(PO08-17-22) Adherence, Compliance, and Diet Quality Among Popular Diet Followers

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Presenting Author(s)

Suzannah Gerber, MA
– PhD Student, Researcher, Tufts University, MEDFORD, Massachusetts, United States

Co-Author(s)

GR

Gail T. Rogers, MA
– JM USDA HNRCA at Tufts University, Boston, Massachusetts, United States
Kara A. Livingston, MPH
– Sr. Project & Data Manager, Tufts University, Boston, Massachusetts, United States
Micaela C. Karlsen, PhD, MSPH
– Sr. Director of Research, American College of Lifestyle Medicine, Chesterfield, Missouri, United States
SF

Sara C. Folta, PhD
– Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States
PJ

Paul F. Jacques, DSc
– Professor, USDA, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States
EN

Elena N. Naumova, PhD
– Professor, Tufts University Friedman School of Nutrition Science and Policy, Boston, Massachusetts, United States
NM

Nicola M. McKeown, PhD
– Boston University

Disclosure(s):

Suzannah Gerber, MA: No relevant financial relationship(s) with ineligible companies to disclose.

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 percent-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