Associations between Determinants of Food Choice and the Healthy Eating Index-2020 in Adults: An NHANES 2017-March...

Strategies for improving suboptimal diet quality are needed and may be informed by investigating associations between determinants of food choice and diet quality.

This study aims to assess associations between determinants of food choice and diet quality assessed by Healthy Eating Index-2020 (HEI-2020) in a nationally representative sample of United States adults.

This cross-sectional analysis included adult participants in the NHANES 2017-March 2020. Determinants of food choice were identified using a previously proposed conceptual framework and included modifiable (i.e., use of nutrition labels, consumption of food away from home, familiarity with MyPlate, perceived diet quality, typical work schedule, number of hours worked per week) and nonmodifiable (i.e., age, sex, race, BMI, education, relationship status) determinants. Survey-weighted univariate and multivariate hierarchical regression was used to assess the relationship between food choice determinants and the HEI-2020 score. Significant variables from the final model were used to predict adequacy and moderation component subscores of the HEI-2020.

In the final model, modifiable determinants of diet quality associated with the HEI-2020 score included use of nutrition labels, frequency of food away from home, and perceived diet quality (R ² _adj = 0.23, P < 0.001). Those reporting rarely or never using nutrition labels had a 6.73-point lower HEI-2020 score than those reporting using them always or most of the time (P < 0.001). Those consuming ≥5 meals away from home in the past week had a 4.78-point lower HEI-2020 score than those consuming 0 meals away from home per week (P = 0.004). Those reporting fair or poor perceived diet quality had a 5.15-point lower HEI-2020 score relative to those with excellent or very good perceived diet quality (P < 0.001). Determinants accounted for a higher proportion of variance in the adequacy score (R ² _adj = 0.26, P < 0.001) than the moderation score (R ² _adj = 0.09, P < 0.001).

These findings suggest that interventions seeking to meaningfully improve diet quality may benefit from simultaneously targeting multiple determinants of food choice.