Greater Exposure to a Multilevel Multicomponent Obesity Prevention Intervention in Rural Native American Communities Is Associated With Improved Diet Quality Among Adults

Abstract Objectives Multilevel multicomponent (MLMC) intervention trials attempt to reach participants in many different settings in their lives to promote environmental and behavioral change; however, individual-level exposure to these complex interventions has rarely been evaluated. We examined the association between exposure to an MLMC intervention and changes in diet quality among Native American adults in rural communities in the Midwest and Southwest U.S. Methods The OPREVENT2 intervention was implemented over 18 months in three reservation-based communities, in the first round of the study. Nutrition and physical activity messages were delivered in local food stores, worksites, schools, and by social and community media, along with changes to food store and workplace environments to support increased physical activity and healthier food choices. A Block Food Frequency Questionnaire (FFQ) was used to calculate a Healthy Eating Index (HEI-2015) score at baseline and follow-up. At follow-up, 234 adults self-reported their exposure to intervention materials and activities via an 81-item questionnaire with illustrations. Exposure scores for each intervention component were calculated and weighted by level of interactiveness (e.g., taste tests were most interactive; posters least interactive), then summed yielding a total exposure score. Linear regression models assessed change in HEI score by participant exposure (component and total), controlling for baseline sociodemographic variables. Results The participants were majority female (73%) with a mean age of 44 (±14) years and mean total exposure score of 11.66 ± 6.71 on a scale of 0–28. Participants with higher total exposure scores had a greater increase in HEI scores compared to those who were least exposed to the intervention (b = 3.61 ± 1.90, P = 0.049). Improved diet quality was also positively associated with exposure to specific intervention components, including educational displays, posters, and radio announcements (P < 0.01). Conclusions We found a dose-response relationship between level of exposure to the intervention and diet quality among participants in the OPREVENT2 intervention. Future MLMC interventions in NA rural communities should consider using radio announcements, posters, educational displays to engage with adults and promote healthy eating. Funding Sources NHLBI.

Download Full-text

Sociodemographic and Psychosocial Factors Associated with Diet Quality Among Native American Adults: Baseline Data from the OPREVENT2 Study (P04-007-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.p04-007-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Michelle Estradé ◽

Angela Trude ◽

Marla Pardilla ◽

Joel Gittelsohn

Keyword(s):

Native American ◽

Psychosocial Factors ◽

Healthy Eating ◽

Diet Quality ◽

Self Efficacy ◽

Regression Models ◽

Nutrition Knowledge ◽

Food Assistance ◽

Linear Regression Models ◽

Dietary Interventions

Abstract Objectives To identify sociodemographic and psychosocial factors associated with diet quality among Native American adults. Methods Cross-sectional data from the baseline assessment of a cluster-randomized obesity prevention trial (OPREVENT2) of 580 Native American adults from six tribal communities in the Midwest and Southwest. The Healthy Eating Index (HEI-2015) was used to define diet quality, calculated from a semi-quantitative food frequency questionnaire (modified Block FFQ). Sociodemographic (age, sex, education, food assistance) and psychosocial factors (nutrition knowledge, self-efficacy, health eating intentions) were assessed via questionnaires administered by trained data collectors. One-way ANOVA, linear regression models, and two-tailed t-tests assessed compared mean total HEI scores among sociodemographic categories. Bivariate linear regression models assessed the relation between psychosocial factors and diet quality. Results Overall diet quality was low, with a mean HEI-2015 score of 49 (SD + 8), which is 10 points lower than in the general U.S. population. The HEI scores of smokers were an average of 3 points lower than those of non-smokers (P < 0.001), and females had better diet quality (2.2 points higher) than males (P < 0.01). Those receiving commodity food assistance had mean total HEI scores 2.7 points lower than those who did not receive commodities (P < 0.005), and no other source of food assistance was associated with HEI. Self-efficacy (b = 0.66; P < 0.001) and healthy eating intentions (b = 0.72; P < 0.001) were positively associated with mean HEI. Conclusions While nutrition knowledge has been a key focus of many dietary interventions, it does not appear to be associated with better diet quality among Native Americans. This finding suggests that it is necessary to focus interventions on factors other than nutrition knowledge that may impact food choice. Because higher self-efficacy and healthy eating intentions were associated with better diet quality, a social-cognitive approach to dietary interventions may be more effective in Native American populations. Funding Sources OPREVENT2 is funded by a grant from the National Heart, Lung, and Blood Institute.

Download Full-text

Social Support, but Not Perceived Food Environment, Is Associated with Diet Quality in French-Speaking Canadians from the PREDISE Study

Nutrients ◽

10.3390/nu11123030 ◽

2019 ◽

Vol 11 (12) ◽

pp. 3030 ◽

Cited By ~ 1

Author(s):

Elise Carbonneau ◽

Benoît Lamarche ◽

Julie Robitaille ◽

Véronique Provencher ◽

Sophie Desroches ◽

...

Keyword(s):

Social Support ◽

Healthy Eating ◽

Diet Quality ◽

Food Environment ◽

Healthy Eating Index ◽

Linear Regression Models ◽

Healthy Foods ◽

French Speaking ◽

Food Recalls ◽

At Home

The objectives were to assess whether social support for healthy eating and perceived food environment are associated with diet quality, and to investigate if sociodemographic characteristics moderate these associations. A probability sample of French-speaking adults from the Province of Québec, Canada, was recruited in the context of the PREDISE study. Participants reported their perceptions of supportive and non-supportive actions related to healthy eating from close others at home and outside of home (n = 952), and of the accessibility to healthy foods (n = 1035). The Canadian Healthy Eating Index (C-HEI) was calculated based on three Web-based 24 h food recalls. Multiple linear regression models showed that supportive (B = 1.50 (95% CI 0.46, 2.54)) and non-supportive (B = −3.06 (95% CI −4.94, −1.18)) actions related to healthy eating from close others at home were positively and negatively associated with C-HEI, respectively, whereas actions from close others outside of home were not. The negative association between non-supportive actions occurring at home and C-HEI was stronger among participants with lower (vs. higher) levels of education (p interaction = 0.03). Perceived accessibility to healthy foods was not associated with C-HEI (p > 0.05). These results suggest that the social environment may have a stronger influence on healthy eating than the perceived physical environment. This adds support for healthy eating promotion programs involving entire families, especially for more socioeconomically disadvantaged individuals, whose efforts to eat healthily may be more easily thwarted by non-supportive households.

Download Full-text

More frequent cooking at home is associated with higher Healthy Eating Index-2015 score

Public Health Nutrition ◽

10.1017/s1368980019003549 ◽

2020 ◽

Vol 23 (13) ◽

pp. 2384-2394 ◽

Cited By ~ 10

Author(s):

Julia A Wolfson ◽

Cindy W Leung ◽

Caroline R Richardson

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Healthy Eating Index ◽

Lower Income ◽

Linear Regression Models ◽

Cross Sectional ◽

Dietary Recall ◽

Income Status ◽

The Usa ◽

At Home

AbstractObjective:To examine the association between cooking frequency and Healthy Eating Index (HEI)-2015, overall and by income, among US adults.Design:Cross-sectional analysis using multivariable linear regression models to examine the association between cooking frequency and total HEI-2015 score adjusted for sociodemographic variables, overall and stratified by income.Setting:Nationally representative survey data from the USA.Participants:Adults aged ≥20 years (with 2 d of 24 h dietary recall data) obtained from the 2007 to 2010 National Health and Nutrition Examination Survey (n 8668).Results:Compared with cooking dinner 0–2 times/week, greater cooking frequency was associated with higher HEI-2015 score overall (≥7 times/week: +3·57 points, P < 0·001), among lower-income adults (≥7 times/week: +2·55 points, P = 0·001) and among higher-income adults (≥7 times/week: +5·07 points, P < 0·001). Overall, total HEI-2015 score was higher among adults living in households where dinner was cooked ≥7 times/week (54·54 points) compared with adults living in households where dinner was cooked 0–2 times/week (50·57 points). In households in which dinner was cooked ≥7 times/week, total HEI-2015 score differed significantly based on income status (lower-income: 52·51 points; higher-income: 57·35 points; P = 0·003). Cooking frequency was associated with significant differences in HEI-2015 component scores, but associations varied by income.Conclusions:More frequent cooking at home is associated with better diet quality overall and among lower- and higher-income adults, although the association between cooking and better diet quality is stronger among high-income adults. Strategies are needed to help lower-income Americans consume a healthy diet regardless of how frequently they cook at home.

Download Full-text

Associations between diet quality and physical activity measures among a southern Ontario regional sample of grade 6 students

Applied Physiology Nutrition and Metabolism ◽

10.1139/h10-085 ◽

2010 ◽

Vol 35 (6) ◽

pp. 826-833 ◽

Cited By ~ 8

Author(s):

Sarah J. Woodruff ◽

Rhona M. Hanning

Keyword(s):

Physical Activity ◽

Healthy Eating ◽

Diet Quality ◽

Odds Ratio ◽

Weight Status ◽

Positive Association ◽

Healthy Eating Index ◽

Normal Weight ◽

Future Research ◽

Ordinal Logistic Regression Analysis

The purpose of this study was to determine diet quality and physical activity behaviours of grade 6 students by sex and body weight status, and to determine the associations between diet quality and physical activity behaviours. The Web-based Food Behaviour Questionnaire, which included a 24-h diet recall and the modified Physical Activity Questionnaire for Older Children (PAQ-C), was administered to a cross-section of schools (n = 405 students from 15 schools). Measured height and weight were used to calculate body mass index and weight status (Cole et al. 2000). A Canadian version of the Healthy Eating Index (HEI-C) was used to describe overall diet quality. The mean HEI-C was 69.6 (13.2) with the majority (72%) falling into the needs improvement category. The overall mean physical activity score was 3.7 out of a maximum of 5, with obese subjects being less active compared with normal weight and overweight (p < 0.001). Ordinal logistic regression analysis (of HEI-C vs. all measures of the PAQ-C, sex, and weight status) revealed that HEI-C ratings were likely to be higher in students that walked to and from school 5 days per week (vs. 0 days per week; odds ratio 3.18, p = 0.010); and were active 1 evening per week (vs. none; odds ratio 3.48, p = 0.039). The positive association between diet quality and some aspects of physical activity suggests possible clustering of health behaviours. Future research should test the potential benefits of promoting 1 health behaviour (e.g., healthy eating) with another (e.g., physical activity).

Download Full-text

Depression and Physical Activity Affect Diet Quality of Foreign-born Latina Women Living on the U.S.-Mexico Border

Nutrients ◽

10.3390/nu11061254 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1254

Author(s):

Vanessa L. Errisuriz ◽

Laura Delfausse ◽

Alice P. Villatoro ◽

Marisol D. McDaniel ◽

Laura Esparza ◽

...

Keyword(s):

Physical Activity ◽

Depressive Symptoms ◽

Healthy Eating ◽

Diet Quality ◽

Depression Scale ◽

Healthy Eating Index ◽

Lower Probability ◽

Foreign Born ◽

Latina Women

There is increasing evidence that depression may affect diet. However, little is known about the association between depression and diet quality among foreign-born Latinas. We hypothesized that depressive symptoms would be associated with poorer diet quality in foreign-born Latinas. Furthermore, we believed that physical activity (PA) would have a protective effect on diet quality for individuals experiencing depressive symptoms. Our study evaluated the diet (Healthy Eating Index) and PA (Actigraph GT3X activity monitors) of 534 foreign-born Latinas with and without depressive symptoms (Center for Epidemiological Studies Depression Scale). A series of logistic regression models were estimated to examine our hypotheses. As predicted, Latinas who were depressed had significantly lower odds of having a high-quality diet than non-depressed Latinas. Unexpectedly, among Latinas who met PA guidelines, depressed Latinas had a significantly lower probability of having higher-quality diets than their non-depressed counterparts. Our findings support current research stating that depressive symptoms are associated with lower Healthy Eating Index scores. More research is necessary to elucidate the relationship between PA and dietary quality of depressed Latinas. Innovative approaches to address mental health and the stressors that can compound its severity are needed to improve diet quality among foreign-born Latina women.

Download Full-text

Quality of Diet and Cardio-Metabolic Outcomes in Native American Adolescents Participating in the Together on Diabetes Home-Visiting Program

Current Developments in Nutrition ◽

10.1093/cdn/nzaa043_031 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 180-180

Author(s):

Kirstie Ducharme-Smith ◽

Summer Rosenstock ◽

Vanessa Garcia-Larsen ◽

Francene Larzelere ◽

Rachel Chambers ◽

...

Keyword(s):

Blood Pressure ◽

Native American ◽

Diet Quality ◽

Home Visiting ◽

Healthy Eating Index ◽

Metabolic Health ◽

P Value ◽

Quartile Score

Abstract Objectives 1) Examine the impact of the Together on Diabetes (TOD) program on diet quality using the Alternative Healthy Eating Index (AHEI); 2) Determine the association of diet quality with outcomes of cardio-metabolic health (systolic and diastolic blood pressure, hemoglobin A1c, and zBMI). Methods TOD was a 12-month home-visiting diabetes prevention/management program, evaluated using a pre/post study design, conducted in four rural, reservation-based Native American communities in the southwestern United States. Participants were 10 to 19 years of age and were identified as pre-diabetic, T2DM or “at risk” based on body mass index (zBMI) and a qualifying laboratory test. Diet information was collected via an adapted Block food-frequency questionnaire (FFQ). Diet quality was calculated using the AHEI, broken into quartiles based on distribution of the sample. Changes in AHEI-score and associations with cardio-metabolic measures were tested, over time, using adjusted linear mixed effects models. Results The majority of the sample (n = 240) completed the FFQ at baseline and reported an average energy intake of 2016.18 Kcal/day (±1260.45) and AHEI-score (Range: 0–110, higher = better diet quality) of 47.37 (±7.36), indicating low diet quality. At 12 months follow-up, there was a reduction in calories (m = –345.75 Kcal/day (P < 0.001)), sugar-sweetened beverages (SSB) (m = –2 fluid ounces/day (P = 0.032)), red-processed meat (m = –1.5 ounces/day (P = 0.008)), and sodium (m = –650.37 mg/day (P < 0.001)) but no change in overall AHEI-score (p-value = 0.600). At baseline, the HbA1c of diabetic participants with the highest quartile AHEI-score was significantly lower (m = –1.43% (p-value = 0.048)) than those with the lowest quartile score. At 12-months the systolic blood pressure of participants with the highest quartile AHEI-score was significantly lower (m = –5.71 mm Hg (p-value = 0.038)) than those with the lowest quartile score. Conclusions Despite stable AHEI-scores during follow-up, there were improvements in diet quality domains most likely to be associated with poor cardio-metabolic health (e.g., overall calories, SSB consumption, and sodium intake). Home-visiting programs, like TOD, are promising interventions for decreasing dietary intake of poor quality foods. Funding Sources The Bristol Meyers Squibb Foundation funded the TOD Program.

Download Full-text

Cross-sectional Relationships between Alternate Healthy Eating Index (AHEI) with General and Abdominal Obesity and Blood Pressure in Iranian Hospital Employees

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530321666210810144259 ◽

2021 ◽

Vol 21 ◽

Author(s):

Shahrzad Mirashrafi ◽

Marzieh Kafeshani ◽

Akbar Hassanzadeh ◽

Mohammad Hassan Entezari

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Healthy Eating ◽

Diet Quality ◽

Healthy Eating Index ◽

Cross Sectional ◽

Hospital Employees ◽

The Mean ◽

The Relationship

Background and Aims: Due to the increasing prevalence of obesity and related disorders, there is an urgent need to examine the relationship between diet quality and public health. The Alternative Healthy Eating Index (AHEI) is one of the indices that is used to assess diet quality. Therefore, we investigated the relationship between AHEI and anthropometric measurements and blood pressure. Methods: In this cross-sectional study, 127 male and female hospital employees were examined. The AHEI was calculated by a 168 items Food Frequency Questionnaire. Body weight, height, Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Hip Ratio (WHR) and blood pressure were measured by skilled nutritionists. Physical activity level was also obtained by International Physical Activity Questionnaire (IPAQ). Results : The mean total AHEI score in participants was reported as 47.1±6.9 (min=31.9, max=60.3). The mean differences of total AHEI score across the obese/non-obese employees were not statistically significant (P>0.05). Furthermore, there was no significant correlation between total AHEI score and BMI (r=0.019), WC (r=0.022), WHR (r=-0.102), systolic (r=-0.133) and diastolic blood pressure (r=-0.040) (P>0.05). The score of nuts and soybeans was inversely related to the WHR (P=0.008) and systolic blood pressure (P=0.030). Cereal fiber score had a negative relationship with BMI (P=0.02), WC (P=0.03), WHR (P=0.004) and systolic (P<0.001) and diastolic blood pressure (P=0.012). Conclusion: Consumption of nuts and soybeans -one serving per day- can be associated with WHR and systolic blood pressure reduction. More studies with a larger scale are needed to examine diet quality.

Download Full-text

Diet Quality Index for older adults (DQI-65): development and use in predicting adherence to dietary recommendations and health markers in the UK National Diet and Nutrition Survey

British Journal Of Nutrition ◽

10.1017/s0007114521005043 ◽

2021 ◽

pp. 1-39

Author(s):

Nicole Dorrington ◽

Rosalind Fallaize ◽

Ditte A. Hobbs ◽

Michelle Weech ◽

Julie A. Lovegrove

Keyword(s):

Physical Activity ◽

Older Adults ◽

Healthy Eating ◽

Diet Quality ◽

Healthy Eating Index ◽

Dietary Quality ◽

Validity And Reliability ◽

Dietary Recommendations ◽

Nutrition Survey ◽

Cross Sectional

Abstract Diet quality indexes (DQIs) are useful tools for assessing diet quality in relation to health and guiding delivery of personalised nutritional advice, however existing DQIs are limited in their applicability to older adults (aged ≥65 years). Therefore, this research aimed to develop a novel evidence-based DQI specific to older adults (DQI-65). Three DQI-65 variations were developed to assess the impacts of different component quantitation methods and inclusion of physical activity. The variations were: Nutrient and Food-based DQI-65 (NFDQI-65), NFDQI-65 with Physical Activity (NFDQI-65+PA) and Food-based DQI-65 with Physical Activity (FDQI-65+PA). To assess their individual efficacy, the NFDQI-65, NFDQI-65+PA and FDQI-65+PA were explored alongside the validated Healthy Eating Index-2015 (HEI-2015) and Alternative Healthy Eating Index-2010 (AHEI-2010) using data from the cross-sectional UK National Diet and Nutrition Survey (NDNS) rolling programme. Scores for DQI-65 variations, the HEI-2015 and AHEI-2010 were calculated for adults ≥65 years from years 2-6 of the NDNS (n=871). Associations with nutrient intake, nutrient status and health markers were analysed using linear and logistic regression. Higher DQI-65s and HEI-2015 scores were associated with increased odds of meeting almost all of our previously proposed age-specific nutritional recommendations, and with health markers of importance for older adults, including lower body mass index, lower medication use and lower C-reactive protein (P<0.01). Few associations were observed for the AHEI-2010. This analysis suggests value of all three DQI-65s as measures of dietary quality in UK older adults. However, methodological limitations mean further investigations are required to assess validity and reliability of the DQI-65s.

Download Full-text

Adaptation and Validation of Alternative Healthy Eating Index in Hemodialysis Patients (AHEI-HD) and Its Association with all-Cause Mortality: A Multi-Center Follow-Up Study

Nutrients ◽

10.3390/nu11061407 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1407 ◽

Cited By ~ 1

Author(s):

Tuyen Van Duong ◽

I-Hsin Tseng ◽

Te-Chih Wong ◽

Hsi-Hsien Chen ◽

Tso-Hsiao Chen ◽

...

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Discriminant Validity ◽

Hemodialysis Patients ◽

Healthy Eating Index ◽

Alternative Healthy Eating Index ◽

All Cause Mortality ◽

Dietary Records ◽

A Prospective Study

A valid diet quality assessment scale has not been investigated in hemodialysis patients. We aimed to adapt and validate the alternative healthy eating index in hemodialysis patients (AHEI-HD), and investigate its associations with all-cause mortality. A prospective study was conducted on 370 hemodialysis patients from seven hospital-based dialysis centers. Dietary data (using three independent 24-hour dietary records), clinical and laboratory parameters were collected. The construct and criterion validity of original AHEI-2010 with 11 items and the AHEI-HD with 16 items were examined. Both scales showed reasonable item-scale correlations and satisfactory discriminant validity. The AHEI-HD demonstrated a weaker correlation with energy intake compared with AHEI-2010. Principle component analysis yielded the plateau scree plot line in AHEI-HD but not in AHEI-2010. In comparison with patients in lowest diet quality (tertile 1), those in highest diet quality (tertile 3) had significantly lower risk for death, with a hazard ratio (HR) and 95% confidence intervals (95%CI) of HR: 0.40; 95%CI: 0.18 – 0.90; p = 0.028, as measured by AHEI-2010, and HR: 0.37; 95%CI: 0.17–0.82; p = 0.014 as measured by AHEI-HD, respectively. In conclusion, AHEI-HD was shown to have greater advantages than AHEI-2010. AHEI-HD was suggested for assessments of diet quality in hemodialysis patients.

Download Full-text

Physical Activity and Diet Quality Modify the Association between Comorbidity and Disability among Stroke Patients

Nutrients ◽

10.3390/nu13051641 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1641

Author(s):

Lien T. K. Nguyen ◽

Binh N. Do ◽

Dinh N. Vu ◽

Khue M. Pham ◽

Manh-Tan Vu ◽

...

Keyword(s):

Physical Activity ◽

Diet Quality ◽

Negative Impact ◽

Cross Sectional Study ◽

World Health ◽

Short Version ◽

Linear Regression Models ◽

Stroke Patients ◽

Disability Score ◽

Cross Sectional

Background: Comorbidity is common and causes poor stroke outcomes. We aimed to examine the modifying impacts of physical activity (PA) and diet quality on the association between comorbidity and disability in stroke patients. Methods: A cross-sectional study was conducted on 951 stable stroke patients in Vietnam from December 2019 to December 2020. The survey questionnaires were administered to assess patients’ characteristics, clinical parameters (e.g., Charlson Comorbidity Index items), health-related behaviors (e.g., PA using the International Physical Activity Questionnaire- short version), health literacy, diet quality (using the Dietary Approaches to Stop Hypertension Quality (DASH-Q) questionnaire), and disability (using the World Health Organization Disability Assessment Schedule II (WHODAS II)). Linear regression models were used to analyze the associations and interactions. Results: The proportion of comorbidity was 49.9% (475/951). The scores of DASH-Q and WHODAS II were 29.2 ± 11.8, 32.3 ± 13.5, respectively. Patients with comorbidity had a higher score of disability (regression coefficient, B, 8.24; 95% confidence interval, 95%CI, 6.66, 9.83; p < 0.001) as compared with those without comorbidity. Patients with comorbidity and higher tertiles of PA (B, −4.65 to −5.48; p < 0.05), and a higher DASH-Q score (B, −0.32; p < 0.001) had a lower disability score, as compared with those without comorbidity and the lowest tertile of PA, and the lowest score of DASH-Q, respectively. Conclusions: Physical activity and diet quality significantly modified the negative impact of comorbidity on disability in stroke patients. Strategic approaches are required to promote physical activity and healthy diet which further improve stroke rehabilitation outcomes.

Download Full-text