Is the Canadian Healthy Eating Index 2007 an Appropriate Diet Indicator of Metabolic Health? Insights from Dietary Pattern Analysis in the PREDISE Study

The objective of this study was to identify key elements from the 2007 Canada’s Food Guide that should be included in a diet quality score aiming to reflect the risk of metabolic syndrome (MetS). Dietary intakes of 998 adults (mean age: 43.2 years, 50% women) were used to obtain the Canadian Healthy Eating Index 2007 (C-HEI 2007) and Alternative Healthy Eating Index 2010 (AHEI) scores, as well as a dietary pattern (DP) generated by the reduced rank regression (RRR) method. Based on these three scores, a modified version of the C-HEI 2007 (Modified C-HEI) was then proposed. The prevalence ratio (PR) of MetS was examined across diet quality scores using multivariate binomial regression analysis. A higher AHEI, Modified C-HEI, and a lower score for DP were all associated with a significantly lower prevalence of MetS (PR = 0.42; 95% confidence interval (CI) 0.28, 0.64; PR = 0.39; 95% CI 0.23, 0.63; and PR = 0.48; 95% CI 0.31, 0.74, respectively), whereas C-HEI 2007 was not (PR = 0.68; 95% CI 0.47, 1.00). Results suggest that a Modified C-HEI that considers key elements from the C-HEI 2007 and the AHEI, as well the DP, shows that participants with a higher score are less likely to have MetS.

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Skipping Breakfast Is Associated with Diet Quality and the Distribution of Food Intake Throughout the Day: NHANES 2005–20016

Current Developments in Nutrition ◽

10.1093/cdn/nzaa046_034 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 534-534

Author(s):

Owen Kelly ◽

Stephanie Fanelli ◽

Sara Thomas ◽

Jessica Krok-Schoen ◽

Satya Jonnalagadda ◽

...

Keyword(s):

Food Intake ◽

Healthy Eating ◽

Diet Quality ◽

Diabetes Management ◽

Population Based ◽

Healthy Eating Index ◽

Dietary Intakes ◽

Nutrient Intakes ◽

Diabetes Status ◽

Skipping Breakfast

Abstract Objectives Distribution of carbohydrate intakes (carb choices) throughout the day are an important aspect to diabetes management and reducing blood glucose spikes. Skipping breakfast represents a behavior of concern, providing an extension of the overnight fast and may result in elevated sugar levels later in the day. Therefore, the purpose of this study was to evaluate dietary intake differences, including carbohydrates, based on consuming breakfast or not, and by diabetes status. Methods Adults over 30 years from NHANES 2005–2016 were classified into nondiabetes (HbA1c <5.7%, n = 14,701), prediabetes (HbA1c 5.7–6.4%, n = 5855) and diabetes (HbA1c (≥6.5%, n = 2881). Dietary intakes were assessed using a multiple pass 24-hour recall to estimate intakes from the foods and beverages reported as consumed on the day prior to the NHANES visit. Breakfast was self-defined by participants. Total population-based means (95% CI) of nutrient intakes, MyPlate equivalents, and Healthy Eating Index 2015 scores from the day of intake were calculated across levels of glycemic control and skipping breakfast status. Results Across all groups, adults who reported breakfast consumption had a significantly better overall diet quality, while total intakes of whole grains and fiber were significantly lower in those who skipped breakfast. Intakes of added sugars were not significantly different between those who skipped versus consumed breakfast. Conclusions The absence of breakfast on the day of intake was related to differential intakes of several nutrients related to healthy eating and glycemic management, resulting in a poorer overall diet quality. Healthcare professionals could evaluate meal skipping patterns and its impact on overall nutrient intakes, and the distribution of food intake throughout the day, in people with diabetes, to help improve disease management. Funding Sources Abbott Nutrition.

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Serum Metabolites Associated with Healthy Diets in African Americans and European Americans

Journal of Nutrition ◽

10.1093/jn/nxaa338 ◽

2020 ◽

Vol 151 (1) ◽

pp. 40-49 ◽

Cited By ~ 1

Author(s):

Hyunju Kim ◽

Emily A Hu ◽

Kari E Wong ◽

Bing Yu ◽

Lyn M Steffen ◽

...

Keyword(s):

African Americans ◽

Healthy Eating ◽

Diet Quality ◽

Healthy Eating Index ◽

P Value ◽

Dietary Intakes ◽

Serum Metabolites ◽

European Americans ◽

Healthy Diets ◽

Participant Characteristics

ABSTRACT Background High diet quality is associated with a lower risk of chronic diseases. Metabolomics can be used to identify objective biomarkers of diet quality. Objectives We used metabolomics to identify serum metabolites associated with 4 diet indices and the components within these indices in 2 samples from African Americans and European Americans. Methods We studied cross-sectional associations between known metabolites and Healthy Eating Index (HEI)-2015, Alternative Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension Trial (DASH) diet, alternate Mediterranean diet (aMED), and their components using untargeted metabolomics in 2 samples (n1 = 1,806, n2 = 2,056) of the Atherosclerosis Risk in Communities study (aged 45–64 y at baseline). Dietary intakes were assessed using an FFQ. We used multivariable linear regression models to examine associations between diet indices and serum metabolites in each sample, adjusting for participant characteristics. Metabolites significantly associated with diet indices were meta-analyzed across 2 samples. C-statistics were calculated to examine if these candidate biomarkers improved prediction of individuals in the highest compared with lowest quintile of diet scores beyond participant characteristics. Results Seventeen unique metabolites (HEI: n = 6; AHEI: n = 5; DASH: n = 14; aMED: n = 2) were significantly associated with higher diet scores after Bonferroni correction in sample 1 and sample 2. Six of 17 significant metabolites [glycerate, N-methylproline, stachydrine, threonate, pyridoxate, 3-(4-hydroxyphenyl)lactate)] were associated with ≥1 dietary pattern. Candidate biomarkers of HEI, AHEI, and DASH distinguished individuals with highest compared with lowest quintile of diet scores beyond participant characteristics in samples 1 and 2 (P value for difference in C-statistics <0.02 for all 3 diet indices). Candidate biomarkers of aMED did not improve C-statistics beyond participant characteristics (P value = 0.930). Conclusions A considerable overlap of metabolites associated with HEI, AHEI, DASH, and aMED reflects the similar food components and similar metabolic pathways involved in the metabolism of healthy diets in African Americans and European Americans.

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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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Abstract P210: Associations Of Early Parental Feeding Concerns And Behaviors With Child’s Dietary Intakes Throughout Childhood

Circulation ◽

10.1161/circ.141.suppl_1.p210 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Veronique Gingras ◽

Karen M Switkowski ◽

Sheryl L Rifas-Shiman ◽

Sabrina Faleschini ◽

Emily Oken ◽

...

Keyword(s):

Early Childhood ◽

Healthy Eating ◽

Diet Quality ◽

Weight Status ◽

Healthy Eating Index ◽

Index Score ◽

Processed Meat ◽

Dietary Intakes ◽

Feeding Behaviors ◽

Parental Feeding

Introduction: Parental feeding behaviors have been found to be associated with dietary intakes and weight status in children, although the longitudinal associations of parental feeding behaviors in early life with diet later in childhood have been scarcely studied. Hypothesis: We hypothesized that parental feeding restriction, pressure to eat, and concerns about child’s weight would be associated with poorer diet quality throughout childhood. Methods: Among 1172 mother-child pairs from Project Viva, we examined associations of parental feeding behaviors at 2 years assessed via questions from the Child Feeding Questionnaire (behaviors dichotomized as yes vs. no) with diet quality in early (mean: 3.2, SD 0.2 years; n=1076) and mid-childhood (mean: 7.8, SD 0.7 years; n=993) assessed via food frequency questionnaires. We used linear regression models adjusted for socio-demographic characteristics, maternal and paternal body mass index, and maternal diet quality in pregnancy. Results: At 2 years postpartum, 47% of parents pressured/encouraged their child to eat more, 8% restricted their intakes, 15% were concerned about their child being overweight and 7% about their child being underweight. Parental pressure to eat at 2 years was associated with higher child intake of fruit juice (β 0.17 serving/day; 95% CI 0.01, 0.34) and snack foods (0.12 serving/day; 0.01, 0.22) in early childhood and with lower youth healthy eating index score (-1.32 points; -2.54, -0.10; score from 0 to 85 points) in mid-childhood. Parental feeding restriction at 2 years was associated with lower intake of sugar-sweetened beverages (-0.17 serving/day; -0.27, -0.06) in early childhood and with lower intake of dairy (-0.29 serving/day; -0.56, -0.02) in mid-childhood. Parental concerns about their child being underweight was associated with lower youth healthy eating index score (-2.18 points; -4.30, -0.05; score from 0 to 95 points) in early childhood while concerns about their child being overweight was associated with higher intakes of red and processed meat (0.14 serving/day; 0.04, 0.23) in early childhood and higher intake of baked products in mid-childhood (0.07 serving/day; 0.01, 0.13). Conclusions: We found that early parental feeding behaviors may have a modest contribution to dietary intakes throughout childhood. However, only a few associations persisted after adjusting for socio-economic and parental characteristics and effect sizes were modest. Strategies to improve diet quality in children might need to focus on the broader family and socio-economic context.

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Identification of Dish-Based Dietary Patterns for Breakfast, Lunch, and Dinner and Their Diet Quality in Japanese Adults

Nutrients ◽

10.3390/nu13010067 ◽

2020 ◽

Vol 13 (1) ◽

pp. 67

Author(s):

Nana Shinozaki ◽

Kentaro Murakami ◽

Keiko Asakura ◽

Shizuko Masayasu ◽

Satoshi Sasaki

Keyword(s):

Cluster Analysis ◽

Healthy Eating ◽

Diet Quality ◽

Dietary Patterns ◽

Dietary Pattern ◽

Healthy Eating Index ◽

Japanese Adults ◽

Dietary Record ◽

Dietary Data

We identified dish-based dietary patterns for breakfast, lunch, and dinner and assessed the diet quality of each pattern. Dietary data were obtained from 392 Japanese adults aged 20–69 years in 2013, using a 4 d dietary record. K-means cluster analysis was conducted based on the amount of each dish group, separately for breakfasts (n = 1462), lunches (n = 1504), and dinners (n = 1500). The diet quality of each dietary pattern was assessed using the Healthy Eating Index 2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3). The extracted dietary patterns were as follows: ‘bread-based’ and ‘rice-based’ for breakfast; ‘bread’, ‘rice-based’, ‘ramen’, ‘udon/soba’, and ‘sushi/rice bowl dishes’ for lunch; and ‘miscellaneous’, ‘meat dish and beer’, and ‘hot pot dishes’ for dinner. For breakfast, the HEI-2015 and NRF9.3 total scores were higher in the ‘rice-based’ pattern than the ‘bread-based’ pattern. For lunch, the HEI-2015 and NRF9.3 total scores were relatively high in the ‘rice-based’ pattern and low in the ‘ramen’ pattern. For dinner, the HEI-2015 total score was the highest in the ‘meat dish and beer’ pattern, and the NRF9.3 total score was higher in the ‘hot pot dishes’ than the ‘miscellaneous’ pattern. These results suggested that breakfast, lunch, and dinner have distinctive dietary patterns with different diet qualities.

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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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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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Higher diet quality is associated with higher diet costs when eating at home and away from home: National Health and Nutrition Examination Survey, 2005-2016

Public Health Nutrition ◽

10.1017/s1368980021002810 ◽

2021 ◽

pp. 1-29

Author(s):

Zach Conrad ◽

Sarah Reinhardt ◽

Rebecca Boehm ◽

Acree McDowell

Keyword(s):

Healthy Eating ◽

National Health ◽

Diet Quality ◽

Healthy Eating Index ◽

Food Prices ◽

Nutrition Examination Survey ◽

Food Away From Home ◽

Health And Nutrition ◽

Food Consumed ◽

At Home

Abstract Objectives: To evaluate the association between diet quality and cost for foods purchased for consumption at home and away from home. Design: Cross-sectional analysis. Multivariable linear regression models evaluated the association between diet quality and cost for all food, food at home, and food away from home. Setting: Daily food intake data from the National Health and Nutrition Examination Survey (2005-2016). Food prices were derived using data from multiple, publicly available databases. Diet quality was assessed using the Healthy Eating Index-2015 and the Alternative Healthy Eating Index-2010. Participants: 30,564 individuals ≥20 y with complete and reliable dietary data. Results: Mean per capita daily diet cost was $14.19 (95% CI: $13.91-14.48), including $6.92 ($6.73-7.10) for food consumed at home and $7.28 ($7.05-7.50) for food consumed away from home. Diet quality was higher for food at home compared to food away from home (P<0.001). Higher diet quality was associated with higher food costs overall, at home, and away from home (P<0.001 for all comparisons). Conclusions: These findings demonstrate that higher diet quality is associated with higher costs for all food, food consumed at home, and food consumed away from home. This research provides policymakers, public health professionals, and clinicians with information needed to support healthy eating habits. These findings are particularly relevant to contemporary health and economic concerns that have worsened because of the COVID-19 pandemic.

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