The Grocery Purchase Quality Index (GPQI) reflects concordance between household grocery purchases and US dietary recommendations. However, it is unclear whether GPQI scores calculated from partial ...purchasing records reflect individual-level diet quality. This secondary analysis of a 9-month randomised controlled trial examined concordance between the GPQI (range 0-75, scaled to 100) calculated from 3 months of loyalty-card linked partial (≥50 %) household grocery purchasing data and individual-level Healthy Eating Index (HEI) scores at baseline and 3 months calculated from FFQ (n 209). Concordance was assessed with overall and demographic-stratified partially adjusted correlations; covariate-adjusted percentage score differences, cross-classification and weighted κ coefficients assessed concordance across GPQI tertiles (T). Participants were middle aged (55·4 (13·9) years), female (90·3 %), from non-smoking households (96·4 %) and without children (70·7 %). Mean GPQI (54·8 (9·1) %) scores were lower than HEI scores (baseline: 73·2 (9·1) %, 3 months: 72·4 (9·4) %) and moderately correlated (baseline r 0·41 v. 3 months r 0·31, P < 0·001). Correlations were stronger among participants with ≤ bachelor's degree, obesity and children. Scores showed moderate agreement (κ = 0·25); concordance was highest in T3. Participants with high (T3) v. low (T1) GPQI scores had 7·3-10·6 higher odds of having HEI scores >80 % at both time points. Household-level GPQI was moderately correlated with self-reported intake, indicating their promise for evaluating diet quality. Partial purchasing data appear to moderately reflect individual diet quality and may be useful in interventions monitoring changes in diet quality.
Purpose of Review
To evaluate the multidimensional influence of food environments on food choice, dietary quality, and diet-related health and identify critical gaps necessary to develop effective ...population interventions that influence food choice.
Recent Findings
Multicomponent interventions that interact with multiple layers of the food environment show limited but consistent effects on dietary behaviors and may have wider and substantive population-level reach with greater incorporation of validated, holistic measurement tools. Opportunities to use smartphone technology to measure multiple components of the food environment will facilitate future interventions, particularly as food environments expand into online settings and interact with consumers in novel ways to shape food choice.
Summary
While studies suggest that all dimensions of the food environment influence diet and health outcomes, robust and consistent measurements of food environments that integrate objective and subjective components are essential for developing stronger evidence needed to shift public policies.
Objective
Higher intake of ultraprocessed foods (UPFs) is associated with obesity. We examined whether replacing UPFs (NOVA 4) with minimally processed foods and culinary ingredients (NOVA 1 + 2) was ...associated with differential weight change in this secondary prospective analysis of the Preventing Overweight Using Novel Dietary Strategies (POUNDS) Lost trial.
Methods
We estimated percent energy intake (%kcal) from the four NOVA groups using 24‐h dietary recalls in a subset of 356 participants. Multivariable‐adjusted substitution models examined whether replacing %kcal from UPFs with NOVA 1 + 2 was associated with greater weight, body fat percentage, trunk fat, and waist circumference reduction at 6 months; changes in parameters were compared among NOVA 1 + 2 tertiles (T).
Results
Participants were on average 52.3 years of age, 85% White, 55% female, and 58.2% nonsmoking, with a mean BMI of 32.7 kg/m2. Replacing 10%kcal of UPFs with NOVA 1 + 2 was associated with greater 6‐month weight (ß = 0.51, 95% CI: −0.93 to −0.09, p = 0.02), body fat percentage (ß = 2.7, 95% CI: −5.10 to −0.43, p = 0.02), and trunk fat reduction (ß = 3.9, 95% CI: −7.01 to −0.70, p = 0.02), but not waist circumference reduction. Participants in T3 (−8.33 kg) versus T1 (−5.32 kg) of NOVA 1 + 2 had greater weight loss (p < 0.001).
Conclusions
Isocaloric substitution of UPFs with NOVA 1 + 2 was associated with marginally greater weight loss under energy restriction. These modest findings support more research exploring the mechanisms linking UPFs with body weight regulation beyond energy intake.
Varied diets are diverse with respect to diet quality, and existing dietary variety indices do not capture this heterogeneity. We developed and evaluated the multidimensional US Healthy Food ...Diversity (HFD) index, which measures dietary variety, dietary quality and proportionality according to the 2010 Dietary Guidelines for Americans (DGA). In the present study, two 24 h dietary recalls from the 2003-6 National Health and Nutrition Examination Survey (NHANES) were used to estimate the intake of twenty-six food groups and health weights for each food group were informed by the 2010 DGA. The US HFD index can range between 0 (poor) and 1 - 1/n, where n is the number of foods; the score is maximised by consuming a variety of foods in proportions recommended by the 2010 DGA. Energy-adjusted Pearson's correlations were computed between the US HFD index and each food group and the probability of adequacy for fifteen nutrients. Linear regression was run to test whether the index differentiated between subpopulations with differences in dietary quality commonly reported in the literature. The observed mean index score was 0·36, indicating that participants did not consume a variety of healthful foods. The index positively correlated with nutrient-dense foods including whole grains, fruits, orange vegetables and low-fat dairy (r 0·12 to 0·64) and negatively correlated with added sugars and lean meats (r - 0·14 to - 0·23). The index also positively correlated with the mean probability of nutrient adequacy (r 0·41; P< 0·0001) and identified non-smokers, women and older adults as subpopulations with better dietary qualities. The US HFD index may be used to inform national dietary guidance and investigate whether healthful dietary variety promotes weight control.
Abstract Exposure to a variety of flavors may promote food enjoyment, but few studies have examined the relationship between food seasoning and food intake. We hypothesized that using a higher ...variety (number) of eleven seasonings to prepare two staple foods (beans, white rice) would be associated with intake of those foods in a population-based case–control study of Costa Rican adults in urban vs. rural areas (n = 1,025), where cooking and dietary practices differ. Participants were surveyed about the variety of seasoning ingredients added when preparing beans or rice. Ingredients were also categorized by their dietary quality (healthfulness), and scores for seasoning variety and quality were created. Multivariable linear regression was used to determine the association between variety and quality scores (continuously and in tertiles (T)) and intake of each staple food. Seasoning variety was positively associated with daily servings of beans (β = 0.02, p = 0.01; 1.31 and 1.23 servings/day in T2 and T3 versus 1.02 servings/day in T1, p < 0.05) and rice (β = 0.04, p = 0.005) in the urban areas only. No differences in ingredient quality across increasing intakes of beans or rice were noted, and the joint associations between variety and quality were not significant. In conclusion, a greater variety, but not quality, of seasoning ingredients was positively associated with intakes of beans and rice in urban Costa Rican adults. Our results suggest that increasing the variety of seasonings added to beans may be a culturally-appropriate strategy to improve intake of this healthy staple food among urban Costa Rican adults.
Objective grocery transactions may reflect diet, but it is unclear whether the diet quality of grocery purchases mirrors geographic and racial/ethnic disparities in diet-related diseases. This ...cross-sectional analysis of 3961 households in the nationally representative Food Acquisition and Purchase Survey evaluated geographic and racial/ethnic disparities in grocery purchase quality. Respondents self-reported demographics and recorded purchases over 7 days; the Healthy Eating Index (HEI) 2015 assessed diet quality. Survey-weighted multivariable-adjusted regression determined whether there were geographic and racial/ethnic differences in HEI-15 scores. Respondents were, on average, 50.6 years, non-Hispanic white (NHW) (70.3%), female (70.2%), and had attended some college (57.8%). HEI-15 scores differed across geographic region (
< 0.05), with the highest scores in the West (57.0
0.8) and lowest scores in the South (53.1
0.8), and there was effect modification by race/ethnicity (
-interaction = 0.02). Regionally, there were diet disparities among NHW and non-Hispanic black (NHB) households; NHWs in the South had HEI-15 scores 3.2 points lower than NHWs in the West (
= 0.003). Southern NHB households had HEI-15 scores 8.1 points lower than Western NHB households (
0.013). Racial/ethnic disparities in total HEI-15 by region existed in the Midwest and South, where Hispanic households in the Midwest and South had significantly lower diet quality than NHW households. Heterogeneous disparities in the diet quality of grocery purchases by region and race/ethnicity necessitate tailored approaches to reduce diet-related disease.
Health stakeholders are interested in the promise of healthy food incentives to improve dietary quality. The Smart Cart Study tested whether targeting healthful food incentives based on customer ...preferences and purchase history was effective for improving grocery purchase quality.
Randomized controlled crossover design of 224 adults who shopped at an independent supermarket for ≥50% of their groceries, participated in the store's loyalty program, and completed validated diet and sociodemographic/behavioral questionnaires. Participants were randomized using 1:1 blocked randomization; all participants received a 5% discount on their purchases with their loyalty card. For the first 13-weeks, the intervention group received individually-targeted weekly coupons (valued up to $10) with brief nutrition education to improve grocery purchase quality. The study team developed healthy food coupons, and the study algorithm allocated targeted coupons to participants' loyalty cards using purchase history, dietary preferences/allergies, and baseline diet quality. Control participants received weekly untargeted nutrition education and occasional generic coupons. Following a 2–4 week washout period, the two groups crossed over. The primary study outcomes were purchases of targeted products and grocery purchase quality measured using the validated Grocery Purchase Quality Index-2016; the study was powered to detect a minimum 3% difference in purchase quality.
The Smart Cart Study tested a novel application of automated individually-targeted marketing using customer purchase history, dietary quality, and preferences to identify and deliver targeted incentives to improve grocery purchase quality. Future research could scale this program through collaboration between multiple stakeholders, including supermarkets, workplace wellness initiatives and insurance companies.
Targeted coupons strongly influence purchasing behavior and may represent an innovative approach for improving dietary behaviors.
The retail analytics firm, Dunnhumby, provided secondary retail data ...containing grocery transactions, targeted coupon exposures, and coupon use for 2500 households over 2-years. The USDA Quarterly At-Home Food Purchasing Database was used to categorize individual foods into 52 categories and combined into 12 food groups. Mixed effects linear models estimated the difference-in-difference effects of coupon exposure on category-level purchase rate/wk. pre- and post-campaign; models also tested effect modification by food category.
Category-level food purchases significantly increased post-campaign. Mean (SD) food purchases/wk. Among exposed households (17.34 (13.08) units/wk) vs. unexposed households (3.75 (4.59) units/wk) were higher (p < 0.001). Difference-in-difference effects of coupon exposure showed a higher increase in purchase rate among exposed vs. unexposed households (5.73 vs. 0.67, p < 0.001). Food category significantly modified the association between coupon exposure and coupon campaign. Category-level purchase rate among exposed vs. unexposed households was relatively higher in less healthful (e.g. convenience foods) vs. more healthful categories (e.g. nuts) with a 1.17 unit/wk. increase in convenience foods purchase (p < 0.001) vs. a 0.03 unit/wk. increase in nuts (p < 0.001). Exploratory analyses suggested that price elasticity of food categories for targeted coupons (1.02-2.81) was higher than previous estimates for untargeted coupons.
Across food categories, coupon exposure increased category-level purchase rate, with a relatively larger effect size for less healthful than more healthful categories. Promising results from this preliminary study suggest that experimental research is warranted to determine whether targeting with the explicit purpose of improving dietary quality can more effectively influence diet, and whether it can do so more cost effectively.
Background
Discrimination promotes multisystem physiological dysregulation termed allostatic load, which predicts morbidity and mortality. It remains unclear whether weight-related discrimination ...influences allostatic load.
Purpose
The aim of this study was to prospectively examine 10-year associations between weight discrimination, allostatic load, and its components among adults 25–75 years in the Midlife Development in the US Biomarker Substudy.
Methods
Participants with information on weight discrimination were analyzed (
n
=986). At both timepoints, participants self-reported the frequency of perceived weight discrimination across nine scenarios as “never/rarely” (scored as 0), “sometimes” (1), or “often” (2). The two scores were averaged and then dichotomized as “experienced” versus “not experienced” discrimination. High allostatic load was defined as having ≥3 out of 7 dysregulated systems (cardiovascular, sympathetic/parasympathetic nervous systems, hypothalamic pituitary axis, inflammatory, lipid/metabolic, and glucose metabolism), which collectively included 24 biomarkers. Relative risks (RR) were estimated from multivariate models adjusted for sociodemographic and health characteristics, other forms of discrimination, and BMI.
Results
Over 41% of the sample had obesity, and 6% reported weight discrimination at follow-up. In multivariable-adjusted analyses, individuals who experienced (versus did not experience) weight discrimination had twice the risk of high allostatic load (RR, 2.07; 95 % CI, 1.21; 3.55 for baseline discrimination; 2.16, 95 % CI, 1.39; 3.36 for long-term discrimination). Weight discrimination was associated with lipid/metabolic dysregulation (1.56; 95 % CI 1.02, 2.40), glucose metabolism (1.99; 95 % CI 1.34, 2.95), and inflammation (1.76; 95 % CI 1.22, 2.54), but no other systems.
Conclusions
Perceived weight discrimination doubles the 10-year risk of high allostatic load. Eliminating weight stigma may reduce physiological dysregulation, improving obesity-related morbidity and mortality.
Fermentable carbohydrates (FC) improve health, but data are lacking on their presence and relationships with dietary quality in self-selected diets. Types of foods chosen within different dietary ...patterns may vary, which could impact the FC distribution and overall diet quality, but these relationships have not been examined to date.
This cross-sectional study compared intakes of FC and subclasses soluble dietary fibers (SDF) and polyols and diet quality in plant-based (PB) and western-style (WS) diets.
Dietary data were collected from 84 adults (26.8 + 11.5y; 23.0 kg/m2) through diet history questionnaire-III; dietary quality was assessed by the 2015 Healthy Eating Index (HEI-2015). Independent sample t-tests compared FC and subclasses (in grams and g/1000 kcal) in PB and WS diets. Multiple regression analyzed HEI-2015 of PB and WS adjusting for confounders. Analysis of variance evaluated if diet influences relationships between diet group and FC and subclasses intakes.
The average intakes of FC PB (9.8 ± 5.2g); WS (7.3 ± 3.6g), p = 0.014*, SDF 8.3 ± 4.4g; 6.4 ± 3.1g, p = 0.02 and polyols 1.5 ± 1.0g; 1.0 ± 0.6g, p = 0.008 were higher in PB than WS. Similarly, the average intake of FC (gram/1000 kcal) 6.5 ± 5.9 vs 4.6 ± 3.9, p = 0.0001*, SDF (g/1000 kcal) 4.5 ± 2.0vs 4.0 ± 1.6, p = 0.0003* and polyol (g/1000 kcal) 1.0 ± 0.6 vs 0.6 ± 0.3, p = 0.0006* was significantly higher in PB than WS. The mean HEI-2015 score for PB was higher than WS 77.9 ± 9.1; 64.7 ± 11.4, p < 0.0001, adj. R2 = 0.36. Higher FC (10.7 ± 3.6g; 5.5 ± 2.4g, p = 0.001*), SDF (9.0 ± 3.0g; 4.8 ± 2.2g, p = 0.001*), and polyols (1.7 ± 0.9g; 0.7 ± 0.3g, p = 0.001*) were seen in the high diet quality PB group than low diet quality WS group.
Overall, self-selected PB diets showed higher FCs and subclasses, and HEI-2015, than WS diets. Importantly higher-quality diets, either PB or WS, had higher FCs and subclasses in this population. An understanding of these relationships might help articulate strategies to increase FC intake.
•First efforts to examine fermentable carbohydrates in diet groups.•Self-selected plant-based diet showed higher fermentable carbohydrates & diet quality.•Higher-quality diets are associated with a higher fermentable carbohydrate intake.•The low-quality western-style diets contained the lowest fermentable carbohydrates.•Diet quality is especially important for people self-selecting western-style diets.
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