Elsevier

Public Health

Volume 140, November 2016, Pages 206-212
Public Health

Original Research
Sandwich consumption in relation to daily dietary intake and diet quality among US adults, 2003–2012

https://doi.org/10.1016/j.puhe.2016.06.008Get rights and content

Highlights

  • We examined sandwich consumption in relation to diet quality in US adults.

  • During 2003–2012 about 53.2% of US adults consumed sandwiches on any given day.

  • Sandwich consumption was associated with higher energy, total fat, and salt intake.

Abstract

Objectives

About one half of the US adult population consumed one or more sandwiches on any given day. Sandwich consumption may profoundly influence people's calorie intake and diet quality. However, few studies have investigated the nutritional impact of sandwich consumption at the national level. We examined sandwich consumption in relation to daily dietary intake and diet quality among US adults.

Study design

Retrospective data analysis.

Methods

Nationally representative sample consisting of 27,075 adults 18 years of age and above came from the National Health and Nutrition Examination Survey (NHANES) 2003–2012 waves. Sandwich consumption was identified based on the What We Eat in America Food Category and the NHANES diet combination code. First-difference estimator addressed confounding bias from time-invariant unobservables (e.g. eating habits, taste preferences) by using within-individual variations in sandwich consumption between two non-consecutive 24-h dietary recalls.

Results

During 2003–2012, approximately 53.2% of US adults consumed sandwiches on any given day. Among sandwich consumers, nearly a quarter of daily total calorie intake and about a third of total fat, saturated fat, cholesterol, and sodium intake came from sandwich consumption. Men, non-Hispanic whites, young and middle-aged adults, people with higher income, and overweight/obese adults were more likely to consume sandwiches. Among those who consumed sandwiches on either but not both of the two dietary recall days, in comparison to no sandwich consumption, sandwich consumption on a dietary recall day was associated with an increase in daily intake of total energy by 98.7 kcal, total fat 6.8 g, and sodium 267.9 mg (P-value < 0.001). Statistically significant but relatively small differences were also found for other nutrients and food groups—sandwich consumption was associated with an increase in daily intake of sugar by 3.0 g (P-value < 0.01) and saturated fat 2.5 g (P-value < 0.001), a decrease in daily intake of vegetables by 8.4 g (P-value < 0.01), fruit 4.5 g (P-value < 0.05), and fibre 0.8 g (P-value < 0.001), and a decrease in the Healthy Eating Index-2010 score by 1.6 points (P-value < 0.001).

Conclusions

Consumers should prudently evaluate the calorie/nutrient content of sandwich in order to make healthier dietary choices.

Introduction

The 2015–2020 Dietary Guidelines for Americans calls for substantial increase in fruit and vegetable consumption and decrease in added sugar, saturated fat, and sodium consumption as a way to improve overall diet quality while reducing daily total calorie intake.1 Sandwiches are a staple of the American diet.2 About one half of the US adult population consumed one or more sandwiches on a daily basis.2, 3 Sandwich consumption may profoundly influence people's diet quality and calorie intake. However, surprisingly little research has investigated the nutritional impact of sandwich consumption at the national level. To our knowledge, only two studies, primarily adopting a descriptive methodology, have documented sandwich consumption status in US adults.2, 3 Cold-cut and poultry sandwiches and burgers were among the most commonly consumed types of sandwiches.3 Compared with non-consumers, sandwich consumers tended to have a substantially higher daily intake of total calories and sodium.3

This study examined sandwich consumption in relation to daily dietary intake and diet quality among US adults, using 24-h dietary recall data from a nationally representative repeated cross-sectional health survey. To our knowledge, this study would serve as the first attempt to assess the role of sandwich consumption in daily diet using a first-difference approach. This approach employed within-individual variations in sandwich consumption status between the two non-consecutive 24-h dietary recalls in an attempt to overcome the confounding bias due to unobservable individual characteristics like eating habits and food/taste preferences. We hypothesized that sandwich consumption would be positively associated with daily total calorie intake and nutrient markers of poorer diet quality including sugar, total fat, saturated fat, cholesterol, and sodium; but inversely associated with overall diet quality and intake of foods and nutrients emphasized in the dietary guidelines including vegetables, fruits, and dietary fibre. We examined sandwich consumption in relation to daily dietary intake and diet quality in the overall US adult population, and identified certain individual characteristics that predicted sandwich consumption.

Section snippets

Survey setting and participants

The National Health and Nutrition Examination Survey (NHANES) is a programme of studies conducted by the National Center for Health Statistics (NCHS) to assess the health and nutritional status of children and adults. The program began in the early 1960s and periodically conducted separate surveys focussing on different population groups or health topics. Since 1999, the NHANES has been conducted continuously in 2-year cycles and has a changing focus on a variety of health and nutrition

Results

Approximately 53.2% of adult participants in the NHANES 2003–2012 waves consumed sandwiches on one of the two dietary recall days (28.2%) or both (25.0%) days (data not shown). Table 1 reports individual characteristics of adult sandwich consumers and non-consumers. Sandwich consumers on average consumed 531.7 kcal of total energy, 19.3 g of vegetables, 1.0 g of fruit, 2.9 g of fibre, 7.9 g of sugar, 25.9 g of total fat, 9.0 g of saturated fat, 97.2 mg of cholesterol, and 1301.5 mg of sodium

Discussion

Sandwiches are a staple of the American diet.2, 3 Using data from a nationally representative survey, this study examined sandwich consumption in relation to daily dietary intake and diet quality among the US adult population. During 2003–2012, over half of US adults consumed sandwiches on a regular basis. Among sandwich consumers, nearly a quarter of daily total calorie intake and about a third of total fat, saturated fat, cholesterol, and sodium intake came from sandwich consumption. Men,

Ethical approval

This study used the NHANES de-identified public data and was exempt from human subjects review.

Funding

None declared.

Competing interests

None declared.

References (14)

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