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, Ն40 and Ն64, respectively). Higher diet scores indicate better diet quality; a minimal clinically important difference has not been quantified.

Background The workplace offers a unique opportunity for effective health promotion. We aimed to comprehensively study the effectiveness of multicomponent worksite wellness programmes for improving diet and cardiometabolic risk factors.Methods We did a systematic literature review and meta-analysis, following PRISMA guidelines. We searched PubMed-MEDLINE, Embase, the Cochrane Library, Web of Science, and Education Resources Information Center, from Jan 1, 1990, to June 30, 2020, for studies with controlled evaluation designs that assessed multicomponent workplace wellness programmes. Investigators independently appraised the evidence and extracted the data. Outcomes were dietary factors, anthropometric measures, and cardiometabolic risk factors. Pooled effects were calculated by inverse-variance random-effects meta-analysis. Potential sources of heterogeneity and study biases were evaluated. FindingsFrom 10 169 abstracts reviewed, 121 studies (82 [68%] randomised controlled trials and 39 [32%] quasiexperimental interventions) met the eligibility criteria. Most studies were done in North America (57 [47%]), and Europe, Australia, or New Zealand (36 [30%]). The median number of participants was 413•0 (IQR 124•0-904•0), and median duration of intervention was 9•0 months (4•5-18•0). Workplace wellness programmes improved fruit and vegetable consumption (0•27 servings per day [95% CI 0•16 to 0•37]), fruit consumption (0•20 servings per day [0•11 to 0•28]), body-mass index (-0•22 kg/m² [-0•28 to -0•17]), waist circumference (-1•47 cm [-1•96 to -0•98]), systolic blood pressure (-2•03 mm Hg [-3•16 to -0•89]), and LDL cholesterol (-5•18 mg/dL [-7•83 to -2•53]), and to a lesser extent improved total fat intake (-1•18% of daily energy intake [-1•78 to -0•58]), saturated fat intake (-0•70% of daily energy [-1•22 to -0•18]), bodyweight (-0•92 kg [-1•11 to -0•72]), diastolic blood pressure (-1•11 mm Hg [-1•78 to -0•44]), fasting blood glucose (-1•81 mg/dL [-3•33 to -0•28]), HDL cholesterol (1•11 mg/dL [0•48 to 1•74]), and triglycerides (-5•38 mg/dL [-9•18 to -1•59]). No significant benefits were observed for intake of vegetables (0•03 servings per day [95% CI -0•04 to 0•10]), fibre (0•26 g per day [-0•15 to 0•67]), polyunsaturated fat (-0•23% of daily energy [-0•59 to 0•13]), or for body fat (-0•80% [-1•80 to 0•21]), waist-to-hip ratio (-0•00 ratio [-0•01 to 0•00]), or lean mass (1•01 kg [-0•82 to 2•83]). Heterogeneity values ranged from 46•9% to 91•5%. Betweenstudy differences in outcomes were not significantly explained by study design, location, population, or similar factors in heterogeneity analyses.Interpretation Workplace wellness programmes are associated with improvements in specific dietary, anthropometric, and cardiometabolic risk indicators. The heterogeneity identified in study designs and results should be considered when using these programmes as strategies to improve cardiometabolic health.

BackgroundWe aimed to systematically identify, standardise and disseminate individual-level dietary intake surveys from up to 207 countries for 54 foods, beverages and nutrients, including subnational intakes by age, sex, education and urban/rural residence, from 1980 to 2015.MethodsBetween 2008–2011 and 2014–2020, the Global Dietary Database (GDD) project systematically searched for surveys assessing individual-level intake worldwide. We prioritised nationally or subnationally representative surveys using 24-hour recalls, Food-Frequency Questionnaires or short standardised questionnaires. Data were retrieved from websites or corresponding members as individual-level food group microdata or aggregate stratum-level data. Standardisation included quality assessment; data cleaning; categorising of foods and nutrients and their units; aggregation by demographic strata and energy adjustment.ResultsWe standardised and incorporated 1220 surveys into the final GDD 2017 database, together represented 188 countries and 99.0% of the world’s population in 2015. 72.1% were nationally, 17.0% subnationally, and 10.9% community-level representative. 41.2% used Food-Frequency Questionnaires; 23.4%, 24-hour recalls; 15.8%, Demographic Health Survey questionnaires; 13.1%, biomarkers and 6.4%, household surveys. 73.9% of surveys included data on children; 52.2%, by urban and rural residence; and 30.2%, by education. Most surveys were in high-income countries, followed by sub-Saharan Africa and Asia. Most commonly ascertained foods were fruits (N=803 surveys), non-starchy vegetables (N=787) and sugar-sweetened beverages (N=440); and nutrients, sodium (N=343), energy (N=256), calcium (N=224) and fibre (N=200). Least available data were on iodine, vitamin A, plant protein, selenium, added sugar and animal protein.ConclusionsThis systematic search, retrieval and standardised effort provides the most comprehensive empirical evidence on dietary intakes across and within countries worldwide.

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Objectives Inadequate fruit and vegetable intake contributes to cardiovascular diseases (CVD), and the impacts of fruits and vegetables on CVD risk worldwide has not been well established by country, age, and sex. Our objective was to derive comprehensive and accurate estimates of the burdens of CVD attributable to fruit and vegetable consumption using the largest standardized global dietary database currently available. Methods National intakes of fruit and vegetables (including legumes) were estimated using a Bayesian hierarchical model using individual-level intake data from nationally and sub-nationally representative diet surveys and country-level availability data (266 surveys representing 1630,069 individuals from 113 of 187 countries─ 82% of the world's population). The effects of fruits and vegetables on coronary heart disease (CHD) and stroke mortality, collectively referred to as CVD mortality, were derived from the most recent meta-analyses of prospective cohorts. Disease specific mortality data were obtained from the Global Burden of Diseases study. A comparative risk assessment framework was used to estimate the proportional attributable fraction (PAF) and number of disease-specific deaths. Results In 2010, suboptimal intakes of fruit were estimated to result in 521,395 (95% uncertainty interval [UI] 498,254–542,808) CHD deaths (PAF: 7.5%; 7.2–7.8%) and 1255,978 (1187,716–1325,879) stroke deaths (PAF: 21.7%; 20.5–22.9%) globally per year. Suboptimal intakes of vegetables were estimated to result in 809,425 (783,362–836,687) CHD deaths (PAF: 11.6%; 11.3–12.0%) and 210,849 (196,297–226,577) stroke deaths (PAF: 3.6%; 3.4–3.9%). The proportion of CVD deaths from suboptimal fruit and vegetable intake was higher in males and younger adults. Among the 20 most populous countries, China (541,564; 482,709–608,314; PAF: 20.3%) had the largest absolute CVD deaths from suboptimal fruit intake and India (199,364; 176,961–222,688; PAF: 11.6%) from vegetables. Results for the global burden of fruits and vegetables on CVD in 1990 and 2015 will be presented at the meeting. Conclusions Suboptimal fruit and vegetable intake each contribute to significant CVD mortality, demonstrating a pressing need for public health and policy priorities to increase intake. Funding Sources Gates Foundation. Supporting Tables, Images and/or Graphs