Nutrition Monitoring and Surveillance

1. Nutrition Monitoring and Surveillance

2. Some Definitions Joint Nutrition Monitoring Evaluation Committee, 1986 Expert Panel on Nutrition Monitoring, 1989

3. 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

4. Nutrition Surveillance • Continuous assessment of nutritional status for the purpose of detecting changes in trend or distribution in order to initiate corrective measures

5. Dietary Status • The condition of a population’s or an individual’s intake of foods and food components, especially nutrients.

6. 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.

7. Nutrition Monitoring in the United States

8. Chronology

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

18. 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

19. Food and Nutrient Composition • Nationwide Food Consumption Survey • Continuing Survey of Food Intakes by Individuals

20. Knowledge, Attitudes, and Behavior • Behavioral Risk Factor Surveillance System • Youth Risk Behavior Survey • Diet and Health Knowledge Survey

21. Food Composition and Nutrient Data Bases • National Nutrient Data Bank (NNDB)

22. Food Supply Determinations • US Food and Nutrition Supply Series

23. Third Report on Nutrition Monitoring in the United States - December 1995

24. 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

25. 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

26. Nutrition Monitoring in theUnited StatesThe Directory of Federal and State NutritionMonitoring and Related Research Activities2000 An Inventory of Resources

27. Major Surveys with Nutrition Content

28. 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-digit-dialed probability samples of the adult (aged 18 years and over) population. • State-specific sample sizes ranged from 1,499 to 6,005

29. 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 State-specific needs

30. BRFSS - Data • National • State • Smaller units when local agencies pay for additional surveys • Data system homepage: http://www.cdc.gov/nccdphp/brfss

31. BRFSS - Nutrition • Self reported height and weight • Trying to loose weight? • 6 fruit and vegetable intake questions • Activity • Food security

32. 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

35. 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

36. YRBS - Categories • injury • tobacco use • alcohol and other drug use • sexual behavior • diet and nutrition • physical activity

37. YRBS - Nutrition • Self reported weight and height • Dieting behaviors • Eating disorder behaviors • Fruit and vegetable intake • Fat intake

38. Seattle YRBS

39. 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.

40. 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.

41. 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

42. CFSII - Data Availability • National; four U.S. Census Bureau regions; Standard Metropolitan Statistical Areas • http://www.barc.usda.gov/bhnrc/foodsurvey/home.htm

43. 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

44. Cleveland et al. Dietary Intake of Whole Grains. J Am Coll Nutr. 2002.

45. Enns et al. Family Economics and Nutrition Review, 1997.

46. 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

47. 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.

48. http://www.cdc.gov/nchs/about/major/nhanes/mectour.htm

50. 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