Evaluation of the Healthy Eating Food Index (HEFI)-2019 measuring adherence to Canada's Food Guide 2019 recommendations on healthy food choices

The objective of this study was to evaluate the construct validity and reliability of the Healthy Eating Food Index-2019 (HEFI-2019), which was developed to measure adherence to Canada’s Food Guide 2019 (CFG) recommendations on healthy food choices. Dietary intake data from 24-hour dietary recalls in the 2015 Canadian Community Health Survey - Nutrition were used for that purpose. Multidimensionality was examined using principal component analysis. Mean scores were compared among subgroups of the population. The association between scores and energy intake was assessed using Pearson correlations. Cronbach’s alpha was calculated to assess reliability. The estimated mean HEFI-2019 score (/80) was 43.1 (95%CI, 42.7 to 43.6) among Canadians 2 years and older. The first and 99th percentiles were 22.1 and 62.9 points. The mean HEFI-2019 score for smokers was 7.1 points lower than for non-smokers (95%CI, -8.4 to -5.8). The HEFI-2019 was weakly correlated with energy intake (r=-0.13; 95%CI, -0.20 to -0.06). The principal components analysis revealed at least 4 dimensions. Cronbach’s alpha was 0.66 (95%CI, 0.63 to 0.69). Evidence of construct validity and internal consistency support the use of the HEFI-2019 to assess adherence to CFG-2019’s recommendations on healthy food choices. Novelty: • Examination of the Health Eating Food Index (HEFI)-2019’s psychometric properties is needed prior to implementation • Analyses support the construct validity and internal consistency of the HEFI-2019 • Interpretation of the total HEFI-2019 score must be accompanied by its components’ scores, considering it assesses multiple dimensions of food choices

Changing Food Consumption and Nutrition Intake in Kazakhstan

Food resource is an important bond that connects human beings and nature. In this study, we investigated the changes in food consumption and nutrition intake in Kazakhstan from a spatial and temporal perspective, from 2001 to 2018. The data were obtained from the Bureau of Statistics, international organizations and our social interview work. After the start of the 21st century, it was found that per capita food consumption significantly increased; however, the consumption of crop, vegetables and milk decreased. Per capita meat consumption was similar in both urban and rural areas. However, some food consumption showed differences between urban and rural areas. Changes of food consumption quantity and structure also had some effects on nutrient intake and the proportion of nutrients. Per capita energy intake in the national, urban and rural areas all increased remarkably. The energy intake changes in eastern states increased much more than that in western states. Protein intake in rural and urban areas was similar; however, the gap between carbohydrates and fat intake in urban and rural areas increased. The intake of protein, carbohydrates and fat in different states showed the same trend. Food consumption and nutrition intake are affected by economic, social and ecological factors.

Energy Intake of Men With Excess Weight During Normobaric Hypoxic Confinement

Due to the observations of weight loss at high altitude, normobaric hypoxia has been considered as a method of weight loss in obese individuals. With this regard, the aim of the present study was to determine the effect of hypoxia per se on metabolism in men with excess weight. Eight men living with excess weight (125.0 ± 17.7 kg; 30.5 ± 11.1 years, BMI: 37.6 ± 6.2 kg⋅m–2) participated in a randomized cross-over study comprising two 10-day confinements: normobaric (altitude of facility ≃ 940 m) normoxia (NORMOXIA; PIO2 = 133 mmHg), and normobaric hypoxia (HYPOXIA). The PIO2 in the latter was reduced from 105 (simulated altitude of 2,800 m) to 98 mmHg (simulated altitude of 3,400 m over 10 days. Before, and at the end of each confinement, participants completed a meal tolerance test (MTT). Resting energy expenditure (REE), circulating glucose, GLP-1, insulin, catecholamines, ghrelin, peptide-YY (PYY), leptin, gastro-intestinal blood flow, and appetite sensations were measured in fasted and postprandial states. Fasting REE increased after HYPOXIA (+358.0 ± 49.3 kcal⋅day–1, p = 0.03), but not after NORMOXIA (−33.1 ± 17.6 kcal⋅day–1). Postprandial REE was also significantly increased after HYPOXIA (p ≤ 0.05), as was the level of PYY. Furthermore, a tendency for decreased energy intake was concomitant with a significant body weight reduction after HYPOXIA (−0.7 ± 0.2 kg) compared to NORMOXIA (+1.0 ± 0.2 kg). The HYPOXIA trial increased the metabolic requirements, with a tendency toward decreased energy intake concomitant with increased PYY levels supporting the notion of a hypoxia-induced appetite inhibition, that could potentially lead to body weight reduction. The greater postprandial blood-glucose response following hypoxic confinement, suggests the potential development of insulin resistance.

Association between Milk Intake and All-Cause Mortality among Chinese Adults: A Prospective Study

Background: Little is known about the effect of milk intake on all-cause mortality among Chinese adults. The present study aimed to explore the association between milk intake and all-cause mortality in the Chinese population. Methods: Data from 1997 to 2015 of the China Health and Nutrition Survey (CHNS) were used. A total of 14,738 participants enrolled in the study. Dietary data were obtained by three day 24-h dietary recall. All-cause mortality was assessed according to information reported. The association between milk intake and all-cause mortality were explored using Cox regression and further stratified with different levels of dietary diversity score (DDS) and energy intake. Results: 11,975 (81.25%) did not consume milk, 1341 (9.10%) and 1422 (9.65%) consumed 0.1–2 portions/week and >2 portions/week, respectively. Milk consumption of 0.1–2 portions/week was related to the decreased all-cause mortality (HR: 0.59, 95% CI: 0.41–0.85). In stratified analysis, consuming 0.1–2 portions/week was associated with decreased all-cause mortality among people with high DDS and energy intake. Conclusions: Milk intake is low among Chinese adults. Consuming 0.1–2 portions of milk/week might be associated with the reduced risk of death among Chinese adults by advocating health education. Further research is required to investigate the relationships between specific dairy products and cause-specific mortality.

Real World Adherence to a Severely Energy Restricted Meal Replacement Diet in Participants with Class II and III Obesity

Severely energy-restricted diets (SERDs) are an effective treatment for obesity, however, adherence to such diets is often perceived as poor by healthcare professionals. This investigation evaluated adherence to a 12-week SERD in participants with class II and III obesity. Reported food consumption was compared against individualised SERD prescriptions. Body weight measures were obtained at baseline, 12 and 52 weeks. The data were analysed in three groups (i) the entire cohort (n = 26), (ii) completers (n = 13) and (iii) non-completers (n = 13). SERD prescription elements included (i) the number of meal replacement products; (ii) total protein; (iii) total energy intake; (iv) level of dietary energy restriction; (v) vegetable serves; (vi) water serves, and (vii) how much physical activity was performed. A generalised repeated-measures mixed-effects model was used to investigate if adherence to the program elements individually, or collectively, influenced weight loss. Completers had an average (± SD) of 4549 ± 748 kJ energy intake per day, resulting in a mean energy restriction of 62% compared to the 69% prescribed, indicating a degree of non-adherence. The percent weight changes for completers and non-completers were −7.8 ± 4.7% and −1.6 ± 2.6% at 12 weeks, and −12.2 ± 12.1% and −1.8 ± 3.2% at 52 weeks, respectively. Complete dietary adherence to a SERD may not be necessary to achieve a clinically relevant weight loss of 12% at 52 weeks, if energy is restricted by at least 62% (~4600 kJ per day) relative to requirements.

Caregiver Nutritional Health Outcomes of the Simple Suppers Study: Results from a 10 Week, Two-Group Quasi-Experimental Family Meals Intervention

Individuals from racial minority backgrounds, especially those with low income, are at increased risk for obesity. Family meals positively impact child nutritional health; however, there is limited evidence examining the impact on caregivers, particularly racial minority and income-restricted individuals. The objective of this intervention study was to determine the effect of Simple Suppers, a 10 week family meals program, on caregiver diet and nutrition outcomes. Intervention versus waitlist control participants were compared from baseline (T0) to post-intervention (T1). In addition, intervention participants were assessed at a 10 week follow-up time point (T2). This study was a two-group quasi-experimental intervention trial. Lessons (10 total) were delivered on a weekly basis for 90 min. Data were collected from intervention and waitlist control participants at T0 and T1, and intervention participants at T2. After baseline (T0) data collection, families enrolled in the immediate upcoming session of Simple Suppers (intervention group) or waited for 10 weeks (waitlist control group) to begin the program. Participants were caregivers of children ages 4–10 years. This study was conducted in a faith-based community center for underserved families in Columbus, Ohio. Primary outcomes were: diet quality assessed by Healthy Eating Index (HEI) total and component scores, and total energy intake (kcal/day); body mass index (BMI) (kg/m2), waist circumference (cm), systolic and diastolic blood pressure (BP) (mmHG); and self-efficacy for having healthy meals and menu planning (both scalar). The impact of the intervention (T0:T1) was assessed using generalized mixed-effects linear regression models. Maintenance of change in study outcomes among intervention participants (T1:T2) was examined with paired t-tests. 109 caregivers enrolled in this study. The retention rate at T1 was 90% (i.e., 98 participants). 56 of 68 intervention participants completed T2, resulting in a retention rate of 82%. Almost all (99%) were female, 61% were Black, and 50% were between 31 and 40 years old. In total, 40% had low income and 37% had low or very low food security. At T1, intervention vs. waitlist controls had a lower daily energy intake (p = 0.04), but an HEI-2010 component score for fatty acids (adequacy) that was lower indicating a lower dietary intake of fatty acids (p = 0.02), and a component score for empty calories (moderation) that was significantly lower indicating a higher intake of empty calorie foods (p = 0.03). At T1, intervention vs. waitlist controls also had a lower BMI (p < 0.001) and systolic BP (p = 0.04), and higher self-efficacy (p = 0.03). There were no group differences in other outcomes. At T2, intervention participants maintained the changes in daily energy intake, BMI, systolic BP, and self-efficacy that improved during the intervention period. There was no change (improvement) in the component score for fatty acids; however, the component score for empty calories significantly improved (p = 0.02). Engagement in the Simple Suppers program led to improvements in caregivers’ daily caloric intake, weight status, systolic blood pressure, and self-efficacy for family meals. Future research should further explore the dietary and nutritional health benefits of family meals among caregivers at the highest risk for obesity.

Associations of Carbohydrate Intake With New-Onset Hypertension Subtypes: Results From the China Health and Nutrition Survey (2000–2011)

Background: The effects of carbohydrate intake on hypertension (HTN) subtypes are scarce. We examined the association of carbohydrate intake with new-onset HTN subtypes in Chinese adults.Methods: Chinese Health and Nutrition Survey (CHNS) 2000–2011, 22,418 individuals were recorded using a 24-h recall method over three consecutive days. We excluded those who were pregnant women, lactating mothers, age &lt;18 years, baseline age, blood pressure, and energy intake deficiency, extreme energy intake (male &gt; 6,000 kcal or &lt; 800 kcal; female &gt; 4,000 kcal or &lt; 600 kcal), and pulse pressure difference (Systolic Blood Pressure [SBP] - Diastolic Blood Pressure [DBP]) &lt;10 mm Hg, HTN at baseline and data from only one survey. The total number of subjects who participated in at least two surveys was 7,930. The main outcome was new-onset HTN subtypes over 6.9 person years of follow-up.Results: 2,521 participants were found to be HTN, which included 1,318 males (52.3%), 1,203 females (47.7%), 721 had systolic-diastolic hypertension (SDH, 28.6%), 655 had isolated systolic hypertension (ISH, 26.0%), and 993 had isolated diastolic hypertension (IDH, 39.4%). Compared with extreme quintiles of carbohydrate, multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for new-onset HTN, SDH, ISH and IDH associated with carbohydrate intake were 1.12 (0.97–1.30), 1.54 (1.18–2.00), 0.89 (0.67–1.19) and 1.15 (0.91–1.45), respectively. The HR of SDH compared with extreme quintiles of carbohydrates was 1.56 (95% CI, 1.08–2.25; Ptrend = 0.04) in men and 1.52 (95% CI, 1.02–2.26; Ptrend = 0.02) in women.Conclusion: Carbohydrates were related to a higher risk of SDH, which were not observed with HTN, ISH, and IDH.

Predictors of Post-Exercise Energy Intake in Adolescents Ranging in Weight Status from Overweight to Severe Obesity

Exercise may sensitize individuals with overweight and obesity to appetitive signals (e.g., hunger and fullness cues), overriding trait eating behaviors that contribute to overeating and obesity, such as uncontrolled eating. The objective of the current study was to measure predictors of objective ad libitum energy intake at a laboratory-based, post-exercise test-meal in adolescents ranging in weight status from overweight to severe obesity. We hypothesized that appetitive states, rather than appetitive traits, would be the strongest predictors of energy intake at a post-exercise test-meal, after controlling for body size. At Baseline, 30 adolescents (ages 10–16 years, 50% female (F), 43% non-Hispanic white (NHW), 83% with obesity (OB)) completed state and trait appetite measures and an ad libitum dinner meal following intensive exercise. Nineteen of those participants (47% F, 32% NHW, 79% OB) completed identical assessments two years later (Year 2). Energy intake (kcal) at each time point was adjusted for fat-free mass index (i.e., body size). Adjusted energy intake was reliable from Baseline to Year 2 (ICC = 0.84). Multiple pre-meal appetite ratings were associated with test-meal energy intake. In stepwise linear regression models, pre-meal prospective food consumption was the strongest and only significant predictor of test-meal energy intake at both Baseline (R2 = 0.25, p = 0.005) and Year 2 (R2 = 0.41, p = 0.003). Baseline post-exercise energy intake was associated with weight change over two years (R2 = 0.24, p = 0.04), but not with change in fat mass (p = 0.11). Appetitive traits were not associated with weight or body composition change (p > 0.22). State appetite cues were the strongest predictors of post-exercise energy intake, independent of body size. Future studies should examine whether long-term exercise programs enhance responsiveness to homeostatic appetite signals in youth with overweight and obesity, with a goal to reduce excess energy intake and risk for weight gain over time.

The Impact of High Carbohydrate Intake on Physical Frailty in Older Korean Adults: a Cohort-based Cross-sectional Study

Background: The relationship between macronutrients and frailty is unclear. Previous studies have confirmed the relationships between energy and protein intake and physical frailty, while few studies have examined the role of carbohydrate or fat intake in the prevalence of frailty. The aim of this study is to investigate the relationship of energy and macronutrients with physical frailty in the Korean elderly population who had a high proportion of energy intake from carbohydrates.Methods: This study included 954 adults aged 70 to 84 years who have completed the assessment of frailty and 24-h recall upon enrolment in the Korean Frailty and Aging Cohort Study and have no extreme intake under 400 kcal (n = 2). The relationship between energy or macronutrients and frailty was evaluated using multivariate logistic regression models and multivariate nutrient density models.Results: In the subjects with low energy intake (odds ratio [OR] = 2.94, 95% confidence interval [CI] = 1.34–6.45) and total subjects (OR = 2.01, 95% CI = 1.03–3.93), consuming carbohydrates above the acceptable macronutrient distribution range (65% of energy) was related to a higher risk of frailty. Substituting the energy from fat with carbohydrates was related to a higher risk of frailty (1%, OR = 1.05, 95% CI = 1.00–1.09; 5%, OR = 1.26, 95% CI = 1.02–1.56; 10%, OR = 1.59, 95% CI = 1.03–2.43).Conclusions: This study showed that the proportion of energy intake from carbohydrates and fats may be an important nutritional intervention factor for reducing the risk of frailty.