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Diet guidelines recommend increasing dietary diversity. Yet, metrics for dietary diversity have neither been well-defined nor evaluated for impact on metabolic health. Also, whether diversity has effects independent of diet quality is unknown. We characterized and evaluated associations of diet diversity and quality with abdominal obesity and type II diabetes (T2D) in the Multi-Ethnic Study of Atherosclerosis. At baseline (2000–02), diet was assessed among 5,160 Whites, Hispanic, Blacks, and Chinese age 45–84 y and free of T2D, using a validated questionnaire. Three different aspects of diet diversity were characterized including count (number of different food items eaten more than once/week, a broad measure of diversity), evenness (Berry index, a measure of the spread of the diversity), and dissimilarity (Jaccard distance, a measure of the diversity of the attributes of the foods consumed). Diet quality was characterized using aHEI, DASH, and a priori pattern. Count and evenness were weakly positively correlated with diet quality (r with AHEI: 0.20, 0.04), while dissimilarity was moderately inversely correlated (r = -0.34). In multivariate models, neither count nor evenness was associated with change in waist circumference (WC) or incident T2D. Greater food dissimilarity was associated with higher gain in WC (p-trend<0.01), with 120% higher gain in participants in the highest quintile of dissimilarity scores. Diet diversity was not associated with incident T2D. Also, none of the diversity metrics were associated with change in WC or incident T2D when restricted to only healthier or less healthy foods. Higher diet quality was associated with lower risk of T2D. Our findings provide little evidence for benefits of diet diversity for either abdominal obesity or diabetes. Greater dissimilarity among foods was actually associated with gain in WC. These results do not support the notion that “eating everything in moderation” leads to greater diet quality or better metabolic health.

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Context Symptoms and quality of life (QOL) are critically important in hematopoietic stem cell transplantation (HSCT). However, few studies have examined these factors by transplant type among diverse cultures. Objectives To identify and compare QOL and symptom severity and prevalence by transplant type in a diverse population having HSCT. Methods The M. D. Anderson Symptom Inventory Blood and Marrow Transplantation (MDASI-BMT) module measured symptom severity and its impact. The Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) measured QOL. Results Symptom data were collected from 164 patients at eight points (pretransplant to 100 days post-transplant) and QOL data at four times. Over time, symptom severity was significantly correlated with QOL and patients who had allogeneic transplants with myeloablative regimens showed more severe sleep disturbance and poorer QOL than patients having autologous transplants. Male patients reported less fatigue than female patients. However, ethnicity was not significant. Patients whose functional status was good had fewer of the five worst symptoms and higher QOL than patients with a poor functional status. Patients with acute graft-versus-host disease had more severe symptoms than those who did not. Conclusion Type of transplant and preparative regimen are the most important aspects to consider when managing symptoms and QOL. This information is important for providing anticipatory guidance and support needed during the transplantation experience, to explore in future research the mechanisms involved in symptoms after HSCT, and to develop additional effective interventions.