Sandwich Consumption in the U.S.: Contributions to Intake and Associations with Dietary Quality among Adults, What We Eat in America, NHANES 2009–2012
Authors: Sebastian Rhonda S , Enns Cecilia Wilkinson , Goldman Joseph D , Moshfegh Alanna J 
Published: June 2021

Sandwiches are a mainstay of the American diet, yet little research has characterized their contributions to intake or investigated whether their consumption is associated with diet quality. This study's purpose was to (1) measure the contribution of sandwiches to adults’ intakes of nutrients and USDA Food Patterns components and (2) compare nutrient intakes and Healthy Eating Index (HEI) 2010 scores between individuals who consumed a sandwich on the intake day (reporters) and those who did not (nonreporters). One day of WWEIA, NHANES 2009–2012 dietary data from 10,563 adults age 20+ years was analyzed to produce nationally representative estimates. The percentage of adults reporting sandwiches on the intake day and the percentage contributions of sandwiches to total nutrient and Food Patterns component intakes were determined. To identify differences between sandwich reporters and nonreporters, adjusted nutrient intake estimates and HEI component scores by reporting status were calculated using linear regression techniques and compared using t‐tests. On any given day, sandwiches were reported by 47% of adults. Sandwiches provided 12% of total energy intake and equal or larger percentages of many nutrients (e.g., protein; total, saturated, monounsaturated, and polyunsaturated fat; folate; calcium; iron; and sodium) and Food Patterns components (e.g., tomatoes; “other” vegetables such as onions, cucumbers, and iceberg lettuce; whole and refined grains; protein foods; dairy–mainly cheese; oils; and solid fats). Compared to nonreporters, sandwich reporters had higher absolute intakes of energy. Whereas sandwich reporters’ higher absolute intakes of total, saturated, and monounsaturated fat and calcium were paralleled by higher density (on a per‐1,000‐kcal basis) of those nutrients, their higher intakes of sodium and iron appear to reflect higher intake alone rather than higher nutrient density. Moreover, density per 1,000 kcal was lower for reporters than for nonreporters for many nutrients, including fiber, vitamins A, C, and E, magnesium, and potassium. Mean total HEI score did not differ significantly between sandwich reporters (50.6) and nonreporters (52.0; p>0.001). However, sandwich reporters had higher HEI scores for whole grains and total protein foods and lower HEI scores for total vegetables, greens/beans, seafood and plant proteins, and sodium (low score = high sodium intake) than did nonreporters. Sandwiches contribute substantially to dietary intakes by adults. Despite several lower HEI component scores for sandwich reporters versus nonreporters, scores regardless of sandwich reporting status were particularly low for greens/beans and whole grains. Diet quality may be enhanced by modifying sandwiches to contain foods lower in sodium, a larger quantity and variety of vegetables, more whole grains, and more seafood/fish/plant protein foods, among other strategies.Support or Funding InformationARS, USDA.