Larry Hand
September 02, 2014
Diet quality in the United States improved during a recent 12-year
period, reflecting positive changes in consumers' food choices and food
processing, according to a new article
published online September 1 in
JAMA Internal Medicine.
The
overall quality of the diet remains poor, however, continuing to leave
people at risk of chronic diseases, including type 2 diabetes — and an
existing gap widened further between high- and
low-socioeconomic-status (SES) individuals, the researchers write.
Dong
D. Wang, MD, MSc, of the department of nutrition, Harvard School of
Public Health, Boston, Massachusetts, and colleagues analyzed data on a
nationally representative sample of 29,124 adults aged 20 to 85
years collected through the National Health and Nutrition Examination
Survey (NHANES) for the years 1999 to 2010.
"Overall, this is
encouraging news for clinicians because there has been kind of a
misperception that the population cannot change their dietary habits,"
coauthor Frank B. Hu, MD, PhD, professor of nutrition and
epidemiology at Harvard School of Public Health, told
Medscape Medical News in a telephone interview.
"There
has been an improvement in diet quality, and professionals can play a
major role in improving the diet quality of their patients and their
families, [who are] more inclined to follow the advice of their
doctor," he continued. "Clinicians and professionals can play a major
role in educating the patient, helping them make healthier choices."
Gap Between Rich and Poor Widens
The researchers collected dietary data during
in-person and telephone interviews conducted as part of NHANES surveys.
They assessed nutrient intake using US Department of Agriculture
(USDA) databases. They also categorized data by groups according to
income, education level, age, race/ethnicity, and body mass index
(BMI).
The
analysis shows that the energy-adjusted mean AHEI-2010 overall score
increased from 39.9 during 1999–2000 to 46.8 during 2009–2010 (linear
trend
P < 0.001).
A reduction in consumption of trans fats accounted for more than 50% of the increased score.
As to individual components:
- Sugar-sweetened beverages increased by 0.9 points, reflecting a decline in consumption.
- Whole fruit increased by 0.7 points, reflecting an increase in consumption.
- Whole grains increased by 0.5 points.
- Polyunsaturated fatty acids increased by 0.5 points.
- Nuts and legumes increased by 0.4 points.
- Sodium significantly decreased by 0.5 points (reflecting an increase in consumption).
Diet quality scores for high-SES groups,
based on income and education level, were consistently higher than for
low-SES groups, and the gap widened over time.
For the
high-SES group, scores increased from 3.9 during 1999–2000 to 7.8 during
2009–2010. The researchers observed no significant temporal trend for
the low-SES group.
Among other categories:
- •Women's scores were significantly higher than men's.
- •Mexican Americans scored higher than non-Hispanic whites.
- •Lower BMI was associated with better diet quality scores.
Overall Picture: Some Good News but Much Room for Improvement
The authors say public-policy changes
regarding trans fat, including labeling requirements, efforts by some
cities and other governments to limit use of trans fat, as well as
some manufacturers' reformulation of food processes, have likely played a
role in overall improvements.
"Science-based nutrition policies can make a huge difference in improving the nutrition quality of the population," Dr. Hu said.
"Diet
quality in the general population has been improving moderately but
steadily. One of the most important changes has been reduction in
consumption of soft drinks or sugar-sweetened beverages," he noted.
"But
consumption is still high, and there's still a lot of room to improve.
Some areas haven't changed that much. One area that is going in the
wrong direction is the consumption of sodium, which has increased in
the population, which may reflect increasing consumption of processed
food. Most sodium, or salt, comes from highly processed food."
"The
most disconcerting finding is the gap between the poor and the rich
widened over time in terms of diet quality. This may explain the
increasing disparity in chronic disease between people in the
high-SES and the low-SES groups," he added.
In order to effect
change, Dr. Hu says, "The environment has to be improved so that healthy
foods become more affordable and more accessible to people in the
low-SES groups. Federal nutrition programs may need to pay more
attention to diet quality and food qualities, not just quantities or the
total amount of calories."
Food "Deserts": Poorer People Need Policies to Help Them
In accompanying invited
commentary,
Takehiro Suglyama, MD, PhD, of the National Center for Global
Health and Medicine, Tokyo, Japan, and Martin F. Shapiro, MD, of the
University of Tokyo, agree. They write that people of lower SES tend
to have less access to healthy food; "food deserts" denote poorer
communities where residents may have difficulty getting nutritious
food.
Higher prices also keep poorer people from buying more
healthful food, they say, and lower-SES individuals also may have
limited knowledge about the effect of an unhealthy diet on their
health.
They conclude, "We urgently need to support multipronged initiatives to improve diet quality for persons of lower SES."
Neither the authors nor the commentators have reported any relevant financial relationships.
JAMA Intern Med. Published online September 1, 2014.
Abstract,
Commentary
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