Adam Drewnowski

Adam Drewnowski
University of Washington Seattle | UW · Department of Epidemiology

About

550
Publications
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Publications

Publications (550)
Article
Full-text available
The ongoing nutrition transition in lower- and middle-income countries (LMIC) in South East Asia may have a positive impact on protein nutrition. This study assessed the diversity of plant and animal protein food sources in relation to essential amino acid (EAA) adequacy in a population-based sample ( N 1665) in Indonesia. Dietary intakes from in-p...
Article
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Objective To examine associations between neighborhood built environment (BE) variables, residential property values, and longitudinal 1- and 2-year changes in body mass index (BMI). Methods The Seattle Obesity Study III was a prospective cohort study of adults with geocoded residential addresses, conducted in King, Pierce, and Yakima Counties in...
Article
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Government agencies and private companies have supported the development of nutrient profiling (NP) systems to facilitate the selection of nutrient-dense foods by consumers, promote nutritious food development, and limit excessive advertising of products with low nutritional value. While most NP models were developed to assess individual foods, the...
Article
Background: Neighborhoods may play an important role in shaping long-term weight trajectory and obesity risk. Studying the impact of moving to another neighborhood may be the most efficient way to determine the impact of the built environment on health. We explored whether residential moves were associated with changes in body weight. Methods: K...
Article
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Background Starchy vegetables, including white potatoes, are often categorized as “lower-quality” carbohydrate foods, along with refined grains, 100% fruit juices, sweetened beverages, and sugars, snacks and sweets. Among “higher-quality” carbohydrates are whole grains, non-starchy vegetables, legumes, and whole fruits. Objective To apply multiple...
Article
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Background Nutrient profiling (NP) models that are used to assess the nutrient density of foods can be based on a combination of key nutrients and desirable food groups.Objective To compare the diagnostic accuracy of a new balanced hybrid nutrient density score (bHNDS) to Nutri-Score and Health Star Rating (HSR) front-of-pack systems using receiver...
Article
In the presence of unmeasured spatial confounding, spatial models may actually increase (rather than decrease) bias, leading to uncertainty as to how they should be applied in practice. We evaluated spatial modelling approaches through simulation and application to a big data electronic health record study. Whereas the risk of bias was high for pur...
Article
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Background Plant-based diets in lower-income countries are often associated with inadequate protein nutrition and adverse health outcomes. Objective To examine the diversity of protein food sources, in both animal and plant, across diverse socio-demographic groups in Indonesia as compared to Malaysia. Design The SCRiPT (Socio Cultural Research in...
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PurposeWhole grains, generally recognised as healthy choices, are not included in most nutrient profiling systems. We tested modifications to the Nutri-Score algorithm to determine whether including whole grains would provide an improved measure of food, and overall diet quality.Methods The whole-grain content of food, with a minimum cut-point of 2...
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Improving the nutrient density of processed foods is one way to bring the global food supply closer to the WHO Sustainable Development Goals. Nutrient profiling (NP) has emerged as the preferred method of monitoring the progress toward product innovation and reformulation. This paper presents PepsiCo Nutrition Criteria (PNC), a new internal NP mode...
Article
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To explore the built environment (BE) and weight change relationship by age, sex, and racial/ethnic subgroups in adults. Weight trajectories were estimated using electronic health records for 115,260 insured Kaiser Permanente Washington members age 18–64 years. Member home addresses were geocoded using ArcGIS. Population, residential, and road inte...
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Background The COVID-19 pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support, and identify long-term impacts and needs. Objective The National Food Access and COVID research Team (NFACT) was formed to assess food security over different U.S...
Article
Typical diets include an assortment of unprocessed, processed, and ultra-processed foods, along with culinary ingredients. Linear programming (LP) can be used to generate nutritionally adequate food patterns that meet pre-defined nutrient guidelines. The present LP models were set to satisfy 22 nutrient standards, while minimizing deviation from th...
Article
Objective: Health system data were assessed for how well they can estimate obesity prevalence in census tracts. Methods: Clinical visit data were available from two large health systems (Kaiser Permanente Washington and University of Washington Medicine) in King County, Washington, as were census tract-level obesity prevalence estimates from the...
Article
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Background: Plant-based beverages (PBB) that are marketed as alternatives to cow milk are gaining in popularity worldwide. Nutrient quality of PBB can be highly variable. Objective: To develop a set of voluntary or mandatory nutrient standards for the PBB product category in order to assist innovation and guide product development and reformulation...
Article
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To determine whether selected features of the built environment can predict weight gain in a large longitudinal cohort of adults. Weight trajectories over a 5-year period were obtained from electronic health records for 115,260 insured patients aged 18–64 years in the Kaiser Permanente Washington health care system. Home addresses were geocoded usi...
Article
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Economics represents one of the four dimensions of sustainable nutrition. Affordable nutrient density is a key indicator of access to sustainable healthy diets. While the nutritional value of foods is assessed using nutrient density metrics, affordability metrics assess energy content and nutritional value of foods in relation to their cost. To be...
Article
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Many plant-based beverages (PBBs) in the US Department of Agriculture Branded Food Products Database serve as milk alternatives or replacements. Their collective nutrient content and fortification patterns need to be evaluated more fully. Listed ingredients for 641 PBBs were machine-searched for added vitamins, minerals, sugar and salt. The Nutrien...
Preprint
Full-text available
Background. The COVID-19 pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support, and identify long-term impacts and needs. Objective. Our team- the National Food Access and COVID research Team (NFACT) was formed to assess food security over di...
Article
This study explored the characteristics of plant-based beverages (PBBs) that are marketed as “milks” in the United States. First, machine searches of product names and ingredients in the USDA Branded Food Products Database (BFPDB) yielded 641 nondairy PBBs that included almond, soy, coconut, cashew, other tree nut, flax/hemp, pea, and quinoa and ri...
Preprint
In the presence of unmeasured spatial confounding, spatial models may actually increase (rather than decrease) bias, leading to uncertainty as to how they should be applied in practice. We evaluated spatial modeling approaches through simulation and application to a big data electronic health record study. Whereas the risk of bias was high for pure...
Article
Full-text available
Balancing the social, economic and environmental priorities for public health is at the core of the United Nations (UN) approaches to sustainable development, including the Sustainable Development Goals (SDGs). The four dimensions of sustainable diets are often presented as health, society, economics, and the environment. Although sustainable diet...
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Background: Hybrid nutrient density scores are based on both nutrients and selected food groups. Objective: To compare the new hybrid nutrient-rich food NRFh 4:3:3 score to other nutrient-rich food (NRF) scores, energy density, and energy cost and to model the impact on the Healthy Eating Index (HEI-2015) of partially replacing less nutrient-rich w...
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Nutrient profiling systems, initially designed to promote healthy food choices at the point of sale, can also provide the scientific basis for innovation and product reformulation by the food industry. This work presents a new profiling system to help define feasible nutrient targets for reformulation of packaged foods. The focus is on five key nut...
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Purpose Bariatric surgery is the most effective treatment for severe obesity, but currently, only 1–2% of all eligible patients undergo surgery each year. This study examined which factors were associated with a patient receiving bariatric surgery after referral in a real-world healthcare setting. Materials and Methods The current study used the b...
Article
Bariatric surgery is associated with changing food preferences, but it is not known whether these changes differ by type of operation or are associated with weight loss. The current study presents validation results for a new 27-item scale, Bariatric Surgical Alterations in Tolerability, Enjoyment and Cravings in the Diet (BSATED). This scale measu...
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Americans waste about a pound of food per day. Some of this is represented by inedible food waste at the household level. Our objective was to estimate inedible food waste in relation to diet quality and participant socio-economic status (SES). Seattle Obesity Study III participants (n = 747) completed the Fred Hutch Food Frequency Questionnaire (F...
Article
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Healthy eating patterns, as described by dietary guidelines, typically favor whole grains, low-fat dairy, vegetables, fruit, legumes, and nuts and seeds. Nutrient-profiling (NP) models capture nutrient density of individual foods and can inform healthier food choices. Although whole grains are prominently featured in most dietary guidelines, they a...
Article
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Background Sustainable healthy diets are those dietary patterns that promote all dimensions of individuals’ health and well-being; have low environmental pressure and impact; are accessible, affordable, safe, and equitable; and are culturally acceptable. The food environment, defined as the interface between the wider food system and consumer’s foo...
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Background The global policy discourse on sustainability and health has called for dietary transformations that require diverse, concerted actions from governments and institutions. In this article, we highlight the need to examine sociocultural influences on food practices as precursors to food policy decisions. Discussion Sociocultural food prac...
Article
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Higher consumption of “ultra-processed”(UP) foods has been linked to adverse health outcomes. The present paper aims to characterize percent energy from UP foods by participant socio-economic status (SES), diet quality measures, self-reported food expenditure, and energy-adjusted diet cost. Participants in the population-based Seattle Obesity Study...
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Background: Choosing water in place of sugar-sweetened beverages (SSB) can reduce added sugars while maintaining adequate hydration. The present goal was to examine 2011–16 time trends in SSB vs. water consumption across US population subgroups. Methods: Dietary intake data for 22,716 persons aged >4 years came from two 24-h dietary recalls in succ...
Article
Objective Affordable nutrition refers to the relation between nutrient density of foods and their monetary cost. There are limited data on affordable nutrition in low- and middle-income countries (LMIC). The present study aimed to develop a nutrient density score and nutrient affordability metrics for 377 most consumed foods in Brazil. Design The...
Article
Adherence to the Dietary Guidelines for Americans (DGA) may involve higher diet costs. This study assessed the relation between two measures of food spending and diet quality among adult participants (N = 768) in the Seattle Obesity Study (SOS III). All participants completed socio-demographic and food expenditure surveys and the Fred Hutch food fr...
Article
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Coffee, obtained from various sources, is consumed by most United States adults. The present analyses of one and two 24-h dietary recalls for 14,865 persons aged ≥20 years in the 2011–2016 National Health and Nutrition Examination Survey (NHANES 2011–2016) aimed to identify socio-demographic predictors of coffee consumption and to examine whether c...
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Background In‐person assessments of physical activity (PA) and body weight can be burdensome for participants and cost prohibitive for researchers. This study examined self‐reported PA and weight accuracy and identified patterns of misreporting in a diverse sample. Methods King, Pierce, and Yakima county residents, aged 21‐59 years,,(n = 728) self...
Article
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Background: Dietary guidelines have shifted emphasis from single nutrients to food patterns, food groups, and dietary ingredients. Nutrient profiling models need to do the same.Methods: Dietary intake data for 23,643 persons aged >2 years came from the 2011–2016 National Health and Examination Survey (NHANES 2011-16). Healthy Eating Index HEI-2015...
Article
Objectives In the United States, replacing sugar-sweetened beverages (SSB) with plain drinking water is recommended via by numerous public health agencies and non-governmental organizations. While declines in SSB consumption in the US are well-documented, it is not clear if consumers are replacing SSBs with other beverages, namely plain drinking wa...
Article
Objectives Young US adults consume inadequate amounts of recommended food groups, including fruit, vegetables, and whole grains but little is known about their fluid consumption. The present study aimed to evaluate if this population is meeting the recommendations for adequate fluid intake issued by National Academy of Medicine (NAM). Methods Beve...
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The amounts of animal-sourced foods required to achieve a least-cost nutritious diet depend on the food prices prevalent in each country. Using linear programming, we determine least-cost dietary patterns in the United States and the constituent amounts of animal-sourced foods. We considered local foods and prices from 2009–2010, and the average en...
Article
Background: Many of the health benefits of tea have been attributed to its flavonoid content. Tea consumption in US adults varies by socioeconomic status (SES). Objectives: The present objective was to explore intakes of total flavonoids and flavonoid subclasses by participant sociodemographics and by patterns of tea consumption. Methods: The...
Article
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Countries in South East Asia are undergoing a nutrition transition, which typically involves a dietary shift from plant to animal proteins. To explore the main drivers of protein consumption, the SCRiPT (Socio Cultural Research in Protein Transition) study recruited a population sample in Malaysia (N = 1604). Participants completed in-person 24 h d...
Article
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Global challenges associated with a growing demand for food in the face of finite natural resources and climate change have prompted concerns about the sustainability of our current food systems. As formulated by the Food and Agriculture Organization, the four principal domains of sustainable diets are health, economics, society, and the environmen...
Article
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This article is based on a session at ASN 2019 entitled "Addressing the Four Domains of Sustainable Food Systems Science (Health, Economics, Society and the Environment): What Will It Take to Harmonize the Evidence to Advance the Field?" A summary of presentations is included. The presentations addressed the 4 principal domains of sustainability de...
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This study explored consumption patterns of 100% orange juice by socio-demographics among US children and adults. Dietary intakes data for 15,983 persons aged >2 y came from the nationally representative National Health and Nutrition Examination Survey (NHANES 2013–2016). The What We Eat in America nutrient composition database was merged with the...
Article
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Obesity is thought to be the product of over 100 different factors, interacting as a complex system over multiple levels. Understanding the drivers of obesity requires considerable data, which are challenging, costly and time-consuming to collect through traditional means. Use of ‘big data’ presents a potential solution to this challenge. Big data...
Article
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This article is based on a session at ASN 2019 entitled Nutrients, Foods, Diets, People: Promoting Healthy Eating. A summary of the 4 presentations at this session is included in this article. The overarching themes that link these 4 presentations are sustainability and food systems. The subjects range from newer definitions of healthy eating to li...
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Background: The US Food and Drug Administration has modified its regulations on nutrient content claims by considering healthy dietary ingredients as well as nutrients. Objective: To assess the relation between dairy and fruit as main ingredients in children's snacks and the Nutrient Rich Food (NRF8.3) nutrient density score. Methods: Commonly cons...
Article
Introduction: There has been considerable work performed on nutrient profiling to assess the nutritional contribution of a food to a healthy dietary pattern. Most profiling approaches have focused on nutrients to limit and nutrients to encourage. A few profiling approaches have also included certain food groups in the profiling algorithm. Objective...
Article
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The category of “ultraprocessed” foods in the NOVA food classification scheme is ostensibly based on industrial processing. We compared NOVA category assignments with the preexisting family of Nutrient Rich Food (NRF) indices, first developed in 2004. The NRF indices are composed of 2 subscores: the positive NR based on protein, fiber, and vitamins...
Article
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Background: Dietary Guidelines for Americans 2015-20 recommend choosing water in place of sugar-sweetened beverages (SSB). This study examined water consumption patterns and trends among children and adults in the US. Methods: Dietary intake data for 7453 children (4-18y) and 15,263 adults (>19y) came from two 24 h dietary recalls in three cycle...
Article
Nutrient profiling (NP) models, intended to capture the full nutritional value of plant-based foods, ought to incorporate bioactive phytochemicals, including flavonoids, in addition to standard nutrients. The well-established Nutrient Rich Food (NRF9.3) score is based on 9 nutrients to encourage (protein, fiber, vitamins A, C, D and calcium, iron,...
Article
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A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, su...
Chapter
Food choices are complex decisions that are largely guided not only by perceptions of taste, cost, and convenience but also by consumer concerns about health, safety, and increasingly, the environment. The concept of taste refers to taste, aroma, texture, and the pleasure response to foods. The cost component covers food prices and the relative aff...
Article
The global spread of diet-related noncommunicable diseases represents a threat to public health and national economies alike. The elimination of poverty and the eradication of hunger, two key United Nations Sustainable Development Goals, cannot be accomplished without a well-nourished labor force. Easy access to low-cost diets that are energy dense...
Article
The built environment (BE) has been viewed as an important determinant of health. Numerous studies have linked BE exposure, captured using a variety of methods, to diet quality and to area prevalence of obesity, diabetes, and cardiovascular disease. First‐generation studies defined the neighborhood BE as the area around the home. Second‐generation...
Article
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Dietary Guidelines for Americans 2015–20 recommend replacing sugar sweetened beverages (SSBs) with plain water in order to promote adequate hydration while reducing added sugar intake. This study explored how water intakes from water, beverages, and foods are distributed across the day. The dietary intake data for 7453 children (4–18 y) and 15,263...
Article
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Flavonoid-rich tea offers an alternative to sugar-sweetened beverages. The present analyses, based on 2 24-hour dietary recalls for 17,506 persons aged ≥9 years old in the 2011-2016 National Health and Nutrition Examination Survey database (NHANES 2011-2016), explored tea consumption patterns in relation to demographics, diet quality, cardiovascula...