Clinical Edge

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Dietary Intake Trends Among US Adults

JAMA; 2016 Jun 21; Rehm, Peñalvo, et al

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Dietary habits among US adults improved between 1999 and 2012; however, persistent and worsening disparities based on race/ethnicity, education level, and income level were also observed. This according to a study of US adults aged ≥20 years from 7 National Health and Nutrition Examination Survey (NHANES) cycles. The sample size per cycle ranged from 4,237 to 5,762. Researchers found:

• The American Heart Association (AHA) primary diet score improved from 19.0 to 21.2 (11.6% improvement).

• The AHA secondary diet score improved from 35.1 to 38.5 (9.7% improvement).

• There was increased consumption between 1999-2000 and 2011-2012 of whole grains and nuts or seeds while consumption of sugar-sweetened beverages decreased. Fish and shellfish intake also increased slightly.

• No significant trend was observed for other score components, including total fruits and vegetables, processed meat, saturated fat, or sodium.

• The estimated percentage of US adults with poor diets (<40% adherence to the primary AHA diet score components) declined from 55.9% to 45.6%, whereas the percentage with intermediate diets increased from 43.5% to 52.9%.

• Disparities in diet quality were observed by race/ethnicity, education, and income level with little evidence of reductions and some evidence of worsening by income level.

Citation: 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.

Commentary: Diet is a major contributor to the most important chronic diseases in the US, including coronary disease, diabetes and obesity. It has been estimated that over 650,000 deaths per year and 14% of all disability-adjusted life-years lost can be attributed to dietary factors.1 Over the last 10 years there has been increased recognition that the poor diets of average Americans contribute to our burden of illness, and there has been a great deal written in both the medical and lay literature about the need to improve our diets. This article suggests that the message is being heard and translated into action as indicated by the increased consumption of whole grains and decreased consumption of sugar-sweetened beverages. This is just the beginning though, as approximately 50% of the population continues to eat poor diets and few eat optimal diets. Much remains to be done and the challenge now is how to motivate patients to follow through on the lifestyle changes that we know can improve their health.2 —Neil Skolnik, MD

1. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591-608. doi:10.1001/jama.2013.13805.

2. Denke MA. Changing dietary habits and improving the healthiness of diets in the United States. JAMA. 2016;315:2527-2528. doi:10.1001/jama.2016.7636.

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