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Overall Dietary Quality in the U.S Remains Poor

Sep 19, 2014

Better dietary quality links to higher socioeconomic status…. 

In a recent study, Dr. Dong Wang from the Department of Nutrition at Harvard School of Public Health, Boston, and colleagues investigated the trend in dietary quality from 1999 to 2010 in the U.S. adult population. The analysis was based on the data of 29,124 adults aged 20-85 years, who participated in the US 1999 to 2010 National Health and Nutrition Examination Survey (NHANES). The main outcomes measured was the Alternate Healthy Eating Index 2010 (AHEI-2010), an 11-dimension score (range, 0-10 for each component score and 0-110 for the total score). The higher AHEI-2010 score indicated a more healthy diet.

Across the 12-year period, there was a modest improvement in the dietary quality in the U.S. adult population. The energy-adjusted mean of the AHEI-2010 increased from 39.9 in 1999 to 46.8 in 2010 (linear trend P<0.001). Reduction in transfat intake accounted for more than half of this improvement. The AHEI-2010 component score increased by 0.9 points for sugar-sweetened beverages and fruit juice, 0.7 points for whole fruit and 0.5 points for whole grains. However, there was a 0.5 points decrease for sodium intake (linear trend P<0.001).

The AHEI-2010 was positively associated with family income and educational level. The difference in AHEI-2010 between low and high socioeconomic status groups increased from 3.9 points in 1999-2000 to 7.8 points in 2009-2010 (interaction P = 0.01). According to the authors, disparities across income levels might be due to several factors such as cost and limited access to healthy food.

In terms of gender, the mean AHEI-2010 was significantly higher in women compared to men. In term of ethnicity, there was a significant difference between Mexican Americans and non-Hispanic whites after adjustment for other socioeconomic covariates. Also, lower BMI category was associated with more dietary quality improvement compared to those with higher BMI.

Overall, the dietary quality of the U.S. population has improved steadily over time. This improvement reflected positive changes in both consumers’ food choice and food processing. However, the improvement in dietary quality is still "far from optimal and there is huge room for further improvement," concluded the authors.

Practice Pearls:
  • The dietary quality of the U.S adult population improved slightly over time.
  • Disparities across income levels were still existed.
  • Dietary assessment and counseling in clinical settings should be considered.

Wang D, Leung C, Li Y, et al. Trends in dietary quality among adults I the United States, 1999 through 2010. JAMA Intern Med. 2014; doi:10.1001/jamainternmed.2014.3422.