Carbohydrate Intakes Below Recommendations With a High Intake of Fat Are Associated With Higher Prevalence of Metabolic Syndrome.

BACKGROUND: More than one-third of adults in the United States have metabolic syndrome, and dietary carbohydrate intake may modify the likelihood of developing this condition. Currently, there is a lack of consistent evidence demonstrating the relationship between carbohydrate intake that falls below recommendations and metabolic syndrome. Not accounting for the differences in fatty acid classes of these dietary patterns may be a reason for inconsistent findings. OBJECTIVE: This study evaluated the association between a carbohydrate intake below recommendations and metabolic syndrome stratified by fat quantity and fatty acid classes in a nationally representative sample of US adults. DESIGN: This cross-sectional study acquired data on food and nutrient intake and markers of metabolic syndrome from respondents in the National Health and Nutrition Examination Survey 1999-2018. PARTICIPANTS/SETTING: This study included 19,078 respondents who were aged 20 years or older, had reliable and complete data on food and nutrient intake and markers of metabolic syndrome, and were not pregnant or breastfeeding. MAIN OUTCOME MEASURES: The main outcome was prevalence of metabolic syndrome. STATISTICAL ANALYSES PERFORMED: Usual dietary intake was estimated using the National Cancer Institute's usual intake methodology. Multivariable logistic regression models assessed the relative odds of prevalent metabolic syndrome between those who had a carbohydrate intake below recommendations and those who met carbohydrate recommendations. RESULTS: Those who had a carbohydrate intake below recommendations had 1.067 (95% CI 1.063 to 1.071) times greater odds of having metabolic syndrome compared with those who met carbohydrate recommendations (P < 0.001). High intake of fat of any class was associated with higher odds of metabolic syndrome (total fat: 1.271, 95% CI 1.256 to 1.286; saturated fatty acid: 1.072, 95% CI 1.060 to 1.085; monounsaturated fatty acid: 1.317, 95% CI 1.300 to 1.333; polyunsaturated fatty acid: 1.056, 95% CI 1.047 to 1.066; P < 0.001 for all comparisons) in those who had a carbohydrate intake below recommendations. CONCLUSIONS: The odds of prevalent metabolic syndrome were higher among individuals who had a carbohydrate intake below recommendations compared with individuals who met carbohydrate recommendations.

Quality of Popular Diet Patterns in the United States: Evaluating the Effect of Substitutions for Foods High in Added Sugar, Sodium, Saturated Fat, and Refined Grains.

Background: Many Americans have adopted popular diet patterns for general health improvement that restrict specific foods, macronutrients, or eating time. However, there is limited evidence to characterize the quality of these diet patterns. Objectives: This study 1) evaluated the quality of popular diet patterns in the United States and 2) modeled the effect of targeted food substitutions on diet quality. Methods: Dietary data from 34,411 adults ≥20 y old were acquired from the NHANES, 2005-2018. Dietary intake was assessed using the National Cancer Institute's usual intake methodology, and the Healthy Eating Index-2015 was used to evaluate diet quality. A diet model was used to evaluate the effect of targeted food substitutions on diet quality. Results: A pescatarian diet pattern had the highest diet quality (65.2; 95% CI: 64.0, 66.4), followed by vegetarian (63.0; 95% CI: 62.0, 64.0), low-grain (62.0; 95% CI: 61.6, 62.4), restricted-carbohydrate (56.9; 95% CI: 56.6, 57.3), time-restricted (55.2; 95% CI: 54.8, 55.5), and high-protein (51.8; 95% CI: 51.0, 62.7) diet patterns. Modeled replacement of ≤3 daily servings of foods highest in added sugar, sodium, saturated fat, and refined grains with alternative foods led to an increase in diet quality and a decrease in energy intake for most diet patterns. Conclusions: Low diet quality was observed for all popular diet patterns evaluated in this study. Modeled dietary shifts that align with recommendations to choose foods lower in added sugar, sodium, saturated fat, and refined grains led to modest improvements in diet quality and larger reductions of energy intake. Greater efforts are needed to encourage the adoption of dietary patterns that emphasize consumption of a variety of high-quality food groups.

Diet Sustainability Analyses Can Be Improved With Updates to the Food Commodity Intake Database.

Diet sustainability analyses inform policymaking decisions and provide clinicians and consumers with evidence-based information to make dietary changes. In the United States, the Food Commodity Intake Database (FCID) provides a crosswalk for integrating nationally representative data on food intake from the National Health and Nutrition Examination Survey (NHANES) with data on sustainability outcomes from other publicly available databases. However, FCID has not been updated since 2010 and does not link with contemporary NHANES data, which limits further advancements in sustainability research. This study fills this research gap by establishing novel linkages between FCID and NHANES 2011-2018, comparing daily per capita food intake with and without these linkages, and making these data publicly available for use by other researchers. To update FCID, two investigators independently established novel data linkages, a third investigator resolved discrepancies, and a fourth investigator audited linkages for accuracy. Dietary data were acquired from nearly 45,000 adults from 2001 to 2018, and food intake was compared between updated vs. non-updated FCID versions. Total food intake from 2011 to 2018 was 5-23% higher using the updated FCID compared to the non-updated version, and intake was over 100% higher in some years for some food categories including poultry, eggs, legumes, starchy vegetables, and tropical oils (P < 0.001 for all comparisons). Further efforts may be needed to create new food composition data to reflect new products and reformulations that enter the food supply over time. This study removes a barrier to further diet sustainability analyses by establishing a data crosswalk between contemporary NHANES and other publicly available databases on agricultural resource use, environmental impacts, and consumer food expenditures.