Trends in Food Sources and Diet Quality Among US Children and Adults, 2003-2018 | Lifestyle Behaviors | JAMA Network Open | JAMA Network
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1.
GBD 2017 Diet Collaborators.  Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.   Lancet. 2019;393(10184):1958-1972. doi:10.1016/S0140-6736(19)30041-8 PubMedGoogle ScholarCrossref
2.
Micha  R, Peñalvo  JL, Cudhea  F, Imamura  F, Rehm  CD, Mozaffarian  D.  Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States.   JAMA. 2017;317(9):912-924. doi:10.1001/jama.2017.0947 PubMedGoogle ScholarCrossref
3.
Zhang  FF, Cudhea  F, Shan  Z, et al. Preventable cancer burden associated with poor diet in the United States. JNCI Cancer Spectr. 2019;3:pkz034. doi:10.1093/jncics/pkz034
4.
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.2016.7491 PubMedGoogle ScholarCrossref
5.
Shan  Z, Rehm  CD, Rogers  G,  et al.  Trends in dietary carbohydrate, protein, and fat intake and diet quality among US adults, 1999-2016.   JAMA. 2019;322(12):1178-1187. doi:10.1001/jama.2019.13771 PubMedGoogle ScholarCrossref
6.
Gu  X, Tucker  KL.  Dietary quality of the US child and adolescent population: trends from 1999 to 2012 and associations with the use of federal nutrition assistance programs.   Am J Clin Nutr. 2017;105(1):194-202. doi:10.3945/ajcn.116.135095 PubMedGoogle ScholarCrossref
7.
Liu  J, Rehm  CD, Onopa  J, Mozaffarian  D.  Trends in diet quality among youth in the United States, 1999-2016.   JAMA. 2020;323(12):1161-1174. doi:10.1001/jama.2020.0878 PubMedGoogle ScholarCrossref
8.
US Department of Agriculture. The National School Lunch Program. Updated November 2017. Accessed April 10, 2020. https://fns-prod.azureedge.net/sites/default/files/resource-files/NSLPFactSheet.pdf
9.
US Department of Agriculture. Healthy Hunger-Free Kids Act. November 20, 2013. Accessed June 18, 2020. https://www.fns.usda.gov/school-meals/healthy-hunger-free-kids-act
10.
Liu  J, Rehm  CD, Micha  R, Mozaffarian  D.  Quality of meals consumed by US adults at full-service and fast-food restaurants, 2003-2016: persistent low quality and widening disparities.   J Nutr. 2020;150(4):873-883. doi:10.1093/jn/nxz299 PubMedGoogle ScholarCrossref
11.
Mancino L, Guthrie J, Ver Ploeg M, Lin B-H. Nutritional Quality of Foods Acquired by Americans: Findings From USDA’s National Household Food Acquisition and Purchase Survey, EIB-188. US Dept of Agriculture, Economic Research Service; February 2018. Accsessed November 11, 2020. https://www.ers.usda.gov/publications/pub-details/?pubid=87530
12.
Centers for Disease Control and Prevention. About the National Health and Nutrition Examination Survey. Updated September 15, 2017. Accessed April 10, 2020. https://www.cdc.gov/nchs/nhanes/about_nhanes.htm
13.
American Association for Public Opinion Research. Standard definitions: final disposition of case codes and outcome rates for surveys. Revised 2016. Accessed December 1, 2020. https://www.aapor.org/AAPOR_Main/media/publications/Standard-Definitions20169theditionfinal.pdf
14.
Centers for Disease Control and Prevention. NHANES survey methods and analytic guidelines. Updated Autgust 4, 2020. Accessed April 10, 2020. https://wwwn.cdc.gov/nchs/nhanes/analyticguidelines.aspx
15.
Centers for Disease Control and Prevention. Accessed April 10, 2020. https://wwwn.cdc.gov/Nchs/Nhanes/2015-2016/DR1IFF_I.htm#DR1FS
16.
Mozaffarian  D, Benjamin  EJ, Go  AS,  et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee.  Heart disease and stroke statistics—2015 update: a report from the American Heart Association.   Circulation. 2015;131(4):e29-e322. doi:10.1161/CIR.0000000000000152 PubMedGoogle Scholar
17.
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.2018.05.019 PubMedGoogle ScholarCrossref
18.
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.109.192703 PubMedGoogle ScholarCrossref
19.
Onufrak  SJ, Zaganjor  H, Pan  L, Lee-Kwan  SH, Park  S, Harris  DM.  Foods and beverages obtained at worksites in the United States.   J Acad Nutr Diet. 2019;119(6):999-1008. doi:10.1016/j.jand.2018.11.011 PubMedGoogle ScholarCrossref
20.
Solutran. Health and wellness incentives. Accessed July 30, 2020. https://www.solutran.com/what-we-do/employer-solutions/
21.
US Department of Agriculture. Food and Nutrition Service: school nutrition and meal cost study: summary of Findings. Accessed June 23, 2020. https://fns-prod.azureedge.net/sites/default/files/resource-files/SNMCS_Summary-Findings.pdf
22.
Powell  LM, Nguyen  BT.  Fast-food and full-service restaurant consumption among children and adolescents: effect on energy, beverage, and nutrient intake.   JAMA Pediatr. 2013;167(1):14-20. doi:10.1001/jamapediatrics.2013.417 PubMedGoogle ScholarCrossref
23.
An  R.  Fast-food and full-service restaurant consumption and daily energy and nutrient intakes in US adults.   Eur J Clin Nutr. 2016;70(1):97-103. doi:10.1038/ejcn.2015.104 PubMedGoogle ScholarCrossref
24.
National Restaurant Association. Kids Live Well. Accessed July 30, 2020. https://restaurant.org/manage-my-restaurant/food-nutrition/kidslivewell/about-kids-livewell
25.
Saksena  MJ, Okrent  AM, Anekwe  TD, et al. America’s Eating Habits: Food Away From Home. Economic Research Service, US Department of Agriculture; September 27, 2018. Accessed November 11, 2020. https://www.ers.usda.gov/publications/pub-details/?pubid=90227
26.
US Department of Agriculture. Accessed June 18, 2020. https://www.ers.usda.gov/data-products/food-expenditure-series/
27.
COVID-19 exacerbates obesity in the United States... and vice versa. Food Safety News. Accessed July 30, 2020. https://www.foodsafetynews.com/2020/06/covid-19-exacerbates-obesity-in-the-united-states-and-vice-versa/
28.
Mande  J, Willett  W, Auerbach  J, et al. Report of the 50th Anniversary of the White House Conference on Food, Nutrition, and Health: Honoring the Past, Taking Actions for Our Future. March 2020. Accessed March 2, 2021. https://sites.tufts.edu/foodnutritionandhealth2019
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    Original Investigation
    Public Health
    April 12, 2021

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

    Author Affiliations
    • 1Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
    • 2Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
    • 3Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
    JAMA Netw Open. 2021;4(4):e215262. doi:10.1001/jamanetworkopen.2021.5262
    Key Points

    Question  What are the trends in nutritional quality of foods consumed from major US sources?

    Findings  In this survey study of 20 905 children and 39 757 adults from 2003-2004 to 2017-2018, modest improvements were found in diet quality for foods from grocery stores and small improvements for foods from restaurants, each with disparities. Diet quality for foods from schools improved significantly, especially after 2010, and equitably across subgroups; by 2017-2018, food consumed at schools had the highest quality, followed by food from grocery stores, other sources, worksites, and restaurants.

    Meaning  By 2017-2018, foods consumed at schools provided the best mean quality of major sources, without disparities, although further improvements are needed in all sources, especially restaurants, with a focus on reducing disparities.

    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.

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