BACKGROUND:Indexes are a standardized tool for assessing dietary exposures from foods/beverages (F&B) and have recently been extended to include dietary supplements (DS). The Total Nutrient Index (TNI) (F&B + DS) and the Food Nutrient Index (FNI) (F&B only) were developed to assess micronutrient intakes relative to Dietary Reference Intakes for micronutrients and were previously examined for relative validity among US adults. OBJECTIVE:This study examined the micronutrient quality (ie, TNI and FNI) of the diet across all age groups and compared TNI and FNI total and component scores with Healthy Eating Index 2020 scores among the US population. This analysis also sought to demonstrate the flexibility of the TNI and FNI frameworks across the life course. DESIGN:A nationally representative, cross-sectional analysis of the 2015-2020 National Health and Nutrition Examination Survey demographic, dietary, and dietary supplement data (ie, 24-hour dietary recall and DS inventory) was conducted among the US population. PARTICIPANTS AND SETTING:This study included US adults and children (aged 1 year and older; n = 19 903) who participated in the 2015-2020 National Health and Nutrition Examination Survey. MAIN OUTCOMES:The main outcome measures were TNI and FNI total and component scores (range = 0 to 100) overall and by age group, with higher scores indicating greater adherence to the Dietary Reference Intakes. STATISTICAL ANALYSES PERFORMED:TNI and FNI scores were calculated via the simple algorithm method, for 11 age group-dependent micronutrients (calcium, choline, magnesium, phosphorus, potassium, and vitamins A, B12, C, D, E, and K), and compared with Healthy Eating Index 2020 scores. RESULTS:Americans scored 72 out of 100 on TNI, but scores varied by age and were higher for the TNI than FNI (∼3 to 11 points.). Younger children (aged 1 to 3 years, TNI = 87; aged 4 to 8 years, TNI = 82) and older adults (aged 71 years and older, TNI = 77) exhibited higher TNI scores than other ages, due to higher calcium, magnesium, and vitamins A, C, and B12 intake. Healthy Eating Index 2020 total scores were low (52) overall and followed similar scoring trajectories by age group as the TNI and FNI. CONCLUSIONS:Evaluating total dietary exposures is important, considering the differential intake patterns from F&B, vs those with DS. Given low Dietary Reference Intakes adherence for some nutrients across the life span, these findings warrant improved diet quality and micronutrient density for many, to optimize nutrition and reduce diet-related chronic disease risk among Americans.

BACKGROUND:Valid dietary supplement (DS) assessment methods are critical for nutrition research and monitoring as DS contributes substantially toward micronutrient exposures for millions of Americans. Little is known about how DS assessment tools vary in estimating the prevalence of use and micronutrient amounts from DS. OBJECTIVES:We compared repeat collections over a year of 2 commonly used DS assessment methods: the diet history questionnaire-II (DHQII) and the automated-self-administered 24-h dietary recall (ASA24), within the longitudinal Interactive Diet and Activity Tracking in American Association of Retired Persons (IDATA) study. METHODS:DS information was collected among IDATA participants (n = 795; 50-74 y) who completed 2-6 ASA24s and a second DHQII. Agreement [Kappa (κ)] at the individual level and group-level prevalence of DS use (McNemar's test) overall and by product type were compared among all participants. Mean calcium and vitamin D intakes, by source, and nutrient amounts per consumption day (i.e., dosages) from DS were compared between the DHQII and ASA24 among DS users. Calcium and vitamin D were chosen as priority nutrients, as they reflect vitamins and minerals and are ubiquitous in DS. RESULTS:Prevalence of DS use varied by product type [13 of 28 comparisons differed in prevalence (McNemar's test); Kappa agreement range: κ = -0.03 to 0.73)]. Mean consumption day amounts of vitamin D (but not calcium) were remarkably different as assessed by the DHQII and ASA24 (mean ± standard error): vitamin D ranged from 24 ± 2.7 to 45 ± 9.5 μg/d on the ASA24 and from 12 ± 0.3 to 14 ± 0.3 μg/d on the DHQII (P < 0.0001). CONCLUSIONS:Within IDATA, the comparability of ASA24 and DHQII in estimating the prevalence of use of and nutrient intakes from DS fluctuates by nutrient and product type. DS approaches beyond a questionnaire may be warranted for estimating absolute nutrient amounts, and the choice of the DS assessment method depends on the nutrient/dietary component of interest.

BACKGROUND:The United States national dietary surveillance program, What We Eat in America (WWEIA), NHANES, quantifies intake of nutrients, food, and other components across ages and life stages for the noninstitutionalized population of the United States. The use of this continuously collected, nationally representative, publicly available data has never been quantified. OBJECTIVES:The aim of this study was to determine the extent to which nutrient data from WWEIA, NHANES are reported in the peer-reviewed, scientific literature. METHODS:Scientific studies were identified using searches in MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Cochrane Central Register of Controlled Trials. Inclusion criteria required studies to be peer-reviewed, published in English between 2013 and 2023, and report ≥1 nutrients using WWEIA, NHANES data from any cycle of the continuous NHANES (1999-2020). Screening and data extraction were conducted by 2 independent reviewers, with conflict resolution by a third reviewer. RESULTS:Of 12,589 screened studies, 2203 met the inclusion criteria. The number of included studies by publication year increased nearly 4-fold over the study period, and the studies were authored by researchers located in 60 countries. The most frequently reported nutrients were energy (n = 1724; 78%), total saturated fatty acids (n = 918; 42%), sodium (n = 828; 38%), protein (n = 748; 34%), total polyunsaturated fatty acids (n = 745; 34%), total monounsaturated fatty acids (n = 702; 32%), dietary fiber (n = 707; 32%), total fat (n = 682; 31%), and carbohydrates (n = 598; 27%). Fifty-seven percent of studies (n = 1266) reported ≥1 mineral, and 35% (n = 771) reported ≥1 vitamin. Nearly one-third of studies used 1 of 38 unique dietary indices (n = 677; 31%). CONCLUSIONS:The use of WWEIA, NHANES data in the scientific literature is prominent and has grown over time. The widespread use of this national dietary surveillance data demonstrates their importance for continued nutrition research, surveillance, and policy.

Caffeine is a popular stimulant, predominantly consumed from beverages. The caffeinated beverage marketplace is continually evolving resulting in considerable interest in understanding the impact caffeinated beverages have on levels of intakes. Therefore, estimates of caffeine intakes in the U.S. population were calculated using a recent 2022 beverage survey, the Kantar Worldpanel Enhanced Beverage Service. A nationally representative sample of 49,700 consumers (aged >= 2 years) completed a 1-day beverage intake survey which collected data on beverage type/category, amount and brand. Approximately 69% of the U.S. population consumed at least one caffeinated beverage per day. The mean (fSE) daily caffeine intake of caffeine consumers (age >2 years) from all beverages was 210 f 1.5 mg. Caffeine intake was highest in consumers aged 50-64 years (246 f 4.5 mg/day) and lowest in children aged 2-5 (42 f 2.4 mg/day). At the 90th percentile intake was 520 mg/day for all ages combined. Coffee was the largest contributor (69%) to caffeine intake across all age groups followed by carbonated soft drinks (15.4%), tea (8.8%), and energy drinks (6.3%). This study indicates that an increase in caffeine intake has occurred with a corresponding shift in beverage consumption patterns compared to previous surveys.

BACKGROUND:The Overall Plant-based Diet Index (PDI), the Healthful Plant-based Diet Index (hPDI), and the Unhealthful Plant-based Diet Index (uPDI) are relatively new tools for characterizing the quality of plant-based dietary patterns in epidemiologic studies. Reproducibility and validity of these indices have not been assessed across populations. OBJECTIVE:The objective of this study was to evaluate the reproducibility and validity of PDI, hPDI, and uPDI in a racially and ethnically diverse population. METHODS:Participants (n = 433 women, n = 244 men, n = 417 non-Hispanic White, n = 159 non-Hispanic Black, and n = 101 Hispanic) from the 2015-2016 Cancer Prevention Study 3 Dietary Assessment Substudy (CPS-3 DAS) completed the CPS-3 Food Frequency Questionnaire (FFQ) on 2 occasions (FFQ1 and FFQ2) and ≤6 24-h dietary recalls (24HRs) over 1 y. Plant-based diet scores were calculated using energy-adjusted food group intakes from each FFQ and mean 24HRs. Pearson correlations were used to evaluate reproducibility of each score between FFQs. Validity of the scores derived from FFQ2 was assessed relative to the mean of the 24HRs and blood and urine biomarkers. RESULTS:Pearson correlations for reproducibility between FFQs for men and women were 0.64 and 0.66 for PDI, 0.85 and 0.80 for hPDI, and 0.84 and 0.78 for uPDI. Pearson correlations for validity between FFQ2 and the mean 24HRs for PDI, hPDI, and uPDI for men were 0.54, 0.68, and 0.60, respectively, and for women were 0.49, 0.0.62, and 0.62, respectively. Biomarkers of most carotenoids, total protein, sodium, and potassium showed correlations ≥0.20 with certain plant-based diet scores. Reproducibility and validity were moderate to good in all racial/ethnic subgroups and were highest in non-Hispanic White adults. CONCLUSIONS:There was good reproducibility and moderate to good validity of PDI within the CPS-3 FFQ. Future work should continue to validate these indices across populations with varied diets and dietary measurement tools.

Background: Poor dietary quality is a risk factor for diet-related chronic disease and suboptimal nutritional patterns often begin early in the life course. Although the dietary intakes of young children, adolescents, and middle-aged and older adults are well established, much less is known about emerging adults, who represent a unique time point in life, as they are undergoing significant changes in food environments, autonomy, finances, and caregiver and parental involvement. Objectives: This study aimed to examine dietary quality, as assessed via the Healthy Eating Index (HEI), by demographic, socioeconomic, and health-related characteristics among emerging adults (18-23 y) in the United States who participated in the 2015-2018 National Health and Nutrition Examination Survey (NHANES). Methods: NHANES data were collected via a household interview and 2 24-h dietary recalls (24HR). Usual dietary intakes from the 24HRs were approximated using the multivariate National Cancer Institute Method to compute mean HEI-2015 overall and component scores (range: 0-100; higher scores indicating higher dietary quality). Results: Overall dietary quality among emerging adults (HEI-2015: 50.3 +/- 1.3) was significantly lower than other adults (>= 24 y) (HEI-2015: 56.3 +/- 0.5; P < 0.0001) in the United States, with differences primarily driven by lower intakes of whole fruit, vegetables, and whole grains and higher intakes of sodium, refined grains, and saturated fat. Few differences in HEI-2015 scores were noted across population subgroups by sex, food security, family income, and food assistance program participation, except for added sugar; intakes of added sugar were significantly higher among women, food insecure, and food assistance program participants than those in their counterparts, respectively. Conclusions: Dietary quality is poor among emerging adults in the United States and persists across all population subgroups, suggesting a significant need for tailored public health interventions to improve dietary quality among this population. Future research investigating to what extent emerging adults prioritize healthful behaviors and exploring other indicators for identifying nutritionally vulnerable subgroups may be impactful for identifying disparities among this life stage.

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

Introduction: There is little known about the impact of dietary patterns on blood pressure (BP) in West Africa. Our study describes associations of dietary patterns with BP and albuminuria and is the first study to do so in a well-phenotyped West African CKD cohort. Research question: What are the associations of dietary patterns with BP and proteinuria in West African CKD patients? Methods: We performed a cross-sectional analysis of participants from the Diet, Apolipoprotein L1, and CKD study; an ancillary study under the H3 Africa Network. We analyzed 24-hour dietary recalls in 583 participants. Dietary patterns were derived via principal component analysis, and the first 3 principal components with eigenvalues > 1 were selected. We measured proteinuria using 24-hour urine samples. Mixed effect linear regression models were used to estimate the β coefficient and 95% confidence interval for the quartiles of the dietary patterns with BP and proteinuria after adjusting for covariates. Results: The mean age was 49±17 years with 51% males and the mean eGFR (2009 CKD-Epidemiology collaboration formula) was 68±39 mL/min/1.73m 2 . The median 24-hour urine protein was 0.31g (IQR=0.13-1.07). We identified the Dried fish, Oils and vegetables; Poultry and Cereal; and the Fruit and Cereal dietary patterns . Compared to Q1 (lowest consumption), higher quartiles of intake of the Poultry and Cereal dietary pattern were associated with lower systolic BP (SBP) and diastolic (DBP). Higher consumption of the Poultry and Cereal dietary pattern was associated with lower 24hr urine protein, with a significant p for trend (p=0.05). Compared to Q1, Q4 of this pattern was associated with reduced odds of proteinuria ( Table 1 ). Conclusions: Consuming a Poultry and Cereal dietary pattern may be beneficial for BP and proteinuria in West African CKD patients.

This study examined the associations between overall diet quality and the risk of dementia in a rural cohort among the oldest old. Included in this prospective cohort study were 2232 participants aged ≥ 80 years and dementia-free at the baseline according to the Geisinger Rural Aging Study (GRAS), a longitudinal cohort in rural Pennsylvania. In 2009, diet quality was assessed by a validated dietary screening tool (DST). Incident cases of dementia during 2009–2021 were identified using diagnosis codes. This approach was validated by a review of electronic health records. Associations between diet quality scores and the incidence of dementia were estimated using the Cox proportional hazards models, adjusted for potential confounders. Across a mean of 6.90 years of follow-up, we identified 408 incident cases of all-cause dementia. Having a higher diet quality was not significantly associated with a lower risk for incidents of all-cause dementia (adjusted HR for the highest compared with the lowest tertile: 1.01, 95% CI: 0.79, 1.29, P-trend = 0.95). Similarly, we did not observe a significant association between diet quality and altered risks of Alzheimer’s disease and other forms of dementia. Overall, having a higher diet quality was not significantly associated with a lower risk of dementia among the oldest old during the full follow-up.

INTRODUCTION:Despite widespread recognition among public health experts that childhood sugar-sweetened beverage consumption should be reduced, doing so has proven to be a challenge. An agent-based model of early childhood sugar-sweetened beverage consumption was applied to data from three high-quality, longitudinal cohort studies to gain insight into potentially effective intervention strategies across contexts. METHODS:From 2021 to 2023, a single agent-based model design was applied to data sets derived from three separate cohorts of children followed from infancy to childhood, with very different populations and environments (participants recruited in 1999-2002; 2003-2010; and 2009-2014). After assessing its ability to reproduce observed consumption patterns across cohorts, it was used to simulate potential impacts of multiple intervention strategies across contexts. RESULTS:Interventions reducing home availability of sugar-sweetened beverages consistently had the largest potential effects. Impact differed between cohort settings: a complete decrease in availability resulted in an estimated 87% decrease in overall early childhood consumption for one of the cohorts, compared with 61% and 54% in the others. Reducing availability in center-based child care resulted in substantially greater reduction in one cohort relative to the other two. CONCLUSIONS:There is untapped potential for strategies targeting children's sugar-sweetened beverage consumption in the home, but in some instances, other approaches might also yield meaningful effects. Tailoring approach to setting may be important, and agent-based models can be informative for doing so. This agent-based model has broad generalizability and potential to serve as a tool for designing effective, context-specific strategies to reduce childhood sugar-sweetened beverage consumption.

Objective Estimate the association between environmental temperature (wet bulb globe temperature [WBGT]) and work rate over the course of a workday. Methods Repeated-measures regression was used to identify characteristics impacting work rate in a cross-sectional study of Latino farmworkers. Minute-by-minute work rate (measured by accelerometer) and WBGT were averaged over 15-minute intervals. Results Work rate decreased by 4.34 (95% confidence interval [CI], −7.09 to −1.59) counts per minute per degree Celsius WBGT in the previous 15-minute interval. Cumulative quarter hours worked (2.13; 95% CI, 0.82 to 3.45), age (−3.64; 95% CI, −4.50 to −2.79), and dehydration at the end of workday (51.37; 95% CI, 19.24 to 83.50) were associated with counts per minute as were gender, pay type (piece rate vs hourly) and body mass index ≥25 kg/m 2 . The effects of pay type and body mass index were modified by gender. Conclusion Increased temperature was associated with a decrease in work rate.

INTRODUCTION:This study estimates the prevalence of food insecurity, mental well-being, and their associations among immigrants and compares the food insecurity-mental well-being associations with nonimmigrants globally and by region. METHODS:The Gallup World Poll data from 2014 to 2019 were analyzed in 2021. A total of 36,313 immigrants and 705,913 nonimmigrants were included. Food insecurity was measured by the Food Insecurity Experience Scale. Mental well-being was assessed using the Negative Experience Index and Positive Experience Index. A community attachment index was used to measure the living environment. Multilevel mixed-effect linear models were used to examine how the Negative Experience Index/Positive Experience Index was associated with food insecurity and the community attachment index in immigrants and nonimmigrants, adjusting for sociodemographic characteristics, survey years, and country fixed effects. The modifying effects of immigration status on food insecurity-mental well-being associations were tested. RESULTS:The weighted proportion of food insecurity among global immigrants was 38.6% during 2014-2019. In the pooled adjusted model, food insecurity was dose-responsively associated with greater Negative Experience Index and lower Positive Experience Index than the food-secure ref (p<0.001 for trend). Similar dose-response associations were observed in nonimmigrants and in region-specific analyses. Community attachment marginally affected the food insecurity-mental well-being associations (all p≤0.001 for interaction). Immigration status significantly modified the food insecurity-mental well-being associations in all analyses (all p=0.01 for interaction), and immigrants experienced poorer mental well-being than nonimmigrants at the same level of community attachment and food insecurity. CONCLUSIONS:Food insecurity is prevalent and is associated with poor mental well-being in immigrants worldwide. Future interventions are needed to alleviate food insecurity and promote community attachment to improve mental health among immigrants, especially in Asian and Pacific countries.

Background Accurate assessment of eating-occasion behaviors, such as timing, frequency, and consumption intervals, is important for evaluating associations with obesity and other chronic diseases. Objectives The main objective of this study was to assess the relative validity of a 24-hour grid approach to assess eating-occasion timing and frequency in comparison to data derived from repeated 24-hour dietary recalls (DRs). A second objective was to assess the 1-year test-retest reproducibility of the 24-hour grid. Methods Between 2015 and 2016, 626 participants in the Cancer Prevention Study-3 (CPS-3) Diet Assessment Substudy (mean age, 52 years; age range, 31-70 years; 64% female; 64% non-Hispanic white, 22% non-Hispanic black, 14% Hispanic) completed 2 grids and up to 6 unannounced, telephone, interviewer-administered DRs over 1 year. Spearman correlations (rho; 95% CIs) were calculated to assess reproducibility between the repeated eating-occasion grid-derived variables (e.g., numbers of snacks and meals per day, timing of eating occasions) and to assess relative validity by comparing the meal grid and DR-derived summary data separately for weekdays and weekend days. Results Reproducibility correlations for eating-occasion variables derived from the eating-occasion grids completed 1 year apart were >= 0.5 for the majority of variables analyzed for both weekdays and weekend days, including numbers of snacks and meals per day and timing of the first and last eating occasions of the day. Relative validity was highest among weekday variables and was >= 0.5 for the majority of variables, with correlations ranging from rho values of 0.32 (number of meals per day) to 0.68 (hour of the first eating occasion). Conclusions These findings suggest the eating-occasion grid used in CPS-3 has good reproducibility over 1 year and yields estimates comparable to those from a more detailed method of assessment of eating timing and frequency.

AbstractBackgroundHealthier lifestyles in early pregnancy are associated with lower rates of pregnancy complications, childhood adiposity, and maternal and child cardiovascular risks. However, it is not known whether lifestyle coaching initiated prior to pregnancy can affect behavior and attitudes during pregnancy.MethodsThree hundred and twenty six women planning pregnancy within 2 years with BMI ≥27 kg/m2 were randomized to a behavioral weight loss intervention or to usual care. Analyses reported here examined the intervention’s impact on mid‐pregnancy diet quality and activity levels; program acceptability; and effects of pregnancy on intervention engagement.ResultsOne hundred and sixty eight participants experienced pregnancy during the study (intervention: 91; usual care: 77). From randomization to mid‐pregnancy, participants who received the intervention had larger increases in fruit intake than usual care participants (+0.67 vs. +0.06 cups; p = 0.02) and engaged in more vigorous‐intensity activity (3.9 [5.5] vs. 1.2 [3.0] Met‐hr/week p = 0.002) and sports/exercise (17.0 [14.1] vs. 11.0 [9.5] Met‐hr/week; p = 0.03); the groups also differed in changes in sedentary time (−4.9 [15.0] vs. +0.5 [7.6] Met‐hr/week; p = 0.02). Intervention satisfaction was high (>80%), and experiencing pregnancy during the intervention was associated with higher engagement.ConclusionA coaching‐based intervention beginning in pre‐pregnancy successfully helped women attain healthier diet and exercise habits in mid‐pregnancy.Clinical trials registrationRegistered with ClinicalTrials.gov, NCT02346162, first registered on January 26, 2015, before date of initial participant enrollment (May 2015), https://clinicaltrials.gov/ct2/show/NCT02346162.

Background Dietary supplement use is common, particularly among cancer survivors and those at increased risk for cancer. Objective The objectives of this study were to assess 1-year testeretest reproducibility of dietary supplement use reported via food frequency questionnaire (FFQ-1 vs FFQ-2) and relative validity in comparison to repeated 24-hour dietary recalls (FFQ-2 vs DRs). Design This ancillary study was conducted within a large prospective cohort, the American Cancer Society's Cancer Prevention Study-3. Participants/setting Between 2015 and 2016, 684 participants in the United States (64% women; 62% non-Hispanic White, 23% non-Hispanic Black, and 15% Hispanic) completed two FFQs and up to six unannounced telephone interviewer-administered DRs over 1 year as part of the Cancer Prevention Study-3 Diet Assessment Substudy. Primary outcome measures FFQs queried current multivitamin-mineral supplement (>= 10 components) use, frequency and dose (range) for seven supplements taken individually or as part of a complex (individual/complex) including calcium, vitamins D, C, and E, folic acid, fish oil, and glucosamine. DRs allowed exact reporting of supplement frequency and dose. Statistical analyses Weighted kappa statistics were used to evaluate reproducibility between FFQ-1 and FFQ-2 and Spearman correlation coefficients assessed agreement between supplemental nutrient amounts assessed by FFQ-2 and the average of DRs. Results Just more than half of the participants reported taking multivitamin-mineral supplements on the baseline FFQ. Kappa statistics for the comparison of categorical responses between FFQ-1 and FFQ-2 were 0.67 for multivitamin-mineral supplements. Kappas for individual/complex supplements ranged from 0.47 for folic acid to 0.74 for vitamin D, with a mean of 0.64. Results were similar between men and women. Spearman correlation coefficients comparing FFQ-2 with the average of DRs (validity) for nutrient intakes from all sources ranged from 0.65 (fish oil for women) to 0.77 (vitamin D for men and calcium for women); results were similar among men and women. Conclusions These findings suggest the FFQ used in Cancer Prevention Study-3 has good reproducibility over 1 year and yields estimates comparable to a more detailed assessment for commonly consumed dietary supplements.