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

2023 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 (NCHS), 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). WWEIA, NHANES 2021-2023 restarted in the summer of 2021 after being paused since March of 2020 due to the COVID-19 pandemic with appropriate adjustments to collection protocols to assure maintaining public health safety of respondents. The methodology for USDA’s Automated Multiple-Pass Method (AMPM) used to collect dietary recalls was updated along with related databases for dietary data coding for the 2021-2023 collection and have been incorporated into the WWEIA collection process for NHANES. FSRG is processing and reviewing dietary data in anticipation of public release of WWEIA, NHANES 2021-2023 in 2024. The AMPM used for WWEIA, NHANES 2021-2023 forms the basis for the foods/beverages and their portion options in the USDA Food and Nutrient Database for Dietary Studies (FNDDS) 2021-2023. The data in FNDDS are used to convert foods/beverages and their amounts reported into gram amounts and determine their nutrient values through calculations. Work is ongoing to develop nutrient profiles for foods added or updated in FNDDS 2021-2023, estimated to be 280 items. An important significant part of that work is incorporating new analytical composition data from USDA FoodData Central (FDC) foundation foods data type publicly released since the prior FNDDS 2019-2020. A new contractor, Research Triangle Inc. (RTI), was named by NCHS in the spring of 2023 for the next decade of NHANES data collection scheduled to begin in 2025. The USDA AMPM will be used for dietary recall collection when that next decade of NHANES begins. FSRG Dietary Intake Data System programs including the AMPM, Post Interview Processing System, and SurveyNet will be used by RTI for the dietary data collection. FSRG is preparing and will conduct training on this system at Beltsville, Maryland, to RTI research staff operating NHANES 2025. FSRG scientists work collaboratively serving on the 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. FNDDS 2019-2020 data files were prepared and incorporated into FDC with the October 2022 bi-annual update. FSRG scientists in collaboration with researchers at the University of Maryland are working on the Recipe Calculator, an application for calculating recipes using data from FDC to determine nutrient profiles for foods and beverages in FNDDS. It is planned that an adaptation of the Recipe Calculator will be tailored for placement on the FDC platform for public access and use. The Nutrients for Dietary Surveillance Project designed to elucidate the scientific basis for nutrients and components to be monitored and reported in U.S. national dietary surveillance was launched. It is anticipated that this project will help to identify priorities for food composition analysis and research. Texas A&M Institute for Advancing Health through Agriculture are working with FSRG on this project. The project will be stakeholder-centered and involve vision, engagement, decision-making, and evaluation. The goals of the project, essential for advancing dietary surveillance and nutrition research, are 3-fold: • conducting a scientific review to identify nutrients and food components that have been reported in the published scientific literature between 2014-2023 using WWEIA, NHANES dietary intake data, • defining scientific-based criteria governing the identification of nutrients and food components to be assessed in national dietary surveillance, and • developing an approach to apply criteria to nutrients and food components for reporting consideration. New food/beverages in FNDDS 2019-2020 were disaggregated into 37 Food Pattern (FP) components defined to assess dietary of individuals compared to the Dietary Guidelines for Americans (DGA). An expert meeting was held with nutritionists representing several Federal agencies (NCI, NCHS, FDA, CNPP, and ERS) to discuss the FSRG approach for development of FPED for Use with WWEIA, NHANES 2017-March 2020. Feedback was affirmative of the approach. Characterizing new food/beverages by FP components allowed for development of the FPED for Use with WWEIA, NHANES 2017-March 2020 Prepandemic database, documentation, and 3 sets of summarized tables reporting 37 Food Patterns components mean intakes by 23 age-gender and socioeconomic subgroups. These estimates provide unique data to evaluate food and beverage intakes of Americans compared to recommendations of the DGA. These research products were peer-reviewed and released on the FSRG website. FSRG scientists continue to provide technical analysis of WWEIA, NHANES data at the request of the 2025 Dietary Guidelines Advisory Council (DGAC), as has been done for past DGACs. Sixty-three analytical data tables have been provided on dietary and nutrient intakes for infants from birth to 24 months of age, pregnant and lactating females, and beverage intakes. FSRG scientist successfully consulted with the National Library of Medicine to index FSRG Dietary Data Briefs on the PubMed platform via Bookshelf, a full text archive of books, reports, databases and other documents related to biomedical, health, and life sciences. Bookshelf publications are publicly available in their entirety and appear in searches along with all other PubMed entries (e.g., journal articles). The result is all FSRG dietary data briefs are indexed on PubMed, the most widely accessed searchable database for biomedical and life sciences research. New dietary data briefs will be added to this platform as soon as they are publicly available on the FSRG website. Analysis of the WWEIA data was completed to construct research articles, dietary data briefs, and scientific presentations on a variety of topics including: impact of fruit and vegetable intake on food and nutrient intake of adults, effect of animal protein intake on meeting recommendations for nutrient intake among adults, animal and plant sources of protein intake of adolescents and adults; dietary intakes of the elderly; development and validation of a physical food security tool for older adults; characterizing lunch and dinner consumption among children, adolescents, and adults; restaurants as a source of dietary intakes; and adult dietary intake and sources of flavonoids.

Accomplishments
1. Release of Food Patterns Equivalents Database for Use with WWEIA, NHANES 2017-March 2020 Prepandemic. The Food Patterns Equivalents Database (FPED) provides the basis to assess diets of individuals compared to the Dietary Guidelines for Americans. FPED was developed by ARS researchers in the Beltsville Human Nutrition Research Center, Beltsville, Maryland. Foods and beverages reported in national dietary surveys have been disaggregated into 37 Food Pattern components and the amounts consumed of those components have been assessed. Three sets of tables have been released on the Web that summarize food and beverage intakes across the 37 Food Pattern components for 23 age-gender and socio-economic groups for national dietary survey data conducted in 2017-March 2020. These estimates provide unique data to evaluate food and beverage intakes of Americans compared to recommendations of the 2020-2025 Dietary Guidelines for Americans. The Food Patterns Equivalents Database (FPED) for Use with WWEIA, NHANES 2017-March 2020 that converts foods reported in the 2017-March 2020 survey years as well as the Methodology and User Guide for FPED were also released on the Web; all are accessible along with the data tables at www.ars.usda.gov/nea/bhnrc/fsrg.

2. Release of five 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 five 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 2017-2018, only 14% of adults fully met the recommendation for consuming 4.5 cup equivalents of fruits and vegetables (FV) per day. Estimated energy intakes significantly decreased with an increase in FV intakes. Meeting FV recommendation was associated with lower energy, macronutrient, saturated fat, and added sugars intakes as well as lower total dairy and total meat, poultry, and seafood intakes. Meeting FV recommendation was also associated with higher vitamins A, C, and K and potassium intakes and lower vitamin B12, phosphorus, zinc, and sodium intakes. 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. Potassium is identified in the 2020-2025 Dietary Guidelines for Americans as a nutrient of concern as it is associated with health benefits but is under consumed by most individuals. In 2017-2018, the average daily potassium intake of the population 2 years and older was 2496 mg. Potassium intake of males 12 years and older was significantly higher than females due to their higher energy intake. Top contributors to potassium intake were Fruits, Vegetables, and 100% Juices (23%), Grain-based Mixed Dishes (15%) and Meats and Poultry (10%). These data briefs are accessible from www.ars.usda.gov/nea/bhnrc/fsrg.

Review Publications
Sebastian, R.S., Martin, C.L., Goldman, J.D., Moshfegh, A.J. 2023. Updating USDA’s flavonoid database to estimate intakes in What We Eat In America, NHANES 2017-2018. Journal of Food Composition and Analysis. https://doi.org/10.1016/j.jfca.2023.105323.
Hoy, M.K., Murayi, T., Moshfegh, A.J. 2022. Effect of animal protein intake on meeting recommendations for nutrient intake among US adults, What We Eat in America, NHANES 2015-2018. Current Developments in Nutrition. https://doi.org/10.1016/j.cdnut.2022.100027.
Bowman, S.A. 2022. Impact of Fruit and Vegetable Intakes on Food and Nutrient 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.
Rhodes, D.G., Morton, S., Moshfegh, A.J. 2022. USDA Food and Nutrient Database for Dietary Studies (FNDDS), 2019-2020 Documentation. 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/fndds-download-databases/.
Sassine, A.J., Rabbitt, M.P., Coleman-Jensen, A., Moshfegh, A.J., Sahyoun, N.R. 2023. Development and validation of a physical food security tool for older adults. Journal of Nutrition. https://doi.org/10.1016/j.tjnut.2023.02.034.
Vaudin, A.M., Moshfegh, A.J., Sahyoun, N.R. 2022. Measuring Food Insecurity in Older Adults Using Both Physical and Economic Food Access, NHANES 2013-2018. Journal of Nutrition. 152(8):1953-1962. https://doi.org/10.1093/jn/nxac058.
Moshfegh, A.J., Rhodes, D.G., Martin, C.L. 2022. National Food Intake Assessment: Technologies to Advance Traditional Methods. Annual Review of Nutrition. 42:401-422. https://doi.org/10.1146/annurev-nutr-062320-110636.
Bailey, R.L., Leidy, H.J., Mattes, R.D., Heymsfield, S.B., Boushey, C.J., Ahluwalia, N., Cowan, A.E., Pannucci, T., Moshfegh, A.J., Goldman, J.D., Rhodes, D.G., Stoody, E.E., De Jesus, J., Casavale, K.O. 2022. Frequency of Eating in the U.S. Population: A Narrative Review of the 2020 Dietary Guidelines Advisory Committee Report. Current Developments in Nutrition. https://doi.org/10.1093/cdn/nzac132.
Sebastian, R.S., Martin, C.L., Goldman, J.D., Moshfegh, A.J. 2022. Flavonoid Values for USDA Survey Foods and Beverages 2017-2018. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/Services/docs.htm?docid=25102.
Rhodes, D.G., Goldman, J.D., Friday, J.E., Morton, S., Moshfegh, A.J. 2022. 2017-March 2020 Prepandemic 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/Services/docs.htm?docid=18349.
Moshfegh, A.J., Goldman, J.D., Anand, J., Friday, J.E., Martin, C.L., Morton, S., Myrowitz, R., Rhodes, D.G., Sebastian, R.S. 2022. What We Eat In America, NHANES 2017-March 2020 Prepandemic: Documentation and Data Files. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/Services/docs.htm?docid=18354.
Rhodes, D.G., Friday, J.E., Morton, S., Moshfegh, A.J. 2022. What We Eat In America Food Categories, 2017-March 2020 Prepandemic. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/Sercices/docs.htm?docid=23429.
Rhodes, D.G., Goldman, J.D., Friday, J.E., Morton, S., Moshfegh, A.J. 2022. 2017-March 2020 Prepandemic What We Eat In America, NHANES Tables 37-40. Worldwide Web Site: Food Surveys Research Group. Available: https://www.ars.usda.gov/Services/docs.htm?docid=18349.
Bowman, S.A., Clemens, J.C. 2022. Food Pattern Food Group Intakes of Children 2 to 5 Years: 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.
Bowman, S.A., Clemens, J.C. 2022. Food Pattern Food Group Intakes of Children 6 to 11 Years: 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.
Hoy, M.K., Clemens, J.C., Murayi, T., Moshfegh, A.J. 2022. Restaurant Food Consumption by U.S. Adults, What We Eat In America, NHANES 2017-2018. 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-data-briefs/.
Hoy, M.K., Goldman, J.D., Moshfegh, A.J. 2022. Potassium Intake of the U.S. Population, 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.