A Nationally Representative Analysis of Trends in Socioeconomic Inequities in Diet Quality Between 2004 and 2015 Among Adults Living in Canada

Abstract Objectives Diet quality is a key determinant of chronic disease and shares a similar socioeconomic patterning. Inequities in diet quality are stable or widening in the US, however these trends have not been examined in other nations. Moreover, prior US studies only examined differences in diet quality between the most and least disadvantaged groups in absolute terms. Quantifying trends in relative terms and along the full socioeconomic gradient according to multiple indicators of socioeconomic position (SEP) can provide a more comprehensive perspective to inform optimal points of intervention. The purpose of this study was to quantify nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to three indicators of SEP among adults living in Canada. Methods Adults (≥18 years) who participated in the nationally representative, cross-sectional Canadian Community Health Survey - Nutrition in 2004 (n = 20,880) or 2015 (n = 13,970) were included. SEP was classified based on annual gross household income (quintiles), education (5 categories) and neighborhood deprivation (quintiles). Dietary intake data from interviewer-administered 24-hour recalls were used to derive Healthy Eating Index-2015 scores. Dietary inequities were quantified using four indices: absolute gaps, relative gaps, absolute gradients (slope index of inequality) and relative gradients (relative index of inequality). Sex-stratified multivariable linear regression models examined trends in HEI-2015 scores between 2004 and 2015. Results Mean HEI-2015 scores improved significantly from 55.3 in 2004 to 59.0 in 2015 (maximum 100 points); however these trends were not consistently equitable. While inequities in HEI-2015 scores were stable in females, the absolute gap and gradient in HEI-2015 scores according to household income increased in males, as did the absolute gradient according to education. Conclusions Absolute and relative gaps and gradients in diet quality remained stable or widened between 2004 and 2015 in Canada. Novel policies are needed to tackle these avoidable inequities. Providing universal access to resources with a scale and intensity proportionate to need (i.e., proportionate universalism) may reduce inequities in diet quality and thus, chronic disease risk. Funding Sources Not applicable.

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Poorer Diet Quality Observed Among US Adults With a Greater Number of Clinical Chronic Disease Risk Factors

Journal of Primary Care & Community Health ◽

10.1177/2150132720945898 ◽

2020 ◽

Vol 11 ◽

pp. 215013272094589

Author(s):

Stephanie M. Fanelli ◽

Satya S. Jonnalagadda ◽

Janell L. Pisegna ◽

Owen J. Kelly ◽

Jessica L. Krok-Schoen ◽

...

Keyword(s):

Chronic Disease ◽

Diet Quality ◽

Chronic Conditions ◽

Healthy Lifestyle ◽

Disease Risk ◽

Healthy Eating Index ◽

Dietary Intakes ◽

Chronic Disease Risk ◽

Total Score Range ◽

Significant Difference

Background Obesity and chronic disease risk are significantly related to healthy lifestyle behavior, including dietary intakes. Further, the interrelated etiology of many chronic conditions supports the comorbidity in US adults to manage multiple diagnoses. The purpose of this study was to assess diet quality across varying numbers of existing conditions, including obesity, hypercholesterolemia, hyperglycemia, and hypertension. Methods Cross-sectional analysis of data from 17 356 adults aged 45 years and older from the 2005-2016 National Health and Nutrition Examination Survey were assessed for the presence of overweight or obesity (body mass index >25 kg/m2), hyperglycemia (glycated hemoglobin >5.7%), hypercholesterolemia (>200 mg/dL), and high blood pressure (>120/80 mm Hg). Overall diet quality was assessed using Healthy Eating Index 2015 scores computed from the intakes reported during the 24-hour dietary recall collected in the mobile examination center. The total score (range 0-100) is based on the sum of 13 subscales that represent concordance with the Dietary Guidelines for Americans. Results Few adults presented with no markers of chronic disease (n = 407), with other presenting 1 indicator (n = 1978), 2 indicators (n = 4614), 3 indicators (n = 6319), and all 4 indicators (4038). While there was no significant difference in mean energy intakes on the day of intake, those with all 4 markers of chronic disease had a significantly poorer diet quality ( P < .001) and consumed significantly more saturated fat ( P = .026), but significantly less total carbohydrates, dietary fiber, and added sugars ( P < .005). While mean consumption of protein was lowest in those with more chronic conditions, the differences were not significant. Conclusion Overall dietary intakes from the day of intake indicated that those with a greater number of chronic conditions presented with poorer overall dietary intakes. The foundational intervention strategy across all evidence-based treatment strategies is the promotion of healthy lifestyle behaviors.

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Caregiver Status and Diet Quality in Community-Dwelling Adults

Nutrients ◽

10.3390/nu13061803 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1803

Author(s):

Sharmin Hossain ◽

May A. Beydoun ◽

Michele K. Evans ◽

Alan B. Zonderman ◽

Marie F. Kuczmarski

Keyword(s):

Diet Quality ◽

Healthy Aging ◽

Healthy Eating Index ◽

Community Dwelling ◽

Rate Of Change ◽

Least Square ◽

Inverse Association ◽

Linear Regression Models ◽

Middle Aged ◽

Cross Sectional

Objective: We investigated cross-sectional and longitudinal associations of diet quality with middle-aged caregiver status. Methods: Caregiving in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (57.7% women, 62% African American (AA)) was measured at waves 3 (2009–2013) and 4 (2013–2017) (mean follow-up time 4.1 years). Diet quality was assessed by the Healthy Eating Index 2010 (HEI-2010) derived from two separate 24 h diet recalls. Multivariable ordinary least square regression was performed for cross-sectional analyses of the association of wave 4 caregiving with wave 4 HEI-2010. Wave 3 caregiving was examined both cross-sectionally and with annual rate of change in HEI using mixed-effects linear regression Models. Multivariable models were adjusted for age, sex, and poverty status. Results: Cross-sectional analyses at wave 4 demonstrate an inverse association of frequent caregiving (“Daily or Weekly” vs. “Never”) for grandchildren with HEI-2010 total score (i.e., lower diet quality) among Whites (β = −2.83 ± 1.19, p = 0.03, Model 2) and AAs (β = −1.84 ± 0.79, p = 0.02,). The “cross-sectional” analysis pertaining to grandchildren caregiving frequency suggested that frequent caregiving (i.e., “Daily or Weekly” vs. “Never” (β = −2.90 ± 1.17, p = 0.04)) only among Whites was inversely related to HEI-2010 total score. Total HEI-2010 score was also related to caring (Model 1), for the elderly over “5 years vs. Never” among Whites (−7.31 ± 3.54, p = 0.04, Model 2). Longitudinally, we found slight potential improvement in diet quality over time (“Daily or Weekly” vs. Never by TIME interaction: +0.88 ± 0.38, p = 0.02) with frequent caregiving among Whites, but not so among AAs. Conclusions: Frequent caring for grandchildren had an inverse relationship with the diet quality of White and AA urban middle-aged caregivers, while caring for elderly was inversely linked to diet quality among Whites only. Longitudinal studies should address the paucity of research on caregivers’ nutritional quality.

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Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance

American Journal of Clinical Nutrition ◽

10.1093/ajcn/76.6.1261 ◽

2002 ◽

Vol 76 (6) ◽

pp. 1261-1271 ◽

Cited By ~ 604

Author(s):

Marjorie L McCullough ◽

Diane Feskanich ◽

Meir J Stampfer ◽

Edward L Giovannucci ◽

Eric B Rimm ◽

...

Keyword(s):

Chronic Disease ◽

Diet Quality ◽

Disease Risk ◽

Men And Women ◽

Chronic Disease Risk ◽

Major Chronic Disease

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Diet Quality among Women with Previous Gestational Diabetes Mellitus in Rural Areas of Hunan Province

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165942 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5942

Author(s):

Mingshu Li ◽

Jingcheng Shi ◽

Jing Luo ◽

Qing Long ◽

Qiping Yang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Ethnic Minority ◽

Diet Quality ◽

Rural Areas ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Hunan Province ◽

Linear Regression Models

Diet quality is critical for postpartum type 2 diabetes mellitus (T2DM) progression among women with a history of gestational diabetes mellitus (GDM). The Chinese Healthy Eating Index (CHEI) is a dietary index developed according to the latest Chinese Dietary Guidelines (CDG-2016). Our study aimed to assess the diet quality of women with previous GDM in rural areas of Hunan Province by applying the CHEI. Women with previous GDM in two counties of Hunan were enrolled. Their food intake data, which were used to calculate their CHEI scores, were collected by a 24-h dietary recall. The association of CHEI with sociodemographic and anthropometric variables was evaluated via linear regression models. 404 women were included in the final analysis. The mean score of the total CHEI was 54.9 (SD 7.9). The components of whole grains and mixed beans, seeds and nuts, tubers, dairy, and poultry scored extremely low. Ethnic minority groups and women younger than 30 years had lower CHEI scores. Our study observed an unsatisfactory diet quality among women with previous GDM in rural areas of Hunan Province. Future dietary education focusing on the CDG is needed to improve their diet quality and help in T2DM prevention among this population, especially young and ethnic minority women.

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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.

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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.

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The Relationship Between the Frequency of Meals Consumed Away-From-Home on the Total Diet Quality and Weight Status

Current Developments in Nutrition ◽

10.1093/cdn/nzaa043_099 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 248-248

Author(s):

Ana Moyeda Carabaza ◽

Phrashiah Githinji ◽

Bong Nguyen ◽

Mary Murimi

Keyword(s):

Fatty Acids ◽

Dietary Fiber ◽

Diet Quality ◽

Trans Fatty Acids ◽

Weight Status ◽

Healthy Eating Index ◽

Dietary Quality ◽

Linear Regression Models ◽

Saturated Fats ◽

Total Diet

Abstract Objectives To assess factors that contribute to the total diet quality and the associated body mass index (BMI) among adults. Methods A cross-sectional study was conducted to assess dietary quality using the Healthy Eating Index (HEI)-2015 among faculty and staff (N = 152) of a public university. The Food Frequency Questionnaire from the Health and Retirement Study was administered via Qualtrics. Dietary quality was determined using the HEI-2015. Weight, height, number of meals consumed away-from-home per week were self-reported. Descriptive statistics were used to analyze demographic characteristics, number of meals consumed away-from-home, dietary intake, and associated HEI score was calculated. Linear regression models were used to measure associations between the total diet quality, nutrient intakes and the number of away-from-home meals consumed with BMI. Results The average age of participants was 34.3 ± 12.3 years. A majority were female and white Americans (74.3%) and had post-secondary education (79.6%). Approximately, one-third of participants (32.2%) reported having a BMI equal or greater than 30 kg/m2. More than half of the participants exceeded the recommended limit for the consumption of saturated fats (69.7%), and sodium (52.6%); and a majority did not meet the minimum recommended intakes of dietary fiber (96.1%). The average HEI score was 66.34 on a 100-point scale. Only 14.5% had a good dietary quality with a HEI score equal or higher than 80. The number of away-from-home meals consumed per week were associated with an increased intake of trans fatty acids (P < .05), while, increased the consumption of trans fatty acids was associated with an increase in BMI (P < .001) in this study. On the contrary, an increase in the HEI score was associated with a reduction in BMI (P < .05). Conclusions This study found that a high percentage of participants had a low diet quality that was characterized by excessive intake of both saturated fats and sodium and inadequate intake of dietary fiber. In addition, the consumption of meals away-from-home was associated with an increase in the amount of trans fatty acids consumed. Concurrently, the consumption of trans fatty acids was associated with an increase in BMI. These results underscore the importance of eating meals prepared at home in an effort to control weight gain. Funding Sources TTU Transdisciplinary Research Academy.

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Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the Risks

Frontiers in Nutrition ◽

10.3389/fnut.2021.702802 ◽

2021 ◽

Vol 8 ◽

Author(s):

Lee Crosby ◽

Brenda Davis ◽

Shivam Joshi ◽

Meghan Jardine ◽

Jennifer Paul ◽

...

Keyword(s):

Chronic Disease ◽

Chronic Diseases ◽

Diet Quality ◽

Disease Risk ◽

Epidemiological Studies ◽

Short Term ◽

Chronic Disease Risk ◽

Ketogenic Diets ◽

Low Carbohydrate

Very-low-carbohydrate ketogenic diets have been long been used to reduce seizure frequency and more recently have been promoted for a variety of health conditions, including obesity, diabetes, and liver disease. Ketogenic diets may provide short-term improvement and aid in symptom management for some chronic diseases. Such diets affect diet quality, typically increasing intake of foods linked to chronic disease risk and decreasing intake of foods found to be protective in epidemiological studies. This review examines the effects of ketogenic diets on common chronic diseases, as well as their impact on diet quality and possible risks associated with their use. Given often-temporary improvements, unfavorable effects on dietary intake, and inadequate data demonstrating long-term safety, for most individuals, the risks of ketogenic diets may outweigh the benefits.

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A lipid-related metabolomic pattern of diet quality

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa242 ◽

2020 ◽

Vol 112 (6) ◽

pp. 1613-1630

Author(s):

Minoo Bagheri ◽

Walter Willett ◽

Mary K Townsend ◽

Peter Kraft ◽

Kerry L Ivey ◽

...

Keyword(s):

Diet Quality ◽

Eating Behaviors ◽

Principal Component ◽

Cross Sectional Study ◽

Healthy Eating Index ◽

Health Study ◽

Linear Regression Models ◽

Cross Sectional ◽

Unhealthy Eating ◽

Complementary Approach

ABSTRACT Background Adherence to a healthy diet has been associated with reduced risk of chronic diseases. Identifying nutritional biomarkers of diet quality may be complementary to traditional questionnaire-based methods and may provide insights concerning disease mechanisms and prevention. Objective To identify metabolites associated with diet quality assessed via the Alternate Healthy Eating Index (AHEI) and its components. Methods This cross-sectional study used FFQ data and plasma metabolomic profiles, mostly lipid related, from the Nurses’ Health Study (NHS, n = 1460) and Health Professionals Follow-up Study (HPFS, n = 1051). Linear regression models assessed associations of the AHEI and its components with individual metabolites. Canonical correspondence analyses (CCAs) investigated overlapping patterns between AHEI components and metabolites. Principal component analysis (PCA) and explanatory factor analysis were used to consolidate correlated metabolites into uncorrelated factors. We used stepwise multivariable regression to create a metabolomic score that is an indicator of diet quality. Results The AHEI was associated with 83 metabolites in the NHS and 96 metabolites in the HPFS after false discovery rate adjustment. Sixty-three of these significant metabolites overlapped between the 2 cohorts. CCA identified “healthy” AHEI components (e.g., nuts, whole grains) and metabolites (n = 27 in the NHS and 33 in the HPFS) and “unhealthy” AHEI components (e.g., red meat, trans fat) and metabolites (n = 56 in the NHS and 63 in the HPFS). PCA-derived factors composed of highly saturated triglycerides, plasmalogens, and acylcarnitines were associated with unhealthy AHEI components while factors composed of highly unsaturated triglycerides were linked to healthy AHEI components. The stepwise regression analysis contributed to a metabolomics score as a predictor of diet quality. Conclusion We identified metabolites associated with healthy and unhealthy eating behaviors. The observed associations were largely similar between men and women, suggesting that metabolomics can be a complementary approach to self-reported diet in studies of diet and chronic disease.

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Diet quality in late midlife is associated with faster walking speed in later life in women, but not men: findings from a prospective British birth cohort

British Journal Of Nutrition ◽

10.1017/s0007114519003313 ◽

2019 ◽

Vol 123 (8) ◽

pp. 913-921 ◽

Cited By ~ 1

Author(s):

Thanasis G. Tektonidis ◽

Shelly Coe ◽

Patrick Esser ◽

Jane Maddock ◽

Sarah Buchanan ◽

...

Keyword(s):

Sex Differences ◽

Diet Quality ◽

Walking Speed ◽

Later Life ◽

Healthy Eating Index ◽

Healthy Diet ◽

Linear Regression Models ◽

Physical Capability ◽

Age Related ◽

Late Midlife

AbstractHealthy diet has been linked to better age-related functioning, but evidence on the relationship of diet quality in late midlife and measures of physical capability in later life is limited. Research on potential sex differences in this relationship is scarce. The aim was to investigate the prospective association between overall diet quality, as assessed by the Healthy Eating Index-2015 (HEI-2015) at 60–64 years and measures of walking speed 7 years later, among men and women from the Insight 46, a neuroscience sub-study of the Medical Research Council National Survey of Health and Development. Diet was assessed at 60–64 years using 5-d food diaries, from which total HEI-2015 was calculated. At 69–71 years, walking speed was estimated during four 10-m walks at self-selected pace, using inertial measurement units. Multivariable linear regression models with sex as a modifier, controlling for age, follow-up, lifestyle, health/social variables and physical performance, were used. The final sample consists of 164 women and 167 men (n 331). Women had higher HEI-2015 and slower walking speed than men. A 10-point increase in HEI-2015 was associated with faster walking speed among women (B 0·024, 95 % CI 0·006, 0·043), but not men. The association remained significant in the multivariable model (B 0·021, 95 % CI 0·003, 0·040). In women, higher diet quality in late midlife is associated with faster walking speed. A healthy diet in late midlife is likely to contribute towards better age-related physical capability, and sex differences are likely to affect this relationship.

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