Recognition of Federal Dietary Guidance Icons Is Associated with Greater Diet Quality

Background Although the purpose of federal dietary guidance is to improve eating habits, few studies have described awareness of guidance and concurrent diet quality. Objective The objective of the current study was to examine the prevalence of individuals who reported hearing of dietary guidance icons and to describe the association between having heard of the icons and diet quality. Design This study was a cross-sectional survey. Participants/setting Participants (n=23,343) were from the National Health and Nutrition Examination-What We Eat in America survey 2005-2014 cycles. Main outcome measures Awareness of the Food Guide Pyramid, MyPyramid, or MyPlate icons by sociodemographic characteristics and diet quality were measured using Healthy Eating Index (HEI) scores derived from 24-hour recall data. Statistical analyses performed Global Wald tests were used to test for differences in awareness of the icons within sociodemographic groups. Total HEI scores were calculated using the population-ratio method. Z-scores were used to test differences in HEI total scores between those with knowledge of the icons and those who responded negatively. Results In all cycles, those with less than a high school diploma were the least likely to report having heard of the icons (P<0.001). In every wave except 2011 to 2012, participants with low or marginal food security status were less likely to report affirmatively (P<0.001), and Supplemental Nutrition Assistance Program (SNAP) participants and SNAP-eligible nonparticipants were least likely to report having heard of the icons (P<0.001) except for 2005 to 2006. HEI scores were higher among those who had heard of MyPyramid in 2007-2012 (P<0.05) and MyPlate in 2013-2014 (P<0.001) compared with those who had not heard of the icon. Conclusions Recognition of federal dietary guidance icons was associated with higher diet quality recently, but the cross-sectional nature of the data precludes conclusions of causality. Further research is needed to identify barriers and promoters for translating awareness of the federal dietary guidance icons into healthful food purchasing and food consumption decisions.