Dietary Guidelines For Americans Recommendations Research Articles

How Successful Are U.S. Adults at Altering Nutrient Intakes and Meeting Dietary Guideline Recommendations?

Abstract Objectives The Dietary Guidelines for Americans (DGAs) recommend dietary patterns that limit added sugar, sodium, and saturated fat and emphasize nutrient-dense foods. It is unknown whether individuals who self-report adhering to a diet that alters nutrient intake are, in fact, meeting DGA recommendations. Objective: To compare dietary intakes and adherence to the DGAs in individuals who self-report following a special diet versus those who report following no diet. Methods NHANES 2003–2014 (≥19 y, n = 30,086) data were analyzed to determine % of the population answering yes or no to “Are you on any type of special diet?”. Individuals who answered yes, were further asked, “What kind of diet are you on?” and chose from a list of special diets (e.g., low salt or sodium; sugar free or low sugar). Mean nutrient intakes for each diet population were compared to the population following no diet. Individual usual intakes were estimated to determine the % of the population above or below nutrient-specific DGA recommendations. P < 0.01 was considered significant. Results In U.S. adults, 15.6 ± 0.3% answered yes when asked if they adhere to a special diet. Individuals who reported following a low sugar diet (n = 208) consumed 8.8 ± 0.7% total daily energy from added sugars, which was less than those following no diet (13.8 ± 0.1%; P < 0.01). Of individuals following a low sugar diet, 67 ± 4% met the recommendation to consume <10% energy from added sugar, which was a greater percentage than those following no diet (32 ± 1%; P < 0.01). Individuals who reported following a low salt/sodium diet (n = 580) consumed 3317 ± 110 mg/d sodium, which was less than those following no diet (3657 ± 17 mg/d; P < 0.01). Only 17 ± 2% of individuals following a low salt/sodium diet met recommendations to consume <2300 mg/d sodium, which was a greater percentage than those following no diet (10 ± 0%; P < 0.01). Conclusions American adults who self-report adhering to a low sugar or low salt/sodium diet consume less added sugar and sodium, respectively, than individuals who report following no diet. However, a substantial proportion of individuals following low sugar or low salt/sodium diets are still not meeting DGA recommendations. Funding Sources DMRP/USAMRDC. Views expressed are those of the authors and do not reflect official policy of the Army, DoD, or US Government.

Adding Unprocessed Lean Red Meat to A Healthy Vegetarian Eating Pattern Does Not Impact Short-Term Improvements in Cardiometabolic Health in Young Adults

Abstract Objectives The 2015–2020 Dietary Guidelines for Americans recommends adopting healthy eating patterns and restricting red meat intake, whereas the impact of consuming red meat on cardiometabolic (CMD) risk factors remains inconsistent in the scientific literature. This study assessed the effects of adding unprocessed lean red meat to a lacto-ovo vegetarian eating pattern (LOV) on changes in cardiometabolic health indexes. It was hypothesized that the addition of red meat would not influence LOV-induced improvements in CMD risk factors. Methods Twenty-nine participants (15 female and 14 male, aged 26 ± 0.8 y, BMI 23.7 ± 0.4 kg/m2) completed this randomized-controlled, crossover trial. All participants consumed the same energy-balanced, LOV diet for two 3-week periods, separated by 5 weeks of habitual eating. Three ounces/day of unprocessed lean red meat (1.5 oz beef tenderloin and 1.5 oz pork loin) were added to the LOV diet without energy compensation for one of the two trials. Fasting blood pressure, serum lipids, lipoproteins, and glucose were measured before and at the end of each trial. Results were adjusted for age, sex, and body mass at each time point (LS Means ± SE, significance at adjusted P < 0.05). Results Adding unprocessed lean red meat (RM) to the LOV diet did not influence responses of the cardiometabolic health indexes after 3 weeks. Overall, significant (P < 0.05) reductions were observed for total cholesterol (without vs. with RM; −14.3 ± 3.6 vs. −14.8 ± 3.5 mg/dl), low-density lipoprotein-cholesterol (LDL-C, −8.6 ± 2.9 vs. −7.5 ± 2.9 mg/dl), and high-density lipoprotein-cholesterol (HDL-C, – 5.3 ± 1.5 vs. −4.8 ± 1.5 mg/dl). No changes were observed in fasting body mass, triglycerides, HDL-C/LDL-C ratio, glucose, or systematic/diastolic blood pressure levels. Conclusions Adopting a healthy lacto-ovo vegetarian eating pattern improves serum lipids and lipoproteins within three weeks. These improvements are retained when the eating pattern becomes omnivorous by adding unprocessed lean red meat. Funding Sources Pork Checkoff, North Dakota Beef Commission, Beef Checkoff, and Foundation for Meat & Poultry Research & Education.

Adequacy of Total Usual Nutrient Intakes from Foods and Supplements Among Pregnant Women in the United States by Level of Dairy Consumption, NHANES 2003–2016

Abstract Objectives Dairy products are a rich source of many nutrients including calcium, vitamins A and D, and potassium; these micronutrients are among the nutrients underconsumed by pregnant women. The objective of this analysis was to examine nutrient intake adequacy from foods (including beverages) and dietary supplements among pregnant women in the US by level of dairy consumption. Methods Using data from pregnant women (n = 806) ages 20–44 years in the combined NHANES 2003–2016, usual intakes (UI) of micronutrients from food and dietary supplement sources were estimated by level of total reported dairy product consumption categorized as <1 (n = 244, 31%), 1 to <2 (n = 211, 28%), 2 to <3 (n = 144, 19%), and ≥3 (n = 207, 22%) cup equivalents per day (cup-eq/d). The Dietary Guidelines for Americans recommendation for dairy product consumption is 3 cup-eq/d. Usual intakes and prevalence of intakes below the Estimated Average Requirement (EAR) for underconsumed nutrients (e.g., magnesium and vitamin A) and nutrients of public health concern (e.g., calcium, potassium, and vitamin D) were calculated using the National Cancer Institute (NCI) method. Statistical significance was set at P < 0.05. Results Mean consumption of dairy products among pregnant women was 2.0 ± 0.08 cup-eq/d, with 78% of pregnant women consuming less than the recommended 3 cup-eq/d. Compared to women consuming ≥3 cup-eq/d, women consuming <1 or 1 to <2 cup-eq/d of dairy products were more likely to have inadequate intakes of vitamin D (22% vs 56% and 22% vs 51%, respectively) and potassium (31% vs 81% and 31% vs 71%, respectively). Compared to women consuming ≥3 cup-eq/d of dairy products, women consuming <1 cup-eq/d were more likely to have inadequate intakes of calcium (<3% vs 43%). Pregnant women consuming ≥3 cup-eq/d of dairy products were less likely to have inadequate intakes of vitamin A and magnesium compared to women consuming the lowest levels of dairy intake. Conclusions Consumption of dairy products among pregnant women is associated with increased prevalence of adequate intakes of select underconsumed micronutrients. Funding Sources Dairy Management Inc.

Abstract P356: Modeling the Impact of Flexibility in Fat Levels of Dairy Foods Consumed to Meet Recommendations From the 2015 Dietary Guidelines for Americans Healthy U.S.-style Eating Pattern

Introduction: The 2015 Dietary Guidelines for Americans (DGA) recommends consuming low-fat or fat-free dairy foods due to concerns about excess intake of energy, which can lead to overweight or obesity, and saturated fat, a type of fat that can increase blood levels of low-density lipoprotein cholesterol, a blood biomarker used to predict cardiovascular disease risk. The 2015 DGA recommends limiting intake of saturated fats to less than 10% of calories per day and balancing energy intake. Hypothesis: The objective of this study was to assess the impact of replacing one serving of fat-free dairy foods provided in current models of the 2000-calorie Healthy U.S.-Style Eating Pattern (HUSEP) with one serving of whole- or reduced-fat dairy foods. We hypothesized that this replacement would still result in an eating pattern within calorie, saturated fat, and sodium limits. Methods: Utilizing the same food pattern modeling procedures used for the 2015 DGA, we assessed the energy and nutrient composition of six alternative models of the 2000-calorie HUSEP. In each pattern, we replaced 1 of the 3 servings of the USDA’s fat-free dairy food composite with whole- or reduced-fat dairy products or whole-/reduced-fat dairy composites. The 6 replacement models included replacements with: 1) a whole-fat dairy food composite, 2) a reduced-fat dairy food composite, 3) whole milk, 4) reduced-fat milk, 5) whole-fat cheese, and 6) reduced-fat cheese. Results: In all 6 models, the amount of saturated fat did not exceed 10% of total calories. In models 2, 3, and 4, saturated fat was 9% of total calories. The amount of energy increased slightly in all models. The original HUSEP provided 2003 calories, and the 6 models in this study provided an additional 45 (Model 4) to 94 (Model 5) additional calories. The amount of sodium also increased. The original HUSEP provides 1787 mg of sodium, and these models provided between 2082 and 2683 mg of sodium. While still lower than the current average sodium intake (3,440 mg/d), the amount of sodium in Models 1, 2, 5, and 6 exceeds 2,300 mg/d, the Chronic Disease Risk Reduction Intake level for sodium. Conclusions: Results of this study indicate that some reduced- and whole-fat dairy foods, especially milk, can fit into calorie-balanced healthy eating patterns that also align with saturated fat and sodium recommendations. Allowing some flexibility in fat level of dairy food servings aligns with the 2010 DGA recommendation that calories from solid fats and added sugars are best used to increase the palatability of nutrient-dense foods, which includes milk, cheese, and yogurt.

Abstract 37: Healthy Eating Patterns and Risk of Cardiovascular Disease: Results From Three Large Prospective Cohort Studies

Introduction: The 2015-2020 Dietary Guidelines for Americans (DGAs) recommend three major healthy dietary patterns: the Healthy US-Style Eating Pattern, the Healthy Mediterranean-Style Eating Pattern, and the Healthy Vegetarian Eating Pattern, for all Americans with diverse cultural and personal food traditions. However, few studies have systematically examined the potential differences in associations of adherence to these recommended dietary patterns with long-term risk of cardiovascular disease (CVD). Hypothesis: We hypothesized that all three DGA-recommended dietary patterns were associated with lower risk of CVD, coronary heart disease (CHD), and stroke. Method: We evaluated data on 74 661 women in the Nurses’ Health Study (NHS), 90 864 women in NHS II, and 41 837 men in the Health Professionals Follow-Up Study (HPFS), who had repeated dietary data and had no history of type 2 diabetes, CVD, or cancer at baseline. Using the food and nutrient components, we calculated the Healthy Eating Index (HEI)-2015, Alternate Mediterranean Diet score (AMED), Healthful Plant-based Diet Index (HPDI), to measure adherence to the Healthy US-Style Eating Pattern, Healthy Mediterranean-Style Eating Pattern, and Healthy Vegetarian Eating Pattern, respectively. Multivariable Cox proportional-hazards regression was used to assess the associations of healthy eating index with CVD risk. Results: We documented 9 262 incident CVD cases (6 628 CHD and 2 701 stroke) during 1 976 026 person years of follow-up in the NHS, 1 916 CVD cases (1 267 CHD and 660 stroke) during 2 173 162 person years of follow-up in NHS II, and 10 203 CVD cases (8 750 CHD and 1 775 stroke) during 873 053 person years of follow-up in HPFS. When comparing the highest to the lowest quintiles, the pooled HRs (95% CIs) of CVD were 0.80 (0.77 to 0.84) for HEI-2015, 0.83 (0.79 to 0.87) for AMED, and 0.85 (0.81 to 0.89) for HPDI (all P for trend <0.001). In addition, a 25-percentile increase in healthy eating scores was associated with 10% to 22% lower risk of CVD (pooled HR: HEI-2015, 0.78 [0.75 to 0.82]; AMED, 0.90 [0.88 to 0.92]; HPDI, 0.84 [0.81 to 0.88]). For CHD, the pooled HRs (95% CIs) per 20-percentile increase were 0.76 (0.73 to 0.80) for HEI-2015, 0.90 (0.87 to 0.92) for AMED, and 0.83 (0.79 to 0.87) for HPDI. For stroke, the pooled HRs (95% CIs) per 20-percentile increase were 0.86 (0.78 to 0.94) for HEI-2015, 0.90 (0.85 to 0.95) for AMED, and 0.90 (0.83 to 0.98) for HPDI. The inverse associations between healthy eating index and CVD risk persisted in analyses stratified by potential risk factors. Conclusions: In three large prospective cohorts with up to 32 years of follow-up, higher adherence to various healthy eating patterns was associated with lower risk of CVD, CHD, and stroke. Our findings support the DGA recommendations for multiple healthy eating patterns.

Health Care Costs and Savings Associated with Increased Dairy Consumption among Adults in the United States.

Background: The purpose of this study is to estimate the impact on health care costs if United States (US) adults increased their dairy consumption to meet Dietary Guidelines for Americans (DGA) recommendations. Methods: Risk estimates from recent meta-analyses quantifying the association between dairy consumption and health outcomes were combined with the increase in dairy consumption under two scenarios where population mean dairy intakes from the 2015–2016 What We Eat in America were increased to meet the DGA recommendations: (1) according to proportions by type as specified in US Department of Agriculture Food Intake Patterns and (2) assuming the consumption of a single dairy type. The resulting change in risk was combined with published data on annual health care costs to estimate impact on costs. Health care costs were adjusted to account for potential double counting due to overlapping comorbidities of the health outcomes included. Results: Total dairy consumption among adults in the US was 1.49 cup-equivalents per day (c-eq/day), requiring an increase of 1.51 c-eq/day to meet the DGA recommendation. Annual cost savings of $12.5 billion (B) (range of $2.0B to $25.6B) were estimated based on total dairy consumption resulting from a reduction in stroke, hypertension, type 2 diabetes, and colorectal cancer and an increased risk of Parkinson’s disease and prostate cancer. Similar annual cost savings were estimated for an increase in low-fat dairy consumption ($14.1B; range of $0.8B to $27.9B). Among dairy sub-types, an increase of approximately 0.5 c-eq/day of yogurt consumption alone to help meet the DGA recommendations resulted in the highest annual cost savings of $32.5B (range of $16.5B to $52.8B), mostly driven by a reduction in type 2 diabetes. Conclusions: Adoption of a dietary pattern with increased dairy consumption among adults in the US to meet DGA recommendations has the potential to provide billions of dollars in savings.

Diet Quality of Long-Term Allogeneic and Autologous Stem Cell Transplant (HCT) Survivors

Introduction Long-term hematopoietic stem cell transplant (HCT) survivors are burdened by a high prevalence and early onset of chronic diseases. Healthy dietary patterns have been associated with lower risks of chronic health conditions in the general population, yet no study to date has comprehensively documented the adherence of HCT survivors to the Dietary Guidelines for Americans (DGA), specifically designed to provide guidance for making healthy food choices. The aims of this study were to evaluate the extent to which HCT survivors adhere to the DGA and to determine nutrient intake adequacy. A secondary aim was to assess their willingness to take part in a future nutritional program or dietary intervention. Methods The study population included adults (≥18 y), who had undergone autologous or allogeneic HCT for a hematologic disease and were at least 1-year post-transplantation. Dietary intake was assessed using the Block 2014 food frequency questionnaire and diet quality (adherence to the DGA) was estimated using the Healthy Eating Index-2015 (HEI-2015). A HEI score of ≤50 indicates "poor diet quality", 51-80 suggests a "diet that needs improvement", and >81 indicates "good diet quality" out of maximum of 100. HEI-2015 scores by patient and transplant characteristics were analyzed by ANCOVA. Nutrient intake adequacies of the group were estimated by determining the percentage of the group falling below the Estimated Average Requirement (EAR) of the Dietary Reference Intakes. Receptivity to participate in a dietary intervention to stay healthy was measured by the question, "How willing would you be to take part in a healthy nutrition program or diet intervention?" Response categories included, "not at all," "somewhat," and "definitely". Results Between December 2017 and September 2018, 124 survivors were invited to participate, of whom 90 (51 autologous and 39 allogeneic HCT survivors) completed the dietary intake assessment and were included in the analysis. Majority were male (56%), White (72%), married (81%) and completed some college education (57%). Most participants were overweight (34%) or obese (37%). The median time from the HCT was 5.2 years. Mean ±SE HEI-2015 scores were 61.6 ± 1.3 and 60.7 ± 2.2 for the 18-64 y and ≥65 y age groups, respectively, slightly higher than the US general population. Adherence to a good quality diet was reported by only 10% of survivors. The majority of the survivors reported a diet in need of improvement (82%) or a poor-quality diet (8%). Intakes of vitamin A (720 ± 447 mcg/d), vitamin C (82 ± 73 mg/d), vitamin D (4.4 ± 3.4 mcg/d), magnesium (253 ± 133 mg/d), and calcium (781 ± 430 mg/d) suggested inadequacy, as more than 50% of the group fell below the specific EARs. Sodium intake at 2834 ± 1345 mg/d exceeded the DGA recommendation of 2300 mg/d. Fiber intake at 8.9 g per 1000 kcal/d was significantly below the Adequate Intake of 14 g per 1000 kcal/d. "Change in taste" was the only variable associated with lower quality of diet (p=0.02). Interestingly, 29% of HCT survivors reported persistent altered taste sensation. No significant relationships were seen for participant's demographics and diet quality which may be due to a sample population skewed toward older, causations and socioeconomically advantaged individuals. More than two thirds of participants (73%) indicated an interest in participating in dietary intervention. HCT survivors within 2 years of transplant were more likely to be receptive to participation in a diet intervention study compared to survivors beyond 2 years (52% vs 28%, p=0.0013). Conclusion Adult HCT survivors report poor adherence to the 2015 Dietary Guidelines for Americans and have numerous short-fall nutrient intakes. However, the willingness to participate in a nutritional program or dietary intervention in this survivorship population was relatively high. These findings reinforce the need to incorporate nutrition into HCT survivor care. Disclosures Wingard: Celgene: Consultancy; Merck: Consultancy; Shire: Consultancy; Ansun: Consultancy; Pluristem: Consultancy.

O2 Participation in the Food Program Ensures Availability of Nutritious Foods but not Intake in Children Attending Childcare

Background Childcare programs participating in the federal Child and Adult Care Food Program (CACFP) serve nutritious foods and beverages to children. Most of these studies however, report on food served but not in comparison with the updated 2017 CACFP meal pattern and foods consumed. Objective The purpose of this study is to assess if CACFP-funded childcare centers are meeting the updated CACFP meal pattern and age-specific Dietary Guidelines for Americans (DGA) 2015-2020 regarding foods served and consumed by children, respectively. Study Design, Settings, Participants Cross-sectional study using dietary observation in childcare method. Children ages three to five years old (n = 108) from three CACFP childcare centers were recruited by convenience sampling. Measurable Outcome/Analysis Food served and food consumed were measured for five food groups during observed lunch. Amounts of food served from each food group were compared with age-specific minimum serving size requirement by CACFP using one-sample t-test. Amounts of food consumed from each food group were compared with age-specific recommendations by DGA using one-sample t-test. Proportions of foods consumed from the served amounts were calculated using descriptive statistics. Results Foods were served and portioned by the childcare providers for 81.5% (n = 88) of the children. Foods served were consistent with CACFP recommendations. Children were over-served whole grains, milk, fruits and vegetables (FV) than the CACFP requirement (P Conclusion Although childcare centers are serving foods based on CACFP requirements, children are not meeting DGA recommendations. CACFP childcare programs may benefit from training regarding best practices related to encouraging children's healthier food choices and managing food refusal. Funding USDA Hatch Project 1011204; Nebraska Agricultural Experiment Station.

Eating Behaviors and Dietary Intakes of Older Adults: What We Eat in America, NHANES 2015–2016 (FS02-07-19)

ObjectivesIt is estimated that the number of older individuals in the U.S. will nearly double between 2020 and 2050 to over 80 million. This research examines eating behaviors and dietary intakes of older adults. MethodsNationally representative day 1 dietary data from 1684 adults ages 60+ participating in What We Eat in America (WWEIA), NHANES 2015–2016 were analyzed to estimate eating pattern behaviors and dietary intakes. The interviewer-administered 5-step USDA Automated Multiple-Pass Method (AMPM) was used to collect the 24-hour dietary recall. The WWEIA Food Categories were used to estimate the percentage who consumed vegetables or fruits. The Food Patterns Equivalents Database (FPED) was used to calculate added sugars intake. ResultsOn any given day, almost all older adults reported eating breakfast (92%) and dinner (94%) and fewer ate lunch (78%); two-thirds reported all three meals. Snacks were consumed by 94%, most commonly 3 to 4 times per day, and provided 20% of daily mean energy intake. In relation to energy, snacks provided more of the daily intakes of caffeine (33%), total sugar (32%), carbohydrates (23%), and calcium (21%). More than 2/3 of older adults consumed a vegetable, 1/3 of which were white potatoes, such as French fried, mashed, or baked potatoes. A fruit was reported by just over half of older adults, the most common being bananas (16%), followed by apples (12%), berries (11%), citrus (9%), melons (8%), and grapes (5%). Four out of ten older adults consumed at least one food or beverage from a restaurant and among these individuals, intake at restaurants provided 42% of their daily energy intake and about half of daily intakes of fat, saturated fat, cholesterol, and sodium. Mean daily intakes of added sugars and saturated fat each provided 12% of daily energy intake, exceeding the Dietary Guidelines for Americans recommendations of less than 10% of calories per day from each, as did sodium with mean daily intake of 3091 mg, exceeding the recommendation of less than 2300 mg. ConclusionsWith the number and proportion of older adults increasing in the U.S., understanding their eating behaviors and dietary intakes can inform strategies for well-being during this life stage. Funding SourcesUSDA, Agricultural Research Service.

Sodium and Potassium in the American Diet: Important Food Sources from NHANES 2015–2016 (P18-045-19)

ObjectivesThis analysis used data from the 2015–2016 National Health and Nutrition Examination Survey (NHANES) to identify major food sources of sodium, potassium, or both in the American diet. MethodsTwenty-four-hour dietary recall data (n = 7817) from the dietary component of the 2015–2016 NHANES was used. Data was analyzed separately for children age 2–18 years and for adults age 19 + years using day one sample weights. Percent sodium and potassium contributions from 48 food subgroups of “What We Eat in America” were determined using SAS (PROC SURVEYREG) and the ratio method. ResultsThe top five food sources of sodium for children 2–18 years of age were: mixed dishes – sandwiches (8.9%), mixed dishes – pizza (8.4%), cured meat/poultry (6.7%), mixed dishes – grain based (6.2%), and poultry (6.0%). Major food sources of potassium for children were milk (11.7%), fruits (7.1%), white potatoes (5.6%), mixed dishes – sandwiches (5.2%), and 100% fruit juices (4.8%). In adults, the top five sources of sodium were mixed dishes – sandwiches (7.5%), cured meat/poultry (7.0%), mixed dishes – Mexican (6.1%), poultry (5.5%), and breads, rolls, tortillas (5.4%). Major food sources of potassium for adults were coffee and tea (8.1%), vegetables, excluding potatoes (7.9%), fruits (6.2%), white potatoes (6.1%), and milk (4.9%). Milk was a minor source of sodium for children (2.6%) and in adults (1.2%). While previous research shows cheese as a source of sodium in the U.S. diet, cheese as consumed was not one of the top 5 sources of sodium for adults or children. However, it is a component of several of the mixed dishes identified in this analysis. ConclusionsIn children, sandwiches was a top food source of both sodium and potassium. There were no other overlaps in sources of sodium and potassium. Mixed dishes were top food sources of sodium in the diets of both children and adults, while milk, fruits, and potatoes were top food sources of potassium for both groups. This information could be used to help Americans move closer to Dietary Guidelines for Americans recommendations for both sodium and potassium. Funding SourcesNational Dairy Council.

Usual Intake of Food Patterns Components by Older Adults from WWEIA, NHANES 2013–2016 (P18-119-19)

ObjectivesCompare the usual intake of food patterns components to the 2015–2020 Dietary Guidelines for Americans (DGA) by demographics for adults age 51 and older. MethodsThis analysis is based on 24-hr recalls from 4736 individuals age 51 and older from What We Eat in America, National Health and Nutrition Examination Survey 2013–2016 (WWEIA, NHANES). It uses the Food Patterns Equivalents Databases for 2013–2014 and 2015–2016. These databases contain the amounts of Food Patterns components for each food and beverage reported by each WWEIA, NHANES respondent. Usual intake distributions of selected food patterns components are estimated using the National Cancer Institute method. These distributions are then compared to the energy-specific recommendations in the DGA as appropriate for each respondent, based on age, sex, and physical activity level. The NHANES Physical Activity Questionnaire is used to classify respondents as sedentary, moderately active, or active. ResultsWhen estimating the Food Patterns component of total protein foods, the mean usual intake ± SE in ounce equivalents for adults age 51 and older, men had significantly higher intake than women (7.3 ± .13 vs 5.1 ± .10 (P < 0.001). The mean usual intake for adults age 71 and older was less than for those age 51–70 (P < 0.001) regardless of sex, race/ethnicity or income (P < 0.001). When considering the energy specific recommendation for total protein foods for adults 51 years and over, women were more likely than men to not meet their recommendation, 57% vs 38% (P < 0.001). Further, women age 71 and older were more likely to not meet their recommendation compared to those age 51–70 (70% vs 52%, P < 0.001), with the differences significant regardless of race/ethnicity and income (P < 0.001). ConclusionsOverall, there are large percentages of adults age 51 and older who failed to meet the DGA recommendations for total protein foods. Comparing usual intake of older adults shows differences between men and women and by age, race/ethnicity, and income. Funding SourcesARS, USDA.

Decreasing the Consumption of Foods with Sugar Increases Their Reinforcing Value: A Potential Barrier for Dietary Behavior Change

BackgroundThe Dietary Guidelines for Americans (DGA) have recommended reducing added sugar intake since its inception in 1980. Nearly 40 years later, added sugar consumption still exceeds 2015-2020 DGA recommendations among most of the population. The reinforcing value of food influences eating behaviors, and foods high in added sugars are highly reinforcing. Restricting intake of foods high in added sugars as part of a low-sugar diet may increase their reinforcing value such that reducing consumption may be difficult to maintain. If so, this would present a mechanistic barrier to making the necessary dietary changes to meet 2015-2020 DGA recommendations. PurposeTo determine whether the relative reinforcing value of foods high in added sugars is altered when reducing intake of all foods high in sugars. MethodsObese (n=19) and normal weight (n=23) men and woman who habitually consumed over 10% of their calories from added sugars completed the study. Reinforcing value of foods high in added sugars was measured via progressive ratio schedules of reinforcement before and on day 7 of a weeklong controlled feeding intervention where added sugars comprised 2.5% to 4.0% of daily calories and total sugars 7.3% to 8.6% of daily calories. ResultsThe reinforcing value of foods high in added sugars increased (P<0.01) after consuming a diet low in total added sugars for 1 week in both obese and normal weight participants. ConclusionAdhering to a low-sugar diet for 1 week increases the reinforcing value of foods high in added sugars. Future studies should examine whether consuming a diet low in added sugars, but not other sugar, increases reinforcing value of foods high in added sugars and whether high–added sugar food reinforcement returns to baseline after longer-term reductions in added sugars.

Variation in Nutritional Quality of School Lunches With Implementation of National School Lunch Program Guidelines

School lunches must meet National School Lunch Program (NSLP) requirements to receive reimbursement. In this study, we sought to determine whether there are significant differences in nutrient content and nutritional quality between 2 menus meeting NSLP requirements. A cross-sectional content analysis compared 6 weeks of a typical school lunch menu (TM) from an actual school district to a best practice school lunch menu (BPM) created by a registered dietitian based on Child and Adult Care Food Program (CACFP) best practices and Dietary Guidelines for Americans (DGA) healthy meal pattern recommendations. Daily nutrient content was determined using nutrient analysis software. Nutritional quality was computed using Healthy Eating Index (HEI) 2010. For nutrients required for analysis, the BPM was lower in calories, saturated fat, and sodium and higher in protein, carbohydrate, and fiber (ps < .01). For other nutrients of concern, the BPM was higher in vitamin A, vitamin D, phosphorus, and magnesium (ps < .01). The BPM had higher HEI scores for nutritional quality (p < .001). Results indicate the possibility for significant variation in nutritional quality of NSLP-qualifying lunches. Using CACFP best practices and DGA recommendations may significantly impact school lunch dietary quality.

Dietary Intakes of EPA and DHA Omega-3 Fatty Acids among US Childbearing-Age and Pregnant Women: An Analysis of NHANES 2001-2014.

Background: The 2015–2020 Dietary Guidelines for Americans (DGA) recommend that the general population should consume about 8 ounces (oz.) per week of a variety of seafood, providing approximately 250 mg per day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and that pregnant and lactating women should consume 8–12 oz. per week of seafood. Methods: We determined the usual intakes, percentage not meeting recommendations, and trends in EPA and DHA intakes among childbearing-age and pregnant women (15–44 years of age) using the NHANES cycles 2001–2002 through 2013–2014. Results: For the childbearing-age women, the mean usual intake of seafood was 0.44 ± 0.02 oz. equivalent per day and 100% of the population was below the DGA recommendation. Mean usual intakes of EPA, DHA, and combined EPA and DHA from foods and dietary supplements combined were 26.8 ± 1.4, 62.2 ± 1.9, and 88.1 ± 3.0 mg per day, respectively. Over 95% of the sample did not meet the daily intakes of 250 mg EPA and DHA. Similar results were observed for pregnant women. After controlling for covariates, there were slight but significant increases in EPA and DHA intakes from foods and dietary supplements over the 14-year span among childbearing-age (p = 0.005) and pregnant women (p = 0.002). Conclusions: It was estimated that a majority of U.S. childbearing-age and pregnant women consumed significantly lower amounts of seafood than what the DGA recommends, which subsequently leads to low intakes of EPA and DHA; in addition, dietary supplement use has not eliminated the nutrient shortfall.

Poor Dietary Guidelines Compliance among Low-Income Women Eligible for Supplemental Nutrition Assistance Program-Education (SNAP-Ed).

The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program aims to improve nutritional intakes of low-income individuals (<185% poverty threshold). The objective of this study was to describe the compliance with Dietary Guidelines for Americans (DGA) recommendations for fruits, vegetables, and whole grains among SNAP-Ed eligible (n = 3142) and ineligible (n = 3168) adult women (19–70 years) nationwide and SNAP-Ed participating women in Indiana (n = 2623), using the NHANES 2007–2012 and Indiana SNAP-Ed survey data, respectively. Sensitivity analysis further stratified women by race/ethnicity and by current SNAP participation (<130% poverty threshold). Nationally, lower-income women were less likely to meet the fruit (21% vs. 25%) and vegetable (11% vs. 19%) guidelines than higher-income women, but did not differ on whole grains, which were ~5% regardless of income. The income differences in fruit and vegetable intakes were driven by non-Hispanic whites. Fewer SNAP-Ed-eligible U.S. women met fruit (21% vs. 55%) and whole grain (4% vs. 18%) but did not differ for vegetable recommendations (11% vs. 9%) when compared to Indiana SNAP-Ed women. This same trend was observed among current SNAP participants. Different racial/ethnic group relationships with DGA compliance were found in Indiana compared to the nation. Nevertheless, most low-income women in the U.S. are at risk of not meeting DGA recommendations for fruits (79%), vegetables (89%), and whole grains (96%); SNAP-Ed participants in Indiana had higher compliance with DGA recommendations. Increased consumption of these three critical food groups would improve nutrient density, likely reduce calorie consumption by replacing high calorie choices, and improve fiber intakes.

Satisfying America's Fruit Gap: Summary of an Expert Roundtable on the Role of 100% Fruit Juice.

The 2015 to 2020 Dietary Guidelines for Americans (DGAs) recognize the role of 100% fruit juice in health and in helping people meet daily fruit recommendations and state that 100% fruit juice is a nutrient-dense beverage that should be a primary choice, along with water and low-fat/fat-free milk. The DGAs note that children are consuming 100% fruit juice within recommendations (that is, 120 to 180 mL/d for children aged 1 to 6 y and 236 to 355 mL/d for children aged 7 to 18 y). Evidence shows that compared to nonconsumers, those who consume 100% fruit juice come closer to meeting daily fruit needs and have better diet quality. In children, 100% fruit juice is associated with increased intakes of nutrients such as vitamin C, folate, and potassium. When consumed within the DGA recommendations, 100% fruit juice is not associated with overweight/obesity or childhood dental caries and does not compromise fiber intake. Preliminary data suggest that polyphenols in some 100% fruit juices may inhibit absorption of naturally occurring sugars. Given its role in promoting health and in helping people meet fruit needs, experts participating in a roundtable discussion agreed that there is no science-based reason to restrict access to 100% fruit juice in public health nutrition policy and programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Reducing or eliminating 100% fruit juice could lead to unintended consequences such as reduced daily fruit intake and increased consumption of less nutritious beverages (for example, sugar-sweetened beverages).

An Exploratory Study Examining the Impact of Participating in a Nutrition‐Education and Culinary Skill‐Building Program on Adolescents' Dietary Intake Using the Remote Food Photography Method

It is important for adolescents to develop healthy eating habits, yet many youth lack adequate cooking skills and frequently purchase and consume foods away from home. Away‐from‐home meals tend to be low in fruits and vegetables, and a lack of these foods can contribute to a lower quality diet. Nutrition‐education and culinary skill‐building programs have been found to improve adolescents' motivation and competence to follow the 2010 Dietary Guidelines for Americans recommendations, yet it is not known if such interventions improve dietary intake. The purpose of this study was to assess the impact of participating in a summer nutrition‐education and culinary skill‐building program on high school students' consumption of fruits, vegetables, and overall dietary quality. Three‐day diet records were gathered before and after participating in a six‐week summer enrichment program using the Remote Food Photography Method. Participants sent photographs of foods and beverages consumed to investigators, and dietary information was analyzed by researchers at Pennington Biomedical Research Center. Normally distributed data were analyzed using t‐tests and data not normally distributed were examined with Wilcoxon Signed Rank Tests. Twenty adolescents were invited to participate, and eight enrolled (40%). Four participants were male (50%) and all were African American. The adolescents' mean age was 16 ± 1.1 years. Wilcoxon Signed Rank Tests indicated that the adolescents' 3‐day‐average servings of fruit significantly increased from baseline (Mdn = 0.00) to post‐program (Mdn = 0.69), Z = −2.02, p &lt; 0.05, r = 0.71, but consumption of vegetables and overall diet quality estimated from Healthy Eating Index (HEI) Score did not change as a result of participating in the program. For the eight participants, the number of vegetable servings pre‐program was Mdn = 0.00, and the number of servings post‐program was Mdn = 0.00. The HEI pre‐program mean score was M = 61.50, SE = 0.54 and the post‐program score was M = 64.58, SE = 2.16. The results from this study suggest that behavioral interventions promoting nutrition education and cooking competence can improve older adolescents' consumption of fruit.Support or Funding InformationPartially funded by Hatch Project 94127, and NIH grants P30DK072476 and U54 GM104940.

Healthcare costs and savings associated with increased dairy consumption in the United States

The vast majority of US adults consume less than the 3 cup‐equivalents (c‐eq) of dairy servings daily recommended in the Dietary Guidelines for Americans (DGA). Numerous studies have examined dose‐response relationships between dairy consumption and chronic disease risk. Using these data, this study quantified the annual net impact on health care costs assuming adults increase dairy consumption to meet the DGA recommendation.Recent, high quality meta‐analyses of prospective cohort studies of health outcomes associated positively or negatively with increased dairy consumption were identified in the literature. Nationally representative annual direct and indirect costs associated with each outcome were identified in the literature and inflated to 2016 dollars. The 2011–12 What We Eat in America data provided estimates of current dairy consumption among US adults. Summary relative risk estimates quantifying the association between increased dairy consumption and health outcomes from the meta‐analyses were combined with the increase in consumption required to meet the dairy recommendation and the resulting change in risk was used to estimate the impact on costs. Total annual costs were reduced proportionally to reflect the change in risk of each health outcome. The primary analysis focused on outcomes in the meta‐analyses with statistically significant associations. Secondary analyses included outcomes that show consistent associations but do not reach statistical significance. When risk estimates associated with increased consumption by dairy type were available (i.e., high fat, low fat, milk, cheese, and yogurt), heath care costs associated with changes in consumption of each dairy type to meet the recommendation were estimated.Significant protective associations between dairy consumption (total or type‐specific) and coronary heart disease (CHD), stroke, hypertension (HT), and type 2 diabetes mellitus (T2D) were identified in the literature. Current total dairy consumption among US adults was 1.63 c‐eq/day, requiring an increase of 1.37 c‐eq/day to meet the 3 c‐eq recommendation. In the primary analysis, $8.9 billion (B) in cost savings ($6.4B direct; $2.5 indirect) was associated with this increase in total dairy consumption. Savings were based on a 3.4% reduction in risk of both HT ($1.8B) and T2D ($7.1B). When all outcomes were included in the secondary analyses, cost savings were estimated to be $17.5B for total dairy. Increased consumption of low fat dairy was associated with reduced risk of CHD, stroke, and HT resulting in projected savings of $12.8B while high fat dairy consumption was limited to stroke risk reduction, yielding savings of $1.6B. Costs associated with the hypothetical increased consumption of individual dairy products also showed significant savings. Notably, an increase of 1.37 c‐eq in cheese consumption resulted in an estimated $27.5B savings, largely from a strong protective association with CHD risk (11.5% reduction; $26.4B).While limited by the quality and quantity of available data, this model is based on recent literature and improves upon previous estimates. Findings from this study suggest that the impact of increasing per capita dairy consumption among adults to meet DGA recommendations could reduce healthcare costs in the US, with billions of dollars in potential savings.Support or Funding InformationNational Dairy Council

The 2015 Dietary Guidelines for Americans is associated with a more nutrient-dense diet and a lower risk of obesity

Dietary pattern analysis represents a departure from the traditional focus on single foods and nutrients and provides a comprehensive understanding of the role of the diet in chronic disease prevention and etiology. Dietary patterns of Canadians have not been evaluated comprehensively with the use of an updated a priori dietary quality index. We aimed to update the Dietary Guidelines for Americans Adherence Index (DGAI) on the basis of the 2015 Dietary Guidelines for Americans (DGA), to evaluate the construct validity and reliability of the revised index, and to examine whether closer adherence to this index is associated with a lower risk of obesity with or without an accompanying chronic disease. Data from 11,748 participants (≥18 y of age) in the cross-sectional Canadian Community Health Survey cycle 2.2 were used in weighted multivariate analyses. Multinomial logistic regression was used to test the association between diet quality and obesity risk. With the use of principal component analyses, the multidimensionality of the 2015 DGAI was confirmed, and its reliability was shown with a high Cronbach's α = 0.75. Moving from the first to the fourth (healthiest) quartile of the 2015 DGAI score, there was a trend toward decreased energy (2492 ± 26 compared with 2403 ± 22 kcal, respectively; ±SE) and nutrients of concern (e.g., sodium), whereas intakes of beneficial nutrients increased (P-trend < 0.05). In the age- and sex-adjusted model, a lack of adherence to the 2015 DGA recommendations increased the OR of being unhealthy obese from 1.42 (95% CI: 1.02, 1.99) in quartile 3 to 2.08 (95% CI: 1.49, 2.90) in quartile 2 to 2.31 (95% CI: 1.65, 3.23) in the first quartile of the 2015 DGAI score, compared with the fourth quartile (healthiest) (P-trend < 0.0001). The odds of being obese without a chronic disease (healthy obese) and having a chronic disease without being obese also increased in the lowest DGAI quartile compared with the highest DGAI quartile, albeit not as much as in the unhealthy obese group. The 2015 DGAI provides a valid and reliable measure of diet quality among Canadians.

Association between barriers and facilitators to meeting the Dietary Guidelines for Americans and body weight status of caregiver–child dyads: the Healthy Eating and Lifestyle for Total Health Study1–3

Few Americans meet the Dietary Guidelines for Americans (DGA), yet a large percentage are overweight. The goal of this research was to examine the association between barriers and facilitators to meeting the DGA and weight in a multisite study. This was a cross-sectional study in which 836 caregiver-child dyads among 3 race/ethnic groups completed the questionnaire across 6 sites participating in the HEALTH (Healthy Eating and Lifestyle for Total Health) Study. Barriers and facilitators to meeting the DGA were assessed by using a validated questionnaire developed specifically for the HEALTH Study. Heights and weights were measured. A series of bivariate regression analyses were conducted to examine the association between caregiver body mass index (BMI) or child BMI z score and the barriers and facilitators to meeting the DGA, adjusting for appropriate covariates in the models. Path analysis was used to examine the relation of caregiver and child barriers and facilitators to their relative BMIs. In children, the BMI z score was associated positively (P < 0.001) with total barriers and negatively (P < 0.001) with total facilitators. In caregivers, BMI was associated positively only with total barriers (P < 0.0001). For each of the 8 MyPyramid components, barriers consistently were associated positively (P < 0.0001) and facilitators were associated negatively (P < 0.001) with BMI z score in children (with the exception of the fruit and physical activity components). For caregivers, most of the barriers to meeting recommendations for meats and beans; solid fats, alcohol, and added sugars; and physical activity components were associated positively (P < 0.01) with BMI. Path analyses show that caregiver facilitators were significantly related to children's facilitators to meeting DGA recommendations (standardized β: 0.12; P < 0.001). To our knowledge, our findings are among the first to show associations between weight and barriers and/or facilitators to meeting the DGA in a national, large sample of caregiver-child dyads. This trial was registered at clinicaltrials.gov as NCT02725970.