Update of the Healthy Eating Index: HEI-2015 Krebs-Smith, Susan M.; Pannucci, TusaRebecca E.; Subar, Amy F. ...
Journal of the Academy of Nutrition and Dietetics,
September 2018, 2018-09-00, 20180901, Letnik:
118, Številka:
9
Journal Article
Recenzirano
Odprti dostop
The Healthy Eating Index (HEI) is a measure for assessing whether a set of foods aligns with the Dietary Guidelines for Americans (DGA). An updated HEI is released to correspond to each new edition ...of the DGA, and this article introduces the latest version, which reflects the 2015-2020 DGA. The HEI-2015 components are the same as in the HEI-2010, except Saturated Fat and Added Sugars replace Empty Calories, with the result being 13 components. The 2015-2020 DGA include explicit recommendations to limit intakes of both Added Sugars and Saturated Fats to <10% of energy. HEI-2015 does not account for excessive energy from alcohol within a separate component, but continues to account for all energy from alcohol within total energy (the denominator for most components). All other components remain the same as for HEI-2010, except for a change in the allocation of legumes. Previous versions of the HEI accounted for legumes in either the two vegetable or the two protein foods components, whereas HEI-2015 counts legumes toward all four components. Weighting approaches are similar to those of previous versions, and scoring standards were maintained, refined, or developed to increase consistency across components; better ensure face validity; follow precedent; cover a range of intakes; and, when applicable, ensure the DGA level corresponds to a score >7 out of 10. HEI-2015 component scores can be examined collectively using radar graphs to reveal a pattern of diet quality and summed to represent overall diet quality.
Evaluation of the Healthy Eating Index-2015 Reedy, Jill; Lerman, Jennifer L.; Krebs-Smith, Susan M. ...
Journal of the Academy of Nutrition and Dietetics,
September 2018, 2018-09-00, 20180901, Letnik:
118, Številka:
9
Journal Article
Recenzirano
Odprti dostop
The Healthy Eating Index (HEI), a diet quality index that measures alignment with the Dietary Guidelines for Americans, was updated with the 2015-2020 Dietary Guidelines for Americans.
To evaluate ...the psychometric properties of the HEI-2015, eight questions were examined: five relevant to construct validity, two related to reliability, and one to assess criterion validity.
Three data sources were used: exemplary menus (n=4), National Health and Nutrition Examination Survey 2011-2012 (N=7,935), and the National Institutes of Health-AARP (formally known as the American Association of Retired Persons) Diet and Health Study (N=422,928).
Exemplary menus: Scores were calculated using the population ratio method. National Health and Nutrition Examination Survey 2011-2012: Means and standard errors were estimated using the Markov Chain Monte Carlo approach. Analyses were stratified to compare groups (with t tests and analysis of variance). Principal components analysis examined the number of dimensions. Pearson correlations were estimated between components, energy, and Cronbach’s coefficient alpha. National Institutes of Health-AARP Diet and Health Study: Adjusted Cox proportional hazards models were used to examine scores and mortality outcomes.
For construct validity, the HEI-2015 yielded high scores for exemplary menus as four menus received high scores (87.8 to 100). The mean score for National Health and Nutrition Examination Survey was 56.6, and the first to 99th percentile were 32.6 to 81.2, respectively, supporting sufficient variation. Among smokers, the mean score was significantly lower than among nonsmokers (53.3 and 59.7, respectively) (P<0.01), demonstrating differentiation between groups. The correlation between diet quality and diet quantity was low (all <0.25) supporting these elements being independent. The components demonstrated multidimensionality when examined with a scree plot (at least four dimensions). For reliability, most of the intercorrelations among the components were low to moderate (0.01 to 0.49) with a few exceptions, and the standardized Cronbach’s alpha was .67. For criterion validity, the highest vs the lowest quintile of HEI-2015 scores were associated with a 13% to 23% decreased risk of all-cause, cancer, and cardiovascular disease mortality.
The results demonstrated evidence supportive of construct validity, reliability, and criterion validity. The HEI-2015 can be used to examine diet quality relative to the 2015-2020 Dietary Guidelines for Americans.
Recent reports have asserted that, because of energy underreporting, dietary self-report data suffer from measurement error so great that findings that rely on them are of no value. This commentary ...considers the amassed evidence that shows that self-report dietary intake data can successfully be used to inform dietary guidance and public health policy. Topics discussed include what is known and what can be done about the measurement error inherent in data collected by using self-report dietary assessment instruments and the extent and magnitude of underreporting energy compared with other nutrients and food groups. Also discussed is the overall impact of energy underreporting on dietary surveillance and nutritional epidemiology. In conclusion, 7 specific recommendations for collecting, analyzing, and interpreting self-report dietary data are provided: (1) continue to collect self-report dietary intake data because they contain valuable, rich, and critical information about foods and beverages consumed by populations that can be used to inform nutrition policy and assess diet-disease associations; (2) do not use self-reported energy intake as a measure of true energy intake; (3) do use self-reported energy intake for energy adjustment of other self-reported dietary constituents to improve risk estimation in studies of diet-health associations; (4) acknowledge the limitations of self-report dietary data and analyze and interpret them appropriately; (5) design studies and conduct analyses that allow adjustment for measurement error; (6) design new epidemiologic studies to collect dietary data from both short-term (recalls or food records) and long-term (food-frequency questionnaires) instruments on the entire study population to allow for maximizing the strengths of each instrument; and (7) continue to develop, evaluate, and further expand methods of dietary assessment, including dietary biomarkers and methods using new technologies.
We investigated the predictive value of geriatric assessment (GA) on overall survival (OS) for older adults with acute myelogenous leukemia (AML). Consecutive patients ≥ 60 years with newly diagnosed ...AML and planned intensive chemotherapy were enrolled at a single institution. Pretreatment GA included evaluation of cognition, depression, distress, physical function (PF) (self-reported and objectively measured), and comorbidity. Objective PF was assessed using the Short Physical Performance Battery (SPPB, timed 4-m walk, chair stands, standing balance) and grip strength. Cox proportional hazards models were fit for each GA measure as a predictor of OS. Among 74 patients, the mean age was 70 years, and 78.4% had an Eastern Cooperative Oncology Group (ECOG) score ≤ 1. OS was significantly shorter for participants who screened positive for impairment in cognition and objectively measured PF. Adjusting for age, gender, ECOG score, cytogenetic risk group, myelodysplastic syndrome, and hemoglobin, impaired cognition (Modified Mini-Mental State Exam < 77) and impaired objective PF (SPPB < 9) were associated with worse OS. GA methods, with a focus on cognitive and PF, improve risk stratification and may inform interventions to improve outcomes for older AML patients.
•Geriatric assessment, with a focus on cognitive and physical function, improves prediction of survival among older adults treated for AML.•Use of geriatric assessment may inform trial design and interventions to improve outcomes for older adults with AML.
The objective of this study was to estimate the prevalence of use and types of dietary supplements (DS) used by U.S. adults (≥19 years) by sociodemographic characteristics: family income-to-poverty ...ratio (PIR), food security status, and Supplemental Nutrition Assistance Program (SNAP) participation using NHANES 2011⁻2014 data (
= 11,024). DS use was ascertained via a home inventory and a retrospective 30-day questionnaire. Demographic and socioeconomic differences related to DS use were evaluated using a univariate
statistic. Half of U.S. adults (52%) took at least one DS during a 30-day period; multivitamin-mineral (MVM) products were the most commonly used (31%). DS and MVM use was significantly higher among those with a household income of ≥ 350% of the poverty level, those who were food secure, and SNAP income-ineligible nonparticipants across all sex, age, and race/ethnic groups. Among women, prevalence of use significantly differed between SNAP participants (39%) and SNAP income-eligible nonparticipants (54%). Older adults (71+ years) remained the highest consumers of DS, specifically among the highest income group (82%), while younger adults (19⁻30 years), predominantly in the lowest income group (28%), were the lowest consumers. Among U.S. adults, DS use and the types of products consumed varied with income, food security, and SNAP participation.
Careful consideration of the validity and reliability of methods intended to assess dietary intake is central to the robustness of nutrition research. A dietary assessment method with high validity ...is capable of providing useful measurement for a given purpose and context. More specifically, a method with high validity is well grounded in theory; its performance is consistent with that theory; and it is precise, dependable, and accurate within specified performance standards. Assessing the extent to which dietary assessment methods possess these characteristics can be difficult due to the complexity of dietary intake, as well as difficulties capturing true intake. We identified challenges and best practices related to the validation of self-report dietary assessment methods. The term validation is used to encompass various dimensions that must be assessed and considered to determine whether a given method is suitable for a specific purpose. Evidence on the varied concepts of validity and reliability should be interpreted in combination to inform judgments about the suitability of a method for a specified purpose. Self-report methods are the focus because they are used in most studies seeking to measure dietary intake. Biomarkers are important reference measures to validate self-report methods and are also discussed. A checklist is proposed to contribute to strengthening the literature on the validation of dietary assessment methods and ultimately, the nutrition literature more broadly.
Objectives
The current Recommended Dietary Allowance (RDA) for protein is based on short‐term nitrogen balance studies in young adults and may underestimate the amount needed to optimally preserve ...physical function in older adults. We examined the association between protein intake and the onset of mobility limitation over 6 years of follow‐up in older adults in the Health ABC study.
Design
Prospective cohort study.
Setting
Memphis, Tennessee and Pittsburgh, Pennsylvania.
Participants
Community‐dwelling, initially well‐functioning adults aged 70–79 years (n = 1998).
Measurements
Protein intake (g/kg body weight/d) was calculated using an interviewer‐administered 108‐item food frequency questionnaire at baseline. Mobility limitation was assessed semi‐annually and defined as reporting any difficulty walking one‐quarter of a mile or climbing 10 steps on 2 consecutive 6‐month contacts. The association between protein intake and incident mobility limitation was examined using Cox proportional hazard regression models adjusting for demographics, behavioral characteristics, chronic conditions, total energy intake, and height.
Results
Mean (SD) protein intake was 0.91 (0.38) g/kg body weight/d, with 43% reporting intakes less than the RDA (0.8 g/kg body weight/d). During 6 years of follow‐up, 705 participants (35.3%) developed mobility limitations. Compared to participants in the upper tertile of protein intake (≥1.0 g/kg body weight/d), participants in the lower two tertiles of protein intake (<0.7 and 0.7 –<1.0 g/kg body weight/d) were at greater risk of developing mobility limitation over 6 years of follow‐up (RR (95% CI): 1.86 (1.41–2.44) and 1.49 (1.20–1.84), respectively).
Conclusion
Lower protein intake was associated with increased risk of mobility limitation in community‐dwelling, initially well‐functioning older adults. These results suggest that protein intakes of ≥1.0 g/kg body weight/d may be optimal for maintaining physical function in older adults.
Fear of recurrence (FoR) is a prevalent concern among breast cancer survivors (BCS), yet few accessible interventions exist. This study evaluated a targeted eHealth intervention, "FoRtitude," to ...reduce FoR using cognitive behavioral skills training and telecoaching.
BCS (N = 196) were recruited from an academic medical center and 3 National Cancer Institute Community Oncology Research Program community sites, had stage 0-III breast cancer, were 1-10 years postprimary treatment, with moderate to high FoR and familiarity with the internet. Using the Multiphase Optimization Strategy, participants were independently randomly assigned to 3 cognitive behavioral skills (relaxation, cognitive restructuring, worry practice) vs an attention control condition (health management content HMC) and to telecoaching (motivational interviewing) vs no telecoaching. Website content was released across 4 weeks and included didactic lessons, interactive tools, and a text-messaging feature. BCS completed the Fear of Cancer Recurrence Inventory at baseline and at 4 and 8 weeks. Fear of Cancer Recurrence Inventory scores over time were compared using mixed-effects models. All statistical tests were 2-sided.
FCRI scores SD decreased statistically significantly from baseline to postintervention (T0 = 53.1 17.4, T2 = 41.9 16.2, P < .001). The magnitude of reduction in FCRI scores was comparable across cognitive behavior therapy (CBT) and attention control HMC conditions and was predicted by increased self-efficacy. Telecoaching was associated with lower attrition and greater website use (mean adherence score SD = 26.6 7.2 vs 21.0 10.5, P < .001).
BCS experienced statistically significant reductions in FoR postintervention, but improvements were comparable between CBT and attention controls. Telecoaching improved adherence and retention. Future research is needed on optimal integration of CBT and HMC, dose, and features of eHealth delivery that contributed to reducing FoR. In the COVID-19 era, remote delivery has become even more essential for reaching survivors struggling with FoR.
The contribution of specific cancer therapies, comorbid medical conditions, and host factors to mortality risk after pediatric Hodgkin lymphoma (HL) is unclear. We assessed leading morbidities, ...overall and cause-specific mortality, and mortality risks among 2742 survivors of HL in the Childhood Cancer Survivor Study, a multi-institutional retrospective cohort study of survivors diagnosed from 1970 to 1986. Excess absolute risk for leading causes of death and cumulative incidence and standardized incidence ratios of key medical morbidities were calculated. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of risks for overall and cause-specific mortality. Substantial excess absolute risk of mortality per 10 000 person-years was identified: overall 95.5; death due to HL 38.3, second malignant neoplasms 23.9, and cardiovascular disease 13.1. Risks for overall mortality included radiation dose ≥ 3000 rad ( ≥ 30 Gy; supra-diaphragm: HR, 3.8; 95% CI, 1.1-12.6; infradiaphragm + supradiaphragm: HR, 7.8; 95% CI, 2.4-25.1), exposure to anthracycline (HR, 2.6; 95% CI, 1.6-4.3) or alkylating agents (HR, 1.7; 95% CI, 1.2-2.5), non–breast second malignant neoplasm (HR, 2.6; 95% CI 1.4-5.1), or a serious cardiovascular condition (HR, 4.4; 95% CI 2.7-7.3). Excess mortality from second neoplasms and cardiovascular disease vary by sex and persist > 20 years of follow-up in childhood HL survivors.
PDF
