Frequency of Eating in the U.S. Population: A Narrative Review of the 2020 Dietary Guidelines Advisory Committee Report

Authors: BAILEY, REGAN - Purdue University; LEIDY, HEATHER - University Of Texas At Austin; MATTES, RICHARD - Purdue University; HEYMSFIELD, STEVEN - Pennington Biomedical Research Center; BOUSHEY, CAROL - Cancer Research Center Of Hawaii; AHLUWALIA, NAMANJEET - National Center For Health Statistics; COWAN, ALEXANDRA - Purdue University; PANNUCCI, TUSA REBECCA - Center For Nutrition Policy & Promotion (CNPP); VARGAS, ASHLEY - US Department Of Health And Human Services (HHS); Moshfegh, Alanna; Goldman, Joseph; Rhodes, Donna; STOODY, EVE - Center For Nutrition Policy & Promotion (CNPP); DE JESUS, JANET - US Department Of Health And Human Services (HHS); CASAVALE, KELLIE - Food And Drug Administration(FDA)

Submitted to: Current Developments in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/15/2022
Publication Date: 8/29/2022
Citation: Bailey, R.L., Leidy, H.J., Mattes, R.D., Heymsfield, S.B., Boushey, C.J., Ahluwalia, N., Cowan, A.E., Pannucci, T., Moshfegh, A.J., Goldman, J.D., Rhodes, D.G., Stoody, E.E., De Jesus, J., Casavale, K.O. 2022. Frequency of Eating in the U.S. Population: A Narrative Review of the 2020 Dietary Guidelines Advisory Committee Report. Current Developments in Nutrition. https://doi.org/10.1093/cdn/nzac132.
DOI: https://doi.org/10.1093/cdn/nzac132

Interpretive Summary: A person’s daily nutrient intake and overall nutritional status are determined by a complex interplay of the types and amounts of foods ingested and the frequency of eating. To exam eating frequency, 24-hr dietary recall data from the 2013-2016 What We Eat in America, National Health and Nutrition Examination Survey were examined. Most Americans report two (28%) or three (64%) meals and 2 to 3 snacks per day (>90%). Adults, Hispanics and non-Hispanic Blacks, and lower income Americans had a lower frequency of eating than their child or adolescent, non-Hispanic Whites and non-Hispanic Asians, and higher income counterparts. Americans who reported three meals per day were determined to consistently consume a diet higher in dietary quality than Americans who consumed two meals per day, regardless of population subgroup. Eating patterns vary by frequency and timing in the U.S. and are shaped by age, race and Hispanic origin, and income. These results can be used to inform constructing healthy dietary patterns to suit different life stages, cultural practices, and income levels. However, given that higher diet quality was associated with three meals per day, careful planning of nutrient-dense meal patterns is needed.

Technical Abstract: A person’s daily nutrient intake and overall nutritional status are determined by a complex interplay of the types and amounts of foods ingested, and the frequency of eating, which can alter digestive and metabolic processes. An examination of whether eating frequency directly affects diet quality and health outcomes is warranted, and was addressed by the 2020 Dietary Guidelines Advisory Committees (DGAC). The objective of this research was to summarize frequency of eating data examined by the 2020 DGAC relative to achieving nutrient and food group recommendations and dietary quality, respectively, among the U.S. population (>2). Demographic and 24-hr dietary recall data from the 2013-2016 What We Eat in America, National Health and Nutrition Examination Survey were examined. An eating occasion (EO) was defined as “any ingestive event (solid food or beverage, including water) that is either energy yielding or non-energy yielding”; all EOs were further divided into discrete meals (i.e., breakfast, lunch, dinner (and Spanish-language equiv.)) and snacks (i.e., snacks, beverage only, extended consumption). Frequency of eating was defined as "the number of daily EOs." Diet quality was assessed via the Healthy Eating Index (HEI)-2015. Most Americans report two (28%) or three (64%) meals and 2 to 3 snacks per day (>90%). Adult, Hispanic and non-Hispanic Black, and lower income (<131% family poverty-to-income ratio) Americans had a lower frequency of eating than their child or adolescent, non-Hispanic White and non-Hispanic Asian, and higher income counterparts. Americans who reported three meals per day (HEI-2015 = 61) were determined to consistently consume a diet higher in dietary quality than Americans who consumed two meals per day (HEI-2015 = 55), regardless of population subgroup. Eating patterns vary by frequency and timing in the U.S. and are shaped by age, race and Hispanic origin, and income. Healthy dietary patterns can be constructed in a variety of ways to suit different life stages, cultural practices, and income levels. However, given that higher diet quality was associated with three meals per day, careful planning of nutrient-dense meal patterns is needed.