A comparison of diet quality indices in a nationally representative cross-sectional study of Iranian households

Abstract Background Iranian diet quality has been evaluated using indices that have not been created based on Iranian dietary guidelines. This study aimed to examine the applicability of two diet quality indices by examining their associations with nutrient adequacy, nutrient intakes and sociodemographics. Methods Dietary data were collected using three 24-h dietary recalls from Iranian households. Nutrient adequacy was assessed using World Health Organization/Food and Agriculture Organization 2002 (WHO/FAO) cut points. Household diet quality was calculated using the Healthy Eating Index (HEI) and Diet Quality Index-International (DQI-I). Sociodemographics of the household members were assessed. Regression analyses were used to examine associations between diet quality and nutrient adequacy, and between sociodemographics and diet quality. Results A total of 6935 households were included in the analysis. Higher household diet quality was associated with adequate intake of calcium (HEI: OR 1.11, 95% CI: 1.10, 1.13; DQI-I: OR 1.14, 95% CI: 1.13, 1.16), vitamin C (HEI: OR 1.19, 95% CI: 1.17, 1.20; DQI-I: OR 1.12, 95% CI: 1.11, 1.12) and protein (HEI: OR 1.01, 95% CI: 1.00, 1.02; DQI-I: OR 1.09, 95% CI: 1.08, 1.09). Higher household diet quality was associated with household heads who were older (> 56 years old) (HEI: β 2.06, 95% CI: 1.63, 2.50; DQI-I β 2.90, 95% CI: 2.34, 3.45), higher educated (college/university completed) (HEI: β 4.54, 95% CI: 4.02, 5.06; DQI-I: β 2.11, 95% CI: 1.45, 2.77) and living in urban areas (HEI: β 2.85, 95% CI: 2.54, 3.16; DQI-I: β 0.72, 95% CI: 0.32, 1.12). Conclusions Based on associations with nutrient adequacy and sociodemographics, the applicability of two diet quality indices for assessing the diet quality of Iranian households was demonstrated. Results also indicated DQI-I may be more applicable than HEI for evaluating Iranian nutrient adequacy. Findings have implications for the design and assessment of diet quality in Iranian populations. Future research should examine the link between these diet quality indices and health outcomes.

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Diet quality among Iranian adolescents needs improvement

Public Health Nutrition ◽

10.1017/s1368980014000767 ◽

2014 ◽

Vol 18 (4) ◽

pp. 615-621 ◽

Cited By ~ 16

Author(s):

Leila Azadbakht ◽

Fahime Akbari ◽

Ahmad Esmaillzadeh

Keyword(s):

Diet Quality ◽

Dietary Diversity ◽

Healthy Eating Index ◽

Dietary Quality ◽

Dietary Intakes ◽

Quality Indices ◽

Cross Sectional ◽

Nutrient Adequacy ◽

Mean Adequacy Ratio ◽

Systematic Cluster

AbstractObjectiveDiet in adolescence is important not only because of adolescents’ rapid growth but also due to its influence on future chronic diseases. On the other hand, dietary quality indices are noteworthy and useful approaches to evaluate dietary intakes. Thus the present study was conducted to assess dietary quality indices in adolescents.DesignCross-sectional.SettingsThe data were collected from schools in Isfahan, Iran.SubjectsFemale students (n 265) aged 11–13 years were enrolled using systematic cluster-random sampling in Isfahan (Iran). Dietary intakes were assessed by a validated FFQ. Diet quality indices including dietary diversity score (DDS), the Healthy Eating Index (HEI) and mean adequacy ratio (MAR) across ten nutrients were calculated.ResultsMean DDS, HEI score and MAR were 6·15 (sd 1·61) out of 10 points, 63·90 (sd 19·86) out of 100 points and 1·32 (sd 0·61), respectively. Mean nutrient adequacy ratio of all nutrients was above 1 except for vitamin D (0·53 (sd 0·51)). Those in the highest tertile of DDS had the most favourable anthropometric variables in comparison to the lowest tertile. There were no significant associations between HEI score and BMI, central or abdominal obesity and blood pressure. Those in the highest tertile of MAR had higher BMI, waist circumference and hip circumference.ConclusionsDiet quality of Isfahani adolescents needs improvement. It may imply the necessity of implementing nutritional instructive policies in this age group and their parents.

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1055The applicability of the Healthy Eating Index to measure Iranian diet quality

International Journal of Epidemiology ◽

10.1093/ije/dyab168.185 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Sara Ebrahimi ◽

Rebecca Leech ◽

Sarah McNaughton ◽

Katherine Livingstone

Keyword(s):

Vitamin C ◽

Healthy Eating ◽

Diet Quality ◽

Urban Areas ◽

Household Head ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Dietary Intakes ◽

Nutrient Intakes ◽

Nutrient Adequacy

Abstract Background Iranian diet quality has been evaluated using indices that are not based on Iranian dietary guidelines. This study examined the applicability of the Healthy Eating Index (HEI) by examining associations with sociodemographics, nutrient intakes and nutrient adequacy. Methods Household sociodemographics and dietary intakes (three 24-h dietary recalls) were collected in the cross-sectional National Comprehensive Study on Household Food Consumption Patterns and Nutritional Status 2001-2003. Household diet quality was calculated using the HEI. Regression analyses examined associations between diet quality and sociodemographics, nutrient intakes and nutrient adequacy. Results A total of 6584 households were included in this study. Age (β-coeff 2.11; 95% CI: 1.64, 2.44), education (β-coeff 4.58; 4.05, 5.11) and living in urban areas (β-coeff 2.87; 2.56, 3.19) (as reported by the household head) were positively associated with diet quality. Higher diet quality was associated with higher intake of protein (% energy) (β-coeff 0.08; 0.07, 0.08), calcium (mg/day) (β-coeff 12.10; 11.23, 12.98), iron (mg/day) (β-coeff 0.04; 0.02, 0.05), vitamin C (mg/day) (β-coeff 3.61; 3.45, 3.77) and fibre (g/day) (β-coeff 0.12; 0.11, 0.14), lower intake of sodium (mg/day) (β-coeff -83.45; -93.02, -73.88) and adequate intake of calcium (mg/day) (OR 1.10; 95% CI: 1.09, 1.12) and vitamin C (mg/day) (1.19; 1.18, 1.20). Conclusions Higher HEI was associated with a range of sociodemographics and better nutrient intakes and nutrient adequacy. Key messages HEI was applicable for assessing the diet quality of Iranian households.

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

10.21203/rs.3.rs-1061469/v1 ◽

2021 ◽

Author(s):

Atiyeh Nayebi ◽

Davood Soleimani ◽

Shayan Mostafaei ◽

Negin Elahi ◽

Homayoun Elahi ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Healthy Eating ◽

Diet Quality ◽

Linear Trend ◽

Cross Sectional Study ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

P Value ◽

Cross Sectional

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

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Determinants of Fast Food Consumption Among Puerto Rican Adults Living in a Rural Community

Current Developments in Nutrition ◽

10.1093/cdn/nzaa046_003 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 503-503

Author(s):

Kiara Amaro-Rivera ◽

Elena Carbone

Keyword(s):

Food Consumption ◽

Rural Community ◽

Diet Quality ◽

Urban Areas ◽

Fast Food ◽

Weight Status ◽

Future Research ◽

Poverty Level ◽

Cross Sectional ◽

Fast Food Consumption

Abstract Objectives The aim of this study was to explore the association between fast food consumption, sociodemographic and health-related variables among adults living in a small rural community in Puerto Rico. Methods This study was cross-sectional. A researcher-designed questionnaire was distributed to every household in the community. A multivariable logistic regression was conducted to examine the association between fast food consumption (<1 or ≥1 time/week), and the following independent variables: age; gender; education; poverty level estimate; employment status; weight status; self-rated health; self-perceived diet quality; self-perceived weight status; currently trying to lose weight; fruit, non-starchy vegetables, starchy vegetables, and sugar-sweetened beverages (SSB) intake; physical activity; and recreational screen time. Results A total of 195 adults aged ≥18 years participated in this study. Of these, 53.1% were female, 53.1% completed more than high school, 45.4% were employed, 28.7% were overweight and 32.3% were obese. Over one-third (34.9%) of participants reported consuming fast food ≥1 time/week. Eating fast food ≥1 time/week was associated with ages 35–49 years (OR = 0.38, 95% CI: 0.16–0.94) and ≥50 years (OR = 0.09, 95% CI: 0.03–0.32) as compared to being 18–34 years old; being unemployed/homemaker/disabled (OR = 0.24, 95% CI: 0.08–0.73) as compared to being employed; being obese (OR = 3.17, 95% CI: 1.02–9.85) as compared to being under/normal weight; currently trying to lose weight (OR = 3.00, 95% CI: 1.31–6.88) as compared to those not trying to lose weight; eating fewer than 1 cup of non-starchy vegetables daily (OR = 0.39 95% CI: 0.16–0.93) as compared to those who eat ≥1cup daily; and drinking SSB ≥1 times daily (OR = 3.80 95% CI: 1.50–9.60) as compared to those who drink SSB less than once daily in the adjusted model. Conclusions Fast food consumption was associated with older age, employment, obesity, trying to lose weight, and intake of non-starchy vegetables and SSB in our sample. Future research should examine the relationship between fast food consumption and diet quality among those living in rural communities, as previous research has shown that Puerto Ricans living in urban areas are undergoing a nutrition transition to lower quality diets. Funding Sources The authors received no financial support for this research.

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Diet Quality and the Fecal Microbiota in Healthy Adults in the American Gut Project

Current Developments in Nutrition ◽

10.1093/cdn/nzaa062_003 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1546-1546

Author(s):

Alexis Baldeon ◽

Jordan Lovett ◽

Hannah Holscher

Keyword(s):

Diet Quality ◽

Fecal Microbiota ◽

Healthy Eating Index ◽

Healthy Adults ◽

Dietary Guidelines ◽

Rrna Gene ◽

Gastrointestinal Microbiota ◽

Cross Sectional ◽

Food And Agriculture ◽

Relative Abundances

Abstract Objectives The human gastrointestinal microbiota contributes to the relationship between diet and health via microbial metabolism of undigested food components. Thus, it is valuable to understand the relations between gut microorganisms and diet quality. Herein, we examined the associations between compliance to the Dietary Guidelines for Americans, as measured by the Healthy Eating Index (HEI) 2010 scores, and the fecal microbiota in a subset of healthy adults in the American Gut Project cohort. Methods This was a cross-sectional observational study of healthy adults (n = 1,573 (984 females); BMI:18.5-29.9 kg/m2; 20–90 years of age) from the American Gut Project cohort who provided a stool sample and completed a Food Frequency Questionnaire (FFQ; VioScreen). Fecal samples were processed using Earth Microbiome Project protocols. Briefly, DNA was extracted from the stool samples and the V4 region of the 16S rRNA gene was amplified and sequenced. Taxonomies were determined using Greengenes 13_8. HEI-2010 scores were calculated by VioScreen, and for the purposes of this study, further divided into tertiles. Bacterial genera that were present in at least 50% of the cohort were assessed. Bacterial relative abundances between high and low tertiles of HEI total score were compared using the Mann-Whitney test. Corrections for multiple comparisons were made using a false discovery rate of 5%. Results Greater abundances of the genera Faecalibacterium, Coprococcus, and Lachnospira were detected among participants within the highest HEI total score tertile (q < 0.03). Alternatively, the relative abundances of Bacteroides, Alistipes, Bilophila, and Collinsella were greatest among those with the lowest HEI total score (q < 0.03). Conclusions These results reveal that higher HEI-2010 total scores were associated with greater abundances of SCFA-producing microorganisms but inversely associated with bile-tolerant taxa. Ongoing analyses include further examination of relations between the 12 different components of the HEI-2010, as well as examining differences among demographic groups. Funding Sources USDA National Institute of Food and Agriculture, Hatch Project 1009249.

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

Circulation ◽

10.1161/circ.141.suppl_1.p360 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Stephanie Harrison ◽

Didier Brassard ◽

Simone Lemieux ◽

Benoit Lamarche

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Nutritive Value ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Food Sources ◽

Dietary Intakes ◽

Trans Fat ◽

Quality Indices ◽

Saturated Fats

Background: Canadian dietary guidelines include a recommendation to limit the consumption of foods high in saturated fats (SFA), regardless of their dietary source. The same guidelines also recommend consumption of lean red meat and low-fat dairy products. Yet, the association between the consumption of SFA from different food sources and diet quality is currently unknown. The objective of this study was to examine associations between SFA from various food sources and different indices of diet quality. Methods: Analyses are based on a sample of 11 106 respondents representative of Canadian adults (19-70 y) from the 2015 Canadian Community Health Survey (CCHS 2015). Dietary intakes and diet quality indices were calculated using a single interview-administered 24-hour recall. Food sources of SFA were classified according to the 2019 Canada’s Food Guide categories: 1) vegetables and whole fruits, 2) whole grain foods and 3) protein foods (including dairy and meat, among others). Foods not included in these three categories were grouped as All other foods . The 2010 alternative Healthy eating index (aHEI), the 2015 Healthy eating index (HEI-2015) and the 2007 Canadian Healthy eating index (C-HEI) were calculated. Due to the unreliability of data for trans-fat consumption in the CCHS 2015 database, the trans-fat subscore of the aHEI was removed from the original score. Results: While total SFA intake and SFA from All other foods were inversely correlated with all indices of diet quality (-0.55<r<-0.10, all p<0.001), associations with SFA from dairy and meat were inconsistent. SFA from dairy were inversely correlated (p<0.001) with the aHEI (r=-0.14) and the HEI-2015 (r=-0.16) but showed a weak positive correlation with the C-HEI (r=0.05, p<0.001). SFA from meat were negatively correlated with the aHEI (r=-0.21, p<0.001) and positively correlated with the C-HEI (r=0.11, p<0.001). Removing subscores directly related to SFA intake in diet quality indices yielded positive correlations between SFA from dairy and the HEI-2015 (r=0.13, p<0.001) and the C-HEI (r=0.19, p<0.001). Conclusion: Consumption of SFA from different food sources are inconsistently associated with different indices of overall diet quality. Unsurprisingly, SFA from All other foods , which include low nutritive value foods, showed the strongest negative correlation with all diet quality scores. These results provide further support to the notion that guidance on SFA in future health policies should focus on food sources rather than on total intake of SFA.

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Association of Yogurt Consumption with Nutrient Intakes, Nutrient Adequacy, and Diet Quality in American Children and Adults

Nutrients ◽

10.3390/nu12113435 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3435

Author(s):

Christopher J. Cifelli ◽

Sanjiv Agarwal ◽

Victor L. Fulgoni

Keyword(s):

Body Weight ◽

Diet Quality ◽

Nutrient Intake ◽

Healthy Eating Index ◽

Dietary Quality ◽

Cross Sectional ◽

Nutrient Adequacy ◽

Health And Nutrition ◽

Calcium Magnesium ◽

American Children

The popularity of yogurt has increased among consumers due to its perceived health benefits. This study examined the cross-sectional association between yogurt consumption and nutrient intake/adequacy, dietary quality, and body weight in children and adults. National Health and Nutrition Examination Survey 2001–2016 data (n = 65,799) were used and yogurt consumers were defined as those having any amount of yogurt during in-person 24-h diet recall. Usual intakes of nutrients were determined using the National Cancer Institute method and diet quality was calculated using the Healthy Eating Index-2015 (HEI-2015) scores after adjusting data for demographic and lifestyle factors. The data show that approximately 6.4% children and 5.5% adults consume yogurt, with a mean intake of yogurt of 150 ± 3 and 182 ± 3 g/d, respectively. Yogurt consumers had higher diet quality (10.3% and 15.2% higher HEI-2015 scores for children and adults, respectively); higher intakes of fiber, calcium, magnesium, potassium, and vitamin D; and higher percent of the population meeting recommended intakes for calcium, magnesium, and potassium than non-consumers. Consumption of yogurt was also associated with lower body weight, body mass index (BMI), and 23% showed a lower risk of being overweight/obese among adults only. In conclusion, yogurt consumption was associated with higher nutrient intake, nutrient adequacy, and diet quality in both children and adults.

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Awareness and use of nutrition information predict measured and self-rated diet quality of older adults in the USA

Public Health Nutrition ◽

10.1017/s1368980020004681 ◽

2020 ◽

pp. 1-11

Author(s):

Anna Vaudin ◽

Edwina Wambogo ◽

Alanna Moshfegh ◽

Nadine R Sahyoun

Keyword(s):

Older Adults ◽

Diet Quality ◽

Economic Status ◽

Adult Population ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Nutrition Information ◽

Cross Sectional ◽

Nutrition Assistance

Abstract Objectives: To examine: (1) diet quality of older adults, using the Healthy Eating Index 2010 (HEI-2010) and self-rated diet quality, (2) characteristics associated with reported awareness and use of nutrition information and (3) factors associated with HEI score and self-rated diet quality. Design: Cross-sectional study. Based on Day 1 and/or Day 2 dietary recalls, the Per-Person method was used to estimate HEI-2010 component and total scores. T-tests and ANOVA were used to compare means. Logistic and linear regressions were used to test for associations with diet quality, controlling for potential confounders. Setting: National Health and Nutrition Examination Survey, 2009–2014. Participants: Three thousand and fifty-six adults, aged 60 years and older, who completed at least one 24-h recall and answered questions on awareness and use of nutrition information. Results: Mean HEI score for men was significantly lower than for women (56·4 ± 0·6 v. 60·2 ± 0·6, P < 0·0001). Compared with men, more women were aware of (44·8 % v. 33·7 %, P < 0·05) and used (13·7 % v. 5·9 %, P < 0·05) nutrition information. In multivariable analyses, awareness and use of nutrition information were significant predictors of both HEI and self-rated diet quality for both women and men. Groups with lower nutrition awareness included men, non-Whites, participants in nutrition assistance programmes and those with lower education and socio-economic status. Conclusions: Nutrition awareness and use of nutrition information are associated with diet quality in adults 60 years and older. Gaps in awareness of dietary guidelines in certain segments of the older adult population suggest that targeted education may improve diet quality for these groups.

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Diet Quality Assessment in Wheelchair Users with Multiple Sclerosis

Nutrients ◽

10.3390/nu13124352 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4352

Author(s):

Stephanie L. Silveira ◽

Brenda Jeng ◽

Gary Cutter ◽

Robert W. Motl

Keyword(s):

Multiple Sclerosis ◽

Healthy Eating ◽

Diet Quality ◽

Assessment Tool ◽

Dietary Assessment ◽

Healthy Eating Index ◽

Normative Values ◽

Future Research ◽

Cross Sectional ◽

Wheelchair Users

Background: Diet quality has not been distinctively examined in wheelchair users with multiple sclerosis (MS). Methods: This cross-sectional study examined the Diet History Questionnaire (DHQ) III and the Automated Self-Administered 24-h (ASA24) Dietary Assessment Tool in 128 wheelchair users with MS. Participants were prompted to complete the DHQ-III and 3 ASA24 recalls during a seven-day data collection period. Healthy Eating Index (HEI)-2015 scores were calculated for DHQ-III and ASA24, and scores were compared with normative values. Spearman’s correlation analyses (rs) estimated the associations between DHQ-III and ASA24 HEI-2015 total and component scores with supportive paired sample t-tests. Results: HEI-2015 scores for DHQ-III and ASA24 were significantly higher than normative values for total score, total protein foods, and added sugar. Correlations between HEI-2015 scores generated using ASA24 and DHQ-III were all statistically significant (range rs = 0.23–0.69); however, significant differences between ASA24 and DHQ-III values were noted for HEI-2015 total score, total fruits, whole fruit, total vegetable, greens and beans, whole grains, seafood and plant protein, refined grains, and saturated fats. Conclusion: This study provided a novel description of diet quality in wheelchair users with MS for guiding future research promoting healthy eating in this population.

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Dietary Saturated Fats from Different Food Sources Show Variable Associations with the 2015 Healthy Eating Index in the Canadian Population

Journal of Nutrition ◽

10.1093/jn/nxaa300 ◽

2020 ◽

Vol 150 (12) ◽

pp. 3288-3295

Author(s):

Stéphanie Harrison ◽

Didier Brassard ◽

Simone Lemieux ◽

Benoît Lamarche

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Nutritive Value ◽

Meat Products ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Food Sources ◽

Dietary Intakes ◽

Cross Sectional ◽

Tier System

ABSTRACT Background Although mostly food-based, the majority of dietary guidelines also recommend limiting the consumption of foods high in SFAs. Yet, the association between the consumption of SFAs from different food sources and overall diet quality remains uncertain. Objectives The objective of this study was to examine the associations between SFAs from various food sources and the 2015 Healthy Eating Index (HEI-2015) as a proxy of overall diet quality. Methods The study sample included 11,106 respondents between 19 and 70 y of age from the 2015 Canadian Community Health Survey. Dietary intakes as well as the HEI-2015 were calculated using data from a single 24-h recall. An HEI-2015 from which the SFA subscores were subtracted was also calculated. Low nutritive value foods were defined using Health Canada's 4-Tier system. Associations were investigated using multivariable linear regressions with restricted cubic splines. Results Major sources of SFAs in this population were low nutritive value foods [4.4% of total energy intake (%E)], dairy (2.7%E), and meat products (1.9%E). The associations between SFA consumption (total and from different food sources) and the HEI-2015 were generally inverse and nonlinear (P for the nonlinearity test <0.03 for all). Total SFA intake showed no association with the SFA-subtracted HEI-2015 (P = 0.29). SFAs from dairy tended to be associated with an increase in the SFA-subtracted HEI-2015 (P < 0.001). Removing the SFA subscore from the HEI-2015 did not materially modify its association with SFAs from meat. SFAs from low nutritive value foods remained significantly and inversely associated with the SFA-subtracted HEI-2015 (P < 0.001). Conclusions These cross-sectional data in Canadian adults suggest that intake of SFAs from low nutritive value foods, but not total SFA intake, is captured by an index of healthy eating that does not account for SFA intake.

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