• 分析1999-2016年美国成年人营养素摄入量、食物来源和膳食质量变化,以2015年健康饮食指数评估食物质量;
  • 43 996名受访者,总碳水化合物52.5%降至50.5%,总蛋白质15.5%升至16.4%,总脂肪32.0%升至33.2%;
  • 低质量碳水化合物45.1%降至41.8%,高质量碳水化合物7.42%升至8.65%,植物蛋白、饱和脂肪酸和多不饱和脂肪酸增加;
  • 健康饮食指数55.7增至57.7,碳水化合物质量变化主因摄入谷物增加及添加糖降低,植物蛋白变化主因摄入谷物和坚果。
flying dutchman
JAMA [IF:45.54]

Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016



2019-09-24, Article

Abstract & Authors:展开

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.

First Authors:
Zhilei Shan

Correspondence Authors:
Zhilei Shan,Fang Fang Zhang

All Authors:
Zhilei Shan,Colin D Rehm,Gail Rogers,Mengyuan Ruan,Dong D Wang,Frank B Hu,Dariush Mozaffarian,Fang Fang Zhang,Shilpa N Bhupathiraju