Trends in “Healthy” Food Consumption Overall and by Nova Food Processing Categories among United States Adults from 2003 to March 2020

BACKGROUND: In 2024, the Food and Drug Administration (FDA) updated the "healthy" claim that can appear on foods and beverages. However, trends and demographic differences in intake of "healthy" foods are unknown, and there is concern that ultraprocessed foods (UPF) may qualify for the "healthy" claim. OBJECTIVES: The objective of this study was to examine trends in "healthy" food intake by Nova food processing category among United States adults, overall and across demographic groups. METHODS: Using a serial cross-sectional design, we examined dietary intake among a nationally representative sample of United States adults (≥20 y) with 2 valid 24-h dietary recalls from the National Health and Nutrition Examination Survey (2003-2004 to 2017-March 2020; n = 34,164). We examined trends in FDA-aligned (i.e., foods meeting "healthy" criteria) and FDA-unaligned (i.e., foods not meeting "healthy" criteria) intake as a proportion of total energy, overall and by Nova category. We used generalized linear models adjusted for demographic characteristics and examined differences using stratified models. RESULTS: FDA-aligned intake increased from 9.7% to 10.7% (P-trend = 0.03). FDA-aligned minimally processed food (MPF) intake did not change (P-trend = 0.36), but FDA-unaligned MPF intake decreased (P-trend < 0.001). FDA-aligned UPF intake increased but comprised 51%) in all years. Intake of "healthy" UPFs differed by age, race and ethnicity, and education. CONCLUSIONS: Intake of "healthy" foods and beverages increased, but comprised