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Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016.
JAMA. 2019 09 24; 322(12):1178-1187.JAMA

Abstract

Importance

Changes in the economy, nutrition policies, and food processing methods can affect dietary macronutrient intake and diet quality. It is essential to evaluate trends in dietary intake, food sources, and diet quality to inform policy makers.

Objective

To investigate trends in dietary macronutrient intake, food sources, and diet quality among US adults.

Design, Setting, and Participants

Serial cross-sectional analysis of the US nationally representative 24-hour dietary recall data from 9 National Health and Nutrition Examination Survey cycles (1999-2016) among adults aged 20 years or older.

Exposure

Survey cycle.

Main Outcomes and Measures

Dietary intake of macronutrients and their subtypes, food sources, and the Healthy Eating Index 2015 (range, 0-100; higher scores indicate better diet quality; a minimal clinically important difference has not been defined).

Results

There were 43 996 respondents (weighted mean age, 46.9 years; 51.9% women). From 1999 to 2016, the estimated energy from total carbohydrates declined from 52.5% to 50.5% (difference, -2.02%; 95% CI, -2.41% to -1.63%), whereas that of total protein and total fat increased from 15.5% to 16.4% (difference, 0.82%; 95% CI, 0.67%-0.97%) and from 32.0% to 33.2% (difference, 1.20%; 95% CI, 0.84%-1.55%), respectively (all P < .001 for trend). Estimated energy from low-quality carbohydrates decreased by 3.25% (95% CI, 2.74%-3.75%; P < .001 for trend) from 45.1% to 41.8%. Increases were observed in estimated energy from high-quality carbohydrates (by 1.23% [95% CI, 0.84%-1.61%] from 7.42% to 8.65%), plant protein (by 0.38% [95% CI, 0.28%-0.49%] from 5.38% to 5.76%), saturated fatty acids (by 0.36% [95% CI, 0.20%-0.51%] from 11.5% to 11.9%), and polyunsaturated fatty acids (by 0.65% [95% CI, 0.56%-0.74%] from 7.58% to 8.23%) (all P < .001 for trend). The estimated overall Healthy Eating Index 2015 increased from 55.7 to 57.7 (difference, 2.01; 95% CI, 0.86-3.16; P < .001 for trend). Trends in high- and low-quality carbohydrates primarily reflected higher estimated energy from whole grains (0.65%) and reduced estimated energy from added sugars (-2.00%), respectively. Trends in plant protein were predominantly due to higher estimated intake of whole grains (0.12%) and nuts (0.09%).

Conclusions and Relevance

From 1999 to 2016, US adults experienced a significant decrease in percentage of energy intake from low-quality carbohydrates and significant increases in percentage of energy intake from high-quality carbohydrates, plant protein, and polyunsaturated fat. Despite improvements in macronutrient composition and diet quality, continued high intake of low-quality carbohydrates and saturated fat remained.

Authors+Show Affiliations

Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts. Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts. Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts. School of Medicine, Tufts University, Boston, Massachusetts.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts. Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31550032

Citation

Shan, Zhilei, et al. "Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016." JAMA, vol. 322, no. 12, 2019, pp. 1178-1187.
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.
Shan, Z., Rehm, C. D., Rogers, G., Ruan, M., Wang, D. D., Hu, F. B., Mozaffarian, D., Zhang, F. F., & Bhupathiraju, S. N. (2019). Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016. JAMA, 322(12), 1178-1187. https://doi.org/10.1001/jama.2019.13771
Shan Z, et al. Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016. JAMA. 2019 09 24;322(12):1178-1187. PubMed PMID: 31550032.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016. AU - Shan,Zhilei, AU - Rehm,Colin D, AU - Rogers,Gail, AU - Ruan,Mengyuan, AU - Wang,Dong D, AU - Hu,Frank B, AU - Mozaffarian,Dariush, AU - Zhang,Fang Fang, AU - Bhupathiraju,Shilpa N, PY - 2020/03/24/pmc-release PY - 2019/9/25/entrez PY - 2019/9/25/pubmed PY - 2019/10/15/medline SP - 1178 EP - 1187 JF - JAMA JO - JAMA VL - 322 IS - 12 N2 - Importance: Changes in the economy, nutrition policies, and food processing methods can affect dietary macronutrient intake and diet quality. It is essential to evaluate trends in dietary intake, food sources, and diet quality to inform policy makers. Objective: To investigate trends in dietary macronutrient intake, food sources, and diet quality among US adults. Design, Setting, and Participants: Serial cross-sectional analysis of the US nationally representative 24-hour dietary recall data from 9 National Health and Nutrition Examination Survey cycles (1999-2016) among adults aged 20 years or older. Exposure: Survey cycle. Main Outcomes and Measures: Dietary intake of macronutrients and their subtypes, food sources, and the Healthy Eating Index 2015 (range, 0-100; higher scores indicate better diet quality; a minimal clinically important difference has not been defined). Results: There were 43 996 respondents (weighted mean age, 46.9 years; 51.9% women). From 1999 to 2016, the estimated energy from total carbohydrates declined from 52.5% to 50.5% (difference, -2.02%; 95% CI, -2.41% to -1.63%), whereas that of total protein and total fat increased from 15.5% to 16.4% (difference, 0.82%; 95% CI, 0.67%-0.97%) and from 32.0% to 33.2% (difference, 1.20%; 95% CI, 0.84%-1.55%), respectively (all P < .001 for trend). Estimated energy from low-quality carbohydrates decreased by 3.25% (95% CI, 2.74%-3.75%; P < .001 for trend) from 45.1% to 41.8%. Increases were observed in estimated energy from high-quality carbohydrates (by 1.23% [95% CI, 0.84%-1.61%] from 7.42% to 8.65%), plant protein (by 0.38% [95% CI, 0.28%-0.49%] from 5.38% to 5.76%), saturated fatty acids (by 0.36% [95% CI, 0.20%-0.51%] from 11.5% to 11.9%), and polyunsaturated fatty acids (by 0.65% [95% CI, 0.56%-0.74%] from 7.58% to 8.23%) (all P < .001 for trend). The estimated overall Healthy Eating Index 2015 increased from 55.7 to 57.7 (difference, 2.01; 95% CI, 0.86-3.16; P < .001 for trend). Trends in high- and low-quality carbohydrates primarily reflected higher estimated energy from whole grains (0.65%) and reduced estimated energy from added sugars (-2.00%), respectively. Trends in plant protein were predominantly due to higher estimated intake of whole grains (0.12%) and nuts (0.09%). Conclusions and Relevance: From 1999 to 2016, US adults experienced a significant decrease in percentage of energy intake from low-quality carbohydrates and significant increases in percentage of energy intake from high-quality carbohydrates, plant protein, and polyunsaturated fat. Despite improvements in macronutrient composition and diet quality, continued high intake of low-quality carbohydrates and saturated fat remained. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/31550032/Trends_in_Dietary_Carbohydrate_Protein_and_Fat_Intake_and_Diet_Quality_Among_US_Adults_1999_2016_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2019.13771 DB - PRIME DP - Unbound Medicine ER -