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

2022 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
Through an ongoing collaboration with the National Center for Health Statistics, Department of Health and Human Services (DHHS), the Food Surveys Research Group (FSRG) has the lead role for dietary data collection and processing of What We Eat in America (WWEIA), the dietary intake component of the National Health and Nutrition Examination Survey (NHANES). Web release of WWEIA, NHANES 2017-March 2020 pre-pandemic data provides the tenth release of national dietary data from this collaboration. The new data provides information on dietary intakes of over 12,600 individuals based on 24-hour dietary recalls weighted to be representative of the population. The corresponding Food and Nutrient Database for Dietary Studies (FNDDS) 2019-2020, used to convert food/beverages consumed in WWEIA, NHANES 2019-March 2020 into gram amounts and to determine their nutrient value, was also released in 2022. The FNDDS includes a 65-nutrient profile for each of more than 5,600 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 new food/beverages in FNDDS 2019-2020 was begun once the FNDDS was final. With each release of the FNDDS, several notable changes to food/beverage codes are 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 2017-2018 and 2019-2020. The crosswalk file identifies codes discontinued, expanded to two or more 2019-2020 codes, or consolidated from multiple codes to a single 2019-2020 code. The availability of a resource to crosswalk appropriate food/beverage code changes 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 the Beltsville Human Nutrition Research Center (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. FNDDS 2019-2020 data files are being prepared for incorporation into FDC with the October 2022 bi-annual update. The Flavonoid Values Database for USDA Survey Foods and Beverages 2017-2018 and the Flavonoid Intakes from Food and Beverages, WWEIA, NHANES 2017-2018 summary table set were completed and released online. Flavonoids, plant-based polyphenolic compounds, may play important roles in promoting health and preventing disease. Although it has been assumed that compliance with established national guidance to eat a diet rich in plant products is likely to result in an abundant intake of flavonoids, it has not been possible to examine this theory in the U.S. population using recent dietary surveillance data because flavonoid content profiles were not available for all foods and beverages reported in the more recent WWEIA, NHANES. With the Flavonoid Values Database for Survey Foods and Beverages in 2017-2018, it is now possible. The Flavonoid Database provides the analytical basis for researchers to quantify dietary flavonoid intakes of the U.S. population and allow further investigation of associations between dietary flavonoid intake and health. It includes estimates of 29 predominant dietary flavonoids categorized into 6 classes. The database release also includes documentation describing the specifics of how the dietary flavonoid profiles were compiled. Analysis of the WWEIA data was completed to construct research articles, dietary data briefs, and scientific presentations on a variety of topics including: role of technologies to advance tradition methods in national food intake assessment, sugar and added sugar intake in the U.S., potassium intake and dietary sources of potassium in the U.S., added sugars intake of adults, adult late evening eating patterns, animal and plant sources of protein intake of adolescents and adults, dietary intakes of the elderly, convenience stores as a source of adult dietary intakes, restaurants as a source of dietary intakes, and flavonoid intakes of individuals.

Accomplishments
1. Release of national dietary survey data - What We Eat in America, NHANES 2017-March 2020. Monitoring dietary intakes is critical to understand nutrition’s implication to health and well-being of Americans. New nationwide dietary intake data, collected in What We Eat in America (WWEIA) for the years 2017-March 2020, were released on the web for public use and the data include information on dietary intakes of over 12,600 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 39 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 (FNDDS) 2019-2020. FNDDS is a food composition database that includes nutrient profiles and associated portions for foods and beverages consumed in What We Eat in America (WWEIA), the dietary intake component of the National Health and Nutrition Examination Survey (NHANES). This version of the FNDDS was used to determine the nutrient values of dietary intakes collected in 2019-March 2020 from WWEIA, NHANES. The database includes descriptions for more than 5,600 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 2019-2020 is accessible from www.ars.usda.gov/nea/bhnrc/fsrg in three formats: Microsoft Access®, SAS®, and Excel®.

3. Release of Flavonoid Values Database for USDA Survey Foods and Beverages 2017-2018. This database provides the amounts of 29 flavonoids, 6 flavonoid classes, and total flavonoids present in 100 grams of each food and beverage in the USDA Food and Nutrient Database for Dietary Studies 2017-2018. The Flavonoid Database corresponds with the 2017-2018 What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey. It provides the analytical basis for researchers to quantify dietary flavonoid intakes of the U.S. population and allows further investigation of associations between flavonoid intake and health. The release also includes a document describing the development of the database and SAS® datasets. The database is accessible from www.ars.usda.gov/ba/bhnrc/fsrg.

4. Release of Flavonoid Intakes from Food and Beverages, WWEIA, NHANES 2017-2018. These summary data tables provide daily mean intakes per individual for 29 individual flavonoids in 6 flavonoid classes grouped by gender and age, race/ethnicity, and annual household income expressed both in dollars and as a percentage of the poverty threshold. What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey 2017-2018 dietary intake data were analyzed for intake of dietary flavonoids. These tables provide users immediate access to comprehensive information concerning U.S. flavonoid intakes. They are of use to policymakers interested in setting national dietary guidance regarding flavonoids, as well as nutrition professionals, and others in need of current population-level information on flavonoid intakes by Americans overall and by specific sociodemographic groups. The data tables are accessible from www.ars.usda.gov/ba/bhnrc/fsrg.

5. Release of six 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 six 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 2015-2018, 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. In 2017-2018, one-third of adults, 20+years, met the Dietary Guidelines for Americans (DGA) recommendation for saturated fat by consuming <10 percent of daily calories from saturated fat. Adults who met the recommendation consumed more whole/intact fruit and 100% fruit juice. Adults who did not meet the recommendation consumed more fluid milk, cheese, meat, cured meat, and eggs. These foods can be appreciable sources of saturated fat. In 2017-2018, 55% of adults reported obtaining foods from restaurants on a given day. This percentage tended to decrease with age and increase as income level increased. These data briefs are accessible from www.ars.usda.gov/nea/bhnrc/fsrg.

Review Publications
Sebastian, R.S., Enns, C.W., Goldman, J.D., Murayi, T., Moshfegh, A.J. 2021. Late evening eating patterns among U.S. adults vary in their associations with, and impact on, energy intake and diet quality: Evidence from What We Eat In America, National Health and Nutrition Examination Survey 2013-2016. Journal of the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2021.11.008.
Vaudin, A.M., Wambogo, E.A., Moshfegh, A.J., Sahyoun, N.R. 2021. Sodium and potassium intake, the sodium to potassium ratio, and associated characteristics in older adults, NHANES 2011-2016. Journal of the Academy of Nutrition and Dietetics. 122:(1):64-77. https://doi.org/10.1016/j.jand.2021.06.012.
Hoy, M.K., Murayi, T., Moshfegh, A.J. 2022. Diet quality of frequent fast-food consumers on non-fast food intake day is similar to a day with fast food. What We Eat In America, NHANES 2013-2016. Journal of the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2022.02.007.
Bowman, S.A. 2021. Methodology for developing a nutrient and food pattern equivalents database for selected branded foods in the USDA National Household Food Acquisition and Purchase Survey-1. Journal of Food Composition and Analysis. 105:104567. https://doi.org/10.1016/j.jfca.2021.104167.
Zimmer, M., Moshfegh, A.J., Vernarelli, J.A., Barroso, C.S. 2021. Participation in the special supplemental nutrition program for women, infants, and children and dietary intake in children: Associations with race and ethnicity. American Journal of Preventive Medicine. https://doi.org/10.1016/j.amepre.2021.10.017.
Bailey, R.L., Stang, J.S., Davis, T., Naimi, T.S., Schneeman, B.O., Dewey, K.G., Donovan, S.M., Novotny, R., Kleinman, R.E., Taveras, E.M., Bazzano, L., Snetselaar, L.G., De Jesus, J., Casavale, K.O., Stoody, E.E., Goldman, J.D., Moshfegh, A.J., Rhodes, D.G., Herrick, K., Koegel, K., Perrine, C., Pannucci, T. 2021. Dietary and complementary feeding practices of U.S. infants, 6-12 months: A narrative review of the Federal nutrition monitoring data. Journal of the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2021.10.017.
Sebastian, R.S., Kuczmarski, M.T.F., Goldman, J.D., Moshfegh, A.J., Zonderman, A.B., Evans, M.K. 2022. Usual intake of flavonoids is inversely associated with metabolic syndrome in African American and white males but not females in Baltimore City, Maryland, USA. Nutrients. 14(9):1924. https://doi.org/10.3390/nu14091924.
Sebastian, R.S., Goldman, J.D., Martin, C.L., Moshfegh, A.J. 2022. Flavonoid Intake from Food and Beverages: What We Eat In America, NHANES 2017-2018 Tables 1-4. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/Services/docs.htm?docid=25102.
Sebastian, R.S., Kuczmarski, M.F., Enns, C.W., Goldman, J.D., Murayi, T., Steinfeldt, L.C., Moshfegh, A.J., Zonderman, A.B., Evans, M.K. 2021. Application of the Flavonoid Database for USDA Food Codes 2007-2010 in assessing differences between the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) Study and WWEIA, NHANES. Journal of Food Composition and Analysis. 104. https://doi.org/10.1016/j.jfca.2021.104124.
Bowman, S.A., Clemens, J.C., Friday, J.E., Anand, J. 2021. Changes in Total Fruit and Fruit Juice Intakes of Individuals: WWEIA, NHANES 2005-2006 to 2017-2018. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/dbrief.
Morton, S., Rhodes, D.G., Moshfegh, A.J. 2021. Convenience Stores: Source of Food/Beverages among Children, What We Eat In America, NHANES 2015-2018. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/dbrief.
Fukagawa, N.K., Mckillop, K.A., Pehrsson, P.R., Moshfegh, A.J., Harnly, J.M., Finley, J.W. 2021. USDA’s FoodData Central: What is it? and why is it needed today? American Journal of Clinical Nutrition. https://doi.org/10.1093/ajcn/nqab397.
Steinfeldt, L.C., Martin, C.L., Clemens, J.C., Moshfegh, A.J. 2021. Comparing two days of dietary intake in What We Eat In America (WWEIA), NHANES, 2013-2016. Nutrients. 13(8):2621. https://doi.org/10.3390/nu13082621.
Hoy, M.K., Murayi, T., Moshfegh, A.J. 2022. Diet quality and food intakes among U.S. adults by level of animal protein intake, What We Eat In America, NHANES 2015-2018. Current Developments in Nutrition. https://doi.org/10.1093/cdn/nzac035.
Bowman, S.A., Clemens, J.C. 2022. Saturated Fat and Food Intakes of Adults: What We Eat In America, NHANES 2017-2018. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/nea/bhnrc/fsrg/wweia/dbrief.