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Perceptions of a Healthy Diet: Insights From a 3-Country Survey

Bailey, Regan L. PhD, MPH, RD; Denby, Nigel RD; Haycock, Bryan PhD; Sherif, Katherine MD; Steinbaum, Suzanne DO; von Schacky, Clemens MD

doi: 10.1097/NT.0000000000000119
International Nutrition

Limited data exist on consumer beliefs and practices on the role of omega-3 fatty acid and vitamin D dietary supplements and health. For this reason, the Global Health and Nutrition Alliance conducted an online survey in 3 countries (n = 3030; United States = 1022, Germany = 1002, United Kingdom = 1006) of a convenience sample of adults (aged 18–66 years) who represented the age, gender, and geographic composition within each country. More than half of the sample (52%) believed they consume all the key nutrients needed for optimal nutrition through food sources alone; fewer women (48%) than men (57%), and fewer middle-aged adults (48%) than younger (18–34 years [56%]) and older (≥55 years [54%]) adults agreed an optimal diet could be achieved through diet alone. Overall, 32% reported using omega-3s (45% in United States, 29% in United Kingdom, and 24% in Germany), and 42% reported using vitamin D dietary supplements (62% in United States, 32% in United Kingdom, and 31% in Germany). Seventy eight percent of the sample agreed that omega-3 fatty acids are beneficial for heart health; however, only 40% thought that their diet was adequate in omega-3 fatty acids. Similarly, 84% agreed that vitamin D was beneficial to overall, and 55% of adults from all countries were unsure or did not think they consume enough vitamin D in their diet. For most findings in our study, US adults reported more dietary supplement use and had stronger perceptions about the health effects of omega-3s and vitamin D than their counterparts in the United Kingdom and Germany. Nevertheless, the consistent findings across all countries were that adults are aware of the importance of nutrition, and most adults believe their diet is optimal for health. Our data serve to alert dietitians and health professionals that consumers may have an elevated sense of the healthfulness of their own diets and may require guidance and education to achieve optimal diets.

Regan L. Bailey, PhD, MPH, RD, is a nutritional epidemiologist and director of Career Development and Outreach at the Office of Dietary Supplements, Office of Disease Prevention at the National Institutes of Health, Bethesda, Maryland. Dr Bailey is also an adjunct professor in the Department of Nutrition Science at Purdue University, West Lafayette, Indiana.

Nigel Denby, RD, is head of Dietetics, Grub4Life and People Matter TV; London, United Kingdom. Nigel Denby is a registered dietitian in the United Kingdom. He has published 9 nutrition books and is a frequent contributor to television and radio across the United Kingdom and Europe.

Bryan Haycock, PhD, is an exercise physiologist at Health Medical Affairs, Reckitt Benckiser, Salt Lake City, Utah. Bryan Haycock has worked extensively in the field of sports medicine and is an expert in the area of exercise physiology. He is currently a part of the Global Medical & Innovations team at Reckitt Benckiser and is a member of the American College of Sports Medicine.

Katherine Sherif, MD, is director of Jefferson Women’s Primary, Philadelphia, Pennsylvania. Dr Sherif’s areas of expertise include hypertension, menopause, diabetes, polycystic ovary syndrome, and heart disease prevention, with a special interest in international women’s health issues. Dr Sherif was named a “Top Doc” by Philadelphia Magazine in 2012 and 2013.

Suzanne Steinbaum, DO, is director and attending cardiologist at Women and Heart Disease Center, Lenox Hill Hospital, New York. Dr Steinbaum is an expert in the areas of cardiology and internal medicine, with subspecialties in prevention and women and heart disease. She is also the medical director for Events of the Heart, a nonprofit organization dedicated to raising awareness about heart disease, and a spokesperson for the American Heart Association.

Clemens von Schacky, MD, is head of Preventative Cardiology, University of Munich, Germany. Dr von Schacky is a cardiologist with a specialty in omega-3 fatty acids. As coinventor of the Omega-3 Index, he devotes his work to Omegametrix, an international reference laboratory. He is also a current board member for the International Society for the Study of Fatty Acids and Lipids and a member of the German National Guideline Committee on cardiovascular prevention.

The survey recruitment and data analysis used in this manuscript was supported through an unrestricted educational grant provided by Reckitt Benckiser, Parsippany, New Jersey.

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the National Institutes of Health or any other entity of the US Government. Tonic Life Communications (Philadelphia, PA) provided funding to allow this article to publish as Open Access.

The authors have no conflicts of interest to disclose.

Correspondence: Regan L. Bailey, PhD, MPH, RD, National Institutes of Health, Office of Dietary Supplements, 6100 Executive Blvd, 3B01 Bethesda, MD 20892 (

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