Nutrition and Health surveys/nutrition monitoring; Epidemiology Chapters 4 & 6

Epidemiology “the study of the distribution and determinants of health-related states and events in specified populations and the application of this study to control of health problems”

Basic Concepts Risk “likelihood that people who are without a disease, but exposed to certain risk factors, will acquire the disease at some point in their lives”

Relative risk “Measure of how much a particular risk factor influences the risk of a specified outcome”

Incidence “the proportion of group initially free of a disease that develops the disease over a period of time”

Prevalence “the proportion of a group possessing a disease at a specific time”

Types of Epidemiologic Studies Ecological or Correlational Studies  Compare the frequency of events in different populations with the per capita consumption of certain dietary factors.  Dietary data collected in this type of study are usually disappearance data, which are the figures for food produced for human consumption minus the food that is exported, fed to animals, wasted, or otherwise not available for human consumption. Cross-sectional or Prevalence Studies  Examine the relationships among dietary intake, diseases, and other variables as they exist in populations at a particular time.

Types of Epidemiologic Studies Cohort Studies  A group of people, called a cohort, free from the disease is identified and examined, and then followed for months or even years  Group members are examined periodically to determine which individuals develop the characteristics of interest and which do not. - Retrospective - - Prospective -

Types of Epidemiologic Studies Case-Control Studies Controlled Trials

Nutritional epidemiology The epidemiologic method lends itself to the study of the relationship of diet to health and disease. The method can also be used to:

National nutrition policy - a set of nationwide guidelines that specify how the nutritional needs of the population will be met. - there is no one federal body or agency with its sole mandate to establish, implement, and evaluate national nutrition policy. U.S. national nutrition policy  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.

Why monitor nations health and nutritional status? 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:

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 The nation’s first comprehensive survey (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.

Types of data Primary data: relate directly to the population served; often collected by the acting agency itself Secondary data: relate to already existing data in either published or unpublished form

National Nutrition Monitoring System NNMRRP = National Nutrition Monitoring and Related Research Program

NNMRRP Goals Collect, analyze, and disseminate data… Establish baseline data and uniform standards Provide data to evaluate proposed policy changes

NNMRRP Goals Provide scientific foundation for improving nutritional status and quality of food supply Identify high risk groups to aid program planning

National Nutrition Monitoring System Federally mandated collection and analysis of data on:  national food ______  Food ___________  food and nutrient ___________  consumer knowledge, attitudes, behaviors  nutritional/health status

National Food Supply U.S. Food Supply Series Quantities available per capita of:  USDA

Food Composition USDA Nutrient Data Base Used for:   USDA

Food & Nutrient Consumption Ten State Survey Nationwide Food Consumption Survey (NFCS) Continuing Survey of Food Intakes by Individuals (CSFII)  USDA Fruits & Veggies — More Matters (5 A Day for Better Health)  NCI…

KAB Assessments Behavioral Risk Factor Surveillance System (BRFSS) designed to examine trends over time. States can readily address urgent and emerging health issues. 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  CDC Youth Risk Behavior Survey (YRBS) Diet and Health Knowledge Survey (DHKS)

Nutrition and Health Status National Health and Nutrition Examination Surveys (NHANES I, II, III) “What we eat in America” (integration of NHANES & CSFII) Hispanic Health and Nutrition Examination Survey (HHANES)  DHHS Pediatric Nutrition Surveillance System (PedNSS)

Uses of NMRR Data Assessment of dietary intake _________ and _____________ Regulation Food programs and ________ Scientific _________ Historical _______