TABLE 2.
Trends in quality of dietary components consumed from full-service and fast-food restaurants based on the American Heart Association 2020 Strategic Impact Goals Among US Adults, 2003–2016
| Dietary consumption | Survey-weighted AHA mean score ± SE1 | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| AHA intake target (range) | Max points | 2003–2004 (n1 = 1405; n2 = 2010) | 2005–2006 (n1 = 1375; n2 = 2122) | 2007–2008 (n1 = 1566; n2 = 2374) | 2009–2010 (n1 = 1631; n2 = 2408) | 2011–2012 (n1 = 1465; n2 = 2401) | 2013–2014 (n1 = 1546; n2 = 2607) | 2015–2016 (n1 = 1460; n2 = 2342) | P-trend | |
| AHA Primary Individual Diet Score | ||||||||||
| Fruits and vegetables | ≥4.5 cup/d (0–≥4.5 cup/d) | 10 | ||||||||
| Full-service restaurant | 5.08 ± 0.15 | 5.06 ± 0.13 | 4.79 ± 0.09 | 4.77 ± 0.13 | 4.84 ± 0.08 | 4.62 ± 0.11 | 4.18 ± 0.17 | <0.001 | ||
| Fast-food restaurant | 3.62 ± 0.07 | 3.58 ± 0.08 | 3.16 ± 0.05 | 3.22 ± 0.07 | 3.01 ± 0.09 | 2.94 ± 0.09 | 2.94 ± 0.08 | <0.001 | ||
| Whole grains | ≥3 oz equivalents/d (0–≥3 oz equivalents/d) | 10 | ||||||||
| Full-service restaurant | 0.58 ± 0.07 | 0.53 ± 0.05 | 0.63 ± 0.05 | 0.55 ± 0.04 | 0.82 ± 0.09 | 0.81 ± 0.08 | 1.00 ± 0.16 | 0.001 | ||
| Fast-food restaurant | 0.21 ± 0.03 | 0.33 ± 0.05 | 0.28 ± 0.03 | 0.24 ± 0.05 | 0.52 ± 0.07 | 0.62 ± 0.07 | 0.62 ± 0.08 | <0.001 | ||
| Fish and shellfish | ≥2 oz/d (0–≥2 oz/d) | 10 | ||||||||
| Full-service restaurant | 1.64 ± 0.17 | 1.72 ± 0.13 | 1.72 ± 0.16 | 1.76 ± 0.14 | 1.54 ± 0.16 | 1.74 ± 0.16 | 1.54 ± 0.12 | 0.57 | ||
| Fast-food restaurant | 0.64 ± 0.05 | 0.63 ± 0.06 | 0.67 ± 0.09 | 0.63 ± 0.08 | 0.47 ± 0.07 | 0.60 ± 0.06 | 0.59 ± 0.04 | 0.15 | ||
| Sugar-sweetened beverages | ≤36 fl oz/wk (≤36→16 fl oz/wk) | 10 | ||||||||
| Full-service restaurant | 7.81 ± 0.15 | 8.13 ± 0.13 | 7.99 ± 0.22 | 8.13 ± 0.12 | 8.21 ± 0.15 | 8.34 ± 0.14 | 8.32 ± 0.22 | 0.02 | ||
| Fast-food restaurant | 7.09 ± 0.17 | 7.33 ± 0.13 | 7.41 ± 0.10 | 7.25 ± 0.12 | 7.40 ± 0.14 | 7.68 ± 0.15 | 7.39 ± 0.18 | 0.055 | ||
| Sodium | ≤1500 mg/d (≤1500→4500 mg/d) | 10 | ||||||||
| Full-service restaurant | 2.72 ± 0.08 | 2.39 ± 0.13 | 2.33 ± 0.09 | 2.37 ± 0.11 | 2.48 ± 0.08 | 2.43 ± 0.07 | 2.23 ± 0.14 | 0.03 | ||
| Fast-food restaurant | 3.39 ± 0.13 | 2.92 ± 0.07 | 3.01 ± 0.07 | 2.90 ± 0.08 | 3.51 ± 0.17 | 3.33 ± 0.07 | 3.18 ± 0.09 | 0.17 | ||
| AHA Secondary Individual Diet Score | ||||||||||
| Nuts, seeds, and legumes | ≥4 servings/wk (0–≥4 servings/wk) | 10 | ||||||||
| Full-service restaurant | 1.23 ± 0.16 | 1.21 ± 0.17 | 1.42 ± 0.16 | 1.20 ± 0.14 | 1.57 ± 0.17 | 1.47 ± 0.15 | 1.47 ± 0.14 | 0.08 | ||
| Fast-food restaurant | 0.67 ± 0.07 | 0.74 ± 0.08 | 0.72 ± 0.08 | 0.67 ± 0.10 | 0.92 ± 0.08 | 0.89 ± 0.08 | 1.16 ± 0.11 | <0.001 | ||
| Processed meat | ≤0.5 oz/d (≤0.5→1.76 oz/d) | 10 | ||||||||
| Full-service restaurant | 8.52 ± 0.12 | 8.47 ± 0.10 | 8.25 ± 0.10 | 8.22 ± 0.14 | 8.08 ± 0.16 | 8.54 ± 0.11 | 8.44 ± 0.17 | 0.73 | ||
| Fast-food restaurant | 7.51 ± 0.14 | 7.68 ± 0.13 | 7.91 ± 0.09 | 7.91 ± 0.14 | 7.76 ± 0.22 | 7.80 ± 0.12 | 7.92 ± 0.12 | 0.08 | ||
| Saturated fat | ≤7% (≤7%→15%) | 10 | ||||||||
| Full-service restaurant | 4.60 ± 0.16 | 4.64 ± 0.13 | 4.25 ± 0.14 | 4.62 ± 0.22 | 5.24 ± 0.16 | 5.20 ± 0.16 | 4.42 ± 0.18 | 0.06 | ||
| Fast-food restaurant | 3.36 ± 0.10 | 3.17 ± 0.13 | 3.13 ± 0.10 | 3.76 ± 0.08 | 3.72 ± 0.14 | 3.72 ± 0.12 | 3.79 ± 0.16 | <0.001 | ||
All dietary variables were scaled-up to 2000 kcal for analysis to account for varying serving sizes and amounts as well as facilitate interpretation of the overall nutritional quality and food and nutrient components of different FS and FF meals as compared to diet quality scores and national dietary recommendations, all intakes were adjusted to 2000 kcal/d. The sample sizes for full-service restaurants and fast-food restaurants are indicated by n1 and n2, respectively; all analyses are survey-weighted to be nationally representative. Each AHA consumption target was evaluated based on a continuous scoring system. Intake of each dietary component was scored from 0 to 10 (beneficial components) and from 10 to 0 (harmful components). For beneficial dietary components, individuals with zero intake received the lowest score (0). For harmful dietary 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 a practical value (e.g. 4500 mg/d of sodium, 1 50-g serving/d of processed meat, 2 8-oz servings/d of sugar-sweetened beverages, and 15% energy of 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 (i.e. his or her sodium consumption was halfway between 1500 mg/d and the maximum value of 4500 mg/d). Details appear in Methods.
AHA, American Heart Association.