Consumption of Key Food Groups by Individuals Consuming Popular Diet Patterns: Mixed Effects of Replacing Foods High in Added Sugar, Sodium, Saturated Fat, and Refined Grains

Abstract

Adults in the United States are increasingly following ‘popular’ diet patterns that restrict food groups, macronutrients, or eating time. However, the intake of food groups associated with these diet patterns has not been well characterized. The objectives of this study were to (1) characterize the mean intake of food groups among consumers of popular diet patterns in the US, and (2) model the effect of targeted food substitutions on the intake of food groups. Data were acquired from the National Health and Nutrition Examination Survey, 2005–2018 (n = 34,411). A diet model was developed to assess the effects of replacing one serving each of foods highest in added sugar, sodium, saturated fat, and refined grains with healthy alternatives on the intake of key food groups for each diet pattern. Modeled replacement resulted in increased intake of fruit and whole grains and decreased intake of dairy for most diet patterns, while the effects on the intake of vegetables, protein foods, and oils were variable across diet patterns. The complexity of the natural eating environment, in which many people consume mixed dishes that include both healthy and less healthy ingredients, produces a challenge for health professionals when providing dietary counseling. Nevertheless, this substitution approach may help improve adherence to dietary guidelines, especially if used as a steppingstone for further dietary improvement.

Micronutrient intake from three popular diet patterns in the United States: modeled replacement of foods highest in added sugar and sodium using the National Health and Nutrition Examination Survey, 2005–2018

“…The mixed nature of replacement dishes (i.e., including nutrients to encourage as well as nutrients to limit) may result in both favorable and unfavorable changes. This is consistent with a similar study that assessed changes in consumption of food groups using modeled substitutions, and found an increase in modeled intake of fruits and whole grains but a decrease in modeled intake of vegetables in some popular diet patterns ( 5 ). Further research is needed to utilize optimization modeling to identify food substitutions that lead to favorable changes in all or most micronutrients.…”

“…When these diets were modified by replacing foods highest in added sugar, sodium, saturated fat, and refined grains with healthier alternatives, diet quality improved modestly (2.5 to 9.8 points), pulling HEI scores slightly above the average score of the US population (58 out of 100), but all diet patterns remained far below optimal ( 3 ). Others have shown that dietary modeling to accommodate DGA recommendation had heterogenous effect on the intake of food groups, such as elevating the intake of fruits and vegetables, respectively, up to 47% and 10%, but decreasing the intake of dairy by as much as 11%, across different popular diet patterns ( 5 ). To our knowledge, dietary modeling has not been used to assess micronutrient intake in popular diet patterns that restrict food groups, macronutrients, or eating time.…”