Trends in Diet Quality Among Older US Adults From 2001 to 2018

IMPORTANCE: Poor diet is a major risk factor for chronic diseases, disability, and death in the US. As older adults comprise the fastest-growing population segment in the US, it is crucial to describe dietary trends among older adults to identify opportunities and challenges for improving health in old age. OBJECTIVE: To characterize trends in overall dietary quality and key food components and nutrients among older US adults by age, sex, race and ethnicity, marital status, educational level, and income. DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study used 24-hour dietary recall data from 10 837 adults aged 65 years or older in 9 National Health and Nutrition Examination Survey cycles (2001-2002 to 2017-2018). Statistical analysis was conducted from June 1 to October 1, 2021. EXPOSURES: Calendar year and sociodemographic subgroups. MAIN OUTCOMES AND MEASURES: Survey-weighted, energy-adjusted mean diet scores and proportions of older US adults with poor, intermediate, or ideal diet scores based on the American Heart Association (AHA) 2020 Strategic Impact Goals for diet. Additional outcomes included the AHA secondary score and the Healthy Eating Index (HEI)–2015 score. RESULTS: A total of 10 837 individuals (5423 women [50.0%]; 6339 White participants [58.5%]; mean [SD] age, 73.9 [0.1] years) were analyzed. Overall dietary quality deteriorated from 2001 to 2018 among older adults. The mean primary AHA score (total = 50 points) decreased from 19.84 (95% CI, 19.40-20.29) to 18.28 (95% CI, 17.84-18.73; a decrease of 7.9%; P < .001 for trend). The mean secondary AHA score (total = 80 points) decreased from 34.75 (95% CI, 34.11-35.39) to 31.83 (95% CI, 31.17-32.48; a decrease of 8.4%; P < .001 for trend). The mean HEI-2015 score (total = 100 points) decreased from 47.82 (95% CI, 47.11-48.52) to 45.25 (95% CI, 44.53-45.98; a decrease of 5.4%; P < .001 for trend). Based on the primary AHA score, the proportion of US older adults with a poor diet quality significantly increased from 50.9% to 60.9%, the proportion with an intermediate diet quality significantly decreased from 48.6% to 38.7%, and the proportion with ideal diet quality remained consistently low (0.4% in both 2001-2002 and 2017-2018). Dietary variations were identified by sociodemographic subgroups. We found a significant decreasing trend in diet scores among both sexes and all age groups except for those aged 75 to 79 years. CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study suggest that dietary quality worsened for most dietary components among older US adults between 2001 and 2018. Despite improvement in some dietary components, more than half of older US adults still have poor dietary quality.