Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods.

BACKGROUND: A proposed topic for the 2025 Dietary Guidelines for Americans (DGA) Scientific Advisory Committee to address is the relationship between dietary patterns with ultra-processed foods (UPF) and body composition and weight status. Implementing the NOVA system, the most commonly applied framework for determining whether a food is "ultra-processed," in dietary guidance could omit several nutrient-dense foods from recommended healthy diets in the DGA. OBJECTIVE: The purpose of this proof-of-concept study was to determine the feasibility of building a menu that aligns with recommendations for a healthy dietary pattern from the 2020 DGA and includes ≥80% kcal from UPF as defined by NOVA. DESIGN: To accomplish this objective, we first developed a list of foods that fit NOVA criteria for UPF, fit within dietary patterns in the 2020 DGA, and are commonly consumed by Americans. We then used these foods to develop a 7-d, 2000 kcal menu modeled on MyPyramid sample menus and assessed this menu for nutrient content as well as for diet quality using the Healthy Eating Index-2015 (HEI-2015). RESULTS: In the ultra-processed DGA menu that was created, 91% of kcal were from UPF, or NOVA category 4. The HEI-2015 score was 86 out of a possible 100 points. This sample menu did not achieve a perfect score due primarily to excess sodium and an insufficient amount of whole grains. This menu provided adequate amounts of all macro- and micronutrients except vitamin D, vitamin E, and choline. CONCLUSIONS: Healthy dietary patterns can include most of their energy from UPF, still receive a high diet quality score, and contain adequate amounts of most macro- and micronutrients.

Biochemical Validation of a Self-Administered Carotenoid Intake Screener to Assess Carotenoid Intake in Nonobese Adults.

Background: Epidemiological studies have demonstrated an association between carotenoid intake and health. However, an accurate measurement of carotenoid intake is challenging. FFQ is the most commonly used dietary assessment method and is typically composed of 100-200 items. However, the greater participant burden that accompanies a more detailed FFQ provides only a marginal gain in accuracy. Therefore, a brief validated carotenoid intake screener is needed. Objectives: To conduct secondary analysis evaluating the validity of a newly developed 44-item carotenoid intake screener from The Juice Study: Sensitivity of Skin Carotenoid Status to Detect Change in Intake (NCT03202043) against corresponding plasma carotenoid concentrations (primary) and skin carotenoids (secondary) in nonobese Midwestern American adults. Methods: Healthy adults (n = 83; 25 men and 58 women) aged 18-65 y (mean age, 32 ± 12 y) with a BMI (in kg/m2) of 18.5-29.9 (mean BMI, 25 ± 3) were recruited between 25 April 2018 and 28 March 2019. Participants completed the carotenoid intake screener weekly during the 8-wk parent study. Plasma carotenoid concentrations were assessed at weeks 0, 4, and 8 using HPLC. Skin carotenoids were assessed weekly using pressure-mediated reflection spectroscopy (RS). Correlation matrices from mixed models were used to determine the correlation between carotenoid intake and plasma and skin carotenoids over time. Results: The total carotenoid intake, as determined by the carotenoid intake screener, correlated with both the plasma total carotenoid concentration (r = 0.52; P < 0.0001) and the RS-assessed skin carotenoid concentration (r = 0.43; P < 0.0001). Correlations between reported intake and plasma concentrations of α-carotene (r = 0.40; P = 0.0002), cryptoxanthin (r = 0.28; P = 0.0113), and lycopene (r = 0.33; P = 0.0022) were also observed. Conclusions: The results of this study demonstrate an acceptable relative validity of the carotenoid intake screener to assess total carotenoid intake in adults classified as those having a healthy body or those with overweight.

Smokers report lower intake of key nutrients than nonsmokers, yet both fall short of meeting recommended intakes.

Smoking is a major risk factor in the development of preventable disease which may be due to a poorer diet and the reduced nutrient intake of smokers. Our objective was to compare and evaluate the reported intake of current smokers with that of nonsmokers among participants of a study evaluating stress and smoking. We hypothesized (1) that overall energy and nutrient intake would be reduced in smokers compared with nonsmokers and (2) that smokers would have increased noncompliance with Dietary Reference Intakes (DRIs). Men and women (smokers n=138, nonsmokers n=46) completed a 3-day diet record at baseline. Mean energy and nutrient intakes were stratified by smoking status and compared with DRI levels. The mean body mass index was 28.3±0.5kg/m2 for smokers and 27.2±1.0kg/m2 for nonsmokers. Compared with nonsmokers, the smokers reported lower intakes of energy, total polyunsaturated fatty acids, linolenic acid, docosahexaenoic acid, total sugars, calcium, iron, magnesium, phosphorus, potassium, vitamin C, riboflavin, niacin, pantothenic acid, vitamin B6, folate, vitamin A, and vitamin E. Smokers reported reduced compliance with the DRIs for iron, phosphorus, vitamin C, riboflavin, and folate compared with nonsmokers. Unlike other evaluations of smokers vs nonsmokers, we observed no difference in body weight between groups. Smokers and nonsmokers alike reported dietary intakes lower than the DRIs for many nutrients. However, the reported nutrient intake of the smokers was substantially lower than nonsmokers for key nutrients, and they were more likely to not comply with the DRIs for essential nutrients, placing them at increased risk of chronic disease.

Diet Quality Is Lower and Energy Intake Is Higher on Weekends Compared with Weekdays in Midlife Women: A 1-Year Cohort Study.

BACKGROUND: Differences in energy and macronutrient intakes by weekday and weekend have been reported, but there are few data on differences in food group consumption and indices of diet quality. OBJECTIVE: The aim of this study was to describe dietary intake by day and on weekends compared with weekdays. DESIGN: This study utilized a longitudinal cohort design with self-reported dietary intake collected using the Automated Self-Administered 24-Hour Dietary Assessment Tool. PARTICIPANTS/SETTING: Participants were ambulatory women with access to high-speed internet, body mass index between 18 and 35, and aged 40 to 60 years from the Life in All Seasons study (n=52) conducted in Grand Forks, ND, between July 2012 and July 2014. Each woman completed an Automated Self-Administered 24-Hour Dietary Assessment Tool diet recall every 10 days for 1 year. MAIN OUTCOME MEASURES: Primary outcome measures were total and energy intake from macronutrients, food groups (per 1,000 kcal), and Healthy Eating Index-2010 (HEI-2010) scores from 1,866 24-hour recalls. STATISTICAL ANALYSES PERFORMED: Effects of weekend on energy and macronutrient intake, energy-adjusted food groups, and HEI-2010 scores and component scores were tested using mixed linear models. RESULTS: Participants (n=52) completed 1,080 recalls on weekdays and 786 on weekends. Seventy-five percent of women reported consuming more energy on weekends than on weekdays, with a higher mean intake of 158 kcal on weekends (P<0.01). The percentage of energy from carbohydrate (P<0.01) and protein (P<0.01) were both lower on weekends, and percentage of energy from alcohol higher (P<0.01). There was no difference in the percentage of energy from fat (P=0.07). Reported energy intake was greatest on Saturdays and lowest on Tuesdays. On weekends, women had reduced diet quality with more alcoholic beverages, solid fat, and potatoes, and less yogurt, whole fruits, dark green and orange vegetables, poultry, nuts and seeds, and whole grains per 1,000 kcal than on weekdays. HEI-2010 scores were lower on weekends than weekdays (P<0.01). Component scores were lower for whole fruits (P<0.01), greens and beans (P=0.02), whole grains (P<0.01), and dairy (P<0.01). CONCLUSIONS: Midlife women should be encouraged to maintain diet quality during weekends to improve overall diet quality scores.

Measures of Diet Quality across Calendar and Winter Holiday Seasons among Midlife Women: A 1-Year Longitudinal Study Using the Automated Self-Administered 24-Hour Recall.

BACKGROUND: Systematic seasonal bias may confound efforts to estimate usual dietary intake and diet quality. Little is known about dietary quality over the winter holiday season. OBJECTIVES: The aims of this study were to test for differences in intakes of energy, percentage of energy from macronutrients, fruits and vegetables, and diet quality measured using the Healthy Eating Index 2010 (HEI-2010) by calendar and winter holiday seasons. DESIGN: Longitudinal cohort design. PARTICIPANTS/SETTING: Data were derived from the Life in All Seasons study. Two cohorts of women aged 40 to 60 years (N=52) from the greater Grand Forks, ND, area were followed for 1 year each between July 2012 and July 2014. Each woman completed an online diet recall using the Automated Self-Administered 24-Hour Recall every 10 days during the year, with a 92% response rate. STATISTICAL ANALYSES: Effects of calendar and winter holiday seasons on intakes of energy, percent energy from macronutrients, HEI-2010 total and component scores, and grams per day of individual fruits and vegetables were tested using mixed linear models. RESULTS: The mean total HEI-2010 score was 60.1±1.4. There were seasonal differences in some HEI-2010 component scores, but not in total scores. More lettuce or mixed lettuce salad was consumed during summer than during winter (P=0.034), and more fresh tomatoes were consumed during summer and fall compared with winter (P=0.001). More corn, berries, peaches and nectarines, and melons (P<0.001) were consumed during summer. There was no seasonal difference in reported intakes of energy (P=0.793). The total HEI-2010 score for dietary intake observed over the winter holiday season was lower than the rest of the year (P<0.001). Reported energy intake was not different (P=0.228). CONCLUSIONS: In this population, diet quality is significantly lower during the winter holiday period, but mostly consistent by season. Multiple recalls in any season can give a reasonable representation of usual overall diet quality throughout the year.

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.

Validity of electronic diet recording nutrient estimates compared to dietitian analysis of diet records: randomized controlled trial.

BACKGROUND: Dietary intake assessment with diet records (DR) is a standard research and practice tool in nutrition. Manual entry and analysis of DR is time-consuming and expensive. New electronic tools for diet entry by clients and research participants may reduce the cost and effort of nutrient intake estimation. OBJECTIVE: To determine the validity of electronic diet recording, we compared responses to 3-day DR kept by Tap & Track software for the Apple iPod Touch and records kept on the Nutrihand website to DR coded and analyzed by a research dietitian into a customized US Department of Agriculture (USDA) nutrient analysis program, entitled GRAND (Grand Forks Research Analysis of Nutrient Data). METHODS: Adult participants (n=19) enrolled in a crossover-designed clinical trial. During each of two washout periods, participants kept a written 3-day DR. In addition, they were randomly assigned to enter their DR in a Web-based dietary analysis program (Nutrihand) or a handheld electronic device (Tap & Track). They completed an additional 3-day DR and the alternate electronic diet recording methods during the second washout. Entries resulted in 228 daily diet records or 12 for each of 19 participants. Means of nutrient intake were calculated for each method. Concordance of the intake estimates were determined by Bland-Altman plots. Coefficients of determination (R(2)) were calculated for each comparison to assess the strength of the linear relationship between methods. RESULTS: No significant differences were observed between the mean nutrient values for energy, carbohydrate, protein, fat, saturated fatty acids, total fiber, or sodium between the recorded DR analyzed in GRAND and either Nutrihand or Tap & Track, or for total sugars comparing GRAND and Tap & Track. Reported values for total sugars were significantly reduced (P<.05) comparing Nutrihand to GRAND. Coefficients of determination (R(2)) for Nutrihand and Tap & Track compared to DR entries into GRAND, respectively, were energy .56, .01; carbohydrate .58, .08; total fiber .65, .37; sugar .78, .41; protein .44, .03; fat .36, .03; saturated fatty acids .23, .03; sodium .20, .00; and for Nutrihand only for cholesterol .88; vitamin A .02; vitamin C .37; calcium .05; and iron .77. Bland-Altman analysis demonstrates high variability in individual responses for both electronic capture programs with higher 95% limits of agreement for dietary intake recorded on Tap & Track. CONCLUSIONS: In comparison to dietitian-entered 3-day DR, electronic methods resulted in no significant difference in mean nutrient estimates but exhibited larger variability, particularly the Tap & Track program. However, electronic DR provided mean estimates of energy, macronutrients, and some micronutrients, which approximated those of the dietitian-analyzed DR and may be appropriate for dietary monitoring of groups. Electronic diet assessment methods have the potential to reduce the cost and burden of DR analysis for nutrition research and clinical practice. TRIAL REGISTRATION: Clinicaltrials.gov NCT01183520; http://clinicaltrials.gov/ct2/show/NCT01183520 (Archived by WebCite at http://www.webcitation.org/6VSdYznKX).

First trimester vitamin D status and placental epigenomics in preeclampsia among Northern Plains primiparas.

AIMS: As maternal vitamin D status has been associated with preeclampsia, the purpose of this study was to determine variations in DNA methylation patterns and associated protein expression in placental genes regulating vitamin D metabolism. MAIN METHODS: A convenience sample of 48 pregnant nulliparous women, including 11 later diagnosed with preeclampsia, were recruited in this prospective study. Using a case-control design in two groups of women, we administered a food frequency questionnaire to determine vitamin D dietary intake. Laboratory measures included serum vitamin D levels (25[OH]D), DNA methylation patterns and protein expression in placental genes regulating vitamin D metabolism (1α-hydroxylase, CYP27B1; vitamin D receptor, VDR; retinoid X receptor, RXR) from placental tissue collected at delivery among those diagnosed with preeclampsia and those who remained normotensive throughout pregnancy. KEY FINDINGS: There were no significant differences in vitamin D dietary intake or mean serum 25[OH]D levels, although the proportion of women with deficient 25[OH]D levels was higher in the preeclampsia group (46%) than the normotensive group (20%). Placenta samples from women with preeclampsia also had increased DNA methylation of CYP27B1, VDR and RXR genes with lower protein expression levels limited to RXR. SIGNIFICANCE: Hypermethylation of key placental genes involved in vitamin D metabolism suggests uncoupling of processes that may interfere with placentation and availability of vitamin D at the maternal-fetal interface.

Foods advertised in US weekly supermarket sales circulars over one year: a content analysis.

BACKGROUND: The nutritional content of Americans' shopping carts is suboptimal despite federal dietary guidance, in this case, the MyPlate consumer icon which displays desired proportions of vegetables, fruits, dairy, grains and protein foods for consumption. Consumers mention print advertising-such as weekly sales circulars-frequently as influencing their grocery shopping decisions. METHODS: To examine and describe the relative proportions of advertised foods aggregated into the MyPlate food grouping system, a content analysis of 9 209 foods advertised in 52 weekly supermarket newspaper sales inserts in 2009 from a local grocery chain was conducted in a Midwestern community. RESULTS: Overall, the protein foods group was most often represented in sales circulars (25% of total items), followed by grains (18%); dairy (10%); vegetables (8%) and fruits (7%). Less than 3% of sales advertisements were for dark green and red & orange vegetables. Over twice as much whole fruit versus 100% fruit juice was advertised (70% vs. 30%, respectively; P < 0.001). Significantly fewer protein foods and more grains than expected were advertised in the fall, and slightly more dark green vegetables were advertised in winter and spring than in summer and fall (P = 0.05). CONCLUSIONS: The average American diet, including underconsumption of fruits and vegetables but overconsumption of protein foods, was reflected in the relative frequency of food groups advertised in weekly sales circulars. Modifying sales circulars to represent healthier food groups may preserve retail profits (considering these groups' higher profit margin) while promoting adherence to federal dietary guidance.

First trimester dietary intake, biochemical measures, and subsequent gestational hypertension among nulliparous women.

INTRODUCTION: The purpose of this study was to evaluate the relationships between first-trimester dietary factors and biochemical measures and subsequent risk of gestational hypertension. METHODS: This pilot study used a prospective design utilizing a convenience sample of nulliparous women enrolled at their first prenatal visit. A total of 57 women completed the study. Participants were divided into 2 groups for data analysis: normotensive pregnancy and gestational hypertension. RESULTS: Nearly one-quarter of study participants (22.8%) developed gestational hypertension, of whom 84.6% had significant proteinuria meeting the criteria for preeclampsia. There were no significant differences in micronutrient or macronutrient dietary intakes between groups. Serum iron and zinc levels were lower for the gestational hypertension group compared with the normotensive pregnancy group (P ≤ .01). Low serum zinc levels were related to a risk of developing gestational hypertension (adjusted odds ratio, 0.930; 95% confidence interval, 0.872-0.992). DISCUSSION: Ensuring adequate intake of zinc and monitoring serum zinc levels in nulliparous pregnant women may help to prevent or contribute to early detection of gestational hypertension.

Diet assessment methods: a guide for oncology nurses.

Diet may play a significant role in cancer prevention, disease progression, and treatment tolerance. An in-depth search of the literature revealed limited information geared toward nurses about diet assessment methods used in research. The purpose of this review is to synthesize the evidence regarding diet assessment methods important in oncology studies. The method used varied based on the study size, duration, and research question. For example, studies focusing on mean nutrient intake of a group used a 24-hour dietary recall, estimated food diary or dietary record, or food frequency questionnaire. Studies investigating usual nutrient intake predominately used multiple 24-hour dietary recalls, dietary records, biomarkers, or food frequency questionnaires. Measuring dietary intake accurately in a cost-effective manner is a difficult task. Selection of the appropriate assessment tool is critical for the generation of quality data. Oncology nurses are increasing their involvement in nutrition research, and the findings from this review may promote a better understanding of the published and ongoing research in this important field of study.

Determinants of selenium status in healthy adults.

BACKGROUND: Selenium (Se) status in non-deficient subjects is typically assessed by the Se contents of plasma/serum. That pool comprises two functional, specific selenoprotein components and at least one non-functional, non-specific components which respond differently to changes in Se intake. A more informative means of characterizing Se status in non-deficient individuals is needed. METHODS: Multiple biomarkers of Se status (plasma Se, serum selenoprotein P [SEPP1], plasma glutathione peroxidase activity [GPX3], buccal cell Se, urinary Se) were evaluated in relation to selenoprotein genotypes (GPX1, GPX3, SEPP1, SEP15), dietary Se intake, and parameters of single-carbon metabolism in a cohort of healthy, non-Se-deficient men (n = 106) and women (n = 155). CONCLUSIONS: Plasma Se concentration was 142.0 ± 23.5 ng/ml, with GPX3 and serum-derived SEPP1 calculated to comprise 20% and 34%, respectively, of that total. The balance, comprised of non-specific components, accounted for virtually all of the interindividual variation in total plasma Se. Buccal cell Se was associated with age and plasma homocysteine (hCys), but not plasma Se. SEPP1 showed a quadratic relationship with body mass index, peaking at BMI 25-30. Urinary Se was greater in women than men, and was associated with metabolic body weight (kg0.75), plasma folate, vitamin B12 and hCys (negatively). One GPX1 genotype (679T/T) was associated with significantly lower plasma Se levels than other allelic variants. Selenium intake, estimated from food frequency questionnaires, did not predict Se status as indicated by any biomarker. These results show that genotype, methyl-group status and BMI contribute to variation in Se biomarkers in Se-adequate individuals.

Nutrition marketing on food labels.

OBJECTIVE: This research sought to determine how often nutrition marketing is used on labels of foods that are high in saturated fat, sodium, and/or sugar. DESIGN AND SETTING: All items packaged with food labels (N = 56,900) in all 6 grocery stores in Grand Forks, ND were surveyed. MAIN OUTCOME MEASURE(S): Marketing strategy, nutrient label information, if the product was fruit/or milk based, and target age. ANALYSIS: Frequency distributions were computed. RESULTS: Forty-nine percent of all products contained nutrition marketing and of those, 48% had both nutrition marketing and were high in saturated fat, sodium and/or sugar (11%, 17%, and 31% respectively). Seventy-one percent of products marketed to children had nutrition marketing. Of those, 59% were high in saturated fat, sodium and/or sugar content, with more than half being high in sugar. The most commonly used nutrition marketing statements were "good source of calcium", "reduced/low/fat free", and "food company's health symbol". CONCLUSIONS AND IMPLICATIONS: Nutrition marketing is commonly used on products high in saturated fat, sodium and/or sugar and is more often used on products marketed toward children than products marketed toward adults. Current food industry symbols may not be helping consumers select foods low in saturated fat, sodium or sugar.