1. National Nutrition Monitoring Allison A. Yates & Mary M. Murphy ENVIRON Health Sciences Institute Arlington, VA National Obesity Prevention Conference October 26, 2004

2. National Nutrition Monitoring What is ‘ Nutrition’? Early surveys focused on foods (NFCS) and nutrients (HANES) in recalls –1974, 1980, 1989 RDAs: energy for sedentary individuals –2002: EERs for active individuals, 60 minutes OR THE EQUIVALENT a day of moderately active intensity Nutrition & physical activity are now linked together

3. National Nutrition Monitoring What is ‘Monitoring’? Establishes baseline information Provides a snapshot at a point in time in which variables are quantified Continuous monitoring allows trends to be identified and assessments to be made –Homocysteine and CVD Continued monitoring should allow evaluation of whether interventions are succeeding –Folate fortification and homocysteine

4. National Nutrition Monitoring, 1990 National Nutrition Monitoring Advisory Council, mandated by the NNMA of 1990 –Reported to the secretaries of HHS and USDA –Under the auspices of the Interagency Nutrition Monitoring Subcommittee

5. National Nutrition Monitoring, 1994 National Nutrition Monitoring Advisory Committee, mandated by the NNMA of 1990 –Reported to the secretaries of HHS and USDA –Under the auspices of the Interagency Nutrition Monitoring Subcommittee Combine surveys: NHANES and CSFII

6. National Nutrition Monitoring, 1994 National Nutrition Monitoring Advisory Committee, mandated by the NNMA of 1990 –Reported to the secretaries of HHS and USDA –Under the auspices of the Interagency Nutrition Monitoring Subcommittee Combine surveys: NHANES and CSFII Develop bottom-up (community) rather than top-down (national) ways to collect information

7. National Nutrition Monitoring, 1994 Why begin at the Community level? –So that relevant data will be available to assist communities as well as federal program planners –Obesity prevention is not only a federal issue, but is an issue that must be addressed at every level e.g. Behavior Risk Factor Surveillance System (BRFSS) Nutrition/Diet/Fruits and Vegetables –How often to you usually eat snacks, such as chips or popcorn? 1994 - M, 1993 - M, 1992 - M, 1991 - M, 1990 - M

8. 2002

9. Where Does Obesity Prevention Fit In? Monitoring and assessment of what we know about the environment: Macro-level Population trends –Behavior: Social cues, time management, media –Food pantry: What’s different?? How is the food supply/demand changing?? What choices are people making?? What constitute their ‘diet’?? –Who’s cooking/shopping/making decisions?? –Body image/health consciousness

10. Where Does Obesity Prevention Fit In? Monitoring and assessment of what we know about the environment: Micro-level Physiological responses that predispose to obesity –Hormonal –Fuel sources; is there a difference? –Genetic expression –Role of other nutrients to modulate energy expenditure Role of physical activity in modulating responses Ethnic differences in responses

11. What Is Needed in Surveys? Qualitatively –Descriptive demographic information (by locale, region, all members of a household together to look at relationships; participating in specific intervention programs such as WIC, etc.) –Eating occasion context (alone or with others; family meal; watching TV, driving/riding in car) –New ways of dealing with survey burden –Ways to integrate data gathered across surveys and by different survey groups

12. What Is Needed in Surveys? Quantitatively –Multiple days of intake –Enhanced food composition analysis to allow for new food components when identified –Longitudinal information to track changes –Adequate sample sizes to Maintain privacy yet allow release of all data Allow for statistical analysis of subgroups –Methods to bridge between surveys e.g. NHANES 1999-2000 with current data

13. Goal: Correlate Food Behavior/Intake Information with Health/BMI Status Over Time How many servings of specific foods are typically consumed per day? Do individuals consume foods from more than one use category per day? How does this change over time for one individual? What if the pyramid changes???

14. Next Steps Integrate coordinated data-gathering in the 15 USDA programs Maintain the new NIH, ARS, FNS, ERS, & CREES initiatives in research that integrate intervention with behavioral correlates Legislate adequate funds to implement planned surveys to directly address the issues identified in this conference (NHANES, BRFSS, etc.) Legislate adequate funds to maintain and enhance the nutrient databases and validity testing that underpin the What We Eat in America survey Take action now!