Depression and Diet Quality, US Adolescents and Young Adults: National Health and Nutrition Examination Survey, 2015-March 2020.

BACKGROUND: Depression is a common mental health disorder. OBJECTIVE: The objective of this study was to explore the association between diet quality, as measured by the Healthy Eating Index 2020 (HEI-2020), and depression symptoms among US adolescents and young adults aged 12 to 29 years. DESIGN: The study design was a cross-sectional secondary data analysis. PARTICIPANTS: Data from the first 24-hour dietary recall for adolescents and young adults aged 12 to 29 years in the National Health and Nutrition Examination Survey from 2015 to March 2020 (n = 4750) were analyzed. MAIN OUTCOME MEASURE: Depression was defined as a score ≥10 on the Patient Health Questionnaire, reflecting moderate or severe symptoms in the previous 2 weeks. STATISTICAL ANALYSES PERFORMED: HEI-2020 total (range, 0-100) and component scores were calculated for those with and without depression. Predicted HEI-2020 scores were estimated from linear regression models, adjusting for age, gender, race and Hispanic origin, family income, and seeing a mental health professional in the past year. Statistical analyses accounted for the complex sample design. RESULTS: The prevalence of depression among adolescents and young adults was 7.8% (95% CI 6.3% to 9.5%). Total HEI-2020 score was 45.9 (95% CI 45.0 to 46.7) out of 100 on a given day during 2015 to March 2020. Among young people with depression, total HEI-2020 score was lower than among those without depression (41.7 vs 46.2; P < .001). After adjustment for covariates, the difference was attenuated, but remained significant. In adjusted analyses, HEI-2020 component scores were lower for those with depression compared with those without depression for the adequacy components: total fruits (1.4 vs 1.7; P = .03), whole fruits (1.2 vs 1.7; P < .01), total vegetables (2.1 vs 2.6; P < .01), greens and beans (0.8 vs 1.2; P < .01), and total protein foods (3.6 vs 4.0; P = .02) out of a maximum score of 5. There were no statistically significant differences observed for whole grains, dairy, seafood and plant proteins, fatty acids, saturated fats, refined grains, sodium, or added sugars. CONCLUSIONS: Overall diet quality is low among young people. Diet quality, especially consumption of fruits, vegetables, and protein foods was lower among young people with depression compared with those without depression.

Differences in Intakes of Select Nutrients by Urbanization Level in the United States Population 2 Years and Older, NHANES 2013-2018.

BACKGROUND: Differences in nutrient intakes by urbanization level in the Unites States is not well understood. OBJECTIVE: Describe, by urbanization level: 1) intake of protein, fiber, percent of energy from added sugars (AS) and saturated fat (SF), calcium, iron, potassium, sodium, and vitamin D; 2) the percent of the population meeting nutrient recommendations. METHODS: Twenty-four-hour dietary recalls from 23,107 participants aged 2 y and over from the 2013-2018 National Health and Nutrition Examination Surveys were analyzed. Usual intakes were estimated, and linear regression models adjusted for age, sex, race and Hispanic origin, and whether family income met the 130% threshold examined intake differences by urbanization levels-large urban areas (LUA), small to medium metro areas (SMMA), and rural areas (RA). RESULTS: A small percentage of the population met the nutrient recommendations, except for protein (92.8%) and iron (70.5%). A higher percentage of the population met recommendations than SMMA and RA for fiber (11.8% compared with 8.1% and 5.3%, P < 0.001), AS (40.2% compared with 33.4% and 31.3%, P < 0.001), SF (26.8% compared with 18.2% and 20.1%, P < 0.001), and potassium (31.5% compared with 25.5% and 22.0%, P < 0.001). Mean protein intake were also higher in LUA than RA (80.0 g compared with 77.7 g, P = 0.003) and fiber intake higher in LUA than SMMA (16.5 g compared with 15.9 g, P = 0.01) and RA (16.5 g compared with 15.2 g, P = 0.001). In addition, contributions to energy intake were lower in LUA than SMMA for AS (11.3% compared with 12.0%, P < 0.001) and SF (11.5% compared with 11.7%, P < 0.001), and for LUA than RA for AS (11.3% compared with 12.9%, P < 0.001) and SF (11.5% compared with 11.8%, P < 0.001). CONCLUSIONS: RA had some markers of poorer diet quality-lower protein and fiber intake and higher AS intake-compared with LUA, and these differences persisted in adjusted regression models. These results may inform public health efforts to address health disparities by urbanization levels in the Unites States.

Dairy, Meat, Seafood, and Plant Sources of Saturated Fat: United States, Ages Two Years and Over, 2017-2020.

BACKGROUND: Research suggests that the effects of saturated fat (SF) on health differ depending on its food source. Dairy SF has been associated with lower cardiovascular disease (CVD) risk, whereas meat SF is linked to a higher CVD risk. OBJECTIVES: To estimate the contribution to the total intake of SF of 1) 5 food groups - dairy, meats, seafood, plants, and "other," and 2) the top 10 specific food category sources in the United States population overall and by sociodemographic subgroup. METHODS: The analysis included data from 11,798 participants in the 2017-March 2020 National Health and Nutrition Examination Survey aged 2+ y. Grams of SF from the food sources expressed as a percentage of the total grams of SF consumed, were estimated using the population ratio method. RESULTS: Mean daily intake of SF was 28.1 g [95% confidence interval (CI): 27.6-28.6 g], comprising 11.9% (95% CI: 11.7-12.1%) of total energy intake. Dairy contributed 28.4% of SF, followed by meats (22.1%), plant sources (7.5%), fish and seafood (1.2%), and the remaining foods (41.6%). Youth had higher SF intake from dairy than adults (P < 0.001), whereas non-Hispanic Whites had higher intake than non-Hispanic Blacks (P < 0.001) and Hispanics (P = 0.016). Adults had higher SF intake from meats than youth (P = 0.002), males more than females (P < 0.001), and non-Hispanic Blacks more than non-Hispanic Asians (P = 0.016) and Hispanics (P < 0.001). The top 10 specific sources of SF were unprocessed red meats, sweet bakery products, cured meats, milk, cheese, pizza, unprocessed poultry, Mexican mixed dishes, eggs, and combined fruits and vegetables. CONCLUSIONS: Although dairy contributed ∼30% of SF compared to ∼20% for total meat, the top specific food category source of SF was unprocessed red meats, which ranked in the top 2 food category sources of SF for most subgroups. These findings may be useful for further research to examine the relationship between the different sources of SF and health outcomes.

Dietary contributions of food outlets by urbanization level in the US population aged 2 years and older-NHANES 2013-2018.

BACKGROUND: Differences in food access, availability, affordability, and dietary intake are influenced by the food environment, which includes outlets where foods are obtained. These differences between food outlets within rural and urban food environments in the United States are not well understood. OBJECTIVES: The aim of this analysis is to describe the contribution of foods and beverages from 6 outlets-grocery stores, convenience stores, full-service restaurants, quick-service restaurants, schools, and other outlets-to the total energy intake and Healthy Eating Index (HEI)-2015 scores in the United States population, by urbanization level (nonmetropolitan statistical areas [MSAs], small-to-medium MSAs, and large MSAs). METHODS: Data from the National Health and Nutrition Examination Survey 2013-2018 were used. Dietary intake from one 24-h dietary recall was analyzed by the outlet where a food or beverage was obtained and by urbanization. Linear regression, adjusted for sex, age, race and Hispanic origin, and family income, was used to predict the contribution of each food outlet to the total energy intake and HEI-2015 total and component scores by urbanization level. RESULTS: During 2013-2018, foods and beverages from grocery stores and quick-service and full-service restaurants contributed to 62.1%, 15.1%, and 8.5% of the energy intake, respectively. The percentage of energy intake from full- and quick-service restaurants increased with increasing urbanization level. HEI-2015 total scores increased with the increasing urbanization level overall (48.1 non-MSAs, 49.2 small-to-medium MSAs, and 51.3 large MSAs) for grocery stores (46.7 non-MSAs, 48.0 small-to-medium MSAs, and 50.6 large MSAs) and for quick-service restaurants (35.8 non-MSAs, 36.3 small-to-medium MSAs, and 37.5 large MSAs). CONCLUSIONS: Grocery stores and restaurants were the largest contributors of energy intake in urban and rural areas. Diet quality improved with increasing urbanization overall and for grocery stores and quick-service restaurants.

Awareness of the MyPlate Plan: United States, 2017-March 2020.

Objective-The United States Department of Agriculture's MyPlate is based on the Dietary Guidelines for Americans and serves as the primary educational tool to communicate federal dietary guidance. This report presents the percentage of adults who have heard of MyPlate and who have tried MyPlate along with their associations with self-rated diet quality.

The Contribution of Discrete Vegetables, Mixed Dishes, and Other Foods to Total Vegetable Consumption: US Ages 2 Years and Over, 2017-2018.

BACKGROUND: The 2020-2025 Dietary Guidelines for Americans recommend intake of a variety of vegetables, including dark green, red, and orange vegetables and starchy and other vegetables. OBJECTIVES: This study aims to describe sociodemographic differences in the contribution of different categories of vegetables and the form in which they are consumed (ie, discrete vegetables, mixed dishes, and other foods such as savory snacks to total vegetable intake on a given day). DESIGN: This is a cross-sectional, secondary analysis of the 2017-2018 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING: This study included the data of 7122 persons aged 2 years with reliable day 1 24-hour dietary recalls. MAIN OUTCOME MEASURES: Serving equivalents of vegetables from 20 discrete categories of vegetables and from mixed dishes and other foods as a percentage of total vegetables. STATISTICAL ANALYSES: Pairwise differences by age, sex, race, Hispanic origin, and family income were examined using univariate t statistics, and trends by age and income were examined using orthogonal polynomials. RESULTS: Mean serving equivalents of vegetables was 1.4 cups. The serving equivalents increased with age among youth, was higher among non-Hispanic Asian (NHA) persons than other subgroups, and increased with increasing family income. Overall, discrete vegetables contributed 55.2% of total vegetable intake, and the contribution increased with age in adults and with increasing family income. The top 5 discrete vegetable contributors were other vegetables and combinations, french fries and other fried white potatoes, lettuce and lettuce salads, mashed potatoes and white potato mixtures, and baked or boiled white potatoes. Nonstarchy discrete vegetables contributed more to total vegetables for adults (37.6%) than youth (28.0%), and the contribution increased with increasing family income. On the other hand, the contribution of mixed dishes and other foods decreased with increasing family income. CONCLUSIONS: Discrete vegetables only contributed 55.2% of total vegetable intake, and the top sources were not varied. Three of them potato based, which may explain the reported low vegetable intake, relative to the 2020-2025 Dietary Guidelines for Americans. More than one-third of vegetables consumed were nonstarchy discrete vegetables, many of which are high in vitamins. Nonstarchy discrete vegetable intake was higher in adults than youth and increased with family income.

Fruit and Vegetable Consumption Among Adults in the United States, 2015-2018.

The Dietary Guidelines for Americans, 2015-2020 suggest that a healthy eating pattern include consuming a variety of different fruit and vegetables (1). Fruits and vegetables are sources of many essential nutrients, such as vitamins, minerals, and fiber, and consumption is associated with decreased risk of chronic disease (1-3). This report examines the percentage of adults aged 20 and over who consumed fruit and vegetables on a given day by sex and income in 2015-2018 and trends in fruit and vegetable consumption.

Fruit and Vegetable Consumption Among Children and Adolescents in the United States, 2015-2018.

The Dietary Guidelines for Americans (DGA), 2015-2020 (1), recommends consuming different types of vegetables, including dark green, red or orange, starchy, and other vegetables, and fruit, especially whole fruit. Fruits and vegetables are part of healthy eating patterns; they are sources of many essential nutrients, fiber and phytochemicals, and are associated with decreased risk of chronic diseases (1-3). This report examines the percentage of children and adolescents aged 2-19 who consumed fruits and vegetables on a given day in 2015-2018.

Breakfast Intake Among Children and Adolescents: United States, 2015-2018.

The American Academy of Pediatrics recommends that children and adolescents consume breakfast for healthier body weights, improved nutrition, better memory, better test scores, and better attention spans (1). This report describes breakfast consumption among children and adolescents by sex, age, race and Hispanic origin, and family income level. Foods and beverages frequently consumed for breakfast, as well as trends in breakfast consumption over the last decade, are also reported.