Trends in Nutrient Intake Among U.S. Adults by Diabetes Status: National Health and Nutrition Examination Survey 2011–2020

OBJECTIVE To examine differences in nutrient intake among U.S. adults with diagnosed diabetes, undiagnosed diabetes, prediabetes, and no diabetes, and how intake of nutrients has changed over time by diabetes status. RESEARCH DESIGN AND METHODS We conducted cross-sectional analyses of major macronutrient and micronutrient intakes using National Health and Nutrition Examination Survey (NHANES) 2011–2020 data. Energy-adjusted nutrient intakes across all year periods were compared across categories of diabetes status. Multiple linear regression models were used to examine the time trends in energy-adjusted nutrient intake by diabetes status after adjusting for age, sex, and race. All analyses were weighted to account for the complex survey design. RESULTS Compared with individuals without diabetes, individuals with diagnosed diabetes had greater average intakes of protein, total fat, cholesterol, calcium, and sodium, but lower total sugar, potassium, and magnesium intakes across all periods. Among individuals with diagnosed diabetes, carbohydrate, dietary fiber, magnesium, sodium, and potassium intake decreased from 2011 to 2020, whereas total fat and saturated fatty acid intakes increased. Adults with undiagnosed diabetes consumed less dietary fiber, more saturated fatty acids, and less magnesium than those without diabetes. The Healthy Eating Index was lower for people with prediabetes and undiagnosed and diagnosed diabetes than for those without diabetes (all P < 0.01). CONCLUSIONS In the 10-year study period, nutrient intakes did not improve in individuals with prediabetes, undiagnosed diabetes, or diagnosed diabetes. The lack of improvement in dietary quality, coupled with a high prevalence of diabetes in the U.S., warrants public health efforts to reverse these adverse trends.