Postpartum maternal diet quality has been linked with optimal infant feeding practices. However, whether maternal diet quality during pregnancy influences infant feeding practices remains unclear. The present study explored the relationship between maternal diet quality in pregnancy and infant feeding practices in Australian women. A brief 15-item food frequency questionnaire was used to collect maternal dietary data (n = 469). Diet quality was calculated using a modified 2013 Dietary Guideline Index (DGI). Multivariable linear and logistic regressions with adjustment for covariates were used to examine associations between maternal diet quality in pregnancy and infant feeding practices: infant feeding mode, breastfeeding duration and timing of solids introduction. Higher DGI score during pregnancy was associated with higher odds of breastfeeding than formula/mixed feeding (adjusted OR 1.03, 95% CI 1.00, 1.07), longer breastfeeding duration (adjusted β 0.09, 95% CI 0.03, 0.15) and higher odds of breastfeeding for ≥6 months (AOR 1.04, 95% CI 1.02, 1.07) than for <6 months. Associations between maternal DGI score and breastfeeding variables were moderated by maternal country of birth, with significant associations observed in Australian-born mothers only. No association was found between maternal DGI score and timing of solids introduction. Higher maternal diet quality was associated with better infant feeding practices, and the association was moderated by country of birth. Our findings provide evidence to support the initiation of dietary interventions to promote diet quality during pregnancy, particularly among Australian-born women. Further research could explore underlying mechanisms linking maternal diet quality and infant feeding practices.

The aim of this study was to examine the relationship between nutrition knowledge and nutritional adequacy among Japanese university students. This cross-sectional study was conducted in 2018 at a university located in Hyogo Prefecture, Kobe, Japan, and 801 students from various academic disciplines were enrolled. Eligible participants were students aged more than 18 years, encompassing all years of study. Nutrition knowledge data were obtained using a nutrition knowledge questionnaire (NKQ) for Japanese adults. Participants were classified into three nutrition knowledge groups according to their total NKQ scores [mean ± standard deviation; all (64.7 ± 15.4%), low (48.1 ± 13.8%), medium (68.3 ± 2.8%), and high (78.5 ± 4.2%)]. Participants reported their dietary habits in the preceding month using a brief self-administered diet history questionnaire. Differences in nutritional adequacy among groups were determined using logistic regression and covariance analyses, adjusted for potential confounding factors. The adequacy of each nutrient was quantified as the proportion of participants with nutrient intake that fell outside the reference range. Although the intakes of only a few nutrients and foods were associated with nutrition knowledge, the total number of nutrients below the estimated average requirement was lower in the high nutrition knowledge group (3.1 ± 2.7) than in the low nutrition knowledge group (3.6 ± 2.9) (P = 0.046). In conclusion, the nutrition knowledge level of Japanese university students is associated with nutritional adequacy but may partially affect eating habits. Future longitudinal studies must clarify the causal and dose-response relationships between nutrition knowledge and dietary habits.

Lifestyle has been associated with in vitro fertilisation (IVF) success rates, but studies on diet and IVF outcomes are inconclusive. We studied associations between adherence to the Dutch guidelines for a Healthy diet 2015 and pregnancy chances among women receiving modified natural cycle in vitro fertilisation (MNC-IVF). This prospective cohort study utilised data from 109 women undergoing MNC-IVF between 2014 and 2018 at University Medical Centre Groningen enrolled in a study examining associations between metabolic profile of follicular fluid and oocyte quality. Adherence to dietary guidelines was assessed by daily food records quantified based on the Dutch Healthy Diet (DHD) 2015 Index. IVF outcomes (i.e. positive pregnancy test, ongoing pregnancy, and live birth) were obtained from patient records. Statistical analyses involved Cox proportional hazard regression analyses while adjusting for maternal covariates age, smoking, and Body Mass Index (BMI), and stratified for treatment, age, BMI, and energy intake. Women were 31.5 ± 3.3 years old, and had a BMI of 23.5 ± 3.5 kg/m2. Higher DHD2015 adherence was linked to a reduced probability of achieving an ongoing pregnancy (HR = 0.77, 95%CI: 0.62–0.96), live birth (HR = 0.78, 95%CI: 0.62–0.98), and showed a non-significant trend towards a lower probability of a positive pregnancy test (HR = 0.85, 95%CI: 0.71–1.01). Associations were particularly present among women undergoing MNC-ICSI (n = 87, p-for-interaction = 0.06), with shorter duration of infertility (n = 44, p-for-interaction=0.06), being overweight (n = 31, p-for interaction = 0.11), and having higher energy intakes (n = 55, p-for-interaction = 0.14). This explorative study suggests inverse trends between DHD2015 adherence and MNC-IVF outcomes, encouraging well-powered stratified analyses in larger studies to further explore these unexpected findings.

This cross-sectional study aimed to identify patterns of food preparation and examine their demographic and socio-economic drivers, along with impacts on health and nutritional status, physical activity, and diet quality. Dietary data from a national-representative sample (n = 5005, 3–84 years) of the Portuguese National Food, Nutrition, and Physical Activity Survey (IAN-AF 2015/16) were classified by preparation locations (at or away from home) and analysed via hierarchical clustering. Logistic regression models were used to examine associations between demographic and socio-economic factors and food preparation patterns and between these patterns and health and nutritional status, physical activity, and diet quality. The most common food preparation pattern (followed by 45.4% of participants) represented the highest intake of foods prepared by away-from-home establishments. Adolescents (vs. children, OR = 0.29, 95%CI = 0.17, 0.49) and older adults (vs. adults, OR = 0.37, 95%CI = 0.26, 0.53) had lower odds of following this pattern, whereas adult men (vs. women, OR = 4.20, 95%CI = 3.17, 5.57) had higher odds. Higher education, higher household income, and having children/adolescents in the household also increased the odds of eating foods prepared away from home, whereas living in rural areas or in food-insecure households decreased the odds. Noticeably, adults consuming more foods prepared away from home had lower odds of being overweight or obese (OR = 0.74, 95%CI = 0.56, 0.97), but higher odds of sedentarism (OR = 1.45, 95%CI = 1.08, 1.96) and poor diet (OR = 3.01, 95%CI = 2.08, 4.34) compared to those consuming more foods prepared at home by themselves. Dietary patterns marked by high away-from-home food preparation prevail. While these correlated with higher socio-economic status, sedentarism, and poorer diet — relatively to patterns with greater reliance on homecooked food — they were not linked to higher odds of obesity.

This cross-sectional ecological study described fruit and vegetable (F&V) intake variability across 144 cities in 8 Latin American countries and by city-level contextual variables. Data sources came from health surveys and census data (Argentina, Brazil, Chile, Colombia, El Salvador, Guatemala, Mexico, and Peru). Self-reported frequency of F&V intake was harmonised across surveys. Daily F&V intake was considered as consumption 7 d of the week. Using a mixed-effects model, we estimated age and sex-standardised city prevalences of daily F&V intake. Through Kruskal–Wallis tests, we compared city F&V daily intake prevalence by tertiles of city variables related to women’s empowerment, socio-economics, and climate zones. The median prevalence for daily F&V intake was 55.7% across all cities (22.1% to 85.4%). Compared to the least favourable tertile of city conditions, F&V daily intake prevalence was higher for cities within the most favourable tertile of per capita GDP (median = 65.7% vs. 53.0%), labour force participation (median = 68.7% vs. 49.4%), women achievement-labour force score (median = 63.9% vs. 45.7%), and gender inequality index (median = 58.6% vs. 48.6%). Also, prevalences were higher for temperate climate zones than arid climate zones (median = 65.9% vs. 50.6%). No patterns were found by city level of educational attainment, city size, or population density. This study provides evidence that the prevalence of daily F&V intake varies across Latin American cities and may be favoured by higher socio-economic development, women’s empowerment, and temperate weather. Interventions to improve F&V intake in Latin America should consider the behaviour disparities related to underlying local social, economic, and climate zone characteristics.

Diet indices are quantitative assessments of the quality of population intake. Understanding diet quality is crucial to support health and well-being; however, knowledge of diet quality across racial groups is limited. To examine diet quality of acial groups ‘White’, ‘Black’, ‘Asian’, and ‘Other’ in the United Kingdom (U.K.) and United States (U.S.), U.K. and U.S. national survey data were used to calculate Alternative Healthy Eating Index (AHEI-2010), Diet Quality Index-International (DQI-I), and EAT-Lancet scores. ANCOVA tests compared median total quality scores across racial groups adjusting for covariates. Kruskal–Wallis tests examined differences in individual component scores. Spearman correlations identified association of diet quality scores across indices. Highest diet quality scores were reported for U.K. and U.S. Asian groups. Most noticeable differences were apparent between U.S. Asian and White/Black groups (62% Asians within highest tertile of AHEI-2010 score vs. 29% Whites; P < 0.001). All racial groups demonstrated poor diet quality in terms of sustainability; EAT-Lancet scores were <40% of maximum total score for U.S. White, Black, and Other groups. AHEI-2010 diet quality scores were moderately associated with EAT-Lancet scores, evident across all groups (r = 0.53–0.65; P < 0.001). There is a need for all groups to increase intake of wholegrains, especially Black groups (mean Wholegrain score for U.S. Black group within DQI-I was 0.60 (maximum score of 5)) as demonstrated within AHEI-2010, DQI-I, and EAT-Lancet component scores. Additionally, increased intake of vegetables and legumes and decreased intake of processed and red meat would improve the adequacy, healthiness, and sustainability of U.K. and U.S. racial diets.

The Mediterranean-Dietary Approach to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) diet is a dietary pattern designed to prevent cognitive decline. Dietary adherence is assessed with the MIND diet scoring system, which is currently based on the American diet and serving sizes. It is known that serving sizes and consumed food products differ between countries. Existing literature lacks reporting on food products included within the MIND diet and weight or volume equivalents corresponding to MIND diet servings, impeding accurate comparisons across studies. This study sought to overcome these limitations by evaluating MIND food products consumed in the Dutch context and developing a scoring system based on consumed quantities in weight or volume amounts rather than in standard serving amounts. The third objective was to modify an existing Dutch brief FFQ (Eetscore-FFQ) to evaluate adherence to the MIND diet. We translated nine of the fifteen MIND food groups directly to grams and volumes using the United States Department of Agriculture measurement conversion table. For the remaining food groups, we employed indirect translation to align them as closely as possible to the original MIND diet. These translated quantities in weight and volumes amounts were subsequently rounded to the nearest Dutch household measures, resulting in the culturally adapted MIND-NL diet scoring. The development of the MIND-NL-Eetscore-FFQ, comprising seventy-two food items (forty-one questions), is described. Our adaption approach is reproducible and can be used to customize the MIND diet scoring system to other cultures.

Beyond obesity, visceral adipose tissue (VAT) has emerged as an important predictor of chronic disease, but the role of diet quality patterns (DQP) in VAT development is not well defined. Therefore, we conducted a systematic review of how various DQP are associated with VAT via literature searches in PubMed and EMBASE. We included observational investigations in disease-free adults/adolescents that related DQP to VAT assessed by imaging methods. The studies were evaluated separately for a priori and a posteriori DQP and according to design differences. Study quality was assessed using the Risk of Bias in Non-randomised Studies of Interventions tool. Of the 1807 screened articles, thirty-five studies met the inclusion criteria. The majority of a priori indices, for example, the Healthy Eating Index, showed significant inverse associations with VAT, while only a small proportion of a posteriori patterns were related to VAT. Results did not differ substantially by the method of exposure and outcome assessment or between studies with (n 20) or without (n 15) body-size adjustment, but significant findings were more common in younger v. older individuals, USA v. other populations and investigations with moderate v. serious risk of bias. The heterogeneity of the existing literature limited the ability to quantify the magnitude of the associations across studies. These findings suggest that a high-quality diet, as assessed by a priori DQP, is generally inversely associated with VAT, but results for a posteriori DQP are less consistent. As associations persisted after adjusting for body size, diet quality may beneficially influence VAT beyond its association with obesity.

The Cardiovascular Health Diet Index (CHDI) is a diet quality score based on the dietary guidelines of the American Heart Association for cardiovascular health but with some adaptations, such as red meat, dairy products, beans and ultra-processed foods in its components. The CHDI has shown good relative validity parameters; however, its association with health outcomes is still unclear. Thus, our aim was to investigate the association between the CHDI score with subclinical atherosclerosis. Data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort were used. Subclinical atherosclerosis was assessed by measuring coronary artery calcification at baseline (2008–2010) and second wave (2012–2014) and carotid intima-media thickness at baseline and at the third wave (2017–2019). The CHDI score (ranges from 0 to 110 points) was applied to dietary data obtained from an FFQ at baseline. Poisson regression with robust variance, linear regression and linear mixed-effects models were used to evaluate the association of the CHDI score with coronary artery calcification incidence (n 2224), coronary artery calcification progression (n 725) and changes in carotid intima-media thickness (n 7341) over time, respectively. After a median 8-year follow-up period, a 10-point increase in the CHDI score was associated with a decrease in carotid intima-media thickness of 0·002 mm (95 % CI –0·005, –0·001). No association was observed between the CHDI score and coronary artery calcification incidence and progression after a 4-year follow-up period. Higher scores in the CHDI were prospectively associated with decreased subclinical atherosclerosis after an 8-year follow-up period.

Dietary intake assessment is often complicated by intrinsic bias. This study investigated whether food purchase data could constitute a valid indication of dietary intake, by evaluating the extent to which diet quality as measured by supermarket food purchases is correlated with diet quality as measured by reported dietary intake. We used data from the Supreme Nudge cluster-randomised controlled supermarket trial (n 227). Data were collected at baseline from supermarket purchases (loyalty cards) and a dietary questionnaire (short forty-item FFQ) to compute two scores reflecting diet quality from purchasing data (purchased diet quality) and FFQ (consumed diet quality). Both scores constituted thirteen food groups and could theoretically range from 0 (low diet quality) to 130 (high diet quality). The relationship between purchased diet quality and consumed diet quality was assessed using correlation coefficients and the Bland–Altman limits-of-agreement method. Multiple linear regression was fitted between purchased diet quality and consumed diet quality, adjusted for age, sex, waist circumference, educational level and household size. Consumed and purchased diet qualities were modestly positively correlated (Pearson’s ρ = 0·31, 95 % CI 0·18, 0·42). A positive association from linear regression was found after confounding adjustments (βbaseline = 0·22, 95 % CI 0·10, 0·34). The purchased diet quality was systematically lower than the consumed diet quality. This study found that diet quality as measured by supermarket purchases provided a reasonable indication of diet quality as reported by short-FFQ, albeit modest.

Globally, more than 13 % of adolescents have clinically significant mental health problems, with anxiety and depression comprising over 40 % of cases. Despite the high prevalence of anxiety disorders among youth, dietary research has been focused on youth with depression, resulting in a significant knowledge gap regarding the impact of anxiety on adolescent diet quality. Adolescents with diagnosed anxiety disorders and healthy controls were included in this study. Anxiety symptoms were measured using the Screen for Child Anxiety-Related Disorders. Diagnosis of anxiety disorder was determined using the Kiddie Schedule for Affective Disorders and Schizophrenia interview. Five diet quality indices were scored from FFQ. Diet quality indices associated with anxiety symptoms in the correlation matrix were interrogated using multiple linear regression modelling. All models were adjusted for depression. One hundred and twenty-eight adolescents (mean age 14·8 years (sd: 2·1); 66·4 % female) were included in this cross-sectional analysis. Although healthy controls and outpatient participants had similar unhealthy dietary index subscale scores, outpatient participants had lower healthy index scores. Higher anxiety symptoms were associated with lower healthy dietary indices in univariate analysis; after adjusting for comorbid depression; however, anxiety symptoms were no longer associated with dietary indices following adjustment for multiple testing (P = 0·038 to P = 0·077). The association between anxiety symptoms and a poor diet is attenuated by depression. The results of this study support the need for an integrated approach to the assessment of mental and physical well-being and further research aimed at understanding the unique contribution of depression to healthy dietary patterns.

Despite the urgent need for plant-based dietary shifts, few studies have examined current diet trajectories using longitudinal data. This study analyzed dietary transitions of French adults over 8 years (2014-2022), assessing diet quality and the role of various socio-economic factors. Consumption data from 17 187 NutriNet-Santé cohort participants, weighted for the French Census, were collected via FFQ in 2014, 2018 and 2022. Adopting a gender-specific approach, consumption changes in twenty-three food groups were assessed over time. Diet quality was evaluated using the Comprehensive Diet Quality Index score, categorising foods into ‘healthy’ and ‘unhealthy’. Socio-economic analysis targeted four food groups (red meat (including fresh beef, pork, offal and lamb), processed meat (e.g. sausages, ham and bacon), legumes and whole-grain products), strongly linked to mortality risk and recognised as significant markers of the sustainable diet transition. All analyses were conducted using multi-adjusted mixed-effects models. Consumption of some healthy plant-based foods (nuts +59 %, legumes +22 %, whole-grain products +7 %) significantly increased over time, while consumption of some unhealthy foods (red meat −19 %, refined cereals −18 %, sweetened drinks −15 %) decreased. Conversely, consumption of prepared and mixed dishes (+16 %) and processed meat (+35 %) increased. These changes differed in magnitude between genders and translated into an improved diet quality score (Comprehensive Diet Quality Index). Occupational status was linked to longitudinal changes in food consumption, showing increased consumption of plant-based foods among students and higher socio-professional categories. Our findings provide accurate data on trends and factors for targeted initiatives, guiding strategic interventions for a sustainable dietary transition.

The aim of this study was to explore the associations between diet quality, socio-demographic measures, smoking, and weight status in a large, cross-sectional cohort of adults living in Yorkshire and Humber, UK. Data from 43, 023 participants aged over 16 years in the Yorkshire Health Survey, 2nd wave (2013–2015) were collected on diet quality, socio-demographic measures, smoking, and weight status. Diet quality was assessed using a brief, validated tool. Associations between these variables were assessed using multiple regression methods. Split-sample cross-validation was utilised to establish model portability. Observed patterns in the sample showed that the greatest substantive differences in diet quality were between females and males (3.94 points; P < 0.001) and non-smokers vs smokers (4.24 points; P < 0.001), with higher diet quality scores observed in females and non-smokers. Deprivation, employment status, age, and weight status categories were also associated with diet quality. Greater diet quality scores were observed in those with lower levels of deprivation, those engaged in sedentary occupations, older people, and those in a healthy weight category. Cross-validation procedures revealed that the model exhibited good transferability properties. Inequalities in patterns of diet quality in the cohort were consistent with those indicated by the findings of other observational studies. The findings indicate population subgroups that are at higher risk of dietary-related ill health due to poor quality diet and provide evidence for the design of targeted national policy and interventions to prevent dietary-related ill health in these groups. The findings support further research exploring inequalities in diet quality in the population.

Previous investigations on protein associations with diet quality and obesity still have inconclusive findings, possibly due to how protein intake was expressed. This study aimed to compare how different ways of expressing total protein intake may influence its relationships with diet quality and obesity. Usual protein intake was estimated from the 2011–12 Australian National Nutrition and Physical Activity Survey (n = 7637 adults, ≥19 years), expressed in grams (g/d), percent energy (%EI), and grams per actual kilogram body weight (g/kgBW/d). Diet quality was assessed using the 2013 Dietary Guidelines Index, and obesity measures included Body Mass Index (BMI) and waist circumference (WC). Sex-stratified multiple linear and logistic regressions were performed and adjusted for potential confounders. Total protein (g/d) was directly associated with diet quality (males, β = 0.15 (95% CI 0.12, 0.19); females, β = 0.25 (0.22, 0.29)), and this association was consistent across units. Protein intake (g/d) was directly associated with BMI (males, β = 0.07% (0.04%, 0.11%); females, β = 0.09% (0.04%, 0.15%)), and WC (males, β = 0.04 (0.01, 0.06); females, β = 0.05 (0.00, 0.09)). While in males, protein as %EI was associated with higher WC, no association was found in females. Adults with higher protein intake (g/d) had higher odds of overweight/obesity (males, OR = 1.01 (1.00, 1.01); females, OR = 1.01 (1.00, 1.01)), and central overweight/obesity (females, OR = 1.01 (1.00, 1.01)), but no significant association with females odds of overweight/obesity when protein was expressed in %EI. In conclusion, protein intake was positively associated with diet quality and obesity, yet these associations were stronger for women. The effect sizes also varied by measurement unit due to the different scales of those units.

Sleep apnoea is a known risk factor for cardiometabolic diseases (CMD), but it is unknown whether sleep apnoea or its symptoms contribute to increased CMD through an association with diet quality. This study assessed the association between sleep apnoea symptoms on future diet quality in the Bogalusa Heart Study (BHS). This prospective study included 445 participants who completed a sleep apnoea questionnaire in 2007–2010 and a FFQ in 2013–2016 (mean follow-up: 5·8 years; age 43·5 years; 34 % male; 71 % White/29 % Black persons). Diet quality was measured with the Alternate Healthy Eating Index (AHEI) 2010, the Healthy Eating Index (HEI) 2015 and the alternate Mediterranean diet score. Adjusted mean differences in dietary patterns by sleep apnoea risk, excessive snoring and daytime sleepiness were estimated with multivariable linear regression. Models included multi-level socio-economic factors, lifestyle and health characteristics including BMI, physical activity and depressive symptoms. Those with high sleep apnoea risk, compared with low, had lower diet quality 5·8 years later (percentage difference in AHEI (95 % CI −2·1 % (–3·5 %, −0·7 %)). Daytime sleepiness was associated with lower diet quality. After adjusting for dietary pattern scores from 2001 to 2002, having high sleep apnoea risk and excessive sleepiness were associated with 1·5 % (P < 0·05) and 3·1 % (P < 0·001) lower future AHEI scores, respectively. These findings suggest that individuals with sleep apnea or excessive sleepiness should be monitored for diet quality and targeted for dietary interventions to improve CMD risk.

The primary aim of this study was to examine the association between snack nutritional quality, overall diet quality and adiposity among Australian adolescents. The secondary aim was to assess the distribution of discretionary foods (i.e. energy-dense and nutrient-poor foods and beverages) and intakes from the five food groups at different levels of snack nutritional quality. Dietary data collected from nationally representative adolescents (12–18 years old) during a 24-h dietary recall in the National Nutrition and Physical Activity Survey were analysed (n 784). Snacks were defined based on participant-identified eating occasions. Snack nutritional quality was assessed using the Nutrient Profiling Scoring Criterion (NPSC), whereas diet quality was evaluated using the Dietary Guideline Index for Children and Adolescents. Adiposity was assessed through BMI Z-score waist circumference and waist:height ratio (WHtR). Higher nutritional quality of snacks, as assessed by the NPSC, has been associated with higher diet quality among both boys and girls (P < 0·001). However, there is no association between snacks nutritional quality with BMI Z-score, waist circumference and WHtR. Among both boys and girls, the consumption of fruits, vegetables and legumes/beans at snacks increased with improvement in snack nutritional quality. Conversely, the consumption of discretionary foods at snack decreased with improvement in snack nutritional quality. In conclusion, improved snack quality was associated with better diet quality in adolescents. However, there was no association between snack nutritional quality and adiposity. Future, snack nutrition quality indices should consider optimum snack characteristics related with adiposity and diet quality.

Children’s eating habits are established early in life and parents play a major role therein. Pregnancy is a teachable moment for the promotion of healthy eating because many women are concerned about their babies’ health and have frequent contact with healthcare providers. We aimed to investigate the association between diet quality during pregnancy and the offspring. A total of 691 sets of data on pregnant mothers and their 3-year-old offspring were obtained from the Seiiku Boshi cohort study. Dietary intake was assessed using a validated food frequency questionnaire for mothers in mid-to-late pregnancy and a validated diet history questionnaire for Japanese preschool children at the 36-month checkup. Diet quality was scored using the Japanese Food Guide Spinning Top. Maternal diet quality score was categorised into quartiles, and the association between offspring and maternal diet quality score, adjusted for socioeconomic factors, was assessed using multiple linear regression. The total offspring diet quality score showed a linear trend with the maternal diet quality score (the mean increments (confidential intervals) for each quartile were –0.12 (–1.32–1.08), 1.54 (0.34–2.73), and 1.22 (0.03–2.42)). In particular, offspring vegetable dishes scored higher in all quartiles of maternal vegetable dish scores than in the lowest quartile (0.69 (0.21–1.17), 0.97 (0.50–1.45), and 1.36 (0.88–1.83)). A high diet quality score during pregnancy was positively associated with that of offspring, suggesting the importance of nutritional education in pregnant women to improve their diet quality.