Adherence, Compliance, and Diet Quality Among Popular Diet Followers. (14th June 2022)

• Record Type: Journal Article
• Authors: Gerber, Suzannah; Rogers, Gail; Staffier, Kara; Karlsen, Micaela; Folta, Sara; Jacques, Paul; Naumova, Elena; McKeown, Nicola
• Is Part Of: Current developments in nutrition. Volume 6(2022)Supplement 1
• Page Start: 364
• Page End: 364
• Publication Date: 2022-06-14
• Subjects: Nutrition -- Periodicals; Nutritional Physiological Phenomena; Nutrition; Periodicals; Periodicals; Fulltext; Internet Resources; Periodicals; 612.3
• DOI: 10.1093/cdn/nzac054.019
• Languages: English
• ISSNs: 2475-2991

Abstract

Abstract: Objectives: 1. To compare diet quality of vegan, vegetarian, paleo, and whole-food plant-based (WFPB) diets; 2. To examine how adherence varies by diet and relates to quality and diet duration; 3. To examine how compliance varies by diet and relates to quality, adherence, and duration. Methods: Analysis was conducted on a subsample of ADAPT participants (n = 1392) who completed a demographics and food frequency questionnaire (FFQ; DHQ-II). After excluding implausible energy intake (600 ≤ KCAL < 5, 000), the final sample was 1291 (vegan [n = 355]; vegetarian [n = 90]; WFPB [n = 710]; paleo [n = 136]). Diet quality was measured with HEI and AHEI. Duration was categorized as short [<2 years (n = 501)]; moderate [2 to <7 y (n = 200)]; and long-term [7–10 + y (n = 592)]. A self-report adherence score was derived from questions targeting commitment to diet, ranging from 0–32. Compliance score for each diet was derived from reported intakes and DHQ-II (i.e., diet-specific restrictions), and data were %-based standardized. Models were adjusted for age and sex; select models were adjusted for diet duration. Results: Mean (SD) HEI score was high in all plant-based diets, highest for WFPB 76.7(5.8), vegan 75.7 (6.5), vegetarian 72.6 ( 9.2), compared to paleo 62.5 (8.5); and with a similar ranking for AHEI. Vegans had highest mean adherence 23.5 (2.8) and paleos the lowest 20.0 (3.3). Vegetarians had highest mean compliance 71% (9) and WFPB lowest 53% (10). Compliance was positively associated with HEI score for WFPB and vegan with one percentage point of compliance associated with a 6.4-point increase in HEI for WFPB (SE ± 2, p < .004) and 17.1 for vegan (SE ± 4, p < .0001). For every point increase in compliance, adherence improved (5.4 ± 0.8, p < .0001) in the full sample, and by diet group. Diet duration was significantly associated with adherence in all but vegetarian. No relationship was observed between duration and compliance within diet. Conclusions: WFPB and vegan diets had the highest diet quality; all four had higher mean HEI than reported average in US adults (HEI = 59). Findings suggest that even imperfect compliance to plant-based diets is associated with greater diet quality. Diet adherence is a complex component of eating behavior, however reported adherence appears to predict higher compliance and longer maintenance. Funding Sources: USDA Cooperative Agreements; NIFA National Needs Fellowship.