Article Content



* Dining Out


* Undernutrition Screening


* Obesity Measures



The typical American adult gets 1 of every 5 calories from a restaurant, but eating out is a recipe for meals of poor nutritional quality in most cases, according to a new study by researchers at the Friedman School of Nutrition Science and Policy at Tufts University. Published in The Journal of Nutrition, the study analyzed the dietary selections of more than 35 000 US adults from 2003 to 2016 in the National Health and Nutrition Examination Survey who dined at full-service (those with wait staff) or fast-food restaurants, which included pizza shops and what has become known as fast-casual. The researchers assessed nutritional quality by evaluating specific foods and nutrients in the meals, based on the American Heart Association 2020 diet score. The primary score assesses the consumption of fruits and vegetables, fish/shellfish, whole grains, sodium, and sugar-sweetened beverages, and the secondary score assesses intake of nuts/seeds/legumes, processed meat, and saturated fat. Researchers also evaluated individual food groups and nutrients based on the USDA Food Patterns Equivalents Database and MyPyramid Equivalents Database associated with chronic illnesses.


At fast-food restaurants, 70% of the meals Americans consumed were of poor dietary quality in 2015-2016, down from 75% in 2003-2004. At full-service restaurants, approximately 50% were of poor nutritional quality, an amount that had remained stable over the study period. The remainder were of intermediate nutritional quality.


Notably, the authors found that less than 0.1%-almost none-of all the restaurant meals consumed over the study period were of ideal quality according to the American Heart Association Heart Check criteria used. The Heart-Check Food Certification Program's nutrition requirements for certification are based on the sound science of the American Heart Association regarding healthy dietary recommendations including food categories, specific product ingredients, and nutrient values.


The disparities documented by the study authors show some groups within the population ate more healthfully than others while dining out. For example, the quality of fast-food meals consumed by non-Hispanic whites and Mexican Americans improved, but there was no change in the quality of fast-food meals consumed by non-Hispanic blacks. Also, the proportion of poor-quality fast-food meals decreased from 74% to 60% over this period for people with college degrees, but remained high at 76% for people without a high school diploma.


The researchers also looked at the extent to which Americans relied on restaurants during the study period and found:


* Restaurant meals accounted for 21% of Americans' total calorie intake.


* Full-service restaurant meals represented 9% of to3tal calories consumed.


* Fast-food meals represented 12% of total calories consumed.


* Fast-food breakfasts increased from just over 4% to nearly 8% of all breakfasts eaten in America.



The researchers also assessed specific foods and nutrients in restaurant meals and identified priorities for improvement. The largest opportunities for enhancing nutritional quality add more whole grains, nuts and legumes, fish, and fruits and vegetables to meals while reducing salt. The researchers noted that there was no improvement in sodium levels in fast-food meals and worsening sodium levels in full-service dishes consumed. Limitations of the study include the fact that self-reported food recall data are subject to measurement error due to daily variations in food intake. Participants may also overreport or underreport healthy or unhealthy foods due to social desirability perceptions.


Source: Liu J, Rehm CD, Micha R, Mozaffarian D. Quality of meals consumed by US adults at full-service and fast-food restaurants, 2003-2016: persistent low quality and widening disparities. J Nutr 2020; DOI: 10.1093/jn/nxz299.



Using one standardized screening tool to identify adults who may have malnutrition or undernutrition increases the likelihood of an accurate diagnosis and timely treatment, according to a position paper from the Academy of Nutrition and Dietetics. Based on current evidence, the Academy of Nutrition and Dietetics recommends the Malnutrition Screening Tool (MST) be used to screen adults for undernutrition regardless of their age, medical history, or setting. The MST is actually misnamed because it screens only for undernutrition, one of many types of malnutrition, but nevertheless can be useful, although has been validated mostly in hospital and clinical settings rather than in the community. The paper is based on an evidence-based systematic review conducted by the Academy's Nutrition Screening for Adults Workgroup. The group determined that all adults, regardless of age or health status, can benefit the most from a single validated tool that is used to screen for undernutrition in all settings where screening occurs. They recommend screening patients for undernutrition to determine who might benefit from the nutritional assessment and nutritional intervention provided by a registered dietitian nutritionist. They also encourage the implementation of this MST and provide ongoing training to those who administer the screening.


Source: Position of the Academy of Nutrition and Dietetics: malnutrition (undernutrition) screening tools for all adults. J Acad Nutr Diet 2019,



Approximately half of the adult US population will be obese, and approximately a quarter will be severely so by 2030, according to a new study in the New England Journal of Medicine led by researchers at the Harvard T. H. Chan School of Public Health. Self-reported body mass index (BMI) data from more than 6.2 million adults who participated in the Behavioral Risk Factor Surveillance System Survey between 1993 and 2016 were studied. Body mass index is calculated by dividing a person's weight in kilograms by the square of their height in meters. Obesity is defined as a BMI of 30 kg/m2 or higher, and severe obesity is a BMI of 35 kg/m2 or higher.


The study also predicts that in 29 states more than half of the population will have obesity, and all states will have a prevalence of obesity higher than 35%. The researchers estimate that, currently, 40% of American adults are obese, and 18% are severely so. These predictions are troubling because the health and economic effects of obesity and severe obesity take a toll on several aspects of society.


Self-reported BMIs are frequently biased, so novel statistical methods were used to correct for this bias. The large amount of data collected in the Behavioral Risk Factor Surveillance System Survey allowed the researchers to drill down for obesity rates for specific states, income levels, and subpopulations. By 2030, assuming nothing changes, several states will have obesity prevalence close to 60%, whereas the lowest states will be approaching 40%. The prediction is that, nationally, severe obesity will likely be the most common BMI category for women, non-Hispanic black adults, and those with annual incomes below $50 000 per year.


Source: Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl Jo Med, December 19, 2019, doi:10.1056/NEJMsa1909301.