Abstract
BACKGROUND: Macroeconomic changes are associated with population health outcomes, such as mortality, accidents, and alcohol use. Diet quality is a risk or protective factor that could be influenced by economic conditions. OBJECTIVE: This study examined the trajectory of diet quality measured by the Healthy Eating Index 2015 before, during, and after the 2008-2009 Great Recession. DESIGN: Repeated cross-sectional survey data from the National Health and Nutrition Examination Survey were analyzed. PARTICIPANTS/SETTING: The analytic sample included 48,679 adults who completed at least one dietary recall from National Health and Nutrition Examination Survey 1999-2018. MAIN OUTCOME MEASURES: Diet quality was assessed with a 24-hour dietary recall to calculate the Healthy Eating Index 2015 total scores, a measure of the conformance with the 2015-2020 Dietary Guidelines for Americans. STATISTICAL ANALYSES PERFORMED: Least squares regression was used to adjust for demographic changes across waves. RESULTS: Diet quality improved noticeably during the Great Recession and deteriorated as economic conditions improved. CONCLUSIONS: Deteriorating economic circumstances may constrain choices, but that does not necessarily imply a worsening of dietary quality. During the Great Recession, American diets became more consistent with Dietary Guidelines for Americans recommendations, possibly because of a shift toward food prepared at home instead of prepared food bought away from home.