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Trends in Diet Quality Among Youth in the United States, 1999-2016.
JAMA. 2020 03 24; 323(12):1161-1174.JAMA

Abstract

Importance

Prior studies of dietary trends among US youth have evaluated major macronutrients or only a few foods or have used older data.

Objective

To characterize trends in diet quality among US youth.

Design, Setting, and Participants

Serial cross-sectional investigation using 24-hour dietary recalls from youth aged 2 to 19 years from 9 National Health and Nutrition Examination Survey (NHANES) cycles (1999-2016).

Exposures

Calendar year and population sociodemographic characteristics.

Main Outcomes and Measures

The primary outcomes were the survey-weighted, energy-adjusted mean consumption of dietary components and proportion meeting targets of the American Heart Association (AHA) 2020 continuous diet score (range, 0-50; based on total fruits and vegetables, whole grains, fish and shellfish, sugar-sweetened beverages, and sodium). Additional outcomes were the AHA secondary score (range, 0-80; adding nuts, seeds, and legumes; processed meat; and saturated fat) and Healthy Eating Index (HEI) 2015 score (range, 0-100). Poor diet was defined as less than 40% adherence (scores, <20 for primary and <32 for secondary AHA scores); intermediate as 40% to 79.9% adherence (scores, 20-39.9 and 32-63.9, respectively); and ideal, as at least 80% adherence (scores, ≥40 and ≥64, respectively). Higher diet scores indicate better diet quality; a minimal clinically important difference has not been quantified.

Results

Of 31 420 youth aged 2 to 19 years included, the mean age was 10.6 years; 49.1% were female. From 1999 to 2016, the estimated AHA primary diet score significantly increased from 14.8 (95% CI, 14.1-15.4) to 18.8 (95% CI, 18.1-19.6) (27.0% improvement), the estimated AHA secondary diet score from 29.2 (95% CI, 28.1-30.4) to 33.0 (95% CI, 32.0-33.9) (13.0% improvement), and the estimated HEI-2015 score from 44.6 (95% CI, 43.5-45.8) to 49.6 (95% CI, 48.5-50.8) (11.2% improvement) (P < .001 for trend for each). Based on the AHA primary diet score, the estimated proportion of youth with poor diets significantly declined from 76.8% (95% CI, 72.9%-80.2%) to 56.1% (95% CI, 51.4%-60.7%) and with intermediate diets significantly increased from 23.2% (95% CI, 19.8%-26.9%) to 43.7% (95% CI, 39.1%-48.3%) (P < .001 for trend for each). The estimated proportion meeting ideal quality significantly increased but remained low, from 0.07% (95% CI, 0.01%-0.49%) to 0.25% (95% CI, 0.10%-0.62%) (P = .03 for trend). Persistent dietary variations were identified across multiple sociodemographic groups. The estimated proportion of youth with a poor diet in 2015-2016 was 39.8% (95% CI, 35.1%-44.5%) for ages 2 to 5 years (unweighted n = 666), 52.5% (95% CI, 46.4%-58.5%) for ages 6 to 11 years (unweighted n = 1040), and 66.6% (95% CI, 61.4%-71.4%) for ages 12 to 19 years (unweighted n = 1195), with persistent differences across levels of parental education, household income, and household food security status.

Conclusions and Relevance

Based on serial NHANES surveys from 1999 to 2016, the estimated overall diet quality of US youth showed modest improvement, but more than half of youth still had poor-quality diets.

Authors+Show Affiliations

Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.Office of Community and Population Health, Montefiore Medical Center, Bronx, New York. 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.Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.

Pub Type(s)

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

Language

eng

PubMed ID

32207798

Citation

Liu, Junxiu, et al. "Trends in Diet Quality Among Youth in the United States, 1999-2016." JAMA, vol. 323, no. 12, 2020, pp. 1161-1174.
Liu J, Rehm CD, Onopa J, et al. Trends in Diet Quality Among Youth in the United States, 1999-2016. JAMA. 2020;323(12):1161-1174.
Liu, J., Rehm, C. D., Onopa, J., & Mozaffarian, D. (2020). Trends in Diet Quality Among Youth in the United States, 1999-2016. JAMA, 323(12), 1161-1174. https://doi.org/10.1001/jama.2020.0878
Liu J, et al. Trends in Diet Quality Among Youth in the United States, 1999-2016. JAMA. 2020 03 24;323(12):1161-1174. PubMed PMID: 32207798.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in Diet Quality Among Youth in the United States, 1999-2016. AU - Liu,Junxiu, AU - Rehm,Colin D, AU - Onopa,Jennifer, AU - Mozaffarian,Dariush, PY - 2020/3/25/entrez PY - 2020/3/25/pubmed PY - 2020/4/1/medline SP - 1161 EP - 1174 JF - JAMA JO - JAMA VL - 323 IS - 12 N2 - Importance: Prior studies of dietary trends among US youth have evaluated major macronutrients or only a few foods or have used older data. Objective: To characterize trends in diet quality among US youth. Design, Setting, and Participants: Serial cross-sectional investigation using 24-hour dietary recalls from youth aged 2 to 19 years from 9 National Health and Nutrition Examination Survey (NHANES) cycles (1999-2016). Exposures: Calendar year and population sociodemographic characteristics. Main Outcomes and Measures: The primary outcomes were the survey-weighted, energy-adjusted mean consumption of dietary components and proportion meeting targets of the American Heart Association (AHA) 2020 continuous diet score (range, 0-50; based on total fruits and vegetables, whole grains, fish and shellfish, sugar-sweetened beverages, and sodium). Additional outcomes were the AHA secondary score (range, 0-80; adding nuts, seeds, and legumes; processed meat; and saturated fat) and Healthy Eating Index (HEI) 2015 score (range, 0-100). Poor diet was defined as less than 40% adherence (scores, <20 for primary and <32 for secondary AHA scores); intermediate as 40% to 79.9% adherence (scores, 20-39.9 and 32-63.9, respectively); and ideal, as at least 80% adherence (scores, ≥40 and ≥64, respectively). Higher diet scores indicate better diet quality; a minimal clinically important difference has not been quantified. Results: Of 31 420 youth aged 2 to 19 years included, the mean age was 10.6 years; 49.1% were female. From 1999 to 2016, the estimated AHA primary diet score significantly increased from 14.8 (95% CI, 14.1-15.4) to 18.8 (95% CI, 18.1-19.6) (27.0% improvement), the estimated AHA secondary diet score from 29.2 (95% CI, 28.1-30.4) to 33.0 (95% CI, 32.0-33.9) (13.0% improvement), and the estimated HEI-2015 score from 44.6 (95% CI, 43.5-45.8) to 49.6 (95% CI, 48.5-50.8) (11.2% improvement) (P < .001 for trend for each). Based on the AHA primary diet score, the estimated proportion of youth with poor diets significantly declined from 76.8% (95% CI, 72.9%-80.2%) to 56.1% (95% CI, 51.4%-60.7%) and with intermediate diets significantly increased from 23.2% (95% CI, 19.8%-26.9%) to 43.7% (95% CI, 39.1%-48.3%) (P < .001 for trend for each). The estimated proportion meeting ideal quality significantly increased but remained low, from 0.07% (95% CI, 0.01%-0.49%) to 0.25% (95% CI, 0.10%-0.62%) (P = .03 for trend). Persistent dietary variations were identified across multiple sociodemographic groups. The estimated proportion of youth with a poor diet in 2015-2016 was 39.8% (95% CI, 35.1%-44.5%) for ages 2 to 5 years (unweighted n = 666), 52.5% (95% CI, 46.4%-58.5%) for ages 6 to 11 years (unweighted n = 1040), and 66.6% (95% CI, 61.4%-71.4%) for ages 12 to 19 years (unweighted n = 1195), with persistent differences across levels of parental education, household income, and household food security status. Conclusions and Relevance: Based on serial NHANES surveys from 1999 to 2016, the estimated overall diet quality of US youth showed modest improvement, but more than half of youth still had poor-quality diets. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/32207798/Trends_in_Diet_Quality_Among_Youth_in_the_United_States_1999_2016_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2020.0878 DB - PRIME DP - Unbound Medicine ER -