Dietary patterns of older adults in NHANES 2013 to 2018: Associations with sociodemographic factors, health characteristics, food security, and diet quality

Authors: SASSINE, ANNIEBELLE - University Of Maryland; WAMBOGO, EDWINA - National Institutes Of Health (NIH); Moshfegh, Alanna; SAHYOUN, NADINE - University Of Maryland

Submitted to: Public Health Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/30/2026
Publication Date: 4/30/2026
Citation: Sassine, A.J., Wambogo, E.A., Moshfegh, A.J., Sahyoun, N.R. 2026. Dietary patterns of older adults in NHANES 2013 to 2018: Associations with sociodemographic factors, health characteristics, food security, and diet quality. Public Health Nutrition. 2026:1-34. https://doi.org/10.1017/S1368980026102560.
DOI: https://doi.org/10.1017/S1368980026102560

Interpretive Summary: Limited research exists on the dietary patterns of older adults, who face an elevated risk of malnutrition due to a combination of factors such as chronic diseases, food insecurity, and social isolation. This study aimed to determine dietary patterns among older adults in the US and explore their associations with sociodemographic factors,health-related characteristics, food security and diet quality. Dietary intake data from older adults aged 60 years and above who participated in the What We Eat in America, National Health and Nutrition Examination Surveys 2013-2018 were analyzed. Using cluster analysis, dietary patterns were derived for 5062 older adults with complete and reliable 24-hour dietary recalls from day 1. The Healthy Eating Index (HEI-2020) score was used as a measure of diet quality. Five distinct dietary patterns were identified. The largest dietary pattern was characterized by high intakes of juices, smoothies/grain drinks, and soups (n=2680). Two patterns were considered featuring processed foods and saturated fats, were labeled as, ‘Cured meats, sandwiches, and sweet bakery products’ (n=918) and ‘Meats, alcohol, and quick breads’ (n=557). The remaining two patterns were considered healthy: ‘Seafood and vegetables’ (n=360) and ‘Cooked cereals and yogurt’ (n=547). These dietary patterns differed in sex, age, race, education, socioeconomic status, body mass index, self-reported hypertension, smoking status, self-reported health and diet quality, food security status, and HEI-2020 total and component scores. Most older adults in the US follow a soft-like, low-calorie diet with high intake of juices, smoothies and soups and nearly one-third follow diets high in red and processed meats, refined grains, added sugar, and saturated fats. Results call for targeted and tailored, educational campaigns to help older adults transition toward nutrient-dense,whole-food-based diets,while addressing barriers like food insecurity to ensure equitable access to healthier options.

Technical Abstract: Limited research exists on the dietary patterns of older adults, who face an elevated risk of malnutrition due to a combination of factors such as chronic diseases, food insecurity, and social isolation. This study aimed to determine dietary patterns among older adults in the US and explore their associations with sociodemographic factors, health-related characteristics, food security and diet quality. Dietary intake data from older adults (aged 60 years and above) who participated in the What We Eat in America, National Health and Nutrition Examination Surveys (NHANES) during 2013 to 2018 were analyzed. Using cluster analysis, dietary patterns were derived for 5062 older adults with complete and reliable 24-hour dietary recalls from day 1. The Healthy Eating Index (HEI-2020) score was used as a measure of diet quality. Five distinct dietary patterns were identified. The largest dietary pattern was characterized by high intakes of juices, smoothies/grain drinks, and soups (n=2680). Two patterns were considered unhealthy with the lowest HEI-2020 scores, featuring processed foods and saturated fats, were labeled as, ‘Cured meats, sandwiches, and sweet bakery products’ (n=918) and ‘Meats, alcohol, and quick breads’ (n=557). The remaining two patterns were considered healthy: ‘Seafood and vegetables’ (n=360) and ‘Cooked cereals and yogurt’ (n=547). These dietary patterns differed in sex, age, race, education socioeconomic status, body mass index, self-reported hypertension, smoking status, self-reported health and diet quality, food security status, and HEI-2020 total and component scores. Most older adults in the US follow a soft-like, low-calorie diet with high intake of juices, smoothies and soups and nearly one-third follow diets high in red and processed meats, refined grains, added sugar, and saturated fats. Results call for targeted and tailored, educational campaigns to help older adults transition toward nutrient-dense, whole-food-based diets, while addressing barriers like food insecurity to ensure equitable access to healthier options.