Assessing the Nutritional
Health of Populations
Some Definitions
Joint Nutrition Monitoring Evaluation Committee, 1986
Expert Panel on Nutrition Monitoring, 1989
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
• 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
Nutrition Monitoring in the
United States
Brief Chronology
1909
USDA starts food supply series
1930s
USDA Household food consumption survey started
(changed name to Nationwide FCS)
1968-70
Ten State Nutrition Survey (Nation’s first
comprehensive survey)
1970s
NHANES I and II
Pediatric Nutrition Surveillance System
1980s
Joint Nutrition Monitoring Evaluation Committee with
USDA and DHHS
1980s
Behavioral Risk Factor Surveillance System
1990s
Household Food Security Questions added to Current
Population Survey
1990
Passage of the National Nutrition Monitoring and
Related Research Act
2001
CSFII and NHANES Integrated
Current Efforts
• Nutrition integrated into other systems
such as:
– ECLS
– Ad Health
– ATUS
– National Immunization Survey
• Efforts expanded to include policy
surveillance
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
Nutrition and Related Health
Measurements
• National Health and Nutrition
Examination Surveys
• 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 – now integrated into What
We Eat in America
Knowledge, Attitudes, and
Behavior
• Behavioral Risk Factor Surveillance
System
• Youth Risk Behavior Survey
Food Composition and
Nutrient Data Bases
• National Nutrient Data Bank (NNDB)
Food Supply Determinations
• US Food and Nutrition Supply Series
Federal Assessment of Policies and Practices
Agency
Years
1994, 2000,
School Health Policies CDC, Division of
2006
and Programs Study
Adolescent and
Planned for
School Health
2012
2007, 2009
Survey of Maternity
CDC, Division of
Practices in Infant
Nutrition, Physical
Nutrition and Care
Activity and
(mPINC)
Obesity
Nutrition, Physical
CDC, Division of
Annual
Activity and Obesity
Nutrition, Physical since
Legislative Database Activity and
2001
Obesity
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/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
The Youth Risk Behavior
Surveillance System (YRBSS)
National, State, and Local Data
Purposes of the YRBSS
• Focus the nation on behaviors among
youth causing the most important health
problems
• Assess how risk behaviors change over
time
• Provide comparable data
Behaviors That Contribute to the Leading
Causes of Morbidity and Mortality
• Behaviors that contribute to
unintentional injuries and violence
• Tobacco use
• Alcohol and other drug use
• Sexual behaviors
• Unhealthy dietary behaviors
• Inadequate physical activity
Policy and Program
Applications
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Describe risk behaviors
Create awareness
Set program goals
Develop programs and policies
Support health-related legislation
Seek funding
Characteristics of the National, State,
and Local School-Based YRBS
• 9th – 12th grade students
• Probability samples of schools and
students
• Anonymous
• Self-administered, computer-scannable
questionnaire or answer sheet
• Completed in one class period (45
minutes)
• Conducted biennially usually during the
spring
Rising Rates of Childhood
Overweight in Lewis County
14
Percent BMI >95%
12
10
8
2002
2004
6
4
2
0
LC 8th
grade
LC 10th
grade
LC 12th
grade
State 10th
grade
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 too small to provide
reliable estimates for many measures and for most
subgroups. Most analyses require 3 years of data for
reliable estimates.
http://www.cdc.gov/nchs/about/major/nhanes/mectour.htm
NHANES – Sample Content
• Chronic disease prevalence and conditions (including
undiagnosed conditions: anemia
– diabetes
– cardiovascular disease
– osteoporosis
– obesity
• full body DXA for body fat as well as bone density
• physical fitness
• Nutrition:
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–
–
–
Food Security
Dietary supplements
Weight history
24 hour dietary recall
NHANES III Anthropometric
Procedures Video
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•
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•
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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
WHAT WE EAT IN AMERICA:
NHANES-CFSII Integration
• Staged integration of the two surveys
• 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)
What We Eat in America
• Food intake data can be linked to health
status data from other NHANES components
• HHS is responsible for the sample design and
data and USDA is responsible for the survey’s
dietary data collection methodology,
maintenance of the database used to code
and process the data, and data review and
processing
History of the Food Security Measurement Project
1990
NMRR Act recommends a standardized mechanism for defining
and obtaining data on the prevalence of food insecurity
1992
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
1996present
Annual Surveys, ERS assumes leadership, others encouraged
to use FSMS
2006
Release of IOM report, “Food Insecurity and Hunger in the
United States: An Assessment of the Measure.”
Sample of Other Population
Surveillance Systems
• Breastfeeding: National Immunization
Survey
• Growth in Low Income Children:
Pediatric Nutrition Surveillance System
– Discontinued in 2011