The Association Between Diet Quality and Fasting Blood Glucose in People Living with HIV (P08-051-19)

Abstract Objectives The purpose of this study was to examine the association between diet quality (utilizing Healthy Eating Index-2010 [HEI-2010] total scores) and fasting blood glucose in people living with human immunodeficiency virus (PLHIV). The associations between refined grains and total fruit consumption (HEI-2010 component scores) and fasting blood glucose were also explored. Methods This was a cross-sectional analysis (N = 191) of an existing dataset from the Cardiovascular Assessment Risk Examination (CARE) study at Tufts Medical Center, Boston, MA between 2007 and 2013. It was hypothesized that there would be no association between diet quality and fasting blood glucose. Multiple linear regression was used to test the hypothesis adjusting for several a priori variables (age, race, sex, employment status, use of highly active antiretroviral therapy [HAART], living situation, body mass index, family history of type 2 diabetes [T2D] and year of enrollment). Results The mean age of the subjects was 41.1 years (SD = 7.1 years). Approximately half were white (50.8%, n = 97) and the majority were male (74.9%, n = 143). Subjects had a mean total HEI-2010 score of 49.3 out of 100 possible points with a range of 10–88 points. This is indicative of poor diet quality in this sample of PLHIV. Total protein foods and refined grains represented the component scores with the highest median scores (5.0 out of 5 possible points and 7.6 out of 10 possible points, respectively). Components with low median scores were total fruit (1.6 out of 5 possible points), whole fruit (1.4 out of 5 possible points), greens & beans (0.9 out of 5 possible points) and whole grains (1.5 out of 10 possible points). No significant associations were found between total HEI-2010 score and fasting blood glucose. No significant associations were found between the refined grains HEI-2010 component score or total fruit HEI-2010 component score and fasting blood glucose. Conclusions Overall diet quality was low in this study and the hypothesis of no association between diet quality and fasting blood glucose was supported. Additional studies are needed to determine the relationship between diet quality and fasting blood glucose in PLHIV and how to improve diet quality in this population. Funding Sources The CARE study was supported by the National Institutes of Health (R01HL065947).

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Associations between diet quality, blood pressure, and glucose levels among pregnant women in the Asian megacity of Jakarta

PLoS ONE ◽

10.1371/journal.pone.0242150 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242150

Author(s):

Deviana A. S. Siregar ◽

Davrina Rianda ◽

Rima Irwinda ◽

Annisa Dwi Utami ◽

Hanifa Hanifa ◽

...

Keyword(s):

Blood Pressure ◽

Blood Glucose ◽

Systolic Blood Pressure ◽

Pregnant Women ◽

Diastolic Blood Pressure ◽

Diet Quality ◽

Fasting Blood Glucose ◽

Healthy Eating Index ◽

Glucose Levels ◽

History Of

Background The prevalence of gestational hypertension and diabetes in pregnancy is increasing worldwide. Diet is a modifiable factor that may influence these conditions, but few studies have examined the association between diet quality and blood pressure and glucose profiles among pregnant women. Data are especially scarce for women in low- and middle-income countries (LMICs), where 90% of global pregnancies occur, and in urban settings. We, therefore, assessed these associations among 174 pregnant women in the Asian megacity of Jakarta in a cross-sectional study of the Brain Probiotic and LC-PUFA Intervention for Optimum Early Life (BRAVE) project. Methods Trained field-enumerators collected socio-demographic characteristics, measured Mid-Upper Arm Circumference (MUAC), and assessed diet by two 24-hour recalls, which were used to calculate the Alternate Healthy Eating Index for Pregnancy (AHEI-P). Blood pressure was measured by automated sphygmomanometer, and fasting blood glucose by capillary glucometer. General linear models were used to identify associations. Results The median AHEI-P score was 47.4 (IQR 19.1–76.6). The middle tertile of the AHEI-P score (39.59–56.58) was associated with a 0.4 SD (standardized effect size, 95% CI -0.7 to -0.06; p = 0.02) lower diastolic blood pressure compared with the lowest tertile (<39.59), after adjustment for level of education, smoking status, MUAC, gestational age, history of hypertension, and family history of hypertension. However, no associations were found between the AHEI-P score and systolic blood pressure and blood glucose. Conclusion Higher diet quality was associated with lower diastolic blood pressure among pregnant women in an urban LMIC community, but not with systolic blood pressure and blood glucose. A behavioral change intervention trial would be warranted to confirm the influence of diet quality on blood pressure and glucose levels and among pregnant women, and even before pregnancy.

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Changes in Maternal Diet Quality Across Pregnancy and Postpartum and Associations with Sociodemographic Characteristics

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_177 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1105-1105

Author(s):

Breanne Wright ◽

Leah Lipsky ◽

Anna Maria Siega-Riz ◽

Aiyi Liu ◽

Tonja Nansel

Keyword(s):

Diet Quality ◽

Healthy Eating Index ◽

Ratio Method ◽

Sociodemographic Characteristics ◽

Full Time ◽

College Degree ◽

Refined Grains ◽

Time Points ◽

Pregnancy And Postpartum ◽

Component Scores

Abstract Objectives This study described diet quality across the perinatal continuum and investigated associations of sociodemographic characteristics with diet quality change from pregnancy to postpartum. Methods Pregnant women (n = 365) in a prospective cohort study completed a demographic questionnaire at recruitment and six 24-hour dietary recalls (one in each pregnancy trimester and 2, 6, and 12 months postpartum). Sample-level diet quality (Healthy Eating Index-2015, HEI total and component scores) at each of the six time points was quantified using the population ratio method and compared using bootstrapping and permutation tests. Individual-level HEI scores during the pregnancy (pooling 3 pregnancy recalls) and postpartum (pooling 3 postpartum recalls) periods were quantified using the by-person method and compared using paired t-tests. Multiple linear regression models examined independent associations of sociodemographic characteristics with change in HEI (postpartum subtracted from pregnancy score). Results Sample-level HEI total and component scores were generally consistent among time points within pregnancy and within postpartum but showed varied changes between periods. Within-person analyses indicated both positive (total protein, fatty acids, refined grains, saturated fat) and negative (total fruit, whole fruit, dairy) changes in HEI from pregnancy to postpartum. Greater improvements in HEI total score were observed in white non-Hispanic versus black non-Hispanic participants (β ± SEM: 6.7 ± 3.2), participants with at least a college degree versus less than a college degree (6.8 ± 2.7), and participants who were not working by choice versus working full time (7.0 ± 2.6). In addition to associations with change in HEI total score, race/ethnicity was associated with change in greens and beans, seafood and plant proteins, and added sugars component scores, education was associated with change in total fruit and refined grains scores, and employment was associated with change in refined grains score. Age, smoking status, and body mass index were also associated with changes in HEI component scores. Conclusions Perinatal decreases in fruit and dairy intake and sociodemographic disparities in dietary changes may represent critical intervention targets. Funding Sources This research was supported by the NICHD Intramural Research Program.

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Abstract P211: Diet Quality Declines and Differs by Race in Early Childhood

Circulation ◽

10.1161/circ.135.suppl_1.p211 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Kelly Reynolds ◽

Heidi Kalkwarf ◽

Suzanne Summer ◽

Philip Khoury ◽

Marcia Gavin ◽

...

Keyword(s):

Fatty Acids ◽

Early Childhood ◽

Healthy Eating ◽

Diet Quality ◽

Dietary Intervention ◽

Healthy Eating Index ◽

Final Visit ◽

White Children ◽

Refined Grains ◽

Component Scores

Introduction: Diet quality is an important determinant of health in children, but little is known about how diet quality progresses during early childhood. We hypothesized that overall diet quality, assessed by the 2010 Healthy Eating Index, would decline during early childhood. Methods: Three hundred seventy-two (372) healthy 3-year-old children were recruited from the Greater Cincinnati area and assessed every 4 months until age 7 at in-person clinical visits, for a total of 13 visits. Parents completed 3-day diet diaries at each visit which were analyzed for nutrient composition using the Nutrition Data Systems for Research system (NDSR). The 2010 Healthy Eating Index (HEI) total and food-group component scores were calculated and averaged by year of study. Longitudinal mixed modeling was used to evaluate longitudinal trends. Results: The population was 52% (195/372) male, 78% (290/372) white and 83% (308/372) completed the final visit. HEI total scores at age 3 were poor (mean±SE: 45.2±0.4) and declined significantly between ages 3-7 (p<0.0001). None of the participants had “good” quality diet (HEI>80) at any point in the study. HEI total scores differed by race, with white children having significantly higher scores (p=0.05, Figure). HEI component scores showed a mixed pattern, with some significantly improving (protein, vegetables and fatty acids), some significantly worsening (dairy, refined grains, sodium, whole fruit and total fruit); other component scores did not change. Differences by race also varied, with African-Americans having consistently better scores for vegetables, greens and beans, protein and fatty acids (all p<0.0001), while white children had better scores for dairy, sodium and refined grains (all p<0.0005). Conclusions: The average HEI scores for young children showed poor baseline diet quality at age 3 that became gradually worse throughout early childhood. The varying patterns in HEI component scores indicate specific areas of focus for early dietary intervention, which may differ by race.

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Socio-demographic Factors Associated with Diet Quality Among a Cohort of People Living with HIV (P04-075-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.p04-075-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Joachim Sackey ◽

Grace Wang ◽

Christine Wanke ◽

Alice Tang ◽

Tamsin Knox

Keyword(s):

Diet Quality ◽

Repeated Measures ◽

Healthy Eating Index ◽

Community Dwelling ◽

People Living With Hiv ◽

Term Survival ◽

Factors Associated ◽

Cardiovascular Assessment ◽

Living With Hiv ◽

Over Time

Abstract Objectives To identify social, demographic and health factors associated with diet quality over time in a community-dwelling population of people living with HIV (PLHIV) in the Greater-Boston area. Methods Secondary analysis of data from the Cardiovascular Assessment Risk Examination (CARE) prospective cohort study carried out between 2007 and 2013. The study included 288 PLHIV recruited from the Greater-Boston area with study visits annually. Repeated measures linear regression models with diet quality [assessed using Healthy Eating Index (HEI-2010)] as the dependent variable was used to analyze the data. The HEI-2010 ranges from 0–100 with a higher score indicating higher diet quality. Results At baseline, study participants were mostly male (73%), 51 ± 7 years, unemployed (56%) and White (51%). They had been living with HIV for an average of 16years with an average CD4 count of 520 cells/mm3. Approximately one third reported being depressed (35%), being food insecure (37%), and binge drinking in the previous 6 months (30%). The mean HEI-2010 score at baseline was 48.7 ± 16.2 with male participants having a higher score (50.5) than females (43.7) (P = 0.004). Longer duration of highly active antiretroviral therapy (HAART), having an undetectable viral load, being food secure, fewer pack-years of smoking, and increasing age were independently associated with higher diet quality over time (P < 0.0001). There were no significant interactions between time and the significant independent variables. Conclusions Among this cohort of PLHIV, several sociodemographic and clinical factors were associated with higher diet quality. Interventions to improve diet quality in PLHIV should focus on younger people and those who are food insecure. In addition, clinicians should continue to push for treatment adherence and viral suppression, along with curtailing smoking. With improved long term survival due to HAART, assessment of food security and diet quality may reduce cardiometabolic risk factors and further improve mortality. Funding Sources National Heart, Lung, And Blood Institute.

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Dietary Restraint in Adolescence Predicts Diet Quality in Young Adulthood

Current Developments in Nutrition ◽

10.1093/cdn/nzaa059_040 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1323-1323

Author(s):

Megan Lawless ◽

Lenka Shriver ◽

Jessica Dollar ◽

Susan Calkins ◽

Susan Keane ◽

...

Keyword(s):

Young Adulthood ◽

Diet Quality ◽

Weight Control ◽

Dietary Restraint ◽

Poor Quality ◽

Mean Value ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Health Study ◽

Component Scores

Abstract Objectives Establishing a diet that follows the Dietary Guidelines for Americans has been associated with lower risk of mortality from cardiovascular disease and cancer. Some research has shown that individuals’ desire for weight control is an important factor in determining food choices. The aims of this study were to 1) examine dietary restraint in adolescence as a predictor of overall diet quality in young adulthood and 2) compare selected dietary components by levels of restraint. Methods Data were collected from participants enrolled in a longitudinal study in NC, the Right Track Health Study (n = 112). Dietary restraint was assessed using the 21-item subscale of the Three Factor Eating Questionnaire. Three 24-hour dietary recalls were collected to estimate dietary intake and Healthy Eating Index 2015 (HEI-2015) scores were calculated to determine diet quality. Multiple linear regression tested the association between restraint and diet quality, adjusting for sex, race, Body Mass Index-for-age percentiles and disinhibition in adolescence. Using the mean value for restraint (score of 6.64), “high restraint” and “low restraint” groups were created, and the specific HEI-2015 component scores were compared using t-tests. Level of significance was set at P < 0.05. Results Overall, participants consumed a poor-quality diet (HEI-2015 score = 50.24 ± 13.56). Higher restraint in adolescence (mean age 16.59 ± 0.39 years) was associated with higher total HEI-2015 score in young adulthood (mean age 18.74 ± 0.51) (β = 15.39 (95% CI: 3.44, 27.34) P = 0.01). The high restraint group had significantly higher HEI-component scores for total vegetables, greens and beans, total fruit, whole fruit, seafood and plant proteins, and added sugars. There were no differences between the two groups in the remaining HEI-2015 component scores (e.g., whole grains, fatty acids, sodium). Conclusions Higher dietary restraint in adolescence predicts better overall diet quality in young adulthood. Nevertheless, young adults in our sample failed to meet the federal dietary guidelines. Interventions aimed at improving diet quality should consider an individual's level of dietary restraint to better tailor nutrition advice. Funding Sources This research was supported by funding from NIH-NICHD and NIH-NIDDK.

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Effect of a Food Scholarship Program on Food Security Status and Diet Quality of College Students (P04-069-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.p04-069-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Carolyn Moore ◽

Torrey Alexis ◽

Jayna Dave ◽

Derek Miketinas ◽

Tzu-An Chen

Keyword(s):

College Students ◽

Food Security ◽

Diet Quality ◽

Short Form ◽

Healthy Eating Index ◽

Food Bank ◽

Food Security Status ◽

Scholarship Program ◽

The Impact ◽

Component Scores

Abstract Objectives To determine how food insecurity is associated with overall diet quality in college students following the implementation of a new food scholarship program. Changes of Healthy Eating Index (HEI) and food security status were compared over a 10-week period. Methods A new food scholarship program at Texas Woman's University in Houston provided students fresh fruits and vegetables, dairy and meat products, as well as non-perishable foods twice monthly. The Houston Food Bank donated all foods. Baseline and 10-week data were collected. Food security was measured with the USDA 6-item short form of the Food Security Survey Module. Total HEI-2015 and component scores were calculated from analysis of 3-day food records and compared by paired t-tests. ANCOVA estimated the impact of food security (high, low, very low) on HEI post scores, controlling for HEI baseline scores, age, gender, and race. Results Participants (n = 49) were primarily female (n = 38, 78%) with an average age of 28 ± 8 years. Ethnic/race distribution was 49% White, 27% Asian, 20% Black, and 4% other. Participants were primarily single (76%). Food security was low (31.9%) or very low (19.1%) at baseline; at post-test, participants reporting very low food secure dropped to 15.6%. Total HEI-2015 scores at baseline (55.9 ± 11.54) did not increase significantly after 10 weeks (57.7 ± 10.63) (P = 0.298). However, after 10 weeks, total vegetable scores significantly increased (2.64 ± 1.39 to 3.19 ± 1.33) (P = 0.023). There was no significant food security group effect (P = 0.49); however, there was a positive association between age and HEI post scores independent of the other model effects (β = 0.59 + 0.17; P = 0.001). Conclusions HEI-2015 total vegetable component scores increased with implementation of a food scholarship program. Nevertheless, many college students remained food insecure and overall diet quality needs improvement. Funding Sources Food donated by the Houston Food Bank.

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Daily intake of non-fried potato does not affect markers of glycaemia and is associated with better diet quality compared with refined grains: a randomised, crossover study in healthy adults

British Journal Of Nutrition ◽

10.1017/s0007114520000252 ◽

2020 ◽

Vol 123 (9) ◽

pp. 1032-1042 ◽

Cited By ~ 2

Author(s):

E. A. Johnston ◽

K. S. Petersen ◽

P. M. Kris-Etherton

Keyword(s):

Crossover Study ◽

Diet Quality ◽

Daily Intake ◽

Saturated Fat ◽

Healthy Eating Index ◽

Refined Grains ◽

Cardiometabolic Diseases ◽

Side Dish ◽

Increased Risk ◽

Potato Consumption

AbstractEpidemiological studies suggest that consumption of potatoes is associated with increased risk of cardiometabolic diseases. However, few clinical trials have empirically tested this. The aim of this single-blind, randomised, crossover study was to evaluate the effect of daily potato consumption, compared with refined grains, on risk factors for cardiometabolic diseases. It was hypothesised that no difference in cardiometabolic endpoints would be detected between conditions, but diet quality would improve with potato consumption. Healthy participants on self-selected diets received one potato-based side dish or one refined grain-based side dish daily, for 4 weeks, separated by a minimum 2-week break. Dishes were isoenergetic, carbohydrate-matched and prepared without excess saturated fat or Na. Participants were instructed to consume the side dish with a meal in place of carbohydrates habitually consumed. Lipids/lipoproteins, markers of glycaemic control, blood pressure, weight and pulse wave velocity were measured at baseline and condition endpoints. Diet quality was calculated, based on 24-h recalls, using the Healthy Eating Index (HEI)-2015. Fifty adults (female n 34; age 40 (sd 13) years; BMI 24·5 (sd 3·6) kg/m2) completed the present study. No between-condition differences were detected for fasting plasma glucose (–0·05 mmol/l, 95 % CI –0·14, 0·04; P = 0·15), the primary outcome or any other outcomes. Compared with refined grains, the HEI-2015 score (3·5, 95 % CI 0·6, 6·4; P = 0·01), K (547 mg, 95 % CI 331, 764, P < 0·001) and fibre (2·4 g, 95 % CI 0·6, 4·2, P = 0·01) were higher following the potato condition. Consuming non-fried potatoes resulted in higher diet quality, K and fibre intake, without adversely affecting cardiometabolic risk.

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Association Between Diet Quality and Prevalence of Obesity, Dyslipidemia, and Insulin Resistance Among Filipino Immigrant Women in Korea: The Filipino Women's Diet and Health Study

Frontiers in Public Health ◽

10.3389/fpubh.2021.647661 ◽

2021 ◽

Vol 9 ◽

Author(s):

Hee Sun Kim ◽

Heejin Lee ◽

Sherlyn Mae P. Provido ◽

Minji Kang ◽

Grace H. Chung ◽

...

Keyword(s):

Insulin Resistance ◽

Blood Glucose ◽

Abdominal Obesity ◽

Diet Quality ◽

Dietary Diversity ◽

Immigrant Women ◽

Fasting Blood Glucose ◽

Density Lipoprotein ◽

Health Study ◽

Prevalence Of Obesity

Objectives: Diet quality may be a key modifiable factor for the prevention of non-communicable disease. We aimed to investigate the association between diet quality and prevalence of obesity, dyslipidemia, and insulin resistance among Filipino immigrant women in Korea.Methods: A total of 413 participants from the 2014–2016 baseline population of the Filipino Women's Diet and Health Study (FiLWHEL) were examined. Individual dietary intakes were evaluated through 24-h recalls and then converted into two dietary quality assessments: Minimum Dietary Diversity for Women (MDD-W) developed by the Food and Agriculture Organization (FAO) and the Data Derived Inflammation Index (DDII) originally developed by our group. Fasting blood levels of triglycerides, high-density lipoprotein cholesterols, glucose, and insulin were measured. We used logistic regression models for odds ratios (ORs) with 95% confidence intervals (CIs).Results: We found a statistically significant association between MDD-W scores and decreased prevalence of abdominal obesity; ORs (95% CIs) of the 3rd vs. 1st tertiles were 0.58 (0.36–0.94; p for trend = 0.029). Increased DDII was associated with elevated prevalence of dyslipidemia and insulin resistance; ORs (95% CIs) of the 5th vs. 1–3rd quintiles were 6.44 (2.56–16.20) for triglycerides (TG), 3.90 (1.92–7.90) for low-density lipoprotein (LDL) cholesterol, 3.36 (1.81–6.24) for total cholesterol (TC), 6.25 (2.53–15.41) for abnormal TG/HDL ratios, 3.59 (1.96–6.59) for HbA1c, 2.61 (1.11–6.17) for fasting blood glucose levels, 9.67 (4.16–22.48) for insulin levels, and 9.73 (4.46–21.25) for homeostasis model assessment of insulin resistance (HOMA-IR) (p for trend <0.001 for all, except 0.033 for fasting blood glucose).Conclusions: Greater dietary diversity was inversely associated with the prevalence of abdominal obesity in Filipino immigrant women. Proinflammatory scores based on diet and lifestyle factors were associated with an increased prevalence of dyslipidemia and insulin resistance. Further, epidemiological studies on the relationship between dietary acculturation and chronic disease are warranted.

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Meal and snack frequency in relation to diet quality in Japanese adults: a cross-sectional study using different definitions of meals and snacks

British Journal Of Nutrition ◽

10.1017/s0007114520002317 ◽

2020 ◽

Vol 124 (11) ◽

pp. 1219-1228 ◽

Cited By ~ 1

Author(s):

Kentaro Murakami ◽

Nana Shinozaki ◽

M. Barbara E. Livingstone ◽

Aya Fujiwara ◽

Keiko Asakura ◽

...

Keyword(s):

Diet Quality ◽

Cross Sectional Study ◽

Time Of Day ◽

Healthy Eating Index ◽

Meal Frequency ◽

Sectional Study ◽

Cross Sectional ◽

Japanese Adults ◽

Dietary Record ◽

Component Scores

AbstractEpidemiological evidence on the association between eating frequency and overall diet quality does not represent a consistent picture. This cross-sectional study examined the associations of meal frequency and snack frequency with diet quality, using different definitions of meals and snacks. Based on 4-d weighed dietary record data obtained from 639 Japanese adults aged 20–81 years, all eating occasions were divided into meals or snacks based on either the participant-identified or time-of-day definitions. Diet quality was assessed by the Healthy Eating Index-2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3). One additional meal per d increased the HEI-2015 total score by 3·6 and 1·3 points based on the participant-identified and time-of-day definitions, respectively. A higher meal frequency was also associated with higher values of some of the HEI-2015 component scores (total vegetables, greens and beans, and total protein foods), irrespective of how meals were defined. Additionally, one additional participant-identified snack per d increased the HEI-2015 total score by 0·7 points. The frequency of participant-identified snacks also showed positive associations with some of the HEI-2015 component scores (total fruits, whole fruits, total vegetables, greens and beans, dairy products, and Na). However, the frequency of time-of-day defined snacks was not associated with the total scores of HEI-2015, although there were some associations for its components. Similar findings were obtained when the NRF9.3 was used. In conclusion, higher meal frequency was consistently associated with higher diet quality, while associations between snack frequency and diet quality varied depending on the definition of snacks.

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The effects of skipping a meal on daily energy intake and diet quality

Public Health Nutrition ◽

10.1017/s1368980020000683 ◽

2020 ◽

Vol 23 (18) ◽

pp. 3346-3355

Author(s):

Eliana Zeballos ◽

Jessica E Todd

Keyword(s):

Food Intake ◽

Energy Intake ◽

Diet Quality ◽

Energy Content ◽

Whole Grains ◽

Healthy Eating Index ◽

Daily Energy Intake ◽

Daily Energy ◽

Skipping Breakfast ◽

Component Scores

AbstractObjective:To examine whether skipping breakfast or lunch increased the next meal’s energy content and changed total daily energy content and the quality of food intake measured by the 2010 Healthy Eating Index (HEI-2010).Design:Means were compared across intake days and meal patterns. Multivariate individual fixed-effects model was used to account for individual food intake and diet quality preferences.Setting:National Health and Nutrition Examination Survey, 2007–2016.Participants:Adults aged 18 years or older who reported 2 d (24-h periods) of dietary intake and were not pregnant or lactating (n 23 488).Results:Adults consumed 193 more kJ at lunch after skipping breakfast and 783 more kJ at dinner after skipping breakfast and lunch. Skipping at least one meal reduced total daily intake between 1053 (breakfast) and 1464 (dinner) kJ and reduced the daily HEI score. Skipping breakfast or skipping lunch reduced the HEI component scores for fruit, whole grains, dairy and empty energy; skipping lunch reduced the component scores for fruit, vegetables, whole grain, dairy, seafood and plant protein, and empty energy. Skipping dinner reduced component scores for vegetables, greens and beans, dairy, protein food, seafood and plant proteins, and empty energy. Skipping one or more meals increased component scores for total vegetables (breakfast), whole grains (dinner), Na (lunch or dinner) and refined grains (breakfast, lunch or dinner).Conclusions:Skipping meals (particularly dinner) reduces daily energy intake, but the reduction in daily diet quality (particularly when skipping breakfast) may impact health negatively over time.

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