The contribution of moderation foods to total energy intake by sociodemographic characteristics in U.S. adults: National Health and Nutrition Examination Survey, 2017 to 2020

BackgroundU.S. adults exceed recommended intakes of multiple nutrients of concern ObjectiveThis study uses a recently-developed food-level classification method for identifying foods exceeding thresholds for nutrients of concern to investigate sociodemographic differences in their contribution to total energy intake among U.S. adults. DesignCross-sectional. Participants/settingParticipants 20 - 80 years of age in the 2017-2020 National Health and Nutrition Examination Survey (n=7706). Main outcome measuresData from 24-hour dietary recalls were used to identify "moderation foods" meeting at least one threshold for high content of nutrients of concern: added sugar >20% energy, sodium >460mg per serving, refined grains >50% of total grains or >10:1 ratio of carbohydrate to fiber content, saturated fat >20% energy, total fat >9% by weight (applied only to vegetables, sweets, and snacks), and all alcoholic beverages. The percentage of energy intake from moderation foods in total and from foods meeting each of the moderation food thresholds were calculated and compared across age, education, income-to-poverty ratio (IPR), and race/ethnicity. Statistical analyses performedLinear regression models with multiplicative interaction terms tested whether race/ethnicity or education modified relationships of IPR with moderation food intake. ResultsModeration foods contributed 76% (95%CI:75%-77%) of energy intake overall. Intake was higher in younger adults (mean=79%) versus older (72%-75%) adults, males (77%) versus females (74%), and adults in the lowest (79%) vs. highest (74%) income quartile. Moderation food intake was lowest in Non-Hispanic Asian adults (66%) and among adults with the highest education (mean=71%). Foods meeting thresholds for sodium, refined grains, and fat contributed the most to overall energy intake. Foods meeting thresholds for added sugar, sodium, and refined grains contributed a smaller share of energy intake in non-Hispanic Asians versus other racial/ethnic groups and in older versus younger adults. Income was inversely associated with moderation food intake only among high school graduates (second highest education group; {beta} = - 1.1 95%CI = -2.1 to -0.2) and modestly inversely associated with moderation food intake in all race/ethnic groups except Mexican Americans/Other Hispanic adults. ConclusionsHigh intake of moderation foods across all subgroups of U.S. adults, with only modest between-group differences in the contributions of different categories of moderation foods, suggest a need for population-wide changes in food selection to align with dietary guidelines. In particular, interventions and policies to assist in identifying foods high in sodium, refined grains, and fat may help consumers improve food choices.