Table 2. Trends in Dietary Components of the American Heart Association 2020 Strategic Impact Goals by SNAP Participation Status, 2003-2014a.
| Dietary Components and AHA Diet Score Point Valueb | AHA Intake Goals (Range) | Survey-Weighted Mean Score (95% CI)a | P Value for Trend | Change From 2003-2014, Mean (95% CI) | |||||
|---|---|---|---|---|---|---|---|---|---|
| 2003-2004 (n = 4066) | 2005-2006 (n = 4030) | 2007-2008 (n = 4654) | 2009-2010 (n = 4996) | 2011-2012 (n = 4288) | 2013-2014 (n = 4437) | ||||
| Total AHA diet score (0-80 points) | |||||||||
| SNAP participants | 31.5 (29.2 to 33.8) | 30.8 (28.6-32.9) | 31.1 (29.5-32.8) | 32.8 (31.2-34.5) | 33.8 (32.7-34.8) | 32.1 (30.6-33.6) | .11 | 0.57 (−2.18 to 0.33) | |
| Income-eligible nonparticipants | 34.2 (32.6-35.9) | 34.7 (33.1-36.3) | 34.9 (32.7-37.1) | 36.3 (34.8-37.9) | 36.5 (35.2-37.7) | 36.8 (35.3-38.3) | .004 | 2.56 (0.36 to 4.76) | |
| Higher-income individuals | 35.8 (34.6-36.9) | 36.4 (35.3-37.4) | 36.7 (35.5-37.8) | 38.7 (37.9-39.4) | 40.0 (38.5-41.5) | 39.6 (38.7-40.5) | <.001 | 3.84 (2.39 to 5.29) | |
| P value for interaction | .02c | .04d | |||||||
| Fruits and vegetables (10 of 80 points)e | ≥4.5 (0 to ≥4.5 cups/d) | ||||||||
| SNAP participants | 3.9 (3.5-4.2) | 3.9 (3.5-4.4) | 3.9 (3.5-4.3) | 4.0 (3.7-4.3) | 4.0 (3.8-4.3) | 3.7 (3.4-4.0) | .71 | −0.18 (−0.63 to 0.28) | |
| Income-eligible nonparticipants | 4.6 (4.2-5.1) | 4.9 (4.6-5.1) | 4.5 (4.2-4.8) | 4.7 (4.5-4.9) | 4.9 (4.6-5.1) | 4.6 (4.2-5.0) | .93 | −0.03 (−0.63 to 0.58) | |
| Higher-income individuals | 5.2 (4.9-5.5) | 5.2 (4.9-5.4) | 5.2 (4.9-5.4) | 5.4 (5.3-5.5) | 5.4 (5.1-5.7) | 5.2 (5.0-5.4) | .36 | −0.02 (−0.34 to 0.29) | |
| P value for interaction | .63c | .80d | |||||||
| Whole grains (10 of 80 points) | ≥3 (0 to ≥3 oz equivalent/d) | ||||||||
| SNAP participants | 1.4 (1.0-1.9) | 1.5 (1.2-1.9) | 1.5 (1.3-1.8) | 2.0 (1.7-2.2) | 2.4 (2.0-2.8) | 2.2 (2.0-2.4) | <.001 | 0.77 (0.32 to 1.22) | |
| Income-eligible nonparticipants | 1.9 (1.5-2.3) | 2.1 (1.8-2.5) | 2.0 (1.7-2.2) | 2.5 (2.1-2.8) | 2.7 (2.2-3.1) | 2.5 (2.1-2.9) | .004 | 0.60 (0.03 to 1.18) | |
| Higher-income individuals | 2.2 (2.0-2.4) | 2.6 (2.4-2.7) | 2.6 (2.4-2.8) | 3.0 (2.9-3.2) | 3.3 (3.1-3.5) | 3.2 (3.1-3.4) | <.001 | 1.02 (0.79 to 1.24) | |
| P value for interaction | .38c | .25d | |||||||
| Fish and shellfish (10 of 80 points) | ≥2 (0 to ≥2 oz/d) | ||||||||
| SNAP participants | 2.1 (1.6-2.7) | 2.0 (1.4-2.6) | 1.9 (1.6-2.2) | 2.4 (1.8-3.0) | 2.1 (1.7-2.6) | 1.9 (1.4-2.5) | .93 | −0.19 (−0.94 to 0.56) | |
| Income-eligible nonparticipants | 2.3 (1.8-2.7) | 2.1 (1.7-2.6) | 2.0 (1.5-2.5) | 2.6 (2.0-3.2) | 2.1 (1.7-2.5) | 2.2 (1.8-2.6) | .94 | −0.10 (−0.71 to 0.51) | |
| Higher-income individuals | 2.6 (2.3-3.0) | 2.7 (2.5-3.0) | 2.6 (2.3-2.9) | 2.8 (2.5-3.1) | 2.7 (2.3-3.1) | 2.7 (2.4-3.1) | .80 | 0.08 (−0.40 to 0.56) | |
| P value for interaction | .93c | .65d | |||||||
| Sugar-sweetened beverages (10 of 80 points) | ≤36 (≤36 to >16 fl oz/wk) | ||||||||
| SNAP participants | 3.8 (3.2-4.4) | 4.6 (3.8-5.3) | 4.3 (3.7-4.9) | 4.6 (4.1-5.0) | 5.3 (4.8-5.8) | 4.8 (4.1-5.5) | .009 | 0.94 (0.05 to 1.83) | |
| Income-eligible nonparticipants | 4.7 (4.1-5.2) | 5.5 (4.8-6.2) | 5.3 (4.8-5.8) | 5.63 (5.11-6.16) | 6.0 (5.5-6.4) | 6.6 (5.9-7.2) | <.001 | 1.92 (1.10 to 2.74) | |
| Higher-income individuals | 6.0 (5.6-6.4) | 6.6 (6.3-6.9) | 6.6 (6.3-6.9) | 7.1 (6.9-7.3) | 7.1 (6.7-7.6) | 7.5 (7.1-7.8) | <.001 | 1.42 (0.89 to 1.94) | |
| P value for interaction | .42c | .25d | |||||||
| Sodium (10 of 80 points) | ≤1500 (≤1500 to >4500 mg/d) | ||||||||
| SNAP participants | 4.4 (4.0-4.7) | 4.1 (3.6-4.7) | 3.9 (3.7-4.1) | 3.9 (3.7-4.2) | 3.9 (3.7-4.2) | 4.0 (3.6-4.3) | .18 | −0.37 (−0.86 to 0.12) | |
| Income-eligible nonparticipants | 3.9 (3.4-4.4) | 3.9 (3.5-4.2) | 3.8 (3.6-4.1) | 3.7 (3.5-4.0) | 3.6 (3.4-3.8) | 3.8 (3.4-4.1) | .33 | −0.13 (−0.73 to 0.47) | |
| Higher-income individuals | 3.7 (3.5-3.8) | 3.4 (3.2-3.5) | 3.4 (3.3-3.5) | 3.6 (3.4-3.7) | 3.8 (3.7-3.9) | 3.7 (3.6-3.9) | .009 | 0.05 (−0.18 to 0.28) | |
| P value for interaction | .02c | .04d | |||||||
| Nuts, seeds, and legumes (10 of 80 points) | ≥4 (0 to ≥4 servings/wk) | ||||||||
| SNAP participants | 3.7 (3.3-4.2) | 3.6 (2.8-4.4) | 3.6 (2.9-4.2) | 3.9 (3.5-4.4) | 3.9 (3.4-4.5) | 4.0 (3.6-4.5) | .20 | 0.30 (−0.34 to 0.93) | |
| Income-eligible nonparticipants | 4.6 (4.1-5.1) | 4.1 (3.6-4.5) | 4.5 (4.0-5.1) | 4.4 (3.9-4.9) | 4.6 (4.0-5.2) | 4.8 (4.3-5.4) | .20 | 0.27 (−0.47 to 1.00) | |
| Higher-income individuals | 4.4 (4.2-4.7) | 4.7 (4.3-5.0) | 4.7 (4.4-5.1) | 4.8 (4.6-5.1) | 5.5 (5.2-5.8) | 5.4 (5.1-5.7) | <.001 | 0.98 (0.61 to 1.36) | |
| P value for interaction | .08c | .07d | |||||||
| Processed meat (10 of 80 points) | ≤0.5 (≤0.5 to >1.76 oz/d) | ||||||||
| SNAP participants | 7.2 (6.8-7.6) | 6.3 (5.5-7.0) | 6.6 (6.2-7.1) | 6.5 (6.1-7.0) | 6.4 (6.0-6.9) | 6.2 (5.8-6.7) | .03 | −0.94 (−1.55 to −0.34) | |
| Income-eligible nonparticipants | 7.1 (6.6-7.6) | 6.9 (6.6-7.3) | 6.9 (6.3-7.5) | 6.9 (6.5-7.3) | 6.9 (6.5-7.3) | 6.8 (6.4-7.3) | .48 | −0.25 (−0.91 to 0.42) | |
| Higher-income individuals | 6.6 (6.5-6.8) | 6.4 (6.1-6.8) | 6.6 (6.4-6.9) | 6.6 (6.3-6.9) | 6.7 (6.4-7.0) | 6.9 (6.6-7.1) | .10 | 0.20 (−0.12 to 0.52) | |
| P value for interaction | .004c | .001d | |||||||
| Saturated fat (10 of 80 points) | ≤7% (≤7% to >15%) | ||||||||
| SNAP participants | 5.0 (4.3-5.7) | 4.8 (4.3-5.2) | 5.5 (5.1-6.0) | 5.5 (5.3-5.8) | 5.5 (5.2-5.9) | 5.3 (4.9-5.6) | .18 | 0.25 (−0.48 to 0.98) | |
| Income-eligible nonparticipants | 5.2 (4.8-5.7) | 5.3 (5.0-5.6) | 5.8 (5.4-6.3) | 5.8 (5.5-6.2) | 5.7 (5.3-6.2) | 5.5 (5.2-5.8) | .10 | 0.28 (−0.24 to 0.80) | |
| Higher-income individuals | 5.0 (4.7-5.2) | 4.8 (4.6-5.0) | 5.0 (4.7-5.2) | 5.3 (5.1-5.5) | 5.5 (5.2-5.7) | 5.1 (4.9-5.3) | .005 | 0.11 (−0.21 to 0.43) | |
| P value for interaction | .99c | .79d | |||||||
Abbreviations: AHA, American Heart Association; SNAP, Supplemental Nutrition Assistance Program.
All dietary variables were adjusted for energy to 2000 kcal/d using the residual method prior to analysis. Each AHA dietary component was evaluated based on a continuous scoring system. Intake of each dietary component was scored from 0 to 10 (beneficial components) or from 10 to 0 (harmful components). For beneficial components, individuals with zero intake received the lowest score (0). For harmful components, the lowest score (0) was assigned to a higher level, approximately equivalent to the 80th to 90th percentile of intake among US adults, and rounded to practical values (eg, 4500 mg/d of sodium, one 50-g serving per day of processed meat, two 8-oz servings per day of sugar-sweetened beverages, and 15% energy from saturated fat). Intermediate dietary intake was scored linearly between 0 and 10. For example, an adult consuming 3000 mg/d of sodium would receive 5 sodium points (ie, his or her sodium consumption was halfway between 1500 mg/d and the maximum value of 4500 mg/d).
The total AHA diet score is the sum of the scores for 8 dietary components (fruits and vegetables; whole grains; fish and shellfish; sugar-sweetened beverages; sodium; nuts, seeds, and legumes; processed meat; and saturated fat).
P value for interaction for potential heterogeneous trends in diet scores by SNAP participation status.
P value for interaction for potential heterogeneous changes in diet scores from 2003 to 2014 by SNAP participation status.
According to the AHA 2020 goals, up to 3 cups per week (0.42 cups per day) of starchy vegetables (eg, potatoes, peas, corn) could be included; this maximum was incorporated into the analysis, with higher intake not contributing toward the score. Consumption of 100% fruit juice could also be included; however, its contribution was not capped in the original AHA 2020 goals and does not contribute to the score.