BACKGROUND: Data on nutrient and diet quality outcomes when additional beans are consumed as part of the typical American dietary pattern are scarce. The purpose of this study was to assess the effect of increased bean consumption, in the typical American dietary pattern, on the intake of shortfall nutrients and overall diet quality.
METHODS: Using data from the US National Health and Nutrition Examination Survey, 2001-2018, the current analyses modeled the addition of one and two servings of canned and dried beans in all adults (N = 44,574; ≥19 y), younger adults (N = 23,554; 19-50 y) and older adults (N = 21,020; ≥51 y). The beans considered were kidney beans, black beans, chickpeas, and pinto beans.
RESULTS: The modeling of beans to the typical American dietary pattern resulted in significant increases in the intake of several shortfall nutrients, including dietary fiber, potassium, magnesium, iron, folate, and choline (p\'s < 0.0001). Modeling 1 and 2 servings of beans daily to the US typical dietary pattern significantly increased overall diet quality in all adult age groups considered. Total diet quality, as measured by Healthy Eating Index-2015 scores, was 15-16 % greater with an additional serving of beans and 19-20 % higher with 2 servings of beans relative to the US typical dietary pattern (p values<0.0001).
CONCLUSIONS: Dietary patterns that are rich in beans are associated with significantly higher diet quality scores and greater intake of shortfall nutrients, including nutrients of public health concern. Dietary guidance should consider the health benefits associated with the promotion of increased consumption of canned and dry beans in dietary patterns as benefits seen in younger adults continue to older adulthood.

BACKGROUND: Limited evidence is available that focuses on beans within American dietary patterns and health. The purpose of this study was to identify commonly consumed adult dietary patterns that included beans and compare shortfall nutrient intakes and diet quality, relative to adults whose typical dietary pattern did not include beans.
METHODS: The analyses used data from the National Health and Nutrition Examination Survey, 2001-2018. Cluster analysis was used to identify bean patterns of consumption, while the USDA food coding system defined daily beans consumed. Five bean dietary patterns of consumption were identified, of which four patterns included both canned beans and dry beans, while one pattern had no bean consumption. Bean consumption was defined as those consuming kidney beans, black beans, chickpeas, and/or pinto beans.
RESULTS: Adults consuming Bean Dietary Patterns 1, 2, 3 and 4 had significantly higher diet quality scores (as assessed by USDA\'s Healthy Eating Index-2015) compared to the no-bean pattern (61.2 ± 0.5, 58.9 ± 0.5, 55.2 ± 0.4 and 56.5 ± 0.8 vs 48.8 ± 0.2 p\'s < 0.0001). Bean consumers also had significantly higher intakes of several shortfall nutrients (choline, alpha-linolenic acid, folate, iron, magnesium and vitamin E) relative to non-consumers of beans. Similarly, intake of dietary fiber, potassium and calcium, all nutrients of public health concern were significantly higher in bean patterns compared to no-beans. Bean Dietary Pattern 1 (~ 13.5% of total daily kcal from beans or ~ 2 servings of beans/day) and 2 (~ 9.5% of total daily kcal from beans or ~ 1.7 servings of beans/day) were significantly associated with lower BMI, decreased body weight and improved waist circumference relative to no-beans.
CONCLUSIONS: Dietary patterns that are rich in canned and dry beans were associated with significantly higher diet quality scores and greater intake of shortfall nutrients, including nutrients of public health concern. Bean dietary patterns were also associated with improved weight-related outcomes. Dietary guidance should consider the nutrient and health benefits associated with the promotion of increased canned and dry bean consumption in American dietary patterns.

The health and environmental advantages of plant-predominant diets will likely lead to increasing numbers of consumers reducing their reliance on animal products. Consequently, health organizations and professionals will need to provide guidance on how best to make this change. In many developed countries, nearly twice as much protein is derived from animal versus plant sources. Potential benefits could result from consuming a higher share of plant protein. Advice to consume equal amounts from each source is more likely to be embraced than advice to eschew all or most animal products. However, much of the plant protein currently consumed comes from refined grains, which is unlikely to provide the benefits associated with plant-predominant diets. In contrast, legumes provide ample amounts of protein as well other components such as fiber, resistant starch, and polyphenolics, which are collectively thought to exert health benefits. But despite their many accolades and endorsement by the nutrition community, legumes make a negligible contribution to global protein intake, especially in developed countries. Furthermore, evidence suggests the consumption of cooked legumes will not substantially increase over the next several decades. We argue here that plant-based meat alternatives (PBMAs) made from legumes are a viable alternative, or a complement, to consuming legumes in the traditional manner. These products may be accepted by meat eaters because they can emulate the orosensory properties and functionality of the foods they are intended to replace. PBMAs can be both transition foods and maintenance foods in that they can facilitate the transition to a plant-predominant diet and make it easier to maintain. PBMAs also have a distinct advantage of being able to be fortified with shortfall nutrients in plant-predominant diets. Whether existing PBMAs provide similar health benefits as whole legumes, or can be formulated to do so, remains to be established.

Avocado is a nutrient-rich food that has been shown to benefit the health and diet quality of adults. In this paper, we examined if habitual intake of avocado among adolescents is associated with their diet quality, food and nutrient intake, and measures of obesity and body composition. Participants aged 12-18 years old (n = 534) from selected public and Adventist middle-high schools reported their dietary intake in a web-based food frequency questionnaire (FFQ); anthropometrics were measured during school visits. Diet quality (DQI-I) and avocado intake were calculated from the FFQ; BMI z-scores (BMIz), waist-to-height ratio (WHtR), and fat mass (FM), fat-free mass (FFM), and %body fat (%BF) were determined from the anthropometric data. Compared to non-consumers, avocado consumers had significantly higher covariate-adjusted mean scores on total DQI-I (68.3 vs. 64.6) and energy-adjusted mean scores on variety (18.8 vs. 18.0) and adequacy (36.4 vs. 33.4). Avocado consumption was significantly associated with DQI-I components adequacy (β [SE] = 0.11 [0.03]) and moderation (β [SE] = 0.06 [0.03]) but not with BMIz, WHtR, FM, FFM, and %BF. Mean intakes of fruits, vegetables, and plant protein foods, total and vegetable proteins, dietary fiber, retinol, vitamin C, calcium, magnesium, iron, and potassium were significantly higher for avocado consumers; saturated and trans fats intakes were significantly higher for non-consumers. In our adolescent population, avocado consumption was associated with higher diet quality and intake of plant-based foods and shortfall nutrients, but not with measures of obesity and body composition. Studies are needed to determine the optimal amount of avocado that would confer health benefits during adolescence.

Limited data are available on how eggs are consumed in the typical American eating pattern and the contribution to usual intakes, diet quality and in meeting recommendations. The objectives of the present analysis included identifying how eggs are consumed within U.S. dietary patterns and how these patterns are associated with the usual intakes of shortfall nutrients and diet quality (Healthy Eating Index 2015) using data from the combined National Health and Nutrition Examination Survey (NHANES) from 2001-2016. An additional objective included assessing the differences between egg consumers and egg non-consumers in nutrient intakes and nutrient adequacy. Several egg-containing dietary patterns were identified, and two egg patterns were associated with a greater diet quality compared to a no egg pattern (p < 0.0001). Most egg patterns identified were similar in diet quality scores when compared to the no egg pattern; however, the two egg patterns had lower diet quality scores. Egg consumption combined with a greater intake of total protein foods, seafood and plant protein, total vegetables, total fruit, whole fruit, whole grains and dairy foods, and a lower intake of refined grains and added sugars contributed to an improved diet quality, supporting that no one food is responsible for a healthy dietary pattern. Egg consumers demonstrated significantly higher intakes of dietary fiber, calcium, magnesium, potassium, total choline, vitamin A, vitamin C, vitamin D and vitamin E when compared to egg non-consumers. A comparison of egg consumers and egg non-consumers found egg consumers had significantly less percentages of the population below the EAR for calcium, iron, magnesium, vitamin A, vitamin C and vitamin E. Similarly, the percentage of the population above the recommendations for potassium and choline were greater for egg consumers vs. egg non-consumers. In egg consumers, 24.4% of the population was above the AI for dietary choline when compared to 4.3% of egg non-consumers (p < 0.0001). Findings from the present analysis demonstrate that eggs and egg-containing foods can be an important part of a healthy dietary pattern when balanced accordingly with other nutrient-dense foods.

Background: While dietary recommendations call for greater whole-grain intake and reduced refined grain consumption, there are limited peer-reviewed studies examining the influence of fortified/enriched refined grains on nutrient adequacy. Methods: A modeling analysis using data from National Health and Nutrition Examination Survey (NHANES) 2009-2016 estimated usual daily intake of shortfall nutrients for Dietary Guidelines for Americans (DGA) in the current dietary pattern and when specific percentages of fortified/enriched refined grain foods (bread, ready-to-eat cereals, and all-grained foods) were removed from the diet (19-50-year-old adults, N = 11,169; 51-99-year-old adults, N = 9,641). Results: While American adults are currently falling short of nutrient recommendations, eliminating 25, 50, and 100% of all grains consumed in the US dietary pattern resulted in a greater percentage of adults not meeting recommendations for several shortfall nutrients, including dietary fiber, folate DFE, iron, and magnesium. Removal of all grains led to a reduced energy intake by ~10% in both age groups examined. Currently, ~3.8% of 19-50-year-old adults meet the adequate intake (AI) for dietary fiber. Removal of 25, 50, and 100% of grains from the diet resulted in 2.6 ± 0.3, 1.8 ± 0.2, and 0.7 ± 0.1% of adults exceeded the AI for dietary fiber, respectively. Similarly, 11.0 and 13.8% of younger and older adults, respectively, fall short of folate, DFE recommendations with the current diet. Following the removal of 100% of grains from the diet, 43.4 ± 1.1 and 56.2 ± 1.0%, respectively, were below the estimated average requirement (EAR) for folate DFE. For iron, current dietary pattern consumption shows 8.4% and 0.8% of younger and older adults, respectively, are not meeting iron recommendations, however, removal of 100% of grains from the diet results in nearly 10 and 22% falling short of the EAR. Currently, about 51 and 54% of younger and older adults are below the EAR for magnesium; however, with the removal of 100% of grains, 68 and 73%, respectively, fall below the EAR. Conclusion: Removal of specific refined grains led to an increased percentage of Americans not meeting recommendations for several shortfall nutrients, including dietary fiber, folate, iron, and magnesium.

Increased consumption of energy-dense, nutrient-poor foods can lead to inadequate intakes of shortfall nutrients, including vitamin A, D, C, and E, dietary folate, calcium, iron, magnesium, potassium, and fiber. The objective was to examine the prevalence of inadequate intake of shortfall nutrients and identify food sources of shortfall nutrients in eight Latin American countries. Data from ELANS, a multi-country, population-based study of 9218 adolescents and adults were used. Dietary intake was collected through two 24 h Recalls from participants living in urban areas of Argentina, Brazil, Chile, Colombia, Ecuador, Peru, and Venezuela. Foods and beverages were classified using the adapted version of the NHANES \"What We Eat in America\" system. Nutrients inadequacy was estimated using the Institute of Medicine recommendations and descriptive statistics were calculated. Prevalence of inadequacy was above 50% for most of the nutrients, which the exception of vitamin C with a prevalence of inadequacy of 39%. Milk, cheese, seafoods, breads, and fruit juices/drinks were among the top 5 sources for each of the 10 shortfall nutrients examined. Many food categories were top contributors to more than one dietary component examined. Understanding the nutrient intake and food sources can help inform dietary guidance and intervention approaches.

Women of childbearing age (WCBA) and women of menopausal age (WMENO) have distinct nutritional needs. Understanding nutrient intake and status in these life stages is critical for tailoring dietary recommendations.
The objectives of this study were to evaluate total estimated usual nutrient intakes from food and food plus supplements and to compare these to established recommendations for WCBA and WMENO life stages and examine associations between self-reported estimated usual intakes and nutrient status biomarkers.
Twenty-four-hour dietary recall data from 2011-2016 NHANES were used to estimate usual intake of nutrients from food and food plus supplements for WCBA (aged 15-44 y, n = 4,134) and WMENO (aged 40-65 y, n = 3,438). Estimates of mean usual intake were derived and compared across clinically defined nutrient biomarker categories.
Both young (aged 15-30 y) and older (aged 31-44 y) WCBA had intakes from food below the Estimated Average Requirement (EAR) for calcium (49% and 44%, respectively), magnesium (62%, 44%), and vitamins A (50%, 44%), C (47%, 46%), D (>97%, >97%), and E (92%, 88%). Similarly, perimenopausal (aged 40-50 y) and menopausal (aged 51-65 y) women had intakes from food below the EAR for calcium (48% and 74%, respectively), magnesium (50%, 49%), and vitamins A (44%, 37%), C (44%, 41%), D (>97%, >97%), and E (88%, 86%). Nutrient gaps decreased with supplement usage. For folate, vitamins D and B-12, and DHA, women in the lowest biomarker category (indicating increased risk of deficiency) had significantly lower intake from food (315.2 ± 25.9 compared with 463.8 ± 5.2 µg dietary folate equivalents, 3.5 ± 0.1 compared with 4.2 ± 0.1 µg, 3.6 ± 0.2 compared with 4.3 ± 0.1 µg, and 0.037 ± 0.005 compared with 0.070 ± 0.006 g, respectively; P < 0.01) of the corresponding nutrient compared with the highest biomarker category.
Substantial percentages of WCBA and WMENO are not meeting recommendations for multiple nutrients, whereas supplement usage partially fills nutrient gaps. Dietary intake was positively associated with most nutrient status biomarkers. Specific guidance is needed to ensure adequate nutrient intakes and nutrient status during these critical life stages.

OBJECTIVE: The US Dietary Guidelines for Americans recommends increased consumption of the dairy group to three daily servings for ages 9+ years to help achieve adequate intakes of prominent shortfall nutrients. Identifying affordable, consumer-acceptable foods to replace dairy\'s shortfall nutrients is important especially for people who avoid dairy.
METHODS: Linear programming identified food combinations to replace dairy\'s protein and shortfall nutrients. We examined cost, energy and dietary implications of replacing dairy with food combinations optimised for lowest cost, fewest kJ or the smallest amount of food by weight.
METHODS: National Health and Nutrition Examination Survey (2011-2014).
METHODS: Nationally representative sample of US population; 2 years and older (n 15 830).
RESULTS: Phase 1 (only dairy foods excluded): when optimised for lowest cost or fewest kJ, all non-dairy food replacements required large amounts (2·5-10 cups) of bottled/tap water. Phase 2 (dairy and unreasonable non-dairy foods excluded (e.g. baby foods; tap/bottled water): when intake of non-dairy foods was constrained to <90th percentile of current intake, the lowest cost food combination replacements for dairy cost 0·5 times more and provide 5·7 times more energy; the lowest energy food combinations cost 5·9 times more, provide 2·5 times more energy and require twice the amount of food by weight; and food combinations providing the smallest amount of food by weight cost 3·5 times more and provide five times more energy than dairy.
CONCLUSIONS: Identifying affordable, consumer-acceptable foods that can replace dairy\'s shortfall nutrients at both current and recommended dairy intakes remains a challenge.

BACKGROUND: Previous research in adults has reported an association between sandwich consumers and increased daily energy, total fat, and sodium intakes and decreased dietary fiber intake. Additionally, sandwich consumers had a lower diet quality, as compared to non-sandwich consumers. However, the research failed to differentiate between the types of sandwiches consumed.
OBJECTIVE: The purpose of this study was to model different sandwiches, using both whole-grain bread (WGB), enriched-grain bread (EGB), and soft taco tortillas, to examine associations with energy (kcal), nutrient intakes, and diet quality, in comparison to the typically consumed sandwich (control).
METHODS: Data from the NHANES 2013-2014 was used to complete the analyses in adults ≥19 years old, and USDA food composites were used to create 5 sandwich types, using WGB, EGB, or soft corn tortillas.
RESULTS: In the modeling analysis, adults consuming the soft corn tortilla taco had lower energy, as compared to those eating the typical sandwich. Total fat intakes were lower in the WGB and EGB grilled chicken/cheese/vegetable sandwiches and in the soft taco tortilla, in comparison to the control sandwich. Sodium intakes were lower in the WGB and EGB grilled chicken/cheese/vegetable sandwiches and in the soft taco tortilla, in comparison to the typical sandwich consumed. All WGB sandwich models and the soft taco tortilla had greater daily dietary fiber intakes, in comparison to the control sandwich. WGB, EGB, and tortilla sandwiches were also associated with greater intakes of shortfall nutrients. All sandwich models, except EGB with meat/cheese/vegetables, had higher diet qualities, in comparison to the control.
CONCLUSIONS: The current data support the inclusion of certain WGB and EGB sandwiches/tortillas, within recommended dietary patterns, in American adults, and suggest that ingredients within a sandwich, rather than the just the bread component, can be an important contributor to overall nutrient intakes and nutrients to limit in the diet.