Development of the Penn Healthy Diet screener with reference to adult dietary intake data from the National Health and Nutrition Examination Survey.

BACKGROUND: There is a need for a feasible, user-friendly tool that can be employed to assess the overall quality of the diet in U.S. CLINICAL SETTINGS: Our objectives were to develop the Penn Healthy Diet (PHD) screener, evaluate screener item correlations with Healthy Eating Index (HEI)-2015 components, and develop a simple scoring algorithm. METHODS: National Health and Nutrition Examination Survey (NHANES) 2017-18 dietary recall data in adults were used to define food examples in screener food groups based on components of the HEI-2015, Diet Approach to Stop Hypertension, and Alternative Mediterranean diet approaches. Instrument Content Validity Index (I-CVI) was used to evaluate the clarity and relevance of the screener. Patient acceptability was evaluated by completion time and response rates. NHANES 2017-18 food recall data were used to simulate responses to the screener items, which were evaluated for association with HEI-2015 components. A scoring algorithm was developed based on screener items moderately or strongly associated with HEI-2015 components. Reproducibility was tested using NHANES 2015-16 data. RESULTS: The screener had strong clarity (I-CVI = 0.971) and relevance for nutrition counseling (I-CVI = 0.971). Median (IQR) completion time was 4 (3-5) minutes on paper and 4 (4-8) minutes online, and 73% of patients invited online completed the survey. Based on simulated NHANES participant screener responses, 15 of the 29 screener items were moderately or strongly associated with HEI-2015 components, forming the basis of the scoring algorithm with a range of 0-63 points, where higher score indicates a healthier diet. The median (IQR) screener and HEI-2015 scores were 14.96 (11.99-18.36) and 48.96 (39.51-59.48), respectively. The simulated PHD score was highly correlated with the HEI-2015 score (Spearman rho 0.75) in NHANES 2017-18 and confirmed in NHANES 2015-16 data (Spearman rho 0.75). CONCLUSIONS: The Penn Healthy Diet screener may be a useful tool for assessing diet quality due to its acceptable content validity, ease of administration, and ability to distinguish between servings of key food groups associated with a healthy versus unhealthy diet according to the HEI-2015. Additional research is needed to further establish the instrument's validity, and to refine a scoring algorithm.

Survival of Listeria monocytogenes in Cottage Cheese.

Most studies on the behavior of Listeria monocytogenes in cheeses have focused on the soft, ripened types because of human listeriosis outbreaks linked to consumption of these foods, while observations in cottage cheese are limited and conflicting. Fresh market cottage cheese samples with and without sorbate, purchased in the United States and Canada, respectively, were contaminated with L. monocytogenes strain Scott A (103 CFU/g). Mean total plate counts/g, log10, in the fresh U.S. and Canadian cheeses were 3.54 and 5.22, respectively. After 24 days at 5°C, the respective numbers were 3.51 and 6.27. Mean pH values in the U.S. cheeses at freshness and after 24 days were 5.05 and 5.03, respectively, and values in the Canadian cheese were 4.89 and 4.77. Increases of >3 logs in cell numbers were seen at temperature abuse (10 and 20°C) in all cheese samples, although sorbate-containing cheese spoiled at a slower rate and samples were free of visible surface mold growth even after 21 days. Cottage cheese did not support growth of L. monocytogenes at any of the storage temperatures, and declines (0.35 and 0.81 log10, in sorbate-free and sorbate-containing cheese, respectively) were seen after 24 days at 5°C. Treatment with 3% sodium or calcium lactate did not affect listerial cell numbers. These findings demonstrate that sorbates in cottage cheese are effective as preservatives but not as antilisterials. Persistence of listeriae in cottage cheese emphasizes the need to prevent contamination during manufacturing and storage.