Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016
- PMID: 31550032
- PMCID: PMC6763999
- DOI: 10.1001/jama.2019.13771
Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016
Abstract
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 (1999-2016) 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.
Conflict of interest statement
Figures
![Figure 1.](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6763999/bin/jama-322-1178-g001.gif)
![Figure 2.](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6763999/bin/jama-322-1178-g002.gif)
Comment in
-
US Dietary Guidance-Is It Working?JAMA. 2019 Sep 24;322(12):1150-1151. doi: 10.1001/jama.2019.13976. JAMA. 2019. PMID: 31550012 No abstract available.
Similar articles
-
Dietary Intake Among US Adults, 1999-2012.JAMA. 2016 Jun 21;315(23):2542-53. doi: 10.1001/jama.2016.7491. JAMA. 2016. PMID: 27327801 Free PMC article.
-
Trends in Diet Quality Among Youth in the United States, 1999-2016.JAMA. 2020 Mar 24;323(12):1161-1174. doi: 10.1001/jama.2020.0878. JAMA. 2020. PMID: 32207798 Free PMC article.
-
Trends in dietary fat and high-fat food intakes from 1991 to 2008 in the Framingham Heart Study participants.Br J Nutr. 2014 Feb;111(4):724-34. doi: 10.1017/S0007114513002924. Epub 2013 Sep 19. Br J Nutr. 2014. PMID: 24047827 Free PMC article.
-
Dietary Patterns and All-Cause Mortality: A Systematic Review [Internet].Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2020 Jul. Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2020 Jul. PMID: 35258870 Free Books & Documents. Review.
-
Dietary Patterns and Growth, Size, Body Composition, and/or Risk of Overweight or Obesity: A Systematic Review [Internet].Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2020 Jul. Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2020 Jul. PMID: 35129906 Free Books & Documents. Review.
Cited by
-
The different association between fat mass distribution and intake of three major nutrients in pre- and postmenopausal women.PLoS One. 2024 May 29;19(5):e0304098. doi: 10.1371/journal.pone.0304098. eCollection 2024. PLoS One. 2024. PMID: 38809895 Free PMC article.
-
Multiomics profiling reveals VDR as a central regulator of mesenchymal stem cell senescence with a known association with osteoporosis after high-fat diet exposure.Int J Oral Sci. 2024 May 22;16(1):41. doi: 10.1038/s41368-024-00309-9. Int J Oral Sci. 2024. PMID: 38777841 Free PMC article.
-
Cardiovascular Risk Profile Among Reproductive-Aged Women in the U.S.: The Behavioral Risk Factor Surveillance System, 2015-2020.AJPM Focus. 2024 Feb 23;3(4):100210. doi: 10.1016/j.focus.2024.100210. eCollection 2024 Aug. AJPM Focus. 2024. PMID: 38766464 Free PMC article.
-
National trends in nine key minerals intake (quantity and source) among U.S. adults, 1999 to march 2020.Nutr J. 2024 May 17;23(1):52. doi: 10.1186/s12937-024-00950-4. Nutr J. 2024. PMID: 38760828 Free PMC article.
-
The Association between Dietary Protein Intake and Sources and the Rate of Longitudinal Changes in Brain Structure.Nutrients. 2024 Apr 25;16(9):1284. doi: 10.3390/nu16091284. Nutrients. 2024. PMID: 38732531 Free PMC article.
References
-
- GBD 2016 Risk Factors Collaborators Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1345-1422. doi:10.1016/S0140-6736(17)32366-8 - DOI - PMC - PubMed
-
- Trumbo P, Schlicker S, Yates AA, Poos M; Food and Nutrition Board of the Institute of Medicine, the National Academies . Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc. 2002;102(11):1621-1630. doi:10.1016/S0002-8223(02)90346-9 - DOI - PubMed
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Medical