Over the past 2 decades, diet quality has taken a sharp decline for older Americans, according to a new study.
Scored based on the American Heart Association (AHA) 2020 Strategic Impact Goals for diet, the average primary score dropped by 7.9% from 2001 to 2018 (P<0.001 for trend) for adults 65 and over, Chenkai Wu, PhD, MPH, MS, of Duke Kunshan University in China, and colleagues reported in JAMA Network Open.
This average AHA diet score — which takes into account consumption of fruits and vegetables, whole grains, fish and shellfish, sugar-sweetened beverages, and sodium — dropped from 19.84 to 18.28 over this time period (out of a total of 50 points ).
The proportion of older adults who were classified as having a “poor diet quality” jumped from 50.9% to 60.9%. This was defined as less than 40% adherence to the AHA goals. At the same time, the proportion of older adults with only an “intermediate” diet quality (40% to 79.9% adherence) dropped from 48.6% to 38.7%.
However, during all time points, less than 1% of these older adults had an “ideal” diet quality, defined as 80% or higher adherence to AHA diet goals.
As for the secondary AHA diet score — rated on a scale out of 80 based upon intake of nuts, seeds, legumes, processed meat, and saturated fat — there was an 8.4% drop among older adults, with the score decreasing from an average of 34.75 to 31.83 over the study period.
In a breakdown of the individual components of the AHA diet score, there was a significant drop in the average consumption of total fruits and vegetables, as well as nuts, seeds, and legumes. On the other hand, there was an increase in the average intake of fish and shellfish, processed meat, sugar-sweetened beverages, and saturated fat.
In yet another measure of diet quality — this time using the 100-point Healthy Eating Index-2015, which measures how diet quality aligns with the US Department of Agriculture 2015-2020 Dietary Guidelines for Americans — there was another significant decrease in score from 2001 to 2018. Dropping an average of 5.4%, this average score decreased from 47.82 to 45.25.
Similar to what was seen with the AHA scores when breaking down the individual components of this diet measure, Wu’s group likewise saw a significant uptick in the amount of total protein foods, seafood and plant proteins, and added sugar.
Some of these changes in diet quality were more noticeable among certain sociodemographic groups, the researchers noted. For example, non-Hispanic white older adults had the biggest drop in diet quality. And not surprisingly, older adults with lower income levels and lower attainment of education consistently saw poorer diet quality.
Pointing out a well-known fact, the researchers highlighted: “Healthier diets cost more than unhealthy diets.”
The team also explained that during the past 20 years, food insecurity is estimated to have more than doubled in the US, leading to a direct negative impact on diet quality.
However, economic reasons aren’t the only driving force behind this diet quality drop-off, which Wu’s group said is both “complex and multifaceted.”
“Social isolation and loneliness might create difficulties in acquiring and preparing food and might encourage unhealthy eating behavior among older adults,” they wrote, pointing out how the prevalence of loneliness has only increased among older adults recently.
Data for this serial cross-sectional study came from nine National Health and Nutrition Examination Survey cycles, which collected 24-hour dietary recalls on 10,837 individuals. Exactly half of survey respondents were women and 58.5% were white. The average age was 73.9.
The study was funded by the Kunshan Municipal Government.
Wu and co-authors reported no disclosures.