Evaluating the food environment: application of the Healthy Eating Index-2005

Refining the Nutrition Environment Measures Survey (NEMS) for Healthy Community Stores: Adaptations to Capture Alternative Food Retailers and Align with Dietary Guidelines

Inadequate consumption of healthy food is an ongoing public health issue in the United States. Food availability measures of supply versus consumption of healthy foods are disconnected in many studies. There is a need for an objective assessment of the food environment in order to assess how the food supply aligns with the Healthy Eating Index (HEI). Data were collected as part of the Healthy Community Stores Case Study Project, including a refined Nutrition Environment Measures Survey for Healthy Community Stores (NEMS-HCS) and an updated Healthy Food Availability Index that aligns with the Healthy Eating Index (HFAHEI). This paper will focus on the NEMS-HCS development process, findings, and HFAHEI application. All food items were more likely to be found at grocery stores rather than corner stores. Food pricing was often above the Consumer Price Index averages for six food items. The NEMS-HCS assessment better aligned with the HEI because it included a wider variety of meats, frozen fruits and vegetables, and an increased selection of whole grains. HFAHEI scoring was inclusive of non-traditional and alternative community stores with a health focus, making it suitable for use at the local level, especially in neighborhoods where supermarkets and large chain stores are less common.

Adaptation of a Modified Diet Quality Index to Quantify Healthfulness of Food-Related Toy Sets

The objective of this cross-sectional study was to examine the construct validity of an adapted modified Diet Quality Index (aDQI) as a measure of the healthfulness of food-related toy sets for young children (3-8 years). A standardized online search was used to identify toy sets (n = 50) from 10 retailers. An aDQI score (aDQI score, range 0-50) was determined for each toy set, mean (standard deviation) = 28.7 (6.1). Regression analyses demonstrated a positive association between aDQI score and percentage of dairy, refined grains, protein, vegetables, and fruit and inverse association with percentage of desserts, sugar-sweetened beverages, and total number of servings. Sets contained more protein and fewer fruits than recommended. The aDQI score demonstrates construct validity to objectively assess the healthfulness of food-related toy sets. There is opportunity for toy manufacturers to make changes to improve the healthfulness in toy sets for young children, and future research can explore the impact of food-related toy sets on nutrition behaviors.

Perceived barriers and facilitators to participating in the North Carolina Healthy Food Small Retailer Program: a mixed-methods examination considering investment effectiveness

OBJECTIVE

The North Carolina Legislature appropriated funds in 2016-2019 for the Healthy Food Small Retailer Program (HFSRP), providing small retailers located in food deserts with equipment to stock nutrient-dense foods and beverages. The study aimed to: (1) examine factors facilitating and constraining implementation of, and participation in, the HFSRP from the perspective of storeowners and (2) measure and evaluate the impact and effectiveness of investment in the HFSRP.

DESIGN

The current analysis uses both qualitative and quantitative assessments of storeowner perceptions and store outcomes, as well as two innovative measures of policy investment effectiveness. Qualitative semi-structured interviews and descriptive quantitative approaches, including monthly financial reports and activity forms, and end-of-programme evaluations were collected from participating HFSRP storeowners.

SETTING

Eight corner stores in North Carolina that participated in the two cohorts (2016-2018; 2017-2019) of the HFSRP.

PARTICIPANTS

Owners of corner stores participating in the HFSRP.

RESULTS

All storeowners reported that the HFSRP benefitted their stores. In addition, the HFSRP had a positive impact on sales across each category of healthy food products. Storeowners reported that benefits would be enhanced with adjustments to programme administration and support. Specific suggestions included additional information regarding which healthy foods and beverages to stock; inventory management; handling of perishable produce; product display; modified reporting requirements and a more efficient process of delivering and maintaining equipment.

CONCLUSIONS

All storeowners reported several benefits of the HFSRP and would recommend that other storeowners participate. The barriers and challenges they reported inform potential approaches to ensuring success and sustainability of the HFSRP and similar initiatives underway in other jurisdictions.

Healthy Eating Index-2015 Scores Vary by Types of Food Outlets in the United States

Diet quality in the United States is improving over time but remains poor. Food outlets influence diet quality and represent the environments in which individuals make choices about food purchases and intake. The objective of this study was to use the Healthy Eating Index-2015 (HEI-2015) to evaluate the quality of foods consumed from the four major outlets where food is obtained—stores, full-service restaurants, quick-services restaurants, and schools—and to assess changes over time. This cross-sectional study used 24 h dietary recall data from eight cycles (2003–2004 to 2017–2018) of the National Health and Nutrition Examination Survey (NHANES). Linear trend estimation was used to test for changes in HEI scores over time, and balanced repeated replicate weighted linear regression was used to test for differences in total and component scores between types of food outlets. Overall, Americans are not consuming a mix of foods from any major category of food outlet that aligns with dietary guidelines. The total score for schools (65/100 points) and stores (62/100 points) was significantly higher than full-service (51/100 points) and quick-service (39/100 points) restaurants (p < 0.0001). HEI scores significantly improved over time for schools (p < 0.001), including an increase in whole grains from less than 1 point in 2003–2004 to 7 out of 10 points in 2017–2018. In 2017–2018, schools received the maximum score for total fruits, whole fruits, and dairy. Continued research on strategies for improving the quality of foods consumed from restaurants and stores is warranted.

Intake of Potatoes Is Associated with Higher Diet Quality, and Improved Nutrient Intake and Adequacy among US Adolescents: NHANES 2001-2018 Analysis

Potatoes are nutrient rich white vegetables, however, research on their impact on public health is limited. The objective of this study was to provide updated evaluation of the cross-sectional association between potato consumption and diet quality, nutrient intake and adequacy. Twenty-four hour diet recall data from adolescents (n = 16,633; age 9-18 years) were used to assess intakes. 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) after adjusting for demographic factors. Consumers of potatoes (baked or boiled potatoes, mashed potatoes and potato mixtures, fried potatoes, and potato chips) had higher (p < 0.05) HEI-2015 total score and subcomponent scores for total vegetables, total protein foods, and refined grain than non-consumers. Consumers also had higher (p < 0.05) intake of energy, dietary fiber, protein, copper, magnesium, phosphorus, potassium, selenium, sodium, zinc, niacin, vitamin B6, vitamin C, vitamin K and total choline; and higher (p < 0.05) adequacy for protein, copper, magnesium, phosphorus, potassium, zinc, thiamine, niacin, vitamin B6, vitamin C, and vitamin K than non-consumers. In conclusion, adolescent potato consumption was associated with higher diet quality, nutrient intake, and adequacy and therefore encouraging their consumption may be an effective strategy for improving nutritional status.

Household time activities, food waste, and diet quality: the impact of non-marginal changes due to COVID-19

In early 2020, a novel coronavirus quickly spread across the globe. In response to the rapidly increasing number of confirmed U.S. cases, state and local governments suggested social distancing, issued stay-at-home orders, and restricted travel, fundamentally changing how individuals allocate time. Directly impacted time activities, such as work, eating food away from home, grocery shopping, and childcare significantly impact two food-related topics: household food waste and diet quality. In order to investigate these non-marginal time changes, we predict weekly time allocated to seven activities for households in the National Food Acquisition and Purchase Survey using information from the American Time Use Survey. Jointly estimating household production functions for food waste and diet quality, we find that time events that are related to fresh produce consumption, such as increased grocery store trips and time spent in FAH activities, are related to higher diet quality, but lower food waste. While time events that are associated with quick convenient meals, such as time spent in secondary childcare and work time, are also associated with lower food waste, these events decrease household diet quality. We then predict the level of household food waste and diet quality for three COVID-19 scenarios: one where the household head is likely able to work remotely, another where the household head is likely to lose their job, and a third, where the household head is likely to be considered an essential worker. Households without children that are likely able to work remotely are predicted to have lower levels of food waste and higher diet quality, while households without children in the other two COVID-19 scenarios are predicted to have only minor differences.

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

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.

Intake of 100% Fruit Juice Is Associated with Improved Diet Quality of Adults: NHANES 2013-2016 Analysis

Fruit intake is generally associated with better diet quality and overall health. This report examined the effect of 100% fruit juice (considered a part of total fruit servings) and its replacement with whole fruits equivalents on nutrient intake and diet quality. National Health and Nutrition Examination Survey 2013-2016 data (24-h dietary recall) from adults 19+ years (n = 10,112) were used to assess the diet quality and nutrient intakes and to isocalorically replace with 100% fruit juice intakes whole fruit equivalents in a modeling analysis. About 15.6% adults were 100% fruit juice consumers. Consumers had higher diet quality (10% higher Healthy Eating Index, HEI 2015 score), and higher intakes of energy, calcium, magnesium, potassium, vitamin C and vitamin D than non-consumers. Consumption of 100% fruit juice was also associated with lower risk of being overweight/obese (-22%) and having metabolic syndrome (-27%). Replacing 100% fruit juice with whole fruits equivalents did not affect nutrient intake except for a modest increase (+6.4%) in dietary fiber. Results show that 100% fruit juice intake was associated with better diet quality and higher nutrient intake. Replacement of 100% fruit juice intake with whole fruits equivalents had no significant effect on nutrients except for dietary fiber.

Applications of the Healthy Eating Index for Surveillance, Epidemiology, and Intervention Research: Considerations and Caveats

The Healthy Eating Index (HEI) is a measure of diet quality that can be used to examine alignment of dietary patterns with the Dietary Guidelines for Americans. The HEI is made up of multiple adequacy and moderation components, most of which are expressed relative to energy intake (ie, as densities) for the purpose of calculating scores. Due to these characteristics and the complexity of dietary intake data more broadly, calculating and using HEI scores can involve unique statistical considerations and, depending on the particular application, intensive computational methods. The objective of this article is to review potential applications of the HEI, including those relevant to surveillance, epidemiology, and intervention research, and to summarize available guidance for appropriate analysis and interpretation. Steps in calculating HEI scores are reviewed and statistical methods described. Consideration of salient issues in the calculation and interpretation of scores can help researchers avoid common pitfalls and reviewers ensure that articles reporting on the use of the HEI include sufficient details such that the work is comprehensible and replicable, with the overall goal of contributing to knowledge on dietary patterns and health among Americans.

Oatmeal-Containing Breakfast is Associated with Better Diet Quality and Higher Intake of Key Food Groups and Nutrients Compared to Other Breakfasts in Children

Oatmeal is a whole grain (WG) food rich in fiber and other nutrients. The study objective was to compare diet quality and nutrient intake of children consuming oatmeal breakfasts to those of children consuming other breakfasts using the National Health and Nutrition Examination Survey (NHANES) 2011–2014. Dietary intake data from 5876 children aged 2–18 years were divided by breakfast food consumption: oatmeal breakfasts, “Doughnuts, sweet rolls, pastries”, “Pancakes, waffles, French toast”, “Eggs and omelets”, “Ready-to-eat cereal, lower sugar”, and “Ready-to-eat cereal, higher sugar” were used to assess diet quality and intake of food groups and nutrients using the USDA Healthy Eating Index-2015 (HEI-2015), Food Patterns Equivalents Database, and Food and Nutrient Database for Dietary Studies, respectively. As compared to consumers of other breakfasts or breakfast skippers, oatmeal consumers had consistently higher diet quality (4–16 points higher HEI 2015 total score, p < 0.05), higher WG intake (0.6–1.6 oz eq. higher, p < 0.05), and higher fiber and magnesium intakes compared to consumers of most other breakfasts or breakfast skippers. The results show that children consuming oatmeal breakfasts have better diet quality and increased intake of key nutrients compared to breakfast skippers and other breakfast consumers and suggest oatmeal may represent an important component of a healthy childhood diet.

Describing Food and Beverage Restaurants: Creating A Reliable Coding Tool

Objective

To develop an informed, reliable data collection tool to code restaurants found within the youth food environment.

Methods

Registered Dietitians were surveyed and academic literature review was reviewed to determine health centric food environment features. Features were incorporated into an electronic data collection tool. Inter-rater reliability was tested across coders of varying nutrition training on all restaurants located within a half-mile of three high schools.

Results

Sixteen restaurant food environment codes were generated. Data collection had a mean inter-rater reliability of 90.7% agreement (range=81.3-100%), suggesting that regardless of nutrition training, the restaurant food environment can be reliability coded.

Conclusions

Academic and public health professionals can use this tool to collect reliable, informed local restaurant food environment data.

An Examination of Demographic and Psychosocial Factors, Barriers to Healthy Eating, and Diet Quality Among African American Adults

A healthy diet is associated with lower risk of chronic disease. African Americans generally have poor diet quality and experience a higher burden of many chronic diseases. We examined the associations of demographic and psychosocial factors and barriers to diet quality among African American adults. This cross-sectional study included 100 African American adults in a southeastern metropolitan area. Psychosocial factors (social support, self-efficacy), and barriers to healthy eating were assessed with validated measures. Diet quality was assessed using the Healthy Eating Index (HEI-2010). Nested linear regressions were used to examine the association between the variables of interest and HEI scores. Participants reported having social support (M (mean) = 2.0, SD (standard deviation) = 0.6, range 0⁻3), high levels of self-efficacy (M = 3.1, SD = 0.7, range 1⁻4), and low barriers (M = 1.4, SD = 0.6, range 0⁻4) to engage in healthy eating but total mean HEI scores needed improvement (M = 54.8, SD = 10.9, range 27.1⁻70.0). Participants consumed significantly higher empty calories and lower whole fruits, dairy, and total protein foods than the national average. Barriers to healthy eating (b = -12.13, p = 0.01) and the interaction between age and barriers (b = 0.25, p = 0.02) were most strongly associated with lower HEI scores. Younger African Americans with the highest barriers to healthy eating had the lowest HEI scores. Culturally appropriate interventions targeting empty calories, barriers to healthy eating, and knowledge of the Dietary Guidelines for Americans are needed for African Americans.

Gender Comparison of the Diet Quality and Sources of Food Purchases Made by Urban Primary Household Food Purchasers

OBJECTIVE

To compare food purchasing behaviors and diet quality of foods purchased between men and women who were the primary food purchaser for their households.

METHODS

Food purchasing was measured via itemized receipts. The dietary composition of purchased foods was derived using the Nutrition Data System for Research and quality was assessed using the Healthy Eating Index-2010.

RESULTS

Men comprised 17.2% of the household primary food purchasers in the sample (n = 204). There were no differences by gender in the number of items purchased or the number of receipts. Men made fewer purchases at stores (74.0%) than did women (81.4%; P < .001). There were no gender differences in the quality of foods purchased overall or by source of purchase.

CONCLUSIONS AND IMPLICATIONS

In primary purchasers, purchasing behaviors varied by gender but not purchases did not. Food purchasing interventions should include both genders for greatest impact.

One-Year Follow-Up Examination of the Impact of the North Carolina Healthy Food Small Retailer Program on Healthy Food Availability, Purchases, and Consumption

We examined the short-term impact of the North Carolina Healthy Food Small Retailer Program (HFSRP), a legislatively appropriated bill providing funding up to $25,000 to small food retailers for equipment to stock and promote healthier foods, on store-level availability and purchase of healthy foods and beverages, as well as customer dietary patterns, one year post-policy implementation. We evaluated healthy food availability using a validated audit tool, purchases using customer bag-checks, and diet using self-reported questionnaires and skin carotenoid levels, assessed via Veggie Meter™, a non-invasive tool to objectively measure fruit and vegetable consumption. Difference-in-difference analyses were used to examine changes in HFSRP stores versus control stores after 1 year. There were statistically significant improvements in healthy food supply scores (availability), with the Healthy Food Supply HFS score being -0.44 points lower in control stores and 3.13 points higher in HFSRP stores pre/post HFSRP (p = 0.04). However, there were no statistically significant changes in purchases or self-reported consumption or skin carotenoids among customers in HFSRP versus control stores. Additional time or other supports for retailers (e.g., marketing and promotional materials) may be needed for HFSRP implementation to influence purchase and consumption.

Diet Quality of US Infants and Toddlers 7-24 Months Old in the WIC Infant and Toddler Feeding Practices Study-2

Background

Despite the important implications of childhood dietary intakes on lifelong eating habits and health, data are lacking on the diet quality of low-income infants and toddlers.

Objective

The objective of this study was to characterize diet quality in low-income US infants and toddlers.

Methods

A national observational study was conducted of 7- to 12-mo-old (n = 1261), 13-mo-old (n = 2515), and 24-mo-old (n = 2179) children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prenatally/at birth from 2013 to 2016. The study used a 24-h dietary recall and survey questions. For 7- to 12-mo-olds, an adapted Complementary Feeding Utility Index (CFUI) was used, and for 13- and 24-mo-olds, the Healthy Eating Index-2015 (HEI-2015) was used. Descriptive statistics were calculated for CFUI and HEI-2015 scores.

Results

For 7- to 12-mo-olds, the CFUI score (mean ± SE) was 0.56 ± 0.003 (range: 0.34-0.90, maximum possible 1.0). Most children met CFUI standards for exposure to iron-rich cereal (86.7%), and low exposure to energy-dense nutrient-poor foods (72.2%) and teas/broths (67.5%). Conversely, at 7-12 mo of age, exposure was low for vegetables (7.0%), fruits (14.4%), any sugary drinks (14.0%), and 12-mo breastfeeding duration (23.8%). At 13 and 24 mo of age, the HEI-2015 total score (maximum possible 100), on average, was 64.0. At both 13 and 24 mo of age, participants achieved, on average, maximal HEI-2015 component scores for total and whole fruits and dairy; however, scores for total vegetables, greens and beans, whole grains, seafood and plant proteins, fatty acids, and saturated fats were relatively low. Scores for refined grains, sodium, and added sugar were lower at 24 than at 13 mo of age, representing higher consumption, on average, over time.

Conclusions

Although findings demonstrate that young children are doing well on some dietary components, there is room for improvement, especially as children age. Findings may be used to inform the Pregnancy and Birth to 24-mo (P/B-24) Project. This trial was registered at clinicaltrials.gov as NCT02031978.

Association of raisin and raisin-containing food consumption with nutrient intake and diet quality in US children: NHANES 2001-2012

BACKGROUND

Raisins are a commonly consumed dried fruit and given their nutrient profile may offer nutritional and health benefits.

OBJECTIVE

To examine the association between consumption of raisins and raisin-containing foods with nutrient intake and dietary quality in children.

METHODS

National Health and Nutrition Examination Survey (NHANES) data for 2001-2012 in those 2-18 years of age (n = 20,175) were used. Consumers of raisins (n = 154, 51.6% female) and raisin-containing foods (n = 1,993, 52.5% female) were defined as reporting any consumption of raisins and raisin-containing foods, respectively, during the first 24-hr diet recall. Diet quality was assessed using the Healthy Eating Index (HEI)-2010. Regression analyses were conducted comparing consumers and nonconsumers using appropriate sample weights and adjusted for demographic and lifestyle covariates with significance set at p < 0.01.

RESULTS

Regarding "nutrients of public health concern/shortfall nutrients" and "nutrients to limit," raisin consumers had higher intakes of dietary fiber (23%), potassium (16%), magnesium (12%) with lower intakes of added sugars (-19%) than nonconsumers. Similarly, consumers of raisin-containing foods also had higher intakes of dietary fiber (15%), potassium (5%), magnesium (11%), iron (6%), vitamin A (10%), and vitamin E (13%) and lower intake of sodium (-5%). Consumers of raisin and raisin-containing foods had higher intakes of fruits (60%, 16%, respectively), whole fruits (119%, 23%, respectively) and whole grains (44%, 93%, respectively) and had a better diet quality as per higher total HEI 2010 scores (22%, 8%, respectively) than nonconsumers.

CONCLUSION

In conclusion, consumption of raisins or raisin-containing foods was associated with better nutrient intake and diet quality in American children.

Refining and implementing the Food Assortment Scoring Tool (FAST) in food pantries

OBJECTIVE

Hunger relief agencies have a limited capacity to monitor the nutritional quality of their food. Validated measures of food environments, such as the Healthy Eating Index-2010 (HEI-2010), are challenging to use due to their time intensity and requirement for precise nutrient information. A previous study used out-of-sample predictions to demonstrate that an alternative measure correlated well with the HEI-2010. The present study revised the Food Assortment Scoring Tool (FAST) to facilitate implementation and tested the tool's performance in a real-world food pantry setting.

DESIGN

We developed a FAST measure with thirteen scored categories and thirty-one sub-categories. FAST scores were generated by sorting and weighing foods in categories, multiplying each category's weight share by a healthfulness parameter and summing the categories (range 0-100). FAST was implemented by recording all food products moved over five days. Researchers collected FAST and HEI-2010 scores for food availability and foods selected by clients, to calculate correlations.

SETTING

Five food pantries in greater Minneapolis/St. Paul, Minnesota, USA.

SUBJECTS

Food carts of sixty food pantry clients.

RESULTS

The thirteen-category FAST correlated well with the HEI-2010 in prediction models (r = 0·68). FAST scores averaged 61·5 for food products moved, 63·8 for availability and 62·5 for client carts. As implemented in the real world, FAST demonstrated good correlation with the HEI-2010 (r = 0·66).

CONCLUSIONS

The FAST is a flexible, valid tool to monitor the nutritional quality of food in pantries. Future studies are needed to test its use in monitoring improvements in food pantry nutritional quality over time.

Association between the Healthy Eating Index-2010 and nutrient and energy densities of German households' food purchases

Background

The USDA Healthy Eating Index (HEI) is used widely to measure diet quality because it allows a number of different applications. Although several evaluations of the HEI-2010 have already been carried out, there is lack of those which focus on associations between the HEI and nutrient intakes. This study updates and expands upon previous findings on these associations. Using German consumption data, where ∼12 million purchases from 13 131 households are recorded, HEI-2010 total and individual scores, as well as several energy and nutrient densities were calculated. Correlations between the HEI and individual energy and nutrient densities were carried out to identify which nutrients are more or less well represented by the HEI. The HEI had the highest correlations with energy density and the densities of water-soluble vitamins (e.g. folic acid) and minerals (e.g. calcium). Weaker associations were identified for the densities of fat-soluble vitamins (e.g. vitamin D) as well as of the vitamins B1 and B12. Negligible correlations were detected for the densities of trace elements (e.g. fluoride and iodine), salt and fat composition. Given that energy intake and the intake of plant-based foods are relevant dietary issues, the HEI-2010 can be defined as a meaningful index to describe diet quality. However, because the intakes of salt, trace elements (e.g. fluoride and iodine) and fat-soluble vitamins, as well as the fat composition may be less reflected, they should be analyzed separately when using the HEI for measuring diet quality.

The relationship between home- and individual-level diet quality among African American and Hispanic/Latino households with young children

Background

The quality of most Americans’ diets is far from optimal. Given that many Americans consume a significant portion of calories in the home, intervening in this setting could be beneficial. However, the relationship between the home food environment and diet quality is not well understood. This study examined the relationship between diet quality at the individual level with home-level diet quality using an index that measures compliance with federal dietary guidance.

Methods

This was a cross sectional study that enrolled 97 African American and Hispanic/Latino low-income parent-child dyads. Diet quality at the individual level was assessed through two 24-h dietary recalls collected for parents and children, respectively. Diet quality at the home level was assessed with two home food inventories conducted in participants’ homes. Diet quality scores at the home and individual levels were computed by applying the Healthy Eating Index-2010 (HEI-2010) to these data. Linear models adjusted for potential confounding factors were used to examine the relationship between diet quality at the home and individual levels.

Results

Total HEI-2010 scores from parents and children’s diets were positively associated with HEI-2010 scores based on home food inventories (parent diet: β: 0.36, 95% CI: 012–0.60; child diet: 0.38 95% CI: 013–0.62). Positive associations were also observed between individual level and home level subcomponent HEI-2010 scores for total fruit (parent: 0.55 95% CI: 0.16–0.94; child: 0.49 95% CI: 0.03–0.94), whole fruit (parent only: 0.41 95% CI: 0.07–0.74), greens and beans (parent only: 0.39 95% CI: 0.05–0.74), and whole grain (children only: 0.33 95% CI: 0.04–0.63).

Conclusion

This study demonstrated that individual level diet quality was positively associated with home-level diet quality. Findings from this study can help us to address modifiable targets of intervention in the home to improve diet quality.

Association of raisin consumption with nutrient intake, diet quality, and health risk factors in US adults: National Health and Nutrition Examination Survey 2001-2012

Raisins are one of the most commonly consumed dried fruits. Because of their unique nutrient profile, raisins may have some distinctive health benefits. The purpose of this study was to examine the cross-sectional association between raisin consumption and nutrient intake, dietary quality, body weight, and metabolic syndrome risk factors in adults. Data from the National Health and Nutrition Examination Survey (NHANES), 2001–2012 (n = 29,684) were used. Raisin consumers (n = 458, 60% female) were defined as those having any amount of raisins during the first 24 h dietary recall. Diet quality was calculated using the Healthy Eating Index-2010 (HEI-2010). Covariate (demographic and lifestyle)-adjusted regression analyses were conducted using appropriate sample weights and significance was set at p < 0.01. Raisin consumers had higher intakes of energy (9%); higher intakes of ‘nutrients of public health concern/shortfall nutrients’, such as dietary fiber (34%), potassium (16%), magnesium (22%), vitamin C (24%), and vitamin E (22%); and lower intakes of ‘nutrients to limit’, such as added sugar (−17%), saturated fat (−15%), and sodium (−10%), than non-consumers. No associations were observed for intakes of calcium, iron, vitamin A, vitamin D, and folate. Consumers had higher intakes of total fruit (72%), whole fruit (111%), vegetables (22%), and whole grains (109%), and had a higher diet quality, as indicated by 25% higher total HEI-2010 scores than non-consumers. Compared to non-consumers, raisin consumers had a lower body weight (−4.2%), body mass index (−5.2%), and waist circumference (−3.8%), were 39% less likely to be overweight or obese, and had a 54% reduced risk of metabolic syndrome. In conclusion, raisin consumption was associated with better nutrient intake, diet quality, and weight parameters, and with lower risk of being obese and having metabolic syndrome in US adults.

Characterizing trends in fruit and vegetable intake in the USA by self-report and by supply-and-disappearance data: 2001-2014

OBJECTIVE

To examine the comparability of fruit and vegetable (F&V) intake data in the USA from 2001 to 2014 between data acquired from two national data collection programmes.

DESIGN

Cross-sectional analysis. Linear regression models estimated trends in daily per capita intake of total F&V. Pooled differences in intake of individual F&V (n 109) were examined by processing form (fresh, frozen, canned, dried and juice).

SETTING

What We Eat in America (WWEIA, 2001-2014) and Loss-Adjusted Food Availability data series (LAFA, 2001-2014).

RESULTS

No temporal trends were observed in daily per capita intake of total F&V from 2001 to 2014 using WWEIA and LAFA. Modest differences between WWEIA and LAFA were observed in mean pooled intake of most individual F&V.

CONCLUSIONS

WWEIA and LAFA produced similar estimates of F&V intake. However, WWEIA may be best suited for monitoring intake at the national level because it allows for the identification of individual F&V in foods with multiple ingredients, and it is structured for sub-population analysis and covariate control. LAFA does retain advantages for other research protocols, specifically by providing the only nationally representative estimates of food losses at various points in the food system, which makes it useful for examining the adequacy of the food supply at the agricultural, retail and consumer levels.

The Development of a Chinese Healthy Eating Index and Its Application in the General Population

The objective of this study was to develop a Chinese Healthy Eating Index (CHEI) based on the updated Dietary Guidelines for Chinese (DGC-2016) and to apply it in the 2011 China Health and Nutrition Survey (CHNS-2011) to assess diet quality and its association with typical sociodemographic/economic factors. Data from 14,584 participants (≥2 years) from the CHNS-2011, including three 24-h dietary recalls and additional variables, were used to develop the CHEI. The standard portion size was applied to quantify food consumption. The CHEI was designed as a continuous scoring system, comprising 17 components; the maximum total score is 100. The mean, 1st and 99th percentiles of the CHEI score were 52.4, 27.6 and 78.3, respectively. Young and middle-aged adults scored better than the elderly. Diet insufficiency was chiefly manifested in fruits, dairy, whole grains and poultry; diet excess was mainly reflected in red meat, cooking oils and sodium. The CHEI was positively associated with education and urbanization levels; current smokers and unmarried people obtained relative low CHEI scores. Occupation and body mass index (BMI) were also related to the CHEI. Our findings indicate that the CHEI is capable of recognizing differences in diet quality among the Chinese, and it is sensitive to typical sociodemographic/economic factors.

Association between store food environment and customer purchases in small grocery stores, gas-marts, pharmacies and dollar stores

Background

Purchases at small/non-traditional food stores tend to have poor nutritional quality, and have been associated with poor health outcomes, including increased obesity risk The purpose of this study was to examine whether customers who shop at small/non-traditional food stores with more health promoting features make healthier purchases.

Methods

In a cross-sectional design, data collectors assessed store features in a sample of 99 small and non-traditional food stores not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Minneapolis/St. Paul, MN in 2014. Customer intercept interviews (n = 594) collected purchase data from a bag check and demographics from a survey. Store measures included fruit/vegetable and whole grain availability, an overall Healthy Food Supply Score (HFSS), healthy food advertisements and in-store placement, and shelf space of key items. Customer nutritional measures were analyzed using Nutrient Databases System for Research (NDSR), and included the purchase of ≥1 serving of fruits/vegetables; ≥1 serving of whole grains; and overall Healthy Eating Index-2010 (HEI-2010) score for foods/beverages purchased. Associations between store and customer measures were estimated in multilevel linear and logistic regression models, controlling for customer characteristics and store type.

Results

Few customers purchased fruits and vegetables (8%) or whole grains (8%). In fully adjusted models, purchase HEI-2010 scores were associated with fruit/vegetable shelf space (p = 0.002) and the ratio of shelf space devoted to healthy vs. less healthy items (p = 0.0002). Offering ≥14 varieties of fruit/vegetables was associated with produce purchases (OR 3.9, 95% CI 1.2–12.3), as was having produce visible from the store entrance (OR 2.3 95% CI 1.0 to 5.8), but whole grain availability measures were not associated with whole grain purchases.

Conclusions

Strategies addressing both customer demand and the availability of healthy food may be necessary to improve customer purchases.

Trial registration

ClinialTrials.gov: NCT02774330. Registered May 4, 2016 (retrospectively registered).

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0531-x) contains supplementary material, which is available to authorized users.

To what extent do food purchases reflect shoppers' diet quality and nutrient intake?

BACKGROUND

Food purchasing is considered a key mediator between the food environment and eating behavior, and food purchasing patterns are increasingly measured in epidemiologic and intervention studies. However, the extent to which food purchases actually reflect individuals' dietary intake has not been rigorously tested. This study examined cross-sectional agreement between estimates of diet quality and nutrient densities derived from objectively documented household food purchases and those derived from interviewer-administered 24-h diet recalls. A secondary aim was to identify moderator variables associated with attenuated agreement between purchases and dietary intake.

METHODS

Primary household food shoppers (N = 196) collected and annotated receipts for all household food and beverage purchases (16,356 total) over 14 days. Research staff visited participants' homes four times to photograph the packaging and nutrition labels of each purchased item. Three or four multiple-pass 24-h diet recalls were performed within the same 14-d period. Nutrient densities and Healthy Eating Index-2010 (HEI-2010) scores were calculated from both food purchase and diet recall data.

RESULTS

HEI-2010 scores derived from food purchases (median = 60.9, interquartile range 49.1-71.7) showed moderate agreement (ρc = .57, p < .0001) and minimal bias (-2.0) with HEI-2010 scores from 24-h recalls (median = 60.1, interquartile range 50.8-73.9). The degree of observed bias was unrelated to the number of food/beverage purchases reported or participant characteristics such as social desirability, household income, household size, and body mass. Concordance for individual nutrient densities from food purchases and 24-h diet recalls varied widely from ρc = .10 to .61, with the strongest associations observed for fiber (ρc = .61), whole fruit (ρc = .48), and vegetables (ρc = .39).

CONCLUSIONS

Objectively documented household food purchases yield an unbiased and reasonably accurate estimate of overall diet quality as measured through 24-h diet recalls, but are generally less useful for characterizing dietary intake of specific nutrients. Thus, some degree of caution is warranted when interpreting food purchase data as a reflection of diet in epidemiological and clinical research. Future work should examine agreement between food purchases and nutritional biomarkers.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02073643 . Retrospectively registered.

Measures of the food environment: A systematic review of the field, 2007-2015

BACKGROUND

Many studies have examined the relationship between the food environment and health-related outcomes, but fewer consider the integrity of measures used to assess the food environment. The present review builds on and makes comparisons with a previous review examining food environment measures and expands the previous review to include a more in depth examination of reliability and validity of measures and study designs employed.

METHODS

We conducted a systematic review of studies measuring the food environment published between 2007 and 2015. We identified these articles through: PubMed, Embase, Web of Science, PsycINFO, and Global Health databases; tables of contents of relevant journals; and the National Cancer Institute's Measures of the Food Environment website. This search yielded 11,928 citations. We retained and abstracted data from 432 studies.

RESULTS

The most common methodology used to study the food environment was geographic analysis (65% of articles) and the domination of this methodology has persisted since the last review. Only 25.9% of studies in this review reported the reliability of measures and 28.2% reported validity, but this was an improvement as compared to the earlier review. Very few of the studies reported construct validity. Studies reporting measures of the school or worksite environment have decreased since the previous review. Only 13.9% of the studies used a longitudinal design.

CONCLUSIONS

To strengthen research examining the relationship between the food environment and population health, there is a need for robust and psychometrically-sound measures and more sophisticated study designs.

Between exposure, access and use: Reconsidering foodscape influences on dietary behaviours

Good accessibility to both healthy and unhealthy food outlets is a greater reality than food deserts. Yet, there is a lack of conceptual insights on the contextual factors that push individuals to opt for healthy or unhealthy food outlets when both options are accessible. Our comprehension of foodscape influences on dietary behaviours would benefit from a better understanding of the decision-making process for food outlet choices. In this paper, we build on the fundamental position that outlet choices are conditioned by how much outlets' attributes accommodate individuals' constraints and preferences. We further argue that food outlets continuously experienced within individuals' daily-path help people re-evaluate food acquisition possibilities, push them to form intentions, and shape their preferences for the choices they will subsequently make. Doing so, we suggest differentiating access, defined as the potential for the foodscape to be used at the time when individuals decide to do so, from exposure, which acts as a constant catalyst for knowledge, intention, preferences and routine tendency. We conclude with implications for future research, and discuss consequences for public policy.

Dietary contribution of foods and beverages sold within a university campus and its effect on diet quality of young adults

OBJECTIVE

Tertiary education institutions have been linked with excessive weight in young adults. However, few data are available on the effect of foods from the university food environment on the diet quality of young adults. The aim of this study was to describe the association of a number of foods and beverages consumed at university food outlets with the diet quality of young adults.

METHODS

This was a cross-sectional survey in which the 103 university student participants, aged 19 to 24 y, contributed 5 d of dietary data. A purposely designed, validated smartphone application was used to collect the data. Diet quality was assessed by adherence to the 2013 dietary guidelines for food groups and nutrients, and the validated Healthy Eating Index for Australians (HEIFA-2013) was applied. Individual HEIFA-2013 scores were compared with the frequency of food purchase and consumption from university outlets to assess a dose-response effect of the food environment. Comparisons by tertiles of diet quality for body mass index, waist circumference, and takeaway food consumption (university and other) were computed using a one-way analysis of variance and post hoc Tukey test.

RESULTS

There was a statistically significant difference between the number of university foods and beverages consumed in 5 d and the HEIFA-2013 scores: More on-campus purchases resulted in a poor-quality diet (P = 0.001). As the HEIFA-2013 tertile scores increased, there was a significant decrease in the number of university campus and other takeaway foods consumed; body mass index and waist circumference showed a decrease in trend.

CONCLUSIONS

Efforts to improve the diet quality of young adults attending university may benefit from approaches to improve the campus food environment.

Food and beverage purchases in corner stores, gas-marts, pharmacies and dollar stores

OBJECTIVE

Little is known about customer purchases of foods and beverages from small and non-traditional food retailers (i.e. corner stores, gas-marts, dollar stores and pharmacies). The present study aimed to: (i) describe customer characteristics, shopping frequency and reasons for shopping at small and non-traditional food retailers; and (ii) describe food/beverage purchases and their nutritional quality, including differences across store type.

DESIGN

Data were collected through customer intercept interviews. Nutritional quality of food/beverage purchases was analysed; a Healthy Eating Index-2010 (HEI-2010) score for purchases was created by aggregating participant purchases at each store.

SETTING

Small and non-traditional food stores that were not WIC-authorized in Minneapolis and St. Paul, MN, USA.

SUBJECTS

Customers (n 661) from 105 food retailers.

RESULTS

Among participants, 29 % shopped at the store at least once daily; an additional 44 % shopped there at least once weekly. Most participants (74 %) cited convenient location as the primary draw to the store. Customers purchased a median of 2262 kJ (540 kcal), which varied by store type (P=0·04). The amount of added sugar far surpassed national dietary recommendations. At dollar stores, participants purchased a median of 5302 kJ (1266 kcal) for a median value of $US 2·89. Sugar-sweetened beverages were the most common purchase. The mean HEI-2010 score across all stores was 36·4.

CONCLUSIONS

Small and non-traditional food stores contribute to the urban food environment. Given the poor nutritional quality of purchases, findings support the need for interventions that address customer decision making in these stores.

Evaluation of a 'healthiness' rating system for food outlet types in Australian residential communities

AIM

To obtain expert consensus to develop and evaluate a rating system on the relative healthiness of Australian suburbs' food outlet types.

METHODS

Twenty-four food outlet types and 10 local suburbs were identified from previous mapping studies and based on a scan of suburbs across one large Australian geographical region. Initial food outlet 'scores' for relative healthiness were proposed based on available literature, classified into five categories, from 'most' to 'least' healthy. In round 1 of a modified Delphi survey, participants, Australian public health and nutrition experts, were given each outlet type's definition and the proposed scores and invited to modify the scores based on their perceived 'healthiness'. In round 2, participants were able to revise or adjust their scores.

RESULTS

Median scores for food outlet types from both rounds highly correlated with the originally proposed scores (two-tailed Pearson's correlation coefficient 0.97 and 0.96, respectively, P = 0.01), and scores from round 1 highly correlated with those from round 2 (Pearson's coefficient 0.998, P = 0.01). Round 2 scores were used to calculate suburbs' overall food environment score, healthiness score, unhealthiness score and a ratio of unhealthiness to healthiness scores. There was strong positive correlation between suburbs' ratio of unhealthiness to healthiness scores and a previously recognised scoring ratio, Retail Food Environment Index (Spearman's rho 0.847, P < 0.01).

CONCLUSIONS

The study generated experts' consensus about relative healthiness of food outlet types found in Australian neighbourhoods. Proposed scores can be used to assess and compare healthiness of community food environments and to explore their associations with area characteristics, population's diet and health outcomes.

Application of the Healthy Eating Index-2010 to the hunger relief system

OBJECTIVE

To demonstrate the feasibility of applying the Healthy Eating Index-2010 (HEI-2010) to the hunger relief setting, specifically by assessing the nutritional quality of foods ordered by food shelves (front-line food provider) from food banks (warehouse of foods).

DESIGN

This Healthy FOOD (Feedback On Ordering Decisions) observational study used electronic invoices detailing orders made by 269 food shelves in 2013 and analysed in 2015 from two large Minnesota, USA food banks to generate HEI-2010 scores. Initial development and processing procedures are described.

RESULTS

The average total HEI-2010 score for the 269 food shelves was 62·7 out of 100 with a range from 28 to 82. Mean component scores for total protein foods, total vegetables, fatty acids, and seafood and plant proteins were the highest. Mean component score for whole grains was the lowest followed by dairy, total fruits, refined grains and sodium. Food shelves located in micropolitan areas and the largest food shelves had the highest HEI-2010 scores. Town/rural and smaller food shelves had the lowest scores. Monthly and seasonal differences in scores were detected. Limitations to this approach are identified.

CONCLUSIONS

Calculating HEI-2010 for food shelves using electronic invoice data is novel and feasible, albeit with limitations. HEI-2010 scores for 2013 identify room for improvement in nearly all food shelves, especially the smallest agencies. The utility of providing HEI-2010 scores to decision makers in the hunger relief setting is an issue requiring urgent study.

Assessing foods offered in the Food Distribution Program on Indian Reservations (FDPIR) using the Healthy Eating Index 2010

OBJECTIVE

To assess the nutritional quality of food packages offered in the Food Distribution Program on Indian Reservations (FDPIR) using the Healthy Eating Index 2010 (HEI-2010).

DESIGN

Data were collected from the list of the food products provided by the US Department of Agriculture's Food and Nutrition Handbook 501 for FDPIR. Nutritional quality was measured through a cross-sectional analysis of five randomly selected food packages offered through FDPIR. HEI-2010 component and total scores were calculated for each food package. ANOVA and t tests assessed significant differences between food packages and HEI-2010 maximum scores, respectively.

SETTING

This study took place in the USA.

SUBJECTS

Study units included food products offered through FDPIR.

RESULTS

The mean total HEI-2010 score for the combined FDPIR food packages was significantly lower than the total HEI-2010 maximum score of 100 (66·38 (sd 11·60); P<0·01). Mean scores for total fruit (3·52 (sd 0·73); P<0·05), total vegetables (2·58 (sd 0·15); P<0·001), greens and beans (0·92 (sd 1·00); P<0·001), dairy (5·12 (sd 0·63); P<0·001), total protein foods (4·14 (sd 0·56); P<0·05) and refined grains (3·04 (sd 2·90); P<0·001) were all significantly lower than the maximum values.

CONCLUSIONS

The FDPIR food package HEI-2010 score was notably higher than other federal food assistance and nutrition programmes. Study findings highlight opportunities for the FDPIR to modify its offerings to best support lifestyles towards prevention of diet-related chronic disease.

American Diet Quality: Where It Is, Where It Is Heading, and What It Could Be

BACKGROUND

Diet quality is critically important to the prevention of many types of chronic disease. The federal government provides recommendations for optimal diet quality through the Dietary Guidelines for Americans, and sets benchmarks for progress toward these recommendations through the Healthy People objectives.

OBJECTIVE

This analysis estimated recent trends in American diet quality and compared those trends to the quality of diets that would meet the Healthy People 2020 objectives and the 2010 Dietary Guidelines for Americans in order to measure progress toward our national nutrition goals.

DESIGN

This analysis used 24-hour recall data from the cross-sectional National Health and Nutrition Examination Survey, between the years of 1999-2000 and 2011-2012, to determine mean intakes of various dietary components for the US population over time. Mean intakes were estimated using the population ratio method, and diet quality was assessed using the Healthy Eating Index 2010 (HEI-2010).

RESULTS

The mean HEI-2010 total score for the US population has increased from 49 in 1999-2000 to 59 in 2011-2012; continuing on that trajectory, it would reach a score of 65 by 2019-2020. A diet that meets the Healthy People 2020 objectives would receive a score of 74 and, by definition, a diet that meets the 2010 Dietary Guidelines for Americans would receive a score of 100. Trends in HEI-2010 component scores vary; all HEI-2010 component scores except sodium have increased over time.

CONCLUSIONS

Diet quality is improving over time, but not quickly enough to meet all of the Healthy People 2020 objectives. Whole fruit and empty calories are the only HEI-2010 components on track to meet their respective Healthy People 2020 targets. Furthermore, the country falls short of the 2010 Dietary Guidelines for Americans by a large margin in nearly every component of diet quality assessed by the HEI-2010.

Geographic access to food shelves among racial/ethnic minorities and foreign-born residents in the Twin Cities

Place-based disparities in access to affordable food sources (e.g., supermarkets) have been well documented, but geographic access to emergency food sources (e.g., food panties, also known as food shelves) is unknown. This study examined the geography of emergency food in the Twin Cities, MN. U.S. Census and American Community Survey data were used to estimate the average distance to the closest food shelf according to area racial/ethnic composition and foreign-born group composition. In adjusted models, areas with the highest proportion of minority groups had shorter distances to the nearest food shelf (0.13-1.03 log-transformed miles, p <0.05), as did census tracts with more residents born in East Africa and Latin America (0.29-0.31 log-transformed miles, p< 0.001). Areas with more racial/ethnic minorities and foreign-born groups may have access to emergency food, but efforts are needed to evaluate the healthfulness and culturally relevance of these offerings.

Association of lunch meat consumption with nutrient intake, diet quality and health risk factors in U.S. children and adults: NHANES 2007-2010

BACKGROUND

Consumption of lean meat is recommended as part of healthy diet by Dietary Guidelines for Americans, 2010. Lunch meats are precooked or cured meats typically used in sandwiches and are also called as cold cuts or deli meat.

OBJECTIVE

The purpose of the study was to examine the association of lunch meat consumption with nutrient intake, diet quality, and physiological measures in children (age 2-18 years; n = 5,099) and adults (age 19 years and older; n = 10,216) using a large, nationally representative database.

METHODS

Lunch meat consumers were defined as those consuming any amount of lunch meat during a 24-h recall and association with nutrient intake, diet quality (Healthy Eating Index (HEI)-2010 score) and physiological measures were evaluated using the National Health and Nutrition Examination Survey (NHANES), 2007-2010.

RESULTS

The lunch meat consumers (both children and adults) had higher intakes of calories, protein, calcium, potassium, sodium and saturated fat (for adults only) compared to non-consumers. Lunch meat intake was also associated with higher intake of meat/poultry/fish food group in both children and adult consumers than non-consumers. There was no difference in total HEI-2010 scores comparing lunch meat consumers and non-consumers in children or adults. However, HEI components scores for total fruit, whole fruit (children only), whole grains, dairy and total protein foods were significantly higher, and for greens & beans (adults only), seafood and plant protein, fatty acid ratio and sodium were significantly lower in children and adult lunch meat consumers compared to non-consumers. There were no significant differences in physiological measures or in the odds ratios of health related conditions between lunch meat consumers and non-consumers in children or adults.

CONCLUSIONS

The results of this study may provide insight into how to better utilize lunch meats in the diets of U.S. children and adults.

Did the 2009 American Recovery and Reinvestment Act affect dietary intake of low-income individuals?

This paper examines the relationship between increased Supplemental Nutritional Assistance Program (SNAP) benefits following the 2009 American Recovery and Reinvestment Act (ARRA) and the diet quality of individuals from SNAP-eligible compared to ineligible (those with somewhat higher income) households using data from the 2007-2010 National Health and Nutrition Examination Survey. The ARRA increased SNAP monthly benefits by 13.6% of the maximum allotment for a given household size, equivalent to an increase of $24 to $144 for one-to-eight person households respectively. In the full sample, we find that these increases in SNAP benefits are not associated with changes in nutrient intake and diet quality. However, among those with no more than a high school education, higher SNAP benefits are associated with a 46% increase in the mean caloric share from sugar-sweetened beverages (SSBs) and a decrease in overall diet quality especially for those at the lower end of the diet quality distribution, amounting to a 9% decline at the 25th percentile.

Diet Quality of Items Advertised in Supermarket Sales Circulars Compared to Diets of the US Population, as Assessed by the Healthy Eating Index-2010

BACKGROUND

Supermarkets use sales circulars to highlight specific foods, usually at reduced prices. Resulting purchases help form the set of available foods within households from which individuals and families make choices about what to eat.

OBJECTIVE

The purposes of this study were to determine how closely foods featured in weekly supermarket sales circulars conform to dietary guidance and how diet quality compares with that of the US population's intakes.

DESIGN

Food and beverage items (n=9,149) in 52 weekly sales circulars from a small Midwestern grocery chain in 2009 were coded to obtain food group and nutrient and energy content. Healthy Eating Index-2010 (HEI-2010) total and component scores were calculated using algorithms developed by the National Cancer Institute. HEI-2010 scores for the US population aged 2+ years were estimated using data from the 2009-2010 National Health and Nutrition Examination Survey. HEI-2010 scores of circulars and population intakes were compared using Student's t tests.

RESULTS

Mean total (42.8 of 100) HEI-2010 scores of circulars were lower than that of the US population (55.4; P<0.001). Among individual components, Total Protein Foods was the only one for which 100% of the maximum score was met by both circulars and the population. The scores were also similar between the circulars and population for Whole Grains (22%; P=0.81) and Seafood and Plant Proteins (70% to 74%; P=0.33). Circular scores were lower than those of the population for Total and Whole Fruits, Total Vegetables and Greens and Beans, Dairy, Sodium, and Empty Calories (P<0.001); they were higher only for Fatty Acids (P=0.006) and Refined Grains (P<0.001).

CONCLUSIONS

HEI-2010 total scores for these sales circulars were even lower than US population scores, which have been shown repeatedly to reflect low diet quality. Supermarkets could support improvements in consumer diets by weekly featuring foods that are more in concordance with food and nutrient recommendations.

Walnut ingestion in adults at risk for diabetes: effects on body composition, diet quality, and cardiac risk measures

BACKGROUND

Despite their energy density, walnuts can be included in the diet without adverse effects on weight or body composition. The effect of habitual walnut intake on total calorie intake is not well studied. Effects on overall diet quality have not been reported.

METHODS

Randomized, controlled, modified Latin square parallel design study with 2 treatment arms. The 112 participants were randomly assigned to a diet with or without dietary counseling to adjust calorie intake. Within each treatment arm, participants were further randomized to 1 of the 2 possible sequence permutations to receive a walnut-included diet with 56 g (providing 366 kcal) of walnuts per day and a walnut-excluded diet. Participants were assessed for diet quality, body composition, and cardiac risk measures.

RESULTS

When compared with a walnut-excluded diet, a walnut-included diet for 6 months, with or without dietary counseling to adjust caloric intake, significantly improved diet quality as measured by the Healthy Eating Index 2010 (9.14±17.71 vs 0.40±15.13; p=0.02 and 7.02±15.89 vs -5.92±21.84; p=0.001, respectively). Endothelial function, total and low-density lipoprotein (LDL) cholesterol improved significantly from baseline in the walnut-included diet. Body mass index, percent body fat, visceral fat, fasting glucose, glycated hemoglobin, and blood pressure did not change significantly.

CONCLUSIONS

The inclusion of walnuts in an ad libitum diet for 6 months, with or without dietary counseling to adjust calorie intake, significantly improved diet quality, endothelial function, total and LDL cholesterol, but had no effects on anthropometric measures, blood glucose level, and blood pressure.

TRIAL REGISTRATION NUMBER

NCT02330848.

Comparison of two indices of diet quality with acculturation factors and demographics in Haitian Americans

This study examined associations of language preference and length of stay in the United States and diet among 132 Haitian Americans aged ≥35, born in Haiti. Two dietary indices, Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI), were used to assess dietary quality. Years in the United States (>15 years; B = 0.063, p = .012) and female gender (B = 5.63, p = .028) were positively associated with AHEI. Lower HEI scores were associated with speaking no English (B = -6.11, p = .026). Participants reporting an income under 20,000/yr had lower AHEI scores (B = -7.63, p = .014). Concurrent use of these indices would provide a screening tool for nutrition intervention. Public health programs targeting low-cost resources, such as community gardening, are recommended to reduce health disparities among this population.

High proportions of foods recommended for consumption by United States Dietary Guidance contain solid fats and added sugar: results from the National Health and Nutrition Examination Survey (2007-2008)

BACKGROUND

The 2010 Dietary Guidelines for Americans (DGA) recommend that individuals age two years and older reduce intakes of solid fats (SoF) and added sugars (AS; together SoFAS). MyPlate illustrates the proportions of five major food groups to promote healthy eating (Vegetables, Grains, Protein Foods, Fruits and Dairy).

METHODS

To assess if the foods currently consumed by Americans are in concordance with the DGA, food consumption data from What We Eat In America, National Health and Nutrition Examination Survey (WWEIA-NHANES) 2007-2008 (n = 8 527) was used to estimate the proportion of foods that contained SoFAS and to report them by food group. Weighted analysis was conducted to be nationally representative.

RESULTS

The Dairy group contained the highest proportion (93%) of either SoF or AS, followed by Grains (70% SoF; 70% AS; 50% both). Fruits contained the least SoFAS (7%).

CONCLUSIONS

Results suggest that the high proportion of SoFAS in each recommended food group makes it challenging for Americans to reduce their intake of SoFAS.

The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans

The Healthy Eating Index (HEI), a measure of diet quality, was updated to reflect the 2010 Dietary Guidelines for Americans and the accompanying USDA Food Patterns. To assess the validity and reliability of the HEI-2010, exemplary menus were scored and 2 24-h dietary recalls from individuals aged ≥2 y from the 2003-2004 NHANES were used to estimate multivariate usual intake distributions and assess whether the HEI-2010 1) has a distribution wide enough to detect meaningful differences in diet quality among individuals, 2) distinguishes between groups with known differences in diet quality by using t tests, 3) measures diet quality independently of energy intake by using Pearson correlation coefficients, 4) has >1 underlying dimension by using principal components analysis (PCA), and 5) is internally consistent by calculating Cronbach's coefficient α. HEI-2010 scores were at or near the maximum levels for the exemplary menus. The distribution of scores among the population was wide (5th percentile = 31.7; 95th percentile = 70.4). As predicted, men's diet quality (mean HEI-2010 total score = 49.8) was poorer than women's (52.7), younger adults' diet quality (45.4) was poorer than older adults' (56.1), and smokers' diet quality (45.7) was poorer than nonsmokers' (53.3) (P < 0.01). Low correlations with energy were observed for HEI-2010 total and component scores (|r| ≤ 0.21). Cronbach's coefficient α was 0.68, supporting the reliability of the HEI-2010 total score as an indicator of overall diet quality. Nonetheless, PCA indicated multiple underlying dimensions, highlighting the fact that the component scores are equally as important as the total. A comparable reevaluation of the HEI-2005 yielded similar results. This study supports the validity and the reliability of both versions of the HEI.