Senator George McGovern of the Senate Select Committee on Nutrition and Human Needs
In order to set public health nutrition policy and make recommendations, we first need to know what nutritional and health status of the public as well as identify relationships between nutrition and disease. Data used to determine nutrition and health policies.
First get the client to give a quick run down of what they ate in the last 24 hours. Then probe for any forgotten foods. Identify the time of the meal and occasion. Get more details. Was it diet soda or regular? What type of milk?
The U.S. does not have a formal nutrition policy. No single entity overseas nutrition policy. The NNMRRP is made up of over 50 surveillance systems and was developed in the early 1990’s as a comprehensive program to coordinate federal nutrition monitoring.
In addition to monitoring peoples intakes and behaviors, we also want to know what is in foods. USDA maintains the primary database of food composition. This database is typically used by most nutrient composition analysis software program. The FDA and USDA work together to monitor nutrition labeling on food packages. Manufacuterers data may be added to database to allow for more data.A major problem with food databases is that they can be incomplete or outdated quick when new foods come on to the market. They may also not have good information on ethnic foods, lack data on bioavailability, phytonutrient composition.
The BHS looked at CVD risk factors in children and whether or not these risk factors tracked throughout life. It has led to the understanding of how CVD develops and determining appropriate cholesterol levels in children. Findings from this study and others like it have served as the basis for dietary recommendations for children including the ADA position paper on nutrition for children and lastly changes in childrens’ diets over the last 30 years.
Wanted to find a typical American town with a stable population. At that time little was known about the causes and risks for atherosclerosis. Started out with a few thousand people in Framingham, MA and followed them over a period of time to see who developed atherosclerosis and who didn’t. Researchers collected base line data on diet and lifestyle behaviors. Findings of this study have served as the basis for health policy and dietary guidelines over the years.
Best if double blind placebo controlled. Tend to be expensive and therefore short-term and small sample sizes.
In the late 90’s the Dietary Reference Intakes began to replace what was previously known and US Recommended Daily Allowances. As you can see here there are 4 components to the DRIs.EAR – estimated average requirement – meets at least 50% of peoples needs. RDA – recommend daily allowance – meets 98% of peoples needs.AI – adequate intake – set high enough to meet almost 100% of peoples needs.UL – upper limit – level at which the nutrient may become toxic if consumed at this level over the course of several day.
Just because it is non-toxic at the upper limit, does not mean you should push the limit.
1. Lona Sandon, MEd, RDFall 2011
2. Public Health RD Nutrition Monitoring Systems Key Epi Studies DRI’s Dietary Guidelines For Americans MyPyramid The Food Label
3. When were the first Dietary Goals for the U.S. issued?A. 1945B. 1977C. 1980D. 1992
4. Today, public health nutrition programs focus on _____________.A. Nutrient deficienciesB. Nutrient excess
5. 60% of all deaths chronic disease as cause Increased medical cost Lost productivity Largely preventable by modifying lifestyle risk factors
6. • Taste • Conveinence • Availability Understand • Affordability what drives • Ethnic/religiousfood & activity preferences choices • Socioeconomic status • Education level • Shopping habits • Time
7. • Pathophysiology of disease • Genetic impactGet a good • Biotechnology & agriculturegrasp of the • Nutritional sciences biochemistry • Nutrigenomics • Nutritional sciences • Epidemiology & statistics
8. • Resources available • Needs assessment • Program planning How to plan, • Health behavior theory • Social marketingimplement, & • Financial planning assess • Program assessment & programs evaluation • Communication technology & informatics
9. Screening Assessment Surveillance• Identify • 24-hour recall • Continuous nutrition • Food records collection of problems • MyPyramid data• mini nutrition tracker • Used for public assessment • Food photos health policies• Food security journals & tool interventions • MPAS method- • Monitor NHANES effectiveness
10. Quick list Forgotten foods Time & occasion Detailed description Final probe
12. Coordinated effort for nutrition monitoring & health & nutrition assessment Interagency board & advisoryNNMRRP panel Requires Dietary Guidelines every 5 years Any federal policy must be review by USDA & HHS
13. NHANES (USDA & DHHS)Nutrition Started in 1971-74status & health Annual, continuous survey since 1999 Home interview & health exam Assesses health & nutrition status http://www.cdc.gov/nchs/nhanes/a bout_nhanes.htm
14. NHANES (USDA & DHHS)Nutrition National Center for Healthstatus & health Statistics (NCHS) ▪ Sample population design & survey questions Agricultural Research Service (ARS) of USDA ▪ Processes dietary data
15. National Health Interview Survey (NHIS)Nutrition U.S. Census Bureaustatus & health Health status & health care access What We Eat in America Survey 2 day 24 hr recallFood & Consumption behaviorNutrient Intake Nutrition content of diet Automated Multi-pass Method http://www.ars.usda.gov/Services/docs. htm?docid=7711
16. BRFSS (CDC of HHS)Knowledge, http://www.cdc.gov/brfss/ Attitudes, Beliefs All 50 states Behavior & disease risk data
17. BRFSS Data:Knowledge, health status blood cholesterol Attitudes, access to care treatment, Beliefs tobacco dietary fat, fruit & alcohol veg. intake injury control prevention YBRFSS services http://www.cdc.gov weight control /HealthyYouth/yrbs/ Risk behaviors of youths
18. What type of Epi study is NHANES & BRFSS?A. Ecological/correlationalB. Cross-sectionalC. CohortD. Case-controlE. RCT
19. Food Label & Package Survey Food (FLAPS) – FDA & USDAComposition & Nutrient Monitors labeling practices of Databases manufacturers USDA National Nutrient Database for Standard Reference Intakes http://www.nal.usda.gov/fnic/f oodcomp/search/
20. Which of the following are negative implications of using nutrient composition databases?A. Missing ethnic foodsB. New foods on the marketC. Lack bioavailability informationD. Lack phytonutrient compositionE. All of the above
21. Food Supply Series Estimate food/nutrient supply perFood Supply capita using disappearance rates USDA Center for Nutrition Policy & Promotion (CNPP) http://www.cnpp.usda.gov/USFo odSupply.htm Food Supply Database http://188.8.131.52/ifs/Query.ht m
22. Bogalusa Heart Study• Cross-sectional & ~ 30 year prospective• CVD risk in pediatric population & risk into adulthood• Basis of position papers on pediatric nutrition recommendations
23. Framingham Heart Study• Prospective study began in 1948What other study was going&on around this• Determine cause, management, complications ofsame time that was the first to identify the atherosclerosisMediterranean diet & lifestyle pattern as• Identified HTN, smoking, & high cholesterol as risk factorscardio protective and who’s lead researcher• Introduced idea of biological, environmental, &also created the K-ration for WWII para- behavioral risk factors for diseasetroopers?• Off-spring of original cohort continue to be followed
24. DASH trials• RCT to determine impact of nutrients on blood pressure• Diets prepared in metabolic kitchen• Control diet; high fruit & veggie diet; or F/V, low fat dairy, low sat & total fat, & cholesterol• Sodium & calories held constant in 1st study
25. CARET & ATBC studies• Premise based on epi data that showed fruit & veggies high in vitamin A may reduce cancer risk• Gave smokers high dose beta-carotene• Actually increased lung cancer• Lesson learned – not good advice to make blanket recs for high dose supplements
26. We are not rats Genetics are similar Can carefully craft the diet Short lifespan Can be sacrificed More easily identify mechanisms
27. Nations health improvement agenda Vision, mission, & goals http://www.healthypeople.gov/2020/about/d efault.aspx Align goals/objectives with nutrition program planning http://www.healthypeople.gov/2020/default.aspx
28. The first set of Recommended Daily Allowances included how many nutrients?A. 5B. 9C. 21D. 40
29. Who determines the standard levels of nutrients we need?A. Dept. Health & Human ServicesB. US Dept. AgricultureC. Institute of Medicine Food and Nutrition BoardD. FDA
30. DRI’s ULEAR RDA AI Food and Nutrition Board. Institute of Medicine. Dietary Reference Intakes: Applications in Dietary Planning. 2003 http://www.nap.edu/catalog/10609.html
31. Median usual intake estimated to meet 50% of healthy individuals needs 50%
32. RDA = EAR + 2 SD If no EAR, then no RDA for a nutrient ~98% Usually > most people need Low probability of inadequate intake
33. Use if no EAR & RDA Assumed to be adequate Set to meet or exceeds the needs of a healthy population Use as a guide for intake Indicates need for more research on a nutrient Low probability of inadequate intake
34. Highest tolerable daily intake considered safe Unlikely risk of toxicity at UL Does not mean people should take this much More is not always better
35. What is the RDA for Ca++?A. 800 mgB. 1000 mg Adults 19-50C. 1300 mg Children & Adolescents 9 – 18 yrs.D. 2500 mg This is the UL
36. What is the RDA of Fe++ for adult men and women 19-50 years?A. 8 mg MenB. 18 mg WomenC. 45 mg This is the ULD. 50 mg
37. RDA Men RDA Women ULVitamin C 90 mg 75 mg 2000 mgVitamin A 900 RAE (3000 IUs) 700 RAE (2333 3000 RAE (15,000 IUs) IUs)Protein 0.8 g/kgAMDR – Acceptable Macronutrient Distribution Range Pro=10-35%, CHO=45-65%, Fat=20-35%)ESADDI - Estimated Safe and Adequate Daily Dietary Intakes Essential nutrient but we don’t know how much we need
38. CNPP – Center for Nutrition Policy & Promotion The Dietary Guidelines for Americans Promote health Reduce chronic disease Evidence based Updated every 5 years Guides: SNAP, School Lunch, WIC, Elderly Nutrition Program, MyPyramid, etc.
39. Make smart choices from every food group Get the most Find balancenutrition out of between food and your calories activity http://www.cnpp.usda.gov/DietaryGuidelines.htm
40. How much physical activity does the DGs recommend?A. 30 min/d Reduce chronic disease riskB. 60 min/d Manage weight & prevent weight gainC. 90 min/d Weight loss & sustained weight lossD. 150 min/d
41. Which food groups do the DGs recommend people get more of?A. Fruits & vegetablesB. Whole grainsC. Low-fat/non-fat milkD. FatsE. ProteinF. Alcohol
42. What amount of alcohol is considered moderate intake?A. 1 drink/d for womenB. 2 drinks/d for womenC. 2 drinks/d for menD. 3 drinks/d for menE. 14 drinks/wk for men or women
43. How much sodium does the DGs recommend per day?A. 1000 mgB. 1500 mgC. 2300 mgD. 3000 mg
44. Food for YoungChildren 1984 19921916 1940s 2005 1970s 1950s-1960s
45. Image conveys concepts of: Variety – six colored bands Proportionality – band thickness Moderation – narrowing of bands at top Activity – person climbing stairs
47. Intends to grab consumers’ attention with a new visual cue Serves as a reminder for healthy eating, not intended to provide specific messages Linked to food and is a familiar mealtime symbol “My” continues the personalization approach from MyPyramid
48. Nutrition Labeling & Education Act (NLEA) of 1990 Trans fats added in 2006 Regulated by FDA & FTC
49. Foods exempt from labeling Served for immediate consumption – cafeterias, airplanes, food service vendors, side walk vendors Ready to eat – bakery or deli type items Foods shipped in bulk Medical foods Plain coffee, tea, or spices
50. The goal is to stayBELOW 100% of theDV for each of thesenutrients per day.
51. Try to get 100% of the DV for each of these nutrients each day.
52. Based on 2000 kcal diet, 100% of each nutrient Uses old US RDA’s from 1968 for: Vitamin A 5000 IU Vitamin C 60 mg Calcium 1000 mg Iron 18 mg
53. For nutrients without an RDA use DRV’s for: Total fat 65 g Sat fat 20 g Cholesterol 300 mg* CHO 300 g See table 12-6 p. 347 of Krause *Same regardless of Kcal Fiber 25 g** **11.5 g/1000 kcal PRO 50 g Sodium 2400 mg* Potassium 3500 mg*
54. 5% DV or less is Low 20% DV or more is HighNote: no DV for trans fat, sugar, orprotein
55. 30% DV of calcium 1968 RDA 1000 mg 1000 mg x 30% = 300 mgCalcium What about vitamin A? What about vitamin D?
56. Nutrient • Contain 1200 mg of calciumContent Claims • Good source of vitamin C (10-19% of RDI) • Authorized by FDA (p. 39), most rigorousHealth Claims • Soluble fiber & heart disease Qualified • Authorized by FDA, must have qualifying words Claims • Eating nuts may help lower risk of heart disease • No preapproval required Structure • Disclaimer- not evaluated by FDAFunction Claims • Calcium builds strong bones
57. Surveillance Consumer• F/V decrease • DGs risk of Ca • NHANES, USDA • AHA Recs • F/V More• F/V maintain a • BRFSS – less • ACS Recs Matters healthy weight than 21% eat enough F/V Policy/Prof Research Orgs http://www.fruitsandveggiesmorematters.org/
58. Dietary Guidelines Food Specific Behaviors Knowledge or Skill NeededAdequate nutrients 1. Choose a variety of foods 1. Know what foods belongwithin calorie needs from all food groups to which food groups 2. Choose foods low in 1. Know food sources saturated fat, trans fats, 2. Know how to read food cholesterol, added sugar, & labels salt. 3. Know low fat/NAS cooking methods 3. Adopt a balanced eating 1. Utilize Mypyramid pattern within calorie needs planner 2. Utilize DASH diet to plan 1 day meal pattern 3. Calculate calorie needs for activity level
59. Dietary Food Specific Knowledge or Skill NeededGuideline BehaviorsFood safety 1. Wash hands 1. Use warm running water & soap or alcohol before, during & based hand sanitizer. after food 2. Wash for the length of time it takes to sing preparation. the alphabet 2. Keep raw foods 1. Use separate cutting boards & utensils for raw separate from or cooked foods cooked foods. 2. Keep stored foods in sealable containers 3. Store thawing meat on bottom shelf 3. Cook & store 1. Know proper temperatures for cooking meat foods at proper thoroughly temperatures 2. Know proper temperature for reheating foods 3. Know temperature for storing & holding hot or cold foods.
60. Dietary Guideline Food Specific Behaviors Knowledge or Skill (see pg. 34) NeededChoose Choose fiber rich fruits,carbohydrates wisely veggies, & whole grains often Choose & prepare foods/beverages with little added sugar
61. DRIs - research DGs – policy & programs MyPlate – help people eat healthy Food labels – communicate nutrition information
62. RCTs, Cohorts, ProfessionalCross-sectional, Organizations, Case-control, Research Stake- Consumers, Public ecological holders Interest Groups, Studies Industry HP 2020, DGs, BRFSS, Legislation/ MyPyramid, Food Data labels, DASH, NCEP,NHANES, NCHS Resources Policy Fed. Nutr. Programs, Consumer education materials