A cross-sectional analysis of baseline diet quality among participants enrolled in delicious eating for life in the southern homes weight loss randomized trial

Background: A healthful dietary pattern, which typically includes regular and generous consumption of healthful fats and carbohydrates, reduces the risk for obesity-related morbidity and mortality. To assess the potential for improving diet quality in the context of a weight loss intervention, it is important to assess baseline measures of diet quality. Aim: To describe the baseline diet quality among participants in a behavioral weight-loss clinical trial. Methods: Participants were referred to this study by primary care clinicians. The Harvard Food Frequency Questionnaire was used to assess dietary intake, and items from this instrument were used to calculate the Alternative Health Eating Index (AHEI)-2010, Dietary Approaches to Stop Hypertension (DASH), and Alternate Mediterranean Diet index scores. Reflection spectroscopy was used to objectively assess skin carotenoids. Results: Among 360 participants, the mean age was 54.7 (SD 12.0) years, 44.1% were male, 36.7% self-identified as Black, 32.5% had type 2 diabetes mellitus, and the median body mass index was 35.1 kg/m 2 (Q1–Q3 32.4–40.2). Median energy intake from fat was 37.2%, including 12.1% from saturated fat, while total carbohydrate intake was 44.8% with total fiber intake 17.0 g/day (Q1–Q3 12.3–23.4). In multivariable models, younger age and Black race were significantly associated with lower AHEI-2010 and DASH scores, representing lower diet quality. Conclusions: Study participants’ dietary intakes were high in saturated fat and low in dietary fiber, underscoring the need for weight loss interventions to focus on diet quality as well as energy restriction.