Replacing American snacks with tree nuts increases consumption of key nutrients among US children and adults: results of an NHANES modeling study - PubMed (original) (raw)

Replacing American snacks with tree nuts increases consumption of key nutrients among US children and adults: results of an NHANES modeling study

Colin D Rehm et al. Nutr J. 2017.

Abstract

Background: Replacing typical American snacks with tree nuts may be an effective way to improve diet quality and compliance with the 2015-2020 Dietary Guidelines for Americans (DGAs).

Objective: To assess and quantify the impact of replacing typical snacks with composite tree nuts or almonds on diet metrics, including empty calories (i.e., added sugars and solid fats), individual fatty acids, macronutrients, nutrients of public health concern, including sodium, fiber and potassium, and summary measures of diet quality.

Methods: Food pattern modeling was implemented in the nationally representative 2009-2012 National Health and Examination Survey (NHANES) in a population of 17,444 children and adults. All between-meal snacks, excluding beverages, were replaced on a per calorie basis with a weighted tree nut composite, reflecting consumption patterns in the population. Model 1 replaced all snacks with tree nuts, while Model 2 exempted whole fruits, non-starchy vegetables, and whole grains (>50% of total grain content). Additional analyses were conducted using almonds only. Outcomes of interest were empty calories (i.e., solid fats and added sugars), saturated and mono- and polyunsaturated fatty acids, fiber, protein, sodium, potassium and magnesium. The Healthy Eating Index-2010, which measures adherence to the 2010 Dietary Guidelines for Americans, was used as a summary measure of diet quality.

Results: Compared to observed diets, modeled food patterns were significantly lower in empty calories (-20.1% and -18.7% in Model 1 and Model 2, respectively), added sugars (-17.8% and -16.9%), solid fats (-21.0% and -19.3%), saturated fat (-6.6% and -7.1%)., and sodium (-12.3% and -11.2%). Modeled patterns were higher in oils (65.3% and 55.2%), monounsaturated (35.4% and 26.9%) and polyunsaturated fats (42.0% and 35.7%), plant omega 3 s (53.1% and 44.7%), dietary fiber (11.1% and 14.8%), and magnesium (29.9% and 27.0%), and were modestly higher in potassium (1.5% and 2.9%). HEI-2010 scores were significantly higher in Model 1 (67.8) and in Model 2 (69.7) compared to observed diets (58.5). Replacing snacks with almonds only produced similar results; the decrease in sodium was more modest and no increase in plant omega-3 fats was observed.

Conclusion: Replacing between-meal snacks with tree nuts or almonds led to more nutrient-rich diets that were lower in empty calories and sodium and had more favorable fatty acid profiles. Food pattern modeling using NHANES data can be used to assess the likely nutritional impact of dietary guidance.

Keywords: Diet quality; Nuts; Snacks.

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Figures

Fig. 1

Fig. 1

Breakdown of composite tree nut. Value indicates the relative weight of each tree nut type. For example, “almonds, not formally specified” contributed 26.8% to the composite tree nut. Graph shows all tree nuts contributing more than 5%. Other nuts contributing between 1-5% include, cashews (dry roasted), almonds (unroasted), cashews (dry roasted, no salt), and almonds roasted

Fig. 2

Fig. 2

Added sugars (Panel a), solid fats (Panel b) and energy from empty calories (Panel c) in observed and modeled diets, overall and by age group. Error bars are 95% confidence intervals. Model 1 is substitution of all solid snack foods with the composite tree nut and Model 2 is substitution of all solid foods except for whole fruit, non-starchy vegetables and foods where more than 50% of the total grain comes from whole grains. _P_-value of difference comparing each model to observed value is indicated by asterisk (***p < 0.001; **0.001 < _p_-value < 0.01; *0.05 < p < 0.01). Hypothesis testing comparing Model 1 to Model 2 was not conducted

Fig. 3

Fig. 3

Oils (Panel a), saturated fatty acids (Panel b), monounsaturated fatty acids (Panel c), and polyunsaturated fatty acids (Panel d) in observed and modeled diets, overall and by age group. Error bars are 95% confidence intervals. Model 1 is substitution of all solid snack foods with the composite tree nut and Model 2 is substitution of all solid foods except for whole fruit, non-starchy vegetables and foods where more than 50% of the total grain comes from whole grains. _P_-value of difference comparing each model to observed value is indicated by asterisk (***p < 0.001; **0.001 < _p_-value < 0.01; *0.05 < p < 0.01). Hypothesis testing comparing Model 1 to Model 2 was not conducted. A reference line is provided for saturated fatty acids, which corresponds to the Daily Value, commonly used on food labels. The Daily Value may not apply to children less than 4y and for pregnant or lactating women

Fig. 4

Fig. 4

Total fat (Panel a), protein (Panel b), total carbohydrates (Panel c) in modeled and observed diets, overall and by age group. Error bars are 95% confidence intervals. Model 1 is substitution of all solid snack foods with the composite tree nut and Model 2 is substitution of all solid foods except for whole fruit, non-starchy vegetables and foods where more than 50% of the total grain comes from whole grains. _P_-value of difference comparing each model to observed value is indicated by asterisk (***p < 0.001; **0.001 < _p_-value < 0.01; *0.05 < p < 0.01). Hypothesis testing comparing Model 1 to Model 2 was not conducted. A reference line is provided which corresponds to the Daily Value, commonly used on food labels. The Daily Value may not apply to children less than 4y and for pregnant or lactating women

Fig. 5

Fig. 5

Dietary fiber (Panel a), magnesium (Panel b), and sodium (Panel c) in modeled and observed diets, overall and by age group. Error bars are 95% confidence intervals. Model 1 is substitution of all solid snack foods with the composite tree nut and Model 2 is substitution of all solid foods except for whole fruit, non-starchy vegetables and foods where more than 50% of the total grain comes from whole grains. _P_-value of difference comparing each model to observed value is indicated by asterisk (***p < 0.001; **0.001 < _p_-value < 0.01; *0.05 < p < 0.01). Hypothesis testing comparing Model 1 to Model 2 was not conducted. A reference line is provided which corresponds to the Daily Value, commonly used on food labels. The Daily Value may not apply to children less than 4y and for pregnant or lactating women

Fig. 6

Fig. 6

Healthy Eating Index-2010 in modeled and observed diets, overall and by age group. Error bars are 95% confidence intervals. Model 1 is substitution of all solid snack foods with the composite tree nut and Model 2 is substitution of all solid foods except for whole fruit, non-starchy vegetables and foods where more than 50% of the total grain comes from whole grains. _P_-value of difference comparing each model to observed value is indicated by asterisk (***p < 0.001; **0.001 < _p_-value < 0.01; *0.05 < p < 0.01). Hypothesis testing comparing Model 1 to Model 2 was not conducted

Fig. 7

Fig. 7

Healthy Eating Index-2010 components in modeled and observed diets. Model 1 is substitution of all solid snack foods with the composite tree nut and Model 2 is substitution of all solid foods except for whole fruit, non-starchy vegetables and foods where more than 50% of the total grain comes from whole grains. _P_-value of difference comparing each model to observed value is indicated by asterisk (***p < 0.001; **0.001 < _p_-value < 0.01; *0.05 < p < 0.01). Hypothesis testing comparing Model 1 to Model 2 was not conducted

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