title: Nutrition facts panel use is associated with higher diet quality and lower glycated hemoglobin concentrations in US adults with undiagnosed prediabetes.
abstract: The majority of US consumers use the nutrition facts panel (NFP) or health claims for food selections. Although previous studies have consistently reported positive impacts of NFP use on dietary intake, evidence regarding the effect of the use of health claims, either alone or in combination with the NFP, on diet quality and health outcomes is scarce.
  
  
  
  Our primary objective was to test for associations of the use of food labels (the NFP or health claims) with overall diet quality in individuals with prediabetes. In addition, we examined the association between food label use and glycated hemoglobin (HbA1c) concentrations.
  
  
  
  We conducted a weighted linear regression, which was appropriate for a complex sampling survey, with the use of cross-sectional data from 2654 US adults with undiagnosed prediabetes who participated in the 2005-2010 NHANES cycles. The following 4 categories of food label (NFP or health claims) use were identified: 1) both labels, 2) health claims only, 3) neither label, and 4) the NFP only. Healthy Eating Index-2010 score, which we used to assess diet quality, was calculated from two 24-h recalls. Blood samples for analyzing HbA1c concentrations (glycemic control) were collected in the mobile examination center.
  
  
  
  The overall diet quality scores for the use of both labels [b: -2.76 (95% CI: -5.04, -0.48); P = 0.019], of health claims only [b: -3.46 (-6.64, -0.28); P = 0.033], and of neither label [b: -4.01 (-5.75, -2.28); P < 0.001] were lower than those of NFP-only users. Moreover, HbA1c concentrations of users of both labels [b: 0.09% (95% CI: 0.03%, 0.16%); P = 0.008] and health claims only [b: 0.13% (95% CI: 0.02%, 0.25%); P = 0.021] were higher than those of NFP-only users.
  
  
  
  In participants with undiagnosed prediabetes, the use of health claims alone, of both labels, or of neither label (compared with the use of the NFP only) was associated with poorer diet quality. In addition, users of neither label and users of both labels had poorer glycemic control. Further studies are needed to understand why the use of health claims may not be health promoting in this high-risk population.
authors: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT graceanup@gmail.com.
authors: Grace
authors: 0000-0001-8675-8434
authors: G
authors: Kollannoor-Samuel
authors: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
authors: Fatma M
authors: FM
authors: Shebl
authors: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
authors: Nicola L
authors: NL
authors: Hawley
authors: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
authors: Rafael
authors: R
authors: Pérez-Escamilla
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D000072001:Diet, Healthy; D002149:Energy Intake; D015444:Exercise; D005260:Female; D005515:Food Labeling; D005518:Food Preferences; D063427:Food Quality; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006304:Health Status; D006630:Hispanic or Latino; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009752:Nutritional Status; D011236:Prediabetic State / Q000097:blood* / Q000175:diagnosis / Q000178:diet therapy; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: diet quality; food label; glucose control; health claims; nutrition facts panel; prediabetes