Racial/Ethnic Disparities in US Adolescents' Dietary Quality and Its Modification by Weight-Related Factors and Physical Activity

There are well-known disparities in the prevalence of obesity across racial-ethnic groups, although the behavioral and psychological factors driving these disparities are less well understood. Therefore, the objectives of this study were: (1) to examine differences in dietary quality by race/ethnicity and weight-related variables [body mass index (BMI), weight loss attempt, and weight dissatisfaction] and physical activity (PA) using the Health Eating Index-2015 (HEI-2015); and (2) to investigate the interactions and independent associations of race/ethnicity, weight-related variables and PA on dietary quality. Data for adolescents aged 12-19 years (n = 3373) were abstracted from the 2007-2014 National Health and Nutrition and Examination Survey and analyzed using multiple PROC SURVEYREG, adjusting for demographics and accounting for complex sampling. Analyses determined that Hispanic males had better overall HEI-2015 scores than non-Hispanic whites (48.4 +/- 0.5 vs. 45.7 +/- 0.6, p = 0.003) or blacks (48.4 +/- 0.5 vs. 45.5 +/- 0.5, p < 0.001). Hispanic females also had better dietary quality than non-Hispanic whites (50.2 +/- 0.4 vs. 47.5 +/- 0.5, p < 0.001) and blacks (50.2 +/- 0.4 vs. 47.1 +/- 0.5, p < 0.001). Meeting the PA recommendation modified racial/ethnic differences in dietary quality for females (p = 0.011) and this was primarily driven by the associations among non-Hispanic white females (Delta R-2 = 2.6%, p = 0.0004). The study identified racial/ethnic and gender differences among adolescents in factors that may promote obesity. Results may be useful for obesity prevention efforts designed to reduce health disparities in adolescents.