National Food Intake Assessment: Technologies to Advance Traditional Methods.

National dietary surveillance produces dietary intake data used for various purposes including development and evaluation of national policies in food and nutrition. Since 2000, What We Eat in America, the dietary component of the National Health and Nutrition Examination Survey, has collected dietary data and reported on the dietary intake of the US population. Continual innovations are required to improve methods of data collection, quality, and relevance. This review article evaluates the strengths and limitations of current and newer methods in national dietary data collection, underscoring the use of technology and emerging technology applications. We offer four objectives for national dietary surveillance that serve as guiding principles in the evaluation. Moving forward, national dietary surveillance must take advantage of new technologies for their potential in enhanced efficiency and objectivity in data operations while continuing to collect accurate dietary information that is standardized, validated, and publicly transparent.

Comparing Two Days of Dietary Intake in What We Eat in America (WWEIA), NHANES, 2013-2016.

The objective of this research is to compare the Day 1 and Day 2 dietary intakes of adults in What We Eat in America, National Health and Nutrition Examination Survey (WWEIA, NHANES) 2013-2016. Dietary recalls of males (n = 2599) and females (n = 2624) 20+ years who had both a Day 1 and Day 2 recall and reported their intake as usual on both days in WWEIA, NHANES 2013-2016 were examined. Mean (±SE) energy intake for males was 2425 ± 26 kcal for Day 1 and 2334 ± 32 kcal for Day 2 (p = 0.004). For females, 1832 ± 18 kcal and 1775 ± 26 kcal were reported for Day 1 and 2, respectively (p = 0.020). There were no significant differences between energy intake on Day 1 and Day 2 within males and females by ten-year age groups. Comparing 20 year age groups for males and females by race/ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic) and income (<131%, 131-350%, and >350% of poverty level) also showed no significant differences in energy intake between Day 1 and Day 2. Mean energy intake of adults was not statistically different between the two days of recall by sex, race/ethnicity or income within selected age groups. Overall, the difference in energy intake was less than 4% for both males and females.

Fruit and Vegetable Consumption of US Adults by Level of Variety, What We Eat in America, NHANES 2013-2016.

BACKGROUND: Dietary guidance encourages consuming a variety of fruit and vegetables (FVs), which has been associated with higher FV intake and nutrient adequacy. Dietary intake of adults in the United States has not been described in the context of variety. OBJECTIVES: The objective of this study was to describe FV consumption of adults in the United States by level of FV variety. METHODS: One day of dietary intake data of adults aged ≥20 y (n = 10,064) in What We Eat in America, NHANES 2013-2016 were used. FV variety was the count of foods consumed that contributed to total FV intake. Each FV was counted only once; a mixed dish counted as 1. Variety levels were high (≥5 items, n = 2316); moderate (3-4 items, n = 3423); or low (1-2 items, n = 3746). Differences between each level of variety were compared by t test. RESULTS: Among the low, moderate, and high levels, total FV intakes were 1.4, 2.6, and 4.4 cup equivalents (CE), respectively. CE amounts of FVs consumed were 0.3, 0.6, and 1.4 of vegetables excluding potatoes; 0.2, 0.3, and 0.3 of potatoes; 0.3, 0.6, and 1.2 of fruit; and 0.4, 0.4, and 0.5 from mixed dishes, respectively; percentages of each level reporting intake were 34%, 64%, and 89% for vegetables excluding potatoes; 23%, 34%, and 32% for potatoes; 22%, 49%, and 75% for fruit; and 72%, 71%, and 72% for mixed dishes, respectively. CONCLUSIONS: Those with more variety of FV intake include whole FVs more frequently and in higher amounts. These results support suggestions for encouraging more FVs at snacks and as side dishes and salads at meals to increase total intake.

A New Database Facilitates Characterization of Flavonoid Intake, Sources, and Positive Associations with Diet Quality among US Adults.

BACKGROUND: Epidemiologic studies demonstrate inverse associations between flavonoid intake and chronic disease risk. However, lack of comprehensive databases of the flavonoid content of foods has hindered efforts to fully characterize population intakes and determine associations with diet quality. OBJECTIVES: Using a newly released database of flavonoid values, this study sought to describe intake and sources of total flavonoids and 6 flavonoid classes and identify associations between flavonoid intake and the Healthy Eating Index (HEI) 2010. METHODS: One day of 24-h dietary recall data from adults aged ≥ 20 y (n = 5420) collected in What We Eat in America (WWEIA), NHANES 2007-2008, were analyzed. Flavonoid intakes were calculated using the USDA Flavonoid Values for Survey Foods and Beverages 2007-2008. Regression analyses were conducted to provide adjusted estimates of flavonoid intake, and linear trends in total and component HEI scores by flavonoid intake were assessed using orthogonal polynomial contrasts. All analyses were weighted to be nationally representative. RESULTS: Mean intake of flavonoids was 251 mg/d, with flavan-3-ols accounting for 81% of intake. Non-Hispanic whites had significantly higher (P < 0.001) intakes of total flavonoids (275 mg/d) than non-Hispanic blacks (176 mg/d) and Hispanics (139 mg/d). Tea was the primary source (80%) of flavonoid intake. Regardless of whether the flavonoid contribution of tea was included, total HEI score and component scores for total fruit, whole fruit, total vegetables, greens and beans, seafood and plant proteins, refined grains, and empty calories increased (P < 0.001) across flavonoid intake quartiles. CONCLUSIONS: A new database that permits comprehensive estimation of flavonoid intakes in WWEIA, NHANES 2007-2008; identification of their major food/beverage sources; and determination of associations with dietary quality will lead to advances in research on relations between flavonoid intake and health. Findings suggest that diet quality, as measured by HEI, is positively associated with flavonoid intake.

Difference in adult food group intake by sex and age groups comparing Brazil and United States nationwide surveys.

BACKGROUND: International comparisons of dietary intake are an important source of information to better understand food habits and their relationship to nutrition related diseases. The objective of this study is to compare food intake of Brazilian adults with American adults identifying possible dietary factors associated with the increase in obesity in Brazil. METHODS: This research used cross-national analyses between the United States and Brazil, including 5,420 adults in the 2007-2008 What We Eat In America, National Health and Nutrition Examination Survey and 26,390 adults in the 2008-2009 Brazilian Household Budget Survey, Individual Food Intake. Dietary data were collected through 24 h recalls in the U.S. and through food records in Brazil. Foods and beverages were combined into 25 food categories. Food intake means and percentage of energy contribution by food categories to the population's total energy intake were compared between the countries. RESULTS: Higher frequencies of intake were reported in the United States compared to Brazil for the majority of food categories except for meat, rice and rice dishes; beans and legumes; spreads; and coffee and tea. In either country, young adults (20-39 yrs) had greater reports of meat, poultry and fish mixed dishes; pizza and pasta; and soft drinks compared to older adults (60 + yrs). Meat, poultry and fish mixed dishes (13%), breads (11%), sweets and confections (8%), pizza and pasta (7%), and dairy products (6%) were the top five food category sources of energy intake among American adults. The top five food categories in Brazil were rice and rice dishes (13%), meat (11%), beans and legumes (10%), breads (10%), and coffee and tea (6%). Thus, traditional plant-based foods such as rice and beans were important contributors in the Brazilian diet. CONCLUSION: Although young adults had higher reports of high-calorie and nutrient-poor foods than older adults in both countries, Brazilian young adults did not consume a diet similar to Americans, indicating that it is still possible to reverse the current trends of incorporating Western dietary habits in Brazil.

A comparison of two systems for entering and assessing dietary data for a research study.

To reduce the cost of analyzing dietary data for research studies, we evaluated the accuracy of an entry and assessment system that could be used by trained food and nutrition professionals who did not routinely perform this type of task. We compared intakes from 24-hour recalls for 175 adult women and 185 schoolchildren using two methods for entry of dietary data. For the standard method, registered dietitians who routinely evaluate dietary data entered the recalls using a professional data entry program, RapidCalc. For the second method, other food and nutrition professionals were trained by the registered dietitians to use the Pacific Tracker program, a consumer-friendly dietary assessment system. Both programs use the same food composition table. Mean food group and nutrient intakes were similar for the two methods, differing by <10% on average for both adults and children. Correlations were also high, ranging from 0.77 to 0.96 for the women and from 0.76 to 0.94 for the children. For adults and children combined, mean energy intakes were remarkably close, at 2,067 kcal/d for RapidCalc and 2,072 kcal/d for Pacific Tracker, although absolute differences in energy intakes were >300 kcal/d for 23% of the women and 30% of the children. Costs are much lower with the Pacific Tracker method, unless the fees for the standard method are subsidized. We conclude that the Pacific Tracker method provides an accurate and cost-effective method of dietary data entry for research purposes.

Contribution of dietary supplements to nutrient adequacy among children in Hawaii.

OBJECTIVES: To quantify the use of dietary supplements over a 24-hour and 1-month time frame, to determine the contribution of dietary supplements to the prevalence of dietary nutrient adequacy in the population, and to identify factors associated with supplement use, including characteristics of caregivers. DESIGN: Cross-sectional study. SUBJECTS/SETTING: Children aged 8 to 11 years from four primarily Native Hawaiian and Pacific Islander communities on Oahu (n=115) and the island of Hawaii (n=70). METHODS: A 24-hour food recall and a dietary supplement record were collected and analyzed for each child. Demographic and supplement use data were collected for each caregiver. STATISTICAL ANALYSES: Significant differences between supplement users and nonusers were determined by chi(2) analysis. Prevalence of dietary nutrient adequacy with and without intake from dietary supplements was calculated using PC-Side software (version 1.02, 2001, Department of Statistics and Center for Agricultural and Rural Development, Iowa State University, Ames). RESULTS: Use of any dietary supplement by children in the previous day and month was 26% (n=48) and 40% (n=74), respectively. Prevalence of dietary nutrient adequacy from foods alone ranged from 33% to 100%, and increased to 59% to 100% when the nutrient contribution from dietary supplements was included. The largest increases in nutrient adequacy were for vitamins A, E, and C. Use of dietary supplements was most strongly associated with use of dietary supplements by caregivers, as well as with younger age of child, and greater years of caregiver education. CONCLUSIONS: Dietary supplements are being used by a large percentage of these children in Hawaii and use is associated with use by their caregivers. The nutrient contribution from dietary supplements increased the prevalence of nutrient adequacy for several nutrients.

Nutrient intake from multivitamin/mineral supplements is similar among users from five ethnic groups: the Multiethnic Cohort Study.

A multivitamin/mineral supplement is the most widely used type of dietary supplement among American adults. Therefore, accurate assessment of intake from this supplement is crucial when studying diet and chronic diseases. From 1999 to 2001, the Multiethnic Cohort Study collected detailed information on multivitamin/mineral use among five ethnic groups: African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites. Daily nutrient intakes from multivitamin/minerals were calculated using the nutrient composition specified on the product label. For reported supplements with insufficient detail to match to a specific product, default nutrient profiles were assigned. Multivitamin/mineral use was reported by 50% of the participants (38% for Native Hawaiians to 57% for whites). Default profiles were assigned for 38% of users. The median daily nutrient intakes from multivitamin/minerals among users (n=75,865) were well above the Recommended Daily Allowance or Adequate Intake for vitamins A, B-6, B-12, and E, thiamin, riboflavin, niacin, pantothenic acid, folate, and zinc. Although nutrient intakes from multivitamin/minerals varied widely among individuals, there was no substantial difference in the median intake across ethnic groups. To accurately estimate nutrient intakes from multivitamin/minerals, detailed information on the product consumed should be collected. When detailed information is not available, the same default nutrient profiles can be used when estimating intakes for these five ethnic groups.

The Pacific Tracker (PacTrac): Development of a dietary assessment instrument for the Pacific.

The Pacific Tracker (PacTrac) is a new dietary assessment program that can be used to evaluate dietary data for nutrition studies in the Pacific Islands. PacTrac is a modification of the Interactive Healthy Eating Index (IHEI) developed by the US Department of Agriculture's Center for Nutrition Policy and Promotion as an online interactive dietary assessment tool for use by the public. Creation of PacTrac required several modifications to the IHEI, including a function to save data to allow for later access and addition of Pacific Island foods. Sources for Pacific Island foods included the Cancer Research Center of Hawaii (CRCH) Food Composition Table (FCT) and recipes from Guam and the Commonwealth of the Northern Mariana Islands (CNMI). Initially, 344 foods in the CRCH FCT were added to the IHEI. Feedback from pilot sessions indicated it was too large and therefore difficult to navigate. Therefore, we removed the original IHEI database (over 7000 foods) and replaced it with the CRCH FCT (2778 foods) plus 85 recipes from Guam and 40 recipes from CNMI. We are currently using PacTrac to evaluate dietary data in Hawaii, Guam and CNMI.