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1 Data Sources, Key Nutrients, and Selection of Targets for Change the current issues surrounding the ade- quacy of the American diet no longer center primarily on nutrient deficiency. Overcon- sumption of calories, fat, saturated fatty acids, cholesterol, and sodium has become a serious problem for many consumers, and animal products have been implicated as major sources of these food components. At the same time, it is recognized that meats, fish, dairy products, and eggs are important sources of many essential nutrients, includ- ing protein, B vitamins, iron, zinc, and calcium. In this renort the committee recom mends various options for improving the nutritional value of animal products. First, however, it is important to understand clearly the contemporary role of animal products in the American diet. The following ques- tions were essential to the committee's charge: What are the uses and limitations of the data available to study consumption and nutrient contribution of animal products? What have been the trends in con- sumption of animal products in the United States? What contribution do animal products 9 make to the nutrients available in the food supply? What is the role of animal products in the diets of different age and sex groups of the population? SOURCES OF DATA AND THEIR LIMITATIONS The U. S. Department of Agriculture (USDA) provides data on food and nutrient consumption at three levels: the U.S. food supply, food use by households, and food intake by individuals. In addition, data on nutritional status from federal surveys are used throughout the report. Food Supply Data (1965-1985) The food supply data (per capita disap- pearance) measure the amount of food avail- able for consumption in the United States, based on annual estimates of production of food products adjusted for imports, exports, and stock exchanges. The data are collected at the wholesale or retail level of distribu- tion. The result is an estimate of the total amount of food that is produced and mar

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10 keted for national consumption. Dividing this total by the U.S. population results in an estimate of consumption per capita. This series is often referred to as disappearance data to indicate that it is based on the disappearance of food through marketing channels ant] is not a direct estimate of consumption. In 1986, the USDA began referring to this series as apparent con- sumption" to distinguish it from more direct estimates of consumption. A companion series, the Nutrient Content of the Food Supply, is derived by calculating the nutri- tive value of the total amount of foods available for national consumption (Marston and Raper, 1987~. In using these data bases, the committee found the term apparent consumption confusing and elected to use per capita disappearance or food supply data instead throughout the report. Federal Surveys Nationwide Food Consumption Survey 1977-1978) More direct estimates of food consump- tion are provided by the USDA's Nation- wide Food Consumption Survey (NFCS), last conducted in 1977-1978. The NFCS, which is conclucted every 10 years, is the most comprehensive source of data available on the food en c] nutrient intake of the U. S. population. In total, 36,142 individuals were surveyed over four consecutive seasons be- ginning in the spring of 1977. A detailed description of the survey methodology is groveled in Peterkin (1981) and will not be presented in this report. Even though the NFCS is now 10 years old, it is still useful for several reasons. For one, it is the most recent information available on food and nutrient intake for the household population and is useful for comparing dietary intakes among age and sex groups, especially when analyzing the data at an aggregated level such as food groups. Furthermore, the survey measured die- tary intake by individuals. In this phase of DESIGNING FOODS the survey, members of the participating households provided information on foods they ate on 3 consecutive days. Each was asked by an interviewer to recall the foods eaten the day before the interview and to keep records offoocls eaten on the interview day and the day following. Nutrient intakes of the individuals were clerived from food composition data for approximately 4,500 foods and food combinations in the USDA's Nutrient Data Bank, a file of food compo- sition maintainer] and updated by USDA s Human Nutrition Information Service. Continuing Survey of Food Intake by Individuals (1985) The most recent source of data available on the dietary intake of individuals is the USDA's Continuing Survey of Food Intake by Individuals (CSFII). This survey was designed to complement the decennial NFCS by providing continuous data on dietary status of selected subgroups, especially those that may be at nutritional risk (Welsh, 1986). It is the first nationwide dietary intake survey designed to be conducted annually. Dietary recall data for 1 day by 1,503 women 19 to 50 years of age and by 548 children 1 to 5 years of age were collected by personal interview from April through June 1985, and for 5 days at 2-month intervals by telephone interview (U.S. Department of Agriculture, 1985). This core respondent group was selected because previous sur- veys had shown that women of childbearing age and young children were more likely than other age and sex groups to have diets low in certain nutrients. The 1985 survey was augmented by a 1-day intake record for 1,134 men (U.S. Department of Agricul- ture, 1986~. Whenever possible, the com- mittee compare(l data from the 1977-1978 NFCS and the 1985 CSFII. National Health and Nutrition Examination Survey Another nationwide survey that includes data on dietary intake is the National Health

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DATA SOURCES, KAY NUTRIENTS, AND SELl:4JC'l'l().Y OF TARCx~'I and Nutrition Examination Survey (NHANES), performed by the U. S. l~e partment of Health and Human Services (DHHS). NHANES I took place between 1971 and 1974 and had ~ sample size of 28,043 individuals from its target population of 1- to 7(year-olds. N HAN E S II was conducted from 1976 to 1980 on a target population of individuals ages 6 nlontlls to 74 years. The sample size was 277801, with oversampling of children ages 6 months to 5 years, adults ages 60 to 74 years, ants Other Data LS`~`rce.s those individuals flying in poverty areas. NHANES is primarily a health survey de J ~ signed to gather information on the total prevalence of disease conditions and phys ical status as well as clinical data Ott the interrelationships of health and nutrition variables. Individuals who participated in the survey were interviewed for diet arid health information and underwent clinical examinations by health professionals. The dietary component of N HAN E S con sisted of a recall of dietary intake for the previous day and an additional recall of usual food consumption for the previous month. NHANES is the only nationwide survey available to measure the relationship between food and nutrient intake and bio chemical nutritional status (McDowell et al., 1981~. It is used as an important source of information on the health and nutritional status of the U. S. population. 11 data On 1-eight, weight, and age are c~on- verted to percentiles of height for a~,e and weight for height using, the National Center for Health Statistics reference population. Durin, 1984, data were submitted for 610,439 children ages birth to 9 years (Centers fUr Disease Control, 1985~. Although this source floes not contain direct estimates of dietary intake, it does provide valuable data on the -tuitional status of c~hilclren. Pediatric Nutrition Surveillance System of the Centers for Disease Control Since 1973, the Centers for Disease Con- trol have coordinated the Pediatric Nutri- tion Surveillance System (PNSS) to con- tinuously monitor the nutritional status of high-risk pediatric populations (Centers for Disease Control, 1985~. The PNSS uses nutrition-related data collected by local health departments during delivery of routine child health services. The data include demo- graphic information, height, weight, birth weight, and hemoglobin or hematocrit de- terminations, or both. The anthropometric The National Live Stocl; ~ Meat Boarcl stu(ly (Breidenstein and Williams, 1987) and the Stanton :1987) study for the American Meat Institute both concentrate on the role of reel Neat in the diet, particularly their co~-~tributioll to the overall fat content of the diet. The Household :tlefUse Analysis Proj- cct, headed lo University of Arizona arche- 'k~gist William Hathje (1984), focuses on trends in consumption of nougats and discard patterns of separable flit through the analysis of residential garbage. Each of these sources has its limitations and advantages but is valuable for its unique analytical approach. Limitations of the Data Bases The per capita disappearance data, NFCS, CSFII, and private studies are important sources of information, but none provide exact measures of food or nutrient intakes. In addition, each measures a different aspect of food intake, and each has advantages and limitations for assessing particular issues. It is preferable, therefore, to use as many suitable sources as possible to more closely assess the consumption of animal products and their contribution to the diet. The per capita disappearance data are primarily designed to measure gross trends in food nutrient availability. They are val- uable for determining the contribution of specific animal products to total nutrients in the food supply because they measure distinct commodities. Because the data are measured at the wholesale or retail level of

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12 the food system, they measure nutrients inherent in primary commodities before processing, such as fresh meats, milk, and cheese. In addition, the data have not been adjusted for waste that may occur beyond the retail level of distribution, such as plate waste or trimming during meal preparation. Moreover, no estimate of the discard of food due to spoilage and other reasons that would preclude human consumption is made. In contrast, the NFCS data measure food intake in the form consumed, such as cheeseburgers and beef stew. Such dietary survey data customarily group food mixtures by the nutrient contribution of the mixture's main ingredient. Such groups cannot cor- rectly account for all nutrients derived from animal products like milk and cheese, meat, poultry, and fish. Nutrients from the cheese and meat in pizza, for example, will be credited to the grain products group because grain is the main ingredient. On the other hand, categories referred to as poultry or meat may include nutrients from other cat- egories, such as the fat used in frying chicken or the vegetables used in beef stew. Thus, assessing fat intake and the contribution of various foods to total fat or any nutrient is not a straightforward exercise and requires numerous assumptions and interpretation of the various sources of data. The food supply data provide information on the total amount of fat available. There is specific information on the exact type of fat ant] oil available (such as soybean oil and lard, as well as fat occurring in foods), but the data overstate the amount actually in- gested because they are not adjusted for waste, spoilage, trimming, or cooking losses. In contrast, NFCS data attempt to include only the fat ingested, but information re- garding type of fat or the food from which it is derived is imprecise, mainly because considerable amounts of fat consumed are in processed or mixed foods. However, survey data more accurately reflect food and nutrient intake than do per capita disap- pearance data because they are based on DESIGNING FOODS individual records of foods eaten and there- fore do not need to be adjusted for waste. All sources of food consumption data are imprecise. Food supply data are derivecl from gross estimates. The accuracy of the survey food intake data is limite(1 by the extent to which individuals can recall and describe the types and amounts of foods they ate. It is likely that the NFCS data generally underestimate foot] intake be- cause it is so difficult for an individual to recall accurately everything eaten (Weir, 1976~. In some cases, when precise descrip- tions of foods eaten are not known or not specifie(l by the individual surveyed, they are entered by the USDA. This couIcl result in errors in the quantities of nutrients con- sumed. For example, if the respondent does not know if the fat on his or her baked potato is margarine or butter, the USDA assumes it is margarine-the most often used fat. If roast beef is reported, without information about whether the fat was eaten, USDA assumes that the lean and fat parts are both eaten. In the 1985 CSFII, addi- tional questions were asked to minimize this problem. Despite these limitations, each data source is valuable because it offers a different perspective on possible avenues for im- provement in the (lies. The food supply data estimate the nutrients inherent in the ani- mal products before processing, which may suggest changes achievable through genetic manipulation, production, or processing practices. The NFCS en c] CSFII survey data point to population subgroups that may be in need of modifying their dietary patterns or the amount or proportion of individual nutrients within the diet. The private stud- ies, based largely on the federal dietary surveys, evaluate trends in the dietary in- take of animal fat and red meat. IDENTIFICATION OF KEY FOOD COMPONENTS In July 1986, the Joint Nutrition Moni- toring Evaluation Committee aNMEC), a

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DATA SOURCES, KEY NUTRIENTS, AND SELECTION OF TARGETS federal advisory committee jointly spon- sored by USDA and DHHS, issued a prog- ress report entitled Nutrition Monitoring in the United States (U. S. Department of Ag- riculture/U.S. Department of Health and Human Services, 1986~. Because this report represents the most current data on the nutritional status of the U.S. population, the committee chose to rely heavily on its content. The INMEC concluded that the principal nutrition-related health problems in the United States arise from the over- consumption of fat, saturated fatty acids, cholesterol, and sodium, the same nutrients emphasized by all the national health or- ganizations issuing dietary recommenda- tions. It stated that more than one-fourth of the adults in the United States are over- weight; for many of these individuals, obe- sity probably resulted from consuming more food energy than needed for their level of physical activity. It also concluded that certain subgroups of the U.S. population have special nutrition-related health prob- lems, specifically, low intakes of iron and vitamin C among young children and fe- males of childbearing age, especially if they are black, poor, or both. The JNMEC also expressed concern over the low intake of calcium among women. The INMEC emphasized that inadequa- cies or excesses of food components in the diet and the effects on nutritional status were indeed cause for concern. It singled out the following 10 food components for highest-priority monitoring on the basis of the relationship of the component to nutri- tional status: High Dietary Consumption Food energy* Total fat* Saturated fatty acids* Cholesterols Sodium* Alcohol Low Dietar?] Consumption Vitamin C Calcium* Iron* Fluoride 13 The seven food components marked with an asterisk are of particular importance to the committee because they are found in animal products. Other national organizations have also recognized these nutrients as exerting the greatest influence on health and have of- fered a variety of specific recommendations for altering their level in the diet. In 1984 a National Institutes of Health consensus development panel on lowering blood cho- lesterol to prevent heart disease suggested that the food industry be encouraged to intensify efforts to develop and market prod- ucts that would facilitate adherence to the dietary guidelines for fat and cholesterol. The panel recommended that school food services and restaurants serve meals con- sistent with those recommendations (Na- tional Institutes of Health, 1984~. The panel also recommended that food labeling in- clude the specific source or sources of fat; the amounts of total fat, saturated and po- lyunsaturated fatty acids, and cholesterol; and other nutrition information. It further recommended that the public be educated on how to best use this information to achieve dietary goals. In the most recent American Heart Association dietary guide- lines, food manufacturers were urged to "gradually reduce the sodium and fat con- tent of the food supply as well as to modify the type of fat in food products" (American Heart Association, 1986~. TARGET LEVELS FOR CALORIC INTAKE AND SELECTED NUTRIENTS Dietary recommendations issued by the major national health organizations in the United States, as summarized in Table 1- 1, acknowledge the importance of eating a varied diet; achieving and maintaining ideal body weight; and limiting intake of total fat, saturated fatty acids, polyunsaturated fatty acids, and cholesterol as positive health measures for optimal nutritional status. The advice given is similar for all these organi

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DATA SOURCES, KAY NUTRIENTS AND 5~1 nations, although some groups are more specific than others. In light of these rec- ommendations and the charge to the com- mittee to identify options to improve the nutritional attributes of animal product), the committee has chosen the following specific target levels f`'r caloric intake and nutrients in the diet: Caloric intake snatcher] to ~ncl'~id~l~ll needs rind appropriate to (lC~iCLC (lnCI IlUlin- tain desirc~l~le body wr~i-,ht (AInel-icall Call- cer Society, 1984; American [leart Ass<'ci- ation, 1986; National Institutes of Health, 1984; National Research Council, 198(), 1982; OfTice of the Assistant Secretary for {lea]th and the Surgeon General, 1979; U.~. De- partment of Agriculture/U.~. Depart net of Health and Human Services, 1985; U. S. Senate Select Committee on Nutrition and Human Needs, 19774. Data frown the 197 1980 NHANES indicate that approximately 34 million U.S. adults are obese, of which 12.4 million are severely obese. The inci- dence of obesity varies widely according to age and sex, with black adults having the highest incidence (61.2 percent for females and 41.4 percent for males). Childhood obesity is more difficult to estimate, but may range from 4 to 14 percent among k~w- income populations. Thirty percent or less of calories from fat for adults (American Cancer Society, 1984; American Heart Association, 1986; National Institutes of Health, 1984; National Research Council, 1982~. Data from the 1977-1978 NFCS indicated that 6 percent of the population overall had diets From which 30 percent or less of the calories came from fat; data from the 1985 CSFII showed that about 15 percent of children and 12 percent of adult women had diets that met the target. Ten percent or less of calories frolic saturated fatty acids for adults (American Heart Association, 1986; National Institutes of Health, 1984~. Data from the 1985 CSFII indicated that about 10 percent of women ht'TiO.~ OF TARt':~ AXIS 15 ages 193 to 50 years and 4 percent off children ages 1 to 5 years had diets that met the target level fUr percentage of Bakeries from saturated f;attv acids. Tell percent or le.s.s of calories from 'olqun.scituratecl fatty ricid.s for cidult.s (AmeI it all Hear t A.~)Ciati()ll, 1986; National Il~stitlltes `'f ~ lealtIl, 1984; National l:le- search C`>uncil, 198()~. Lutz 1r()ln the 1985 CSt'II il~clicatecl that 86 pCl'C'Cllt `'f Walden arcs 19 t() 50 VCdI'S aIld 98 pC'I'CC'Ilt `~fchildren ages I t() 5 years had diets that met tile t~I'gOt {Ol- p()lVIlIl.~]tIlr~tCCl tclttV cIC'iCiS. Fifteen ~ercc~nt or le.s.s of caloric.s (re- ''~aincle~r of calories fro- the fatty cicid.sJ from mono~ln.scitilrcite~ciicitt'~ acid.sfor (ldult.s :~ati`'na1 Institutes `~! Health, 1084~. Data Freon the 198.5 C ~ HI iI~clic atecl that about 65 peIce~t off women awe 19 to 50 years and 78 pert eat of chilclre~ age s 1 to 5 years lead diets that met the target level for mollou~lsaturate~1 kitty acids. Three hundred ''lill~gra~as or less of chole.ster`'l tier day for adults (American I I cart Association, 1986; National Institutes of I-Icalth, 19844. Data from the 1985 CSFII indicated that cholesterol levels averaged 254 mg/clay for children ages 1 to 5 years, 3()4 mg/day for women ages 19 to 50 years, and 435 mg/day fair men ages 19 to 50 years. Between 72 and 80 percent of children ages 1 to 5 years and 62 percent of women ages 19 to 50 years had diets that met the target level for cholesterol; comparable data for men were not available, but the trends are thought to be similar. Calcium intake of the Recommender] Dietary Allowances (RDAs) for age and sex (National Research Council, 19804. Data from the 1977-1978 NFCS indicated that 32 percent of individuals had diets that met the target level for calcium (100 percent of the RDA), including 48 percent of children ages 1 to 8 years, 42 percent of males ages 9 to 18 years, arid 23 percent of females ages 9 to 18 years. Data from the 1985 CSFII indicated that both total calcium intake (mg/day) and mg/l, ()00 kcal have

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16 increased in the diets of all population groups since the 1977-1978 survey, but women's mean intakes still fell short of meeting the target level. About three-fourths of the women did not meet 100 percent of the RDA; of this group, half did not achieve 70 percent of the RDA. Iron intake of the RDA for age and sex (National Research Council, 1980~. Data from the 1977-1978 NFCS indicated that 44 percent of individuals had diets that met the target level for iron (100 percent of the RDA), including 38 percent of children ages 1 to 8 years, 36 percent of males ages 9 to 18 years, and 18 percent of females ages 9 to 18 years. Data from the 1985 CSFII indicated that mean intakes (mg/day) in- creased for women ant] children but not for men, and that mg/l,OOO kcal increased for children but not for women or men since the 1977-1978 survey. About 95 percent of the women did not meet 100 percent of the RDA; of this group, three-fourths die] not achieve 70 percent of the RDA. These targeted levels are chosen by the committee as constituting the consensus of dietary and nutrition recommendations made by the various government and nongovern- ment agencies cited. It is not the intention of the committee to establish new dietary guidelines for the American public. The Food and Nutrition Board of the National Research Council is currently conducting a major study of diet and health issues, and a new National Research Council report may eventually be issued dealing with spe- cific recommendations for these guidelines. For the purpose of assessing target levels of various food components in the diet, the committee has followed the basic recom- mendations that have been made by other organizations. The target levels do not include all im- portant characteristics of diets thought to promote health and prevent disease. For example, protein is not targetec! because it is plentiful in the fliers of most people in DESIGNING FOODS the United States. Of the many essential vitamins and minerals, only calcium and iron are targeted] because their levels in many diets are below that recommended and animal products are rich sources of them. REFERENCES American Cancer Society. 1984. Nutrition and cancer, cause and prevention. An American Cancer Society special report. Ca A Cancer Journal for Clinicians 34(29:121-126. American Heart Association. 1986. Dietary guidelines for healthy adult Americans. Circulation 74:1465A. Breidenstein, B. C., and J. C. Williams. 1987. Con- tribution of Red Meat to the U.S. Diet. Chicago, Ill.: National Live Stock & Meat Board. Centers for Disease Control. 1985. Nutrition Surveil- lance 1983. U. S. Department of Health and Human Services, Public Health Service, DHHS Publication No. (CDC) 8~8295. Atlanta, Gal: Centers for Dis- ease Control. Marston, R., and N. Raper. 1987. Nutrient content of the U.S. food supply. Pp. 18-23 in National Food Review, NFR-36, Economic Research Service. Washington, D. C.: U. S. Department of Agriculture. McDowell, A., A. Engel, J. T. Massey, and K. Maurer. 1981. Plan and Operation of the Second National Health and Nutrition Examination Survey, 197~80. Series 1, No. 15. DHHS Publication No. (PHS) 81- 1317. Vital and Health Statistics. Washington, D.C.: U.S. Public Health Service. National Institutes of Health. 1984. NIH Consensus Development Statement on Lowering Blood Cho- lesterol to Prevent Heart Disease. Vol. 5, No. 7. Washington, D.C.: National Institutes of Health. National Research Council. 1980. Recommended Di- etary Allowances, 9th ed. Washington, D.C.: Na- tional Academy Press. National Research Council. 1982. Diet, Nutrition, and Cancer. Washington, D.C.: National Academy Press. Office of the Assistant Secretary for Health and the Surgeon General. 1979. Healthy People, the Sur- geon General's Report on Health Promotion and Disease Prevention. DHEW (PHS) Publication No. 7~55071. Washington, D.C.: U.S. Public Health Service. Peterkin, B. B. 1981. Nationwide Food Consumption Survey, 1977-1978. Pp. 59~9 in Nutrition in the 1980s: Constraints on Our Knowledge. New York: Alan R. Liss. Rathje, W. L. 1984. Where's the beef? Red meat and reactivity. Am. Behav. Sci. 28:71-91. Stanton, J. L. 1987. An Investigation of Fat Intake. Paper presented to the American Meat Institute, Washington, D.C., January 1987.

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DATA SOURCES, KEY NUTRIENTS, AND SELECTION OF TARGETS U. S. Department of Agriculture. 1985. P. 48 in Women 19-50 Years and Their Children 1-5 Years, 1 Day, 1985. Nationwide Food Consumption Survey, Con- tinuing Survey of Food Intakes by Individuals, Report 85-1, Human Nutrition Information Service. Hyattsville, Md.: U. S. Department of Agriculture. U.S. Department of Agriculture. 1986. P. 46 in Men 19-50 Years, 1 Day, 1985. Nationwide Food Con- sumption Survey, Continuing Survey of Food In- takes by Individuals, Report 85-3, Human Nutrition Information Service. Hyattsville, Md.: U. S. De- partment of Agriculture. U.S. Department of Agriculture/U.S. Department of Health and Human Services. 1985. Nutrition and Your Health: Dietary Guidelines for Americans, 2nd ed. Home and Garden Bulletin No. 232. Washing- ton, D.C.: U.S. Government Printing Office. 17 U. S. Department of Agriculture/U. S. Department of Health and Human Services. 1986. Nutrition Mon- itoring in the United States: A Progress Report from the Joint Nutrition Monitoring Evaluation Commit- tee. DHHS Publication No. (PHS) 86-1255. Wash- ington, D. C.: U. S. Government Printing Office. U.S. Senate Select Committee on Nutrition and Hu- man Needs. 1977. Dietary Goals for the United States, 2nd ed. No. 052-070~4376-8. Washington, D. C.: U. S. Government Printing Office. Weir, C. E. 1976. Overview of the role of animal products in human nutrition. Pp. ~23 in Fat Content and Composition of Animal Products. Washington, D.C.: National Academy Press. Welsh, S. 1986. The joint nutrition monitoring com- mittee. Pp. 7-20 in What is America Eating? Wash- ington, D. C.: National Academy Press.