To assess trends in the dietary quality of Mexican adolescents from 2006 to 2018, both overall and by sociodemographic indicators, using adaptations of the EAT-Lancet Planetary Health (PH) recommendations, optimal intake estimated by the Global Burden of Disease (GBD) and 2015 Mexican Dietary Guidelines (MDG) in nationally representative samples.

Using dietary data from a semi-quantitative FFQ, dietary quality indexes were constructed as adaptations of three dietary intake recommendations. Trends in adherence to recommendations were evaluated with multivariate quantile regression models with survey year as the main independent variable and adjusted for age, sex, energy intake, dwelling area, geographical region, household assets condition, and student/non-student status. P values and CI were Bonferroni-corrected.

Mexico.

Non-pregnant or lactating adolescents aged 12–19 years (n 16 520).

Adherence to the PH index was about 40 %, GBD was nearly 35 % and MDG was about 37 %. The lowest adherences were for added sugars, sugar-sweetened beverages, nuts and seeds, red meats, processed meats, and legumes (<28 %). No 2006–2018 trends in total adherence were found in any index. Nevertheless, negative adherence trends were identified for poultry (β = –2·4), and saturated fats (β = –0·93), and positive for unsaturated oils (β = 1·23), in the PH. In MDG, relevant trends were found for plain water (β = 1·63) and foods rich in fats (β = –1·24).

Mexican adolescents have demonstrated poor dietary quality by these three approaches. Therefore, this population has a high-risk profile for diet-associated chronic diseases. Further research and appropriate public policies are needed.

The primary objective of this study was to determine whether Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) scores were associated with incident metabolic syndrome.

This study is a secondary analysis of data from the Jackson Heart Study. HEI and AHEI scores were divided into quintiles and Cox proportional hazards regression models were analysed for 1864 African American adults free from metabolic syndrome at Exam 1 to examine the incidence of metabolic syndrome by quintile of dietary quality score.

Hinds, Madison and Rankin counties, Mississippi, USA.

African American adults, ages 21–94 years, 60·9 % female.

Over a mean follow-up time of 6·7 years, we observed 932 incident cases of metabolic syndrome. After adjusting for multiple covariates, a higher HEI score at Exam 1 was not associated with the risk of incident metabolic syndrome, except when looking at the trend analysis for the subgroup of adults with two metabolic syndrome components at Exam 1 (P-trend = 0·03). A higher AHEI score at Exam 1 was associated with the risk of incident metabolic syndrome (hazard ratio for those in the highest quintile compared to the lowest: 0·80 (95 % CI: 0·65, 0·99), P-trend = 0·03).

These findings suggest that a dietary pattern that scores higher on the AHEI may help reduce the risk of metabolic syndrome, even for adults who already have two of the minimum of three components required for a diagnosis of metabolic syndrome.

Given the rapidly changing food environment and proliferation of ultra-processed foods (UPF) in South Africa (SA), this study aimed to critically evaluate dietary quality and adequacy of low-income adults using the Nova classification system and WHO and World Cancer Research Fund dietary guidelines.

Secondary household data and 1-d 24-h recalls were analysed from two cross-sectional studies conducted in 2017–2018. Foods consumed were classified according to the Nova classification system. Compliance with WHO dietary guidelines and UPF consumption trends were evaluated.

Three low-income areas (Langa, Khayalitsha and Mount Frere) in SA were included.

In total, 2521 participants (18–50 years) were included in the study.

Participants had a mean energy intake of 7762 kJ/d. Most participants were within the acceptable WHO guideline range for saturated fat (80·4 %), total fat (68·1 %), Na (72·7 %) and free sugar (57·3 %). UPF comprised 39·4 % of diets among the average adult participant. Only 7·0 % of all participants met the WHO guideline for fruit and vegetables and 18·8 % met the guideline for fibre. Those within the highest quartile of share of energy from UPF consumed statistically higher amounts of dietary components to limit and were the highest energy consumers overall.

Low-income adults living in SA are consuming insufficient protective dietary components, while UPF consumption is prevalent. Higher UPF consumers consume larger amounts of nutrients linked to increased chronic disease risk. Policy measures are urgently needed in SA to protect against the proliferation of harmful UPF and to promote and enable consumption of whole and less UPF.

The consumption of various foods is internationally recommended in healthy diet although the association between dietary variety and incident dementia is unknown. We aimed to examine the association between dietary variety and the incidence of disabling dementia in older Japanese adults.

We conducted a prospective cohort study. Dietary variety was assessed based on the Dietary Variety Score (DVS). DVS was assessed by counting the number of ten food components (meat, fish/shellfish, eggs, milk, soyabean products, green/yellow vegetables, potatoes, fruit, seaweed and fats/oils) that were consumed almost daily using a FFQ. Participants were categorised into low (0–2 points), middle (3–4 points) and high (5–10 points) groups based on the DVS. Data on newly diagnosed disabling dementia were retrieved from the public long-term care insurance database. Cox proportional hazards regression was used to estimate hazard ratios (HR) with 95 % CI.

Yabu cohort study, Japan.

A total of 4972 community-dwelling adults aged 65 years or older.

During the median follow-up of 6·8 years, 884 participants were newly diagnosed with disabling dementia. After adjusting for confounders, the multivariable-adjusted HR for incident disabling dementia was 0·82 (95 % CI, 0·69, 0·97) for participants in the highest DVS category compared with those in the lowest DVS category (Pfor trend = 0·019).

A higher dietary variety is associated with a reduced risk of disabling dementia in older Japanese adults. These results have potential implications for the development of effective public nutritional approaches to prevent dementia in older adults.

We investigated the prospective associations between meat consumption and CVD and whether these relationships differ by dietary quality among African American (AA) adults.

Baseline diet was assessed with a regionally specific FFQ. Unprocessed red meat included beef and pork (120 g/serving); processed meat included sausage, luncheon meats and cured meat products (50 g/serving). Incident total CVD, CHD, stroke and heart failure were assessed annually over 9·8 years of follow-up. We characterised dietary quality using a modified Healthy Eating Index-2010 score (m-HEI), excluding meat contributions.

Jackson, MS, USA.

AA adults (n 3242, aged 55 y, 66 % female).

Mean total, unprocessed red and processed meat intakes were 5·7 ± 3·5, 2·3 ± 1·8 and 3·3 ± 2·7 servings/week, respectively. Mostly, null associations were observed between meat categories and CVD or subtypes. However, greater intake of unprocessed red meat (three servings/week) was associated with significantly elevated risk of stroke (hazard ratio = 1·43 (CI: 1·07,1·90)). With the exception of a more positive association between unprocessed meat consumption and stroke among individuals in m-HEI Tertile 2, the strength of associations between meat consumption categories and CVD outcomes did not differ by m-HEI tertile. In formal tests, m-HEI did not significantly modify meat–CVD associations.

In this cohort of AA adults, total and processed meat were not associated with CVD outcomes, with the exception that unprocessed red meat was related to greater stroke risk. Dietary quality did not modfiy these associations. Research is needed in similar cohorts with longer follow-up and greater meat consumption to replicate these findings.

Many mental disorders, including depression, bipolar disorder and schizophrenia, are associated with poor dietary quality and nutrient intake. There is, however, a deficit of research looking at the relationship between obsessive–compulsive disorder (OCD) severity, nutrient intake and dietary quality.

This study aims to explore the relationship between OCD severity, nutrient intake and dietary quality.

A post hoc regression analysis was conducted with data combined from two separate clinical trials that included 85 adults with diagnosed OCD, using the Structured Clinical Interview for DSM-5. Nutrient intakes were calculated from the Dietary Questionnaire for Epidemiological Studies version 3.2, and dietary quality was scored with the Healthy Eating Index for Australian Adults – 2013.

Nutrient intake in the sample largely aligned with Australian dietary guidelines. Linear regression models adjusted for gender, age and total energy intake showed no significant associations between OCD severity, nutrient intake and dietary quality (all P > 0.05). However, OCD severity was inversely associated with caffeine (β = −15.50, 95% CI −28.88 to −2.11, P = 0.024) and magnesium (β = −6.63, 95% CI −12.72 to −0.53, P = 0.034) intake after adjusting for OCD treatment resistance.

This study showed OCD severity had little effect on nutrient intake and dietary quality. Dietary quality scores were higher than prior studies with healthy samples, but limitations must be noted regarding comparability. Future studies employing larger sample sizes, control groups and more accurate dietary intake measures will further elucidate the relationship between nutrient intake and dietary quality in patients with OCD.

To evaluate diets in terms of nutritional characteristics and quality from the perspectives of health, greenhouse gas emissions (GHGE) and possible associations with each other in a representative sample of students at a public university.

Cross-sectional. Dietary intake was evaluated with a validated FFQ, and diet quality was assessed through the Healthy Eating Index (HEI-2010) and MedDietScore (MDS). GHGE data were obtained from the literature. In addition, sex, socio-economic status (SES) and body fat (BF) status were analysed as covariates.

Basque Autonomous Community, Spain.

Totally, 26 165 healthy adults aged 18–28 years.

Student diets were characterised by low consumption of carbohydrates (38·72 % of total energy intake (TEI)) and a high intake of lipids (39·08 % of TEI). Over half of the participants had low dietary quality. The low-emitting diets were more likely to be consumed by subjects with low HEI-2010 scores (β: 0·039 kg eCO2/1000 kcal/d) and high MDS scores (β: −0·023 kg eCO2/1000 kcal/d), after controlling for sex, SES and BF status. Both the low-emitting and healthy diets were more likely to be consumed by women and by those with normal BF percentage.

UPV/EHU university students’ diets were characterised by moderate quality from a nutritional perspective and moderate variation in the size of carbon footprints. In this population, diets of the highest quality were not always those with the lowest diet-related GHGE; this relationship depended in part on the constructs and scoring criteria of diet quality indices used.

Food delivery apps represent an important and emerging dimension of the digital food environment. This study aimed to examine food availability and the use of marketing strategies by two food delivery apps in a Brazilian metropolis.

An exploratory study was conducted in the city of Belo Horizonte, Minas Gerais. Food groups were identified and the use of price discounts and photos by the apps was observed.

Eighteen neighbourhoods and the ten best rated restaurants in each app.

Three hundred sixty-two commercial food establishments.

The proportion of ultra-processed beverages on offer in the apps (78·45 %) was much higher in comparison with water (48·89 %), natural juices or smoothies (27·07 %). Ultra-processed ready-to-eat meals represented almost 70 % of the food offered in the establishments’ menus, while traditional meals and vegetables represented just over 30 % of the offering. Ice cream, candies and salty packaged snacks were nine times more frequently presented than fruits. The use of photos and price discounts prevailed predominantly among ultra-processed beverages, sandwiches and ice cream, candies and salty packaged snacks. These marketing strategies were least used for promoting fruits and vegetables.

Restaurants registered on food delivery apps offered a significant amount of ultra-processed foods with price discounts and photos in comparison with unprocessed and minimally processed foods.

To evaluate the association between nutritional quality of breakfast and cardiometabolic risk factors.

Cross-sectional study, 2015 Health Survey of São Paulo (2015 ISA-Capital) with Focus on Nutrition Study (2015 ISA-Nutrition).

Population-based study, with a representative sample of adults and elderlies living in São Paulo, Brazil.

The sample included 606 adults (aged 20–59 years) and 537 elderlies (aged ≥60 years) from the 2015 Health Survey of São Paulo. Dietary intake was assessed by at least one 24-h recall. Breakfast quality was evaluated using the proposed Brazilian Breakfast Quality Index (BQI), ranging scores from 0 to 10. BQI associations with sociodemographic, lifestyle, dietetic and cardiometabolic variables were estimated using survey-weighted multiple logistic regression models.

Being ≥60 years of age, self-identifying as White or Asian, having a per capita family income with ≥1 minimum wage, being sufficiently active at leisure time and non-smoker were associated with better scores of BQI. A higher BQI score was inversely associated with elevated blood pressure (OR 0·81, 95 % CI 0·70, 0·94), fasting glucose (OR 0·85, 95 % CI 0·73, 0·98), HOMA-IR (OR 0·86, 95 % CI 0·74, 0·98), total cholesterol (OR 0·87, 95 % CI 0·76, 0·99), LDL-C (OR 0·85, 95 % CI 0·74, 0·97), metabolic syndrome (OR 0·82, 95 % CI 0·72, 0·93) and being overweight (OR 0·87, 95 % CI 0·76, 0·99).

Breakfast quality of Brazilian adults needs improvement with disparities across some sociodemographic factors. BQI was associated with lower odds of cardiometabolic risk factors, suggesting a beneficial effect in this population and emphasising the role of breakfast in reducing the risk of CVD.

The present study investigated the association between dietary patterns and hypertension applying the Chinese Dietary Balance Index-07 (DBI-07).

A cross-sectional study on adult nutrition and chronic disease in Inner Mongolia. Dietary data were collected using 24 h recall over three consecutive days and weighing method. Dietary patterns were identified using principal components analysis. Generalized linear models and multivariate logistic regression models were used to examine the associations between DBI-07 and dietary patterns, and between dietary patterns and hypertension.

Inner Mongolia (n 1861).

A representative sample of adults aged ≥18 years in Inner Mongolia.

Four major dietary patterns were identified: ‘high protein’, ‘traditional northern’, ‘modern’ and ‘condiments’. Generalized linear models showed higher factor scores in the ‘high protein’ pattern were associated with lower DBI-07 (βLBS = −1·993, βHBS = −0·206, βDQD = −2·199; all P < 0·001); the opposite in the ‘condiments’ pattern (βLBS = 0·967, βHBS = 0·751, βDQD = 1·718; all P < 0·001). OR for hypertension in the highest quartile of the ‘high protein’ pattern compared with the lowest was 0·374 (95 % CI 0·244, 0·573; Ptrend < 0·001) in males. OR for hypertension in the ‘condiments’ pattern was 1·663 (95 % CI 1·113, 2·483; Ptrend < 0·001) in males, 1·788 (95 % CI 1·155, 2·766; Ptrend < 0·001) in females.

Our findings suggested a higher-quality dietary pattern evaluated by DBI-07 was related to decreased risk for hypertension, whereas a lower-quality dietary pattern was related to increased risk for hypertension in Inner Mongolia.

To estimate the consumption of ultra-processed foods and determine its association with dietary quality among middle-aged Japanese adults.

Cross-sectional study using data from the Saitama Prefecture Health and Nutrition Survey 2011. Dietary intake was assessed using one- or two-day dietary records. Sociodemographic and lifestyle factors were obtained via self-administered questionnaire. Food items were classified according to the NOVA system into four groups: unprocessed or minimally processed foods; processed culinary ingredients; processed foods; and ultra-processed foods. The dietary share of each NOVA food group and their subgroups was calculated in relation to total energy intake, and the average dietary content of key nutrients was determined across tertiles of the dietary energy share of ultra-processed foods (low, middle and high intake).

Saitama Prefecture in Japan.

Community-dwelling adults aged 30–59 years (256 men, 361 women).

Consumption of unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods contributed 44·9 (se 0·8) %, 5·5 (se 0·2) %, 11·3 (se 0·4) % and 38·2 (se 0·9) % of total daily energy intake, respectively. A positive and statistically significant linear trend was found between the dietary share of ultra-processed foods (tertiles) and the dietary content of total and saturated fat, while an inverse relationship was observed for protein, vitamin K, vitamin B6, dietary fibre, magnesium, phosphorus and iron.

Our findings show that higher consumption of ultra-processed foods was associated with decreased dietary quality among Japanese adults.

Dietary quality (DQ), as assessed by the Alternative Healthy Eating Index for Pregnancy (AHEI-P), and conception and pregnancy outcomes were evaluated.

In this prospective cohort study on couples planning their first pregnancy. Cox proportional hazards regression assessed the relationship between AHEI-P score and clinical pregnancy, live birth and pregnancy loss.

Participants were recruited from the Northeast region of the USA.

Participants: Healthy, nulliparous couples (females, n 132; males, n 131; one male did not enrol).

There were eighty clinical pregnancies, of which sixty-nine resulted in live births and eleven were pregnancy losses. Mean (sd) female AHEI-P was 71·0 (13·7). Of those who achieved pregnancy, those in the highest tertile of AHEI-P had the greatest proportion of clinical pregnancies; however, this association was not statistically significant (P = 0·41). When the time it took to conceive was considered, females with the highest AHEI-P scores were 20 % and 14 % more likely to achieve clinical pregnancy (model 1: hazard ratio (HR) = 1·20; 95 % CI 0·66, 2·17) and live birth (model 1: HR = 1·14; 95 % CI 0·59, 2·20), respectively. Likelihood of achieving clinical pregnancy and live birth increased when the fully adjusted model, including male AHEI-P score, was examined (clinical pregnancy model 4: HR = 1·55; 95 % CI 0·71, 3·39; live birth model 4: HR = 1·36; 95 % CI 0·59, 3·13).

The present study is the first to examine AHEI-P score and achievement of clinical pregnancy. DQ was not significantly related to pregnancy outcomes, even after adjustments for covariates.

Assessing dietary exposure or nutrient intakes requires detailed dietary data. These data are collected in France by the cross-sectional Individual and National Studies on Food Consumption (INCA). In 2014–2015, the third survey (INCA3) was launched in the framework of the European harmonization process which introduced major methodological changes. The present paper describes the design of the INCA3 survey, its participation rate and the quality of its dietary data, and discusses the lessons learned from the methodological adaptations.

Two representative samples of adults (18–79 years old) and children (0–17 years old) living in mainland France were selected following a three-stage stratified random sampling method using the national census database.

Food consumption was collected through three non-consecutive 24 h recalls (15–79 years old) or records (0–14 years old), supplemented by an FFQ. Information on food supplement use, eating habits, physical activity and sedentary behaviours, health status and sociodemographic characteristics were gathered by questionnaires. Height and body weight were measured.

In total, 4114 individuals (2121 adults, 1993 children) completed the whole protocol.

Participation rate was 41·5% for adults and 49·8% for children. Mean energy intake was estimated as 8795 kJ/d (2102 kcal/d) in adults and 7222 kJ/d (1726 kcal/d) in children and the rate of energy intake under-reporters was 17·8 and 13·9%, respectively.

Following the European guidelines, the INCA3 survey collected detailed dietary data useful for food-related and nutritional risk assessments at national and European level. The impact of the methodological changes on the participation rate should be further studied.