The JAMA Network Journals
In nationally representative surveys conducted between 1999 and
2012, several improvements in self-reported dietary habits were identified,
such as increased consumption of whole grains, with additional findings suggesting
persistent or worsening disparities based on race/ethnicity and education and
income level, according to a study appearing in the June 21 issue of JAMA.
Suboptimal diet is among the leading causes of poor health,
particularly obesity, diabetes, cardiovascular diseases, and diet-related
cancers.
In the United States, dietary factors are estimated to account for
more than 650,000 deaths per year and 14 percent of all disability-adjusted
life-years lost.
Understanding trends in dietary habits is crucial to inform
priorities and policies to improve diets and reduce diet-related illness.
Dariush Mozaffarian, M.D., Dr.P.H., of the Tufts Friedman School of Nutrition Science and Policy, Boston, and colleagues examined trends in overall diet quality and multiple dietary components related to major diseases using 24-hour dietary recalls in nationally representative samples that included 33,932 U.S. adults age 20 years or older from 7 National Health and Nutrition Examination Survey (NHANES) cycles (1999-2012).
As a summary indicator, a diet score was
constructed based on the American Heart Association (AHA) 2020 Strategic Impact
Goals for diet.
The researchers found that many aspects of the U.S. diet
improved, including increased consumption of whole grains, nuts or seeds, a
slight increase in fish and shellfish and decreased consumption of
sugar-sweetened beverages.
Other dietary trends included increased consumption
of whole fruit and decreased consumption of 100 percent fruit juice.
No
significant trend was observed for other diet score components, including total
fruits and vegetables, processed meat, saturated fat, or sodium.
The estimated percentage
of U.S. adults with poor diets declined from 56 percent to 46 percent. The
percentage with ideal diets increased but remained low (0.7 percent to 1.5
percent).
Disparities in diet quality were observed by race/ethnicity,
education, and income level; for example, the estimated percentage of
non-Hispanic white adults with a poor diet significantly declined (54 percent
to 43 percent), whereas similar improvements were not observed for non-Hispanic
black or Mexican American adults.
There was little evidence of reductions in
these disparities and some evidence of worsening by income level.
"These findings may inform discussions on emerging
successes, areas for greater attention, and corresponding opportunities to
improve the diets of individuals living in the United States," the authors
write.
Editorial: Changing Dietary Habits and Improving the Healthiness
of Diets in the United States
Margo A. Denke, M.D., formerly with the University of Texas
Southwestern Medical Center, Dallas, comments on the findings of this study in
an accompanying editorial.
"Achieving dietary changes remains a challenging task. The
advice of clinicians may not provide lasting effects unless patients can
incorporate meaningful dietary changes into a daily sustainable pattern. How to
best accomplish this task is the goal. The article by Rehm et al provides a
current dietary report card to help with this task. Even though there has been
some improvement from 1999 to 2012, clinicians, patients, and the food industry
all need to work together to meet the challenge of improving the healthiness of
the U.S. diet."