Evaluating the influence of ultra-processed food intake on associations between dietary indices with systemic inflammation in adulthood and old ages.

BACKGROUND & AIMS: Low-grade systemic inflammation (LGSI) is critical to developing many chronic diseases. In turn, it has been shown that the diet can modulate favorably or unfavorably the inflammatory status. Thus, evaluating the diet from appropriate approaches is fundamental; to do so, there are different proposals for dietary indexes. We aimed to: (i) investigate the association between three well-known dietary indexes and LGSI biomarkers; (ii) test these associations individually or in combination with an indicator of ultra-processed foods (UFPs) intake. (iii) as an additional aim, hypothesizing that all the indexes should be capable of identifying the inflammatory potential of diet, we tested the hypothesis that these indexes agree and correlate with each other. METHODS: Cross-sectional population-based data of adults and older persons (n = 583). Dietary data were obtained through two non-consecutive 24-h dietary recalls (24HDR) and calculated for Dietary Inflammatory Index (DII), Mediterranean-Style Dietary Pattern Score (MSDPS); Brazilian Healthy Eating Index - Revised (BHEI-R) and energy ingested from UPFs (UPFs ratio). An LGSI score was created from some plasma inflammatory biomarkers [C-Reactive Protein (CRP), tumor necrosis factor-alpha (TNF-α), and adiponectin]. Logistic and linear regression models tested the associations between dietary indexes and LGSI score. RESULTS: The MSDPS and DII were significantly associated with our inflammatory score, but the BHEI-R did not. Including UPFs in regression models did not increase the strength of these associations. CONCLUSIONS: From the three scores, the dietary inflammatory index and the Mediterranean-style dietary pattern score (MSDPS) were the ones that showed significant association with the inflammatory biomarker. The combination of the indexes with a ratio of UPF intake did not increase the significance of our analyses. The best agreement between the indexes was found between MSDPS and UPFs ratio; the only pair of indexes considered concordant and correlated was the BHEI-R and DII.

The healthy eating index for older adults: adaptation of the 2015 healthy eating index considering dietary guidelines for healthy aging.

INTRODUCTION: The Healthy Eating Index (HEI) is a comprehensive measure to assess diet quality. Because of the various factors that influence the nutritional status of older adults, there is a need to adapt an index that assesses the quality of the diet considering the dietary requirements of aging and health promotion. This study aimed to adapt the HEI for older adults, considering their needs for healthy eating. METHODS: Food consumption data was collected by means of three non-consecutive 24-hour food recalls (R24h). For the adaptation of the Healthy Eating Index for Older Adults (HEI-OA), the components and scoring methodology of HEI-2015 were maintained and Brazilian food intake recommendations for the older population were used, which are in line with international recommendations. The validity of the HEI-OA was assessed by four ideal diets, Mann-Whitney's test, Spearman's correlation analysis and Cronbach's coefficient. RESULTS: Content validity of the HEI-OA was confirmed by the maximum score for diets recommended to older adults and by the score between groups with known differences in diet quality. The HEI-OA total score did not correlate with total energy intake (TEI - total energy value: r = -0.141, p > 0.05). The total HEI-OA score showed a statistically significant correlation with several nutrients. These correlations allowed identifying that these nutrients are closely related to the components of the HEI-OA. The internal consistency value for the HEI-OA total score was 0.327, similar to the 2005 and 2010 versions of the HEI. CONCLUSION: The HEI was successfully adapted for use with older adults, presenting validity and reliability. The HEI-OA can be used to assess diet quality in line with international dietary guidelines for healthy aging.

Diet quality and nutritional status in children with human immunodeficiency virus.

Background: Poor diet quality in children and adolescents may contribute to decreased immunity and lead to an increased risk of opportunistic diseases. Aim: To investigate diet quality and its relationship to nutritional status in human immunodeficiency virus (HIV)-infected pediatric patients (HIV-PIHIV). Methods: We conducted a cross-sectional study with 87 patients aged between 6 and 19 years carried out in two University Hospitals. Diet quality was analyzed by an adapted Healthy Eating Index (HEI) and nutritional status. The association between HEI with body mass index-for-age (BMI-for-age) and height-for-age was performed using a linear regression model. Clinical, maternal, anthropometric, and dietary data were collected through a semi-structured questionnaire, based on nutrition service protocols. Results: Diet quality was intermediate (median IAS = 54.8 interquartile range: 47.5 to 65.9 points), due to low consumption of fruits, vegetables, and dairy products and high empty calories and sodium by the PPIHIV. The multivariate regression model indicated that HEI was not significant for explaining BMI-for-age [ß = -0.01; 95% CI = (-0.03; 0.01); p 0.40] nor height-for-age [ß = 0.01; 95% CI = (-0.02; 0.03); p 0.51]. However, it was observed that adolescents showed 1 Z-score [95% CI = (-1.6; -0.44); p 0.001] a reduction in BMI-for-age compared with children, and those black patients showed an increase in BMI-for-age Z-score of 0.57 [95% CI = (0.7; 1.1); p 0.03] compared with non-blacks. Conclusion: The diet quality of the HIV-infected children and adolescents was below desired. No association was found between diet quality and inadequate nutritional status of HIV-PIHIV.

Distinct fecal microbial signatures are linked to sex and chronic immune activation in pediatric HIV infection.

Introduction: Our understanding of HIV-associated gut microbial dysbiosis in children perinatally-infected with HIV (CLWH) lags behind that of adults living with HIV. Childhood represents a critical window for the gut microbiota. Any disturbances, including prolonged exposure to HIV, antiretroviral drugs, and antibiotics are likely to have a significant impact on long-term health, resulting in a less resilient gut microbiome. The objective of our study was to characterize the gut microbiota in CLWH, and compare it with HIV-unexposed and -uninfected children. Methods: We enrolled 31 children aged 3 to 15 years; 15 were CLWH and 16 were HUU. We assessed dietary patterns and quality; quantified soluble and cellular markers of HIV disease progression by flow cytometry, enzyme-linked immunosorbent and multiplex-bead assays, and profiled the gut microbiota by 16S rRNA sequencing. We explored relationships between the gut microbiota, antibiotic exposure, dietary habits, soluble and cellular markers and host metadata. Results: Children had a Western-type diet, their median health eating index score was 67.06 (interquartile range 58.76-74.66). We found no discernable impact of HIV on the gut microbiota. Alpha diversity metrics did not differ between CLWH and HUU. Sex impacted the gut microbiota (R-squared= 0.052, PERMANOVA p=0.024). Male children had higher microbial richness compared with female children. Two taxa were found to discriminate female from male children independently from HIV status: Firmicutes for males, and Bacteroides for females. Markers of HIV disease progression were comparable between CLWH and HUU, except for the frequency of exhausted CD4+ T cells (PD-1+) which was increased in CLWH (p=0.0024 after adjusting for confounders). Both the frequency of exhausted CD4+ and activated CD4+ T cells (CD38+ HLADR+) correlated positively with the relative abundance of Proteobacteria (rho=0.568. false discovery rate (FDR)-adjusted p= 0.029, and rho=0.62, FDR-adjusted p=0.0126, respectively). Conclusion: The gut microbiota of CLWH appears similar to that of HUU, and most markers of HIV disease progression are normalized with long-term ART, suggesting a beneficial effect of the latter on the gut microbial ecology. The relationship between exhausted and activated CD4+ T cells and Proteobacteria suggests a connection between the gut microbiome, and premature aging in CLWH.

Factors associated with diet quality among Brazilian individuals with cardiovascular diseases.

BACKGROUND: An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors. METHODS: This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant. RESULTS: In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence. CONCLUSIONS: A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country.

Nosotros mismos nos estamos matando/We are the ones killing ourselves: Unraveling individual and network characteristics associated with negative dietary acculturation among Mexican Americans in New York City.

BACKGROUND: Research on negative dietary acculturation among Mexican-Americans has mostly focused on individual-level processes and has largely ignored the role of social networks. METHODS: This mixed-method study used an egocentric network approach and derived 1620 personal ties of self-identified Mexican adults in New York. 24-hour dietary recalls were used to derive a total Healthy Eating Index (HEI) and subscores. The qualitative portion generated narratives around who helps or hinders their efforts to eat healthfully. RESULTS: At the individual level, age at which participants migrated to the U.S. was negatively associated with total HEI (ß = -0.39, p < .01). An annual income below $30,000 was positively associated with total HEI (ß = 0.25, p < .05) and with HEI fruit subscores (ß = 0.25, p < .05). Acculturative stress was negatively associated with HEI fruit (ß = -0.29, p < .05) and refined grain subscores (ß = -0.34, p < .01). At the network level, the proportion of network members who consumed traditional Latino diets was negatively associated with total HEI and HEI refined grains subscores (ß = -0.39, p < .001; and ß = -0.23, p < .05; respectively). In contrast, the proportion of alters who lived in another country was positively associated with HEI dairy subscores (ß = 0.25, p < .05). Juxtaposing qualitative participants' visual representation of their total HEI scores with their lay interpretations of healthy and unhealthy eating matched public health messages of reducing sugar, red meat intake, and processed foods. However, participants felt that this could only be achieved through restriction rather than balance. Qualitative narratives also elucidated how dietary acculturation and income could help shape dietary quality in unexpected ways. CONCLUSIONS: This study found evidence of negative dietary acculturation and showcases the complex ways in which both individual- and network-level processes help shape dietary choices for Mexican-Americans.

Healthy Eating Index Diet Quality in Randomized Weight Loss Trials: A Systematic Review.

BACKGROUND: Weight loss interventions focus on dietary and physical activity changes to induce weight loss. Both through weight loss and independent of it, diet quality is important for reducing chronic disease risk. However, whether and how diet quality changes over the course of a behavioral intervention is unclear. OBJECTIVE: To systematically review the evidence from randomized controlled trials on the effect of behavioral interventions on diet quality as defined by the Healthy Eating Index (HEI) among adults with overweight and obesity. METHODS: PubMed, Ebscohost CINAHL, Embase, OVID APA PsycInfo, Scopus, and Web of Science were searched through May 2021. Inclusion criteria comprised randomized controlled trial design, a primary or secondary aim of weight loss, a sample of US adults with overweight or obesity, measurement using the HEI-2005, 2010, or 2015, and assessment of the time by treatment effect. Interventions must have included behavioral components and lasted at least 3 months. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. The systematic review protocol was published on Open Science Framework. RESULTS: Of 3,707 citations retrieved, 18 studies met inclusion criteria. A wide array of behavioral interventions were assessed, including in-person and mobile health interventions as well as those prescribing intake of specific foods. Risk of bias in the included studies primarily arose from the measurement of the outcome variable. Sample sizes ranged from 34 to 413 participants. Nine studies used multiple dietary recalls, with few using the recommended method of Healthy Eating Index calculation. Changes in diet quality ranged from no improvement to a 20-point improvement. More often, improvement was in the 4- to 7-point range. CONCLUSIONS: The evidence for the efficacy of behavioral weight loss interventions for improving diet quality among adults with overweight and obesity is limited. Modest improvements in HEI scores were observed in the reviewed studies.

Nutritional Status, Dietary Habits, and Physical Activity in Older Adults from Manta, Manabí.

Defining the nutritional status and physical activity level of older adults makes it possible to guide them toward healthy lifestyles. OBJECTIVE: The aim of this study was to evaluate dietary habits, nutritional status, and physical activity engagement in older adults living in the city of Manta, Manabí. METHODS: An observational, descriptive, and cross-sectional study of 130 older adults was conducted to determine nutritional status via anthropometry, self-reported frequency of the consumption of foodstuffs, calculation of the healthy eating index (IAS), and physical activity patterns. RESULTS: Average age was 71.62 ± 4.34 years, whilst 83.07% of participants were at nutritional risk due to being overweight or obese. Dietary habits in males were characterized by the consumption of three meals a day, as well as greater intake of cereals, roots, tubers, and milk and its derivatives, whilst females consumed more fruits and vegetables. Meat was widely consumed, although females consumed more fish and seafood than males. Eggs were hugely popular foods, in contrast to legumes. Pasta was a dietary staple in females. Visible fats and luncheon meats were consumed little. IAS values reflected the "need to change", whilst physical activity engagement was found to be low. CONCLUSIONS: The nutritional status of the present study population was characterized by a tendency toward increasing overweight, particularly amongst females, with the predominance of class 1 obesity, low physical activity, and a healthy eating index requiring change toward more healthy habits.

Association between self-reported sleep duration and dietary quality in Mexican school-aged children.

Short sleep duration has been associated with poor diet quality in school-aged children in multiple populations. However, investigations of sleep and dietary quality in Mexican school-aged children are scarce. The main objective of this work was to assess the association between sleep duration and dietary quality in Mexican school-aged children stratified by sex. The data were collected from 373 (138 girls and 235 boys) elementary school children aged 6-12 years in Monterrey, Nuevo Leon, Mexico. Surveys collected information on general demographic characteristics and self-reported sleep duration. Diet was assessed with 24-h recalls, and dietary quality was calculated by the Healthy Eating Index (HEI-2015). Results indicated that overall mean sleep duration was 8.23 ± 1.06 h. From the total sample, 6.7% slept ≤6 h (not recommended), 55.8% 7-8 h (may be appropriate), and 37.5% ≥ 9 h (recommended). Average total HEI-2015 score was 64.6 (out of possible 100), with boys having lower HEI-2015 scores than girls (57.7 vs 69.4). Moreover, girls and boys with shorter sleep duration (≤6 h compared to ≥ 9 h) had lower HEI-2015 scores (-1.03 [95% CI -2.74, -0.47; p < .01] and -1.78 [95% CI -3.15, -0.86; p < .001], respectively). Regarding the individual components of dietary quality, those with ≤6 h of sleep had lower scores particularly in vegetables, protein sources, added sugars and saturated fats for girls and boys compared to those with ≥9 h. These findings suggest sleep may be an important determinant of dietary practices within the Mexican children.

Diet quality, general health and anthropometric outcomes in a Latin American population: evidence from the Colombian National Nutritional Survey (ENSIN) 2010.

OBJECTIVE: Colombia is experiencing a nutrition transition, characterised by nutritionally poor diets and an increased prevalence of non-communicable diseases (NCD). We aimed to investigate the association between diet quality and general health outcomes related to the risk of NCD, in a nationally representative sample of Colombian adolescents and adults. DESIGN: Cross-sectional analysis. The Alternative Healthy-Eating Index (AHEI) was derived to calculate diet quality. Adjusted regressions were used to examine the association between AHEI, self-perceived general health status (GHS) and anthropometric variables (i.e. age-specific z-scores for height, and BMI for adolescents; waist circumference and BMI for adults). SETTING: Nationally representative data from the Colombian National Nutrition Survey (ENSIN) 2010. PARTICIPANTS: Adolescents aged 10-17 years (n 6566) and adults aged ≥18 years (n 6750). RESULTS: AHEI scores were similar between adolescents (mean 29·3 ± 7·2) and adults (mean 30·5 ± 7·2). In the whole sample, a better diet quality (higher AHEI score) was associated with worse self-perceived GHS (adjusted (a) ß-coefficient: -0·004; P < 0·001) and with a smaller waist circumference ((a) ß-coefficient: -0·06; P < 0·01). In adults, a higher AHEI score was negatively associated with BMI ((a) ß-coefficient: -0·02; P < 0·05), whilst in adolescents it was associated with a reduced height-for-age z-score ((a) ß-coefficient: -0·009; P < 0·001). CONCLUSIONS: A better diet quality was associated with reduced prevalence of predictors of NCD and with some indicators of general health in the Colombian population. In light of the high prevalence of overweight, our findings support the need for public health interventions focused on sustainable positive changes in dietary habits in the general population.

Food Insecurity Is Associated with the Quality of Diet of Non-Institutionalized Older Adults from a Southern Chilean Commune: A Cross-Sectional Study.

As the population ages, greater attention to age-related health problems related to diet and lifestyles is needed. Here, we sought to evaluate the associations between demographic and clinical characteristics and food insecurity with the quality of diet of non-institutionalized elderly from a southern Chilean commune. We performed an analytical cross-sectional study in a sample of 376 older adults. Nutritional status was evaluated through anthropometric measurements. Quality of diet was determined by the healthy eating index (HEI), obtained through the frequency of consumption questionnaire. Socioeconomic, demographic, and lifestyle variables were also collected. Ordinal logistic and Poisson regression models were applied to study associations with quality of diet. The sample consisted of more women (81.6%) than men (18.4%). Most older adults were found to live in a situation of vulnerability or poverty (82.4%), with most having food security (65.7%). According to the HEI, only 14.1% had a good quality of diet, 83.8% had diet in need of improvement, and 2.1% had an unhealthy diet. There was an association of food insecurity and cardiovascular risk (according to waist circumference) with lower quality of diet categories. However, an association with the unhealthy quality of diet category was not confirmed with Poisson regression analysis, which was possibly due to the low number of subjects in that category (n = 8, 2.1%). Other modifiable factors like physical activity, hours of sleep, and polypharmacy were not associated with lower quality of diet categories. Socioeconomic status, which is a structural health determinant, was not associated with decreased quality of diet. Since this was a cross-sectional study performed on a small sample from a Chilean commune, directionality of associations cannot be discerned, and future longitudinal studies could aim to better characterize these associations in larger samples of elderly patients.

Calidad de la dieta según el Índice de Alimentación Saludable: Análisis en la población adulta de la ciudad de Rosario, Argentina / Diet quality according to the Healthy Eating Index: Analysis in the adult population of Rosario City, Argentina

Introducción: el Índice de Alimentación Saludable (IAS) fue desarrollado en base a las recomendaciones de las guías alimentarias para la población americana y es de utilidad para identificar los grupos de alimentos que presentan menor consumo en relación a las recomendaciones y los grupos poblacionales con alimentación de baja calidad. Objetivo: estimar la calidad de la dieta en la población adulta de la ciudad de Rosario, e identificar su relación con variables sociodemográficas, indicadores antropométricos y del estilo de vida. Materiales y Método: investigación observacional, descriptiva y transversal de una muestra por cuotas estratificada de 1200 adultos entre 18 a 70 años. Se empleó la metodología actualizada en el 2010 para el cálculo de IAS, a partir de la información obtenida del recordatorio de 24 horas. Se utilizó un cuestionario para relevar las variables sociodemográficas y el consumo de tabaco, se realizaron mediciones antropométricas, la actividad física se midió con el cuestionario IPAQ y el consumo de alcohol por frecuencia de consumo. Las asociaciones se evaluaron mediante test Chi cuadrado y la diferencia de medias por Anova, considerando p<0,05. Resultados: los adultos evaluados tenían en promedio 39±15 años, el 69% fueron mujeres, el 32% con estudios terciarios completos o más, 56% tenía un IMC≥25 kg/m², 34% presentaba riesgo según circunferencia de cintura, 54% realizaba <150 min/sem de actividad física, 67% consumía alcohol y 26% era fumador actual. El IAS alcanzó un promedio de 48,5±15,1 puntos, los valores más alejados del ideal se encontraron en los pescados, mariscos y proteínas vegetales (0,7/5); granos enteros (1,5/10); granos y cereales refinados (2/10); frutas (1,7/5); vegetales verdes y legumbres (1,7/5); ácidos grasos (3,7/10) y lácteos (4,3/10). El 58,6% tuvo una dieta de pobre calidad (IAS <50). Se observó una alimentación menos saludable en los hombres (p<0,05), adultos jóvenes (p<0,01), aquellos con menor nivel educativo (p<0,01), los individuos que realizan <150 minutos semanales de actividad física moderada o intensa (p<0,01) y los que fuman en la actualidad (p<0,01). Conclusión: La alimentación de la población estudiada demuestra características poco saludables. La identificación de grupos de mayor riesgo permitirá orientar mejor las acciones educativas y sanitarias tendientes a modificar estilos de vida y hábitos alimentarios.

Introduction: The Healthy Eating Index (HEI) was developed based on the recommendations of the dietary guidelines for the American population and is useful to identify food groups that have lower consumption in relation to recommendations and population groups with low diet quality. Objective: To estimate the quality of the diet in the adult population of the city of Rosario, and to identify its relationship with sociodemographic, anthropometric indicators and lifestyle variables. Materials and Methods: Observational, descriptive and cross-sectional research of a stratified sample of 1200 adults aged 18 to 70 years. The updated methodology of HEI 2010 was used, based on the information obtained from the 24-hour recall. A questionnaire was used to collect sociodemographic variables and tobacco consumption, alcohol consumption was assessed by frequency of consumption, anthropometric measurements were measured and physical activity was assessed with the IPAQ questionnaire. The associations were evaluated by Chi square test and the difference of means by Anova (p<0,05). Results: The average age of adults evaluated was 39±15 years, 69% were women, 32% had completed tertiary studies or more, 56% with BMI≥25 kg/m², 34% had risk according to waist circumference, 54% realized <150 min/week of physical activity, 67% consumed alcohol and 26% were current smokers. The HEI reached an average of 48.5±15.1 points, the values farthest from the ideal were found in fish, shellfish and vegetable proteins (0.7/5); whole grains (1.5/10); refined grains and cereals (2/10); fruit (1.7/5); green vegetables and legumes (1.7/5); fatty acids (3.7/10) and dairy (4.3/10). The 58.6% had a poor quality diet (HEI <50). In men (p<0,05), young adults (p<0,01), those with a lower educational level (p<0,01), individuals who perform <150 minutes per week of moderate or intense physical activity (p<0,01) and those who smoke have observed a less healthy diet (p<0,01). Conclusion: The diet of the studied population shows unhealthy characteristics. The identification of groups of greater risk will allow to orient better the educative and sanitary actions tending to modify styles of life and alimentary habits.

Análise crítica do índice de qualidade da dieta revisado para a população brasileira (IQD-R): aplicação no ELSA-Brasil / Critical analysis of the revised diet quality index for the Brazilian population (DQI-R): its application in ELSA-Brasil

Resumo O objetivo deste estudo foi analisar criticamente a aplicação do Índice de Qualidade da Dieta - Revisado (IQD-R), explicitar facilidades e dificuldades em seu cálculo, sugerir adaptações e comparar sua distribuição segundo variáveis sociodemográficas entre os 15.105 servidores públicos participantes do Estudo Longitudinal de Saúde do Adulto, no período de 2008 a 2010. O consumo alimentar foi aferido com base em Questionário de Frequência Alimentar e o IQD-R foi estimado de quatro maneiras: original; ponderado para frequência de consumo de frutas e hortaliças; modificado considerando leguminosas separado dos demais vegetais e adaptado abrangendo as duas alterações anteriores. Os resultados indicaram que independentemente da adaptação realizada, as mulheres, os indivíduos com mais de 65 anos e os indivíduos de menor escolaridade apresentaram escores médios mais altos indicando dieta de melhor qualidade. Acredita-se que as adaptações propostas podem ser úteis para estudos futuros que apliquem o IQD-R.

Abstract The scope of this study was to conduct a critical analysis of the application of the Brazilian Healthy Eating Index - Revised (BHEI-R), to explain the ease and difficulties in its calculation, to suggest adaptations and to compare its distribution. This was done in accordance with sociodemographic variables among the 15,105 public servants participating in the Longitudinal Study of Adult Health from 2008 to 2010. Food consumption was assessed based on a Food Frequency Questionnaire and BHEI-R was estimated in four ways: original; weighted for frequency of consumption of fruits and vegetables; modified considering legumes separated from other vegetables, and adapted covering the two previous changes. The results indicated that irrespective of the adaptation performed, women, individuals over 65 years of age and individuals with lower schooling had higher mean scores indicating a better quality diet. It is believed that the proposed adaptations may be useful for future studies that apply BHEI-R.

Diet Quality among the Brazilian Population and Associated Socioeconomic and Demographic Factors: Analysis from the National Dietary Survey 2008-2009.

BACKGROUND: Evaluating diet quality is a way to monitor a population's adherence to dietary guidelines. OBJECTIVE: To adapt the Healthy Eating Index-2015 (HEI-2015) to the Brazilian population, to evaluate the validity and reliability of the adapted HEI-2015, and to assess diet quality of Brazilian adults as well as socioeconomic and demographic factors associated with diet quality. DESIGN: In this cross-sectional study, two dietary records from nonconsecutive days were used to obtain food intake information. The collected socioeconomic and demographic data included sex, age, education, per capita income, and residence area. PARTICIPANTS/SETTING: A representative sample (n=27,760) of the Brazilian adult population participated in the Nutrition Dietary Survey 2008-2009. MAIN OUTCOME MEASURES: Total and component scores for the adapted HEI-2015. The validity and reliability of the index were tested. STATISTICAL ANALYSIS PERFORMED: Mean total and component scores were estimated for the adapted HEI-2015. Also, the proportion of subjects that achieved the maximum score for each component was calculated. Regarding validity and reliability analysis, principal components analysis examined the number of dimensions; Pearson correlations were estimated between total score, components, and energy, and Cronbach's coefficient α was estimated. Diet quality was compared among socioeconomic and demographic categories. RESULTS: The mean total score for the adapted HEI-2015 was 45.7 (95% CI: 45.4 to 46.0). Women had higher diet quality scores (46.4; 95% CI: 46.1 to 46.7) than men (44.9; 95% CI: 44.6 to 45.3). Age, education, and per capita income were directly associated with the adapted HEI-2015 total score. Greater than or equal to 50% of subjects received the maximum adapted HEI-2015 component scores for "total protein foods," "seafood and plant proteins," "fatty acids," and "sodium." In contrast, less than 30% of subjects received the maximum component scores for "total vegetables," "dairy," and "saturated fats." Higher percentages of women received the maximum component scores for "total fruits," "whole fruits," "total vegetables," "greens," "dairy," and "sodium," whereas higher percentages of men received the maximum component scores for "total protein foods," "seafood and plant proteins," "fatty acids," "added sugars," and "saturated fats" components. Finally, validity analysis revealed weak correlations between component scores and energy and weak to moderate correlations with total scores; six dimensions were responsible for the total variance in diet quality and the standardized Cronbach's coefficient α was .65 (unstandardized=.64). CONCLUSIONS: Brazilian adults have suboptimal diet quality as assessed by the adapted HEI-2015. Diet quality varied by socioeconomic and demographic factors. Results support the validity and the reliability of the index.

Diet Quality Profile of Track-and-Field Paralympic Athletes.

This study aimed to assess the diet quality of Brazilian Paralympic track-and-field team sprinters and its variation between days. All sprinters (n = 28) were invited, and 20 (13 men and seven women) accepted the invitation consisting of 13 athletes with visual impairment, four with cerebral palsy, and three with limb deficiency. The dietary intake was recorded by photographic register on four consecutive days, and diet quality was determined using a revised version of the Healthy Eating Index for the Brazilian population. Physical activity was assessed using an accelerometer, and metabolic unit information was used to classify exercise intensity. Variance Analysis Model and Bonferroni multiple comparisons were used to assess relationships between variables. The correlations between variables used Pearson linear correlation coefficient. The results show that revised version of the Healthy Eating Index score was classified as "needs to be modified" for all athletes. The maximum score for the components "Whole fruits," "Total vegetables," and "Dark green and orange vegetables and legumes" was achieved by 23.1% and 14.3%, 7.7% and 14.3%, and 46.2% and 57.8% of male and female athletes, respectively. Only 38.5% of the male athletes achieved the maximum score for the "Total cereal" component. Female athletes achieved higher scores than male athletes for the "Milk and dairy products" component (p = .03). Intake of whole grain cereals, dairy products, vegetables, and whole fruits needs modifications to improve adequate intake of vitamins and antioxidants, highlighting the need of continuous actions of nutrition education for this population.

Socioeconomic and ethnic differences in the relation between dietary costs and dietary quality: the HELIUS study.

BACKGROUND: Healthier dietary patterns are generally more costly than less healthy patterns, but dietary costs may be more important for dietary quality in lower educated and ethnic minority groups. The aim of this study was to investigate the association between dietary costs and dietary quality and interactions with ethnicity and socioeconomic position (SEP). METHODS: We used cross-sectional data from 4717 Dutch, Surinamese, Turkish and Moroccan origin participants of the multi-ethnic HELIUS study (the Netherlands), who completed an ethnic-specific food frequency questionnaire (FFQ). The primary outcome measure was dietary quality according to adherence to the Dutch Healthy Diet index 2015 (DHD15-index, range 0-130). Individual dietary costs (the monetary value attached to consumed diets in Euros) were estimated by merging a food price variable with the FFQ nutrient composition database. Regression analyses were used to examine main and interaction effects. Analyses were adjusted for age, sex, smoking, energy intake, physical activity, ethnicity and educational level. RESULTS: Having higher dietary costs was associated with higher dietary quality. Analyses stratified by educational level showed that associations were stronger in higher educated (Btertile3 = 8.06, 95%CI = 5.63; 10.48) than in lower educated participants (Btertile3 = 5.09, 95%CI = 2.74; 7.44). Stratification by ethnic origin showed strongest associations in Turkish participants (Btertile2 = 9.31, 95%CI = 5.96; 12.65) and weakest associations in Moroccan participants (Btertile3 = 4.29, 95%CI = 0.58; 8.01). Regardless of their level of education, Turkish and Moroccan individuals consumed higher quality diets at the lowest cost than Dutch participants. CONCLUSIONS: The importance of dietary costs for dietary quality differs between socioeconomic and ethnic subgroups. Increasing individual food budgets or decreasing food prices may be effective for the promotion of healthy diets, but differential effects across socioeconomic and ethnic subgroups may be expected.

Diet Quality and Glycemic Control in Patients with Type 2 Diabetes.

BACKGROUND: The overall diet quality of individuals and populations can be assessed by dietary indexes based on information from food surveys. Few studies have evaluated the diet quality of individuals with type 2 diabetes or its potential associations with glycemic control. OBJECTIVE: To evaluate the relationship between diet quality and glycemic control. DESIGN: Cross-sectional study with consecutive enrollment from 2013 to 2016. PARTICIPANTS: Outpatients with type 2 diabetes treated at a university hospital in southern Brazil. MAIN OUTCOME MEASURES: Dietary information was obtained by a quantitative food frequency questionnaire validated for patients with diabetes. Overall diet quality was evaluated by the Healthy Eating Index 2010. Glycemic control was assessed by fasting plasma glucose and glycated hemoglobin. STATISTICAL ANALYSES: A receiver operating characteristic curve was constructed to find the optimal Healthy Eating Index cutoff point to discriminate diet quality, considering good glycemic control as glycated hemoglobin level <7%. Patients were then classified as having lower vs higher diet quality, and the two groups were compared statistically. Logistic regression models were constructed with glycated hemoglobin level ≥7% as the dependent variable, adjusted for age, current smoking, diabetes duration and treatment, physical activity, body mass index, high-density lipoprotein cholesterol level, and energy intake. RESULTS: A total of 229 patients with type 2 diabetes (median age=63.0 years [interquartile range=58.0 to 68.5 years]; diabetes duration=10.0 years [interquartile range=5 to 19 years]; body mass index 30.8±4.3; and glycated hemoglobin=8.1% [interquartile range=6.9% to 9.7%]) were evaluated. A Healthy Eating Index score >65% yielded the best properties (area under the receiver operator characteristic curve=0.60; sensitivity=71.2%; specificity=52.1%; P=0.018). Patients with lower-quality diets were younger and more likely to be current smokers than patients with higher-quality diets. After adjusting for confounders, patients with lower-quality diets had nearly threefold odds of poorer glycemic control (2.92; 95% CI 1.27 to 6.71; P=0.012) than those in the higher-quality diet group. CONCLUSIONS: Lower diet quality, defined as an Healthy Eating Index 2010 score <65%, was associated with poor glycemic control in this sample of outpatients with type 2 diabetes.

Modified Healthy Eating Index and Incidence of Metabolic Syndrome in Children and Adolescents: Tehran Lipid and Glucose Study.

OBJECTIVE: To assess the relationship between modified healthy eating index (mHEI) with the development of metabolic syndrome (MetS) among children and adolescents. STUDY DESIGN: Dietary data were collected using a food frequency questionnaire among 424 healthy subjects, aged 6-18 years. The components of mHEI were grains, vegetables and fruits, dairy, red to white meat ratio, butter, sweet snacks, sweetened beverages, salty snacks, and fast food. Multivariable logistic regression models were used to estimate the incidence of MetS after 3.6 years of follow-up in each quartile of the mHEI score, adjusted for baseline age, sex, total energy intake, physical activity, and body mass index. RESULTS: The mean ± SD age and mHEI scores of participants were 13.6 ± 3.7 years and 55.9 ± 10.0, respectively, at baseline. MetS developed in 11% of the participants at the end of follow-up. After adjustment for confounders, the occurrences of MetS decreased in the highest quartile compared with the lowest quartile of the mHEI score (OR = 0.35, 95% CI 0.13-0.98, P for trend = .025). In addition, higher scores of mHEI components including fruits, salty snacks, and fast food were associated with lower risk of MetS. CONCLUSIONS: Higher scores of mHEI as an indicator of diet quality may hinder the development of MetS among children and adolescents.

Validation of the Brazilian Healthy Eating Index-Revised Using Biomarkers in Children and Adolescents.

The Brazilian Healthy Eating Index-Revised (BHEI-R) can be used to determine overall dietary patterns. We assessed the BHEI-R scores in children and adolescents, aged from 9 to 13 years old, and associated its component scores with biomarkers of health and dietary exposure. Three 24-h recalls were used to generate BHEI-R. Biomarkers were analyzed in plasma and red blood cells. Correlation tests, agreement, and covariance analyses were used to associate BHEI-R components with biomarkers. Data from 167 subjects were used. The strongest correlations were between fruits, vegetables and legumes with omega-6 and omega-3 fatty acids, and ß-carotene intakes. Milk and dairy correlated with plasma retinol and pyridoxine. All components rich in vegetable and animal protein sources correlated with plasma creatine. Total BHEI-R scores were positively associated with intakes of omega-6, omega-3, fiber and vitamin C, and inversely associated with energy and saturated fat intakes of individuals. Plasma ß-carotene and riboflavin biomarkers were positively associated with total BHEI-R. An inadequate food consumption pattern was captured by both biomarkers of health and dietary exposure. BHEI-R was validated for the above dietary components and can be associated with metabolomics and nutritional epidemiological data in future pediatric studies.

Diet Quality of patients with chronic Chagas disease in a tertiary hospital: a case-control study

Abstract INTRODUCTION: Nutritional status has been implicated in the modulation of the immune response, possibly augmenting the pathogenesis of Chagas disease (Cd). We evaluated diet quality and nutritional status in adults and elderly patients with chronic Cd in a tertiary hospital. METHODS: A case-control study of Cd patients was conducted, paired for gender, age, and co-morbidities with non-Cd patients. Anthropometric measurements and food frequency questionnaire was used, and diet quality was assessed by the Brazilian Healthy Eating Index-Revised (BHEI-R). The Estimated Average Requirement cut-off points were used to determine the dietary micronutrient adequacy. The Cd group was further grouped according to Los Andes classification. RESULTS: The study participants were 67 ± 10 years old, 73.6% elderly and 63% female. The prevalence of overweight/obesity and abdominal fat was high in both groups; however, Cd group showed a lower prevalence of obesity and increased risk of disease according to waist circumference classification. There was no difference in BHEI-R score between groups (p=0.145). The Cd group had sodium and saturated fat intake above recommendations and low intake of unsaturated fat, vitamin D, E, selenium, magnesium, and dairy products; but higher intake of iron. According to Los Andes classification, group III presented lower intake of whole fruit and dietary fiber. CONCLUSIONS: Patients with Cd were overweight and the quality of their diet was unsatisfactory based on the recommended diet components for age and sex.