Adherence to Federal Dietary Recommendations for Total Fruit Consumption and the Intake of Underconsumed Nutrients: Findings from the National Health and Nutrition Examination Survey, 2015 to 2018

Abstract

Background: A persistent gap exists between U.S. consumers' actual fruit consumption and Federal dietary recommendations for fruit. Individuals who most deviate from recommendations may be at a greater risk of underconsuming some nutrients.

Objective: We investigated how widely total fruit consumption varies across adult consumers and whether those who most deviate from recommendations also consume less vitamins A and C, calcium, magnesium, and potassium. The 2020 Dietary Guidelines Advisory Committee has identified each of these nutrients as being underconsumed by the U.S. population in general.

Methods: Data used were from the NHANES, 2015 to 2016 and 2017 to 2018 cycles. For 9832 adults (age >18), we compared their total fruit consumption to recommendations for their age and sex. We also calculated 2015 Healthy Eating Index (HEI-2015) scores. Component scores for Total Fruit and Whole Fruit were subtracted from the total HEI-2015 scores to measure adherence with dietary recommendations outside the fruit group. Two-way and 3-way contingency tables were then used to measure the association between adherence to fruit recommendations and the intake of underconsumed nutrients before and after controlling for adherence to other food group recommendations, respectively.

Results: About two-thirds of adults eat less than half the recommended amount of fruit on any given day. Those who routinely unconsume fruit may be at a greater risk of underconsuming potassium and vitamin C. Calcium, magnesium, and vitamin A consumption do not show a consistent relationship with fruit intake relative to recommendations after controlling for diet quality outside the fruit group.

Conclusions: There is much variation across the U.S. population in fruit consumption relative to recommendations. The present study suggests that individuals who deviate the most are at a particularly increased risk of underconsuming vitamin C and potassium.

Keywords: 2015 Healthy Eating Index; Dietary Guidelines for Americans; NHANES; National Health and Nutrition Examination Survey; WWEIA; What We Eat in America; dietary trends; fruit consumption; underconsumed nutrients.