(P14-083-23) Associations Between Eating Meals Prepared Outside the Home, Perceived Diet Quality, and the Healthy Eating Index-2015 in U.S. Adults: An Analysis of NHANES 2017-2018

Objectives: Individual-level diet-related behaviors are common intervention targets for improving diet quality to reduce the risk of diet-related chronic disease. We examined the relationship between perceived diet quality and frequency of eating foods prepared outside the home and the Healthy Eating Index-2015 (HEI-2015) in a nationally representative sample of U.S. adults.

Methods: In this cross-sectional analysis of NHANES 2017 – 2018, adults aged ≥20 who were not pregnant or breast feeding, not on a special diet, had complete data, and had reliable 24-h dietary recalls were included. The HEI-2015 was calculated from two 24-h dietary recalls. Responses from the diet behavior and nutrition survey were used to assess perceived diet quality and frequency of eating foods prepared outside the home. Bivariate analyses were used to assess the relationship between these diet-related behaviors and the HEI-2015. Significant predictors of the HEI-2015 identified in the bivariate analyses were included in a multiple linear regression model adjusted for demographic characteristics including age, gender, income-to-poverty ratio, education, race/ethnicity, marital status, and food security status.

Results: The analytic sample included 2,957 individuals; the weighted mean HEI-2015 score was 51.97 points (95% CI 50.28, 53.65). After adjustment for demographic characteristics, perceived diet quality (p < .0005), eating out (p = 0.0004), and eating frozen meals/pizza (p = .0006) were significant predictors of total HEI-2015 score (R²_adj = 0.19, p < .0001). Very good/good perceived diet quality was associated with a 5.77 point higher HEI-2015 score compared to perceptions of fair/poor. Eating out ≥5 times a week was associated with a 4.33 point lower HEI-2015 score relative to not eating out. Similarly, eating frozen meals/pizza ≥3 times a month was associated with a 3.41 point lower HEI-2015 score compared to no intake of frozen meals.

Conclusions: Individual-level diet-related behaviors were significant predictors of diet quality; however, these factors accounted for a relatively small proportion of the total variance in the HEI-2015 score. Further research examining environment-level determinants of diet quality is needed to inform interventions targeting diet quality improvement.

Funding Sources: Texas Tech University