Nutrient intake disparities in the US: Modeling the effect of food substitutions

Authors: Conrad, Zachary; JOHNSON, LUANN - University Of North Dakota; Roemmich, James; JUAN, WENYEN - Us Food & Drug Administration (FDA); Jahns, Lisa

Submitted to: Nutrition Journal
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/1/2018
Publication Date: 5/17/2018
Publication URL: http://handle.nal.usda.gov/10113/5949627
Citation: Conrad, Z.S., Johnson, L., Roemmich, J.N., Juan, W., Jahns, L.A. 2018. Nutrient intake disparities in the US: Modeling the effect of food substitutions. Nutrition Journal. https://doi.org/10.1186/s12937-018-0360-z.
DOI: https://doi.org/10.1186/s12937-018-0360-z

Interpretive Summary: Americans’ diet quality is low, especially individuals with low income and low food security. Yet little is known about whether small dietary changes at breakfast, lunch, and dinner can meaningfully improve their nutrient intake. We acquired data on food and nutrient consumption from over 31,000 adults from a national survey conducted from 2001-2014. We then used a computer-based modeling tool to examine how each individual’s nutrient intake would change if they consumed nutrient-rich eggs at breakfast, lunch, or dinner instead of what they usually consume. We found that eating eggs at lunch or dinner would increase nutrient consumption by 6-8 percentage points, but eating eggs at breakfast would not result in any change in nutrient consumption. These findings show that when making food substitutions to increase nutrient intake, eating occasion is an important consideration.

Technical Abstract: Background: Diet quality among federal food assistance program participants remains low, and little research has assessed the diet quality of food insecure non-participants. Further research is needed to assess population-level interventions to improve the nutritional status of these vulnerable populations. Objective: To model the effect of food substitutions on nutrient inadequacy among individuals participating in different food assistance programs, food insecure non-participants, and food secure non-participants. Methods: Dietary data from 34,741 adults >20 y were acquired from the National Health and Nutrition Examination Survey, 2001-2014. Diet pattern modeling was used to substitute commonly consumed egg dishes for commonly consumed main dishes at breakfast, lunch, and dinner. National Cancer Institute usual intake methods were used to estimate the prevalence of inadequate intake of 28 nutrients pre- and post-substitution, and a novel index was used to estimate change in intake of all nutrients collectively. Results: Substituting eggs for commonly consumed main dishes at lunch or dinner increased total daily nutrient intake by 6-8 percentage points for each group, and specifically decreased the prevalence of vitamin D inadequacy by 1-4 percentage points. However, substituting eggs for commonly consumed foods at breakfast increased the prevalence of folate inadequacy by 8-12 percentage points among each group. Conclusions: This study is the first to use diet modeling to examine the effects of food substitutions at multiple eating occasions on meeting daily nutrient intake recommendations among distinct groups of nutritionally vulnerable populations. Our findings indicate that when making food substitutions to increase nutrient intake, eating occasion is an important consideration. Further research is needed to better understand how food substitutions affect diet costs, which may be an important driver of food purchasing decisions among low income individuals with limited food budgets.