{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T09:58:22Z","timestamp":1773395902622,"version":"3.50.1"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009659","name":"Guangzhou Medical University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Dietary habits play crucial roles in gastrointestinal health. The relationship between dietary patterns, measured using the Healthy Eating Index-2020 (HEI-2020), and bowel habits remains unclear. This study aimed to explore the associations between HEI-2020 scores and bowel habits, including fecal incontinence, diarrhea, and constipation, in adults in the US.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross-sectional study included 11,590 participants of the National Health and Nutrition Examination Survey. Multivariate logistic regression models were used to assess the associations adjusted for demographic, socioeconomic, and health-related covariates. Weighted quantile sum (WQS) regression was used to evaluate the combined effects of the dietary components.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Analysis of 11,590 individuals showed that higher HEI-2020 scores were negatively correlated with fecal incontinence and constipation. When treated as a continuous variable, HEI-2020 scores were associated with reduced odds of fecal incontinence (weighted adjusted OR: 0.86, 95% CI: 0.79\u20130.95, <jats:italic>p<\/jats:italic>\u202f=\u202f0.004) and constipation (weighted adjusted OR: 0.78, 95% CI: 0.73\u20130.84, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). In quartile analysis, the highest HEI-2020 quartile was linked to a 48% lower constipation risk compared with the lowest quartile (weighted adjusted OR: 0.52, 95% CI: 0.40\u20130.68, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). Subgroup analysis indicated that higher HEI-2020 scores were more strongly associated with a reduced constipation risk in participants with sleep disorders. WQS regression revealed significant protective effects of HEI-2020 scores on fecal incontinence and constipation, but not on diarrhea.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Higher HEI-2020 scores were associated with a reduced risk of fecal incontinence and constipation. Adherence to the HEI-2020 guidelines may enhance gastrointestinal health by mitigating abnormalities in bowel habits.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2025.1578124","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T05:49:22Z","timestamp":1749793762000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Healthy Eating Index-2020 and bowel habits: a cross-sectional analysis of NHANES"],"prefix":"10.3389","volume":"12","author":[{"given":"Rongpeng","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zexin","family":"Fu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhicheng","family":"Feng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guoqiang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1038\/s41395-018-0137-1","article-title":"Association between ultra-processed food consumption and functional gastrointestinal disorders: results from the French 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