The researchers found that diet quality among U.S. adults improved modestly between 1999 and 2020.
But the number of Americans with poor diet quality remains high, the study found. Most notably, disparities persist and, in some cases, are getting worse.
Unhealthy eating habits continue to have a negative impact on American adults. According to the Food and Drug Administration, an unhealthy diet is a leading risk factor for obesity, type 2 diabetes, cardiovascular disease and certain cancers, and more than one million Americans die each year from diet-related illnesses.
Unhealthy diets and food insecurity are also costly, costing the U.S. an estimated $1.1 trillion in health care costs and lost productivity. These burdens also translate into large health disparities based on income, education, zip code, and race and ethnicity.
“Americans’ diets have improved somewhat over the past 20 years, but those improvements have not reached everyone, and for many Americans, their diets have worsened,” says cardiologist Dariush Mozaffarian, director of the Food Is Drug Institute at the Friedman School of Nutrition Science and Policy at Tufts University. Annals of Internal Medicine.
“Our new research shows that the nation will not achieve nutrition and health equity unless we address the barriers many Americans face when it comes to accessing and eating nutritious foods.”
The researchers looked at data from 10 cycles of the National Health and Nutrition Examination Survey from 1999 to 2020, a nationwide survey in which citizens complete repeated 24-hour dietary recalls to report all foods and beverages consumed during the previous day. The study analyzed 51,703 adults who completed at least one valid 24-hour recall, with 72.6% completing two recalls.
The researchers measured diet quality using the American Heart Association Diet Score, a validated measure of a healthy diet that includes ingredients such as fruits, vegetables, legumes, nuts, whole grains, sugar-sweetened beverages and processed meats.
The study found that over the past 20 years, the proportion of adults with poor diet quality has decreased from 48.8% to 36.7%, while the proportion with fair diet quality has increased from 50.6% to 61.1%. The proportion of adults consuming an ideal diet has also improved but remains significantly low, from 0.66% to 1.58%.
Specific changes contributing to these trends include increased intake of nuts and seeds, whole grains, poultry, cheese, and eggs. Researchers also found decreases in intake of refined grains, sugar-sweetened beverages, fruit juice, and milk. Total intake of fruits and vegetables, seafood, processed meats, potassium, and sodium remained relatively stable.
When they narrowed their analysis to key subgroups, the researchers found that these improvements were not universal: Improvements in diet quality were most pronounced among younger adults, women, Hispanic adults, and those with greater education, income, food security, and access to private health insurance.
The prevalence of poor diet quality was lower among older adults, men, blacks, those with less education, those with lower income, those who were food insecure, and those with non-private health insurance. For example, the proportion of adults with poor diet quality decreased from 51.8% to 47.3% among low-income adults, from 50.0% to 43.0% among middle-income adults, and from 45.7% to 29.9% among high-income adults.
“It’s encouraging to see some improvements, particularly reduced consumption of added sugars and fruit drinks, but we still have a long way to go, especially for people from marginalized communities and backgrounds,” said lead author Junxiu Liu, a postdoctoral fellow at the Friedman School at the time of the study and now an assistant professor at the Icahn School of Medicine at Mount Sinai.
“We face a national nutrition crisis as rates of obesity and type 2 diabetes continue to rise,” Mozaffarian said. “These diseases affect all Americans, but especially those who are socioeconomically and geographically vulnerable. We must address nutrition security and other social determinants of health, including housing, transportation, fair wages and structural racism, and address the human and economic costs of unhealthy diets.”
Source: Jen A. Miller Tufts UniversityYeah
