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Background and aim: A healthy diet has been recommended for non-alcoholic fatty liver disease (NAFLD). We aim to investigate the associations of diet quality indices with the risk of developingmetabolic-associated fatty liver disease (MAFLD). Methods: We conducted this nested case-control study by recruiting 968 cases with MAFLD and 964 controls from the participants of the baseline phase of the Sabzevar Persian Cohort Study (SPCS). MAFLD was defined as having a fatty liver index ≥ 60 plus at least one of the following: overweight or obese, Type II diabetes mellitus, or evidence of metabolic dysregulation. Healthy Eating Index-2015 (HEI-2015) and Alternative Healthy Eating Index-2010 (AHEI-2010) were calculated from a validated food frequency questionnaire. We estimated the associations of HEI-2015 and AHEI-2010 with MAFLD risk using multivariable logistic regression. Results: Among those in the highest relative to the lowest quintile of HEI-2015 and AHEI-2010, the multivariable-adjusted odds ratios (OR) were 0.45 (95% CI [confidence interval] 0.29–0.69; Ptrend = 0.002) and 0.55 (95% CI 0.35–0.85; Ptrend = 0.04), respectively. Conclusion: The results of our study suggest that there is a significant associationbetween adherence to a healthy diet, indicated by a higher score of HEI or AHEI, and a reduced likelihood of developingMAFLD. [ABSTRACT FROM AUTHOR]

Background: Obesity and certain associated environmental factors increase the risk of type 2 diabetes mellitus (T2DM). This research aims to evaluate the relationship between sociodemographic characteristics, lifestyle, and diet quality with diabetes risk in overweight and obese Turkish adults. Methods: A questionnaire form including sociodemographic characteristics, lifestyle, body weight and height was applied. Finnish Diabetes Risk Score (FINDRISC) tool was used to identify the risk of T2DM. Dietary assessments were made by 24 h dietary recall and diet quality was evaluated by Healthy Eating Index-2015 (HEI-2015). Results: According to FINDRISC score, 38.1% of adults were at mild risk, 21.9% were at moderate risk, and 20.9% were at high risk. In regression model, factors such as low educational level, being married, being employed, smoking, and the presence of comorbidities were found to increase the risk of developing diabetes. Each unit decline in HEI-2015, the risk of diabetes increased by a factor of 0.983. Conclusions: Sociodemographic factors, lifestyle, and diet quality significantly contribute to the increased risk of diabetes in overweight and obese Turkish adults. This trial was registered at clinicaltrials.gov with number NCT06614075 and registration date of 26 September 2024, retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: A diet high in added sugars has been linked to poor diet quality; however, little is known about specific sources of added sugars and their association with diet quality. Objective: This study examined associations between added sugars intake from specific food and beverage sources and diet quality, as indicated by the Healthy Eating Index (HEI) 2020 score, among the U.S. population. Methods: Data from eight consecutive 2-year cycles of the National Health and Nutrition Examination Survey (2003–2004 through 2017–2018) were pooled, and regression analysis was conducted to examine associations between total HEI-2020 score or HEI-2020 component scores and added sugars intake (% kcal) from key contributors: soft drinks, fruit drinks and coffee and tea; ready-to-eat cereals; flavored milk; sweet bakery products; and snack/meal bars. Results: A higher added sugars intake from soft drinks, fruit drinks and coffee and tea was associated with lower diet quality (lower total HEI score and lower scores on most of the HEI components) among both children and adults (p < 0.0001). In contrast, higher added sugars intakes from flavored milk (p < 0.0001) and snack/meals bars (p < 0.001) among children, and from sweet bakery products (p < 0.0001) among adults, were associated with higher diet quality. For all these associations, changes in the total HEI score across quintiles of added sugars intake were very small, ranging from 50.2 to 52.8 for children and 55.4 to 57.5 for adults, depending on the added sugars source. Conclusions: The nature of the relationship between added sugars intake and diet quality depends on the source of added sugars. While the small differences in diet quality may be of limited practical significance, our results suggest that the consideration of the different roles of various added sugars sources in the diet is warranted when developing dietary guidance. [ABSTRACT FROM AUTHOR]

The Healthy Eating Index 2010 (HEI-2010) and Alternative Healthy Eating Index 2010 (AHEI-2010) are commonly used to measure dietary quality in research settings. Neither index is designed specifically to compare diet quality between low-carbohydrate (LC) and low-fat (LF) diets. It is unknown whether biases exist in making these comparisons. The aim was to determine whether HEI-2010 and AHEI-2010 contain biases when scoring LC and LF diets. Secondary analyses of the Diet Intervention Examining the Factors Interacting With Treatment Success (DIETFITS) weight loss trial were conducted. The trial was conducted in the San Francisco Bay Area of California between January 2013 and May 2016. Three approaches were used to investigate whether biases existed for HEI-2010 and AHEI-2010 when scoring LC and LF diets. DIETFITS participants were assigned to follow healthy LC or healthy LF diets for 12 months (n = 609). Mean diet quality index scores for each diet were measured. Approach 1 examined both diet quality indices' scoring criteria. Approach 2 compared scores garnered by exemplary quality LC and LF menus created by registered dietitian nutritionists. Approach 3 used 2-sided t tests to compare the HEI-2010 and AHEI-2010 scores calculated from 24-hour dietary recalls of DIETFITS trial participants (n = 608). Scoring criteria for both HEI-2010 (100 possible points) and AHEI-2010 (110 possible points) were estimated to favor an LF diet by 10 points. Mean scores for exemplary quality LF menus were higher than for LC menus using both HEI-2010 (91.8 vs 76.8) and AHEI-2010 (71.7 vs 64.4, adjusted to 100 possible points). DIETFITS participants assigned to a healthy LF diet scored significantly higher on HEI and AHEI than those assigned to a healthy LC diet at 3, 6, and 12 months (all, P <.001). Mean baseline scores were lower than mean scores at all follow-up time points regardless of diet assignment or diet quality index used. Commonly used diet quality indices, HEI-2010 and AHEI-2010, showed biases toward LF vs LC diets. However, both indices detected expected changes in diet quality within each diet, with HEI-2010 yielding greater variation in scores. Findings support the use of these indices in measuring diet quality differences within, but not between, LC and LF diets. [ABSTRACT FROM AUTHOR]

Purpose: To improve sustainability, adjustments to current diets are necessary. Therefore, limited planetary resources are considered within the healthy reference diet proposed by the EAT-Lancet Commission. The agreement with nationwide food intake was evaluated with two indices which reflect this reference and German food intake recommendations. Methods: A healthy eating index (HEI-MON) reflecting the dietary guidelines of the German nutrition society and a planetary healthy eating index (PHEI-MON) reflecting the healthy reference diet were developed, with scores from 0 to 100. Both indices were applied to data from a nationally representative sample of the German population aged 18–79 years for which data from a 53-item food frequency questionnaire are available. Results: Mean scores for the indices were 53 for HEI-MON and 39 for PHEI-MON. A better adherence to either guideline could be found among women, persons of older age as well as persons with higher education level. The sub-scores for HEI-MON showed high agreement with the recommendations for side dishes, fruit/nuts, (processed) meat and cereals, but low agreement with the recommendations for free sugar and vegetables/legumes. PHEI-MON sub-scores were highest for poultry, fruits and potatoes, and lowest for nuts, red meat and legumes. High scores in one index do not necessarily correspond to high scores in the other index. Individuals with more plantbased diets had higher scores in both indices, while high sugar and meat consumption led to lower scores. Conclusions: More plant-based diets are crucial for individual and planetary health. Both indices reflect such diets which consider already health and sustainability aspects. At an individual level, the scores for both indices may differ considerably, but overall there is a huge potential in the population to adapt to a diet more in line with both guidelines. [ABSTRACT FROM AUTHOR]

Backgrounds: The potential link between functional gastrointestinal disorders and eating disorders has been reported recently. Aims: The present study aimed to explore the relationship between orthorexic tendencies and irritable bowel syndrome (IBS)-related quality of life in IBS patients. Method: This cross-sectional study was conducted with 121 IBS patients. The data were collected using Orthorexia Nervosa-11 (ORTO-11) to assess orthorexic tendencies, Irritable Bowel Syndrome Quality of Life Scale (IBS-QoL) to measure quality of life, and Irritable Bowel Syndrome Symptom Severity Score (IBS-SSS) to measure IBS symptoms. Food consumption record was taken to assess diet quality with the Healthy Eating Index 2015 (HEI-2015). The relationship between measured variables was assessed. Results: The mean ORTO-11 score of the patients was 24.76 ± 3.99. Most patients had poor diet quality (52.00%). A moderate positive correlation was found between ORTO-11 and IBS-QoL (model 0, p < 0.005 and model 1, p < 0.001) and a strong negative correlation between IBS-SSS and IBS-QoL (p < 0.001). Conclusions: In conclusion, we can conclude that both altered IBS symptoms and orthorexic tendencies affect the quality of life of irritable bowel patients independently of each other. These findings provide valuable insights into the treatment of IBS and inform clinicians and researchers in the fields of gastroenterology, nutrition, psychiatry,and psychology. [ABSTRACT FROM AUTHOR]

Background: Children's dietary quality is suboptimal, increasing the risk of numerous chronic illnesses. Salad bars (SBs) have potential to enhance children's nutritional intake within the National School Lunch Program (NSLP); yet, empirical support is lacking. To address this gap, we evaluated the impact of school salad bars on dietary quality and energy intake at lunch. Methods: Seven matched elementary school pairs were randomly selected. All schools served pre-portioned fruit and vegetables (F&V) at baseline. Within each pair, one school received an SB. Digital imagery plate waste methods were applied at baseline and 4–6 weeks post salad bar installation to determine intake (20% increments for food, ounces for beverages). Dietary quality (Healthy Eating Index (HEI-2015)) and energy intake (kcal) were evaluated in NDSR. Multilevel modeling evaluated group (SB vs. control) and time (baseline vs. post) differences and group-by-time interactions for: (1) HEI-2015 (total and component scores) and (2) kcal intake (overall, F&V, non-F&V, and beverage kcals). Results: Data from 5674 trays are reported. Significant group-by-time interactions were observed for HEI-2015 total scores and Greens and Beans, Total Fruit, Whole Fruit, Refined Grains, and Added Sugar component scores (p < 0.0001), supporting improved dietary quality in SB schools. SB HEI-2015 scores were 60.1 ± 9.8 at post (+5.3 from baseline; p < 0.0001) compared with 57.2 ± 9.5 in controls (+1.0 from baseline; p = 0.065). Total energy intake significantly increased in SB schools (376 ± 151 kcal (baseline) → 434 ± 176 kcal (post)), driven by F&V energy (+59 kcal), with no change for controls. Discussion: Within the NSLP, SBs improved dietary quality and increased energy intake due to increased F&V intake without replacing other foods. Results can inform school nutrition policies designed to reduce chronic illness risk. [ABSTRACT FROM AUTHOR]

Objective: Diet habit plays a vital role in fecal incontinence (FI) progression. However, it remains unknown whether dietary quality is related to FI. Our study sought to explore the relationship between healthy eating index-2015 (HEI-2015) score and FI among US adults. Methods: An analysis of data from the 2005–2010 National Health and Nutrition Examination Survey was conducted in our study. The Bowel Health Questionnaire defined FI as losing liquid, solid, or mucus stool at least monthly. The diet's quality was evaluated using HEI-2015 score. The odds ratios (ORs) and 95% confidence interval (95%CI) were calculated using multi-variable logistic regression models. Results: There were 11,452 participants, with 9.3% (1062/11452) who experienced FI. Compared with individuals with inadequate group (HEI score < 50), the adjusted OR values for HEI score and FI in average group (50 ≤ HEI score < 70) and optimal group (HEI score ≥ 70) were 0.89 (95%CI: 0.74–1.07, p = 0.214) and 0.69 (95%CI: 0.52–0.91, p = 0.011), respectively. Subsequent stratified analyses did not reveal any interactions. Conclusions: High-quality diets are related with a lower risk of FI. Therefore, it is imperative to take into account the potential impact of diet on FI when devising strategies for the treatment and prevention. [ABSTRACT FROM AUTHOR]

Background/Objectives: Alcohol consumption and poor dietary habits are on the rise in the United States, posing significant challenges to public health due to their contribution to chronic diseases such as liver failure. While associations between alcohol consumption patterns and diet quality have been explored, the relationship between specific alcoholic beverage types and diet quality remains underexamined. This study aims to compare diet quality among consumers of different alcoholic beverage types. Methods: We conducted a cross-sectional analysis of 1917 current alcohol drinkers from the National Health and Nutrition Examination Survey (NHANES) who completed a 24 h dietary recall survey. Diet quality was assessed using the Healthy Eating Index (HEI), with higher scores indicating superior diet quality. Multivariable logistic regression models were employed to assess differences in HEI between consumers of various alcoholic beverage types, using wine-only drinkers as the reference group and controlling for demographic, socioeconomic, lifestyle, and metabolic syndrome variables. Results: Beer-only drinkers were more likely to have lower income, higher rates of cigarette smoking, and insufficient physical activity compared to other alcohol consumers. In the fully adjusted multivariable model, beer-only drinkers had an HEI score that was 3.12 points lower than wine-only drinkers. In contrast, liquor/cocktail-only and multiple-type drinkers had similar HEI scores to wine-only drinkers. Conclusions: Beer-only consumption is associated with poorer diet quality among alcohol drinkers. Targeted patient education and public health campaigns may be effective in addressing the combined impact of alcohol consumption and poor diet quality on chronic disease risk. [ABSTRACT FROM AUTHOR]

Few studies have examined whether diet quality is lower in women with body weight dissatisfaction compared with women without body weight dissatisfaction. (1) Examine the association between body weight dissatisfaction and diet quality among women (18–65 years old) in the healthy weight body mass index (BMI) category, and (2) explore dietary and behavioral patterns among women with body weight dissatisfaction. Data were extracted from the cross-sectional 2014–2015 Swiss National Nutrition Survey. Population-based sample of 507 women with BMI ≥ 18.5 and < 25. Dietary intakes assessed by registered dietitians using 2 nonconsecutive computer-assisted multi-pass 24-hour dietary recalls. Diet quality was measured with a slightly modified version of the Healthy Eating Index (HEI)-2020. Multiple linear regressions were performed to test the association between body weight dissatisfaction and total HEI-2020 score. Hierarchical cluster analysis was used to identify subgroups of women with body weight dissatisfaction. Body weight dissatisfaction was not found to be associated with diet quality (β = –1.73 [–4.18; 0.71], P =.16). However, women who were dissatisfied with their body weight had lower scores for the HEI-2020 total fruits (P =.050) and whole grains (P =.014) components than women who were satisfied with their body weight. Four profiles with different dietary patterns were identified among women with body weight dissatisfaction: "Unhealthy diet with dairy," "Protein and fat," "Vegetables without protein," and "Healthier diet without dairy." Among women with a BMI in the healthy weight category, overall diet quality was not observed to differ between those with or without body weight dissatisfaction. More research is needed to explore the different profiles of dietary intake in women with body weight dissatisfaction. [ABSTRACT FROM AUTHOR]

Background: Dietary habits have been suggested to play a role in incidence of colorectal cancer (CRC). The current study aimed to evaluate the relationship between dietary patterns (Healthy Eating Index-2015 (HEI-2015) and Dietary Quality Index International (DQI-I)) and CRC risk among Iranian population.Methods: This case-control study was performed in the CRC Surgery Department of Imam Khomeini Hospital enrolling simultaneously 71 participants with CRC as cases and 142 subjects without neoplastic and acute diseases from the same hospital as controls. Participants’ food intake was assessed by a food frequency questionnaire (FFQ). Also, the scores of each of the dietary patterns (HEI-2015 and DQI-I) were classified into tertiles and analyzed.Results: In the crude model, the odds of developing CRC in the third tertile was significantly lower than those in the first tertile of both HEI-2015 (Odds ratio (OR)=0.41; 95% confidence interval (CI)=0.20-0.83) and DQI-I (OR=0.48; 95%CI=0.23-0.98). In the adjusted model, the odds of developing CRC was significantly lower in the last tertile of HEI-2015 (OR=0.37; 95%CI=0.17-0.80) and second (OR=0.45; 95%CI=0.20-0.99) and last tertile of DQI-I (OR=0.30; 95%CI=0.12-0.74) in comparison to the first tertile.Conclusion: A higher score of HEI-2015 and DQI-I was found to be significantly associated with a lower CRC risk. Further prospective studies in diverse populations are recommended to validate these findings.

BackgroundEating a high-quality diet or adhering to a given dietary strategy may influence weight loss. However, these 2 factors have not been examined concurrently for those following macronutrient-limiting diets.ObjectiveTo determine whether improvement in dietary quality, change in dietary macronutrient composition, or the combination of these factors is associated with differential weight loss when following a healthy low-carbohydrate (HLC) or healthy low-fat (HLF) diet.DesignGenerally healthy adults were randomly assigned to HLC or HLF diets for 12 mo (n = 609) as part of a randomized controlled weight loss study. Participants with complete 24-h dietary recall data at baseline and 12-mo were included in this secondary analysis (total N = 448; N = 224 HLC, N = 224 HLF). Participants were divided into 4 subgroups according to 12-mo change in HEI-2010 score [above median = high quality (HQ) and below median = low quality (LQ)] and 12-mo change in macronutrient intake [below median = high adherence (HA) and above median = low adherence (LA) for net carbohydrate (g) or fat (g) for HLC and HLF, respectively]. Baseline to 12-mo changes in mean BMI were compared for those in HQ/HA, HQ/LA, LQ/HA subgroups with the LQ/LA subgroup within HLC and HLF.ResultsFor HLC, changes (95 % confidence level [CI]) in mean BMI were -1.15 kg/m2 (-2.04, -0.26) for HQ/HA, -0.30 (-1.22, 0.61) for HQ/LA, and -0.80 (-1.74, 0.14) for LQ/HA compared with the LQ/LA subgroup. For HLF, changes (95% CI) in mean BMI were -1.11kg/m2 (-2.10, -0.11) for HQ/HA, -0.26 (-1.26, 0.75) for HQ/LA, and -0.66 (-1.74, 0.41) for LQ/HA compared with the LQ/LA subgroup.ConclusionWithin both HLC and HLF diet arms, 12-mo decrease in BMI was significantly greater in HQ/HA subgroups relative to LQ/LA subgroups. Neither HQ nor HA alone were significantly different than LQ/LA subgroups. Results of this analysis support the combination of dietary adherence and high-quality diets for weight loss.Clinical trial registryclinicaltrials.gov (Identifier: NCT01826591).

Abstract Background Substantial variability in response to lifestyle interventions has been recognized for many years, and researchers have begun to disentangle sources of error from inherent differences in individual responsiveness. The objective of this secondary analysis of an intensive lifestyle intervention (diet and exercise) for metabolic syndrome (MetS) was to identify potentially important differences among study completers grouped by treatment response as measured by change in a continuous metabolic syndrome score (Gurka/MetS). Methods All study completers from a 12-month primary care study were categorized into one of five groups according to change in the Gurka/MetS score. A change of 0.4 in z-score defined clinically relevant change in line with results of previous studies. Repeated measures analysis of variance was used to examine cardiovascular disease risk and individual clinical indicators of MetS over 12 months, looking for differences in response over time by the five groups. Results Of 176 participants, 50% (n = 88) had stable scores, 10% (n = 18) had relevant change scores in the first 3 months only and reverted toward baseline, 20% (n = 35) achieved meaningful change over the whole study, 11% (n = 20) had a delayed response at 3–12 months, and 9% (n = 15) demonstrated worsening scores. Significant differential patterns were noted for groups over the duration of the intervention (p

In this study, we aimed to compare metabolic risk factors, lipid indices, healthy eating index, and physical activity among premenopausal, menopausal, and postmenopausal women.

Abstract Background College students are vulnerable to high perceived stress (PS) and emotional eating (EE) levels, which are associated with their food consumption. In this study, we aimed to examine the links between perceived stress, emotional eating, and adherence to a healthy eating index. Furthermore, we aimed to test whether sociodemographic data and health measures, including body mass index and physical activity, are associated with perceived stress, emotional eating, or healthy eating index. Methods This study included students from King Abdulaziz University. The participants completed validated perceived stress, emotional eating, and short healthy eating index surveys via an online questionnaire from September to December 2022. Univariate linear regression analysis was performed to examine the association between perceived stress, emotional eating, and adherence to healthy eating index using the short healthy eating index. Results Of 434 students (49.8% male, mean age 21.7 ± 3.0 years), 11.3% had low, 72.0% moderate, and 16.7% high perceived stress. Students with moderate perceived stress had the highest short healthy eating index score (P = 0.001), outperforming those with low and high perceived stress for fruit juice (P = 0.002), fruits (P $$\:

Abstract Background Food intakes 1–2 years following bariatric surgery depend more on patients than the surgery’s gastrointestinal tract changes. This study aimed to determine the major dietary patterns of patients after the first two years of sleeve gastrectomy and to investigate their associations with total weight loss (TWL) and the proportion of TWL as fat mass (FM) and fat-free mass (FFM) loss. Methods This cross-sectional study included 146 patients undergoing sleeve gastrectomy 2–4 years after surgery. Dietary patterns were determined using principal component analysis based on the 19 food groups. The percentage of FM loss relative to TWL (%FML) and FFM loss relative to TWL (%FFML) were calculated. A suboptimal clinical response was defined as a TWL of less than 25%. High FM loss and excessive FFM loss were defined based on the highest tertiles. Linear and logistic regression models were used to derive unstandardized (B) coefficients and odds ratios (OR), with dietary pattern scores serving as both a continuous and a binary variable (higher vs. lower adherence groups based on median). Results Two predominant dietary patterns were retained. Each 1-unit increase in the first dietary pattern score characterized by high intakes of fast foods, soft drinks, processed meats, sugar confectionary, salty snacks, grains, and organ meats was associated with higher %FFML (B = 1.99; 95% confidence interval (CI) 0.34, 3.66), lower %FML (B = − 1.84; 95% CI − 3.49, − 0.20), and higher odds of excessive FFM loss (OR = 1.84; 95% CI 1.09, 3.11). Participants with higher adherence to the first dietary pattern had lower %TWL, and greater odds of suboptimal clinical response and excessive FFM loss than those with lower adherence. Each 1-unit increase in score for the second dietary pattern characterized by a high intake of fruits, dairy, vegetables, legumes, eggs, nuts, red meats, poultry, and fish was associated with lower odds of suboptimal clinical response (OR = 0.51; 95% CI 0.31, 0.86). Conclusion Patients should be encouraged to modify their diet by reducing the consumption of ultra-processed foods and increasing their intake of high-quality protein sources, fruits, and vegetables to achieve the best postoperative outcome.

Abstract Background Although the Healthy Eating Index (HEI) is widely recommended to reduce the risk of cardiovascular disease and all-cause death, there are significant differences in physiological and nutritional factors between the sexes. The potential impact of sex on adult dietary health is still poorly understood. The study was designed to assess whether the health benefits of diet differed by sex. Methods In a prospective study of 39,567 U.S. adults (51.2% female, age 46.8 ± 17.6 years), we examined sex-specific, multivariable-adjusted associations of HEI with all-cause mortality and cardiovascular disease mortality. Restricted cubic splines (RCS), subgroup analysis, propensity score matching (PSM), random forest feature importance, and sensitivity analysis were also used. Results During 328,403 person-years of follow-up, a total of 4754 all-cause deaths were recorded, including 1481 cardiovascular deaths. Compared to the lowest quartile of HEI, the all-cause mortality rate of females and males in the highest quartile array decreased by 34% (HR 0.66 [95% CI 0.55–0.8]) and 15% (HR 0.85 [95% CI 0.73–0.99]), respectively. The restricted cubic spline showed a linear inverse association between baseline HEI and all-cause mortality and CVD mortality, with similar sex-specific results. Similarly, component scores were sex-specific for mortality risk, with females benefiting more from diet. The benefits of dairy products, vegetables, and sodium scores on the risk of all-cause death were higher in males and females. However, the benefits of vegetable, sodium, and fatty acid scores on the risk of cardiovascular death were different. Conclusions In the adult population of the U.S., there are more opportunities for females to reduce the risk of all-cause mortality and cardiovascular mortality from the same dose of healthy dietary intake than males. These findings could reduce the risk of death by motivating the population, especially females, to consume healthy dietary components, especially vegetables and dairy products.

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Background: Substantial variability in response to lifestyle interventions has been recognized for many years, and researchers have begun to disentangle sources of error from inherent differences in individual responsiveness. The objective of this secondary analysis of an intensive lifestyle intervention (diet and exercise) for metabolic syndrome (MetS) was to identify potentially important differences among study completers grouped by treatment response as measured by change in a continuous metabolic syndrome score (Gurka/MetS). Methods: All study completers from a 12-month primary care study were categorized into one of five groups according to change in the Gurka/MetS score. A change of 0.4 in z-score defined clinically relevant change in line with results of previous studies. Repeated measures analysis of variance was used to examine cardiovascular disease risk and individual clinical indicators of MetS over 12 months, looking for differences in response over time by the five groups. Results: Of 176 participants, 50% (n = 88) had stable scores, 10% (n = 18) had relevant change scores in the first 3 months only and reverted toward baseline, 20% (n = 35) achieved meaningful change over the whole study, 11% (n = 20) had a delayed response at 3–12 months, and 9% (n = 15) demonstrated worsening scores. Significant differential patterns were noted for groups over the duration of the intervention (p <.001). Improvement in diet quality and fitness scores were similar across all groups. Other available variables were tested and did not account for the differences. Conclusion: Work is needed to identify key factors that account for differences in responses to lifestyle interventions that can be used to guide treatment decisions for intensive lifestyle interventions for this common condition. Trial Registration: ClinicalTrials.gov Identifier: NCT01616563; first registered June 12, 2012. [ABSTRACT FROM AUTHOR]

Background: Vaginal Lactobacillus predominance is associated with improved vaginal health and reduced pregnancy complications. Little is known about how dietary quality may improve vaginal microbial composition or about dietary interventions that may promote Lactobacillus abundance. To understand the host factors affecting vaginal microbiota during pregnancy in a multi-ethnic cohort in Hawai'i. We hypothesize that better diet quality improves vaginal microbial composition, as represented by Lactobacillus abundance and depletion of anaerobic organisms. Methods: We compared comprehensive diet quality, as measured by the Healthy Eating Index-2015 (HEI-2015), to taxonomic classifications of bacteria present within the vagina. Participants of the four predominant ethnic groups in Hawai'i (Japanese, Filipino, Non-Hispanic White and Native Hawaiian) completed Quantitative Food Frequency Questionnaires (QFFQs) and collected vaginal swabs during each trimester. 16s rRNA amplicon sequencing (V2–V9 regions) was performed on vaginal samples. HEI-2015 scores and macro- and micronutrient intake were compared with the predominant species present using the Mann–Whitney-U test, PERMANOVA, and the Pearson correlation coefficient. A mixed-effects logistics regression model was used to predict the depletion of Lactobacillus species while accounting for confounding demographic factors. Results: Matched, longitudinal data for 40 participants demonstrated three predominant Lactobacillus species: L. crispatus, L. iners, and L. gasseri, with another subset of samples with anaerobic abundance. (Primarily, Atopobium vaginae, Prevotella, and Gardnerella vaginalis.) Non-Hispanic White participants had lower amounts of Lactobacillus iners compared to other racial and ethnic groups. HEI scores correlated with the chao index and observed species number primarily in the first trimester (r = 0.25, p < 0.05). Greater carbohydrate intake was associated with a higher abundance of L. crispatus, while lower carbohydrate intake trended towards more L. iners (0.056) and anaerobic species. Conclusions: Increased carbohydrate consumption and improved diet quality may be associated with beneficial vaginal microbial composition in pregnancy. [ABSTRACT FROM AUTHOR]

Eating disorders are serious health issues among young people that contribute to increased morbidity rates. The prevalence and severity of eating disorders among Latvian youth aged 18–24 and their relationship with the Healthy Eating Index, dietary habits, and BMI were analyzed in the present study. At the beginning of the study, 190 respondents participated by completing the SCOFF questionnaire, from which the sample group was selected based on the criterion of SCOFF ≥ 2. For the next stage of the study, the responses of 74 participants who completed the EDE-Q-6 questionnaire and the Canadian Food Intake Screener were analyzed. The symptoms of eating disorders were identified in 38.9% of the respondents (SCOFF ≥ 2). The global score of the EDE-Q-6 was 2.00 ± 1.81 where subscales such as body shape concerns (2.93 ± 1.44) and weight concerns (2.68 ± 1.36) were the most important factors that young people paid attention to. The severity of eating disorders was 3.20 for males and 2.62 for females, where a score of 4 and above is classified as an eating disorder. Participants with eating disorder symptoms had a higher BMI, with females having a BMI of 22.5 (normal weight) and 25.5 for males (overweight). The study sample had a poor diet, as the Healthy Eating Index was 8.7 with a maximum score of 24. Weak negative correlations were found between eating disorder severity and eating habits. The issue of eating disorders is topical among young people in Latvia, which requires solutions such as the inclusion of educational programs on healthy nutrition and eating disorders, and psychological support for young people. [ABSTRACT FROM AUTHOR]

Background: Although the Healthy Eating Index (HEI) is widely recommended to reduce the risk of cardiovascular disease and all-cause death, there are significant differences in physiological and nutritional factors between the sexes. The potential impact of sex on adult dietary health is still poorly understood. The study was designed to assess whether the health benefits of diet differed by sex. Methods: In a prospective study of 39,567 U.S. adults (51.2% female, age 46.8 ± 17.6 years), we examined sex-specific, multivariable-adjusted associations of HEI with all-cause mortality and cardiovascular disease mortality. Restricted cubic splines (RCS), subgroup analysis, propensity score matching (PSM), random forest feature importance, and sensitivity analysis were also used. Results: During 328,403 person-years of follow-up, a total of 4754 all-cause deaths were recorded, including 1481 cardiovascular deaths. Compared to the lowest quartile of HEI, the all-cause mortality rate of females and males in the highest quartile array decreased by 34% (HR 0.66 [95% CI 0.55–0.8]) and 15% (HR 0.85 [95% CI 0.73–0.99]), respectively. The restricted cubic spline showed a linear inverse association between baseline HEI and all-cause mortality and CVD mortality, with similar sex-specific results. Similarly, component scores were sex-specific for mortality risk, with females benefiting more from diet. The benefits of dairy products, vegetables, and sodium scores on the risk of all-cause death were higher in males and females. However, the benefits of vegetable, sodium, and fatty acid scores on the risk of cardiovascular death were different. Conclusions: In the adult population of the U.S., there are more opportunities for females to reduce the risk of all-cause mortality and cardiovascular mortality from the same dose of healthy dietary intake than males. These findings could reduce the risk of death by motivating the population, especially females, to consume healthy dietary components, especially vegetables and dairy products. [ABSTRACT FROM AUTHOR]

Background: Food intakes 1–2 years following bariatric surgery depend more on patients than the surgery's gastrointestinal tract changes. This study aimed to determine the major dietary patterns of patients after the first two years of sleeve gastrectomy and to investigate their associations with total weight loss (TWL) and the proportion of TWL as fat mass (FM) and fat-free mass (FFM) loss. Methods: This cross-sectional study included 146 patients undergoing sleeve gastrectomy 2–4 years after surgery. Dietary patterns were determined using principal component analysis based on the 19 food groups. The percentage of FM loss relative to TWL (%FML) and FFM loss relative to TWL (%FFML) were calculated. A suboptimal clinical response was defined as a TWL of less than 25%. High FM loss and excessive FFM loss were defined based on the highest tertiles. Linear and logistic regression models were used to derive unstandardized (B) coefficients and odds ratios (OR), with dietary pattern scores serving as both a continuous and a binary variable (higher vs. lower adherence groups based on median). Results: Two predominant dietary patterns were retained. Each 1-unit increase in the first dietary pattern score characterized by high intakes of fast foods, soft drinks, processed meats, sugar confectionary, salty snacks, grains, and organ meats was associated with higher %FFML (B = 1.99; 95% confidence interval (CI) 0.34, 3.66), lower %FML (B = − 1.84; 95% CI − 3.49, − 0.20), and higher odds of excessive FFM loss (OR = 1.84; 95% CI 1.09, 3.11). Participants with higher adherence to the first dietary pattern had lower %TWL, and greater odds of suboptimal clinical response and excessive FFM loss than those with lower adherence. Each 1-unit increase in score for the second dietary pattern characterized by a high intake of fruits, dairy, vegetables, legumes, eggs, nuts, red meats, poultry, and fish was associated with lower odds of suboptimal clinical response (OR = 0.51; 95% CI 0.31, 0.86). Conclusion: Patients should be encouraged to modify their diet by reducing the consumption of ultra-processed foods and increasing their intake of high-quality protein sources, fruits, and vegetables to achieve the best postoperative outcome. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

BackgroundPoor diet quality is a risk factor for type 2 diabetes and cardiovascular disease. However, knowledge of metabolites marking adherence to Dietary Guidelines for Americans (2015 version) are limited.ObjectivesThe goal was to determine a pattern of metabolites associated with the Healthy Eating Index (HEI)-2015, which measures adherence to the Dietary Guidelines for Americans.MethodsThe analysis examined 3557 adult men and women from the longitudinal cohort Multiethnic Study of Atherosclerosis (MESA), without known cardiovascular disease and with complete dietary data. Fasting serum specimens and diet and demographic questionnaires were assessed at baseline. Untargeted 1H 1-dimensional nuclei magnetic resonance spectroscopy (600 MHz) was used to generate metabolomics and lipidomics. A metabolome-wide association study specified each spectral feature as outcomes, HEI-2015 score as predictor, adjusting for age, sex, race, and study site in linear regression analyses. Subsequently, hierarchical clustering defined the discrete groups of correlated nuclei magnetic resonance features associated with named metabolites, and the linear regression analysis assessed for associations with HEI-2015 total and component scores.ResultsThe sample included 50% women with an mean age of 63 years, with 40% identifying as White, 23% as Black, 24% as Hispanic, and 13% as Chinese American. The mean HEI-2015 score was 66. The metabolome-wide association study identified 179 spectral features significantly associated with HEI-2015 score. The cluster analysis identified 7 clusters representing 4 metabolites; HEI-2015 score was significantly associated with all. HEI-2015 score was associated with proline betaine [β = 0.12 (SE = 0.02); P = 4.70 × 10-13] and was inversely related to proline [β = -0.13 (SE = 0.02); P = 4.45 × 10-14], 1,5 anhydrosorbitol [β = -0.08 (SE = 0.02); P = 4.37 × 10-7] and unsaturated fatty acyl chains [β = 0.08 (SE = 0.02); P = 8.98 × 10-7]. Intake of total fruit, whole grains, and seafood and plant proteins was associated with proline betaine.ConclusionsDiet quality is significantly associated with unsaturated fatty acyl chains, proline betaine, and proline. Further analysis may clarify the link between diet quality, metabolites, and pathogenesis of cardiometabolic disease.

BackgroundUtilizing the National Health and Nutrition Examination Survey (NHANES) dataset to investigate the relationship between dietary quality, as assessed by the Healthy Eating Index-2015 (HEI-2015), and the prevalence of metabolic associated fatty liver disease (MAFLD) among adults in the United States, our analysis revealed that an increased dietary quality was significantly correlated with a reduced risk of MAFLD in the American population.MethodThe NHANES dataset, encompassing the years 2017–2018 and comprising 3,557 participants, was incorporated into our analytical framework. Weighted multivariate linear regression model was performed to assess the linear relationship between the HEI-2015 and MAFLD. Dietary intake data were derived from two 24-h dietary recall interviews conducted as part of NHANES.ResultsFollowing multivariable adjustment, the weighted multivariable linear regression models demonstrated a negative correlation between the HEI-2015 total scores and the risk of MAFLD. The weighted logistic regression models revealed that each unit of increased HEI-2015 total value was associated with a 1.2% (95% CI: 0.9%, 1.5%; P < 0.001) decrease in the risk of f MAFLD. Upon categorization of the HEI-2015 scores into quartiles, the odds ratios (ORs) for the association between the risk of MAFLD and the quartile scores of HEI-2015, in comparison to the baseline quartile, were 0.945 (95% CI: 0.852–1.047; P = 0.279), 0.834 (95% CI: 0.750–0.927; P < 0.001), and 0.723 (95% CI: 0.646–0.811; P < 0.001), respectively. When participants were stratified by age and sex, subgroup analyses showed a similar trend. This pattern was also evident in the smooth curve fitting (SCF) and weighted generalized additive model (GAM).ConclusionElevated dietary quality, as assessed by the total and component food scores of the HEI-2015, was significantly correlated with a diminished risk of MAFLD among participants in the NHANES survey featured in this investigation.

BackgroundEvidence on the relationship between the Healthy Eating Index (HEI) and mortality in breast cancer (BC) survivors remains inconclusive. Moreover, rare studies have explored the effect of individual HEI components on survival in this population. This study explored the association between the HEI-2020, including total and 13 component scores, and mortality in BC survivors.MethodsThis cross-sectional study included data of 481 female BC survivors (representing a 3.3 million population) obtained from the National Health and Nutrition Examination Survey (NHANES) 2005–2018. The HEI-2020 total and component scores (higher scores indicating superior dietary quality) were calculated based on the 24 h dietary recall interview. Data on mortality until December 31, 2019, were obtained from the NHANES Public-Use Linked Mortality File. The weighted Cox proportional hazards models were used to assess the association between HEI-2020 and mortality outcomes.ResultsAfter fully adjusting for confounders, a qualified total HEI-2020 score (≥60) was significantly associated with reduced non-cancer mortality (HR 0.59, 95%CI: 0.35–0.99), but not with all-cause or cancer-specific mortality. Among the 13 HEI components, a lower intake of added sugars (with a qualified component score) was linked to a decreased risk of both all-cause and non-cancer mortality (HR 0.44 and 0.25, 95%CI: 0.25–0.77 and 0.13–0.48, respectively, all p

BackgroundMigraine is a disabling neurovascular disorder often associated with comorbidities such as mental health disorders, cardiovascular diseases, and metabolic syndromes. While certain dietary triggers have been identified, the impact of overall diet quality on migraine severity and frequency is not well understood. This study aimed to evaluate the association between diet quality, lifestyle factors, and the Healthy Eating Index (HEI) with migraine severity and frequency.MethodsA cross-sectional study was conducted on 280 patients aged 18–50 years newly diagnosed with migraines. Dietary intake was assessed using a 147-item Food Frequency Questionnaire (FFQ), and diet quality was evaluated using the Lifelines Diet Score (LLDS) and HEI. Migraine-related disability and severity were assessed using the Migraine Disability Assessment (MIDAS) questionnaire and the Visual Analogue Scale (VAS), respectively. Logistic regression models were applied to examine the association between diet quality and migraine outcomes.ResultsHigher LLDS and HEI scores were significantly associated with reduced odds of migraine-related disability. Participants in the highest LLDS tertile had an odds ratio (OR) of 0.68 (95% CI: 0.42–0.96; p = 0.02) for migraine disability. Similarly, the highest HEI tertile was associated with an OR of 0.58 (95% CI: 0.41–0.88; p = 0.025). For pain intensity, the highest tertile of LLDS showed an OR of 0.55 (95% CI: 0.38–0.75; p = 0.026), while the HEI showed an OR of 0.62 (95% CI: 0.45–0.85; p = 0.03).ConclusionHigher diet quality, as measured by LLDS and HEI scores, is inversely associated with migraine severity and frequency. These findings suggest that dietary improvements may be a viable strategy for managing migraine symptoms.

Abstract Objective The aim of the present study was the association between the relationship between Dietary Quality Index-International (DQI-I) and Healthy Eating Index (HEI) and the urinary levels of F2alpha-isoprostane (F2a-IP) and 8-hydroxy-2’-deoxyguanosine (8-OHdG) was investigated as indicators of oxidative stress. Results Based on HEI (low, moderate, and good), the diet quality of both groups was classified as moderate. In all participants, HEI (β=-0.29; P = 0.04) and DQI-I (β=-0.46; P = 0.005) were inversely associated with 8-OHdG. Furthermore, a negative correlation was found between HEI (mean β=-3.53; P = 0.04) and DQI-I (mean β=-5.53; P = 0.004) with F2a-IP. The quality of the footballers’ diet was higher than that of the control group. Following a high-quality diet, which is rich in antioxidants, is likely to effectively reduce oxidative stress.

Abstract Diminished ovarian reserve (DOR) is associated with reduced fertility and poor reproductive outcomes. The association between dietary patterns and DOR was not well studied. The purpose of this study was to evaluate the relationship between adhering to the healthy eating index (HEI-2015) and the risk of DOR. In this case–control study, 370 Iranian women (120 with DOR and 250 age- and BMI-matched controls) were examined. A reliable semi-quantitative food frequency questionnaire was used to collect diet-related data. We analyzed the HEI-2015 and their dietary intake data to determine major dietary patterns. The multivariable logistic regression was used in order to analyze the association between HEI-2015 and risk of DOR. We found no significant association between HEI-2015 score and risk of DOR in the unadjusted model (OR 0.78; 95%CI 0.59, 1.03). After controlling for physical activity and energy intake, we observed that women in the highest quartile of the HEI-2015 score had 31% decreased odds of DOR (OR 0.69; 95%CI 0.46, 0.93). This association remained significant even after adjusting for all potential confounders. Overall, increased adherence to HEI may lead to a significant reduction in the odds ratio of DOR. Clinical trials and prospective studies are needed to confirm this association.

Abstract Background Obesity, cardiovascular diseases, and metabolic disorders are common problems among participants with non-alcoholic fatty liver disease (NAFLD). However, the association between these problems and the healthy eating index-2015 (HEI-2015) remains unknown. Although the HEI-2015 originated from American dietary guidelines, its comprehensive evaluation of diet quality provides valuable insights for various populations, including Iranians. Therefore, the objective of this study was to investigate the association between anthropometric, hepatic, and cardio-metabolic indices with HEI-2015 scores in participants with NAFLD. Methods We conducted a cross-sectional analysis of data from the Hoveyzeh Cohort Study, which included adults aged 35 to 70 years between 2016 and 2018. A total of 664 participant with NAFLD (452 females and 212 males) were included in the analysis. The HEI-2015 was assessed using the Food Frequency Questionnaire (FFQ). Various indices, including the body shape index (ABSI), atherogenic index of plasma (AIP), visceral adiposity index (VAI), lipid accumulation product (LAP), cardiometabolic index (CMI), lipoprotein combine index (LCI), AST/ALT ratio, ALD/NAFLD index, and hepatic steatosis index (HSI), were calculated. Results No significant differences were observed in anthropometric, cardio-metabolic, and hepatic indices across the quartiles of HEI-2015. However, among participants with NAFLD, men had significantly higher AIP and LCI levels, while women had significantly higher BMI, ABSI, VAI, LAP, and CMI levels. Additionally, women with NAFLD exhibited higher AST/ALT and HSI levels but lower ALD/NAFLD levels compared to men with NAFLD. Linear regression analysis among men with NAFLD revealed a significant negative correlation between HEI-2015 score and HSI in both the unadjusted model (β=-0.131, SE = 0.058, p = 0.024) and the adjusted model for energy intake (β=-0.129, SE = 0.058, p = 0.028). Conclusion The present study demonstrated a correlation between lower HEI-2015 scores and an increased risk of steatosis in men with NAFLD. Moreover, our findings highlighted gender-related differences in NAFLD and cardio-metabolic disorders.

Abstract Diet quality in childhood and adolescence can affect health outcomes such as physical and cognitive growth and preventing chronic diseases in adulthood. This study aimed to evaluate the relationship between diet quality using the modified youth healthy eating index (MYHEI) with socioeconomic factors and nutrition status in 7–12-year-old children in Iran. This descriptive-cross-sectional study was performed on 580 students in Zabol, Iran, selected through multistage cluster sampling. The diet was assessed through the 168-item food frequency questionnaire (FFQ) and eating behaviors. Then, the MYHEI scoring system was used to calculate the diet quality. In addition, we used the WHO growth indices, such as weight to age, height to age, and body mass index (BMI) to age ratios, to evaluate nutrition status. The mean total MYHEI score in children was 56.3 ± 11.2. Among children with the highest MYHEI score quartile, the number of girls was significantly higher than boys (p = 0.001). The prevalence of underweight, stunting, and wasting was 25.3%, 17.4%, and 21.7%, respectively. The prevalence of underweight (OR: 2.2; 95% CI 1.26, 3.90, p = 0.001) and stunting (OR: 3.2; 95% CI 1.65, 6.14, p = 0.006) were significantly lower in the higher MYHEI score quartile compared to the lower quartile. The overall diet quality of most children should be modified. Therefore, to improve the children’s health and nutrition status, it is necessary to perform nutritional interventions such as training and promotional programs, especially in schools.

BACKGROUND: Dietary patterns high in healthy minimally processed plant foods play an important role in modulating the gut microbiome and promoting cardiometabolic health. Little is known on the diet-gut microbiome relationship in US Hispanics/Latinos, who have a high burden of obesity and diabetes. OBJECTIVE: In a cross-sectional analysis, we sought to examine the relationships of 3 healthy dietary patterns-the alternate Mediterranean diet (aMED), the Healthy Eating Index (HEI)-2015, and the healthful plant-based diet index (hPDI)-with the gut microbiome in US Hispanic/Latino adults, and to study the association of diet-related species with cardiometabolic traits. METHODS: The Hispanic Community Health Study/Study of Latinos is a multi-site community-based cohort. At baseline (2008-2011), diet was assessed by using 2, 24-hour recalls. Shotgun sequencing was performed on stool samples collected in 2014-17 (n = 2444). Analysis of Compositions of Microbiomes 2 (ANCOM2) was used to identify the associations of dietary pattern scores with gut microbiome species and functions, adjusting for sociodemographic, behavioral, and clinical covariates. RESULTS: Better diet quality according to multiple healthy dietary patterns was associated with a higher abundance of species from class Clostridia, including [Eubacterium] eligens, Butyrivibrio crossotus, and Lachnospiraceae bacterium TF01-11, but functions related to better diet quality differed for the dietary patterns (e.g., aMED with pyruvate:ferredoxin oxidoreductase, hPDI with L-arabinose/lactose transport). Poorer diet quality was associated with a higher abundance of Acidaminococcus intestini and with functions of manganese/iron transport, adhesin protein transport, and nitrate reduction. Some healthy diet pattern-enriched Clostridia species were related to more favorable cardiometabolic traits such as lower triglycerides and waist-to-hip ratio. CONCLUSIONS: Healthy dietary patterns in this population are associated with a higher abundance of fiber-fermenting Clostridia species in the gut microbiome, consistent with previous studies in other racial/ethnic groups. Gut microbiota may be involved in the beneficial effect of higher diet quality on cardiometabolic disease risk.

Diminished ovarian reserve (DOR) is associated with reduced fertility and poor reproductive outcomes. The association between dietary patterns and DOR was not well studied. The purpose of this study was to evaluate the relationship between adhering to the healthy eating index (HEI-2015) and the risk of DOR. In this case–control study, 370 Iranian women (120 with DOR and 250 age- and BMI-matched controls) were examined. A reliable semi-quantitative food frequency questionnaire was used to collect diet-related data. We analyzed the HEI-2015 and their dietary intake data to determine major dietary patterns. The multivariable logistic regression was used in order to analyze the association between HEI-2015 and risk of DOR. We found no significant association between HEI-2015 score and risk of DOR in the unadjusted model (OR 0.78; 95%CI 0.59, 1.03). After controlling for physical activity and energy intake, we observed that women in the highest quartile of the HEI-2015 score had 31% decreased odds of DOR (OR 0.69; 95%CI 0.46, 0.93). This association remained significant even after adjusting for all potential confounders. Overall, increased adherence to HEI may lead to a significant reduction in the odds ratio of DOR. Clinical trials and prospective studies are needed to confirm this association. [ABSTRACT FROM AUTHOR]

Simple Summary: Quality of life significantly affects health outcomes in cancer patients. However, evidence of an association between diet quality and quality of life in cancer survivors is sparse in Mediterranean countries. The aim of this study was to evaluate the associations between an a priori diet quality index, the Healthy Eating Index-2015 (HEI-2015), and quality of life, assessed through a validated questionnaire targeted at women with a breast cancer diagnosis. A higher HEI-2015 score was positively associated with summary quality of life score and inversely associated with symptom scores. Health-related quality of life (HRQoL) represents one of the most concerning aspects for cancer patients. The Healthy Eating Index (HEI) is an a priori diet quality index directly associated with health outcomes and HRQoL in cancer survivors in North American populations. We evaluated, in a Mediterranean population, the baseline associations between HEI-2015 and HRQoL in 492 women with breast cancer recruited in a DEDiCa lifestyle trial. Dietary data were obtained from 7-day food records; HRQoL was assessed through the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30) and the C30 Summary Score (SumSc). Analysis of variance and multivariable linear and log-gamma regression models were performed. Mean and standard deviation for HEI-2015 score was 68.8 ± 11.2; SumSc was 81.5 ± 12.9. Women with lower HEI-2015 score had higher BMI, were more frequently exposed to tobacco smoke and had fewer years of education. Patients with a HEI-2015 score greater than 68.7 (median value) showed a significant increase in SumSc of 4% (p = 0.02). HEI-2015 components also associated with SumSc were beans and greens (β = 1.04; p = 0.02). Weak associations were found for total vegetables and saturated fats. Higher diet quality in breast cancer survivors was associated with higher overall HRQoL in this cross-sectional analysis. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was the association between the relationship between Dietary Quality Index-International (DQI-I) and Healthy Eating Index (HEI) and the urinary levels of F2alpha-isoprostane (F2a-IP) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) was investigated as indicators of oxidative stress. Results: Based on HEI (low, moderate, and good), the diet quality of both groups was classified as moderate. In all participants, HEI (β=-0.29; P = 0.04) and DQI-I (β=-0.46; P = 0.005) were inversely associated with 8-OHdG. Furthermore, a negative correlation was found between HEI (mean β=-3.53; P = 0.04) and DQI-I (mean β=-5.53; P = 0.004) with F2a-IP. The quality of the footballers' diet was higher than that of the control group. Following a high-quality diet, which is rich in antioxidants, is likely to effectively reduce oxidative stress. [ABSTRACT FROM AUTHOR]

We evaluated associations between diet quality and migraine outcomes. The current work represented a cross-sectional study on 262 patients with migraine (20–50 y). Diet quality was assessed using the standard healthy eating index 2015 (HEI-2015) and alternative healthy eating index 2010 (AHEI-2010). A validated 168-item food frequency questionnaire was used to assess dietary intake. Migraine outcomes included clinical factors (severity, duration, frequency, and disability related to migraine) and serum nitric oxide (NO). Associations between diet quality indices and migraine outcomes were evaluated using linear regressions, and β and 95% corresponding confidence interval (CI) were reported. HEI-2015 was inversely associated with migraine frequency (β = −4.75, 95% CI: −6.73, −2.76) in patients with the highest HEI scores (third tertile) vs. those with the lowest scores (first tertile) after adjusting for relevant confounders. AHEI-2010 was inversely associated with migraine frequency (β = −3.67, 95% CI: −5.65, −1.69) and migraine-related disability (β = −2.74, 95% CI: −4.79, −0.68) in adjusted models. Also, AHEI-2010 was inversely associated with migraine severity in patients in the second vs. first tertile (β = −0.56; 95% CI: −1.08, −0.05). We detected no associations between diet quality and NO levels (All P > 0.14). Improved diet quality may be associated with favorable migraine outcomes (lower headache frequency, severity, and migraine-related disability). Future studies are required to confirm and delineate the causal mechanisms of our observations. [ABSTRACT FROM AUTHOR]

Migraine headaches are the most prevalent disabling primary headaches, affecting individuals at an active age. Dietary interventions are considered low‐cost and practical approaches to migraine prophylaxis. Hence, the present study aimed to assess the association between adherence to the Healthy Eating Index 2015 (HEI‐2015) and migraine headaches. The present case–control study was conducted on 476 newly diagnosed adults with migraine headaches, based on the International Classification of Headache Disorders 3rd edition (ICHDIII criteria(, and 512 healthy controls. Participants' dietary intakes were collected using a validated, 168‐item semi‐quantitative food frequency questionnaire (FFQ). The association between HEI‐2015 and migraine headaches was assessed using logistic regression models. Although the trend was not statistically significant, being in the 4th quantile of the HEI‐2015 was associated with about 50% lower odds of migraine headaches in both primary (adjusted for age and gender) (odds ratios (OR): 0.51, 95% confidence intervals (CI): 0.33, 0.78) and fully adjusted models (additionally adjusted for body mass index (BMI) and total calories) (adjusted OR: 0.50, 95%CI: 0.32, 0.77). Intriguingly, the odds of migraine headaches were significantly higher in those in the last quantile of "Total Fruits," which is equal to more than 237 g per 1000 kcal (aOR: 2.96, 95%CI: 1.99, 4.41) and "Whole Fruits," which is equal to more than 233 g per 1000 kcal (aOR: 2.90, 95%CI: 1.94, 4.31). Similarly, higher intakes of "Dairy," which is equal to more than 138 g per 1000 kcal (aOR: 2.66, 95%CI: 1.71, 4.14), and "Total Protein Foods," which is equal to more than 259 g per 1000 kcal (aOR: 2.41, 95%CI: 1.58, 3.70), were associated with higher odds of migraine headaches. The current study revealed an indirect association between HEI‐2015 and its components, including "Greens and Beans," "Whole Grains," "Refined Grains," and "Added Sugars" and lower odds of migraine headaches. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In the United States, 10.2% households (HH) report child food insecurity. We assessed associations between metabolic dysfunction-associated fatty liver disease (MASLD) and food insecurity among the adolescents in the United States. METHODS: This cross-sectional study was performed using data from the National Health and Nutrition Examination Survey 2017-2018. Food insecurity was assessed by the US Department of Agriculture Child Food Security Survey Module. MASLD was defined by transient elastography. RESULTS: Among 771 adolescents (aged 12-18 years) (mean age 14.7 years; 52.5% male; 50.9% White, 12.7% Black, 24.4% Hispanic, and 12.1% other), 9.8% reported food insecurity; MASLD prevalence of 10.12% (95% confidence interval [CI] 7.13%-13.20%) affecting 4.27 million adolescents; and nonalcoholic fatty liver disease prevalence of 10.77% (95% CI 7.76-13.78) affecting 4.52 million adolescents. There was near-perfect concordance between MASLD and nonalcoholic fatty liver disease (Cohen's k coefficient of 0.971, 95% CI 0.946-0.996). The prevalence of MASLD was greater among food-insecure adolescents vs food-secure ones (17.4% vs 9.4%) and adolescents living with a low HH income vs those with a higher HH income (15.0% vs 7.2%) and living with a head of HH with a lower education level vs one with a higher education level (18.0% vs 8.2%) (P < 0.05). The fully adjusted model showed that compared with adolescents living in a higherHHincome, food-insecure adolescents living in low income HH had a 3-fold greater risk (odds ratio [OR] 3.25, 1.31-8.08) of having MASLD, while food-secure adolescents living in low-income HH had no increased risk (OR 1.58, 0.85-2.93, = 50.139). The fully adjusted odds of having MASLD was elevated by1163% with the presence of HTN (OR 2.63, 1.02-6.78), 1241% with being Hispanic (OR 3.41, 1.36-8.56), and 1138% with being male (OR 2.38, 1.20-4.75). In addition, a 1-unit increase inBMI was associated with 25% increase in the odds of having MASLD (OR 1.25, 1.17-1.33) among US adolescents. DISCUSSION: Food insecurity is associated with MASLD among US low-income adolescents especially Hispanic male individuals with obesity and hypertension. Policies addressing inequities are needed. [ABSTRACT FROM AUTHOR]

There are studies on the effect of general nutrition education on diet quality and anthropometric measurements, while studies showing the effectiveness of sustainable nutrition education, which also addresses the effect of food on the environment, are quite limited. This study aimed to investigate the effects of sustainable nutrition education on diet quality, anthropometric measurements, and the carbon footprint (CFP) and water footprint (WFP) of diet. A total of 160 university students received 1 h of sustainable nutrition education for 6 weeks. Before, at the end of, and 2 months after the courses, 24 h food consumption records were taken to assess diet quality and CFP and WFP values of diet, and Mediterranean diet (MedDiet) and Healthy Eating Index (HEI)-2020 scores were evaluated. The results of the study showed that sustainable nutrition education increased MedDiet score by 1.86 points and HEI-2020 score by 7.38 points. This education program also decreased body weight, body mass index (BMI), fat mass, and neck circumference. Sustainability education has a positive impact on calcium, potassium, and magnesium intakes, a negative impact on vitamin B12 and zinc intakes, and no effect on total protein intake. Education resulted in a 22% reduction in CFP and a 10% reduction in WFP. [ABSTRACT FROM AUTHOR]

Diet quality in childhood and adolescence can affect health outcomes such as physical and cognitive growth and preventing chronic diseases in adulthood. This study aimed to evaluate the relationship between diet quality using the modified youth healthy eating index (MYHEI) with socioeconomic factors and nutrition status in 7–12-year-old children in Iran. This descriptive-cross-sectional study was performed on 580 students in Zabol, Iran, selected through multistage cluster sampling. The diet was assessed through the 168-item food frequency questionnaire (FFQ) and eating behaviors. Then, the MYHEI scoring system was used to calculate the diet quality. In addition, we used the WHO growth indices, such as weight to age, height to age, and body mass index (BMI) to age ratios, to evaluate nutrition status. The mean total MYHEI score in children was 56.3 ± 11.2. Among children with the highest MYHEI score quartile, the number of girls was significantly higher than boys (p = 0.001). The prevalence of underweight, stunting, and wasting was 25.3%, 17.4%, and 21.7%, respectively. The prevalence of underweight (OR: 2.2; 95% CI 1.26, 3.90, p = 0.001) and stunting (OR: 3.2; 95% CI 1.65, 6.14, p = 0.006) were significantly lower in the higher MYHEI score quartile compared to the lower quartile. The overall diet quality of most children should be modified. Therefore, to improve the children's health and nutrition status, it is necessary to perform nutritional interventions such as training and promotional programs, especially in schools. [ABSTRACT FROM AUTHOR]

This study explored the relationship between the Korean Healthy Eating Index (KHEI) and non-alcoholic fatty liver disease (NAFLD). This cross-sectional study included 34,174 Korean adults. The KHEI was composed of three subcomponents (adequacy, moderation, and energy balance) and calculated based on a 24 h dietary recall. The total score ranged from 0 to 100, with a higher score indicating a greater adherence to the Korean dietary guidelines. The total KHEI scores were categorized into quartiles (Q1–Q4). NAFLD was classified using the hepatic steatosis index. Logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The adjusted OR (95% CI) of NAFLD was 0.95 (0.87–1.03) for the Q2 group, 0.90 (0.83–0.98) for the Q3 group, and 0.79 (0.72–0.87) for the Q4 group, compared with the Q1 group. Among the subcomponents of the KHEI, individuals with high scores in the adequacy component, characterized by an abundant consumption of fruits, vegetables, and dairy products, exhibited the most pronounced association with NAFLD. A higher KHEI score was negatively associated with NAFLD in Korean adults. Therefore, the promotion of healthy dietary patterns can play a beneficial role in the prevention or management of NAFLD. [ABSTRACT FROM AUTHOR]

Background: Obesity, cardiovascular diseases, and metabolic disorders are common problems among participants with non-alcoholic fatty liver disease (NAFLD). However, the association between these problems and the healthy eating index-2015 (HEI-2015) remains unknown. Although the HEI-2015 originated from American dietary guidelines, its comprehensive evaluation of diet quality provides valuable insights for various populations, including Iranians. Therefore, the objective of this study was to investigate the association between anthropometric, hepatic, and cardio-metabolic indices with HEI-2015 scores in participants with NAFLD. Methods: We conducted a cross-sectional analysis of data from the Hoveyzeh Cohort Study, which included adults aged 35 to 70 years between 2016 and 2018. A total of 664 participant with NAFLD (452 females and 212 males) were included in the analysis. The HEI-2015 was assessed using the Food Frequency Questionnaire (FFQ). Various indices, including the body shape index (ABSI), atherogenic index of plasma (AIP), visceral adiposity index (VAI), lipid accumulation product (LAP), cardiometabolic index (CMI), lipoprotein combine index (LCI), AST/ALT ratio, ALD/NAFLD index, and hepatic steatosis index (HSI), were calculated. Results: No significant differences were observed in anthropometric, cardio-metabolic, and hepatic indices across the quartiles of HEI-2015. However, among participants with NAFLD, men had significantly higher AIP and LCI levels, while women had significantly higher BMI, ABSI, VAI, LAP, and CMI levels. Additionally, women with NAFLD exhibited higher AST/ALT and HSI levels but lower ALD/NAFLD levels compared to men with NAFLD. Linear regression analysis among men with NAFLD revealed a significant negative correlation between HEI-2015 score and HSI in both the unadjusted model (β=-0.131, SE = 0.058, p = 0.024) and the adjusted model for energy intake (β=-0.129, SE = 0.058, p = 0.028). Conclusion: The present study demonstrated a correlation between lower HEI-2015 scores and an increased risk of steatosis in men with NAFLD. Moreover, our findings highlighted gender-related differences in NAFLD and cardio-metabolic disorders. [ABSTRACT FROM AUTHOR]

Optimizing diet quality is an important concept for college athletes. Purpose: To evaluate dietary quality of National Collegiate Athletic Association (NCAA) Division I athletes. Methods: Total 94 college athletes (n= 21 male, 73 female) from 19 different varsity teams at a single university completed a 24-hour dietary recall using the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. Diet quality was assessed using the Healthy Eating Index (HEI) with higher scores indicating better diet quality (range 0-100). Results: The average HEI score for the total sample was 59.2 ± 16.6 and only nine athletes achieved an HEI score ≥ 80. There were no significant differences in HEI scores between sexes, class, majors, sport played, or those who did or did not report taking previous nutrition coursework. Conclusions: The dietary quality was poor based on US dietary guidelines for the general population, which could have negative effects on health and performance. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association of food insecurity with overall and disease-specific mortality among US cancer survivors. Methods: Data from the National Health and Nutrition Examination Survey (NHANES 1999–2018) were used to examine the impact of food insecurity on mortality risks among cancer survivors in the US. Study participants aged ≥ 20 years who had a history of cancer and completed the Adult Food Security Survey Module were included. Mortality data [all-cause, cancer, and cardiovascular (CVD) specific] through December 31, 2019 were obtained through linkage to the National Death Index. Using multivariable Cox proportional hazard regression, hazard ratios of mortality based on food security status were estimated. Results: Among 5032 cancer survivors (mean age 62.5 years; 58.0% women; 86.2% non-Hispanic White), 596 (8.8%) reported food insecurity. Overall, 1913 deaths occurred (609 cancer deaths and 420 CVD deaths) during the median follow-up of 6.8 years. After adjusting for age, food insecurity was associated with a higher risk of overall (HR = 1.93; 95% CI = 1.56–2.39), CVD-specific (HR = 1.95; 95% CI = 1.24–3.05), and cancer-specific (HR = 1.70; 95% CI = 1.20–2.42) mortality (P < 0.001). However, after adjusting for socioeconomic characteristics and health-related factors (physical activity, diet quality measured by healthy eating index), the association between food insecurity and overall mortality was no longer statistically significant. Conclusions: Food insecurity was associated with a greater risk of overall mortality among cancer survivors. Further studies are needed to confirm these findings and evaluate whether the observed association represents a causal phenomenon and, if so, whether the effect is modifiable with food assistance programs. [ABSTRACT FROM AUTHOR]