(P22-034-24) Moving Towards Nutrition Security: Examining Differences in Sociodemographic, Dietary, and Cardiometabolic Profiles Using Evidence-Based Diet Quality Categories

Objectives: To characterize the diet quality of US adults using evidence-based Healthy Eating Index-2020 (HEI-2020) categories and examine differences in sociodemographic, dietary, and cardiometabolic profiles.

Methods: We analyzed nationally-representative data for N=22,168 US adults ( >=20 years) from the 2009-2018 National Health and Nutrition Examination Surveys (NHANES). We derived HEI-2020 diet quality scores (0-100) from participants’ two 24-hour dietary recalls and estimated usual HEI-2020 scores following the National Cancer Institute’s (NCI) method. Diet quality categories were established based on the literature and NCI’s cut-points: high diet quality (>70-100), moderate ( >60-70), low ( >50-60), and very low (0-50). Differences in sociodemographic, dietary, and cardiometabolic profiles were examined.

Results: Only 0.8% of US adults were classified as having high diet quality, 12.9% had moderate diet quality, 41.3% had low diet quality, and 45.0% had very low diet quality. Compared to adults with high diet quality, adults with very low diet quality were more likely to be younger (43.3 vs. 58.9 years, respectively), male (55.2% vs. 30.6%), Black (15.3% vs. 5.7%), had less than or equivalent to a high school education (49.1% vs. 7.9%), and had a family income ≤200% of the federal poverty line (43.4% vs. 9.6%). Adults with very low diet quality had higher intakes of ultra-processed foods, refined grains, and added sugars compared to those with high diet quality. Adults with very low diet quality were more likely to have obesity compared to adults with high diet quality (44.4% vs. 12.8%), and adverse fasting LDL cholesterol (62.3% vs. 56.7%), HDL cholesterol (23.8% vs. 9.4%), fasting triglycerides (24.6% vs. 13.1%), and fasting glucose (42.7% vs. 26.5%).

Conclusions: Less than 1% of Americans had a diet characterized as high quality, while nearly 9 in 10 US adults had diets characterized as low or very low quality. Marked racial and socioeconomic disparities were observed and those with low or very low diet quality disproportionately had poorer cardiometabolic health. Public health policies and programs should carefully monitor overall diet quality as a critical component of cardiometabolic disease prevention using the HEI-2020 as a benchmark for the nation’s nutrition security.

Funding Sources: The authors have no funding to disclose.