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Diet Diversity and Diet Quality
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Diet Diversity and Diet Quality

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (31 May 2019) | Viewed by 121147

Special Issue Editors

Dr. Lisa Jahns

E-Mail Website
Guest Editor
USDA-ARS Grand Forks Human Nutrition Research Center, USA
Interests: vegetables; fruits; diet quality; dietary guidance; carotenoids
Dr. Zach Conrad

E-Mail Website
Guest Editor
USDA-ARS Grand Forks Human Nutrition Research Center, USA
Interests: diet quality; sustainability; food systems; fruits; vegetables; modeling

Special Issue Information

Dear Colleagues,

Diet quality is a construct that describes the relationship between food consumption patterns and health outcomes. While substantial evidence links the amount of certain foods consumed to health outcomes, there is less information on how diet diversity, or variety, contributes to health outcomes. Given the importance of diet quality to public health priorities, there is a need to better understand the relationship between diet diversity, diet quality, and health outcomes.

Therefore, this Special Issue of Nutrients, titled “Diet Diversity and Diet Quality”, has been developed to compile contemporary research on this important topic. We invite you and your collaborators to consider submission of your original research, protocol development and methodological studies, and reviews. To better understand these complex relationships, we welcome all types of study designs in various populations, including epidemiologic analyses, post-hoc analyses of existing datasets, clinical and field trials, and qualitative investigations.

Potential topics may include, but are not limited to:

  • Diet diversity and quality in vulnerable populations
  • Association of diet diversity and quality with health outcomes
  • Indices of diet diversity or quality
  • Specific foods or food groups in the context of diet quality
  • Diet variety and adequacy of nutrient intakes
  • Clinical trials with food supplementation

Dr. Lisa Jahns
Dr. Zach Conrad
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Food consumption patterns
  • Diet diversity
  • Diet variety
  • Diet quality
  • Health outcomes
  • Indices of diet quality

Published Papers (17 papers)

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16 pages, 262 KiB  
Article
Predictors of Dietary Diversity of Indigenous Food-Producing Households in Rural Fiji
by Lydia O’Meara, Susan L. Williams, David Hickes and Philip Brown
Nutrients 2019, 11(7), 1629; https://doi.org/10.3390/nu11071629 - 17 Jul 2019
Cited by 16 | Viewed by 4781
Abstract
Fiji, like other Pacific Islands, are undergoing economic and nutrition transitions that increase the risk of noncommunicable diseases (NCDs) due to changes of the food supply and dietary intake. This study aimed to examine dietary diversity (DD) in indigenous food-producing households in rural [...] Read more.
Fiji, like other Pacific Islands, are undergoing economic and nutrition transitions that increase the risk of noncommunicable diseases (NCDs) due to changes of the food supply and dietary intake. This study aimed to examine dietary diversity (DD) in indigenous food-producing households in rural Fiji. Surveys were conducted with households from the Nadroga-Navosa, Namosi and Ba Provinces of Western Fiji in August 2018. Participants reported on foods consumed in the previous 24 h per the Household Dietary Diversity Score. Data was analysed using multinomial logistic regression. Of the 161 households, most exhibited medium DD (66%; M = 7.8 ± 1.5). Commonly consumed foods included sweets (98%), refined grains (97%) and roots/tubers (94%). The least consumed foods were orange-fleshed fruits (23%) and vegetables (35%), eggs (25%), legumes (32%) and dairy (32%). Households with medium DD were more likely to be unemployed (OR 3.2, p = 0.017) but less likely to have ≥6 occupants (OR = 0.4, p = 0.024) or purchase food ≥2 times/week (OR = 0.2, p = 0.023). Households with low DD were more likely to have low farm diversity (OR = 5.1, p = 0.017) or be unemployed (OR = 3.7, p = 0.047) but less likely to have ≥6 occupants (OR = 0.1, p = 0.001). During nutrition transitions, there is a need for public health initiatives to promote traditional diets high in vegetables, fruits and lean protein and agricultural initiatives to promote farm diversity. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
14 pages, 683 KiB  
Article
Dietary Diversity of an Adult Solomon Islands Population
by Bridget Horsey, Libby Swanepoel, Steven Underhill, Judith Aliakbari and Sarah Burkhart
Nutrients 2019, 11(7), 1622; https://doi.org/10.3390/nu11071622 - 17 Jul 2019
Cited by 28 | Viewed by 7421
Abstract
Ongoing dietary transitions in the Solomon Islands has resulted in an over-reliance on commercially sourced foods, leading to food insecurity, and a subsequent rise in multiple forms of malnutrition. The aim of this study was to investigate the individual dietary diversity and food [...] Read more.
Ongoing dietary transitions in the Solomon Islands has resulted in an over-reliance on commercially sourced foods, leading to food insecurity, and a subsequent rise in multiple forms of malnutrition. The aim of this study was to investigate the individual dietary diversity and food preferences of the adult population living in Auki, Solomon Islands. A cross-sectional study involving 133 adults was undertaken in the Auki district via an interviewer-administered questionnaire. Individual dietary diversity scores (DDS) were determined based on the results of a 24-h recall method. Overall mean DDS was 7.27 (range 2–12). Females and participants who lived outside the Auki town center had significantly higher dietary diversity scores. Low consumption of a variety of nutritious foods within food groups and high consumption of energy dense processed foods, indicates that diet quality is likely limited in some of this population. Participants desire for a diverse diet including local foods suggests that current dietary diversity status in this population may be influenced by food security rather than food preference. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
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17 pages, 480 KiB  
Article
Diet Quality and Diet Diversity in Eight Latin American Countries: Results from the Latin American Study of Nutrition and Health (ELANS)
by Georgina Gómez, Regina Mara Fisberg, Ágatha Nogueira Previdelli, Cristiane Hermes Sales, Irina Kovalskys, Mauro Fisberg, Marianella Herrera-Cuenca, Lilia Yadira Cortés Sanabria, Martha Cecilia Yépez García, Rossina Gabriella Pareja Torres, Attilio Rigotti, Viviana Guajardo, Ioná Zalcman Zimberg, Anne Chinnock, Ana Gabriela Murillo, Juan Carlos Brenes and on behalf of the ELANS Study Group
Nutrients 2019, 11(7), 1605; https://doi.org/10.3390/nu11071605 - 15 Jul 2019
Cited by 40 | Viewed by 7254
Abstract
This study aimed to assess diet quality score (DQS), considering healthy and unhealthy foods and nutrients, and diet diversity score (DDS) as indicators of risk of noncommunicable diseases in eight Latin American countries, and to verify the possible differences considering country, sex, age, [...] Read more.
This study aimed to assess diet quality score (DQS), considering healthy and unhealthy foods and nutrients, and diet diversity score (DDS) as indicators of risk of noncommunicable diseases in eight Latin American countries, and to verify the possible differences considering country, sex, age, socioeconomic, and nutritional status. A multicenter household population-based cross-sectional survey was conducted with 9218 individuals (age range 15–65 years). Sociodemographic and anthropometric data were collected. Dietary intake was measured using two non-consecutive 24-h recalls and diet quality and diversity were assessed. In the whole sample, scores were observed from 63.0% ± 9.3% to total DQS, 65.0% ± 13.6% to healthy dietary items and 60.2% ± 13.6% to unhealthy items, and 5.6 ± 1.1 out of 9 points to DDS. Women presented lower DDS compared to men (5.5 ± 1.1 vs. 5.6 ± 1.1, p < 0.001). Healthy DQS was higher as the socio-economic level increased, and unhealthy DQS was the opposite (p < 0.05). Total DQS was significantly lower only at the low socio-economic level (p < 0.05). Chile and Venezuela showed the lowest healthy (62.2 ± 15.2 and 61.9 ± 11.7, p < 0.05) and total DQS (61.4 ± 10.3, 61.2 ± 8.7, p < 0.05). No effects were observed when considering the age and anthropometric measurements. Promoting consumption of a diverse and high-quality diet is an essential challenge to accomplish. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
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15 pages, 793 KiB  
Article
Pregnant Women in Four Low-Middle Income Countries Have a High Prevalence of Inadequate Dietary Intakes That Are Improved by Dietary Diversity
by Rebecca L. Lander, K. Michael Hambidge, Jamie E. Westcott, Gabriela Tejeda, Tshilenge S. Diba, Shivanand C. Mastiholi, Umber S. Khan, Ana Garcés, Lester Figueroa, Antoinette Tshefu, Adrien Lokangaka, Shivaprasad S. Goudar, Manjunath S. Somannavar, Sumera Aziz Ali, Sarah Saleem, Elizabeth M. McClure, Nancy F. Krebs and on behalf of the Women First Preconception Nutrition Trial Group
Nutrients 2019, 11(7), 1560; https://doi.org/10.3390/nu11071560 - 10 Jul 2019
Cited by 53 | Viewed by 6830
Abstract
Background: Up-to-date dietary data are required to understand the diverse nutritional challenges of pregnant women living in low-middle income countries (LMIC). To that end, dietary data were collected from 1st trimester pregnant women in rural areas of Guatemala, India, Pakistan, and Democratic Republic [...] Read more.
Background: Up-to-date dietary data are required to understand the diverse nutritional challenges of pregnant women living in low-middle income countries (LMIC). To that end, dietary data were collected from 1st trimester pregnant women in rural areas of Guatemala, India, Pakistan, and Democratic Republic of the Congo (DRC) participating in a maternal lipid-based nutrient supplement (LNS) Randomized Controlled Trial to examine dietary diversity (DD), usual group energy and nutrient intakes, and prevalence of inadequate dietary intakes. Methods: Two 24-h dietary recalls were conducted in ~240 pregnant women/site (total n = 966) prior to 12-week gestation. Adequate DD was assessed, i.e., ≥5 major food groups consumed within the past 24 h. Median, Q1, Q3 intakes (without LNS) of energy, macronutrients, 12 micronutrients, and phytate were examined. The “at risk” prevalence of inadequate intakes were based on international guidelines for pregnant women. Results: Dietary patterns varied widely among sites, with adequate DD reported: 20% (Pakistan), 25% (DRC), 50% (Guatemala), and 70% (India). Significantly higher intakes of most key nutrients were observed in participants with adequate DD. More than 80% of women in all sites had inadequate intakes of folate, vitamin B12, and choline, and >80% of women in India and DRC also had inadequate intakes of calcium, thiamine, riboflavin, and vitamin B6. Conclusions: Our data highlight the likely need for micronutrient supplementation in pregnancy, specifically multi-micronutrient interventions, and support the value of increasing DD as part of sustainable long-term nutrition programs for women of reproductive age in these poor rural settings in LMIC. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
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21 pages, 2181 KiB  
Article
Seasonal Food Insecurity among Farm Workers in the Northern Cape, South Africa
by Stephen Devereux and Lauren Tavener-Smith
Nutrients 2019, 11(7), 1535; https://doi.org/10.3390/nu11071535 - 05 Jul 2019
Cited by 16 | Viewed by 6876
Abstract
Very little is known about seasonal hunger in South Africa, or about the food security and nutritional status of farm workers. This article identifies a pathway to seasonal hunger—through intra-annual fluctuations in agricultural employment and income—that is underanalyzed in the literature. We report [...] Read more.
Very little is known about seasonal hunger in South Africa, or about the food security and nutritional status of farm workers. This article identifies a pathway to seasonal hunger—through intra-annual fluctuations in agricultural employment and income—that is underanalyzed in the literature. We report on findings from a year-long data collection process, comprising baseline and endline surveys and monthly monitoring of three food security indicators, with a sample of 195 female farm workers in the Northern Cape province in South Africa. The three monthly monitoring indicators—the Household Food Insecurity Access Scale (HFIAS), Dietary Diversity Score (DDS), and Coping Strategies Index (CSI)—which measure different aspects of food insecurity, are analyzed to determine whether and to what extent food security fluctuates seasonally in our sample. HFIAS results show unambiguous evidence of seasonal food insecurity, with the highest prevalence (88 percent experiencing severe food insecurity) and severity during the low employment winter period, and lowest prevalence (49 percent) and severity during the summer harvest, which corresponds with relatively higher employment and earnings. The DDS results show evidence of highest dietary diversity during summer and the CSI results reveal the need to employ coping strategies to deal with intensified food insecurity during winter. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
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14 pages, 259 KiB  
Article
Application of an Australian Dietary Guideline Index to Weighed Food Records
by Susan J. Ward, Alison M. Coates and Alison M. Hill
Nutrients 2019, 11(6), 1286; https://doi.org/10.3390/nu11061286 - 06 Jun 2019
Cited by 5 | Viewed by 4176
Abstract
The Dietary Guideline Index (DGI) is a validated diet quality index that reflects adherence to the Australian Dietary Guidelines. The aim of the current study was to establish a novel methodology that applied the DGI to dietary data collected via gold standard, weighed [...] Read more.
The Dietary Guideline Index (DGI) is a validated diet quality index that reflects adherence to the Australian Dietary Guidelines. The aim of the current study was to establish a novel methodology that applied the DGI to dietary data collected via gold standard, weighed food records (WFR). Consisting of 10 components with a maximal score of 120, the DGI reflected the food-based recommendations of the current Australian Dietary Guidelines and included indicators to score adequacy and quality of core food components and discretionary choices within the diet. The DGI was applied to WFR collected from a sample of 141 adults (84 women, 57 men). Differences between gender for each indicator, as well as subscores for core and noncore components of the DGI were examined. Construct validity was assessed by evaluating the relationship between total DGI score and intake of key nutrients of interest. Overall, the median DGI score was low, 50.87 (range 20.6–104.1). Higher DGI scores were associated with lower intakes of saturated fat, added sugars and sodium (P < 0.05). This methodological approach of applying the DGI to WFR may improve our ability to quantify diet quality, thereby providing a tool to assess changes in dietary intake over time and allow the quantification of diet quality as a variable in relation to health outcomes. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
14 pages, 662 KiB  
Article
Aspects of Dietary Diversity Differ in Their Association with Atherosclerotic Cardiovascular Risk in a Racially Diverse US Adult Population
by Marie Fanelli Kuczmarski, Benjamin C. Brewer, Rita Rawal, Ryan T. Pohlig, Alan B. Zonderman and Michele K. Evans
Nutrients 2019, 11(5), 1034; https://doi.org/10.3390/nu11051034 - 08 May 2019
Cited by 13 | Viewed by 3859 | Correction
Abstract
The study objectives were to measure dietary diversity (DD) of an urban US population and to determine if associations of 10 year atherosclerotic cardiovascular (ASCVD) risk with DD were independent of dietary quality. Participants were drawn from the Healthy Aging in Neighborhoods of [...] Read more.
The study objectives were to measure dietary diversity (DD) of an urban US population and to determine if associations of 10 year atherosclerotic cardiovascular (ASCVD) risk with DD were independent of dietary quality. Participants were drawn from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, wave 4 (n = 2066, 1259 African Americans (AA), 807 Whites (W). Three DD measures were derived from 2 days of 24 h recall data collected with the USDA automated-multiple-pass-method. Count was based on consumption of at least half an equivalent of food from 21 subgroups. Evenness was calculated using Berry Index (BI) and BI-adjusted by food health values. Dissimilarity was calculated by Mahalanobis Distance. Diet quality was assessed by Mean Nutrient Adequacy (MAR) and DASH scores. Associations of DD and quality with ASCVD risk, calculated using 2013 American College of Cardiology and American Heart Association guidelines, were assessed with multivariable regression. Covariates included income, education, food security, and energy/kg weight. Count and MAR were positively associated whereas dissimilarity was negatively associated with ASCVD risk. There was no evidence that evenness contributed to cardiovascular health. The findings suggest more diversity in food attributes and diets rich in micronutrients rather than increased count support cardiovascular health. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
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17 pages, 529 KiB  
Article
Dietary Diversity and Nutritional Adequacy among an Older Spanish Population with Metabolic Syndrome in the PREDIMED-Plus Study: A Cross-Sectional Analysis
by Naomi Cano-Ibáñez, Alfredo Gea, Miguel A. Martínez-González, Jordi Salas-Salvadó, Dolores Corella, M. Dolors Zomeño, Dora Romaguera, Jesús Vioque, Fernando Aros, Julia Wärnberg, J. Alfredo Martínez, Lluis Serra-Majem, Ramón Estruch, Francisco J. Tinahones, José Lapetra, Xavier Pintó, Josep A. Tur, Antonio García-Ríos, Blanca Riquelme-Gallego, Miguel Delgado-Rodríguez, Pilar Matía, Lidia Daimiel, Vicente Martín, Josep Vidal, Clotilde Vázquez, Emilio Ros, Pilar Buil-Cosiales, Andrés Díaz-López, Rebeca Fernández-Carrión, Montserrat Fitó, Jadwiga Konieczna, Leyre Notario-Barandiaran, Ángel M. Alonso-Gómez, Eugenio Contreras-Fernández, Itziar Abete, Almudena Sánchez-Villegas, Rosa Casas, Araceli Muñoz-Garach, José Manuel Santos-Lozano, Laura Gallardo-Alfaro, Josep Basora, Olga Portoles, Miguel Ángel Muñoz, Manuel Moñino, Salvador Miralles Gisbert, Anai Moreno Rodríguez, Miguel Ruiz-Canela, Antoni Palau Galindo, Karla Alejandra Pérez-Vega and Aurora Bueno-Cavanillasadd Show full author list remove Hide full author list
Nutrients 2019, 11(5), 958; https://doi.org/10.3390/nu11050958 - 26 Apr 2019
Cited by 32 | Viewed by 7468
Abstract
Dietary guidelines emphasize the importance of a varied diet to provide an adequate nutrient intake. However, an older age is often associated with consumption of monotonous diets that can be nutritionally inadequate, increasing the risk for the development or progression of diet-related chronic [...] Read more.
Dietary guidelines emphasize the importance of a varied diet to provide an adequate nutrient intake. However, an older age is often associated with consumption of monotonous diets that can be nutritionally inadequate, increasing the risk for the development or progression of diet-related chronic diseases, such as metabolic syndrome (MetS). To assess the association between dietary diversity (DD) and nutrient intake adequacy and to identify demographic variables associated with DD, we cross-sectionally analyzed baseline data from the PREDIMED-Plus trial: 6587 Spanish adults aged 55–75 years, with overweight/obesity who also had MetS. An energy-adjusted dietary diversity score (DDS) was calculated using a 143-item validated semi-quantitative food frequency questionnaire (FFQ). Nutrient inadequacy was defined as an intake below 2/3 of the dietary reference intake (DRI) forat least four of 17 nutrients proposed by the Institute of Medicine (IOM). Logistic regression models were used to evaluate the association between DDS and the risk of nutritionally inadequate intakes. In the higher DDS quartile there were more women and less current smokers. Compared with subjects in the highest DDS quartile, those in the lowest DDS quartile had a higher risk of inadequate nutrient intake: odds ratio (OR) = 28.56 (95% confidence interval (CI) 20.80–39.21). When we estimated food varietyfor each of the food groups, participants in the lowest quartile had a higher risk of inadequate nutrient intake for the groups of vegetables, OR = 14.03 (95% CI 10.55–18.65), fruits OR = 11.62 (95% CI 6.81–19.81), dairy products OR = 6.54 (95% CI 4.64–9.22) and protein foods OR = 6.60 (95% CI 1.96–22.24). As DDS decreased, the risk of inadequate nutrients intake rose. Given the impact of nutrient intake adequacy on the prevention of non-communicable diseases, health policies should focus on the promotion of a healthy varied diet, specifically promoting the intake of vegetables and fruit among population groups with lower DDS such as men, smokers or widow(er)s. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
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21 pages, 747 KiB  
Article
Nutrient Composition Comparison between the Low Saturated Fat Swank Diet for Multiple Sclerosis and Healthy U.S.-Style Eating Pattern
by Catherine A. Chenard, Linda M. Rubenstein, Linda G. Snetselaar and Terry L. Wahls
Nutrients 2019, 11(3), 616; https://doi.org/10.3390/nu11030616 - 13 Mar 2019
Cited by 10 | Viewed by 6212
Abstract
Multiple sclerosis (MS) is an incurable degenerative disease that attacks the central nervous system. Roy Swank proposed a low saturated fat diet to treat MS around 1950 and showed delayed disease progression in his patients. However, there is insufficient evidence to recommend this [...] Read more.
Multiple sclerosis (MS) is an incurable degenerative disease that attacks the central nervous system. Roy Swank proposed a low saturated fat diet to treat MS around 1950 and showed delayed disease progression in his patients. However, there is insufficient evidence to recommend this diet for MS and default dietary recommendations are the Dietary Guidelines for Americans (DGA). This study assessed the nutritional adequacy of seven-day menus developed by Swank and their compliance with the DGA; menus were modeled for comparison with the DGA Healthy US-Style Eating Pattern (HEP) for males and females 31–50 years. Swank recommended dietary supplements corrected menu shortfalls in vitamins D, E, calcium, folate and iron but not dietary fiber, potassium and choline. Healthy Eating Index-2015 score for Swank menus (93.2/100) indicated good compliance with the DGA. Nutritional adequacy of the Swank modeled diet was similar to HEP for 17 vitamins and minerals (Mean Adequacy Ratios ≥94%) with similar shortfall nutrients except magnesium (HEP males) and dietary fiber (Swank males). Alternate Healthy Eating Index-2010 scores for Swank male (90/110) and female (88/110) model diets were similar to HEP. Swank menus have similar nutritional adequacy as HEP. Inclusion of foods high in dietary fiber, potassium and choline may be advised as well as selection of foods to reduce sodium below the Tolerable Upper Intake Level. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
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21 pages, 391 KiB  
Article
Nutrient Composition Comparison between a Modified Paleolithic Diet for Multiple Sclerosis and the Recommended Healthy U.S.-Style Eating Pattern
by Catherine A. Chenard, Linda M. Rubenstein, Linda G. Snetselaar and Terry L. Wahls
Nutrients 2019, 11(3), 537; https://doi.org/10.3390/nu11030537 - 01 Mar 2019
Cited by 19 | Viewed by 10165
Abstract
Multiple sclerosis (MS) is a demyelinating disease that attacks the central nervous system. Evidence-based dietary guidelines do not exist for MS; the default advice is to follow the Dietary Guidelines for Americans (DGA). A modified Paleolithic Wahls Elimination (WahlsElim) diet promoted for MS [...] Read more.
Multiple sclerosis (MS) is a demyelinating disease that attacks the central nervous system. Evidence-based dietary guidelines do not exist for MS; the default advice is to follow the Dietary Guidelines for Americans (DGA). A modified Paleolithic Wahls Elimination (WahlsElim) diet promoted for MS excludes grains and dairy and encourages 9+ cups fruits and vegetables (F/V) and saturated fat for cooking. This study evaluated the nutritional adequacy of seven-day menus and modeled them with varying amounts of F/V for comparison with the DGA Healthy US-Style Eating Pattern (HEP) for ages 31–50 years. WahlsElim menus had low added sugar and glycemic index. Nutritional adequacy of the menus and modeled versions were similar to HEP for 17 vitamins and minerals (mean adequacy ratio ≥92%). Nutrient shortfalls for the modeled diet with 60% F/V were identical to HEP for vitamin D, iron (females), magnesium (marginally males), choline and potassium; this modeled diet was also low in dietary fiber and calcium but met vitamin E requirements while HEP did not. WahlsElim-prescribed supplements corrected vitamin D and magnesium shortfalls; careful selection of foods are needed to meet requirements of other shortfall nutrients and reduce saturated fat and sodium. Doctors should monitor nutritional status, supplement doses, and possible contraindications to high vitamin K intake in individuals following the WahlsElim diet. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
15 pages, 315 KiB  
Article
An Examination of Demographic and Psychosocial Factors, Barriers to Healthy Eating, and Diet Quality Among African American Adults
by Ingrid K. Richards Adams, Wilson Figueroa, Irene Hatsu, James B. Odei, Mercedes Sotos-Prieto, Suzanne Leson, Jared Huling and Joshua J. Joseph
Nutrients 2019, 11(3), 519; https://doi.org/10.3390/nu11030519 - 28 Feb 2019
Cited by 20 | Viewed by 7178
Abstract
A healthy diet is associated with lower risk of chronic disease. African Americans generally have poor diet quality and experience a higher burden of many chronic diseases. We examined the associations of demographic and psychosocial factors and barriers to diet quality among African [...] Read more.
A healthy diet is associated with lower risk of chronic disease. African Americans generally have poor diet quality and experience a higher burden of many chronic diseases. We examined the associations of demographic and psychosocial factors and barriers to diet quality among African American adults. This cross-sectional study included 100 African American adults in a southeastern metropolitan area. Psychosocial factors (social support, self-efficacy), and barriers to healthy eating were assessed with validated measures. Diet quality was assessed using the Healthy Eating Index (HEI-2010). Nested linear regressions were used to examine the association between the variables of interest and HEI scores. Participants reported having social support (M (mean) = 2.0, SD (standard deviation) = 0.6, range 0–3), high levels of self-efficacy (M = 3.1, SD = 0.7, range 1–4), and low barriers (M = 1.4, SD = 0.6, range 0–4) to engage in healthy eating but total mean HEI scores needed improvement (M = 54.8, SD = 10.9, range 27.1–70.0). Participants consumed significantly higher empty calories and lower whole fruits, dairy, and total protein foods than the national average. Barriers to healthy eating (b = −12.13, p = 0.01) and the interaction between age and barriers (b = 0.25, p = 0.02) were most strongly associated with lower HEI scores. Younger African Americans with the highest barriers to healthy eating had the lowest HEI scores. Culturally appropriate interventions targeting empty calories, barriers to healthy eating, and knowledge of the Dietary Guidelines for Americans are needed for African Americans. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
10 pages, 235 KiB  
Article
Investigating Items to Improve the Validity of the Five-Item Healthy Eating Score Compared with the 2015 Healthy Eating Index in a Military Population
by Marissa M. Shams-White, Kenneth Chui, Patricia A. Deuster, Nicola M. McKeown and Aviva Must
Nutrients 2019, 11(2), 251; https://doi.org/10.3390/nu11020251 - 23 Jan 2019
Cited by 13 | Viewed by 4215
Abstract
Military researchers utilize a five-item healthy eating score (HES-5) in the Global Assessment Tool (GAT) questionnaire to quickly assess the overall diet quality of military personnel. This study aimed to modify the HES-5 to improve its validity relative to the 2015 Healthy Eating [...] Read more.
Military researchers utilize a five-item healthy eating score (HES-5) in the Global Assessment Tool (GAT) questionnaire to quickly assess the overall diet quality of military personnel. This study aimed to modify the HES-5 to improve its validity relative to the 2015 Healthy Eating Index (HEI-2015) in active duty military personnel (n = 333). A food frequency questionnaire was used to calculate HEI-2015 scores and to assess sugar-sweetened beverage (SSB) intake in 8-oz (SSB-8) and 12-oz servings. GAT nutrition questions were used to calculate HES-5 scores and capture breakfast and post-exercise recovery fueling snack (RFsnack) frequencies. Two scoring options were considered for the highest RFsnack category: “4” vs. “5” (RFsnack-5). Potential candidates were added alone and in combination to the HES-5 and compared to the HEI-2015 with a Pearson correlation coefficient. Scores with the highest correlations were compared via a z-score equation to identify the simplest modification to the HES-5. Correlations between HES-5 and HEI-2015 scores in total participants, males, and females were 0.41, 0.45 and 0.32, respectively. Correlations were most significantly improved in total participants by adding RFsnack-5, SSB-8, RFsnack-5 + SSB-8, and RFsnack-5 + SSB-8 + breakfast, though the addition of SSB-8 + RFsnack-5 performed best (r = 0.53). Future work should consider scoring mechanisms, serving sizes, and question wording. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
12 pages, 308 KiB  
Article
Predictors of Diet Quality as Measured by Malaysian Healthy Eating Index among Aboriginal Women (Mah Meri) in Malaysia
by Su Pei Chong, Geeta Appannah and Norhasmah Sulaiman
Nutrients 2019, 11(1), 135; https://doi.org/10.3390/nu11010135 - 10 Jan 2019
Cited by 31 | Viewed by 7271
Abstract
Socioeconomic status and nutrition knowledge are the determining factors of food choices. However, their relationship with diet quality is ambiguous among aboriginal women in Malaysia. Henceforth, the objective of this study was to examine diet quality and its predictors among the aboriginal women [...] Read more.
Socioeconomic status and nutrition knowledge are the determining factors of food choices. However, their relationship with diet quality is ambiguous among aboriginal women in Malaysia. Henceforth, the objective of this study was to examine diet quality and its predictors among the aboriginal women from the Mah Meri ethnic group in Malaysia. Data on socioeconomic characteristics, nutrition knowledge, and 24-h dietary recalls were obtained through face-to-face interviews with the respondents. Household food insecurity was assessed using Radimer/Cornell Hunger and Food Insecurity Instrument. The Malaysian Healthy Eating Index (HEI) was used to measure the diet quality of this population. The overall diet quality of the respondents was poor, with a mean Malaysian HEI score of 45.3%. Household income (r = 0.242, p < 0.001) and nutrition knowledge (r = 0.150, p < 0.05) were positively correlated with diet quality. More importantly, the predictors of diet quality were marital status (β = 0.181, p < 0.01), household income (β = 0.237, p < 0.001), food security status (β = −0.151, p < 0.01), and fat intake (β = −0.438, p < 0.001). Women being married and those with higher household income was associated with a better diet quality among Malaysian aborigines. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
14 pages, 595 KiB  
Article
Influence of Parental Healthy-Eating Attitudes and Nutritional Knowledge on Nutritional Adequacy and Diet Quality among Preschoolers: The SENDO Project
by Andrea Romanos-Nanclares, Itziar Zazpe, Susana Santiago, Lucía Marín, Anaïs Rico-Campà and Nerea Martín-Calvo
Nutrients 2018, 10(12), 1875; https://doi.org/10.3390/nu10121875 - 03 Dec 2018
Cited by 66 | Viewed by 8265
Abstract
Parental nutrition knowledge and attitudes play a fundamental role in their children’s food knowledge. However, little is known about their influence on their children’s diet quality and micronutrient intake. Thus, we aimed to assess the association of parental nutrition knowledge and healthy-eating attitudes [...] Read more.
Parental nutrition knowledge and attitudes play a fundamental role in their children’s food knowledge. However, little is known about their influence on their children’s diet quality and micronutrient intake. Thus, we aimed to assess the association of parental nutrition knowledge and healthy-eating attitudes with their children’s adherence to the Mediterranean dietary pattern and micronutrient adequacy. Parental healthy-eating attitudes and knowledge of the quality of their child’s diet as well as anthropometric, lifestyle, and nutrient intake characteristics were recorded with a basal questionnaire that included a 140-item-food frequency-questionnaire. A total of 287 pre-school children were included in the analyses. Intake adequacy was defined using the Estimated Average Requirements (EAR) cut-off point method. We developed a parental nutrition knowledge and healthy-eating attitudes scores and evaluated whether they were independently associated with 1) children’s inadequate intake (probability of failing to meet ≥3 EAR) of micronutrients, using logistic regression analyses, and 2) children’s diet quality (adherence to the Mediterranean Diet according to a Mediterranean Diet Quality Index for children and adolescents, the KIDMED index), using multiple linear regression models. A higher score in the parental healthy-eating attitudes score was associated with lower risk of failing to meet ≥3 EAR compared with the reference category (odds ratio (OR): 0.3; 95% confidence interval (CI) 0.12–0.95; p for trend: 0.037) and a higher adherence to the Mediterranean diet in the most adjusted model (β coefficient: 0.34; 95% CI 0.01–0.67; p for trend: 0.045). Our results suggest a positive association of parental healthy-eating attitudes with nutritional adequacy and diet quality in a sample of Spanish preschoolers. Public health strategies should focus on encouraging parental healthy-eating attitudes rather than simply educating parents on what to feed their children, recognizing the important influence of parental behavior on children’s practices. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
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11 pages, 423 KiB  
Article
Regularity of Breakfast Consumption and Diet: Insights from National Adult Nutrition Survey
by Irina Uzhova, Deirdre Mullally, José L Peñalvo and Eileen R. Gibney
Nutrients 2018, 10(11), 1578; https://doi.org/10.3390/nu10111578 - 26 Oct 2018
Cited by 27 | Viewed by 6751
Abstract
Breakfast is considered to be one of the most important meals of the day. Its omission has been reported to be associated with increased disease risk, such as obesity, diabetes, and coronary heart disease, as well as unhealthy lifestyle and lower dietary quality. [...] Read more.
Breakfast is considered to be one of the most important meals of the day. Its omission has been reported to be associated with increased disease risk, such as obesity, diabetes, and coronary heart disease, as well as unhealthy lifestyle and lower dietary quality. Using data from the National Adult Nutrition Survey (NANS)—a food consumption survey conducted among 1500 Irish men and women over 18 years of age, residing in the Republic of Ireland at the time the survey was conducted—we aimed to characterize breakfast regularity, identify dietary patterns associated with regular breakfast consumption, and assess the nutritional quality of such dietary patterns, using the nutrient-rich food index score NRF9.3. We determined two breakfast regularity categories and assessed dietary quality, by means of adherence to the principal component analysis derived dietary patterns and the NRF9.3 dietary index. Regular breakfast consumers were identified as those who consumed breakfast 3–4 times out of the 4 days of the collection period; such consumers comprised the majority of the population (94.4%). They had the highest adherence to healthier dietary patterns, namely, the “vegetarian” (odds ratio (OR): 2.59: 95% Confidence Interval (CI): 1.40, 4.77), “fish and vegetables” (OR: 2.88: 95% CI: 1.63, 5.10), and “breakfast cereals” (OR: 4.62: 95% CI: 2.43, 8.79) dietary patterns. Breakfast significantly contributed to the daily micronutrient intake by providing, on average, 24% of dietary fiber, 32% of iron, 30% of calcium, 32% of folate, and 37% of riboflavin. The importance of regular breakfast consumption on those who skip breakfast should be highlighted, in order to improve compliance with nutritional recommendations and adherence to a healthy lifestyle. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
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9 pages, 538 KiB  
Article
Prospective Analysis of Vegetable Amount and Variety on the Risk of All-Cause and Cause-Specific Mortality among US Adults, 1999–2011
by Zach Conrad, Jessica Thomson and Lisa Jahns
Nutrients 2018, 10(10), 1377; https://doi.org/10.3390/nu10101377 - 27 Sep 2018
Cited by 10 | Viewed by 3742
Abstract
The Dietary Guidelines for Americans 2015–2020 (DGA) provides recommendations for consuming a specific amount and variety of vegetables, but no studies have assessed the relationship between DGA-recommended vegetable variety and risk of mortality. We prospectively assessed the relationship between vegetable amount and variety [...] Read more.
The Dietary Guidelines for Americans 2015–2020 (DGA) provides recommendations for consuming a specific amount and variety of vegetables, but no studies have assessed the relationship between DGA-recommended vegetable variety and risk of mortality. We prospectively assessed the relationship between vegetable amount and variety and the risk of mortality using nationally-representative survey data (n = 29,133). Hazard ratios were estimated using survey-weighted, multivariate, Cox-proportional hazards models. Mean follow-up time was 6.5 years (12.8 years maximum). Total deaths from all causes were 2861, which included 829 deaths from cardiometabolic disease (556 coronary heart disease, 170 stroke, and 103 diabetes). Compared to individuals who reported consuming the greatest amount of vegetables daily, those with the least intake had a 78% greater risk of mortality from all causes (HR: 1.78, 95% CI: 1.29–2.47), a 68% greater risk of death from cardiovascular disease (1.68, 1.08–2.62), and an 80% greater risk of death from coronary heart disease (1.80, 1.09–2.08). No relationships were observed between vegetable variety and risk of all-cause or cause-specific mortality. Greater vegetable amount, but not variety, was associated with a reduced risk of mortality from all causes, cardiovascular disease, and coronary heart disease. Additional large-scale longitudinal studies with repeated measures of dietary exposure are needed. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
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Review

Jump to: Research

32 pages, 526 KiB  
Review
Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic
by Terry L. Wahls, Catherine A. Chenard and Linda G. Snetselaar
Nutrients 2019, 11(2), 352; https://doi.org/10.3390/nu11020352 - 07 Feb 2019
Cited by 38 | Viewed by 17326
Abstract
The precise etiology of multiple sclerosis (MS) is unknown but epidemiologic evidence suggests this immune-mediated, neurodegenerative condition is the result of a complex interaction between genes and lifetime environmental exposures. Diet choices are modifiable environmental factors that may influence MS disease activity. Two [...] Read more.
The precise etiology of multiple sclerosis (MS) is unknown but epidemiologic evidence suggests this immune-mediated, neurodegenerative condition is the result of a complex interaction between genes and lifetime environmental exposures. Diet choices are modifiable environmental factors that may influence MS disease activity. Two diets promoted for MS, low saturated fat Swank and modified Paleolithic Wahls Elimination (WahlsElim), are currently being investigated for their effect on MS-related fatigue and quality of life (NCT02914964). Dr. Swank theorized restriction of saturated fat would reduce vascular dysfunction in the central nervous system (CNS). Dr. Wahls initially theorized that detailed guidance to increase intake of specific foodstuffs would facilitate increased intake of nutrients key to neuronal health (Wahls™ diet). Dr. Wahls further theorized restriction of lectins would reduce intestinal permeability and CNS inflammation (WahlsElim version). The purpose of this paper is to review the published research of the low saturated fat (Swank) and the modified Paleolithic (Wahls™) diets and the rationale for the structure of the Swank diet and low lectin version of the Wahls™ diet (WahlsElim) being investigated in the clinical trial. Full article
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
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