Transcript Nutrition Monitoring and Surveillance Some Definitions Joint Nutrition Monitoring Evaluation Committee, 1986 Expert Panel on Nutrition Monitoring, 1989

Nutrition Monitoring and
Surveillance
Some Definitions
Joint Nutrition Monitoring Evaluation Committee, 1986
Expert Panel on Nutrition Monitoring, 1989
Nutrition Monitoring
• Assessment of dietary or nutrition status
at intermittent times with the aim of
detecting changes in the dietary or
nutritional status of a population
Nutrition Surveillance
• Continuous assessment of nutritional
status for the purpose of detecting
changes in trend or distribution in order
to initiate corrective measures
Dietary Status
• The condition of a population’s or an
individual’s intake of foods and food
components, especially nutrients.
Nutrition Assessment
• Measurement of indicators of dietary
status and nutrition related health status
to identify the possible occurrence,
nature, and extent of impaired
nutritional status.
Nutrition Monitoring in the
United States
Chronology
1909
USDA starts food supply series
1930s
USDA Household food consumption survey
started (changed name to Nationwide FCS)
Ten State Nutrition Survey (Nation’s first
comprehensive survey)
NHANES I and II
Pediatric Nutrition Surveillance System
Joint Nutrition Monitoring Evaluation
Committee with USDA and DHHS
Passage of the National Nutrition Monitoring
and Related Research Act
CSFII and NHANES Integrated
1968-70
1970s
1980s
1990
2001
Goals of NNMS
• Provide foundations for improvement of
nutritional status and quality and
healthfulness of food supply
• Collect, analyze, and disseminate timely
data on nutrition and dietary status,
quality of food supply, food consumption
patterns, consumer knowledge and
attitudes
NNMS Goals, cont...
• ID high risk groups and geographic
areas and trends
• Establish national baseline data and
develop standards for monitoring
• Provide data for evaluating implications
of changes in agricultural policy
National Nutrition Monitoring
System
• Jointly administered by USDA and
DHHS
• 22 federal agencies involved
• Over 70 surveys and surveillance
activities
• Ten year comprehensive plan for
Nutrition Monitoring and Related
Research sent to congress in 1993
NNMS - Some Agencies
• USDA
– Food and Nutrition Service
– Food Safety and Inspection Service
– Agricultural Research Service
– Economic Research Service
– Extension Service
– Cooperative State Research Service
• Department of Health and Human
Services
– National Center for Health Statistics
– CDC-National Center for Chronic Disease
Prevention and Health Promotion
– Food and Drug Administration
– Heath Resources and Services
Administration
– Indian Health Services
– National Institutes of Health
– Substance Abuse and Mental Health Services
Administration
• Others:
– Department of Defense
– Department of Education
– Agency for International Development
– Department of Veterans Affairs
– Census Bureau
– Bureau of Labor Statistics
– National Marine Fisheries Service
5 Areas of NNMS
• Nutrition and related health
measurements
• Food and nutrient composition
• Knowledge, attitudes, and behavior
• Food composition and nutrient
databases
• Food Supply Determinations
Nutrition and Related Health
Measurements
• National Health and Nutrition
Examination Surveys (I-V, and
continuous)
• National Health Interview Survey
• National Hospital Discharge Survey
• Pediatric Nutrition Surveillance System
Food and Nutrient
Composition
• Nationwide Food Consumption Survey
• Continuing Survey of Food Intakes by
Individuals
Knowledge, Attitudes, and
Behavior
• Behavioral Risk Factor Surveillance
System
• Youth Risk Behavior Survey
• Diet and Health Knowledge Survey
Food Composition and
Nutrient Data Bases
• National Nutrient Data Bank (NNDB)
Food Supply Determinations
• US Food and Nutrition Supply Series
Third Report on Nutrition
Monitoring in the United
States - December 1995
• Increase in rates of overweight and sedentary
lifestyle
• Increase in proportion of adults with desirable
serum total cholesterol
• Hypertension remains major public health
problem - especially in non-Hispanic blacks
• 9-13% of low income households experience
food insecurity
• Rates of femoral osteoporosis in females > 50
years old:
– 21% in non-Hispanic whites
– 10% in non-Hispanic blacks
– 16% in Mexican Americans
• Intakes of % of diet from total fat, saturated
fatty acids, and cholesterol have decreased,
but remain above recommended levels for
large proportion of the population
• Mean calcium intakes are below
recommendations - especially in adolescents,
adult females, elderly, and non-Hispanic black
males
• Median iron intakes below recommendations
for children 1-2, female adolescents, females
20-59
• Average daily intake of fruits and vegetables is
about 4 servings
Nutrition Monitoring in the
United States
The Directory of Federal and
State Nutrition
Monitoring and Related Research
Activities
2000
An Inventory of Resources
Major Surveys with Nutrition
Content
Behavioral Risk Factor Surveillance
System (BRFSS)
• CDC, National Center for Chronic Disease
Prevention and Health Promotion (NCCDPHP)
• Annually since 1984 (not all states at first)
• Telephone interview
• Data collection is conducted separately by each
State. Sample design uses State-level, random-digitdialed probability samples of the adult (aged 18 years
and over) population.
• State-specific sample sizes ranged from 1,499 to
6,005
BRFSS - Questions
• Behavioral risk factors (for example, alcohol and
tobacco use), preventive health measures, HIV/AIDS,
health status, limitation of activity, and health care
access and utilization
• Core of questions asked in all States
• Standardized optional questions on selected topics
administered at the State’s discretion
• Rotating core of questions asked every other year in
all States
• State-added questions developed to address Statespecific needs
BRFSS - Data
• National
• State
• Smaller units when local agencies pay
for additional surveys
• Data system homepage:
http://www.cdc.gov/nccdphp/brfss
BRFSS - Nutrition
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Self reported height and weight
Trying to loose weight?
6 fruit and vegetable intake questions
Activity
Food security
Youth Risk Behavior Surveillance
System (YRBSS)
• CDC, National Center for Chronic Disease
Prevention and Health Promotion (NCCDPHP)
• School based, grades 9-12
• National survey is done in 150 schools, states and
local districts conduct their own surveys
• Other components: national alternative school
survey, middle school surveys in selected States, and
the National College Health Risk Behavior Survey
• Anonymous self-administered questionnaires
• Biennial (odd-numbered years)
• 1999 national survey, N= 15,349
YRBS - Data
• Gender, age, grade, race/ethnicity,
urbanicity of school
• National and 4 census regions
• By state for 41 states in 1999
• 16 large metropolitan school districts
• http://www.cdc.gov/nccdphp/dash/yrbs/ov.htm
YRBS - Categories
• injury
• tobacco use
• alcohol and other drug use
• sexual behavior
• diet and nutrition
• physical activity
YRBS - Nutrition
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Self reported weight and height
Dieting behaviors
Eating disorder behaviors
Fruit and vegetable intake
Fat intake
Seattle YRBS
1993 1999
Percentage of students who were trying
to lose weight
34.4 38.3
Percentage of students who exercised or
participated in physical activities for at
least 20 minutes that made them sweat
and breathe hard on three or more of the
past seven days
64.4 64.1
Continuing Survey of Food Intake by
Individuals (CSFII)
• USDA
• 1994-1996
• in-person interviews
• 24-hour dietary recall: 2 nonconsecutive days of food
intake data collected 3-10 days apart
• 2 weeks later, one adult from each household asked
questions about knowledge and attitudes toward
dietary guidance, health, and use of food labels.
CFSII - Sample
• Nationally representative stratified multistage area
probability sample of U.S. noninstitutionalized civilian
population, all ages.
• Oversampling of low-income households
• For 1994–96, sample size for 1-day dietary data was
16,103; for 2-day dietary data, it was 15,303.
CFSII - Data
• kinds and amounts of foods consumed
• sources of foods
• time, name of each eating occasion
• food expenditures, shopping practices
• pregnancy, lactation, nursing status,
• height and weight
• income, poverty status, household size,
• participation in Food Stamp and WIC programs
CFSII - Data Availability
• National; four U.S. Census Bureau regions;
Standard Metropolitan Statistical Areas
• http://www.barc.usda.gov/bhnrc/foodsurvey/home.htm
CFSII - Nutrition
• food intakes in grams of 71 USDA-defined food
groups and subgroups
• nutrient intakes of 28 nutrients and food components
• nutrient intakes expressed as percentages of the
1989 Recommended Dietary Allowance
• Pyramid servings from 30 food groups
Cleveland et al. Dietary Intake of Whole Grains. J Am Coll
Nutr. 2002.
Enns et al. Family Economics and Nutrition Review, 1997.
National Health and Nutrition
Examination Survey (NHANES)
• CDC, National Center for Health Statistics (NCHS)
• In-person interview in household and mobile
examination center
• stratified multistage probability sample, nationally
representative of the U.S. civilian noninstitutionalized
population
• Approximately 5,000 people are examined at 15
locations each year
• All ages beginning in 1999
NHANES - Continuous
• Periodic (1960–94);
• annual beginning in 1999
• after 1999 annual sample size will be too small to
provide reliable estimates for many measures and for
most subgroups. Most analyses will require 3 years
of data for reliable estimates.
http://www.cdc.gov/nchs/about/major/nhanes/mectour.htm
NHANES - Content
• Chronic disease prevalence and conditions (including
undiagnosed conditions
• immunization status
• infectious disease prevalence
• health insurance
• measures of environmental exposures
• hearing
• vision
• mental health
NHANES - Content
• anemia
• diabetes
• cardiovascular disease
• osteoporosis
• obesity
• oral health
• physical fitness
NHANES - New in 1999
• cardiorespiratory fitness
• physical functioning
• lower extremity disease
• full body DXA for body fat as well as
bone density
• tuberculosis
NHANES - Data
• National; four U.S. Census Bureau
regions
• Demographics: Gender, age, education,
race/ethnicity, place of birth, income,
occupation, and industry
• http://www.cdc.gov/nchs/nhanes.htm
NHANES - Nutrition
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Food Security
Dietary supplements
Weight history
Dietary Recall - one 24 hour
NHANES III Anthropometric
Procedures Video
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Body weight
Standing height
Sitting height
Upper leg length
Recumbent length
Upper arm length
Knee height
Arm circumference
Waist circumference
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Buttocks circumference
Thigh circumference
Head circumference
Skinfolds (including
thighs, triceps,
subscapular, and
suprailiac)
• Wrist breadth
• Elbow breadth
NHANES-CFSII Integration
• Staged integration of two surveys underway
• 2001 a year of testing, 2002 full integration
• Goals: continuous data collection, linkage of diet and
health data, 2 days of dietary data collection (second
day by phone 3 to 10 days after initial exam)
• DHKS not part of integrated efforts at this time, but
under consideration
Diet and Health Knowledge
Survey (DHKS)
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USDA, Agricultural Research Service
Periodically from 1989 to 1996
In conjunction with CSFII
Sample size per year
– ~1300 from 1989 through 1991
– ~2000 per year 1994-1996
• telephone follow up conducted with one adult
in each household 2-3 weeks after CFSII
DHKS - Content
• Designed to assess relationships
between knowledge and attitudes about
dietary guidance and food safety, food
choice decisions and nutrient intakes
• Variables can be linked to CFSII
variables for individuals.
DHKS - Questions
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Self perceived intake levels
awareness of diet/health relationships
use of food labels
perceived importance of following dietary
guidance for specific nutrients and food
components
• beliefs about food safety
• Knowledge about food sources of nutrients
DHKS - Descriptive Variables
• Individual: gender, age, ethnicity,
education, employment status, height
and weight
• Household: income, size, cash assets,
region, urbanization, tenancy,
participation in food stamps and WIC
DHKS - URL
www.barc.usda.gov/bhnrc/foodsurvey/csfii94.htm
Optimists: rate diet quality as better than actually is
Pessimists: rate diet quality as worse than it is
http://www.ers.usda.gov/briefing/DietAndHealth/healthfuldiet.htm
Household Food Security in the
United States, 2001
Food Assistance and Nutrition
Research Report #29
Economic Research Service
U.S. Department of Agriculture
November 2002
• 89.3 percent of U.S. households were food secure
throughout the entire calendar year 2001.
• 10.7 percent of U.S. households were food insecure
at some time during the year.
• In 3.3 percent of households people were hungry at
times during the year because they couldn’t afford
enough food.
• Rates of food insecurity and hunger in the U.S.
increased during the 2-year period 1999-2001.
Nutrition Security
• The provision of an environment that
encourages and motivates society to
make food choices consistent with short
and long term good health.
Food Security
• Assess by all people at all times to
sufficient food for an active and healthy
life. Food security includes at a
minimum: the ready availability of
nutritionally adequate and safe foods,
and an assured ability to acquire
acceptable foods in socially acceptable
ways.
Food Insecurity
• a household had limited or uncertain
availability of food, or limited or
uncertain ability to acquire acceptable
foods in socially acceptable ways (i.e.,
without resorting to emergency food
supplies, scavenging, stealing, or other
unusual coping strategies).
Hunger
• The uneasy or painful sensation caused
by a lack of food.
• Involuntary hunger that results from not
being able to afford enough food
• The recurrent and involuntary lack of
access to food
• May produce malnutrition over time.
1990
1992
History of the Food Security
Measurement Project
NMRR Act recommends a standardized
mechanism for defining and obtaining data on
the prevalence of food insecurity
USDA staff review existing research
1994
USDA and DHHS sponsor conference on Food
Security Measurement and Research
1995
Current Population Survey of US Census
Bureau includes Food Security Measurement
scale
Annual Surveys, ERS assumes leadership,
1996present others encouraged to use FSMS
Washington State, 1999-2001
• Food Insecure without hunger – 12.5%
• Food Insecure with hunger – 4.6
Prevalence
• The West and South Census Regions
registered somewhat higher
prevalences than did the Northeast and
Midwest.
• Food insecurity and hunger were more
prevalent in central cities and in
nonmetropolitan areas than in suburban
areas.
Update with 2003 data
2003 National Results
• Food Insecurity = 11.2%
– (increased from 11.1%)
• Food Insecurity with hunger = 3.5%
– No change from 2002
Food Insecurity with Hunger
Food Insecure Numbers in
Washington
Year
Numbers of
Households
2002
290,000
2003
275,000
Why did Washington’s rates
improve?
• Increased participation in federal
programs
• Between 2001 and 2004 there was a
59% increase in food stamp
participation.
• Improving economy?
Other National Findings
• 70% of food insecure families had
visited a food pantry within the past
year.
• Only 18.3% of families with incomes
below 130% had participated in food
stamps in the past month.