Dietary Quality and Usual Intake of Underconsumed Nutrients and Related Food Groups Differ by Food Security Status for Rural, Midwestern Food Pantry Clients



      Food pantry users represent a predominantly food insecure population, yet dietary intake may differ among food secure (FS), low FS, and very low FS clients. Usual intake of food groups and nutrients by food security status has not previously been compared among food pantry clients.


      This study aimed to estimate the usual intakes of underconsumed nutrients (ie, potassium; dietary fiber; choline; magnesium; calcium; vitamins A, D, E, and C; and iron) and related food groups (ie, vegetables, fruits, whole grains, and dairy) and dietary quality, and to evaluate their relationship with food security status.


      This cross-sectional, secondary analysis used baseline data from a prior intervention study (Clinical Trial Registry: NCT03566095). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected.


      This community-based study included a convenience sample of adult, midwestern food pantry clients (N=579) recruited from August to November 2014.

      Main outcome measures

      Main outcomes evaluated were Healthy Eating Index-2010 scores and usual intakes of underconsumed nutrients and related food groups.

      Statistical analyses performed

      Linear regression models and the National Cancer Institute method, adjusting for confounders, were used to estimate associations of food security with diet quality and usual intake, respectively.


      Being FS was associated with a higher whole grains HEI-2010 score and higher mean usual intake of whole grains compared with being low FS. Being FS was associated with higher usual intakes of iron and dairy compared with being very low FS. Being FS was associated with a higher mean usual intake of dark green vegetables compared with being low FS and very low FS. Usual intakes were below federal guidance for all subgroups of food security.


      Although food security status may differentiate dietary intake among food pantry clients, improvements are needed among all clients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Coleman-Jensen A.
        • Rabbitt M.P.
        • Gregory C.
        • Singh A.
        Statistical supplement to household food security in the United States in 2018.
        • US Dept of Agriculture, Economic Research Service
        Definitions of food security.
        • Hanson K.L.
        • Connor L.M.
        Food insecurity and dietary quality in US adults and children: A systematic review.
        Am J Clin Nutr. 2014; 100: 684-692
        • Seligman H.K.
        • Laraia B.A.
        • Kushel M.B.
        Food insecurity is associated with chronic disease among low-income NHANES participants.
        J Nutr. 2010; 140: 304-310
        • Wright B.N.
        • Bailey R.L.
        • Craig B.A.
        • et al.
        Daily dietary intake patterns improve after visiting a food pantry among food-insecure rural midwestern adults.
        Nutrients. 2018; 10
        • Tarasuk V.S.
        • Beaton G.H.
        Women’s dietary intakes in the context of household food insecurity.
        Am Soc Nutrition Sci. 1999; 129: 672-679
        • US Depts of Health and Human Services and Agriculture
        Dietary Guidelines for Americans.
        • Tooze J.A.
        • Kipnis V.
        • Buckman D.W.
        • et al.
        A mixed-effects model approach for estimating the distribution of usual intake of nutrients: The NCI method.
        Stat Med. 2010; 29: 2857-2868
        • Tooze J.A.
        • Midthune D.
        • Dodd K.W.
        • et al.
        A new method for estimating the usual intake of episodically-consumed foods with application to their distribution.
        J Am Diet Assoc. 2006; 106: 1575-1587
        • Institute of Medicine Standing Committee on the Scientific Evaluation of Dietary Reference Intakes
        Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride.
        National Academies Press, Washington, DC1997
        • Institute of Medicine Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline
        Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline.
        National Academies, Washington, DC1998
        • Institute of Medicine Panel on Dietary Antioxidants and Related Compounds
        Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids.
        National Academies Press, Washington, DC2000
        • Institute of Medicine Panel on Micronutrients
        Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc.
        National Academies, Washington DC2001
      1. Institute of Medicine Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. The National Academies Collection: Reports funded by National Institutes of Health.
        in: Ross A.C. Taylor C.L. Yaktine A.L. Del Valle H.B. Dietary Reference Intakes for Calcium and Vitamin D. National Academies Press, Washington, DC2011
        • Institute of Medicine Panel on Dietary Reference Intakes for Electrolytes and Water
        Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate.
        The National Academies Press, Washington, DC2005: 638
        • Trumbo P.
        • Schlicker S.
        • Yates A.A.
        • Poos M.
        Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids.
        J Am Diet Assoc. 2002; 102: 1621-1630
      2. US Dept of Agriculture, Center for Nutrition Policy and Promotion. Dietary Guidelines for Americans 2015-2020. Table A3-1. Healthy U.S.-style eating pattern: Recommended amounts of food from each food group at 12 calorie levels.
        • Stluka S.
        • Moore L.
        • Eicher-Miller H.A.
        • et al.
        Voices for food: methodologies for implementing a multi-state community-based intervention in rural, high poverty communities.
        BMC Public Health. 2018; 18: 1055
        • US Dept of Agriculture Economic Research Service
        County-level data sets.
        • Liu Y.
        • Zhang Y.
        • Remley D.T.
        • Eicher-Miller H.A.
        Frequency of food pantry use is associated with diet quality among Indiana food pantry clients.
        J Acad Nutr Diet. 2019; 119: 1703-1712
        • Bickel G.
        • Nord M.
        • Price C.
        • Hamilton W.
        • Cook J.
        Guide to measuring household food security.
        • US Dept of Agriculture Economic Research Service
        US adult food security survey module: Three-stage design, with screeners.
        • Subar A.F.
        • Kirkpatrick S.I.
        • Mittl B.
        • et al.
        The Automated Self-Administered 24-hour dietary recall (ASA24): A resource for researchers, clinicians, and educators from the National Cancer Institute.
        J Acad Nutr Diet. 2012; 112: 1134-1137
        • Kirkpatrick S.I.
        • Guenther P.M.
        • Douglass D.
        • et al.
        The provision of assistance does not substantially impact the accuracy of 24-hour dietary recalls completed using the Automated Self-Administered 24-H Dietary Assessment Tool among women with low incomes.
        J Nutr. 2019; 149: 114-122
      3. US Dept of Agriculture, Food and Nutrition Service. Supplemental Nutrition Assistance Program (SNAP).
      4. US Dept of Agriculture, Food and Nutrition Service. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
        Date accessed: January 24, 2020
        • National Cancer Institute Division of Cancer Control and Population Sciences Epidemiology and Genomics Research Program
        Healthy Eating Index SAS code.
        Date accessed: November 22, 2019
        • Guenther P.M.
        • Kirkpatrick S.I.
        • Reedy J.
        • et al.
        The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans.
        J Nutr. 2014; 144: 399-407
        • Krebs-Smith S.M.
        • Pannucci T.E.
        • Subar A.F.
        • et al.
        Update of the Healthy Eating Index: HEI-2015.
        J Acad Nutr Diet. 2018; 118: 1591-1602
        • National Cancer Institute Dietary Assessment Primer
        Describing dietary intake.
        • National Cancer Institute
        Usual Dietary Intakes: SAS macros for the NCI method.
        • Institute of Medicine, Food and Nutrition Board
        Dietary Reference Intakes: A Risk Assessment Model for Establishing Upper Intake Levels for Nutrients.
        National Academies Press, Washington, DC1998
        • VanBuren J.
        • Cavanaugh J.
        • Marshall T.
        • Warren J.
        • Levy S.M.
        AIC identifies optimal representation of longitudinal dietary variables.
        J Public Health Dent. 2017; 77: 360-371
        • Tooze J.A.
        • Grunwald G.K.
        • Jones R.H.
        Analysis of repeated measures data with clumping at zero.
        Stat Methods Med Res. 2002; 11: 341-355
      5. SAS [computer program]. Version 9.4. SAS Institute Inc, Cary, NC; 2013.

        • National Cancer Institute Dietary Assessment Primer
        Summary Tables: Recommendations on potential approaches to dietary assessment for different research objectives requiring group-level estimates.
        • Institute of Medicine Subcommittee on Interpretation and Uses of Dietary Reference Intakes; Institute of Medicine Standing Committee on the Scientific Evaluation of Dietary Reference Intakes
        DRI Dietary Reference Intakes: Applications in Dietary Assessment. 4, Using the Estimated Average Requirement for Nutrient Assessment of Groups.
        National Academies Press, Washington, DC2000
        • Murakami K.
        • Livingstone M.B.
        Prevalence and characteristics of misreporting of energy intake in US adults: NHANES 2003-2012.
        Br J Nutr. 2015; 114: 1294-1303


      B. N. Wright is a postdoctoral fellow, Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.


      J. A. Tooze is a professor, Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC.


      R. L. Bailey is a professor, Department of Nutrition Science, Purdue University, West Lafayette, IN.


      H. A. Eicher-Miller is an associate professor, Department of Nutrition Science, Purdue University, West Lafayette, IN.


      Y. Liu is a clinical assistant professor, School of Public Health and Health Professions, University at Buffalo-The State University of New York, Buffalo, NY.


      R. L. Rivera is a postdoctoral research fellow, Public & Population Health Informatics, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, IN.


      L. McCormack is an associate professor, Health and Nutritional Sciences, South Dakota State University, Brookings, SD.


      S. Stluka is Extension Food & Families Program director, South Dakota State University, Brookings, SD.


      L. Franzen-Castle is an associate professor and extension nutrition specialist, Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE.


      B. Henne is an associate program leader, Michigan State University Extension, Eaton County Extension Office, Charlotte, MI.


      D. Mehrle is an Extension specialist, University of Missouri, Columbia, MO.


      D. Remley is an associate professor, Extension, Ohio State University, Piketon, OH.