Corrigendum: A community focused approach toward making healthy and affordable daily diet recommendations.

[This corrects the article DOI: 10.3389/fdata.2023.1086212.].

Workshop summary: building an NHANES for the future.

The American Society for Nutrition's (ASN) Committee on Advocacy and Science Policy (CASP) organized a workshop, "Building a National Health and Nutrition Examination Survey (NHANES) for the Future," held during NUTRITION 2023, which took place in Boston, MA in July 2023. CASP had already identified an urgent need for increased support and modernization to ensure that a secure future for NHANES is achievable. The survey faces challenges associated with data collection, stagnant funding, and a need for more granular data for subpopulations and groups at risk. The workshop provided an overview of NHANES, including the nutrition component, and the many other uses for the survey's data, which extend beyond nutrition. Speakers highlighted NHANES's current and emerging challenges, as well as possible solutions to address these challenges, especially with regard to response rates of underrepresented groups, linkage of survey data to other resources, incorporation of new survey methodologies, and emerging data needs. The workshop also included a "Town Hall" component to gather additional feedback on NHANES' challenges and proposed solutions from audience members. The workshop provided many possible action items that ASN will explore and use to inform effective continued advocacy in support of NHANES and to find possible opportunities for ASN and others to partner with the Centers for Disease Control and Prevention National Center for Health Statistics to strengthen this vital survey and maintain its robust and relevant data moving forward.

The role of the community café in addressing food security: Perceptions of managers and directors.

In the United States, the pay-what-you-can restaurant model (community cafes) is an increasingly popular approach to addressing food insecurity in local communities. We conducted semi-structured interviews (n = 13) with community café executive managers and directors to assess their perceptions of the role that their cafes play in addressing food security (FS). Analysis of interviews revealed two major areas of emphasis by participants. Filling an unoccupied space in the food security landscape. Interviewees regularly cited the goal of making meals available through a dependable schedule, convenient location, and welcoming atmosphere for guests to promote regular visits to the café, and they did so with an awareness of how their practices were shaped by perceived shortcomings in comparable services. In addition, guest agency and social aspects of the café as components of utilization, was another major area. Interviewees often regarded the opportunity of the food insecure guest to choose healthy options (i.e., nutritionally dense) over less healthful ones (i.e., calorically dense) from the menu as a critical component of their service. The social component of the café (e.g., community atmosphere, 'dining-out' experience) was another aspect of the café's function that promoted dignity for the guest which can lead to greater likelihood of return visits. Perceptions shared by participants of the café's role in addressing food security suggest that rather than simply adding to the available options of hunger relief services, the café model attempts to address many areas of concern, such as structural and cultural barriers, found in the traditional forms of charitable food provision.

Dietary Intakes of Community-Dwelling Adults in the United States across Older Adulthood: National Health and Nutrition Examination Survey 2015-March 2020.

BACKGROUND: Dietary guidance is set on the basis of age and life stage and defines older adults as ≥60 y. Yet, little is known about if and/or how diet quality differs beyond the age of 60. OBJECTIVE: The objective of this study was to compare the dietary intakes of 60-69 (n = 2079), 70-79 (n = 1181), and 80+ y old (n = 644) noninstitutionalized men and women in the United States using the Healthy Eating Index 2015 (HEI) and the What We Eat in America food categories. METHODS: Data were obtained from National Health and Nutrition Examination Survey 2015-2016 and 2017-March 2020. HEI and component scores were calculated using the population ratio method. Population estimates for dietary intake were calculated as the average reported over 2 separate nonconsecutive 24-h dietary recalls. RESULTS: In men and women, the reported energy intake was lower among the 80+ y olds (kcal/d men-80+: 1884 ± 30, 70-79: 2022 ± 33, 60-69: 2142 ± 39; women-80+: 1523 ± 36; 70-79: 1525 ± 33, 60-69: 1650 ± 25; P-trend < 0.001). Total HEI scores did not differ significantly across the 3 age categories, but the 80+ y olds had significantly lower scores for the green vegetables and beans component than the 60-69 y olds [men-mean (95% confidence interval): 2.0 (1.5, 2.5) compared with 3.4 (2.6, 4.1); women-2.3 (1.8, 2.8) compared with 4.4 (3.7, 5.0)]. In women, the percentage of daily calories from protein was significantly lower in the 80+ y olds than in the 60-69 and 70-79 y olds (12.9% ± 0.6%, compared with 17.0% ± 0.9% and 15.6% ± 0.6%, respectively). Protein intake did not differ significantly among the 3 age groups in men. The 80+ y old men and women reported consuming a significantly higher percentage of calories from snacks and sweets compared with the 60-69 y olds (men-80+: 18.1% ± 0.8%, 60-69: 15.4% ± 0.7%; women-80+: 19.6% ± 0.8%, 60-69: 15.5% ± 0.7%). CONCLUSION: The diet of 80+ y olds differed from that of 60-69 y olds in some key components, including energy, snacks and sweets, protein, and green vegetables. Future research is needed to determine if there are health-related consequences to these differences.

Temporal Dietary Pattern Cluster Membership Varies on Weekdays and Weekends but Both Link to Health.

BACKGROUND: Energy and dietary quality are known to differ between weekdays and weekends. Data-driven approaches that incorporate time, amount, and duration of dietary intake have previously been used to partition participants' daily weekday dietary intake time series into clusters representing weekday temporal dietary patterns (TDPs) linked to health indicators in United States adults. Yet, neither the relationship of weekend day TDPs to health indicators nor how the TDP membership may change from weekday to weekend is known. OBJECTIVES: This study was conducted to determine the association between TDPs on weekdays and weekend days and health indicators [diet quality, waist circumference (WC), body mass index (BMI), and obesity] and their overlap among participants. METHODS: A weekday and weekend day 24-hour dietary recall of 9494 nonpregnant United States adults aged 20-65 years from the cross-sectional National Health and Nutrition Examination Survey 2007-2018 was used to determine the timing and amount of energy intake. Modified dynamic time warping and kernel k-means algorithm clustered participants into 4 TDPs on weekdays and weekend days. Multivariate regression models determined the associations between TDPs and health indicators, controlling for potential confounders and adjusting for the survey design and multiple comparisons. The percentages of overlap in cluster membership between TDPs on weekdays and weekend days were also determined. RESULTS: United States adults with a TDP of evenly spaced, energy-balanced eating occasions, representing the TDP of more than one-third of all adults on weekdays and weekends, had significantly higher diet quality, lower BMI, WC, and odds of obesity when compared to those with other TDPs. Membership of most United States adults to TDPs varied from weekdays to weekends. CONCLUSIONS: Both weekday and weekend TDPs were significantly associated with health indicators. TDP membership of most United States adults was not consistent on weekdays and weekends.

Integration of USDA Food Classification System and Food Composition Database for Image-Based Dietary Assessment among Individuals Using Insulin.

New imaging technologies to identify food can reduce the reporting burden of participants but heavily rely on the quality of the food image databases to which they are linked to accurately identify food images. The objective of this study was to develop methods to create a food image database based on the most commonly consumed U.S. foods and those contributing the most to energy. The objective included using a systematic classification structure for foods based on the standardized United States Department of Agriculture (USDA) What We Eat in America (WWEIA) food classification system that can ultimately be used to link food images to a nutrition composition database, the USDA Food and Nutrient Database for Dietary Studies (FNDDS). The food image database was built using images mined from the web that were fitted with bounding boxes, identified, annotated, and then organized according to classifications aligning with USDA WWEIA. The images were classified by food category and subcategory and then assigned a corresponding USDA food code within the USDA's FNDDS in order to systematically organize the food images and facilitate a linkage to nutrient composition. The resulting food image database can be used in food identification and dietary assessment.

Temporal Patterns of Diet and Physical Activity and of Diet Alone Have More Numerous Relationships With Health and Disease Status Indicators Compared to Temporal Patterns of Physical Activity Alone.

BACKGROUND: Daily temporal patterns of energy intake (temporal dietary patterns [TDPs]) and physical activity (temporal physical activity patterns [TPAPs]) have been independently and jointly (temporal dietary and physical activity patterns [TDPAPs]) associated with health and disease status indicators. OBJECTIVE: The aim of this study was to compare the number and strength of association between clusters of daily TDPs, TPAPs, and TDPAPs and multiple health and disease status indicators. DESIGN: This cross-sectional study used 1 reliable weekday dietary recall and 1 random weekday of accelerometer data to partition to create clusters of participants representing the 3 temporal patterns. Four clusters were created via kernel-k means clustering algorithm of the same constrained dynamic time warping distance computed over the time series for each temporal pattern. PARTICIPANTS/SETTING: From the National Health and Nutrition Examination Survey (2003-2006), 1,836 US adults aged 20 through 65 years who were not pregnant and had valid diet, physical activity, sociodemographic, anthropometric, questionnaire, and health and disease status indicator data were included. MAIN OUTCOME MEASURES: Health status indicators used as outcome measures were body mass index, waist circumference, fasting plasma glucose, hemoglobin A1c, triglycerides, high-density lipoprotein cholesterol, total cholesterol, and systolic and diastolic blood pressure; disease status indicators included obesity, type 2 diabetes mellitus, and metabolic syndrome. STATISTICAL ANALYSES PERFORMED: Multivariate regression models determined associations between the clusters representing each pattern and health and disease status indicators, controlling for confounders and adjusting for multiple comparisons. The number of significant differences among clusters and adjusted R2 and Akaike information criterion compared the strength of associations between clusters of patterns and continuous and categorical health and disease status indicators. RESULTS: TDPAPs showed 21 significant associations with health and disease status indicators, including body mass index, waist circumference, obesity, and type 2 diabetes; TDPs showed 19 significant associations; and TPAPs showed 8 significant associations. CONCLUSIONS: TDPAPs and TDPs had stronger and more numerous associations with health and disease status indicators compared with TPAPs. Patterns representing the integration of daily dietary habits hold promise for early detection of obesity.

Usual nutrient intakes and diet quality among United States older adults participating in the Supplemental Nutrition Assistance Program compared with income-eligible nonparticipants.

BACKGROUND: The proportion of older adults with food insecurity at 8% has increased faster than that of the general United States population from 2001 to 2017. Many low-income food-insecure older adults rely on food-assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP), for meeting energy and nutrient needs, whereas others are eligible but do not participate. Neither updated nutrient intake estimates nor potential differences in meeting the Dietary Reference Intakes from foods alone and with dietary supplements (DS) among low-income older adults using or eligible for SNAP are known. OBJECTIVES: This study assessed and compared national estimates of usual nutrient adequacy and dietary quality of United States older adults using SNAP and income-eligible nonparticipants. METHODS: Usual dietary intake was estimated among older adults (≥60 y; n = 2582) in the 2007-2016 NHANES cross-sectional national survey. Data on food-assistance participation and eligibility (poverty-income-ratio ≤130%), DS use, and ≥24-h dietary recalls were used. The NCI method (Markov Chain Monte Carlo approach) was applied to estimate mean usual nutrient intakes, proportion of inadequate nutrient intake, and dietary quality using the 2015 Healthy Eating Index. RESULTS: Neither usual nutrient intake from dietary and total sources nor dietary quality differed between older adult SNAP participants and eligible nonparticipants. Low dietary quality and high percentage of inadequate intake for several nutrients were apparent among both groups, especially from food sources alone, including vitamins A (56%), C (55%), D (97%), E (99%), calcium (73%), and magnesium (74%), but rates were attenuated when DS were also considered (i.e., 36% reduced risk for vitamin D inadequacy). CONCLUSIONS: Diet quality and usual nutrient intake among older adult SNAP participants and eligible nonparticipants were poor, but DS lowered the risk of nutrient inadequacy. Future policies and programs should focus on improving the intake of vitamins A, C, D, E, calcium, and magnesium and dietary quality for all older adults.

Long-Tailed Food Classification.

Food classification serves as the basic step of image-based dietary assessment to predict the types of foods in each input image. However, foods in real-world scenarios are typically long-tail distributed, where a small number of food types are consumed more frequently than others, which causes a severe class imbalance issue and hinders the overall performance. In addition, none of the existing long-tailed classification methods focus on food data, which can be more challenging due to the inter-class similarity and intra-class diversity between food images. In this work, two new benchmark datasets for long-tailed food classification are introduced, including Food101-LT and VFN-LT, where the number of samples in VFN-LT exhibits real-world long-tailed food distribution. Then, a novel two-phase framework is proposed to address the problem of class imbalance by (1) undersampling the head classes to remove redundant samples along with maintaining the learned information through knowledge distillation and (2) oversampling the tail classes by performing visually aware data augmentation. By comparing our method with existing state-of-the-art long-tailed classification methods, we show the effectiveness of the proposed framework, which obtains the best performance on both Food101-LT and VFN-LT datasets. The results demonstrate the potential to apply the proposed method to related real-life applications.

A Scoping Review of Household Factors Contributing to Dietary Quality and Food Security in Low-Income Households with School-Age Children in the United States.

Low-income and food-insecure households are at risk of poor dietary quality and even more severe food insecurity. Especially in childhood, consuming a nutritionally adequate diet is an essential driver of health, growth, and development. Household-level factors can present challenges to support the nutritional needs of low-income and food-insecure household members. The aim of this scoping review is to identify the contributing household factors to dietary quality and food security in US households of school-aged children 5 to 19 years and synthesize the evidence around emergent themes for application to future interventions. The scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews using search terms addressing food insecurity, low income, and dietary behaviors in the database PubMed. Screening by 3 independent reviewers of the title, abstract, and full study phases identified 44 studies. The 5 themes around which the studies grouped were: parental behaviors, child/adolescent behaviors, food procurement behaviors, food preparation behaviors, and household environment factors. Most studies were cross-sectional (n = 41, 93%) and focused on parental behaviors (n = 31, 70%), followed by food preparation and procurement behaviors. The themes identified were interrelated and suggest that incorporating education on parent and child behaviors that influence food procurement and preparation, along with strengthening organization and planning in the household environment, may hold promise to improve dietary quality and food security among food-insecure and low-income households. The findings can be used to inform future nutrition education interventions aimed at improving dietary quality and food security in households with school-aged children.

Major Gaps in Understanding Dietary Supplement Use in Health and Disease.

Precise dietary assessment is critical for accurate exposure classification in nutritional research, typically aimed at understanding how diet relates to health. Dietary supplement (DS) use is widespread and represents a considerable source of nutrients. However, few studies have compared the best methods to measure DSs. Our literature review on the relative validity and reproducibility of DS instruments in the United States [e.g., product inventories, questionnaires, and 24-h dietary recalls (24HR)] identified five studies that examined validity (n = 5) and/or reproducibility (n = 4). No gold standard reference method exists for validating DS use; thus, each study's investigators chose the reference instrument used to measure validity. Self-administered questionnaires agreed well with 24HR and inventory methods when comparing the prevalence of commonly used DSs. The inventory method captured nutrient amounts more accurately than the other methods. Reproducibility (over 3 months to 2.4 years) of prevalence of use estimates on the questionnaires was acceptable for common DSs. Given the limited body of research on measurement error in DS assessment, only tentative conclusions on these DS instruments can be drawn at present. Further research is critical to advancing knowledge in DS assessment for research and monitoring purposes.

Cluster Analysis to Find Temporal Physical Activity Patterns Among US Adults.

Physical activity (PA) is known to be a risk factor for obesity and chronic diseases such as diabetes and metabolic syndrome. Few attempts have been made to pattern the time of physical activity while incorporating intensity and duration in order to determine the relationship of this multi-faceted behavior with health. In this paper, we explore a distance-based approach for clustering daily physical activity time series to estimate temporal physical activity patterns among U.S. adults (ages 20-65) from the National Health and Nutrition Examination Survey 2003-2006 (NHANES). A number of distance measures and distance-based clustering methods were investigated and compared using various metrics. These metrics include the Silhouette and the Dunn Index (internal criteria), and the associations of the clusters with health status indicators (external criteria). Our experiments indicate that using a distance-based cluster analysis approach to estimate temporal physical activity patterns through the day, has the potential to describe the complexity of behavior rather than characterizing physical activity patterns solely by sums or labels of maximum activity levels.

Joint Temporal Patterns By Integrating Diet and Physical Activity.

Both diet and physical activity are associated with obesity and chronic diseases such as diabetes and metabolic syndrome. Early efforts in connecting dietary and physical activity behaviors to generate patterns rarely considered the use of time. In this paper, we propose a distance-based cluster analysis approach to find joint temporal diet and physical activity patterns among U.S. adults ages 20-65. Dynamic Time Warping (DTW) generalized to multi-dimensions is combined with commonly used clustering methods to generate unbiased partitioning of the National Health and Nutrition Examination Survey 2003-2006 (NHANES) dataset. The clustering results are evaluated using visualization of the clusters, the Silhouette Index, and the associations between clusters and health status indicators based on multivariate regression models. Our experiments indicate that the integration of diet, physical activity, and time has the potential to discover joint temporal patterns with association to health.

Dietary Costs among Midwestern Adult Food-Pantry Users by Food-Security Status.

Evidence of the relationship between dietary cost, diet quality, and socio-economic status is mixed. No studies have directly evaluated food-security status and dietary cost. This study investigated whether food-pantry clients with low and very low food-security status had less expensive daily diets than food-secure clients by comparing total cost, cost per gram, and cost per calorie of total daily dietary intake both per person and by individual food item, followed by evaluations of each food group. Mixed-model regression and Tukey-Kramer comparisons were used to compare food-security groups. There was no clear association between food-security status and cost of daily diet. Analyzed per person, total price and price per gram showed significant differences between low food-secure and food-secure groups. When analyzing individual food items, prices per calorie were significantly different between food-secure and very low food-secure groups. The directionality of the relationships by food-security status was inconsistent. Per person, those with lower food security had lower mean prices, and for individual foods this association was reversed. Therefore, the metric of food cost and the unit of analysis are critical to determining the relationship between food-security status and dietary cost.

Grit but Not Help-Seeking Was Associated with Food Insecurity among Low Income, At-Risk Rural Veterans.

Rural veterans have poorer health, use healthcare services less often than their urban counterparts, and have more prevalent food insecurity than average U.S. households. Food insecurity and resource use may be influenced by modifiable psychological attributes such as grit and help-seeking behaviors, which may be improved through interventions. Grit and help-seeking have not been previously evaluated among rural veterans. Thus, this cross-sectional study evaluated the hypothesis that grit and help-seeking were associated with food insecurity and the use of resources. Food security, resource use, grit, and help-seeking behavior were assessed among rural veterans (≥18 years) from five food pantries in southern Illinois counties (n = 177) from March 2021 to November 2021. Adjusted multiple regression was used to estimate the relationship between the odds of food insecurity and the use of resources with grit and help-seeking scores. Higher grit scores were significantly associated with lower odds of food insecurity (OR = 0.5, p = 0.009). No other associations were detected. The results provided evidence to inform the content of future educational interventions to improve food insecurity and address health disparities among rural veterans by addressing grit. The enhancement of psychological traits such as grit is related to food security and has the potential to benefit other aspects of well-being.

A narrative review of nutrient based indexes to assess diet quality and the proposed total nutrient index that reflects total dietary exposures.

A priori dietary indices provide a standardized, reproducible way to evaluate adherence to dietary recommendations across different populations. Existing nutrient-based indices were developed to reflect food/beverage intake; however, given the high prevalence of dietary supplement (DS) use and its potentially large contribution to nutrient intakes for those that use them, exposure classification without accounting for DS is incomplete. The purpose of this article is to review existing nutrient-based indices and describe the development of the Total Nutrient Index (TNI), an index developed to capture usual intakes from all sources of under-consumed micronutrients among the U.S. population. The TNI assesses U.S. adults' total nutrient intakes relative to recommended nutrient standards for eight under-consumed micronutrients identified by the Dietary Guidelines for Americans: calcium, magnesium, potassium, choline, and vitamins A, C, D, E. The TNI is scored from 0 to 100 (truncated at 100). The mean TNI score of U.S. adults (≥19 y; n = 9,954) based on dietary data from NHANES 2011-2014, was 75.4; the mean score for the index ignoring DS contributions was only 69.0 (t-test; p < 0.001). The TNI extends existing measures of diet quality by including nutrient intakes from all sources and was developed for research, monitoring, and policy purposes.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.1967872.

A Randomized Intervention of Supplemental Nutrition Assistance Program-Education Did Not Improve Dietary Outcomes Except for Vitamin D Among Lower-Income Women in Indiana.

BACKGROUND: The goal of US Department of Agriculture Supplemental Nutrition Assistance Program-Education (SNAP-Ed) is to improve the likelihood that those eligible for SNAP will make healthy choices aligned with the Dietary Guidelines for Americans, 2020-2025. OBJECTIVE: The objective of the study was to evaluate the long-term effects of a direct SNAP-Ed intervention in which participants actively engage in learning with educator instruction about dietary quality and usual intake of key nutrient and food groups among Indiana SNAP-Ed-eligible women participants as an example sample in the context of no similar existing evaluation. DESIGN: The study design was a parallel-arm, randomized controlled, nutrition education intervention, with follow-up at 1 year. PARTICIPANTS/SETTING: Participants (18 years and older; n = 97 women) eligible for SNAP-Ed and interested in receiving nutrition education lessons were recruited from 31 Indiana counties from August 2015 to May 2016 and randomized to an intervention (n = 53) or control (n = 44) group. INTERVENTION: The intervention comprised core lessons of Indiana SNAP-Ed delivered between 4 and 10 weeks after baseline assessment. Each participant completed a baseline and 1-year follow-up assessment. Dietary intake was assessed using repeated 24-hour dietary recalls (up to 2). MAIN OUTCOME MEASURES: Mean usual nutrient, food group intake, diet quality (ie, Healthy Eating Index-2010 scores), and proportion of intervention and control groups meeting Dietary Guidelines for Americans, 2020-2025 recommendations and Dietary Reference Intake indicators of requirement or adequacy, were determined using the National Cancer Institute method and the simple Healthy Eating Index-2010 scoring algorithm method. Dietary changes between intervention and control groups were examined over time using mixed linear models. STATISTICAL ANALYSES PERFORMED: Bonferroni-corrected significance levels were applied to the results of the mixed linear models for comparisons of usual intake of nutrients and foods. RESULTS: No differences in diet quality, intake of food group components, food group intake, or nutrients were observed at 1-year follow-up, except that vitamin D intake was higher among those who received SNAP-Ed compared with the control group. CONCLUSIONS: A direct SNAP-Ed intervention did not improve diet quality, food group intake, or key nutrient intake, except for vitamin D, among Indiana SNAP-Ed-eligible women up to 1 year after the nutrition education.

Trends in Overall and Micronutrient-Containing Dietary Supplement Use in US Adults and Children, NHANES 2007-2018.

BACKGROUND: Dietary supplement (DS) use is widespread in the United States and contributes large amounts of micronutrients to users. Most studies have relied on data from 1 assessment method to characterize the prevalence of DS use. Combining multiple methods enhances the ability to capture nutrient exposures from DSs and examine trends over time. OBJECTIVES: The objective of this study was to characterize DS use and examine trends in any DS as well as micronutrient-containing (MN) DS use in a nationally representative sample of the US population (≥1 y) from the 2007-2018 NHANES using a combined approach. METHODS: NHANES obtains an in-home inventory with a frequency-based dietary supplement and prescription medicine questionnaire (DSMQ), and two 24-h dietary recalls (24HRs). Trends in the prevalence of use and selected types of products used were estimated for the population and by sex, age, race/Hispanic origin, family income [poverty-to-income ratio (PIR)], and household food security (food-secure vs. food-insecure) using the DSMQ or ≥ 1 24HR. Linear trends were tested using orthogonal polynomials (significance set at P < 0.05). RESULTS: DS use increased from 50% in 2007 to 56% in 2018 (P = 0.001); use of MN products increased from 46% to 49% (P = 0.03), and single-nutrient DS (e.g., magnesium, vitamins B-12 and D) use also increased (all P < 0.001). In contrast, multivitamin-mineral use decreased (70% to 56%; P < 0.001). In adults (≥19 y), any (54% to 61%) and MN (49% to 54%) DS use increased, especially in men, non-Hispanic blacks and Hispanics, and low-income adults (PIR ≤130%). In children (1-18 y), any DS use remained stable (∼38%), as did MN use, except for food-insecure children, whose use increased from 24% to 31% over the decade (P = 0.03). CONCLUSIONS: The prevalence of any and MN DS use increased over time in the United States. This may be partially attributed to increased use of single-nutrient products. Population subgroups differed in their DS use.

The Discovery of Data-Driven Temporal Dietary Patterns and a Validation of Their Description Using Energy and Time Cut-Offs.

Data-driven temporal dietary patterning (TDP) methods were previously developed. The objectives were to create data-driven temporal dietary patterns and assess concurrent validity of energy and time cut-offs describing the data-driven TDPs by determining their relationships to BMI and waist circumference (WC). The first day 24-h dietary recall timing and amounts of energy for 17,915 U.S. adults of the National Health and Nutrition Examination Survey 2007−2016 were used to create clusters representing four TDPs using dynamic time warping and the kernel k-means clustering algorithm. Energy and time cut-offs were extracted from visualization of the data-derived TDPs and then applied to the data to find cut-off-derived TDPs. The strength of TDP relationships with BMI and WC were assessed using adjusted multivariate regression and compared. Both methods showed a cluster, representing a TDP with proportionally equivalent average energy consumed during three eating events/day, associated with significantly lower BMI and WC compared to the other three clusters that had one energy intake peak/day at 13:00, 18:00, and 19:00 (all p < 0.0001). Participant clusters of the methods were highly overlapped (>83%) and showed similar relationships with obesity. Data-driven TDP was validated using descriptive cut-offs and hold promise for obesity interventions and translation to dietary guidance.

Differences in Dietary Intake Exist among U.S. Adults by Diabetic Status Using NHANES 2009-2016.

The objective was to determine the most frequently consumed food items, food subcategories, and food categories, and those that contributed most to total energy intake for the group of U.S. adults reporting taking insulin, those with type 2 diabetes (T2D) not taking insulin, and those without diabetes. Laboratory tests and questionnaires of the National Health and Nutrition Examination Survey 2009-2016 classified 774 participants reporting taking insulin, 2758 participants reporting T2D not taking insulin, and 17,796 participants without diabetes. Raw and weighted frequency and energy contributions of each food item, food subcategory, and food category were calculated and ranked. Comparisons among groups by broad food category used the Rao-Scott modified chi-square test. Soft drinks ranked as the 8th and 6th most consumed food subcategory of participants with T2D not taking insulin and those without diabetes, and contributed 5th and 2nd most to energy, respectively. The group reporting taking insulin is likely to consume more protein foods and less soft drink compared to the other two groups. Lists of the most frequently reported foods and foods contributing most to energy may be helpful for nutrition education, prescribing diets, and digital-based dietary assessment for the group reporting taking insulin.