© 2006 Thomson-Wadsworth Chapter 6 A National Nutrition Agenda for the Public’s Health

© 2006 Thomson-Wadsworth Learning Objectives Describe the relationship of nutrition research and nutrition monitoring to U.S. national nutrition policy. Describe five key components of the National Nutrition Monitoring and Related Research Program. Discuss the Dietary Reference Intakes and explain how they are used to plan and assess diets. Describe appropriate uses of current dietary guidance systems.

© 2006 Thomson-Wadsworth Introduction There has been a paradigm shift in the U.S. from concentrating on eliminating deficiency diseases in the mid 1940s to preventing chronic diseases today.

© 2006 Thomson-Wadsworth National Nutrition Policy National nutrition policy - a set of nationwide guidelines that specify how the nutritional needs of the population will be met. The U.S. does not have such a policy in the sense that there is no one federal body or agency with its sole mandate to establish, implement, and evaluate national nutrition policy.

© 2006 Thomson-Wadsworth National Nutrition Policy However, it can be said that the U.S. has a national nutrition policy that manifests itself in the following: –Food assistance programs. –National nutrition and health objectives. –Regulations to safeguard the food supply and ensure safe handling of food. –Dietary guidance systems. –Monitoring and surveillance programs. –Food labeling legislation.

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National Nutrition Monitoring Nations monitor health and nutrition status to decide how to allocate scarce resources, enhance the quality of life, and improve productivity. Nutrition monitoring is a term that includes: –Nutrition assessment –Nutrition monitoring –Nutrition surveillance –Nutrition screening

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Background on Nutrition Monitoring in the United States The U.S. government has been involved in tracking certain elements of the food supply and food consumption for more than 8 decades. The first USDA Household Food Consumption Survey was conducted in the 1930s.

© 2006 Thomson-Wadsworth Background on Nutrition Monitoring in the United States The nation’s first comprehensive survey was the Ten-State Nutrition Survey conducted between 1968 and More recently Congress passed legislation that established the National Nutrition Monitoring and Related Research Program (NNMRRP). –It includes more than 50 surveillance activities that monitor and evaluate the health and nutritional status of the U.S. population.

© 2006 Thomson-Wadsworth The National Nutrition Monitoring and Related Research Program The NNMRRP has the following goals: –Provide scientific foundation for maintenance and improvement of nutrition status and quality of national food supply. –Collect, analyze, and disseminate timely data on nutrition status of population, quality of food supply, food consumption patterns, and consumer knowledge and attitudes.

© 2006 Thomson-Wadsworth The National Nutrition Monitoring and Related Research Program NNMRRP goals (continued): –Identify high-risk groups and geographical areas, as well as nutrition-related problems and trends. –Establish national baseline data and develop and improve standards, methods, criteria, policies, and procedures for nutrition monitoring. –Provide data for evaluating the implications of changes in agricultural policy related to food production, processing, and distribution.

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The National Nutrition Monitoring and Related Research Program Nutritional Status and Nutrition- Related Health Measurements –National Health and Nutrition Examination Survey (NHANES I) –NHANES II –Hispanic Health and Nutrition Examination Survey (HHANES) –NHANES III

© 2006 Thomson-Wadsworth The National Nutrition Monitoring and Related Research Program Current NHANES

© 2006 Thomson-Wadsworth Overview of the Multiple-Pass Method for 24-Hour Dietary Recalls

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The National Nutrition Monitoring and Related Research Program Food and Nutrient Consumption –Continuing Survey of Food Intakes by Individuals (CSFII), 1985 and 1986 –Continuing Survey of Food Intakes by Individuals (CSFII), , , and 1998 –Total Diet Study

© 2006 Thomson-Wadsworth The National Nutrition Monitoring and Related Research Program Knowledge, Attitudes, and Behavior Assessments –Gather data on weight loss practices and the public’s knowledge about the relationship of diet to health problems. –Behavioral Risk Factor Surveillance System (BRFSS) –Weight Loss Practices Survey

© 2006 Thomson-Wadsworth The National Nutrition Monitoring and Related Research Program Food Composition and Nutrient Databases –National Nutrient Data Bank –Nutrient Database for Standard Reference –Survey Nutrient Database

© 2006 Thomson-Wadsworth The National Nutrition Monitoring and Related Research Program Food Supply Determinations –Examine the nutrient content of the available food supply –Provide an estimate of the nutrient content of the food supply on a per capita basis

© 2006 Thomson-Wadsworth Measuring Health Risks Among Adults: CDC’s Unique Surveillance System BRFSS questions focus on: –Not getting enough physical activity –Eating a high-fat, low-fiber diet –Using tobacco and alcohol –Not getting medical care that is known to save lives e.g. mammograms, Pap smears, colorectal cancer screening, and flu shots

© 2006 Thomson-Wadsworth Measuring Health Risks Among Adults: CDC’s Unique Surveillance System State and local health departments rely heavily on data from the BRFSS to: –Determine priority health issues –Identify populations at highest risk for morbidity –Develop strategic plans –Target prevention programs –Monitor the effectiveness of interventions –Monitor progress in meeting prevention goals

© 2006 Thomson-Wadsworth Measuring Health Risks Among Adults: CDC’s Unique Surveillance System State and local health departments rely heavily on data from the BRFSS to (continued): –Educate the public, the health community, and policy makers about disease prevention –Support community policies that promote health and prevent disease

© 2006 Thomson-Wadsworth Measuring Health Risks Among Adults: CDC’s Unique Surveillance System The BRFSS data can be analyzed according to: –Age –Sex –Education –Income –Race –Ethnicity

© 2006 Thomson-Wadsworth Measuring Health Risks Among Adults: CDC’s Unique Surveillance System The BRFSS is designed to examine trends over time. States can readily address urgent and emerging health issues.

© 2006 Thomson-Wadsworth Uses of National Nutrition Monitoring Data The primary purpose of national nutrition monitoring activities is to obtain the information needed to ensure a population’s adequate nutrition.

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Nutrient Intake Standards The Food and Nutrition Board (FNB) was established in 1940 to: –Study issues of national importance pertaining to the safety and adequacy of the nation’s food supply. –Establish principles and guidelines for adequate nutrition. –Render authoritative judgment on the relationships among food intake, nutrition, and health.

© 2006 Thomson-Wadsworth Dietary Reference Intakes (DRIs) Dietary recommendations by the FNB address dietary inadequacies and excesses and are intended to be used with the Dietary Reference Intakes (DRIs) in planning optimal diets.

© 2006 Thomson-Wadsworth Dietary Reference Intakes (DRIs) DRIs are nutrient goals to be achieved over time and can be used in a variety of ways: –To set standards for food assistance programs and for licensing group facilities such as daycare centers. –To design nutrition education programs. –To develop new food products.

© 2006 Thomson-Wadsworth Dietary Reference Intakes (DRIs) DRIs include: –EAR –RDA –AI –EER –AMDR –UL

© 2006 Thomson-Wadsworth Dietary Reference Intakes (DRIs) Estimated Average Requirement (EAR) –The amount of a nutrient that is estimated to meet the requirement for the nutrient in half of the people of a specific age and gender. –The EAR is used in setting the RDA.

© 2006 Thomson-Wadsworth Dietary Reference Intakes (DRIs) Recommended Dietary Allowance (RDA) –The average daily amount of a nutrient that is sufficient to meet the nutrient needs of 97-98% of healthy individuals of a specific age and gender.

© 2006 Thomson-Wadsworth Dietary Reference Intakes (DRIs) Adequate Intake (AI) –The average amount of a nutrient that is assumed to be adequate for individuals when there is not sufficient scientific research to calculate an RDA. –The AI exceeds the EAR and possibly the RDA.

© 2006 Thomson-Wadsworth Dietary Reference Intakes (DRIs) Estimated Energy Requirement (EER) –The average calorie intake that is predicted to maintain energy balance in a healthy adult of a defined age, gender, weight, height, and level of physical activity, consistent with good health.

© 2006 Thomson-Wadsworth Dietary Reference Intakes (DRIs) Acceptable Macronutrient Distribution Range (AMDR) –A range of intakes for a particular energy source (carbohydrates, fat, protein) that is associated with a reduced risk of chronic disease while providing adequate intakes of essential nutrients.

© 2006 Thomson-Wadsworth Dietary Reference Intakes (DRIs) Tolerable Upper Intake Level (UL) –The maximum amount of a nutrient that is unlikely to pose any risk of adverse health effects to most healthy people. –The UL is not intended to be a recommended level of intake.

© 2006 Thomson-Wadsworth Dietary Reference Intakes (DRIs) Compared with the RDAs, the DRIs represent a major shift in thinking about nutrient requirements for humans from prevention of nutrient deficiencies to prevention of chronic disease.

© 2006 Thomson-Wadsworth Dietary Recommendations of Other Countries and Groups The Food and Agriculture Organization/World Health Organization (FAO/WHO) recommendations are considered sufficient for the maintenance of health in nearly all people.

© 2006 Thomson-Wadsworth Dietary Recommendations of Other Countries and Groups FAO/WHO recommendations: –Assume a protein quality lower than that consumed in the U.S. and set a higher intake for protein. –Take into consideration that people worldwide are generally smaller and more physically active than the U.S. population.

© 2006 Thomson-Wadsworth Nutrition Survey Results: How Well Do We Eat? The answer to this question is mixed because the U.S. population is well nourished and we are also generally over-fat, under-exercised, and beset to some extent with nutrient deficiencies. The overall dietary pattern for the U.S. population based on NHANES III data was 52% of energy from carbohydrate, 15% energy from protein, and 33% energy from fat.

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Nutrition Survey Results: How Well Do We Eat? The USDA Healthy Eating Index is a summary measure of overall diet quality as compared to: –The Dietary Guidelines for Americans –The food guidance system

© 2006 Thomson-Wadsworth HEI Component Mean Scores,

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Nutrition Survey Results: How Well Do We Eat? Current findings indicate that groups with lower-quality diets include: –15-18 year old males –Non-Hispanic blacks –Low-income groups –Those with a high school education or less have lower quality diets

© 2006 Thomson-Wadsworth Dietary Guidance Systems Dietary Guidelines for Americans –Focus on overall nutrient intake and daily eating patterns. –Must be revised every five years. –The current version emphasizes: Adequate nutrients within calorie needs Weight management Physical activity

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Dietary Guidance Systems Other Government Dietary Guidelines Non-government Dietary Recommendations –A variety of non-government dietary recommendations have been issued by nonprofit health organizations, such as the American Heart Association and American Cancer Society.

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Dietary Guidance Systems Food Intake Patterns/Food Group Plans –Most recent USDA food intake pattern, called MyPyramid, was released in

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Implementing the Recommendations: From Guidelines to Groceries The challenge today is helping consumers put the dietary recommendations into practice. This requires translating the recommendations into food- specific guides that consumers can use in their homes, in grocery stores, and in restaurants.

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Implementing the Recommendations: From Guidelines to Groceries Many decisions made by community nutritionists are opportunities for making and implementing policy.

© 2006 Thomson-Wadsworth Implementing the Recommendations: From Guidelines to Groceries Opportunities exist for community nutritionists to serve as liaisons between policy makers and the general public in areas related to: –Medicare reform –Reimbursement for medical nutrition therapy –Food and supplement labeling requirements –New science-based dietary guidelines –Market forces in the health care field –Food industry

© 2006 Thomson-Wadsworth Implementing the Recommendations: From Guidelines to Groceries Policy Making in Action

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Implementing the Recommendations: From Guidelines to Groceries Policy Making Does Not Stand Still

© 2006 Thomson-Wadsworth Evaluating Research and Information on Nutrition and Health

© 2006 Thomson-Wadsworth Evaluating Research and Information on Nutrition and Health Where is the study published? –Should be published in a peer- reviewed journal. How recent is the study?

© 2006 Thomson-Wadsworth Evaluating Research and Information on Nutrition and Health What research methods were used to obtain the data? –Epidemiologic studies - examine populations to determine food patterns and health status over time. –Intervention studies - examine the effects of a specific treatment or intervention on a particular group of subjects and compare the results to a similar group of people not receiving the treatment.

© 2006 Thomson-Wadsworth Evaluating Research and Information on Nutrition and Health What was the size of the study? –Studies must generally include a sufficiently large number of people, such as 50 or more in intervention studies. Who were the subjects? –The more you have in common with the participants, the more pertinent the study results may be for you.

© 2006 Thomson-Wadsworth Evaluating Research and Information on Nutrition and Health Does a consensus of published studies support the results reported in the news? –Findings cannot be considered definitive until they have been confirmed by other research.

© 2006 Thomson-Wadsworth Evaluating Research and Information on Nutrition and Health CARS Checklist - one method for determining whether the information found on the Internet is reliable and of good quality.

© 2006 Thomson-Wadsworth Evaluating Research and Information on Nutrition and Health CARS Checklist –Credibility - Check the credentials of the author or sponsoring organization. –Accuracy - Check to ensure that the information is current, factual, and comprehensive. –Reasonableness - Evaluate the information for fairness, balance, and consistency. –Support - Check to see whether supporting documentation is cited for scientific statements.

© 2006 Thomson-Wadsworth Evaluating Research and Information on Nutrition and Health The following red flags can help you spot a quack: –The promoter claims that the medical establishment is against him or her and that the government won’t accept this new “alternative” treatment. –The promoter uses testimonials and anecdotes from satisfied customers to support claims. –The promoter uses a computer-scored questionnaire for diagnosing “nutrient deficiencies.”

© 2006 Thomson-Wadsworth Evaluating Research and Information on Nutrition and Health Red flags (continued): –The promoter claims that the product will make weight loss easy. –The promoter promises that the product is made with a “secret formula” available only from this one company. –The treatment is offered only in the back pages of magazines, over the phone, or by mail-order solicited by ads in the form of news stories or infomercials.