LAUSR

Objective: A healthy diet is key to preventing and managing CVD. Despite clear AHA guidelines, eating healthy can be difficult due to misinformation. We investigated perceived vs. actual diet quality and what contributes to perceiving a poor diet ‘healthy’. Methods: We identified adults aged > 19 in 2005-2018 National Health and Nutrition Examination Survey. Healthy perceived diet was defined as answering “excellent” or “very good” to “how healthy is the diet?”. We assessed actual diet quality by calculating AHA Healthy Diet Score based on a 24-hour dietary recall and scaled the raw score to 0-100%; ‘poor diet’ was defined as AHA score < 40%. We first estimated prevalence of poor actual diet and perceived healthy diet. Among those with poor diet (AHA score < 40%), we fit modified-Poisson regression models to identify factors associated with perceiving a poor diet as ‘healthy’ and reported risk ratios with 95% confidence limits. Results: Among 31,621 adults (50% female, mean age 50, 43% non-Hispanic White, mean BMI 29), prevalence of ‘healthy’ perceived diet and actual ‘poor diet’ was 29% and 47%, respectively. Among adults with a ‘poor diet’ (n=14,951), 23% perceived their diet as ‘healthy’ and many sociodemographic and lifestyle factors and comorbidities were significantly associated with perceiving a poor diet as healthy in univariate analyses (Table). In multivariable analysis, increased age, male sex, White race (compared to Black and Hispanic race), MI history, smaller waist circumference, higher physical activity, and alcohol use were independently associated with perceiving their poor diet as ‘healthy’ (RR ranged from 0.77-1.48, Table). Conclusion: Nearly half of US adults had a poor diet based on dietary targets from AHA 2020 Strategic Impact Goals for CV health, yet nearly a quarter of them perceived their diet as ‘healthy’. Targeting high risk adults with focused educational interventions to calibrate their perception of a healthy diet can be effective in modifying their eating behavior and promoting CV health.