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Seventy five percent of older adults are affected by multiple chronic diseases. Consuming a high quality diet consisting of fruits, vegetables, whole grains, and lean protein assists with chronic disease prevention and management. Healthful food availability is a major determinant of individual eating behaviors. The purpose of the current study was to describe the types, variety, and density of food outlets and to estimate access to a high quality diet for older adults in an urban setting. The Community Nutrition Environment Evaluation Data System (C-NEEDS) survey and restaurant menus were used to determine availability of healthful food in thirteen neighborhoods in Springfield, Massachusetts. A "Dietary Guidelines for Americans Adherence Index Food Environment" (DGAIFE) algorithm was created to estimate access to a high quality diet based on the stores and restaurants within the study area. Environmental characteristics that are recognized as facilitators or barriers to a high quality diet were added to the DGAIFE algorithm to calculate a "Dietary Guidelines for Americans Adherence Index Food Environment plus Environmental Characteristics" (DGAIFEC) score. The DGAIFE and DGAIFEC score ranges for all study areas were 1.53-2.25 and 1.38-2.50, respectively (possible range 1.00 higher to 5.00 lower access). Access to a high quality diet is within reach but not equal across the thirteen study areas. The findings can be used by Registered Dietitians to guide clients to make healthful food choices in urban neighborhoods and provides information to improve public health policy to increase access to healthful foods.

Food insecurity, poor diet quality, and periodontal disease are critical problems in the United States, yet limited studies examine how these three conditions are related. Men and the Hispanic population suffer a disproportionate burden of periodontal disease and are understudied groups. Using NHANES data from 2015 to 2018 and the HEI-2015, this study describes the prevalence of men’s periodontitis and its association with food insecurity and diet quality. The final sample was 4,582 men, aged 30 years or older, of whom 1,130 were Hispanic. Odds ratios were calculated via multivariable logistic regression models. Very low food security significantly increased the odds of perceived periodontitis in Hispanic men (AOR = 2.11, 95% CI (1.21-3.70), p = .01) and in all men (AOR = 1.69, 95% CI (1.15-2.48), p = .01). Diet quality had no association with perceived periodontitis in all Hispanic men or in all men. The effect of food insecurity on periodontitis was not mediated by diet quality. Culturally competent strategies addressing men’s health should target food insecurity and diet quality as individual influences on periodontal health.

Regular breakfast consumption among adolescents has been linked to decreased risk of obesity and chronic diseases, improved cognition and improved nutrient intake in adolescents. Despite this, research has indicated that adolescent breakfast consumption is declining globally. Adolescents are at particularly high-risk for health compromising behaviours such as increased fast food consumption, increased sedentary levels and frequent breakfast skipping. Research shows that lifestyle and behaviour habits which are entrenched during adolescence are likely to remain throughout adulthood. The reported prevalence of breakfast skipping among different adolescent population groups in South Africa ranges from 13 to 36%. However, little is known about breakfast behaviour among adolescents in the South African context. Studying breakfast behaviour and the mechanism by which breakfast influences positive health outcomes creates an understanding of the magnitude of the problem to be addressed and guides effective recommendations for public health guidelines. The aim of the present study was to determine the proportion and quality of breakfast intake among adolescents attending public secondary schools in Potchefstroom and its surrounding areas in the Northwest Province, and to determine the effect of breakfast intake and quality on overall diet quality and other lifestyle behaviours. A cross sectional quantitative study design was used. Adolescents in grades nine to eleven (n = 254) were randomly selected from seven public secondary schools across quintiles in Potchefstroom and its surrounding areas in the Northwest Province of South Africa. A basic self-administered demographic questionnaire was used. A single 24-hour recall using the four-stage multiple pass method was conducted to obtain information on breakfast and dietary intake for the day. A self-administered questionnaire was used to select the type of breakfast usually consumed by the adolescents. Height and weight were measured by a level one anthropomotrist. Dietary data was analysed using the Medical Research Council Food Composition Tables. Breakfast quality was measured through the allocation of a breakfast quality score and the Diet Quality Index Revised (DQI-R) was used to assess the quality of the overall diet. Associations between breakfast intake and categorical characteristics were assessed by either the Chi-squared Test or Fisher’s Exact Test. Spearman correlations were used to assess the associations between breakfast quality score and continuous variables. The threshold for statistical significance was set at 0.05. The Goldberg cut-off was applied to exclude over- and under-reporters. Information was collected for 244 adolescents with a mean age of 17.5 years (± 2.3). The proportion of breakfast intake and skipping was 81% and 19% respectively. The mean breakfast quality score was 3.1 out of a possible score of 5, indicating moderate breakfast quality which incorporates one of the Australian Guide to Healthy Eating (AGHE) food groups. Breakfast intake was influenced by race, and breakfast quality was influenced by participation in physical activity. Breakfast eaters and skippers showed no significant difference in diet quality score. Breakfast quality score was marginally associated with calcium intake (p<0.0001; r=0.418), phosphorous intake (p<0.0001; r=0.378) and total diversity score (p<0.0001; r=0.369). The foods most frequently consumed at breakfast were bread, milk, ready-to-eat cereal (RTEC) and maize porridge. In conclusion, breakfast skipping proportion was consistent with published South African data. The quality of the breakfast consumed among adolescents in the present study was moderate. Cultural and socio-environmental factors may influence breakfast intake and breakfast quality among adolescents. Breakfast intake did not influence diet quality, but the intake of certain foods at breakfast improved the mean scores for components of the DQI-R and improved the intake of key nutrients. It is recommended that the governmental departments responsible for the Integrated School Health Policy (ISHP) incorporate breakfast messaging into the nutrition education component of the ISHP. Facilitators involved in implementing the ISHP, such as School-based support teams, teachers and healthcare professionals are encouraged to continue the promotion of breakfast intake among adolescents. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2014

Regular breakfast consumption among adolescents has been linked to decreased risk of obesity and chronic diseases, improved cognition and improved nutrient intake in adolescents. Despite this, research has indicated that adolescent breakfast consumption is declining globally. Adolescents are at particularly high-risk for health compromising behaviours such as increased fast food consumption, increased sedentary levels and frequent breakfast skipping. Research shows that lifestyle and behaviour habits which are entrenched during adolescence are likely to remain throughout adulthood. The reported prevalence of breakfast skipping among different adolescent population groups in South Africa ranges from 13 to 36%. However, little is known about breakfast behaviour among adolescents in the South African context. Studying breakfast behaviour and the mechanism by which breakfast influences positive health outcomes creates an understanding of the magnitude of the problem to be addressed and guides effective recommendations for public health guidelines. The aim of the present study was to determine the proportion and quality of breakfast intake among adolescents attending public secondary schools in Potchefstroom and its surrounding areas in the Northwest Province, and to determine the effect of breakfast intake and quality on overall diet quality and other lifestyle behaviours. A cross sectional quantitative study design was used. Adolescents in grades nine to eleven (n = 254) were randomly selected from seven public secondary schools across quintiles in Potchefstroom and its surrounding areas in the Northwest Province of South Africa. A basic self-administered demographic questionnaire was used. A single 24-hour recall using the four-stage multiple pass method was conducted to obtain information on breakfast and dietary intake for the day. A self-administered questionnaire was used to select the type of breakfast usually consumed by the adolescents. Height and weight were measured by a level one anthropomotrist. Dietary data was analysed using the Medical Research Council Food Composition Tables. Breakfast quality was measured through the allocation of a breakfast quality score and the Diet Quality Index Revised (DQI-R) was used to assess the quality of the overall diet. Associations between breakfast intake and categorical characteristics were assessed by either the Chi-squared Test or Fisher’s Exact Test. Spearman correlations were used to assess the associations between breakfast quality score and continuous variables. The threshold for statistical significance was set at 0.05. The Goldberg cut-off was applied to exclude over- and under-reporters. Information was collected for 244 adolescents with a mean age of 17.5 years (± 2.3). The proportion of breakfast intake and skipping was 81% and 19% respectively. The mean breakfast quality score was 3.1 out of a possible score of 5, indicating moderate breakfast quality which incorporates one of the Australian Guide to Healthy Eating (AGHE) food groups. Breakfast intake was influenced by race, and breakfast quality was influenced by participation in physical activity. Breakfast eaters and skippers showed no significant difference in diet quality score. Breakfast quality score was marginally associated with calcium intake (p<0.0001; r=0.418), phosphorous intake (p<0.0001; r=0.378) and total diversity score (p<0.0001; r=0.369). The foods most frequently consumed at breakfast were bread, milk, ready-to-eat cereal (RTEC) and maize porridge. In conclusion, breakfast skipping proportion was consistent with published South African data. The quality of the breakfast consumed among adolescents in the present study was moderate. Cultural and socio-environmental factors may influence breakfast intake and breakfast quality among adolescents. Breakfast intake did not influence diet quality, but the intake of certain foods at breakfast improved the mean scores for components of the DQI-R and improved the intake of key nutrients. It is recommended that the governmental departments responsible for the Integrated School Health Policy (ISHP) incorporate breakfast messaging into the nutrition education component of the ISHP. Facilitators involved in implementing the ISHP, such as School-based support teams, teachers and healthcare professionals are encouraged to continue the promotion of breakfast intake among adolescents. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2014

Introdução: O aumento na prevalência de doenças crônicas não transmissíveis (DCNT) tem resultado em mudança nos padrões de mortalidade em vários países, inclusive no Brasil. Considerando associação entre transição demográfica, nutricional e epidemiológica, há necessidade de ações em saúde direcionadas à prevenção de doenças e agravos, aliada a estratégias de promoção da saúde da população, de forma a proporcionar maior qualidade de vida aos indivíduos. Objetivo: Conduzir análise custo-efetividade da dieta de uma amostra de pacientes com idade igual ou superior a 50 anos, usuários de Unidades Básicas de Saúde (UBS) do município de Bauru (SP), comparando-se com um padrão de alimentação saudável dentro de parâmetros nutricionais recomendados, preferências alimentares locais e custo similar à alimentação usual dos pacientes. Metodologia: Tratou-se de estudo transversal com caráter retrospectivo, originado de projeto de pesquisa de maior abrangência intitulado \"Relação entre atividade física habitual e desenvolvimento de síndrome metabólica e comorbidades associadas em usuários do sistema público de saúde: Um estudo de coorte de 8 anos\", incluindo aplicação de recordatório 24 horas para registro do consumo alimentar. Adicionalmente, foi realizada pesquisa de preços no varejo para estimativa dos custos da alimentação rotineira e calculada qualidade da dieta por meio do Índice Qualidade da Dieta Revisado adaptado para população brasileira para avaliação da razão custo-efetividade da alimentação dos pacientes da amostra. Resultados: Identificou-se influência positiva da classe econômica, consumo de bebidas alcoólicas e escore de qualidade nutricional da dieta sobre custos da alimentação dos pacientes; assim como incremento da RCE em relação à idade, à escolaridade e ao consumo de bebidas alcoólicas dos indivíduos. Conclusão: A partir da estimativa do custo diário da alimentação, verificou-se possibilidade de mudança na dieta a baixo custo, de forma a reduzir o impacto do fator renda na tomada de decisão pela melhoria da qualidade nutricional da alimentação da população. / Introduction: The increase in the prevalence of non-communicable diseases (NCDs) has resulted in a change in mortality patterns in several countries, including Brazil. Considering the association between demographic, nutritional and epidemiological transition, there is a need for health actions directed to the prevention of diseases and conditions, allied with strategies to promote the health of the population, in order to provide a better quality of life for individuals. Objective: To conduct a cost-effectiveness analysis of the diet of a sample of patients aged 50 years or older, users of Basic Health Units (UBS) in the city of Bauru (SP), comparing them with a healthy eating pattern inside of recommended nutritional parameters, local food preferences and cost similar to the usual diet of the patients. Methodology: This is a retrospective cross-sectional study from a larger research project entitled \"Relationship between habitual physical activity and the development of metabolic syndrome and associated co-morbidities in users of the public health system: An 8-year cohort study \", including application of a 24-hour recall to record food consumption. In addition, a retail price survey was conducted to estimate the costs of routine feeding and calculated diet quality using the Revised Diet Quality Index adapted for the Brazilian population to evaluate the cost-effectiveness ratio of the sample patients\' feed intake. Results: We identified a positive influence of the economic class, consumption of alcoholic beverages and score of nutritional quality of the diet on costs of the patients\' diet; as well as increase of the RCE in relation to the age, the schooling and the consumption of alcoholic beverages of the individuals. Conclusion: From the estimated daily cost of food, was checked a possibility to change the low cost diet, in order to reduce the impact of the income factor in decision making in favor of improving the nutritional quality of the population\'s diet.

Introdução: O aumento na prevalência de doenças crônicas não transmissíveis (DCNT) tem resultado em mudança nos padrões de mortalidade em vários países, inclusive no Brasil. Considerando associação entre transição demográfica, nutricional e epidemiológica, há necessidade de ações em saúde direcionadas à prevenção de doenças e agravos, aliada a estratégias de promoção da saúde da população, de forma a proporcionar maior qualidade de vida aos indivíduos. Objetivo: Conduzir análise custo-efetividade da dieta de uma amostra de pacientes com idade igual ou superior a 50 anos, usuários de Unidades Básicas de Saúde (UBS) do município de Bauru (SP), comparando-se com um padrão de alimentação saudável dentro de parâmetros nutricionais recomendados, preferências alimentares locais e custo similar à alimentação usual dos pacientes. Metodologia: Tratou-se de estudo transversal com caráter retrospectivo, originado de projeto de pesquisa de maior abrangência intitulado \"Relação entre atividade física habitual e desenvolvimento de síndrome metabólica e comorbidades associadas em usuários do sistema público de saúde: Um estudo de coorte de 8 anos\", incluindo aplicação de recordatório 24 horas para registro do consumo alimentar. Adicionalmente, foi realizada pesquisa de preços no varejo para estimativa dos custos da alimentação rotineira e calculada qualidade da dieta por meio do Índice Qualidade da Dieta Revisado adaptado para população brasileira para avaliação da razão custo-efetividade da alimentação dos pacientes da amostra. Resultados: Identificou-se influência positiva da classe econômica, consumo de bebidas alcoólicas e escore de qualidade nutricional da dieta sobre custos da alimentação dos pacientes; assim como incremento da RCE em relação à idade, à escolaridade e ao consumo de bebidas alcoólicas dos indivíduos. Conclusão: A partir da estimativa do custo diário da alimentação, verificou-se possibilidade de mudança na dieta a baixo custo, de forma a reduzir o impacto do fator renda na tomada de decisão pela melhoria da qualidade nutricional da alimentação da população. / Introduction: The increase in the prevalence of non-communicable diseases (NCDs) has resulted in a change in mortality patterns in several countries, including Brazil. Considering the association between demographic, nutritional and epidemiological transition, there is a need for health actions directed to the prevention of diseases and conditions, allied with strategies to promote the health of the population, in order to provide a better quality of life for individuals. Objective: To conduct a cost-effectiveness analysis of the diet of a sample of patients aged 50 years or older, users of Basic Health Units (UBS) in the city of Bauru (SP), comparing them with a healthy eating pattern inside of recommended nutritional parameters, local food preferences and cost similar to the usual diet of the patients. Methodology: This is a retrospective cross-sectional study from a larger research project entitled \"Relationship between habitual physical activity and the development of metabolic syndrome and associated co-morbidities in users of the public health system: An 8-year cohort study \", including application of a 24-hour recall to record food consumption. In addition, a retail price survey was conducted to estimate the costs of routine feeding and calculated diet quality using the Revised Diet Quality Index adapted for the Brazilian population to evaluate the cost-effectiveness ratio of the sample patients\' feed intake. Results: We identified a positive influence of the economic class, consumption of alcoholic beverages and score of nutritional quality of the diet on costs of the patients\' diet; as well as increase of the RCE in relation to the age, the schooling and the consumption of alcoholic beverages of the individuals. Conclusion: From the estimated daily cost of food, was checked a possibility to change the low cost diet, in order to reduce the impact of the income factor in decision making in favor of improving the nutritional quality of the population\'s diet.

Poor diet quality is a source of morbidity and mortality within the United States. Previous researchers have examined psychosocial influences on diet; however, the relationship between life chaos, a psychosocial measure, and diet quality was not known. The purpose of this cross-sectional survey study was to use the Life Chaos Scale and the Healthy Eating Index-2010 to collect data on life chaos and diet quality, consistent with the biopsychosocial model of health, from a sample of 103 U.S. adults. Regression analysis was used to construct a predictive model. According to the study results, life chaos was not a significant predictor of diet quality (p = .699), although household income, when added to the model, was a predictor of diet quality (p = .011). Although there was no relationship between life chaos and diet quality, life chaos could be found universally throughout household income levels. Additionally, diet quality had a negative correlation with household income. Life chaos was not a significant predictor of diet quality, while confirming the role of income in diet quality. As inequalities of health and nutrition continue to be better understood through studies such as this, social change efforts can be targeted in an evidence-based way to bring the health benefits of a high quality diet to more Americans starting with greater outreach to low-income individuals.

Introduction: About 80% of those affected by osteoporosis are postmenopausal women. Therefore, identifying beneficial or harmful dietary factors for postmenopausal osteoporosis may have a significant public health impact. Objectives: The overall objective of this thesis was to examine the relations between various dietary factors and bone health in postmenopausal women aged ≥ 45 years using different analytical approaches. Methods: First, the associations between fruit and vegetables (F&V) intake and indicators of bone health were assessed using a systematic review approach. Electronic databases were searched and peer-reviewed observational and interventional studies published in English with F&V intake as a main dietary exposure were included. Data selection, extraction and evaluation of risk of bias were performed independently by two reviewers. Second, the associations between an overall diet quality index (HEI-2005) and its components with bone turnover markers (BTMs) were examined. Third, the relationships between alpha-tocopherol intake, serum alpha- and gamma-tocopherol, two concentration biomarkers of vitamin E intake, and their ratio and BTMs were assessed. For the second and third studies, cross-sectional data from the National Health and Nutrition Examination Survey 1999-2002 were used. Weighted multiple regression models with adjustments for relevant confounders were used to examine the relationship between exposures and serum bone-specific alkaline phosphatase (BAP), a biomarker of bone formation, and urinary N-Telopeptides/Creatinine (uNTx/Cr), a biomarker of bone resorption. Results: There was significant between-study heterogeneity in design, definition and amount of F&V intake, outcomes, analyses and reporting of results in the eight included studies. Overall, cross-sectional and case-control analyses reported protective associations between F&V intake and bone health, whereas interventional and prospective cohort analyses did not. There were no associations between total HEI-2005 scores and BTMs. However, the Milk Group component of HEI-2005 had a significant inverse relationship with uNTx/Cr. Higher serum gamma-tocopherol and lower ratio of serum alpha- to gamma-tocopherol were associated with higher BAP concentrations but had no associations with NTx/Cr concentrations. Conclusions: The results confirm the existing knowledge that a diet with adequate intake of dairy may reduce bone loss. Further research is needed to examine the potential anabolic effects of gamma-tocopherol on bone in postmenopausal women.