Association of Dietary Approaches to Stop Hypertension diet and Mediterranean diet with blood pressure in less-developed ethnic minority regions

Objective: We aimed to investigate the association of Dietary Approaches to Stop Hypertension (DASH)-style diet and Mediterranean-style diet with blood pressure in less-developed ethnic minority regions (LMERs). Design: Cross-sectional study. Setting: Dietary intakes were assessed by a validated food frequency questionnaire. Dietary quality was assessed by the DASH-style diet score and the alternative Mediterranean-style diet (aMED) score. The association between dietary quality and blood pressure was evaluated using multivariate linear regression model. We further examined those associations in subgroups of blood pressure level. Participants: A total of 81433 adults from the China Multi-Ethnic Cohort (CMEC) study were included in this study. Results: In the overall population, compared with the lowest quintile, the highest quintile of DASH-style diet score was negatively associated with systolic BP (coefficient: −2.78, 95% CI: −3.15 to −2.41; P-trend<0.001), while the highest quintile of aMED score had a weaker negative association with systolic BP (coefficient: −1.43, 95% CI: −1.81 to −1.05; P-trend<0.001). Both dietary indices also showed a weaker effect on diastolic BP (coefficient for DASH-style diet: −1.06, 95% CI: −1.30 to −0.82; coefficient for aMED: −0.43, 95% CI: −0.68 to −0.19). In the subgroup analysis, both dietary indices showed a stronger beneficial effect on systolic BP in the hypertension group than in either of the other subgroups. Conclusion: Our results indicated that the healthy diet originating from Western developed countries can also have beneficial effects on blood pressure in LEMRs. DASH-style diet may be a more appropriate recommendation than aMED as part of a dietary strategy to control blood pressure, especially in hypertensive patients.

Dietary Quality of Women of Reproductive Age in Low-Income Settings: A Cross-Sectional Study in Kyrgyzstan

Dietary diversity and adequate nutrient intake are essential for conducting a healthy life. However, women in low-income settings often face difficulties in ensuring dietary quality. This research assessed relationships between the dietary diversity, nutrient adequacy, and socio-economic factors among women of reproductive age (WRA) in Kyrgyzstan. A cross-sectional study was undertaken in four locations, including two rural and two urban areas in the north and south of Kyrgyzstan. A survey with pre-coded and open-ended questions was employed during the interviews of 423 WRAs aged 18–49. Data collection was conducted in March–May 2021. The average value body mass index (BMI) of WRA was 24.2 ± 4.6 kg/m2. The dietary diversity score (DDS) was higher among rural women (common language effect size) cles = 0.67, adjusted p < 0.001) in the northern region (cles = 0.61, p < 0.05) who have cropland (cles = 0.60, p < 0.001) and a farm animal (cles = 0.60, p < 0.05). Mean nutrient adequacy ratio (NAR) was below 1 in most micronutrients, whereas thiamine, riboflavin, vitamins B6 and C, folic acid, calcium, and magnesium were even lower than 0.5. Women with a kitchen garden or a cropland had better NAR energy (cles = 0.57), NAR carbohydrate (cles = 0.60), NAR fiber (cles = 0.60), NAR vitamin B1 (cles = 0.53), and NAR folic acid (cles = 0.54). Respondents who receive remittances and a farm animal have better NARs for energy, carbohydrates, fiber, vitamin B1, folic acid, iron, zinc, and mean adequacy ratio for 16 nutrients (MAR 16) than those who do not. Education and income have a negative correlation with dietary quality. This study contributes to the limited literature on the quality of diets in Kyrgyzstan. Hidden hunger and undernutrition are a severe problem among WRA in low-income settings. Recommendations are including study programs in nutrition, teaching households farming practices, and raising awareness on adequate nutrition.

Caregiver Perceptions of Child Diet Quality: What Influenced Their Judgment

This study aimed at assessing the correctness of a caregiver’s perception of their child’s diet status and to determine the factors which may influence their judgment. 815 child-caregiver pairs were recruited from two primary schools. 3-day 24-h recall was used to evaluate children’s dietary intake, Chinese Children Dietary Index (CCDI) was used to evaluate the dietary quality. Multivariate logistic regression models were used to explore the factors that could influence the correctness of caregiver’s perception. In the current study, 371 (62.1%) children with “high diet quality” and 35 (16.1%) children with “poor diet quality” were correctly perceived by their caregivers. Children who were correctly perceived as having “poor diet quality” consumed less fruits and more snacks and beverages than those who were not correctly perceived (p < 0.05). Obese children were more likely to be correctly identified as having “poor diet quality” (OR = 3.532, p = 0.040), and less likely to be perceived as having “high diet quality”, even when they had a balanced diet (OR = 0.318, p = 0.020). Caregivers with a high level of education were more likely to correctly perceive children’s diet quality (OR = 3.532, p = 0.042). Caregivers in this study were shown to lack the ability to correctly identify their children’s diet quality, especially amongst children with a “poor diet quality”. Obesity, significantly low consumption of fruits or high consumption of snacks can raise caregivers’ awareness of “poor diet quality”.

Diet Quality Index for older adults (DQI-65): development and use in predicting adherence to dietary recommendations and health markers in the UK National Diet and Nutrition Survey

Diet quality indexes (DQIs) are useful tools for assessing diet quality in relation to health and guiding delivery of personalised nutritional advice, however existing DQIs are limited in their applicability to older adults (aged ≥65 years). Therefore, this research aimed to develop a novel evidence-based DQI specific to older adults (DQI-65). Three DQI-65 variations were developed to assess the impacts of different component quantitation methods and inclusion of physical activity. The variations were: Nutrient and Food-based DQI-65 (NFDQI-65), NFDQI-65 with Physical Activity (NFDQI-65+PA) and Food-based DQI-65 with Physical Activity (FDQI-65+PA). To assess their individual efficacy, the NFDQI-65, NFDQI-65+PA and FDQI-65+PA were explored alongside the validated Healthy Eating Index-2015 (HEI-2015) and Alternative Healthy Eating Index-2010 (AHEI-2010) using data from the cross-sectional UK National Diet and Nutrition Survey (NDNS) rolling programme. Scores for DQI-65 variations, the HEI-2015 and AHEI-2010 were calculated for adults ≥65 years from years 2-6 of the NDNS (n=871). Associations with nutrient intake, nutrient status and health markers were analysed using linear and logistic regression. Higher DQI-65s and HEI-2015 scores were associated with increased odds of meeting almost all of our previously proposed age-specific nutritional recommendations, and with health markers of importance for older adults, including lower body mass index, lower medication use and lower C-reactive protein (P<0.01). Few associations were observed for the AHEI-2010. This analysis suggests value of all three DQI-65s as measures of dietary quality in UK older adults. However, methodological limitations mean further investigations are required to assess validity and reliability of the DQI-65s.

The Role of Diet Quality in Mediating the Association between Ultra-Processed Food Intake, Obesity and Health-Related Outcomes: A Review of Prospective Cohort Studies

Prospective cohort studies show that higher intakes of ultra-processed food (UPF) increase the risk of obesity and obesity-related outcomes, including cardiovascular disease, cancer and type 2 diabetes. Whether ultra-processing itself is detrimental, or whether UPFs just have a lower nutritional quality, is debated. Higher UPF intakes are inversely associated with fruit, vegetables, legumes and seafood consumption. Therefore, the association between UPFs and poor health could simply be from excess nutrient intake or from a less healthful dietary pattern. If so, adjustment for dietary quality or pattern should explain or greatly reduce the size of the significant associations between UPFs and health-related outcomes. Here, we provide an overview of the literature and by using a novel approach, review the relative impact of adjusting for diet quality/patterns on the reported associations between UPF intake and health-related outcomes in prospective cohort studies. We find that the majority of the associations between UPFs, obesity and health-related outcomes remain significant and unchanged in magnitude after adjustment for diet quality or pattern. Our findings suggest that the adverse consequences of UPFs are independent of dietary quality or pattern, questioning the utility of reformulation to mitigate against the obesity pandemic and wider negative health outcomes of UPFs.

Diet Quality and Mental Health Status among Division 1 Female Collegiate Athletes during the COVID-19 Pandemic

The International Olympic Committee has identified mental health as a priority that significantly affects the physical health and safety of collegiate athletes. Interventions that improve diet quality have been shown to improve mental health in several populations. However, studies are needed to examine this relationship in female collegiate athletes, who have elevated risk of experiencing anxiety and depression symptoms, as well as dietary insufficiencies. In a quantitative, cross-sectional study, female student athletes at a U.S. university completed three mental health questionnaires: Depression Anxiety and Stress Scale (DASS-21), Athlete Psychological Strain Questionnaire (APSQ), and COVID Stress Scales (CSS). Each female athlete also completed a validated, web-based Diet History Questionnaire (DHQ-III) resulting in a Healthy Eating Index (HEI). Seventy-seven participants completed all survey information. HEI scores were consistently higher for athletes with poorer mental health. HEI scores were significantly positively associated with stress (p = 0.015), performance concerns (p = 0.048), CSS components of danger (p = 0.007), contamination (p = 0.006), and traumatic stress (p = 0.003). Although findings support statistically significant associations among dietary quality and mental health indicators, including broad symptom severity or stressors specific to athletics or COVID-19, these associations were in the opposite direction hypothesized. Possible reasons for results and suggestions for future research are discussed.

Longitudinal dietary trajectories from preconception to mid-childhood in women and children in the Southampton Women’s Survey and their relation to offspring adiposity: a group-based trajectory modelling approach

Background Rates of childhood obesity are increasing globally, with poor dietary quality an important contributory factor. Evaluation of longitudinal diet quality across early life could identify timepoints and subgroups for nutritional interventions as part of effective public health strategies. Objective This research aimed to: (1) define latent classes of mother-offspring diet quality trajectories from pre-pregnancy to child age 8–9 years, (2) identify early life factors associated with these trajectories, and (3) describe the association between the trajectories and childhood adiposity outcomes. Design Dietary data from 2963 UK Southampton Women’s Survey mother-offspring dyads were analysed using group-based trajectory modelling of a diet quality index (DQI). Maternal diet was assessed pre-pregnancy and at 11- and 34-weeks’ gestation, and offspring diet at ages 6 and 12 months, 3, 6-7- and 8–9-years using interviewer-administered food frequency questionnaires. At each timepoint, a standardised DQI was derived using principal component analysis. Adiposity age 8–9 years was assessed using dual-energy X-ray absorptiometry (DXA) and BMI z-scores. Results A five-trajectory group model was identified as optimal. The diet quality trajectories were characterised as stable, horizontal lines and were categorised as poor (n = 142), poor-medium (n = 667), medium (n = 1146), medium-better (n = 818) and best (n = 163). A poorer dietary trajectory was associated with higher maternal pre-pregnancy BMI, smoking, multiparity, lower maternal age and lower educational attainment. Using linear regression adjusted for confounders, a 1-category decrease in the dietary trajectory was associated with higher DXA percentage body fat (0.08 SD (95% confidence interval 0.01, 0.15) and BMI z-score (0.08 SD (0.00, 0.16) in the 1216 children followed up at age 8–9 years. Conclusion Mother-offspring dietary trajectories are stable across early life, with poorer diet quality associated with maternal socio-demographic and other factors and childhood adiposity. The preconception period may be an important window to promote positive maternal dietary changes in order to improve childhood outcomes.

Factors Associated With Dietary Quality During Initial and Later Stages of the COVID-19 Pandemic in Mexico

Background: The COVID-19 pandemic disrupted the global economy and modified lifestyles. The aim of our study was to identify factors associated with dietary quality, and their frequency, in Mexican adults at the initial and later stages of the pandemic.Methods: Two online surveys were conducted between June and July 2020 (n = 3,131) and between November and December 2020 (n = 1,703 including non-participants from 1st round). A diet quality score was estimated using a short instrument to measure the consumption of several healthy/unhealthy food items. Linear regression models were used to identify the association between pandemic related factors and the diet quality score, adjusted by sociodemographic characteristics. The 2nd round was weighted to represent the 1st round.Results: During the 1st and 2nd rounds only ~12% of the sample perceived that their intake of healthy food decreased, relative to before the pandemic; ~20% perceived that their intake of unhealthy foods increased. Diet quality remained similar between the 1st and 2nd round. The following factors were negatively associated with diet quality: Eating food prepared away-from-home; going out to work ≥4 times/week; decreased time for food preparation; decreased interest in eating healthy; eating more due to anxiety, depression, or boredom; food insecurity; and stockpiling junk food. Purchasing food using a mixed modality of both in-store and home delivery was positively associated with diet quality. With the exception of eating more due to anxiety (reported by 47% of participants), all these factors were reported by a minority of participants during the first round (≤15%). During the 2nd round, there was an increase in the frequency of participants who reported eating food prepared away-from-home, going out to work ≥4 times/week, having less time to prepare food, being more interested in eating healthfully, and a decrease in participants eating more due to anxiety, depression or boredom, or stockpiling junk food.Conclusions: Most participants perceived that their dietary intake improved during both initial and later stages of the pandemic. This might be related to factors associated with higher dietary quality, such as not going out to work, eating homemade food, and online grocery shopping.

Women’s participation in the local food system and implications for their dietary quality in rural Northern Ghana: A qualitative study

Background Women’s activities within local food systems are linked with their dietary quality. Their ability to achieve a nutritious diet is often limited by socio-cultural norms, which have not been adequately studied. This study examined socio-cultural norms linked with rural food systems and their adverse effects on women’s diets. Methods The study was conducted in two rural communities, Yilkpene and Kpachilo, in Northern Ghana between May and July 2016. Sixteen key informant interviews (KII) with community and institutional leaders, and eleven focus group discussions (FGDs) with community members were used to explore the nature of the food system, (production, processing, distribution, preparation and consumption), and how it is influenced by socio-cultural norms. Transcribed interviews were coded and analysed thematically, using inductive reasoning. Results The components of the food system in both communities were constructed, primarily, around men. Quantities, quality, and varieties of produce, distribution/marketing, and intra-household allocation were strongly dominated by male perceptions and practices about access and ownership of productive resources, and roles and responsibilities of household members. Men dominated in the production of cereals, and legumes, while women mainly produced/harvested vegetables and fruits, and limited quantities of legumes that have low economic value. Men sell their produce at higher market prices, at urban markets; women rarely sell their vegetables; it is preserved and stored for home consumption. Women’s produce were often sold at farm gates or local markets at lower prices, for income to supplement household diets. Men are responsible for allocating staple foods used in the household for meal preparation to women; women are expected to provide other ingredients needed to accompany the supply of staple food provided by men. Although women prepare household meals, men receive lion’s share of nutrient-dense portions of meals. Conclusion The local food system is heavily dominated by gender-driven socio-cultural norms, which constitute a barrier to women achieving dietary adequacy. Interventions are needed to improve women’s diets; such interventions should deliberately address these culturally-established barriers, in contexts where subsistence farming is the main source of livelihood.