: 0.90–0.98), HEI-mod (OR = 0.83, 95% CI: 0.74–0.83) and HEI-adq (OR = 0.95, 95% CI: 0.90–1.01). SGA was not associated with prenatal diet quality. Associations were not changed when adjusted for energy intake but were modestly attenuated when adjusted for BMI. Conclusions Higher maternal prenatal and postnatal diet quality were associated with more favorable indicators of infant adiposity from birth through 12 months of age. Interventions are needed to determine whether targeting both prenatal and postnatal diet may lead to improved infant adiposity development. Funding Sources This research was supported by the NICHD Intramural Research Program.

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