Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016 | Nutrition | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.175.212.130. Please contact the publisher to request reinstatement.
1.
GBD 2016 Risk Factors Collaborators.  Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.  Lancet. 2017;390(10100):1345-1422. doi:10.1016/S0140-6736(17)32366-8PubMedGoogle ScholarCrossref
2.
Pan  A, Lin  X, Hemler  E, Hu  FB.  Diet and cardiovascular disease: advances and challenges in population-based studies.  Cell Metab. 2018;27(3):489-496. doi:10.1016/j.cmet.2018.02.017PubMedGoogle ScholarCrossref
3.
Ley  SH, Hamdy  O, Mohan  V, Hu  FB.  Prevention and management of type 2 diabetes: dietary components and nutritional strategies.  Lancet. 2014;383(9933):1999-2007. doi:10.1016/S0140-6736(14)60613-9PubMedGoogle ScholarCrossref
4.
Mokdad  AH, Ballestros  K, Echko  M,  et al; US Burden of Disease Collaborators.  The state of US health, 1990-2016: burden of diseases, injuries, and risk factors among US states.  JAMA. 2018;319(14):1444-1472. doi:10.1001/jama.2018.0158PubMedGoogle ScholarCrossref
5.
Trumbo  P, Schlicker  S, Yates  AA, Poos  M; Food and Nutrition Board of the Institute of Medicine, the National Academies.  Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids.  J Am Diet Assoc. 2002;102(11):1621-1630. doi:10.1016/S0002-8223(02)90346-9PubMedGoogle ScholarCrossref
6.
Sacks  FM, Lichtenstein  AH, Wu  JHY,  et al; American Heart Association.  Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association.  Circulation. 2017;136(3):e1-e23. doi:10.1161/CIR.0000000000000510PubMedGoogle ScholarCrossref
7.
Bernstein  AM, Sun  Q, Hu  FB, Stampfer  MJ, Manson  JE, Willett  WC.  Major dietary protein sources and risk of coronary heart disease in women.  Circulation. 2010;122(9):876-883. doi:10.1161/CIRCULATIONAHA.109.915165PubMedGoogle ScholarCrossref
8.
Ludwig  DS, Hu  FB, Tappy  L, Brand-Miller  J.  Dietary carbohydrates: role of quality and quantity in chronic disease.  BMJ. 2018;361:k2340. doi:10.1136/bmj.k2340PubMedGoogle ScholarCrossref
9.
Song  M, Fung  TT, Hu  FB,  et al.  Association of animal and plant protein intake with all-cause and cause-specific mortality.  JAMA Intern Med. 2016;176(10):1453-1463. doi:10.1001/jamainternmed.2016.4182PubMedGoogle ScholarCrossref
10.
Reynolds  A, Mann  J, Cummings  J, Winter  N, Mete  E, Te Morenga  L.  Carbohydrate quality and human health: a series of systematic reviews and meta-analyses.  Lancet. 2019;393(10170):434-445. doi:10.1016/S0140-6736(18)31809-9PubMedGoogle ScholarCrossref
11.
Berryman  CE, Lieberman  HR, Fulgoni  VL  III, Pasiakos  SM.  Protein intake trends and conformity with the dietary reference intakes in the United States: analysis of the National Health and Nutrition Examination Survey, 2001-2014.  Am J Clin Nutr. 2018;108(2):405-413. doi:10.1093/ajcn/nqy088PubMedGoogle ScholarCrossref
12.
Cohen  E, Cragg  M, deFonseka  J, Hite  A, Rosenberg  M, Zhou  B.  Statistical review of US macronutrient consumption data, 1965-2011: Americans have been following dietary guidelines, coincident with the rise in obesity.  Nutrition. 2015;31(5):727-732. doi:10.1016/j.nut.2015.02.007PubMedGoogle ScholarCrossref
13.
Centers for Disease Control and Prevention.  Trends in intake of energy and macronutrients—United States, 1971-2000.  MMWR Morb Mortal Wkly Rep. 2004;53(4):80-82.PubMedGoogle Scholar
14.
Centers for Disease Control and Prevention. About the National Health and Nutrition Examination Survey. https://www.cdc.gov/nchs/nhanes/about_nhanes.htm. Accessed June 2, 2019.
15.
Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey response rates and population totals. https://wwwn.cdc.gov/nchs/nhanes/ResponseRates.aspx. Accessed June 2, 2019.
16.
Centers for Disease Control and Prevention. Information about dietary variables in National Health and Nutrition Examination Survey. https://www.cdc.gov/nchs/tutorials/dietary/AdditionalResources/Info_DietaryVariables.htm. Accessed June 2, 2019.
17.
Moshfegh  AJ, Rhodes  DG, Baer  DJ,  et al.  The US Department of Agriculture Automated Multiple-Pass Method reduces bias in the collection of energy intakes.  Am J Clin Nutr. 2008;88(2):324-332. doi:10.1093/ajcn/88.2.324PubMedGoogle ScholarCrossref
18.
Blanton  CA, Moshfegh  AJ, Baer  DJ, Kretsch  MJ.  The USDA Automated Multiple-Pass Method accurately estimates group total energy and nutrient intake.  J Nutr. 2006;136(10):2594-2599. doi:10.1093/jn/136.10.2594PubMedGoogle ScholarCrossref
19.
Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey: measuring guides for the dietary recall interview. https://www.cdc.gov/nchs/nhanes/measuring_guides_dri/measuringguides.htm. Accessed June 2, 2019.
20.
Centers for Disease Control and Prevention. Key concepts about the NHANES sample weights. https://www.cdc.gov/nchs/tutorials/nhanes/SurveyDesign/SampleDesign/Info1.htm. Accessed June 2, 2019.
21.
Pasiakos  SM, Agarwal  S, Lieberman  HR, Fulgoni  VL  III.  Sources and amounts of animal, dairy, and plant protein intake of US adults in 2007-2010.  Nutrients. 2015;7(8):7058-7069. doi:10.3390/nu7085322PubMedGoogle ScholarCrossref
22.
Reedy  J, Lerman  JL, Krebs-Smith  SM,  et al.  Evaluation of the Healthy Eating Index–2015.  J Acad Nutr Diet. 2018;118(9):1622-1633. doi:10.1016/j.jand.2018.05.019PubMedGoogle ScholarCrossref
23.
Willett  WC.  Nutritional Epidemiology. 3rd ed. Oxford, England: Oxford University Press; 2013.
24.
Tooze  JA, Midthune  D, Dodd  KW,  et al.  A new statistical method for estimating the usual intake of episodically consumed foods with application to their distribution.  J Am Diet Assoc. 2006;106(10):1575-1587. doi:10.1016/j.jada.2006.07.003PubMedGoogle ScholarCrossref
25.
La Berge  AF.  How the ideology of low fat conquered America.  J Hist Med Allied Sci. 2008;63(2):139-177. doi:10.1093/jhmas/jrn001PubMedGoogle ScholarCrossref
26.
US Department of Health and Human Services; US Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 8th ed. December 2015. https://health.gov/dietaryguidelines/2015/guidelines/. Accessed June 2, 2019.
27.
Lloyd-Jones  DM, Hong  Y, Labarthe  D,  et al; American Heart Association Strategic Planning Task Force and Statistics Committee.  Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond.  Circulation. 2010;121(4):586-613. doi:10.1161/CIRCULATIONAHA.109.192703PubMedGoogle ScholarCrossref
28.
Wang  DD, Leung  CW, Li  Y,  et al.  Trends in dietary quality among adults in the United States, 1999 through 2010.  JAMA Intern Med. 2014;174(10):1587-1595. doi:10.1001/jamainternmed.2014.3422PubMedGoogle ScholarCrossref
29.
Rehm  CD, Peñalvo  JL, Afshin  A, Mozaffarian  D.  Dietary intake among US adults, 1999-2012.  JAMA. 2016;315(23):2542-2553. doi:10.1001/jama.2016.7491PubMedGoogle ScholarCrossref
30.
Kelemen  LE, Kushi  LH, Jacobs  DR  Jr, Cerhan  JR.  Associations of dietary protein with disease and mortality in a prospective study of postmenopausal women.  Am J Epidemiol. 2005;161(3):239-249. doi:10.1093/aje/kwi038PubMedGoogle ScholarCrossref
31.
Farvid  MS, Cho  E, Chen  WY, Eliassen  AH, Willett  WC.  Dietary protein sources in early adulthood and breast cancer incidence: prospective cohort study.  BMJ. 2014;348:g3437. doi:10.1136/bmj.g3437PubMedGoogle ScholarCrossref
Original Investigation
September 24, 2019

Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016

Author Affiliations
  • 1Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 2Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
  • 3Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 4Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
  • 5Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
  • 6School of Medicine, Tufts University, Boston, Massachusetts
  • 7Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 8Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
JAMA. 2019;322(12):1178-1187. doi:10.1001/jama.2019.13771
Key Points

Question  What were the trends in carbohydrate, fat, and protein intake among US adults from 1999 to 2016?

Findings  In this nationally representative serial cross-sectional study that included 43 996 adults, there were decreases in low-quality carbohydrates (primarily added sugar) and increases in high-quality carbohydrates (primarily whole grains), plant protein (primarily whole grains and nuts), and polyunsaturated fat. However, 42% of energy intake was still derived from low-quality carbohydrates and the intake of saturated fat remained above 10% of energy.

Meaning  The macronutrient composition of diet among US adults has improved, but continued high intake of low-quality carbohydrates and saturated fat remain.

Abstract

Importance  Changes in the economy, nutrition policies, and food processing methods can affect dietary macronutrient intake and diet quality. It is essential to evaluate trends in dietary intake, food sources, and diet quality to inform policy makers.

Objective  To investigate trends in dietary macronutrient intake, food sources, and diet quality among US adults.

Design, Setting, and Participants  Serial cross-sectional analysis of the US nationally representative 24-hour dietary recall data from 9 National Health and Nutrition Examination Survey cycles (1999-2016) among adults aged 20 years or older.

Exposure  Survey cycle.

Main Outcomes and Measures  Dietary intake of macronutrients and their subtypes, food sources, and the Healthy Eating Index 2015 (range, 0-100; higher scores indicate better diet quality; a minimal clinically important difference has not been defined).

Results  There were 43 996 respondents (weighted mean age, 46.9 years; 51.9% women). From 1999 to 2016, the estimated energy from total carbohydrates declined from 52.5% to 50.5% (difference, −2.02%; 95% CI, −2.41% to −1.63%), whereas that of total protein and total fat increased from 15.5% to 16.4% (difference, 0.82%; 95% CI, 0.67%-0.97%) and from 32.0% to 33.2% (difference, 1.20%; 95% CI, 0.84%-1.55%), respectively (all P < .001 for trend). Estimated energy from low-quality carbohydrates decreased by 3.25% (95% CI, 2.74%-3.75%; P < .001 for trend) from 45.1% to 41.8%. Increases were observed in estimated energy from high-quality carbohydrates (by 1.23% [95% CI, 0.84%-1.61%] from 7.42% to 8.65%), plant protein (by 0.38% [95% CI, 0.28%-0.49%] from 5.38% to 5.76%), saturated fatty acids (by 0.36% [95% CI, 0.20%-0.51%] from 11.5% to 11.9%), and polyunsaturated fatty acids (by 0.65% [95% CI, 0.56%-0.74%] from 7.58% to 8.23%) (all P < .001 for trend). The estimated overall Healthy Eating Index 2015 increased from 55.7 to 57.7 (difference, 2.01; 95% CI, 0.86-3.16; P < .001 for trend). Trends in high- and low-quality carbohydrates primarily reflected higher estimated energy from whole grains (0.65%) and reduced estimated energy from added sugars (−2.00%), respectively. Trends in plant protein were predominantly due to higher estimated intake of whole grains (0.12%) and nuts (0.09%).

Conclusions and Relevance  From 1999 to 2016, US adults experienced a significant decrease in percentage of energy intake from low-quality carbohydrates and significant increases in percentage of energy intake from high-quality carbohydrates, plant protein, and polyunsaturated fat. Despite improvements in macronutrient composition and diet quality, continued high intake of low-quality carbohydrates and saturated fat remained.

×