Quality of Popular Diet Patterns in the United States: Evaluating the Effect of Substitutions for Foods High in Added Sugar, Sodium, Saturated Fat, and Refined Grains

Background: Many Americans have adopted popular diet patterns for general health improvement that restrict specific foods, macronutrients, or eating time. However, there is limited evidence to characterize the quality of these diet patterns. Objectives: This study 7) evaluated the quality of popular diet patterns in the United States and 2) modeled the effect of targeted food substitutions on diet quality. Methods: Dietary data from 34,411 adults [greater than or equal to]20 y old were acquired from the NHANES, 2005-2018. Dietary intake was assessed using the National Cancer Institute's usual intake methodology, and the Healthy Eating Index-201 5 was used to evaluate diet quality. A diet model was used to evaluate the effect of targeted food substitutions on diet quality. Results: A pescatarian diet pattern had the highest diet quality (65.2; 95% CI: 64.0, 66.4), followed by vegetarian (63.0; 95% CI; 62.0, 64.0), low-grain (62.0; 95% CI; 61.6, 62.4), restricted-carbohydrate (56.9; 95% CI: 56.6, 57.3), time-restricted (55.2; 95% CI: 54.8, 55.5), and high-protein (51.8; 95% CI: 51.0, 62.7) diet patterns. Modeled replacement of