Is America Eating Healthier? Yes, but More Work is Needed

Is America eating healthier? A new analysis suggests that the answer a little complicated. (©Maksymiv Iurii/stock.adobe.com)

Adults in the US have improved their eating habits, however, they are still getting >50% of their energy intake from low-quality carbohydrates and saturated fats, according to a new analysis. 

In the cross-sectional analysis published September 24 in JAMA, researchers found that US adults are consuming more foods with less added sugar as well as more whole grains, plant proteins, and sources of healthy fats vs just a few decades ago.

Over the past 2 decades, research has made strides in generating new ideas regarding healthy eating patterns, which led to the 2015-2020 Dietary Guidelines for Americans. The guidelines recommend individuals eat more fruits, vegetables, whole grains, and other nutrient-dense foods while limiting their intake of foods with added sugar, saturated fats, and salt.

Do Americans follow the recommendations?

To find out, researchers analyzed data from >43 000 US adults who participated in the National Health and Nutrition Examination Survey where they answered questions regarding their dietary intake over a 24-hour period at least once during 9 annual survey cycles between 1999 and 2016. Participants were aged ≥20 years (weighted mean age, 46.9 years; 51.9% women).

Overall diet quality was examined using the Healthy Eating Index 2015 (HEI-2015), which measures adherence to key recommendations from the 2015-2020 Dietary Guidelines for Americans. The total HEI-2015 score ranges from 0 (nonadherence) to 100 (perfect adherence).

Over the 16-year study period, the American diet only improved minimally, going from a score of 55.7 to 57.7.

How healthy is the American diet?

“The macronutrient composition of diet among US adults has improved, but continued high intake of low-quality carbohydrates and saturated fat remain,” wrote researchers led by Shilpa Bhupathiraju, PhD, research scientist, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

The biggest improvements were found in consumption of whole grains and whole fruits. From 1999-2016, the estimated percentage of caloric intake from whole grains increased from 2% to 2.65% and that from whole fruits increased from 2.87% to 3.21%.

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The estimated percentage of caloric intake from polyunsaturated fats increased from 7.58% to 8.23%; a slight increase was also seen in plant protein (5.38%-5.76%).

Consumption of low-quality carbohydrates, however, remained high with 21.2% of American’s caloric intake coming from refined grains, fruit juice, and potatoes and 14.4% from added sugars.

Also, saturated fat intake remained above the recommended 10% of daily energy intake as US adults still favor unprocessed red meat and processed meat.

“Most Americans still have an awfully long way to go to shape up their diets,” Francis S. Collins, MD, PhD, Director of the National Institutes of Health (NIH) wrote in his blog post about the NIH-funded study. They could be helped along, he says, by the “renaissance” in nutrition research.

“Tremendous progress is being made in studying the microbial communities, or microbiomes, helping to digest our foods,” Collins added.

Meanwhile, physicians can help their patients maintain a healthy diet by reminding them to make healthy food choices such as reading nutrition labels, limiting calories or portion sizes, exercising, and finding healthy recipes that they enjoy.

Additional Resources for Patients:

• Eat Right (National Heart, Lung, and Blood Institute/NIH)

• Dietary Fats (MedlinePlus, National Library of Medicine/NIH)

• ChooseMyPlate (US Department of Agriculture)

• Dietary Guidelines for Americans (US Department of Health and Human Services)