Research Project: The Role of Dietary and Lifestyle Factors on Nutrition and Related Health Status Using Large-Scale Survey Data

Location: Food Surveys Research Group

2020 Annual Report

Objectives
Objective 1: Determine if adherence to Dietary Guidelines recommendations, such as consuming fruits, vegetables, and whole grains, and limiting added sugars and saturated fat, is associated with fewer health risk factors among the population and population subgroups in What We Eat in America, NHANES. [NP107, C2, PS2B] Objective 2: Establish whether variations in meal patterns, such as meal skipping, eating away from home, and snack and beverage consumption, are associated with diet quality and health risk factors among the population and population subgroups in What We Eat in America, NHANES. [NP107, C2, PS2B] Objective 3: Investigate if flavonoid intake is positively associated with diet quality and negatively associated with cardiovascular health markers and health outcomes among at-risk adults in the NIH Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. [NP107, C2, PS2B]

Approach
Diet-related disease rates have risen in the U.S. over the past two decades. Secular trends in food intake show that a majority of Americans continue to follow unhealthy eating patterns. Progress in reversing these trends requires evidence-based, comprehensive, and coordinated strategies. Two large-scale health surveys conducted by the Federal government--the National Health and Nutrition Examination Survey (NHANES) and the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study--provide extensive data on dietary and health measures. What We Eat in America (WWEIA), the dietary component of NHANES, is the sole source of nationally representative food and nutrient intake data in the U.S. It provides food and nutrient estimates for not only the general population, but also for specific subgroups including low-income individuals, children, and minority populations. The National Institutes of Health-sponsored HANDLS study allow estimation of food and nutrient intake in populations who have been identified as particularly vulnerable to nutrition-related diseases. FSRG scientists, responsible for the dietary methodology used in NHANES and HANDLS, are expertly positioned to utilize data from these surveys to conduct secondary data analyses. Factors related to healthy food choices and dietary patterns available from these studies across gender/age and socio-demographic groups will be analyzed to 1) scientifically evaluate factors related to adherence of Dietary Guideline recommendations, particularly those that many fail to meet, and identify associations with health benefits; 2) comprehensively explore the variety of meal patterns across the population and population subgroups and establish associations with dietary quality and health risk factors; and 3) investigate associations of flavonoid intake with diet quality and cardiovascular health markers and health outcomes among at-risk adults in the unique HANDLS study. The evidence-based knowledge resulting from this research will also inform Federal policy addressing the nutritional well-being of Americans through future nutrition program needs.

Progress Report
Objective 1A. A research manuscript has been prepared for submission to a scientific journal comparing vegetarian and non-vegetarian diets. Results show that the vegetarian dietary pattern was associated with lower intakes of energy, total fat, and sodium and higher intakes of whole grains, legumes, nuts, and intact fruit by adults compared to their counterparts consuming a non-vegetarian diet in 2013-2016. However, when evaluating the dietary patterns by nutrient density estimated per 1,000 calories, the vegetarian diet was more nutrient dense with respect to dietary fiber, calcium, magnesium, potassium, and iron than the non-vegetarian diet. There were no significant differences in the mean Body Mass Index and percentages overweight adult males and females in both groups. Mean serum total cholesterol and HDL-cholesterol were not significantly different between the groups. Objective 1C. Two dietary data briefs were published on added sugars intake of children and adults in 2015-2016. The study showed non-diet soft drinks, fruit drinks, and sports and energy drink were the top sources of added sugars. This study informed grouping of beverages for Objective 1C. In addition, a literature review of beverage consumption of children has been completed and data analysis has begun. Objective 2A. A research manuscript has been prepared for submission comparing dietary intake of foods and nutrients of those who reported consuming a food or beverage from a restaurant to those who did not. Preliminary findings show that restaurant reporters have higher intakes of energy and macronutrients as well as grains, dairy, oils, solid fats, and added sugars. Fruit intake was higher for non-restaurant reporters, and there were no differences in intakes of protein foods and vegetables. Objective 2B. A research manuscript is being prepared for submission describing demographic factors associated with preparing foods at home. In addition to age, gender, income and race/ethnicity, additional characteristics included in the analyses are marital status, length of time in the U.S., family size, presence of children, and working status of families. Objective 2C. A manuscript draft is in preparation comparing dietary intake and diet quality of those who report frequent fast food consumption (3 times or more per week) with infrequent consumers (none in the previous week). On a day when fast food is consumed by frequent consumers, energy intake was higher and diet quality was lower compared to infrequent consumers. On a day when frequent fast food consumers do not consume fast food, energy intake is lower, but diet quality is similar to frequent consumers with fast food intake. A sub-analysis is being conducted to investigate the dietary intake of individuals who reported no fast food intake in the previous year. Objective 2D. A scientific literature review is in progress on nutrition behaviors such as use of nutrition labels associated with demographic and behavioral characteristics, and diet quality. Objective 3A. A paper has been published describing differences in flavonoid intake by race (African American, white) and income in an at-risk population. It found that with the exception of the flavanone class, flavonoid intakes of African Americans were significantly lower than those of whites regardless of other potential mediating factors. However, flavonoid intakes did not differ by income. Objective 3C. Literature review of flavonoid intakes of representative populations and at-risk subgroups has been conducted. Data analysis has been completed. Preliminary findings indicate that relative to a representative sample of the U.S. population, intake of multiple flavonoid classes were lower in the at-risk population. Objective 3D. Scientific literature reviews have been conducted on factors related to cardiometabolic health and flavonoid intake associations with these factors. Data analysis of usual intakes of flavonoids and flavonoid classes in the HANDLS population and selected subgroups has been completed, and will be employed using the appropriate methodologies to investigate flavonoid associations with identified factors of interest. Through an ongoing collaboration with the National Center for Health Statistics, DHHS, the Food Surveys Research Group (FSRG) has the lead role for dietary data collection and processing of What We Eat in America (WWEIA), NHANES. Web release of WWEIA, NHANES 2017-2018 database provides the ninth release of national dietary data from this collaboration. The new data provides information on dietary intakes of over 7,600 individuals based on 24-hour dietary recalls weighted to be representative of the population. The corresponding Food and Nutrient Database for Dietary Studies (FNDDS) 2017-2018, used to convert food/beverages consumed in WWEIA, NHANES into gram amounts and to determine their nutrient value, was also released in 2020. The FNDDS includes a 65-nutrient profile for each of more than 13,000 foods and beverages. In addition to analyzing dietary intakes from WWEIA, the FNDDS is used by nutrition researchers in the U.S. and internationally in their dietary studies. Development of the 37 Food Patterns Equivalents components for all food/beverages in FNDDS 2017-2018 was begun once the FNDDS was final. When the components are completed, the 2017-2018 Food Patterns Equivalents Database will be compiled and publicly released. Training for and data collection of the 2020 WWEIA, NHANES began in January 2020 but was paused in mid-March due to the COVID-19 pandemic. FSRG conducted training sessions and quality control oversight for data collection and coding performed by the NHANES contractor until data collection was paused. FSRG instructed NHANES dietary interviewers on updates and changes in data collection and procedures. The USDA 5-step Automated Multiple-Pass Method (AMPM), the computer-based instrument used to collect 24-hour dietary recalls in WWEIA, has thousands of questions and subsequent response options specific to the variety of foods and beverages consumed in the U.S. These questions, grouped into more than 130 pathways, require review and update. The review and update of questions and response options for 14 pathways was also completed for the 2021 and 2022 data collection years. To ensure that supporting survey food databases are current and reflect changes in the U.S. food market, data for items in selected food and beverage categories were reviewed and revised as appropriate to reflect new items in the market place, changes to current foods in the database, and new portion sizes. With each release of the FNDDS, a number of notable changes to food/beverage codes is made. Such changes to a database maintained over several years are necessary but can pose challenges for researchers, especially those conducting analyses over time or trend analyses. FSRG scientists developed a special crosswalk file of code changes and linkages between FNDDS 2015-2016 and 2017-2018. The crosswalk file identifies codes discontinued, expanded to two or more 2017-2018 codes, or consolidated from multiple codes to a single 2017-2018 code. The availability of a resource to crosswalk appropriate discontinued food/beverage codes between FNDDS versions benefits researchers conducting trend analysis or using the FNDDS to support other food intake databases. The file is available on the FSRG website at www.ars.usda.gov.nea/bhnrc/fsrg. FSRG scientists work collaboratively serving on the FoodData Central (FDC). Principles group within BHNRC providing input on key decisions for maintaining and enhancing FDC. A critical input includes data analysis from WWEIA, NHANES on top reported foods consumed by Americans to inform FDC decision making on foods to analyze for nutrient composition. Another contribution is providing for the incorporation of FSRG’s FNDDS database into FDC to enhance a one-stop web location for all composition databases developed by BHNRC. The WWEIA Food Categories 2017-2018 were developed and released online to provide an application to analyze foods and beverages as consumed in the American diet. Each food and beverage in the national survey is sorted into approximately 150 unique and mutually exclusive food categories. Designed to be flexible, the categories can be combined as necessary to address specific research questions. A new version of the WWEIA Food Categories is produced for each 2-year release cycle of NHANES and available on the FSRG Web site www.ars.usda.gov/nea/bhnrc/fsrg. Uses of the WWEIA Food Categories have included development of food guidance and educational programs, monitoring food intake, and identifying food trends and food/beverage sources of nutrients. FSRG scientists are working with the ERS on a project to improve the food patterns groups and Healthy Eating Index database for the National Household Food Acquisition and Purchase Survey 2 (FoodAPS 2). Two databases of more than 3,600 foods in FoodAPS 1 were researched, compiled, and provided to ERS. Extensive data on nutrients and characteristics to assess DGA recommendations were determined for each food and compiled into these databases. In addition, the ERS Food-at-Home database of 53,000 foods were reviewed to determine foods needing revision. Work is progressing on the revision of more than 13,000 of those foods. Analysis of the WWEIA data was completed to construct research articles, dietary data briefs, and scientific presentations on a variety of topics including: variety of adult fruit and vegetable intake, adult late evening eating patterns, food insecurity and pediatric malnutrition systematic review, added sugars intake of children and adults, late night eating of adolescents, protein intake of adolescents and adults, dietary intakes of the elderly, and convenience stores as a source of adult dietary intakes.

Accomplishments
1. Release of national dietary survey data - What We Eat in America, NHANES 2017-2018. Monitoring dietary intakes is critical to understand nutrition’s implication to health and well-being of Americans. New nationwide dietary intake data, collected in WWEIA for the years 2017-2018, were released on the web for public use and the data include information on dietary intakes of over 7,600 individuals from two nonconsecutive days, 24-hour dietary recalls along with sample weights that can be used to make estimates about dietary intakes of the U.S. population. Select results show that a) 2 out of 3 adults are late evening eaters from 8 pm on with sweets, sandwiches, and beverages the most likely types of foods reported; b) 1 out of 4 adults consume food items from convenience stores on any given day, accounting for nearly 20% of convenience store reporters daily energy intake; and c) more than 1 out of 3 individuals consume a savory snack food such as chips, flavored snacks, popcorn and pretzels on any given day. Linked with health indicators from other components of the NHANES, these data provide stakeholders critical measures to study relationships between nutrient intakes, eating patterns and health conditions. The data and 57 summarized data tables are accessible from www.ars.usda.gov/nea/bhnrc/fsrg.

2. Update and release of the Food and Nutrient Database for Dietary Studies 2017-2018. FNDDS is a food composition database that includes nutrient profiles and associated portions for foods and beverages consumed in WWEIA, NHANES. This version of the FNDDS was used to determine the nutrient values of dietary intakes from What We Eat in America (WWEIA), the dietary intake component of the National Health and Nutrition Examination Survey (NHANES) 2017-2018. The database includes descriptions for more than 7,000 foods/beverages; more than 32,000 weights for common portions; and food energy and 64 nutrient/food components for each of these foods/beverages. This database is a research resource used by to scientists to enhance analysis of WWEIA dietary intakes and in other dietary research studies to determine amounts of nutrients/food components in food and beverages. FNDDS 2017-2018 is available in three formats: as a Microsoft Access® database, as a SAS® dataset, and as Excel® files and are accessible from www.ars.usda.gov/nea/bhnrc/fsrg.

3. Release of national dietary intake estimates as compared to nutrient requirements in summary data table sets. Assessing nutrient intakes of the U.S. population in relation to recommended nutrient requirements provides understanding of how nutrient needs are met across population groups and identifies nutrient shortfalls. Analysis conducted by ARS researchers in the Beltsville Human Nutrition Research Center, Beltsville, Maryland, produced this assessment using data from WWEIA, NHANES 2013-2016. Vitamin C and calcium are two nutrients in which about 1 out of every 3 Americans had inadequate intakes as compared to recommended requirements. This research, summarized in 18 data tables sets that estimate the proportion of individuals not meeting nutrient recommendations, is beneficial to government groups, health and nutrition policymakers, food industry, nutrition researchers, and the public. More specifically, these analyses provided the scientific basis for the 2020 Dietary Guidance Advisory Committee to determine nutrients of concern for the American population. All summarized data tables are accessible from www.ars.usda.gov/nea/bhnrc/fsrg.

4. Release of national estimates in summary dietary data tables. Dietary supplement use in the U.S. continues to increase. Analyzing What We Eat in America (WWEIA), National Health and Nutrition Examination Survey (NHANES) dietary intake and dietary supplement use data is critical to understand the total intake of nutrients from not only food but also dietary supplements. Analysis conducted by ARS researchers in the Beltsville Human Nutrition Research Center, Beltsville, Maryland, produced summarized tables on nutrient intakes from food and beverages and dietary supplements during 2015-2016. Nutrients most commonly included in dietary supplements reported by Americans include calcium, vitamin D, vitamin, vitamin B12, or vitamin B6. These new tables represent a major advance in reporting total intakes that include estimates of nutrient intake from dietary supplements. Data tables summarizing dietary intakes of the U.S. population can readily be used by government groups, nutrition researchers, and the public. All summarized data tables are accessible from www.ars.usda.gov/nea/bhnrc/fsrg.

5. Release of seven dietary data briefs. Analyzing What We Eat in America (WWEIA), National Health and Nutrition Examination Survey (NHANES) dietary intake data to assess how American’s dietary status compares to recommendations provides critical information for nutrition policy and education. Analysis conducted by ARS researchers in the Beltsville Human Nutrition Research Center, Beltsville, Maryland, resulted in seven dietary data briefs on single topics of importance to improving dietary status. The advances in knowledge from these analyses are diverse but important to furthering the understanding of dietary status and eating patterns. In 2015-2016, only about one-third of children and about one-half of adults met the Dietary Guidelines for Americans (DGA) recommendation of limiting added sugars intake to less than 10 percent of daily calories. While the DGA encourage protein intake from plant sources, they accounted for about one-third of protein intakes. In 2013-1016, two-thirds of adolescents reported consuming a food or beverage in the late evening for an average daily increase of about 300 calories as compared to their counterparts. Less than a quarter of adults 71 years of age and older meet the DGA recommendations for vegetables, fruit, and dairy. Convenience stores were found to be an important source for dietary intakes with 1 out of 4 adults consuming a food or beverage from a convenience store on any given day. Among those, about 19% of daily energy intake came from convenience store items. These data briefs are accessible from www.ars.usda.gov/nea/bhnrc/fsrg.

Review Publications
Sebastian, R.S., Enns, C.W., Goldman, J.D., Moshfegh, A.J. 2019. Late evening food and beverage consumption by adolescents in the U.S.: What We Eat in America, NHANES 2013-2016. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/dbrief.
Bowman, S.A., Clemens, J.C., Friday, J.E., LaComb, R.P., Paudel, D., Shimizu, M. 2019. Added Sugars in Adults’ Diet: What We Eat in America, NHANES 2015-2016. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/dbrief.
Bowman, S.A., Clemens, J.C., Friday, J.E., Schroeder, N., LaComb, R.P. 2020. Added Sugars in American Children’s Diet: What We Eat in America, NHANES 2015-2016. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/dbrief.
Martin, C.L., Clemens, J.C., Moshfegh, A.J. 2019. Items Designated as Fortified: Food and Nutrient Database for Dietary Studies (FNDDS), 2015-2016. Journal of Food Composition and Analysis. 84:103255. https://doi.org/10.1016/j.jfca.2019.103255.
Moshfegh, A.J., Goldman, J.D., Rhodes, D.G., Clemens, J.C., LaComb, R.P. 2019. Usual Nutrient Intake from Food and Beverages, Among Race/Ethnicity Groups, What We Eat in America, NHANES 2013-2016. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/usual.
Moshfegh, A.J., Goldman, J.D., Rhodes, D.G., Clemens, J.C., LaComb, R.P. 2019. Usual Nutrient Intake from Food and Beverages, Among Income Groups, What We Eat in America, NHANES 2013-2016. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/usual.
Moshfegh, A.J., Goldman, J.D., Rhodes, D.G., Clemens, J.C., LaComb, R.P. 2020. Total Usual Nutrient Intake from Food, Beverages, and Dietary Supplements, Among Income Groups, What We Eat in America. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/usual.
Moshfegh, A.J., Goldman, J.D., Rhodes, D.G., Clemens, J.C., LaComb, R.P. 2020. Total Usual Nutrient Intake from Food, Beverages, and Dietary Supplements, Among Race/Ethnicity Groups, What We Eat in America. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/usual.
Moshfegh, A.J., Goldman, J.D., Rhodes, D.G., Clemens, J.C., LaComb, R.P. 2020. Total Usual Nutrient Intake from Food, Beverages, and Dietary Supplements, by Gender and Age, What We Eat in America, NHANES 2013-2016. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/usual.
Moshfegh, A.J., Goldman, J.D., Rhodes, D.G., Clemens, J.C., LaComb, R.P. 2020. Usual Nutrient Intake from Food and Beverages and Total Usual Nutrient Intake from Food, Beverages, and Dietary Supplements, by Pregnancy and Lactation Status, What We Eat in America, NHANES 2013-2016. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/usual.
Rhodes, D.G., Clemens, J.C., Goldman, J.D., LaComb, R.P., Moshfegh, A.J. 2019. 2015-2016 What We Eat In America, NHANES Tables 37-40. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/bhnrc/fsrg/wweia/datatables.
Spoede, E., Corkins, M., Spear, B., Becker, P., Gunnell Bellini, S., Hoy, M.K., Piemonte, T.A., Rozga, M. 2020. Food insecurity and pediatric malnutrition related to under- and overweight in the United States: An evidence analysis center systematic review. Journal of the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2020.03.009.
Hoy, M.K., Clemens, J.C., Martin, C.L., Moshfegh, A.J. 2020. Fruit and vegetable consumption of U.S. adults by level of variety, What We Eat in America, NHANES 2013-2016. Current Developments in Nutrition. 4(3). https://doi.org/10.1093/cdn/nzaa014.
Wambogo, E.A., Vaudin, A.M., Moshfegh, A.J., Spungen, J.H., Van Doren, J.M., Sahyoun, N.R. 2020. Towards a better understanding of listeriosis risk among older adults in the United States: Characterizing dietary patterns and the sociodemographic and economic attributes of consumers with these patterns. Journal of Food Protection. 83(7):1208-1217. https://doi.org/10.4315/JFP-19-617.
Morton, S., Rhodes, D.G., Moshfegh, A.J. 2020. Convenience Stores: Source of Food/Beverages among Adults, What We Eat In America, NHANES, 2013-2016. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/dbrief.
Moshfegh, A.J., Goldman, J.D., Anand, J., Clemens, J.C., Enns, C.W., Friday, J.E., Hymes, M.A., LaComb, R.P., Martin, C.L., Morton, S., Rhodes, D.G., Steinfeldt, L.C. 2020. What We Eat in America, NHANES 2017-2018: Documentation and Data Files. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/food-surveys-research-group/docs/wweia-documentation-and-data-sets/.
Steinfeldt, L.C., Martin, C.L., Goldman, J.D., Moshfegh, A.J. 2020. Meeting Dietary Guidelines Recommendations: Older Adults, What We Eat in America, NHANES 2013-2016. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/dbrief.
Hoy, M.K., Clemens, J.C., Moshfegh, A.J. 2020. Protein Intake of Adolescents: What We Eat in America, NHANES 2015-2016. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/dbrief.
Hoy, M.K., Clemens, J.C., Moshfegh, A.J. 2020. Protein Intake of Adults: What We Eat in America, NHANES 2015-2016. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/dbrief.
Rhodes, D.G., Clemens, J.C., Goldman, J.D., Friday, J.E., Moshfegh, A.J. 2020. 2017-2018 What We Eat In America, NHANES Tables 1-36 and 41-56. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/datatables.
Rhodes, D.G., Clemens, J.C., Friday, J.E., Martin, C.L., Moshfegh, A.J. 2020. What We Eat in America Food Categories, 2017-2018. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia_categories.
Rhodes, D.G., Morton, S., Hymes, M.A., Friday, J.E., Martin, C.L., Steinfeldt, L.C., Moshfegh, A.J. 2020. USDA Food and Nutrient Database for Dietary Studies (FNDDS), 2017-2018. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/fndds/download.