Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation





First Advisor

Dr. Martha J. Biddle

Second Advisor

Dr. Debra K. Moser


Cardiovascular diseases (CVDs), a group of disorders of the heart and blood vessels, are the leading cause of death worldwide, causing one-third of deaths each year. Diet is one of the most important behavioral risk factors for CVD. The effects of behavioral risk factors, such as diet, may lead to increased blood pressure, increased blood glucose, raised blood lipids, and overweight and obesity. Inflammation contributes to the development of CVD and can be influenced by diet. Dietary assessment indices can measure diet quality from an individual's dietary intake by scoring food and nutrient intakes. However, the mediation effects of diet quality on the relationship between psychological factors and CVD risks are not well known. Thus, the purposes of this dissertation are to (1) examine the associations between the dietary assessment indices and cardiac-related health outcomes and (2) evaluate the association of diet quality with psychological factors, CVD risks, and plasma levels of inflammatory biomarkers.

Four research studies were included in this dissertation. The first study was a cross-sectional study using National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2014 to evaluate a mediation effect of the inflammatory properties of diet between depressive symptom severity and CVD risk in men and women among the general population. The second study was a cross-sectional design to (1) compare diet quality between community-dwelling older patients with heart failure (HF) and age- and sex-matched healthy older adults and (2) determine an association between HF status and lower diet quality. The third study was a prospective, observational multicenter study to evaluate an association between the inflammatory properties of diet and event-free survival among patients with heart failure. The fourth study was a cross-sectional study to examine the associations among chronic stress, diet quality, and biomarkers of oxidative stress and inflammation among patients with metabolic syndrome.

Results from four studies indicated (1) inflammatory properties of diet mediates the relationship between depressive symptoms and CVD risk in men and women; (2) a lower consumption of whole grains, a lower caloric intake, a higher odds of being in a high micronutrient deficiency group for patients with HF when compared to the similarly aged healthy older adults; (3) the inflammatory properties of diet was an independent predictor of all-cause hospitalization and death in patients with HF; and (4) diet quality was a part of serial mediation paths between perceived chronic stress and a CVD-related inflammatory biomarker, high-sensitivity C-reactive protein.

Digital Object Identifier (DOI)

Funding Information

This study was supported by the University of Kentucky Center for Clinical and Translational Science (National Institute of Health, UL1TR001998) in 2019-2021, University of Kentucky College of Nursing Metabolic pilot study funding in 2019-2021, Research and Interventions for Cardiovascular Health (RICH) Heart program in 2019-2021, University of Kentucky College of Nursing Delta Psi Research Scholarship in 2019, Dorothy Luther Fellowship Fund in 2015-2018 and 2020, and Jonas Nurse Leader Scholarship in 2016-2018.

Available for download on Saturday, December 23, 2023