Healthy eating index and anthropometric status in young children: A cross-sectional study

Two a Priori Dietary Indices among Young Children in the Children's Healthy Living (CHL) Trial: Validation and Association with Health Outcomes

BACKGROUND

Children's diets affect multiple health outcomes. Dietary indices are a useful tool for quantifying the quality of the overall diet, but their performance may differ among children of different ages and in understudied populations.

OBJECTIVES

This analysis aimed to validate 2 dietary indices and examine their associations with physical body measures among 2-8-y-old children of the United States-Affiliated Pacific region.

METHODS

Data were collected on children (n = 2359) from 5 jurisdictions of the children's healthy living randomized control trial in independent cross-sectional cluster samples over 3-time points. Anthropometric measurements were taken, and dietary intakes were ascertained from 2 d of dietary records completed by caregivers. The Healthy Eating Index (HEI)-2020 and dietary approaches to stop hypertension (DASH) scores were calculated using a simple scoring algorithm, their construct validity and performance were evaluated, and associations with nutrient intake, body measures, and obesity status were examined using covariate-adjusted means and unconditional logistic regression.

RESULTS

We observed a wide range of variation in DASH (9-38 points) and HEI-2020 (10-94.7 points), clear separation of mean component scores by quintile of the total score, and multiple dimensions for each index. Significant trends in polyunsaturated and saturated fat were observed from the lowest to the highest quintile of HEI-2020 (12% higher and 21% reduction, respectively) but not for DASH. Significant differences by quintile of DASH and HEI-2020 were found for mean body mass index z-score among 6-8-y-olds and for waist circumference among boys and 6-8-y-olds. The odds of obesity exhibited statistically significant downward trends across quintiles of HEI-2020 among all participants and in all sexes and age groups, and across quintiles of DASH among all participants, boys and 6-8-y-olds.

CONCLUSIONS

We found that HEI-2020 is a better measure of dietary intake than DASH in this population of 2-8-y-old children of the United States-Affiliated Pacific region.

Diet Quality Scores, Obesity and Metabolic Syndrome in Children and Adolescents: A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

We aimed to examine the relationship between various diet quality scores and obesity and Metabolic Syndrome (MetS) in children and adolescents.

RECENT FINDINGS

Obesity and MetS, which increase the risk of type 2 diabetes and cardiovascular disease from childhood through adolescence, have been associated with adherence to various diet quality scores. A systematic search was performed in PubMed/Medline, Scopus, SciELO, Embase, and Cochrane, covering the period until March 2024. Two researchers evaluated 3,519 studies according to the inclusion criteria. Finally, 73 articles that analysed the relationship between diet quality scores and obesity and MetS were included, and 6 of them were included in a meta-analysis. Children younger than 12 years old showed statistically significant differences indicating a higher Mediterranean diet (MD) score adherence compared to those with a low score adherence for BMI (MD = 0.33 kg/m2, 95% CI: 0.01, 0.64) and WC values (MD = 1.21 cm, 95% CI: 0.50, 1.93). Additionally, in the meta-regression analysis, boys showed stronger associations for BMI, z-score BMI and WC (β = 19.82, 95% CI: 17.62, 22.03, β = 0.64, 95% CI: 0.33, 0.96 and β = 67.03, 95% CI: 57.29, 76.77, respectively). Studies in this review suggest an association between high adherence to different diet quality scores and low BMI. Meta-analysis assessing the association between adherence to the MD and BMI, and WC, showed a protective effect of the MD pattern against obesity outcomes. This systematic review and meta-analyses provided evidence on the effect of the diet quality on obesity and MetS in children and adolescents.

Association between modified youth healthy eating index and nutritional status among Iranian children in Zabol city: a cross-sectional study

Diet quality in childhood and adolescence can affect health outcomes such as physical and cognitive growth and preventing chronic diseases in adulthood. This study aimed to evaluate the relationship between diet quality using the modified youth healthy eating index (MYHEI) with socioeconomic factors and nutrition status in 7-12-year-old children in Iran. This descriptive-cross-sectional study was performed on 580 students in Zabol, Iran, selected through multistage cluster sampling. The diet was assessed through the 168-item food frequency questionnaire (FFQ) and eating behaviors. Then, the MYHEI scoring system was used to calculate the diet quality. In addition, we used the WHO growth indices, such as weight to age, height to age, and body mass index (BMI) to age ratios, to evaluate nutrition status. The mean total MYHEI score in children was 56.3 ± 11.2. Among children with the highest MYHEI score quartile, the number of girls was significantly higher than boys (p = 0.001). The prevalence of underweight, stunting, and wasting was 25.3%, 17.4%, and 21.7%, respectively. The prevalence of underweight (OR: 2.2; 95% CI  1.26, 3.90, p = 0.001) and stunting (OR: 3.2; 95% CI   1.65, 6.14, p = 0.006) were significantly lower in the higher MYHEI score quartile compared to the lower quartile. The overall diet quality of most children should be modified. Therefore, to improve the children's health and nutrition status, it is necessary to perform nutritional interventions such as training and promotional programs, especially in schools.

Association of healthy eating index and anthropometric indices among primary school girls in southeast of Iran: a cross-sectional study

BACKGROUND

The school-age period is marked by substantial advancements in physical and cognitive development, highlighting the importance of assessing the diet quality and its impact on body weight and height. The main objective of this study was to evaluate the association between diet quality and selected anthropometric indices of primary school girls in southeast of Iran using the healthy eating index-2015 (HEI-2015).

METHODS

This cross-sectional study involved 330 students aged 6-12 years from 10 primary schools in Kerman City. Standard protocols and a dish-based food frequency questionnaire were employed to evaluate anthropometric indices and dietary intake. The HEI-2015 was utilized to assess the quality of participants' diets, with a total score ranging from zero to 100, based on thirteen food score components.

RESULTS

In the present study, older participants had higher HEI scores (p = 0.02). Additionally, participants in the highest tertile of HEI score had greaterodds of being overweight (OR: 2.13; CI = 1.17-3.85, P = 0.011) and had higher intakes of whole fruits, total fruits including fruit juice, whole grains, total protein foods, seafood and plant proteins, greens, and beans (p < 0.05). However, no significant association was found between HEI score and other anthropometric indices, obesity, and thinness.

CONCLUSIONS

The study found no significant association between HEI scores and the likelihood of being thin or obese. However, children with the highest HEI scores were more likely to beoverweight. Therefore, it is recommended to implement health programs for primary school girls in Kerman to improve their eating habits and reduce the risk of overweight and obesity.

Association of Healthy Eating Index-2015 and Dietary Approaches to Stop Hypertension Patterns with Insulin Resistance in Schoolchildren

Background: Diet quality patterns are associated with a lower incidence of insulin resistance (IR) in adults. The aim of this study was to investigate the association between two diet quality indices and IR in schoolchildren and to identify the best diet quality index associated with a lower risk of IR. Methods: A total of 854 schoolchildren (8−13 years) were included in a cross-sectional study, who completed a three-day dietary record to assess their diet. Fasting plasma glucose and insulin were also measured, and anthropometric data were collected. Healthy Eating Index-2015 (HEI-2015), Dietary Approaches to Stop Hypertension (DASH), and adjusted DASH (aDASH) were calculated as diet quality indices. The homeostasis model assessment of insulin resistance (HOMA-IR) was used, and IR was defined as HOMA-IR > 3.16. Results: The prevalence of IR was 5.5%, and it was higher in girls. The mean HEI-2015 and DASH scores were 59.3 and 23.4, respectively, and boys scored lower in both indices. In girls, having a HEI-2015 score above the 33rd percentile was associated with a lower risk of IR (odds ratio [95% CI]: 0.43 [0.19−0.96], p = 0.020). Conclusion: Greater adherence to a healthy dietary pattern, as assessed by a higher HEI-2015 score, was associated with a lower risk of IR in schoolchildren, especially in girls.

The association between the Healthy Eating Index (HEI-2015) score and body composition among Iranian soccer players and referees: a cross-sectional study

For an optimal performance, soccer players and referees need to consume a high-quality diet. The Healthy Eating Index (HEI) is a tool that can estimate diet quality and has been shown to be associated with body composition. The aims of the present study were first to determine the HEI-2015 score of the diets consumed by athletes and second its association with different body composition parameters of athletes. We conducted a cross-sectional study on 198 soccer players and referees. Dietary intakes were recorded using a validated food frequency questionnaire (FFQ), and HEI scores were calculated. Body composition parameters were measured using the bioelectrical impedance analysis. The mean score for the HEI-2015 was 65⋅04. A multiple linear regression model showed significant associations of the HEI-2015 score with percent body fat (PBF), percent muscle mass (PMM), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) in male soccer players aged <18 years, body mass index (BMI) in male soccer players aged ≥18 years and BMI and waist-to-height ratio (WHtR) in male soccer referees after adjustment for covariates (P < 0⋅05). The mean overall score for the HEI-2015 shows that Iranian soccer players and referees have an acceptable quality of diet. We also found significant associations between the HEI-2015 score and different body composition parameters in male soccer players and referees but we did not find any significant association in female athletes (P > 0⋅05).

Association Between Korean-Style Balanced Diet and Risk of Abdominal Obesity in Korean Adults: An Analysis Using KNHANES-VI (2013-2016)

Abdominal obesity is a critical factor for metabolic diseases, and specific eating patterns such as the Mediterranean diet help prevent metabolic diseases. This study aimed to investigate the association between the modified Korean health eating index (MKHEI), including a Korean-balanced diet, and abdominal obesity risk according to genders in adults aged 20-64 years (4,886 males and 7,431 females), using the Korea National Health and Nutrition Examination Survey VI (2013-2016). Adjusted means and 95% confidence intervals of MKHEI scores and nutrient intake estimated using the 24-h recall method were calculated according to abdominal obesity (waist circumference ≥90 cm for men and ≥85 cm for women) after adjusting for age, residence area, region, education, income, drinking status, smoking status, marital status, and exercise. Adjusted odds ratios (ORs) for abdominal obesity were measured according to MKHEI tertiles using logistic regression analysis while controlling for covariates. Individuals aged >50 years, married, below high school, lower-income, heavy alcohol drinkers, past and current smokers, and males living in the southern areas had a higher risk of abdominal obesity. In both genders, the scores of all MKHEI components were lower in the abdominal obesity group (n = 2,895) than in the control group (n = 9,422). Further, the scores of fruits with and without fruit juice and those of beans, including fermented beans, were lower in the abdominal obesity group only in females but not in males. Further, the scores of fast foods were higher in the abdominal obesity group than in the control group only in females. After adjusting for covariates, the adjusted OR for abdominal obesity was inversely associated with Korean balanced diet (KBD) related to KHEI scores. Unlike KBD, MKHEI of Western-style diet was not associated with abdominal obesity in either gender. In conclusion, KBD can lower the risk of abdominal obesity in females and should thus be recommended to prevent abdominal obesity.