Replacing Solid Snacks with Almonds or Adding Almonds to the Diet Improves Diet Quality and Compliance with the...

Background: Healthier between-meal snacks can improve diet quality in the US and globally. Objectives: To assess the impact on diet quality of replacing solid snacks with almonds or adding almonds (30 g) to the diet. Methods: Dietary data for 4333 children (4-19 y) and 10,925 adults (>19 y) came from the National Health and Nutrition Examination Survey (NHANES 2017-23). Nutrient composition data came from the Food and Nutrient Databases for Dietary Studies (FNDDS). Substitution Model 1 replaced all solid snacks with almonds on a per-calorie basis. Model 2 exempted "healthy" snacks. Model 3 added almonds to the observed diet. The Healthy Eating Index (HEI-2020), Nutrient Rich Food Index (NRF), Mean Adequacy Ratio (MAR), and Mean Excess Ratio (MER) were measures of diet quality. Results: Solid snacks provided 329 kcal/day (15.6% of dietary energy), of which 58 kcal came from healthy snacks (2.9%). The 4-13 y age group consumed the most energy from snacks. Diets with almonds replacing solid snacks were lower in added sugar, sodium, and saturated (solid) fat but higher in protein, fiber, mono- and polyunsaturated fats, and magnesium. MAR dietary nutrient density scores were significantly higher, and MER scores were lower. Total HEI-2020 scores rose from 52.4 (observed) to 59.6 (Model 1) and to 60.6 in Model 2_100. The addition of almonds (30 g or 50 g) increased HEI-2020 values to 59.2 and to 61.4, respectively. Several HEI-2020 sub-scores increased as well. The greatest dietary benefits were obtained for children and young adults. Conclusions: Replacing solid snacks with small amounts of almonds led to higher quality modeled food patterns, especially for younger age groups. The DGA 2025-30 should address the inclusion of healthy energy-dense snacks into everyday diets.