The traditional approach to evaluating dietary quality is based on the achievement of the recommended intakes for each food group, which may overlook the achievement of correct relative proportions between food groups. We propose a \"Dietary Non-Adherence Score (DNAS)\" to assess the degree of similarity between subjects\' diets and those recommended in the Chinese Dietary Guidelines (CDG). Furthermore, it is important to incorporate the time-dependent nature of dietary quality into mortality prediction. This study investigated the association between long-term changes in adherence to the CDG and all-cause mortality. This study included 4533 participants aged 30-60 from the China Health and Nutrition Survey study with a median follow-up of 6.9 years. Intakes from 10 food groups were collected in 5 survey rounds from 2004 to 2015. We calculated the Euclidean distance between the intake of each food and the CDG-recommended intake, and then summed all the food groups as DNAS. Mortality was assessed in 2015. Latent class trajectory modeling was used to identify three classes of participants with distinct longitudinal trajectories of DNAS during the follow-up period. The Cox proportional hazard model was used to assess the risk of all-cause mortality in the three classes of people. Risk factors for death and confounders for diets were sequentially adjusted in the models. There were 187 deaths overall. Participants in the first class identified had consistently low and decreasing DNAS levels (coefficient = -0.020) over their lifetime, compared with a hazard ratio (HR) of 4.4 (95% confidence interval [CI]: 1.5, 12.7) for participants with consistently high and increasing DNAS levels (coefficient = 0.008). Those with moderate DNAS had an HR of 3.0 (95% CI: 1.1, 8.4). In summary, we find that people with consistently high adherence to CDG-recommended dietary patterns had a significantly lower mortality risk. DNAS is a promising method to assess diet quality.

UNASSIGNED: A person\'s daily nutrient intake and overall nutritional status are determined by a complex interplay of the types and amounts of foods ingested in combination with the timing and frequency of eating.
UNASSIGNED: The aim was to summarize frequency of eating occasion data examined by the 2020 Dietary Guidelines Advisory Committee, the macronutrient contributions they provide, and meal frequency relative to dietary quality among the US population (≥2 y), with a focus on sex, age, race/Hispanic origin, and income.
UNASSIGNED: Demographic and 24-h recall data from the 2013-2016 NHANES were examined. An eating occasion was defined as \"any ingestive event (e.g., solid food, beverage, water) that is either energy yielding or non-energy yielding\"; all eating occasions were further divided into discrete meals and snacks. Frequency of meals and snacks was defined as \"the number of daily EOs [eating occasions],\" respectively. Diet quality was assessed via the Healthy Eating Index (HEI)-2015.
UNASSIGNED: Most Americans consume 2 (28%) to 3 (64%) meals on a given day and >90% consume 2 to 3 snacks on that day. Adult, Hispanic, and non-Hispanic Black and lower-income (<131% family poverty-to-income ratio) Americans had a lower frequency of eating than children or adolescents, non-Hispanic White, and non-Hispanic Asian Americans and higher-income Americans, respectively. Americans who reported 3 meals on a given day consumed a diet higher in dietary quality than Americans who consumed 2 meals on a given day (HEI-2015: 61.0 vs. 55.0), regardless of population subgroup.
UNASSIGNED: The frequency of the types of eating occasions differs according to age, race and Hispanic origin, and income. Dietary quality is associated with the number of meals consumed. Healthy dietary patterns can be constructed in a variety of ways to suit different life stages, cultural practices, and income levels; improved diet quality and careful consideration of nutrient density when planning meals are warranted.

BACKGROUND: Compliance with dietary guidelines among pregnant women can positively influence not only their own health but also the health of their babies. Measuring the compliance requires professional skills in nutrition and dietary counseling. In China, few simple and effective techniques assess dietary quality among pregnant women, especially in rural areas. We aimed to establish a new simple and effective assessment technique, the \"Chinese Dietary Guidelines Compliance Index for Pregnant Women (CDGCI-PW)\" and assess the association between maternal dietary compliance and risks of pregnancy complications.
METHODS: The CDGCI-PW consists of 13 main components which were based on the 2016 edition of the Chinese dietary guidelines for pregnant women. Each component was assigned a different score range, and the overall score ranged from 0 to 100 points. The Tongji Maternal and Child Health Cohort study (from September 2013 to May 2016) was a prospective cohort study designed to examine maternal dietary and lifestyle effects on the health of pregnant women and their offspring. The maternal diet during the second trimester was compared with the corresponding recommended intake of the Chinese balanced dietary pagoda for pregnant women to verify their compliance with dietary guidelines. The association between maternal dietary quality and risks of pregnancy complications was estimated by regression analysis. Receiver operating characteristic (ROC) curves were constructed to identify the optimal cut-off values of CDGCI-PW for gestational hypertension and gestational diabetes mellitus (GDM).
RESULTS: Among the 2708 pregnant women, 1489 were eventually followed up. The mean CDGCI-PW score was 74.1 (standard deviation (SD) 7.5) in the second trimester. The majority of foods showed the following trend: the higher the CDGCI-PW score, the higher the proportion of pregnant women who reported food intake within the recommended range. Moreover, a higher maternal CDGCI-PW score was significantly associated with lower risks of gestational hypertension [odds ratio (OR) (95% confidence interval [(CI): 0.30 (0.20, 0.37)] and GDM [OR (95% CI): 0.38 (0.31, 0.48)]. The optimal CDGCI-PW cut-off value for gestational hypertension was ≥68.5 (sensitivity 82%; specificity: 61%; area under the ROC curve, AUC = 0.743), and the optimal CDGCI-PW cut-off score for GDM was ≥75.5 (sensitivity 43%; specificity: 81%; area under the ROC curve, AUC = 0.714).
CONCLUSIONS: The CDGCI-PW is a simple and useful technique that assesses maternal diet quality during pregnancy, while adherence to the CDGCI-PW is associated with a lower risk of gestational hypertension and GDM.

Meat intake has been linked to increased risk of colorectal cancer (CRC) and mortality. However, diet composition may affect the risks. We aimed to estimate associations between red and processed meat and poultry intake and risk of CRC and all-cause mortality and if they are modified by dietary quality using Cox regression analyses. Baseline dietary data were obtained from three survey rounds of the Danish National Survey on Diet and Physical Activity. Data on CRC and all-cause mortality were extracted from national registers. The cohort was followed from date of survey interview-or for CRC, from age 50 years, whichever came last, until 31 December 2017. Meat intake was analysed categorically and continuously, and stratified by dietary quality for 15-75-year-old Danes at baseline, n 6282 for CRC and n 9848 for mortality analyses. We found no significant association between red and processed meat intake and CRC risk. For poultry, increased CRC risk for high versus low intake (HR 1.62; 95%CI 1.13-2.31) was found, but not when examining risk change per 100 g increased intake. We showed no association between meat intake and all-cause mortality. The association between meat intake and CRC or mortality risk was not modified by dietary quality.

Research suggests that the dietary quality (DQ) of school lunches meeting the National School Lunch Program (NSLP) requirements may vary significantly. Possible drivers of variation include factors, such as socioeconomic status (SES) and rurality. The purpose of this cross-sectional study was to determine whether there was variation in nutrient content and DQ by SES and rurality, when analyzing middle school lunch menus meeting NSLP requirements. A random sample of 45 Kansas middle school lunch menus each were obtained from websites of randomly selected districts from low- and high-SES strata. Thirty-day menus were analyzed for nutrient content. Healthy Eating Index (HEI) 2015 scores were calculated for DQ. Rurality was determined for schools by National Center for Education Statistics (NCES) locale. There were significant differences in added sugar (p < 0.001) and calcium (p = 0.001) favoring high-SES menus, and in sodium (p = 0.001) favoring low-SES menus. There were no nutrient differences by rurality. The HEI scores were not different by SES or rurality, with a mean score (SD) 61.9 (2.6) across all schools. Middle school lunch DQ in Kansas does not vary by SES or rurality. Efforts to improve DQ should focus on all foodservice operations, not specifically low-SES or rural schools.

The Healthy Mediterranean-Style Eating Pattern (HMEP) in the 2015 Dietary Guidelines for Americans (DGA) recommends that adults eating less than 2400 kcal a day consume only two daily servings (or cup-equivalents) of low-fat or fat-free dairy foods like milk, cheese, and yogurt, which does not provide enough calcium, potassium, and vitamin D to meet dietary reference intakes (DRIs). Our objective was to assess the impact of additional servings of dairy foods on the nutrient adequacy of the 1600, 2000, and 2400 kcal HMEP in the 2015 DGA.
Using the same food pattern modeling procedures as the 2015 DGA, we assessed the nutrient composition of three alternative models of the 1600, 2000, and 2400 kcal HMEP. For Model 1, we increased servings of dairy foods (77 kcal/serving). For Model 2, we added one serving of dairy foods and removed one serving of refined grains (85 kcal/serving), and for Model 3 (2400 kcal HMEP only), we added one-half serving of dairy foods and removed one-half serving of refined grains. We then assessed these models for nutrient adequacy and compared them to the Healthy U.S.-Style Eating Pattern and the HMEP.
The changes to the HMEP with these models increased the amounts of several nutrients to encourage, including calcium, vitamin D, potassium, vitamin A, phosphorus, riboflavin, vitamin B12, zinc, and magnesium. For instance, Model 1 increased the calcium (by 295 mg), vitamin D (by 59.3 IU), potassium (by 235 mg), vitamin A (by 98 mcg), and phosphorus (by 232 mg) content of the original HMEP, and Model 3 increased the amounts of these nutrients by half of those amounts. Model 2 increased the calcium content by 266 mg, vitamin D by 58 IU, potassium by 202 mg, vitamin A by 88 mcg, and phosphorus by 193 mg. Notably, Models 1 and 2 increased the vitamin D content of the HMEP to about 62% of the DRI (average across all calorie levels) and the potassium content to 78% of the DRI (average across all calorie levels), from 52% and 73%, respectively, in the original HMEP. Most of our models increased the saturated fat (0.5 g in Model 1 and 0.2 g in Model 2) and sodium (202 mg in Model 1 and 101 mg in Model 2) content as well. The amounts of these nutrients to limit remained within the ranges recommended in the 2015 DGA.
The addition of a dairy food serving to the 1600, 2000, and 2400 kcal HMEP brings their nutrient profiles closer to the DRIs for several nutrients to encourage, including calcium, vitamin D, and potassium.

The prevalence of adverse mental health outcomes in adults is increasing. Although beneficial effects of selected micronutrients and foods on mental health have been reported, they do not reflect the impact of the habitual diet on mental health. Therefore, our objective is to examine potential associations between dietary quality, dietary composition and compliance with food pyramid recommendations with depressive symptoms, anxiety and well-being (assessed using CES-D, HADS-A and WHO-5 screening tools) in a cross-sectional sample of 2047 middle-aged adults. Diet was assessed using a self-completed FFQ. Chi-square tests, t-tests and logistic regression analyses were used to investigate the associations between dietary components and mental health outcomes. Dietary quality, but not dietary composition or guideline adherence, was associated with well-being. Those with high dietary quality were more likely to report well-being (OR =1.67, 95% CI 1.15-2.44, p = 0.007) relative to those with low dietary quality. This remained significant among females (OR = 1.92, (95% CI 1.14-3.23, p = 0.014) and non-obese individuals (OR = 2.03, 95% CI 1.28-3.20, p = 0.003). No associations between any dietary measures with anxiety or depressive symptoms were observed. These novel results highlight the importance of dietary quality in maintaining optimal psychological well-being. Better understanding of the relationship between dietary quality and mental health may provide insight into potential therapeutic or intervention strategies to improve mental health and well-being.

OBJECTIVE: To determine the relationship between adherence to the 2010 Dietary Guidelines for Americans and adiposity in young women with and without statistical adjustment for physical activity (PA).
METHODS: Participants included 324 young women (aged 17-25 years). The researchers measured dietary intake using the Dietary History Questionnaire and determined diet quality using the 2010 Healthy Eating Index (HEI-2010). BOD POD (Cosmed, Rome, Italy, 2006) and accelerometry were used to assess body fat and PA, respectively.
RESULTS: Women in the top quartile of HEI-2010 had significantly lower percent body fat than women in the lowest 3 quartiles (F = 3.36; P = .03). Controlling for objectively measured PA weakened this relationship by 20%. These young women (top quartile of HEI-2010) also had 0.37 odds (95% confidence interval, 0.16-0.85) of having body fat > 32%.
CONCLUSIONS: Young women whose diets most closely meet the 2010 Dietary Guidelines for Americans have lower adiposity.