Browsing by Subject "Diet quality"

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Animal-based beef and plant-based beef: HEI-2015 score comparisons
(2024-05) Lee, Josephine (M.S. in Nutritional Sciences); Marissa Burgermaster; Monica Jane Milonovich
Maternal diet can affect breastmilk composition, and breastfeeding women gravitate towards a healthier diet compared to other women. However, a healthy diet can be difficult to navigate. For example, plant-based food is marketed as healthy but is also ultra-processed which leaves health-conscious consumers, like many new moms, wondering how to make healthy choices. Therefore, this report aims to determine whether HEI-2015 scores are higher on a beef or plant-based beef diet, with all other ingredients identical, and how either diet condition compares to HEI-2015 scores of participants’ usual dietary intake. This report uses data from participants who completed a double-blinded randomized cross-over controlled feeding trial (SUPER-BEEF) at the time of this report. Participants underwent a 6-day normal eating period followed by a 6-day diet condition (Diet A), 6-day washout period, and the other 6-day diet condition (Diet B). Because the blinded study is ongoing, Diet A was considered the beef and Diet B was considered the plant-based beef condition for this report. The feeding trial meals were designed to meet acceptable macronutrient ranges and energy requirements of breastfeeding women with Nutritionist Pro software. Additionally, meals were formulated to have equal amounts of beef or plant-based beef (113g) and dietary fat (13g). We entered data from normal eating 24-hour diet recalls and diet condition menu checkoffs into the Nutrition Data System for Research (NDSR) software from which Healthy Eating Index-2015 (HEI-2015) scores were calculated. The beef condition had higher average HEI-2015 scores and lower average daily calories compared to plant-based beef (mean 72.9 vs. 58.9, 2222 kcals vs. 2337 kcals; respectively). In Diet A (beef), average HEI-2015 scores were higher for all participants (mean 70.5-72.5) compared to normal eating (mean 42.6-66.8). In Diet B (plant-based beef), average HEI-2015 scores were mixed (mean 56.1-58.2) compared to normal eating. In conclusion, our trial diets with acceptable macronutrient distribution and calorie requirements for breastfeeding women only differing in plant-based vs. animal-based beef differed in HEI-2015 scores. Compared to participants’ usual diets, the beef diet universally yielded higher diet quality scores while the plant-based diet yielded a higher diet quality score for 44% of participants.
Associations between diet quality, vegetable availability and access, and food security in low-income children
(2019-08) Landry, Matthew James; Davis, Jaimie Nicole; Bray, Molly S; Ranjit, Nalini; Evans, Alexandra E; Widen, Elizabeth
Food insecurity is a pervasive problem in the United States, and has been previously associated with adverse health and wellbeing in children. The mechanism that underlies this association is assumed to be poor dietary intake, which is likely a result of lack of access to healthy, affordable foods. The purpose of this research was to examine associations between dietary quality, vegetable availability and access, and food insecurity within low-income children. Cross-sectional data from TX Sprouts, a school-based randomized controlled cooking, gardening, and nutrition intervention, were used. Public health and surveillance efforts rely on accurate measures of child food insecurity; however, research suggests that current efforts which utilize parent report of child-level food insecurity may be inaccurate or underestimate the true prevalence. The first aim was to compare child versus parent perceptions of child-level food security status via questionnaires within a large, ethnically diverse population. Previous approaches to alleviating food insecurity and providing nutritious foods, like vegetables, have focused on community or policy level barriers that these households may face. However, even when these barriers have been overcome, individual and interpersonal barriers to vegetable availability, access, and utilization may still persist. The second aim was to examine the relationship between individual and interpersonal barriers to availability, access and utilization of vegetables and household food insecurity. The third aim was to examine the relationship between self-reported food insecurity and dietary quality. Research in this area was needed as evidence linking food insecurity to child dietary intake has been largely unclear and has utilized parent’s perception of child-level food insecurity. The results of this research demonstrated the discordance that exists between child report and parent perceptions of child-level food insecurity and that additional research is needed in large, nationally representative samples. Further, within food-insecure households, significant barriers to access, availability, and utilization of vegetables were found. These barriers serve as ideal targets for future interventions seeking to improve vegetable consumption in low-income children. Lastly, food insecurity was associated with lower diet quality. Interventions targeting food insecure children are needed to improve dietary quality as this may alleviate some of the detrimental impacts of food insecurity on health and wellbeing.
Determinants of diet quality and weight status of women participating in the Supplemental Nutrition Assistance Program
(2017-08) Sanjeevi, Namrata; Freeland-Graves, Jeanne H.; Sanders, Bob; Jolly, Christopher; Hersh, Matthew; Lewis, Karron
The purpose of this research was to analyze the monthly dietary and food expenditure patterns of women participating in the Supplemental Nutrition Assistance Program (SNAP). The secondary goal was to identify factors that influence weight status of women in SNAP. In Study 1, a 95-item, semi-quantitative food frequency questionnaire based on a 1-week reference period was developed. It was validated against 3-day diet records in a sample of 70 female SNAP participants. The food frequency questionnaire was administered again after one month in a subgroup of 40 women to evaluate its test-retest reliability. Mean daily nutrient intakes obtained from the two tests of the 95-item food frequency questionnaire, and 3-day diet records were calculated. The average correlation and weighted Cohen’s kappa for the validity study were 0.60 and 0.39, respectively. The mean correlation and kappa statistics for the reliability study were 0.66 and 0.50, respectively. Thus, the 95-item, 1-week food frequency questionnaire effectively measured diets of women participating in SNAP. In study 2, a sample of 151 SNAP women were administered the 1-week food frequency questionnaire four times, each with an interval of one week, so that it reflected weeks 1, 2, 3 and 4 of the diets of participants. A significant decrease in intakes of fruits, vegetables, whole grains, dairy and total protein foods were observed with an increase in time since receipt of benefits. Moreover, a decline in diet quality towards the end of the SNAP month was determined. In Study 3, 160 women participating in SNAP saved their grocery receipts for one month, and were measured for height and weight. Spending patterns on 29 food categories were determined from the receipts, and compared to the Thrifty Food Plan (TFP) recommendations. Some of the food categories for which the expenditure was significantly greater than the recommendations included: refined grains, red meat, frozen entrees, soft drinks, and sodas, fruit drinks and ades. A greater amount spent on monthly groceries relative to the TFP recommended total cost was significantly associated with higher compliance of spending on low fat dairy, vegetables, whole grains and fruits to the recommendations. In Study 4, 152 women in SNAP completed the multi-dimensional home environmental scale and adult food security module and were measured for height and weight. Multi-dimensional home environmental subscales that were significantly associated with body mass index, and also differed according to food security status were: availability of unhealthy foods at home and neighborhood safety. Factors measured by this scale significantly mediated the relationship between food insecurity and body mass index
Examining the link between diet quality and patterns with metabolic parameters in historically underserved and ethnically diverse pediatric populations
(2022-12-02) Jeans, Matthew Ryan; Davis, Jaimie Nicole; Bray, Molly S.; Leidy, Heather J.; Gray, Megan J.; Whittaker, Tiffany A.
Childhood overweight and obesity prevalence is a prominent public health crisis in the United States that contributes to increases in associated cardiometabolic diseases, all of which disproportionately affect racial/ethnic subgroups. Dietary habits are modifiable behaviors that have been shown to inflect changes in cardiometabolic parameters. Specifically, breakfast consumption is touted to have protective effects on cardiometabolic health and increase dietary quality. Many interventions aim to increase breakfast consumption and/or improve dietary quality through limiting processed foods and promoting whole foods. The purpose of this research was to elucidate relationships between cardiometabolic parameters, dietary patterns, and dietary quality in a historically underserved and ethnically diverse pediatric population. Baseline and post-intervention data were used from TX Sprouts, a school-based gardening, cooking, and nutrition education randomized controlled trial. The first aim was to examine and compare metabolic syndrome prevalence between existing definitions and elucidate racial-/ethnic-specific characteristics within each definition to clarify the utility of those definitions for a clinical population. There is no standardized definition for metabolic syndrome in pediatric populations, and research has highlighted racial/ethnic differences in metabolic syndrome prevalence but lacked recommendations to improve screening and provide equitable diagnoses. The second aim was to evaluate the impact of TX Sprouts on changes in breakfast consumption and the effect of changes in breakfast consumption on cardiometabolic outcomes. The third aim was to examine the effect of TX Sprouts on dietary quality using the NOVA food classification system, which classifies foods based on level of processing. Research was warranted because there are no known experimental studies that have examined the impact of a school-based gardening, cooking, and nutrition education intervention on breakfast consumption nor diet quality using the NOVA system in a predominately low-income, non-White population. The results of this research highlighted potential biases that exist in proposed pediatric metabolic syndrome definitions and recommend alternative biomarkers to better predict metabolic syndrome. Furthermore, increases in breakfast consumption were shown to improve glucose metabolism in a high-risk pediatric population, and TX Sprouts was effective at increasing unprocessed food and decreasing ultra-processed food consumption. Interventions targeting historically underserved populations are needed to improve dietary intake and quality to support cardiometabolic health.
Influence of the home environment on diet quality and weight status of adolescents : a social ecological framework
(2015-12-02) Tabbakh, Tamara; Freeland-Graves, Jeanne H.; Finnell, Richard; Jolly, Christopher; Lewis, Karron; Steinhardt, Mary
The home environment is a critical setting for the development of weight status in adolescence. At present a limited number of valid and reliable tools are available to evaluate the weight-related comprehensive home environment of this population. Aim 1a was to develop and validate the Multidimensional Home Environment Scale (MHES), which measures multiple components of the home. This scale includes psychological, social, and environmental domains from the perspective of adolescents and their mothers. After establishing content validity via an expert panel in nutrition, a validation sample of 218 mother-adolescent dyads completed a demographics survey and original version of the MHES. A focus group with the target population of adolescents (n=7) was conducted and feedback regarding item difficulty, content, bias, and relevance was incorporated. Principal components analysis yielded a 12-factor structure for adolescents and 14-factor structure for mothers. Internal consistency reliability was achieved for the majority of subscales, with α=0.5-0.9 for adolescents and α=0.7-0.9 for mothers. In addition, the MHES showed test-retest reliability for both adolescents (r=0.90) and mothers (r=0.91). Aim 1 b was to develop and validate a Nutrition Knowledge scale using the same sample as Aim 1a. Nutrition knowledge was assessed in this sample of 114 dyads. A 20-item scale was modified from previous version developed by the author. This instrument was composed of multiple-choice questions classified into four categories of knowledge: macronutrient, micronutrient, healthy eating and physical activity recommendations and fast-food nutrition. Content validity of the scale was established using feedback from an expert panel in nutrition (n=10) and a focus group of the sample population tested (n=7). The scale demonstrated high internal consistency reliability (adolescents: α=0.70, mothers: α=0.78) and test-retest reliability (adolescents: r=0.47, p=0.01, mothers: r=0.77, p=0.00). Aim 2 was to examine the impact of the comprehensive home environment on diet quality and weight status of adolescents using the MHES. A sample of 206 mothers and adolescents were recruited from local middle schools in the Austin area and completed a demographics survey, final version of the MHES, Food Frequency Questionnaire, and a Nutrition Knowledge scale online. Weight and height of adolescents were measured by the author using a standard protocols. Body Mass Index (BMI)-for-age percentiles were determined using the Center for Disease Control growth charts. Diet quality was estimated using the Healthy Eating Index-2010. Two models were created and reported in this dissertation. The first univariate model included each of the home environment factors as independent variables, and diet quality and BMI as dependent variables. The second model was developed using significant variables only from the initial model. Availability of healthy foods (p=0.00), healthy eating attitude (p=0.01), and accessibility to unhealthy foods (p=0.04) in the home were the strongest predictors of diet quality. Self-efficacy (p=0.02) and availability of healthy foods (p=0.02) emerged as significant predictors of BMI. Aim 3 of this dissertation research was to determine the effect of nutrition knowledge on the home environment and diet quality using the Healthy Eating Index-2010. This aim was accomplished using the same sample as Aim 2. It was hypothesized that the comprehensive home, with its psychological, social, and environmental features, would mediate the relationship between maternal nutrition knowledge and diet quality. A non-linear relationship between nutrition knowledge of the mother and diet quality of the adolescent was observed. Inclusion of the mediator in the model yielded significant estimates of the indirect effect (β=0.61, 95% CI: 0.3-1.0), with a 65.2% reduction in the model. This suggests that the home environment functioned as a partial mediator of the influence of nutrition knowledge on diet quality. Then, mediation analysis with the combination of psychological, social, and environmental factors was conducted in three separate regressions. Psychological (β=0.46), social (β=0.23), and environmental (β=0.65) variables were all significant mediators of nutrition knowledge on diet quality. Collectively, these results suggest that the MHES is an appropriate tool for measurement of the nutritional home environment of adolescents. The home environment appeared to significantly modulate diet quality and BMI of adolescents, particularly with respect to availability of healthy foods, healthy eating attitudes, and self-efficacy.
Motivations to eat as a predictor of weight status and dietary intake in low-income, minority women in early postpartum
(2009-05) Cahill, Jodi Marie; Freeland-Graves, Jeanne H.
The purpose of this research was to develop, validate, and test an instrument to evaluate motivations to eat in low-income women during the early postpartum period. The instrument was also used in a sample of young college women to further validate the measure and explore determinants of eating in this population. In study 1, the Eating Stimulus Index was validated in 179 low-income women in early postpartum. Validity and reliability were determined via principal components analysis, internal consistency reliability, and test-retest reliability using a subgroup of 31 low-income new mothers. The factor analysis produced an eight factor structure with reliability coefficients ranging from 0.54-0.89. Convenience eating (r=-0.25, P<0.01), emotional eating (r=-0.17, P<0.05), and dietary restraint (r=-0.21, P<0.01) were significantly related to weight status. In study 2, the relationship between eating motivations and diet quality, determined via the Dietary Guidelines Adherence Index, was established in 115 low-income women in early postpartum. High diet quality was related to fruit and vegetable availability (r=0.25, P<0.01), convenience eating resistance (r=-0.36, P<0.001), and vegetable taste preference (r=0.23, P<0.05). Motivations to eat differed between overweight and obese women with the primary motivation being convenience eating and taste, respectively. In study 3, determinants of weight loss were examined in 58 low-income women in early postpartum participating in an 8-week weight loss intervention. Participants were evaluated at pre- and post-study for all measures. Factors related to weight loss included increases in dietary restraint, weight management skills, and weight loss self-efficacy and decreases in fruit juice servings, total energy, and discretionary energy intakes. After hierarchical regression analysis, improvement in weight loss self-efficacy was the most significant determinant (β=0.263, P<0.05) followed by decreases in discretionary energy intake (β=-0.241, P<0.05). In study 4, determinants of diet quality were assessed in a sample of 88 young college women using the Eating Stimulus Index. Low diet quality was associated with poor fruit and vegetable availability, convenience eating resistance, vegetable taste preference, and weight management self-efficacy, while high diet quality was related to increased frequency of meals prepared at home and decreased frequency of meals consumed at fast food restaurants.
Nutritional and economic outcomes of fast food meal plans designed for weight loss and health
(2023-01-04) Pham, Kristi Nhu Quynh; Bray, Molly S.
Background: Between 2013-2016, approximately 1/3 of Americans reported consuming fast food each day.¹ Despite the goals of many fast food establishments to increase the perceived healthiness of restaurant items, the potential nutritional and economic effects of eating fast food as part of a weight-loss are unknown. Objective: The purpose of this study was to characterize and compare the nutrient composition, caloric content, HEI (Healthy Eating Index), and cost for three fast food meal plans. Methods: Fast food data collection was limited to items available from June 6, 2020 to April 5, 2021. Items were classified by seven types: breakfast, breakfast sides, entrees, sides, sauces, drinks, and treats. Three 28-day meal plans (randomly-selected control, reduced calorie, and healthy meal plan) were randomly generated using set parameters. Average daily calories, nutrient composition, HEI scores, and cost were calculated using STATA/SE 17.0. Results: The healthy meal plan had significantly lower average daily kcals and trans-fat compared to the randomly-selected control and reduced calorie meal plan (p < 0.05). There was significantly less sugar in the reduced calorie and healthy meal plan compared to the randomly-selected control meal plan (p<0.001). None of the meal plans met the recommendations for fiber, saturated fat, sodium, or the AMDR for all macronutrients. There were no significant differences in HEI score between the healthy and randomly- selected control meal plans. However, when reducing calories, the HEI score significantly decreases (p<0.001) The randomly-selected control and healthy meal plans were approximately 2.5 times the average monthly grocery expense for a single individual living in Texas. When adjusting for cost for total kcals, the healthy meal plan was the most expensive. Conclusion: Despite being more expensive, the healthy meal plan had the lowest average daily kcals and trans fats, met the AMDR for fat and protein, and was 2% below the AMDR for carbohydrates. However, recommendations for other nutrients were not met. Even when focusing on the healthiest foods, if eaten long-term, fast food meal plans may not provide the adequate amount of nutrients and can potentially increase risk for chronic diseases related to ultra-processed foods.
Test-retest reliability and validity of the feeding your preschooler questionnaire for low-income Hispanic populations
(2009-08) Loyo, Jennifer Joleen; Gottlieb, Nell H.; Holahan, Carole K.
This methods-oriented dissertation focuses on the psychometric evaluation of the Feeding Your Preschooler Questionnaire (FYPQ) designed to assess the eating habits and diet quality of young children. Parental proxy reports (n=135) were obtained through pen and pencil administration of the FYPQ and an in-person interview using a 24- hour food recall (24HR).Test-retest reliability (n=82) was determined using a repeated measures design with Wilcoxon signed rank tests and Spearman correlations for the food frequency questionnaire (FFQ) portion of the survey, parental self-efficacy, parental role modeling, parental practices, and parental perception of child food preference regarding fruits and vegetables scales. Test-retest reliabilities ranged from r=.53 for water to r=.84 for vegetables for the FFQ and from r=.64 for role modeling to r=.71 for parental perception of child preference for the psychosocial measures. Concurrent construct validity (n=107) was examined with a cross-sectional study design using the Wilcoxon signed rank test, Spearman correlations, and cross-classification analysis into quartiles of food group intakes. Spearman’s correlations between the FFQ and the 24HR were .46 for milk, .22 for fruit, .22 for vegetables, .11 for grains and .07 for protein. Cross-classification analysis revealed that 29% of children were classified in the same quartile and 69% in the same or within one quartile, and gross misclassification ranged from 2% to 10%. Nomological validity was examined using weighted least squares regression. Two regression analyses with fruit and vegetable intake on first the FFQ and second the 24HR as the dependent variable examined the influences of psychosocial environmental predictors and food insecurity. The FFQ regression model explained 28% (p<.05) of the variance in fruit and vegetable intake, with the significant predictors of parental role modeling and food insecurity. The 24HR regression analysis predicting fruit and vegetable intake explained 11% (p<.05), with parental perception of child preference and parental role modeling as significant predictors. In summary, the FYPQ demonstrated good test-retest reliability. The study provides evidence of concurrent validity for the FFQ for assessment of milk consumption and fruit and vegetable variety in preschool children's diets and of nomological validity in the prediction of fruit and vegetable consumption.