Identify dietary patterns among U.S. older adults and examine their associations with sociodemographic and health characteristics including economic and physical functioning-related food insecurity.

Secondary analysis of dietary intake data from the 2013–2018 What We Eat in America component of NHANES. Dietary patterns were derived using cluster analysis and compared by diet quality (Healthy Eating Index (HEI)-2020), demographic characteristics, health indicators and multidimensional food insecurity.

United States.

A nationally representative sample of 5062 adults aged ≥ 60 years

Five dietary patterns were identified. The largest pattern, ‘juices, smoothies, grain drinks and soups’ (53·0 %), was characterised by the lowest mean energy and protein intake and a moderate HEI-2020 score (66·0 ± 0·8). In contrast, the ‘cooked cereals and yogurt’ pattern (10·8 %) had the highest HEI-2020 score (72·3 ± 1·4) and more favourable health indicators. Patterns high in processed meats and baked goods – ‘cured meats, sandwiches and sweet bakery products’ (18·1 %) and ‘meats, alcohol and quick breads’ (11·0 %) – had the lowest diet quality scores (48·5 ± 1·0 and 58·3 ± 1·6, respectively) and were more common among younger older adults, males, current smokers and individuals with obesity. Food insecurity due to both economic constraints and physical functioning limitations was most prevalent in the lower-quality soft-food pattern and least prevalent in the ‘Seafood and vegetables’ pattern (0·5 %).

Distinct dietary patterns exist among U.S. older adults, with substantial variation in diet quality, health characteristics and food insecurity. Interventions should address both economic and functional barriers to support nutrient-dense, texture-appropriate diets in older adults.