The nutritional quality of meals from some sources has improved in recent years in the United States, but a strikingly high number of meals consumed still have poor nutritional quality, according to a new article published in the journal JAMA Network Open.
Researchers conducted dietary surveys of both adults and children in two different time periods — 2003 to 2004, and 2017 to 2018. A total of 39,757 adults and 20,905 children were included in the survey, which asked respondents in detail what they ate and where they ate it in the last 24 hours. Food intake was reported from restaurants, grocery stores, schools, workplaces and other sources.
The researchers analyzed the nutritional quality of foods participants consumed according to the American Heart Association (AHA) diet score, which ranks foods and meals on a scale from 0 to 80. A diet of poor quality was defined as less than 40% adherence to the AHA guidelines (a score lower than 32), a diet of intermediate quality was defined as between 40% and 79.9% adherence (a score of 32 to 63.9), and an ideal diet was defined as 80% adherence or higher (a score of 64 or higher). Meals consumed from different sources were graded according to these criteria.
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Between the two different survey periods, the proportion of foods of low nutritional quality dropped in several categories. Among children, the share of poor-quality foods consumed from grocery stores dropped from 53.2% to 45.1%, while among adults, it dropped from 40.1% to 32.9%. Restaurant foods scored much worse, with the share of unhealthy food dropping from 84.8% to 79.6% in children and only from 65.4% to 65.2% in adults. Workplaces for adults also saw only a modest improvement, from 55.6% to 50.7% of foods scored as unhealthy.
The largest improvement in the study was seen in schools, with unhealthy foods dropping from 55.6% to 24.4%. This progress, the researchers noted, was most likely due in large part to a 2010 federal law called the Healthy, Hunger-Free Kids Act, which enacted new nutrition standards for schools that emphasized more fruits, vegetables and whole grains, and less refined grains, sodium and unhealthy fats in school meals. On the other hand, the quality of foods consumed from sources other than grocery stores, restaurants, workplaces and schools actually got worse, with the share of unhealthy foods growing from 33.8% to 44.8% in adults and from 40.0% to 51.7% in children.
During both of the study’s survey periods, large differences in diet quality were seen based on sex, race and ethnicity, education level, and household income. As one example, the share of poor-quality foods from grocery stores dropped from 36.9% to 26.5% for high-income adults, but only from 45.8% to 41.3% for low-income adults. The share of poor-quality foods from grocery stores dropped from 40.1% to 33.9% for non-Hispanic white adults, from 32.7% to 28.9% for Hispanic adults, and from 50.6% to 40.8% for non-Hispanic Black adults.
The researchers wrote that “The retail grocery environment remains a top opportunity for improving diet quality, followed by restaurants, schools and, increasingly, other settings, such as entertainment venues and food trucks.” Grocery stores are a top target for improvement since they provide about two-third of total calories, while restaurants provide about one-fifth of total calories. It’s unclear whether the success of improvement in school nutrition can be replicated in other settings, though, since both the nutritional quality of foods offered and consumer choices play a role in the nutrition quality of what people consume from grocery stores, restaurants and other settings.
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