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Author ORCID Identifier


Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded


Month Degree Awarded


First Advisor

Elena T. Carbone

Second Advisor

Lisa M. Troy

Third Advisor

Jessica Pearlman

Subject Categories



Perceived diet quality is a potential modifiable factor that could explain dietary choices. Research has shown that some individuals tend to misperceive the healthfulness of their diet, rating it more or less healthy than it actually was when compared to dietary recommendations. In particular, overestimation of diet quality has been associated with lower intention to change dietary behaviors. Using the National Health and Nutrition Examination Survey (NHANES) dataset, this dissertation explores factors associated with the perception of diet quality among U.S. adults.

In Chapter 1, we derived dietary patterns using latent class analysis and explored their association with perceived diet quality among young adults aged 18-29 years. We identified six dietary patterns. We found that those following less healthful dietary patterns were more likely to rate their diet worse, as compared to those following more healthful dietary patterns.

In Chapter 2, we examined the rates of misperception of diet quality among a sample of U.S. adults, and explored factors associated with overestimation and underestimation of diet quality in this population. We found that misperception of diet quality was prevalent in our sample. Overestimation of diet quality was associated with increased age, non-Hispanic Whites, higher education, and more positive health and nutrition-related outcomes, while underestimation of diet quality was associated with Hispanics and non-Hispanic Blacks, and more negative health and nutrition-related outcomes.

In Chapter 3, we explored the association between perceived diet quality, Healthy Eating Index (HEI)-2015, and metabolic syndrome and its components among U.S. adults. We found a positive association between perceived diet quality and HEI-2015 total score. Perceived diet quality and HEI-2015 were associated with increased risk of metabolic syndrome, elevated waist circumference, reduced HDL cholesterol, and elevated fasting blood glucose. Perceived diet quality was also associated with elevated triglycerides. When comparing the predicted probabilities for perceived diet quality and HEI-2015 categories, both followed a similar trend.

These findings suggest that perceived diet quality is a psychosocial factor that takes into consideration various aspects life, including nutrition, health, and lifestyle behaviors. It could be used by healthcare providers as a screening tool for those in need of a dietary intervention.


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