Racial and ethnic heterogeneity in diets of low-income adult females in the United States: results from National Health and Nutrition Examination Surveys from 2011 to 2018

Background: Poor diet is a major risk factor of cardiovascular and chronic diseases, particularly for low-income female adults. However, the pathways by which race and ethnicity plays a role in this risk factor have not been fully explored. Objectives: This observational study aimed to identify dietary consumption differences by race and ethnicity of US female adults living at or below the 130% poverty income level from 2011 to 2018. Methods: A total of 2917 adult females aged 20 to 80 years from the National Health and Nutrition Examination Survey (2011-2018) living at or below the 130% poverty income level with at least one complete 24-hour dietary recall were classified into 5 self-identified racial and ethnic subgroups (Mexican, other Hispanic, non-Hispanic [NH]-White, NH-Black, and NH-Asian). Dietary consumption patterns were defined by 28 major food groups summarized from the Food Pattern Equivalents Database and derived via a robust profile clustering model, which identifies foods that share consumption patterns across all low-income female adults and foods that differ in consumption patterns based on the racial and ethnic subgroups. Results: All food consumption patterns were identified at the local level, defined by racial and ethnic subgroups. Legumes and cured meats were the most differentiating foods identified across all racial and ethnic subgroups. Higher consumption levels of legumes were observed among Mexican-American and other Hispanic females. Higher consumption levels of cured meat were observed among NH-White and Black females. NH-Asian females had the most uniquely characterized patterns with a higher consumption of prudent foods (fruits, vegetables, and whole grains). Conclusions: Differences among the consumption behaviors of low-income female adults were found along racial and ethnic lines. Efforts to improve the nutritional health of low-income female adults should consider racial and ethnic differences in diets to appropriately focus interventions.