Dietary intakes of the US child and adolescent population and their adherence to the current dietary guidelines: trends from 1999 to 2012

Background Overall dietary quality in children and adolescents has improved from 1999 through 2012. Understanding which dietary components contributed to this improvement, and corresponding disparities across socio‐demographic subgroups is crucial to identify challenges and opportunities for programs and policy. Objective To investigate time trends in intakes of dietary components related to major disease risk, from 1999 to 2012, in the US child and adolescent population, to assess their adherence to current dietary guidelines. Design This analysis included a nationally representative sample of 38,487 children and adolescents, aged 2–18 years, from 1999 to 2012 in the National Health and Nutrition Examination Survey (NHANES). Dietary information was collected by 24‐hour dietary recall. Crude and multivariable‐adjusted mean intakes of 19 foods and nutrient were calculated, incorporating complex survey weights. We also calculated proportions meeting the latest dietary recommendations including the 2015 Dietary Guidelines for Americans. Results We observed significant increases in consumption of whole grains, whole fruit, and dairy, and significant decreases in consumption of sugar‐sweetened beverages (SSB), each contributing to improvement in overall dietary quality (linear trend p<0.001). Mean (95% CI) SSB intake dropped from 2.09 oz/day to 1.21 oz/day, and mean intake of whole grains increased, from 0.42 oz/day to 0.78 oz/day, over the 14 years. However, we also observed decreased intakes of total vegetables and fruit juice (P trend<0.001). Among nutrients, polyunsaturated fatty acids (PUFA), calcium, protein, fiber, and sodium increased significantly (linear trend p<0.001). The percentages of US children and adolescents meeting dietary recommendations for whole fruit, whole grains, nuts, seeds and soy products, dairy, SSB, PUFA, and dietary fiber increased over time. However, intakes of most recommended dietary components still fell short: fewer than 50% met recommended intakes for any of the dietary components, except for juice. Although we found improving trends in intake of most dietary components across socio‐demographic subgroups, children and adolescents from higher income or from Mexican American families showed greater reductions in consumption of SSB and red meat than other groups. Higher consumption of nuts, seeds, and soy products in Mexican American participants contributed significantly to their higher over dietary quality. Conclusions From 1999 to 2012, we found improvements in several dietary components, but the overall percentages of US children and adolescents who met specific dietary recommendations remains low, with disparities across socio‐demographic groups. The increasing trend in sodium intake and decreasing trend in vegetable intake are of particular concern. These findings suggest the need for more targeted nutrition interventions and policies. 1 Characteristics of 38,487 children and adolescents, aged 2–18 y, from 1999 to 2012 in the National Health and Nutrition Examination SurveyNHANES Cycle1999–2000 2001–2002 2003–2004 2005–2006 2007–2008 2009–2010 2011–2012Sex Male 1822(50.8) 2000(49.5) 3390(49.6) 3534(49.0) 2782(51.5) 2970(51.6) 2850(50.5) Female 1768(49.2) 2039(50.5) 3451(50.4) 3681(51.0) 2620(48.5) 2781(48.4) 2799(49.5) Age. Year 2–5 665(18.5) 856(21.2) 1455(21.3) 1692(23.5) 1494(27.7) 1570(27.3) 1550(27.4) 6–11 961(26.8) 1136(28.1) 1729(25.3) 1942(26.9) 2022(37.4) 2121(36.9) 2172(38.4) 12–18 1964(54.7) 2047(50.7) 3657(53.5) 3581(49.6) 1886(34.9) 2060(35.8) 1927(34.1) Race/Ethnicity Mexican American 1482(41.3) 1189(29.4) 2068(30.2) 2403(33.3) 1358(25.1) 1600(27.8) 1092(19.3) Non‐Hispanic White 786(21.9) 1258(31.1) 1889(27.6) 1944(26.9) 1772(32.8) 1959(34.1) 1261(22.3) Non‐Hispanic Black 999(27.8) 1225(30.3) 2339(34.2) 2206(30.6) 1342(24.8) 1111(19.3) 1645(29.1) Other Race 323(9.0) 367(9.1) 545(8.0) 662(9.2) 930(17.2) 1081(18.8) 1651(29.2) Poverty Income Ratio 1 ≤1.30 1414(39.4) 1558(38.6) 2817(41.2) 2709(37.5) 2206(40.8) 2441(42.4) 2442(43.2) 1.31–3.50 1045(29.1) 1400(34.7) 2347(34.3) 2572(35.6) 1747(32.3) 1805(31.4) 1690(29.9) >3.50 572(15.9) 813(20.1) 1261(18.4) 1569(21.7) 1034(19.1) 987(17.2) 1072(19.0) Weight Status Not obese or overweight 2377(66.2) 2756(68.2) 4418(64.6) 4796(66.5) 3553(65.8) 3771(65.6) 3772(66.8) Overweight 539(15.0) 601(14.9) 1141(16.7) 1042(14.4) 802(14.8) 883(15.4) 833(14.7) Obese 674(18.8) 682(16.9) 1282(18.7) 1377(19.1) 1047(19.4) 1097(19.1) 1044(18.5)1 Participants with missing values of poverty income ratio were not included in this analysis.2 Covariate‐adjusted mean food consumption components in the whole study population 1NHANES Cycle1999–2000 2001–2002 2003–2004 2005–2006 2007–2008 2009–2010 2011–2012 P for trendTotal Vegetables (cup/day) 1.06 (0.97, 1.15) 1.00 (0.92, 1.07) 1.06 (0.99, 1.14) 0.98 (0.91, 1.05) 0.97 (0.9, 1 04) 0.97 (0 89, 1.05) 0.95 (0 89, 1.02) <0.001 Vegetables excluding potatoes & starchy (cup/day) 0.65 (0.58, 0.72) 0.62 (0.56, 0.68) 0.65 (0.60, 0.71) 0.61 (0.56, 0.67) 0.59 (0.54, 0.65) 0.62 (0.55, 0.68) 0.60 (0.55, 0.65) 0.03 Starchy vegetables (cup/day) 0.41 (0.36, 0 46) 0.38 (0 33, 0.42) 0.41 (0.36, 0.46) 0.37 (0.32, 0.41) 0.38 (0.33, 0.42) 0.35 (0.31, 0.40) 0.35 (0 31, 0.40) 0.004 Whole fruit (cup/day) 0.45 <0.37, 0.53) 0.47 (0.38, 0.56) 0.48 (0.40, 0.57) 0.57 (0.48, 0.66) 0.64 (0.56, 0.73) 0.67 (0.57, 0.77) 0.75 (0.65, 0.85) <0.001 Fruit juice (cup/day) 0.49 (0.42, 0.56) 0.53 (0.46, 0.61) 0.62 (0.54, 0.70) 0.54 (0.47, 0.61) 0.47 (0.40, 0.53) 0.48 (0.41, 0.55) 0.48 (0.41, 0.55) <0.001 Whole grains (oz/day) 0.42 (0.34, 0.50) 0.49 (0.40, 0.57) 0.46 (0.37, 0.55) 0.50 (0.40, 0.60) 0.53 (0.45, 0.60) 0.64 (0.55, 0.72) 0.78 (0.69, 0.87) <0.001 Nuts, seeds & soy products (oz/day) 0.39 (0.28, 049) 0.34 (0.24, 0.43) 0.36 (0.27, 0.45) 0.34 (0.24, 0 44) 0.34 (0.26, 0.42) 0.38 (0.28, 0.48) 0.37 (0 28, 0.46) 0.65 Red & processed meat (servings/day) 0.68 (0.57, 0.78) 0.67 (0.58, 0.77) 0.64 (0.55, 0.73) 0.67 (0.58, 0.75) 0.65 (0.57, 0.74) 0.67 (0.59, 0.75) 0.60 (0.52, 0.69) 0.27 Dairy (cup/day) 1.75 (1.60, 1.90) 1.94 (1.80, 2.08) 1.98 (1.84, 2.13) 2.03 (1.89, 2.17) 2.01 (1.88, 2.13) 2.18 (2.05, 2.31) 2.11 (2.00, 2.23) <0.001 Seafood (oz/day) 0.19 (0.12, 0.27) 0.22 (0.13, 0.31) 0.21 (0.13, 0 29) 0.24 (0.14, 0 34) 0.19 (0.12, 0.25) 0.19 (0.11, 0.27) 0.26 (0.16, 0.36) 0.56 Sugar‐sweetened beverage (oz/day) 2.09 (1.66, 2.52) 1.92 (1.50, 2.35) 1.90 (1.47, 2.33) 1.75 (1.48, 2.02) 1.64 (1.25, 2.02) 1.48 (1.09, 1.87) 1.21 (0.83, 1.59) <0.001 Total saturated fatty acids (%E) 11.37 (10.98, 11.75) 11.14 (10.80, 11.49) 11.37 (11.06, 11.67) 11.60 (11.35, 11.84) 11.50 (11.23, 11.78) 11.19 (10.91, 11.47) 11.09 (10.76, 11.42) 0.12 Total polyunsaturated fatty acids (%E) 6.24 (6.01, 6.47) 5.99 (5.76, 6.21) 6.41 (6.21, 6.61) 6.41 (6.17, 6.64) 6.57 (6.37, 6.77) 6.85 (6.66, 7.03) 7.44 (7.21, 7.67) <0.001 Omega‐3 fatty acids (%E) 0.03 (0.02, 0.03) 0.03 (0.02, 0.03) 0.03 (0.02, 0.04) 0.03 (0.02, 0.04) 0.03 (0.02, 0.04) 0.02 (0.02, 0.03) 0.02 (0.02, 0.03) 0.02 Calcium (mg) 820.74 (783.35, 858.13) 905.98 (866 68, 945.28) 931.87 (888.39, 975.35) 950.74 (916.23, 985.25) 985.32 (948.70, 1021.94) 1062.08 (1026.21, 1097.95) 1033.74 (1000.12, 1067.36) <0.001 Iron (mg) 14.35 (13.64, 15.07) 14.68 (14.10, 15.26) 15.12 (14.53, 15.70) 15.50 (14.84, 16.16) 14.86 (14.34, 15.38) 15.14 (14.64, 15.65) 15.17 (14.57, 15.76) 0.05 Protein (%E) 13.61 (13.56, 13.66) 13.89 (13.85, 13.94) 14.33 (14.28, 14.38) 14.40 (14.35, 14.44) 14.66 (14.62, 14.70) 14.94 (14.89, 14.98) 14.70 (14.65, 14.74) <0.001 Sodium (mg) 3026.52 (2958.12, 3094.92) 2929.00 (2877.10, 2980.90) 2959.38 (2902, 46, 3016.30) 3023.19 (2964.57, 3081.81) 3047.42 (2975.32, 3119.52) 3166 39 (3094.19, 3238.59) 3071.61 (3010.71, 3132.51) <0.001 Dietary fiber (g) 12.41 (11.91, 12.91) 12.35 (11.93, 12.78) 12.54 (12.10, 12.98) 12.94 (12.46, 13.43) 13.37 (12.95, 13.78) 14.24 (13.81, 14.67) 14.97 (14.59, 15.36) <0.0011 Linear regression model was adjusted for sex, age, total energy intake, race/ethnicity, poverty income ratio, household size, reference person's education level and marriage status