U.S. dietary food quality improvement greatest in schools
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The diet quality of foods consumed at schools improved dramatically while diet quality of foods consumed from grocery stores, restaurants and worksites showed small to modest gains, researchers reported.
“CV disease remains the leading cause of death in the U.S., and poor diet is the leading modifiable risk factor for CV disease. We need to know what people are eating and the nutritional quality of that food,” Dariush Mozaffarian, MD, DrPH, dean of the Friedman School of Nutrition Science and Policy at Tufts University, told Healio.
“The biggest and most striking improvement in the last 20 years has been in nutritional quality in school meals to where now, schools are the single healthiest place to get food in the U.S., and that improvement was entirely equitable. COVID-19 has focused the country on food around food security, which is access to calories. What our study highlights is that we have to think about nutrition security — not just access to calories but access to calories that are of high nutritional quality,” Mozaffarian said.
Policy changes like The Healthy, Hunger-Free Kids Act of 2010 “improved nutrition dramatically for millions of kids,” Mozaffarian said in an interview.
The researchers analyzed a cohort of 20,905 U.S. children (mean age, 12 years) and 39,757 U.S. adults (mean age, 47) covering eight NHANES cycles from 2003-2004 to 2017-2018.
Researchers observed that during the study period, the biggest improvement in diet quality came from schools, with the percentage of children eating food with poor diet quality decreasing by more than half, from 55.6% (95% CI, 49.1-62) to 24.4% (95% CI, 21.2-27.5; P < .001).
Improvement in consumption of food with poor diet quality was more modest from grocery stores (decline from 53.2%; 95% CI, 49.3-57.1; to 45.1%; 95% CI, 40.8-49.4; P = .006 for trend) from restaurants (decline from 84.8%; 95% CI, 81.8-87.7; to 79.6%; 95% CI, 76.4-82.3; P = .003 for trend), and from other sources (increase from 40%; 95% CI, 34.9-45.1; to 51.7%; 95% CI, 50.1-58; P < .001 for trend), according to the researchers.
In an analysis of the study, at fast-food or quick-serve restaurants, the percentage of children eating food with poor diet quality declined from 86.5% (95% CI, 83.1-90) to 81.2% (95% CI, 79.1-83.2; P = .001 for trend) but the percentage did not significantly change at full-service restaurants (69.3% in 2003-2014; 95% CI, 62.9-75.8; 68.2% in 2017-2018; 95% CI, 61.4-75; P = .48 for trend).
In the adult cohort, the percentage of poor nutritional quality food consumed from restaurants during the study period stayed stable at 65%. The percentage of poor nutritional quality food consumed by adults from the workplace declined from 56% to 51%. For poor-quality food from grocery stores, the decline was from 40% to 33%.
According to a related editorial, the study highlighted the promising trend of improved diet quality in school settings. “The study’s findings call for policy commitment and multifaceted interventions in settings outside school to start making the positive changes in these settings,” Muzi Na, PhD, MHS, with the department of nutritional sciences, College of Health and Human Development, The Pennsylvania State University, wrote.
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