The diets of children and teens in the United States have improved over the past two decades, but the meals eaten by most children are still nutritionally poor, according to a study published online in the Journal of the American Medical Association (JAMA).
The study found that young people are drinking less sugary beverages and consuming slightly more fruit and whole grains than they were in 1999. But they are still eating less than the recommended daily amount of fruit, vegetables and whole grains.
“This is a classic ‘glass half full or half empty’ story,” said Dr. Dariush Mozffarian, the study’s senior author and dean of the Friedman School of Nutrition Science and Policy at Tufts University, in a released statement. “Kids’ diets are definitely improving, and that’s very positive. On the other hand, most still have poor diets, and this is especially a problem for older youth and for kids whose households have less education, income or food security.”
As background information in the study points out, the diets we follow in childhood shape our lifelong food preferences — and thus our health throughout adulthood. Unhealthful diets are a major contributor to a variety of chronic diseases, including type 2 diabetes, heart disease, stroke and several cancers.
Poor-quality diets have also helped fuel the obesity epidemic of recent decades. Despite several national efforts aimed at improving the diets of U.S. children and teens, the obesity rate among young people has steadily climbed, although there are some signs that the rise may have slowed in recent years.
In 2016, 18.5 percent of American youth were obese — a rate that was 33 higher than it was in 1999.
How the study was done
To get a better idea about the current quality of the diets of U.S. children and teens, Mozffarian and his co-authors analyzed National Health and Nutrition Examination Survey (NHANES) data collected between 1999 and 2016 for a representative sample of more than 31,000 young people aged 2 to 19. The survey asked participants to recall what they ate within the previous 24 hours. Parents and other caregivers provided the information for children under the age of 12, while older children filled out the survey themselves.
The researchers scored each child’s diet either “poor,” “intermediate” or “ideal” based on the American Heart Association’s “Healthy Diet Score” and the U.S. Department of Agriculture’s “Healthy Eating Index.” These assessment tools give highest scores to meals that contain plenty of fruits, vegetables, fish, whole grains, nuts, legumes and seeds, while cutting back on sugar, salt, saturated fat and processed meat.
The data revealed that the diets of U.S. children and teens had improved during the study’s 18-year period. In 2016, 56 percent of young people had poor diets, compared to 77 percent in 1999.
Most of those improvements were from poor diets to intermediate ones. By 2016, only 0.25 percent of American children had an ideal diet, although that was up from 0.07 percent in 1999.
Teens had the worst diets. In 2016, 67 percent of them had poor diets, compared to 53 percent of children aged 6 to 11 years and 40 percent of children aged 5 years and under.
The study also found troubling disparities between different income groups. By the end of the study, 65 percent of children in families with the lowest annual household income (about $34,000 or less for a family of four) had poor diets, compared to 47 percent of children in families with the highest annual household income (about $78,000 or more).
Children whose low-income families participated in two government programs that provide food assistance — the Supplemental Nutrition Assistant Program (SNAP) or the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) — were, however, less likely to have poor diets than children in low-income families who didn’t receive that assistance.
Ups and downs
The biggest improvement in diets was a decline in the amount of sugary drinks consumed. In 2016, children drank eight fewer ounces of sugar-sweetened beverages each day, on average, than they did in 1999. That’s the equivalent of about eight fewer teaspoons of added sugar.
“Overall, added sugar intake among American children was reduced by a third, largely because sugary beverages were cut in half,” says Junxiu Liu, the study’s lead author and a postdoctoral scholar at Tufts University, in a released statement.
“But there was little reduction in added sugars consumed from foods, and by 2016, American kids were still eating about 18 teaspoons or about 71.4 grams of added sugar each day — equivalent to one out of every seven calories,” she adds. “That’s much too high.”
Smaller improvements were found in two other nutritional categories. In 2016, young people averaged a half serving more of whole grains (about half a slice of whole grain bread) and one-fifth serving more of whole fruit (about seven grapes) than in 1999.
In several categories, the young people remained far below general nutritional recommendations. Most notably, by 2016, children and teens were consuming only about 1.8 daily servings of fruits and vegetables — significantly below the recommended 4.5 servings. And they were also eating only one daily serving of whole grains — a third less than the recommended three servings.
Limitations and implications
This study relies on self-reports of the foods people are eating, including the self-reports of teenagers, which, of course, can be unreliable. Parents and teenagers may have over-reported or under-reported certain foods.
Still, the findings give us the best snapshot we have of the current nutritional quality of the foods our children and teenagers are eating. Unfortunately, that quality remains poor for a majority of young people.
“Our findings of slowly improving, yet still poor, diets in U.S. children are consistent with the slowing of rises in childhood obesity but not any reversal,” says Mozaffarian. “Understanding these updated trends in diet quality is crucial to informing priorities to help improve the eating habits and long-term health of all of America’s youth.”
“Food is the number one cause of chronic illness and death in our country, and these results affect our children — our future,” he adds.
FMI: You’ll find an abstract of the study on JAMA’s website, but the full paper is behind a paywall.