Healthy Grains in Healthy Diets: The Contribution of Grain Foods to Diet Quality and Health in the National Health and Nutrition Examination Survey 2017–2023

<b>Background</b>: Grain foods are important sources of complex carbohydrates, fiber, vitamins, and minerals. <b>Objective</b>: To identify healthy grain foods and to assess their associations with composite diet quality measures and selected health outcomes. <b>Methods</b>: Healthy grain foods were identified using two methods. The first one, Carbohydrate Food Quality Score (CFQS-3) was based on whole grains, fiber, and added sugar. The second, NRF9.3g score for grains, balanced nutrients to encourage (protein, fiber, vitamins B1, B2, B3, and E, folate, iron, and magnesium) against added sugar, sodium, and saturated fat. Nutrient composition data for 1244 grain foods came from the USDA Food and Nutrient Database for Dietary Studies (FNDDS 2017-2023). Dietary intakes came from the National Health and Nutrition Examination Surveys (NHANES 2017-2023). The Healthy Eating Index (HEI 2020) and the diet-level Nutrient Rich Food Index (NRF) were the two measures of diet quality. National food prices came from the USDA 2021 Thrifty Food Plan. Data on body weight, waist circumference, insulin, and cholesterol came from NHANES clinical files. <b>Results</b>: Healthy grain foods were those that scored >2 points on CFQS-3 or were in the top tertile of NRF9.3g scores. The CFQS-3 score favored cooked whole grains and cereals and savory snacks. The NRF9.3g score gave the highest ratings to breads, rolls, and RTE cereals. Consumers of healthy grains identified using both methods had higher HEI 2020 values and higher diet-level NRF scores. Both effects were dose-dependent. Consumption of healthy grains was associated with lower obesity rates and lower fasting insulin levels. <b>Conclusions</b>: Consumption of healthy grain foods was associated with healthier diets and lower obesity prevalence. Dietary guidelines need to acknowledge the contribution of healthy grain foods to diet quality and health.