Despite consuming fewer sugar-sweetened beverages and more whole grains, most American children and adolescents still eat poorly, according to a study published in JAMA.

The research team analyzed the diets of more than 31,000 U.S. youth, aged 2–19, based on national data across nine cycles of the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016. They assessed each child’s diet as poor, intermediate, or ideal, based on three validated dietary scores, all of which are designed to measure adherence to accepted nutritional guidelines.

They found that 56% of American children and adolescents had diets of poor nutritional quality in 2016. However, the proportion of children and adolescents with poor diets declined during the 18-year study, from 77% to 56%. The proportion of children and adolescents with intermediate diets increased from 23% to 44%. At the end of the study period, adolescents (aged 12–19) were found to have the worst diet of three age categories, with 67% having a poor diet, compared with 53% of children aged 6–11 and 40% of children aged 5 and younger.

Key dietary disparities persisted, especially based on parental education and household food security status, and worsened by household income. For example, at the end of the study period, 65% of children from households in the lowest income category were found to have a poor diet, compared with 47% of children in the highest income category.

“This is a classic ‘glass half full or half empty’ story,” said senior author Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy at Tufts University, in a university press release. “Kids’ diets are definitely improving, and that’s very positive. On the other hand, most still have poor diets, and this is especially a problem for older youth and for kids whose households have less education, income, or food security.”

The researchers found that while intakes of some healthful foods increased, they remained far below general national recommendations. By 2016, the kids were eating:

  • About 1.8 daily servings of fruits and vegetables (less than half the recommendation of 4.5 servings).
  • One daily serving of whole grains (less than one-third the recommendation of three servings).
  • Just under half a daily serving of fish/seafood (less than one-fourth the recommendation of two servings per week).

The team also found that children’s salt intake increased and continued to exceed the recommended daily amount, possibly due to more reliance on processed foods and foods prepared away from home.

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