IMPORTANCE Changes in the economy, nutrition policies, and food processing methods can affect dietary macronutrient intake and diet quality. It is essential to evaluate trends in dietary intake, food sources, and diet quality to inform policy makers.OBJECTIVE To investigate trends in dietary macronutrient intake, food sources, and diet quality among US adults.DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional analysis of the US nationally representative 24-hour dietary recall data from 9 National Health and Nutrition Examination Survey cycles (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) among adults aged 20 years or older. EXPOSURE Survey cycle.MAIN OUTCOMES AND MEASURES Dietary intake of macronutrients and their subtypes, food sources, and the Healthy Eating Index 2015 (range, 0-100; higher scores indicate better diet quality; a minimal clinically important difference has not been defined).RESULTS There were 43 996 respondents (weighted mean age, 46.9 years; 51.9% women). From 1999 to 2016, the estimated energy from total carbohydrates declined from 52.5% to 50.5% (difference, −2.02%; 95% CI, −2.41% to −1.63%), whereas that of total protein and total fat increased from 15.5% to 16.4% (difference, 0.82%; 95% CI, 0.67%-0.97%) and from 32.0% to 33.2% (difference, 1.20%; 95% CI, 0.84%-1.55%), respectively (all P < .001 for trend). Estimated energy from low-quality carbohydrates decreased by 3.25% (95% CI, 2.74%-3.75%; P < .001 for trend) from 45.1% to 41.8%. Increases were observed in estimated energy from high-quality carbohydrates (by 1.23% [95% CI, 0.84%-1.61%] from 7.42% to 8.65%), plant protein (by 0.38% [95% CI, 0.28%-0.49%] from 5.38% to 5.76%), saturated fatty acids (by 0.36% [95% CI, 0.20%-0.51%] from 11.5% to 11.9%), and polyunsaturated fatty acids (by 0.65% [95% CI, 0.56%-0.74%] from 7.58% to 8.23%) (all P < .001 for trend). The estimated overall Healthy Eating Index 2015 increased from 55.7 to 57.7 (difference, 2.01; 95% CI, 0.86-3.16; P < .001 for trend). Trends in high-and low-quality carbohydrates primarily reflected higher estimated energy from whole grains (0.65%) and reduced estimated energy from added sugars (−2.00%), respectively. Trends in plant protein were predominantly due to higher estimated intake of whole grains (0.12%) and nuts (0.09%).CONCLUSIONS AND RELEVANCE From 1999 to 2016, US adults experienced a significant decrease in percentage of energy intake from low-quality carbohydrates and significant increases in percentage of energy intake from high-quality carbohydrates, plant protein, and polyunsaturated fat. Despite improvements in macronutrient composition and diet quality, continued high intake of low-quality carbohydrates and saturated fat remained.
Background: The health benefits and risks of dietary supplementation use remain controversial. Objective: To evaluate the association between dietary supplement use, levels of nutrient intake from foods and supplements, and mortality among US adults. Design: Prospective cohort study. Setting: National Health and Nutrition Examination Survey (NHANES) 1999–2010 linked to National Death Index Mortality Data. Patients: 30,899 US adults aged 20+ years who answered questions on dietary supplement use. Measurements: Dietary supplement use in the past 30 days and nutrient intake from foods and supplements. Outcomes included mortality from all causes, cardiovascular disease (CVD), and cancer. Results: During a median follow-up of 6.1 years, a total of 3,613 total deaths occurred, including 945 CVD deaths and 805 cancer deaths. Ever use of dietary supplements was not associated with mortality outcomes. Adequate nutrient intake (≥ Estimated Average Requirement or Adequate Intake) of vitamin A, vitamin K, magnesium, and zinc was associated with reduced all-cause or CVD mortality, but the associations were confined to nutrient intake from foods not supplements. Excess nutrient intake (> Tolerable Upper Intake Level) of calcium was associated with an increased risk of cancer mortality (> vs. ≤ Tolerable Upper Intake Level: multivariable-adjusted mortality rate ratio = 1.62, 95% CI: 1.07, 2.45; multivariable-adjusted mortality rate difference = 1.7, 95% CI: −0.1, 3.5 per 1,000 person-years), and the association appeared to be related to calcium intake from supplements (≥1000 mg/d vs. non-users: multivariable-adjusted mortality rate ratio=1.53, 95% CI: 1.04, 2.25; multivariable-adjusted mortality rate difference = 1.5, 95% CI: −0.1, 3.1 per 1,000 person-years) not foods. Limitations: Results from observational data may be affected by residual confounding. Reporting of dietary supplement use is subject to recall bias. Conclusion: Use of dietary supplements is not associated with mortality benefits among US adults. Primary Funding Source: National Institutes of Health
Background: Accumulating evidence links excessive consumption of processed meat to an increased risk of obesity, diabetes, cardiovascular diseases, and some cancers. Yet, trends in consumption of different types of processed meat in the US have not been quantified. Objective: The aim of the study was to characterize trends in consumption of different types of processed meat among US adults in relation to the consumption of unprocessed red meat, poultry, and fish/shellfish in the past 18 years and their purchase locations. Design: Dietary data collected from U.S. adults aged 20+ years completing at least 1 valid 24hour diet recall from 9 cycles of the National Health and Nutrition Examination Survey (NHANES) (1999-2016) were used to evaluate the trends in mean consumption of processed meat, unprocessed red meat, poultry, and fish/shellfish. Participants/setting: Nationally representative sample of 43,995 US adults aged 20+ years. Main outcome measures: Survey-weighted, energy-adjusted mean consumption of processed meat, unprocessed red meat, poultry, and fish/shellfish. Statistical analysis: Trends in mean intake were assessed by treating the 2-year survey cycle as a continuous variable in survey-weighted linear regression models. Changes in mean intake was computed as the difference in mean intake between the earliest (1999-2000) and latest (2015-2016) cycle. Results: The mean consumption of processed meat among US adults remained unchanged in the past 18 years (mean change = 4.22 g/wk, p-trend = 0.95). The top 5 processed meats consumed by US adults in 2015-2016 were luncheon meat (mean intake = 73.3 g/wk), sausage (45.5 g/wk), hot
Background Diet is an important risk factor for cancer that is amenable to intervention. Estimating the cancer burden associated with diet informs evidence-based priorities for nutrition policies to reduce cancer burden in the United States. Methods Using a comparative risk assessment model that incorporated nationally representative data on dietary intake, national cancer incidence, and estimated associations of diet with cancer risk from meta-analyses of prospective cohort studies, we estimated the annual number and proportion of new cancer cases attributable to suboptimal intakes of seven dietary factors among US adults ages 20 years or older, and by population subgroups. Results An estimated 80 110 (95% uncertainty interval [UI] = 76 316 to 83 657) new cancer cases were attributable to suboptimal diet, accounting for 5.2% (95% UI = 5.0% to 5.5%) of all new cancer cases in 2015. Of these, 67 488 (95% UI = 63 583 to 70 978) and 4.4% (95% UI = 4.2% to 4.6%) were attributable to direct associations and 12 589 (95% UI = 12 156 to 13 038) and 0.82% (95% UI = 0.79% to 0.85%) to obesity-mediated associations. By cancer type, colorectal cancer had the highest number and proportion of diet-related cases (n = 52 225, 38.3%). By diet, low consumption of whole grains (n = 27 763, 1.8%) and dairy products (n = 17 692, 1.2%) and high intake of processed meats (n = 14 524, 1.0%) contributed to the highest burden. Men, middle-aged (45–64 years) and racial/ethnic minorities (non-Hispanic blacks, Hispanics, and others) had the highest proportion of diet-associated cancer burden than other age, sex, and race/ethnicity groups. Conclusions More than 80 000 new cancer cases are estimated to be associated with suboptimal diet among US adults in 2015, with middle-aged men and racial/ethnic minorities experiencing the largest proportion of diet-associated cancer burden in the United States.
Background Many cancer patients initiate dietary supplement use after cancer diagnosis. How dietary supplement use contributes to the total nutrient intake among cancer survivors as compared with individuals without cancer needs to be determined. Objectives We aimed to evaluate nutrient intakes from dietary supplements among cancer survivors in relation to their total nutrient intake and compare those with individuals without cancer. Methods We evaluated the prevalence, dose, and reason for using dietary supplements among 2772 adult cancer survivors and 31,310 individuals without cancer who participated in the NHANES 2003–2016. Results Cancer survivors reported a higher prevalence of any (70.4% vs. 51.2%) and multivitamin/mineral (48.9% vs. 36.6%) supplement use and supplement use of 11 individual vitamins and 8 minerals than individuals without cancer. Overall, cancer survivors had significantly higher amounts of nutrient intake from supplements but lower nutrient intakes from foods for the majority of the nutrients. Compared with individuals without cancer, cancer survivors had a higher percentage of individuals with inadequate intake (total nutrient intake <Estimated Average Requirement or Adequate Intake) for folate, vitamin B-6, niacin, calcium, copper, and phosphorus, due to lower intakes of these nutrients from foods. Cancer survivors also had a higher proportion of individuals with excess intake (total nutrient intake ≥Tolerable Upper Intake Level) for vitamin D, vitamin B-6, niacin, calcium, magnesium, and zinc, contributed by higher intakes of these nutrients from dietary supplements. Nearly half (46.1%) used dietary supplements on their own without consulting health care providers. Conclusions Cancer survivors reported a higher prevalence and dose of dietary supplement use but lower amounts of nutrient intake from foods than individuals without cancer. The inadequate nutrient intake from foods and the short-term and long-term health impact of dietary supplement use, especially at high doses, need to be further evaluated among cancer survivors.
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