Sandwich Consumption Can Favorably Impact Energy and Nutrients to Limit in US Adults: A Modeling Analysis Using Data from the National Health and Nutrition Examination Survey, 2003–2014 and the USDA Typical Food Pattern

The inclusion of sandwiches in dietary patterns, with particular emphasis on bread consumption, has recently garnered negative attention with a recent study suggesting that all sandwich consumption is associated with increased calories and greater amounts of nutrients to avoid, including total and saturated fat. The objective of the current study was two‐fold: 1) to conduct an analysis to assess energy and nutrients contributed from all sandwiches in the US diet and 2) conduct a modeling analysis to develop and compare sandwiches using both whole grain and enriched/refined grains to the USDA typical food pattern in adults consuming 2000 kcal. Sandwich consumers (N=13,799) were identified using data from What We Eat in America 2003–2014, the dietary component of the National Heath and Examination Survey, in adults (≥19 years‐old). USDA has developed food patterns to help individuals meet nutrient needs without exceeding the calorie requirements and simultaneously has previously published typical food patterns present in the American population. For the modeling portion of the analysis, we used the USDA typical food pattern and removed energy and nutrients contributed from all sandwiches and substituted energy and nutrients derived from four sandwich models using food composites from the 2015–2020 Dietary Guidelines for Americans. The four sandwich models were a) Sandwich 1: 2 oz. equivalent (eq) whole grains, 2.5 oz. eq meat, 1 cup eq dairy (i.e., cheese), 0.1 cup eq dark green vegetable (i.e., spinach) + 0.1 cup eq red/orange vegetable (i.e., tomato), b) Sandwich 2: 2 oz. equivalent refined grains, 2.5 oz. eq meat, 1 cup eq dairy, 0.1 cup eq dark green vegetable + 0.1 cup eq red/orange vegetable, c) 2 oz. eq whole grains, 2 oz. nut/seeds (i.e., peanut butter), and 15 g added sugar (i.e., jam), and d) 2 oz. eq refined grains, 2 oz. nut/seeds (i.e., peanut butter), and 15 g added sugar (i.e., jam). The four sandwich models were used to create four dietary patterns that were compared to the USDA typical food pattern. Results showed that sandwich 1, 2, 3 and 4 contributed 391, 377, 331 and 317 kcal, respectively, to the dietary pattern compared to 561 kcal from all sandwiches. Total calories in the dietary patterns that included sandwich 1, 2, 3 and 4 were 2220, 2206, 2247 and 2233, respectively, compared to 2390 kcal in the USDA typical dietary pattern. Total and saturated fat in the dietary patterns that included sandwich 1, 2, 3 and 4 were meaningfully reduced in all sandwich model dietary patterns compared to the USDA typical dietary pattern (total fat and saturated fat decreased by 10 to 19 g/day and 6–7 g/day, respectively, in all sandwich model dietary patterns). Daily sodium intake in the dietary patterns that included sandwich 1, 2, 3 and 4 were 2853, 2887, 2365 and 2399 mg compared to 3550 mg/day sodium in the USDA typical dietary pattern. Both whole grain and enriched/refined grain sandwich models contributed meaningful reductions in total calories and nutrients to limit, including total fat, saturated fat and sodium. The results of this analysis support the inclusion of select sandwiches within recommended dietary patterns in American adults. This data also suggests that ingredients within a sandwich, rather than the bread component, can be an important contributor to energy and nutrients to limit in the diet. Support or Funding Information Supported by the Grain Foods Foundation