Submitted to: Public Health Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/19/2018
Publication Date: 2/15/2019
Citation: Sebastian, R.S., Enns, C.W., Goldman, J.D., Hoy, M.K., Moshfegh, A.J. 2019. Findings from What We Eat in America, National Health and Examination Survey 2011-2014 support salad consumption as an effective strategy for improving adherence to dietary recommendations. Public Health Nutrition. 22(6):976-987. https://doi.org/10.1017/S1368980018003695.
Interpretive Summary: The Dietary Guidelines for Americans 2015-2020 provide information to help Americans make healthy food choices. Few Americans eat enough vegetables. The Dietary Guidelines suggest that eating more salad is one way to increase the amount of vegetables people eat. No study had examined whether this strategy is effective in the U.S. population. We used nationwide survey data to see if eating salad is related to higher overall vegetable intakes. We analyzed salads that were composed mostly of raw vegetables. We found that 23% of U.S. adults ate this type of salad on the survey day. Compared to adults who did not eat salad on the survey day, those who did eat salad (salad reporters) consumed more total, dark-green, red/orange, and other vegetables. Salad reporters were much more likely to meet their Dietary Guidelines goals for these food groups. Our results confirm that eating more salad is one effective way to help bring vegetable intakes in line with the Dietary Guidelines. This article can inform policymakers, nutrition experts, and consumers about how salads can help improve adults’ adherence to the Dietary Guidelines for Americans.
Technical Abstract: Though vegetable intake is emphasized in the Dietary Guidelines for Americans and other nationwide programs promoting good nutrition, most individuals in the U.S. consume far less than recommended. One strategy for boosting vegetable consumption proposed in the Dietary Guidelines for Americans 2015-2020 is to include vegetable dishes, such as salads, in most meals and snacks. However, the effectiveness of this strategy in the U.S. population had not yet been evaluated. The objective of this study was to determine if salad consumption is associated with higher vegetable intake and better adherence to recommendations outlined in the Dietary Guidelines for Americans 2015-2020. We performed a cross-sectional analysis of data collected from 9,678 adults age 20 years and over in 2011-2014 in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey. Pregnant and lactating women were excluded. Individuals were classified as salad reporters or nonreporters based on whether they consumed a salad (composed primarily of raw vegetables) on the intake day. Regression analyses were applied to calculate adjusted estimates of food group intakes and assess the likelihood of meeting Healthy U.S.-Style Food Pattern recommendations by salad reporting status. On the intake day, 23% of adults ate salad. The proportion of individuals reporting salad varied by sex, age, race, income, education, and smoking status (p<0.001). Compared to nonreporters, salad reporters consumed significantly larger quantities of vegetables (total, dark-green, red/orange, and other), which translated into a two- to three-fold greater likelihood of meeting dietary recommendations for these food groups. More modest associations were observed between salad reporting and differences in intake and likelihood of meeting recommendations for protein foods (total and seafood), oils, and refined grains. Results of this study confirm the Guidelines message that incorporating more salads into the diet is an effective strategy (among many possible strategies) to augment vegetable consumption and adherence to dietary recommendations concerning vegetables.