Investigation of the geographic, sociodemographic, and patient specific differences in plant-based food consumption in youth to inform strategies that promote better nutrition and improve health - ABSTRACT Nearly half of American youth have poor nutrition: 66% of calories come from ultra-processed foods (UPF), 23.5% from healthier unprocessed or minimally processed foods, and 17.5% from junk food. Poor diet in childhood translates to increased risk for adult onset cardiometabolic disease. Differences in diet quality among U.S. youth exist. Although there have been modest improvements in overall diet quality, youth from higher income, non-Hispanic white families, and younger children have benefited more. Plant-based diets (PBDs) can improve poor nutrition, but not all PBDs are healthful. New research tools can evaluate PBDs by their quality and composition. The Overall Plant-Based Diet Index (oPDI) emphasizes all plant-based foods while reducing animal sources. The Healthful Plant-Based Diet Index (hPDI) focuses on minimally processed plant foods and is linked to lower disease risk in adults; while the Unhealthful Plant-Based Diet Index (uPDI) highlights unhealthy plant foods and is linked to higher mortality risk. Despite their utility, these tools haven’t been applied to youth. Further, the relationship between these indices and UPF, as quantified by the NOVA classification system, which measures the extent of food processing, has yet to be assessed in U.S. youth. As with broader nutrition patterns, certain youth may face differences in hPDI, uPDI, and UPF consumption. Children from lower socioeconomic backgrounds often eat more energy-dense, nutrient-poor foods and fewer fruits and vegetables, leading to unhealthy diets high in processed foods and sugary drinks, which likely contributes to higher disease burdens in certain sociodemographic groups. Current understanding of the barriers and facilitators to consuming hPDI, uPDI, and UPF is limited, restricting the design of data-driven interventions. Insights into these dietary patterns will help develop strategies to promote hPDI, reduce uPDI and UPF intake, and address differences in nutrition and health outcomes among youth. This research will use a mixed-method approach to identify at risk children of low hPDI and high uPDI and UPF intake in large populations and clinical settings to inform targeted interventions. In aim 1, I will use National Health and Nutrition Examination Survey to examine temporal trends from 1990-2020 in the quality of and differences in the consumption of PBDs among American youth. In aim 2, I will use the social-ecological model to evaluate hPDI, uPDI, and UPF intake and the barriers and facilitators to consuming these diets among pediatric patients from food or nutrition insecure households. This grant will advance science by understanding the current state of hPDI, uPDI, and UPF intake among youth. These findings can be translated into evidence-based strategies that improve diet, enhance health outcomes, and promote better health for youth. Through this fellowship, I will gain quantitative and qualitative research skills, hands-on experience with primary data collection and secondary data analysis, and regular engagement with pediatric patients and their families. These unique features of this application will combine synergistically to develop the skills required for a career as a pediatrician and dedicated nutrition and public health researcher.
