Dataset Information

Trends in Food Sources and Diet Quality Among US Children and Adults, 2003-2018.

ABSTRACT:

Importance

Time trends and population disparities in nutritional quality of foods from major US sources, including grocery stores, restaurants, schools, worksites, and other sources, are not well established.

Objective

To investigate patterns and trends in diet quality by food sources among US children and adults overall and in sociodemographic subgroups.

Design, setting, and participants

This serial, cross-sectional survey study included respondents from 8 National Health and Nutrition Examination Survey cycles (2003-2018) with valid dietary recalls. Data were analyzed from April 16, 2020, to July 20, 2020.

Exposures

Survey cycle, food source, and key sociodemographic subgroups.

Main outcomes and measures

Mean diet quality of foods (meals, snacks, and beverages) consumed per person, characterized by the American Heart Association diet score (range, 0-80, with higher scores indicating healthier diets), the Healthy Eating Index 2015 (range, 0-100, with higher scores indicating healthier diets), and their components. For the American Heart Association diet score, poor diet was defined as less than 40.0% adherence (score, <32.0), intermediate diet as 40.0% to 79.9% adherence (score, 32.0-63.9), and ideal as 80.0% or greater adherence (score, ≥64.0).

Results

The study included 20 905 children 5 to 19 years of age (mean [SD] age, 12.1 [5.24] years; 51.0% male) and 39 757 adults 20 years or older (mean [SD] age, 47.3 [15.1] years; 51.9% female). Diet quality of foods consumed from grocery stores increased modestly in children (53.2% to 45.1% with poor diet quality; P = .006 for trend) and adults (40.1% to 32.9% with poor diet quality; P = .001 for trend), with smaller changes for restaurants among children (84.8% to 79.6% with poor diet quality; P = .003 for trend). Changes for restaurants among adults were not statistically significant (65.4% to 65.2% with poor diet quality; P = .07 with poor diet quality); the same was true of worksites (adults: 55.6% to 50.7% with poor diet quality; P = .25 for trend). Food quality from other sources worsened (children: 40.0% to 51.7% with poor diet quality; adults: 33.8% to 43.8% with poor diet quality; P < .001 for trend each). The largest improvement in diet quality was in schools, with the percentage with poor diet quality decreasing from 55.6% to 24.4% (P < .001 for trend), mostly after 2010, and with equitable improvements across population subgroups. Findings were similar for Healthy Eating Index 2015. Significant disparities in diet quality trends were seen by sex, race/ethnicity, educational level, and household income for food consumed from grocery stores. For example, the proportion of foods consumed from grocery stores that were of poor diet quality decreased among high-income adults (from 36.9% to 26.5%; P = .001 for trend) but not among low-income adults (from 45.8% to 41.3%; P = .09 for trend).

Conclusions and relevance

By 2017-2018, foods consumed at schools improved significantly and provided the best mean diet quality of major US food sources, without population disparities. Additional improvements are needed from all major US food sources, with particular attention on equity.

SUBMITTER: Liu J

PROVIDER: S-EPMC8042524 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundTrends in junk food consumption, a risk for obesity, are not well established.ObjectivesWe examined national trends in types of junk food (excluding beverages) and their sources (grocery, restaurants, schools, etc.), overall and in population subgroups.MethodsWe assessed 29,970 children (aged 2-19 y) and 44,501 adults (aged ≥20 y) with 24-h dietary recall data from 9 NHANES cycles (2001-2002 to 2017-2018). Trends in junk food were assessed over time using 1-d values for individuals with single recalls and 2-d means for others.ResultsFrom 2001 to 2018, percent energy (%E) from junk food remained stable for children (from 18.1% to 17.5%, P-trend = 0.25) and decreased for adults (14.1% to 13.0%, P-trend = 0.002). Among children, increases occurred in %E from crackers (1.19% to 1.35%) and snack/meal bars (0.38% to 0.69%) and decreases in candy (2.58% to 1.96%) and other desserts (3.11% to 2.48%) (all P-trends < 0.01). Among adults, increases occurred in snack/meal bars (0.31% to 0.78%, P-trend < 0.001) and decreases in candy (1.97% to 1.55%; P-trend < 0.001), sweet bakery products (5.52% to 4.98%; P-trend = 0.04), and other desserts (2.19% to 1.86%; P-trend = 0.001). In 2017-2018, grocery stores provided the largest proportion of junk food (72.7% for children, 77.1% for adults), followed by other sources (13.1%, 12.1%), restaurants (8.05%, 9.11%), schools (4.86%), and worksites (1.99%). In both children and adults, junk food intake was higher among non-Hispanic white and black Americans compared with Mexican Americans, among those with higher compared with lower education, among women compared with men, and among older compared with younger adults. In sensitivity analyses using only 1-d recalls, mean junk food intake each cycle was ∼0.8-1.0 and 0.3-0.4%E units higher in children and adults, respectively, with otherwise similar trends and subgroup differences over time.ConclusionsFrom 2001 to 2018, %E from junk food represented nearly 1 in 5 calories among children, without change, and nearly 1 in 7 calories, with modest decrease, among adults, with disparities in subgroups.

Project description:ImportanceFew studies have examined the dietary trends in Korea beyond evaluating selected food groups. To help prevent cardiometabolic disease burdens, a comprehensive investigation of the trends in overall diet quality and identification of possible contributing factors would be useful.ObjectiveTo investigate the trends and independent associations of age, period, and birth cohort with diet quality and cardiometabolic risk factors among Korean adults.Design, setting, and participantsSerial cross-sectional and age-period-cohort analyses were conducted of nationally representative 24-hour dietary recall data from the Korea National Health and Nutrition Examination Survey 2007-2018. The study population included 65 416 Korean adults aged 19 to 79 years. Data analyses were conducted from March 1, 2020, through April 30, 2021.ExposuresAge, calendar year, birth cohort, and population sociodemographic characteristics.Main outcomes and measuresKorean Healthy Eating Index (KHEI), a validated diet quality score (range, 0-90, with higher scores indicating greater diet quality), and 8 cardiometabolic risk factors (waist circumference and systolic blood pressure, diastolic blood pressure, serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, and fasting blood glucose levels).ResultsAmong 65 416 participants, mean age (SD) was 44.5 (0.1) years and 36 631 were women (55.8%). In 2007-2018, the age-standardized mean (SE) KHEI score increased from 51.0 (0.4) to 52.1 (0.5), which was associated with reduced sodium intake and increased whole grain, dairy, and protein-rich food intakes. The mean (SE) KHEI score was lowest at age 39 years (50.1 [0.3]) and increased at older ages (58.0 [0.3] at 79 years). Controlling for age and period effects, the highest KHEI score was observed among the birth cohorts of 1960-1964 (53.6 [0.9]) and decreased in subsequent cohorts (45.5 [1.2] in the 1990-1999 birth cohort). Similar cohort effects in cardiometabolic risk factors were observed, showing the lowest waist circumference, blood pressure, and total cholesterol levels among the birth cohorts of the 1960s and 1970s and higher levels among more recent birth cohorts (1990-1999 vs 1960-1964: waist circumference, 83.8 [0.5] vs 81.4 [0.4] cm; systolic blood pressure, 118.7 [0.7] vs 116.4 [0.4] mm Hg; total cholesterol, 200.2 [0.9] vs 198.9 [0.7] mg/dL). At most ages, periods, and birth cohorts, the mean KHEI score was consistently higher in adults living in urban areas (at age 45 years: 50.5 [1.0] vs 49.7 [0.9] rural) and among high-income (at age 45 years: 50.7 [1.1] vs 49.3 [0.9] low income) and educational levels (at age 45 years: 53.1 [0.9] vs 49.1 [1.0] low educational level).Conclusions and relevanceThe findings of this study suggest that, from 2007 to 2018, the diet quality of Korean adults modestly improved. Despite the improvement, inequalities in diet among age, birth cohort, and socioeconomic subgroups persisted, suggesting that more intense interventions may be needed to target the susceptible groups.

Project description:Background/objectivesFood insecurity has emerged as a critical health issue for older adults. Food insecurity has been shown to disrupt healthy eating patterns, but these associations have not been widely studied among older adults. The objectives of the present study were to: (1) examine national trends in food insecurity across a 10-year period, and (2) evaluate the associations between food insecurity and multiple diet quality indices in a recent and nationally representative sample of adults aged 60 or older.DesignCross-sectional analysis of the 2007-2016 National Health and Nutrition Examination Surveys.SettingNationally representative sample of the United States.ParticipantsThe analytic sample was comprised of 5,097 adults aged 60 or older, with household incomes at or below 300% of the federal poverty level.MeasurementsHousehold food security was measured using the 18-item US Household Food Security Survey Module. Diet was assessed using two 24-hour dietary recalls. Multivariate linear and logistic regression models examined the associations between household food security and three evidence-based diet quality indices, adjusting for sociodemographic and health characteristics.ResultsAcross the 10-year period, food insecurity increased significantly from 5.5% to 12.4% among older adults; this increase was more pronounced among lower-income older adults. From the linear regression models, food insecurity was associated with lower scores on the Healthy Eating Index (β = -1.90, 95% confidence interval (CI) = -3.70, -0.09), the Alternate Healthy Eating Index-2010 (β = -1.47, 95% CI = -2.51, -0.44), and the Mediterranean Diet Score (β = -0.54, 95% CI = -1.06, -0.01) after multivariate adjustment. Further adjustment for the presence of chronic medical conditions did not attenuate these results.ConclusionFood insecurity is associated with lower overall diet quality among older adults, supporting the need for clinical efforts to identify those at risk of food insecurity and public health efforts to alleviate food insecurity and promote healthy eating behaviors among older adults.