Given the current prevalence of both cigarette use and obesity in the United States, identification of dietary patterns that reduce mortality risk are important public health priorities. The objective of the present study was to evaluate the correlation between cigarette use and dietary energy density, a marker for diet quality, in a population of current smokers, former smokers, and never smokers. Data from a nationally representative sample of 5293 adults who participated in the 2013–2014 National Health and Nutrition Examination Surveys (NHANES) were analyzed. Specific survey procedures were used in the analysis to account for sample weights, unequal selection probability, and clustered design when evaluating the association between dietary energy density (ED, energy per weight of food, kcal/g) and current smoking status. Never smokers reported < 100 lifetime cigarettes. Smokers were identified as individuals reporting > 100 lifetime cigarettes and current smoking status was recorded as daily, some days (nondaily), or not at all (former). A strong linear relationship was observed between smoking pattern and dietary ED in current smokers. Compared to never smokers, daily smokers and nondaily smokers have significantly higher dietary ED (1.79 vs. 2.02 and 1.88, respectively; both p < 0.05); demonstrating that any amount of current cigarette consumption is associated with poor diet. Though former smokers had a higher dietary ED than never smokers, this difference still significantly lower than that of current smokers (p = 0.002). These findings suggest that smoking status is associated with poor diet quality. Former smokers had a slightly lower ED value (1.84) than current non-daily smokers (1.89) but a higher value than never smokers (1.79).

Recent studies have demonstrated the importance of flavonoid intake and disease risk, however the association between flavonoid intake and obesity has not been evaluated in a nationally representative sample of US adults. The objective of the study was to evaluate the association between flavonoid consumption and established risk factors for obesity and obesity-related inflammation. Data from a nationally representative sample of 9551 adults who participated in the 2005–2008 National Health and Nutrition Examination Survey (NHANES) were analyzed. Flavonoid consumption was inversely associated with obesity in both men and women in multivariate models. Adults in the highest quartile of flavonoid intake had significantly lower body mass index and waist circumference than those in the lowest quartile of flavonoid intake (P<0.03 andP<0.04, respectively), and flavonoid intake was inversely related to C-reactive protein levels in women (p-trend, 0.01). These findings support a growing body of laboratory evidence that flavonoid consumption may be beneficial for disease prevention.

Childhood obesity is an ongoing public health program. As such, a major public health research objective is to identify potential targets for intervention; one such area is school lunches (SL). The National School Lunch Program (NSLP) serves over 31 million children each day; the National Health and Nutrition Examination Survey (NHANES) is uniquely positioned to allow researchers to assess diet quality in federal nutrition assistance programs. The objective of the study was to investigate whether lunches provided by schools provide different nutritional value than lunches obtained elsewhere. In a nationally representative sample of 2190 children, consumption of a school-provided lunch (SL) was associated with greater nutritional quality compared to lunches obtained elsewhere across both age and income categories. Children who were eligible for no-cost school lunch, but did not participate in the NSLP consumed approximately 60% more energy, 58% more total fat, 60% more saturated fat, 50% more solid fat, 61% more sodium, double the amount of added sugars and less than half the amount of fruit than NSLP participants (all p < 0.001). The results of this study suggest that though widely criticized, school lunches provide superior nutrient quality than lunches obtained from other sources, particularly for low-income children.