Limited Association between the Total Healthy Eating Index-2015 Score and Cardiovascular Risk Factors in Individuals with Long-Standing Spinal Cord Injury: An Exploratory Study: An Exploratory Study.

BACKGROUND: The healthy eating index-2015 (HEI-2015) reflects diet quality in reference to the 2015-2020 Dietary Guidelines for Americans (DGA). Little is known regarding its application in individuals with chronic spinal cord injury (SCI). OBJECTIVE: To explore the relationship between diet quality as assessed by the HEI-2015 and cardiovascular risk factors among individuals with chronic SCI. DESIGN: This is a cross-sectional analysis of baseline data collected from August 2017 through November 2019 for an interventional study that evaluates the effects of a high-protein/low-carbohydrate diet on cardiovascular risk factors in individuals with chronic SCI at the University of Alabama at Birmingham. PARTICIPANTS/SETTING: Twenty-four free-living adults with SCI (mean age, 45 ± 12 y; 8F/16M, level of injury: nine cervical, 15 thoracic; mean duration of injury: 20 ± 13 y) were included. MAIN OUTCOME MEASURES: Participants underwent a 2-hour oral glucose tolerance test (OGTT) and a dual-energy x-ray absorptiometry scan. Dietary intake was assessed by three, 24-hour multiple-pass dietary recalls to calculate the HEI-2015 using the simple HEI scoring algorithm method. DATA ANALYSIS: Multiple linear regression analyses were performed to predict indices of lipid metabolism and glucose homeostasis and C-reactive protein (CRP) from the HEI-2015. Principal component analysis was used to reduce the number of covariates (level of injury, sex, and body fat percentage). RESULTS: On average, participants' diets were of low quality (HEI-2015, 47.2 ± 10.8). The regression models for fasting glucose (FG), cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and CRP had moderate to large effect sizes (adjusted R2 ≥ 13%), suggesting good explanatory abilities of the predictors. Small or limited effect sizes were observed for glucose tolerance, fasting insulin, triglycerides, and Matsuda index (adjusted R2 < 13%). The HEI-2015 accounted for a moderate amount of variation in FG (partial omega-squared, ωP2 = 13%). Each 10-point HEI-2015 score increase was associated with a 3.3-mg/dL decrease in FG concentrations. The HEI-2015 accounted for a limited amount of variation in other indices (ωP2 < 5%). CONCLUSIONS: Among participants with SCI, higher conformance to the 2015-2020 DGA was 1) moderately associated with better FG homeostasis; and 2) trivially associated with other cardiovascular risk factors. Because of the small sample size, these conclusions cannot be extrapolated beyond the study sample. Future larger studies are warranted to better understand the relationship between diet quality and cardiovascular disease risks in this population.

Diet Quality in Early Care and Education Centers: A Comparison of Menu, Served, and Consumed Lunch Measures.

OBJECTIVE: Assess if diet quality (DQ) differs among 3 lunch measures commonly used to assess DQ in early care and education (ECE) centers, which include what is listed on the menu, served, and consumed. DESIGN: This quantitative observational study measured DQ of food and beverage items listed on the menu, what children were served, and what they consumed during one lunch meal. SETTING: Alabama ECE centers. PARTICIPANTS: ECE centers (n = 28) with attendance of ≥10 children ages 3 to 5 years and provided lunch daily. MAIN OUTCOME MEASURE(S): DQ measured through Healthy Eating Index-2015 (HEI) scores, which were calculated for the menu, served, and consumed lunch measures. ANALYSIS: Menu, served, and consumed HEI scores compared using either Kruskal-Wallis or ANOVA. Dunn Bonferroni or Duncan post hoc tests identified which group differed. RESULTS: Total HEI scores were significantly higher among menus, compared with served and consumed (P = .001). Served and consumed total HEI scores were not different. CONCLUSIONS AND IMPLICATIONS: Menu DQ differed from both the served and consumed lunch measures. These findings support the need for nutrition education on the importance of menu adherence in ECE centers.

Reasons for Late-Night Eating and Willingness to Change:A Qualitative Study in Pregnant Black Women.

OBJECTIVE: Late-night eating during pregnancy is associated with greater risk for gestational diabetes. The purposes of this study were to describe reasons why women engage in late-night eating and to understand perceptions about changing this behavior. DESIGN: Focus groups using a semi-structured interview script. SETTING: Urban university-affiliated obstetric clinic. PARTICIPANTS: Low-income black women (n = 18) with overweight/obesity at entry to prenatal care. PHENOMENON OF INTEREST: Late-night eating. ANALYSIS: Exhaustive approach coding responses to specific questions. RESULTS: Individual and interpersonal contributors to late-night eating included hunger, altered sleep patterns, fetal movement, and the influence of others. Food choices were largely driven by taste and convenience. Some women reported that they could alter nightly eating patterns, whereas others would consider changing only if late-night eating were associated with a severe illness or disability for the child. CONCLUSIONS AND IMPLICATIONS: There was considerable heterogeneity among the participants of this study regarding reasons for late-night eating during pregnancy and attitudes toward changing this behavior. Although the themes identified from this study cannot be generalized, they may be useful to inform future studies. Future research might develop strategies to overcome individual and social factors that contribute to late-night eating during pregnancy.