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NUI~IENT
ADEQUACY
Assessment Using
Food Consumption
Surveys
Subcommittee on Criteria for Dietary Evaluation
Coordinating Committee on Evaluation of
Food Consumption Surveys
Foocl and Nutrition Board
Commission on Life Sciences
National Research Council
NATIONAL ACADEMY PRESS
Washington, D.C. 1986
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NATIONAL ACADEMY PRESS ~ 2101 Constitution Avenue, NW ~ Washington, DC 20418
NOTICE: The project that is the subject of this report was approved by the Governing
Board of the National Research Council, whose members are drawn from the Councils of
the National Academy of Sciences, the National Academy of Engineenng, and the
Institute of Medicine. The members of the committee responsible for the report were
chosen for their special competences and with regard for appropriate balance.
As report has been reviewed by a group other than the authors according to
procedures approved by a Report Review Committee consisting of members of the
National Academy of Sciences, the National Academy of Engineering, and the Institute
of Medicine.
The Research Council was established by the National Academy of Sciences in 1916 to
associate the broad conununity of science and technology with the Academy's purposes
of furthering knowledge and of advising the federal government. The Council operates
in accordance with general policies determined by the Academy under the authority of
its congressional charter of 1863, which establishes the Academy as a pnvate, nonprofit,
self-governing membership corporation. The Council has become the principal operat-
ing agency for both the National Academy of Sciences and the National Academy of
En~neenng in the conduct of their services to the government, the public, and the
scientific and engineering communities. It is administered jointly by both Academies
and the Institute of Medicine. The National Academy of Engineering and the Institute of
Medicine were established in 1964 and 1970, respectively, under the charter of the
National Academy of Sciences.
The work on which this publication is based was performed pursuant to Contract No.
59-319~2 46 with the U.S. Department of Agriculture.
Library of Congress Catalog Card Number 85-62938
International Standard Book Number 0-309-03634 8
First Printing, December 1985
Second Printing, March 1987
Third Printing, September 1988
Fourth Printing, December 1990
Fifth Printing, March 1992
Printed in the United States of America
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Subcommittee on
Criteria for Dietary Evaluation
L. I. FILER, Jr. (Chairman), University of Iowa College of Medicine,
Iowa City, Iowa
GEORGE H. BEATON, Department of Nutritional Sciences, Faculty
of Medicine, University of Toronto, Ontario, Canada
JACOB l. FELDMAN, National Center for Health Statistics, U.S.
Department of Health and Human Services, Hyattsville,
Maryland
HELEN A. GUTHRIE, Department of Nutrition, Pennsylvania State
University, University Park, Pennsylvania
lEAN-PIERRE HABICHT, Division of Nutritional Sciences, Cornell
University, Ithaca, New York
RICHARD HAVLIK, Clinical and Genetic Epidemiology Section,
Division of Heart and Vascular Diseases, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda,
Maryland
D. MARK HEGSTED, Professor Emeritus, Harvard University, School
of Public Health, Boston, Massachusetts
KENT K. STEWART, Department of Biochemistry and Nutrition,
Virginia Polytechnic Institute and State University, Blacksburg,
Virginia
HELEN SMICIKLAS-WRIGHT, Department of Mutation, Pennsylvania
State University, University Park, Pennsylvania
ANASTASIOS A. TSIATIS, Division of Biostatistics, Dana-Farber
Cancer Institute, Boston, Massachusetts
National Research Council Staff
VIRGINIA MIGHT LAUKARAN, Staff Officer, Food and Nutrition
Board
FRANCES M. PETER, Editor, Commission on Life Sciences
JUDITH GRUMSTRUP-SCOTT, Editorial Consultant
SUSHMA PALMER, Executive Director, Food arid Nutrition Board
· . .
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Coordinating Committee on
Evaluation of Food Consumption Surveys
JEAN-PIE ~BIC~ (Cation), Division of Nutritional Sciences,
Cornell University, Ithaca, New York
GEORGE H. BEATON (vice C~i~an), Department of Nutritional
Sciences, Faculty of Medicine, University of Toronto, Ontario,
Canada
PER PINSTRUP-ANDERSON, Food Consumption and Nutrition Policy
Research, International Food Policy Research Institute,
Washington, D.C.
JACOB J. FELDMAN, National Center for Health Statistics, U.S.
Department of Health and Human Services, Hyattsville, Maryland
OWEN R. FENNEMA, Deparl~ent of Food Science, University of
Wisconsin, Madison, Wisconsin
L. J. FILER, JR., University of Iowa College of Mediane, Iowa City, Iowa
PETER GREENWALD, Division of Cancer Prevention and Control,
National Cancer Institute, Bethesda, Maryland
HELEN A. GUTHRIE, Department of Nutrition, Pennsylvania State
University, University Park, Pennsylvania
RICHARD HAVLIK, Clinical and Genetic Epidemiology Section,
Division of Heart and Vascular Diseases, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda,
Maryland
D. MARK HEGSTED, Professor Emeritus, Harvard University, School
of Public Health, Boston, Massachusetts
H. DAVID HURT, Quaker Oats Company, John Stuart Research
Laboratory, Barnngton, Illinois
KENT K. STEWART, Department of Biochemistry and Nutrition,
Virginia Polytechnic Institute and State University, Blacksburg,
VirgiIua
HELEN SMICIKLAS-WRIGH1, Deparl~.ent of Nutrition, Pennsylvania
State University, University Park, Pennsylvania
National Research Council Staff
VIRGINIA MIGHT LAUKARAN, Staff Officer, Food and Nutrition Board
STEPHANIE C. CROCCO, Staff Officer, Food and Nutrition Board
(until July 1984)
FRANCES M. PETER, Editor, Commission on Life Sciences
SUSHMA PALMER, Executive Director, Food and Nutrition Board
IV
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Food and Nutrition Board
KURT I. ISSELBACHER (Chairman), Harvard Medical School and
Department of Gastroenterology, Massachusetts General
Hospital, Boston, Massachusetts
RICHARD J. HAVEL (Vice Chair~n), Cardiovascular Research
Institute, University of Califorrua School of Medicine, San
Franasco, California
HAMISH N. MUNRO (Vice Chairman), Human Nutrition Research
Center on Aging, Tufts University, Boston, Massachusetts
WILLIAM E. CONNOR, Department of Medicine, Oregon Health
Sciences University, Portland, Oregon
PETER GREENWALD, Division of Cancer Prevention and Control,
National Cancer Institute, Bethesda, Maryland
M. R. C. GREENWOOD, Department of Biology, Vassar College,
Poughkeepsie, New York
JOAN D. GUSSOW, Department of Nutrition Education, Teachers
College, Columbia University, New York, New York
NAMES R. ARK, Research and Development, Campbell Soup
Company, Camden, New Jersey
REYNALDO MARTORELL, Food Research Institute, Stanford
University, Stanford, California
WALTER MERTZ, Human Nutrition Research Center, Agricultural
Research Service, U.S. Department of Agriculture, Beltsville,
Maryland
J. MICHAEL McGINNIS, Office of Disease Prevention and Health
Promotion, U.S. Department of Health and Human Services,
Washington, D.C.
MALDEN C. NESHEIM, Division of ~NJutTitional Sciences, Cornell
University, Ithaca, New York
RONALD C. SHANK, Department of Community and Environmental
Medicine and Department of Pharmacology, University of
California, Irvine, California
ROBERT H. WASSERMAN, Department/Section of Physiology, New
York State College of Veterinary Medicine, Cornell University,
Ithaca, New York
MYRON WINICK, Institute of Human Nutntion, College of
Physicians and Surgeons, Columbia University, New York, New
York
Staff
SUSHMA PALMER, Executive Director, Food and Nutrition Board
v
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Preface
At the request of the U.S. Department of Agriculture (USDA), the
National Research Council undertook a study of the criteria used to
evaluate data on dietary intake. This study was performed by a
subcommittee of the Coordinating Committee on Evaluation of
Food Consumption Surveys. In January 1934, the subcommittee
was formed to develop criteria for the use of survey data in the
evaluation of dietary adequacy, paying particular attention to appli-
cations to data from the Nationwide Food Consumption Survey.
During the course of its study, the subcommittee examined in-
formation on levels and variability of human nutrient require-
ments, survey methodology, and the reliability of food composition
data.
Estimates of the proportion of the population with inadequate
dietary intake have provided the impetus for food assistance pro-
grams and other efforts to improve the diet of the U.S. public.
Increasingly, policymakers, scientists, and others interested in
health maintenance recognize the need to improve the utilization of
data on dietary intake and other information to monitor the U.S.
population's nutritional status.
The proportion of the population at risk for inadequate nutrient
intake can be estimated from survey data on dietary intake, even
though the nutritional status of individuals can only be analyzed
according to Probabilities. The subcommittee in its deliberations
(_7 1 ~ ~ . , ~ . ~ 1 ~ ~ ~
developed an approach to dietary analysts that Is cased on these
probabilities and takes into account the inherent variability of nu-
trient intake by individuals over time and of nutrients in the same
foods.
Chapter 1 is a summary oi the report. The history of dietary
surveys is recounted in Chapter 2 along with a description of the
committee's task and its approach to the study. In Chapter 3, the
· .
V11
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basis of dietary evaluation and its relationship to the recommended
dietary allowances are discussed. The method of estimating usual
dietary intake from survey data is described in Chapter 4. In Chap-
ter 5, the recommended approach to dietary analysis is presented
with examples. Chapter 6 deals with the application of the method
in analysis of excessive intake and the utility of nutrient energy
ratios. The impact of technical error on the analysis of dietary intake
data is discussed in Chapter 7. Chapter ~ presents the results of
confidence interval calculations. Chapter 9 is a summary of the
subcommittee's recommendations. Additional details of the analy-
ses described in the text are included in the appendices.
The committee gratefully acknowledges Susan Welsh, Betty
Peterkin, and Robert L. Rizek of the USDA Human Nutrition In-
formation Service (HNIS) for their interest and support; Brucy
Gray, also of FINIS, for his preliminary analysis of the USDA data
set; and Wayne Wolf and Joanne Holden of the Nutrient Composi-
tion Laboratory, USDA Beitsville Human Nutrition Center, for the
reanalysis of their earlier work.
The subcommittee commends the able and dedicated assistance
of the Food and Nutrition Board staff under the direction of Sushma
Palmer, inclucling staff officers Stephanie C. Crocco (prior to July
1984) and Virginia Hight Laukaran (beginning August 1984), and
senior secretaries Sylvia Glasser and Tujuana M. Albritton. It is also
grateful for the editorial assistance of Frances M. Peter and Judith
Grumstrup-Scott.
L. J. FILER, JR.
Chairman
Subcommittee on Criteria
for Dietary Evaluation
· · —
vail
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Contents
1. EXECUTIVE SUMMARY ....
Major Conclusions, 4
Major Recommendations, 5
2. INTRODUCTION............
3. NUTRIENT REQUIREMENTS AS A BASIS FOR
DIETARY EVALUATION ......................
Variability of Nutrient Requirements, 10
Levels of Requirement, 12
Fixed Cutoff Points, 14
4. THE USE OF SHORT-TERM DIETARY INTAKE
DATA TO ESTIMATE USUAL DIETARY INTAKE.
Relationship of Daily Dietary Intake Data
to Usual Intake, 17
Procedure for Adjusting Intake Data, 21
5. THE PROBABILITY APPROACH ...........
Requirement Information Needed for the
Probability Approach, 29
Effect of Requirement Distribution on Estimates
of the Prevalence of Intake Adequacy, 30
Influence of Mean and Standard Deviation
of Requirement, 30
Influence of the Shape of Requirement
Distribution, 32
1X
.. 10
17
...... 25
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Impact of the Mode in Which
Requirements Are Expressed, 35
Impact of Criteria for Requirement
Estimate, 37
Comparison with Fixed Cutoff
Approach, 39
Summary, 40
6. ASSESSING EXCESSIVE INTAKE AND
NUTRIENT ENERGY RATIOS.............
Fat Intake, 41
Nonnutrients, 42
Assessment of the Prevalence of Excessive
Intake, 42
Energy from Protein, Fat, and Carbohydrate, 45
Use of the Probability Approach to Assess
Energy Intake, 46
7. ERRORS IN NUTRIENT INTAKE
MEASUREMENT...............
Sampling Vanation, 48
Random Error, 48
Systematic Bias, 48
Errors in Estimating Usual Nutrient Intake, 49
Errors in Reporting Usual Food Intake, 49
Variability Due to Coding and Analysis of the
Nutrient Content of Foods, 55
Nutrient Data with Probable Bias, 59
Impact of Systematic Bias, 62
8. MODELING OF SOURCES OF VARIABILITY
AND BIASES .............................
Variability Due to Sampling of Respondents, 67
41
.. 48
...... 66
Random Variability in Foods Consumed, 67
Variability in Food Composition Data, 70
Effect of Random Statistical Error on Estimation of
Prevalence, 72
Impact of Random Under- and O`,erreporting, 74
x
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9. CONCLUSIONS AND RECOMMENDATIONS
Analysis of Dietary Adequacy, 79
Study Design, 82
Sensitivity Analysis, 84
Improvement of the Food Composition Data Base, 85
Prerequisites and Limitations of the Proposed
Approach, SS
Acceptable Precision of the Estimates, SS
Estimation of Usual Food Intake, 89
Computation of Nutrient Intake, 90
Definition of Nutrient Requirements, 91
Conclusions, 92
· · —
79
REFERENCES ·~ bee
STATEMENT CONCERNING APPLICATION OF THE
RECOMMENDED METHOD .....................
APPENDICES
A. Adjustment of Intake Distributions Used in This
Report..........................................
B. Derivation of Criteria for Interpretating Iron Intake
in Women ......................................
C. Method of Estimating Confidence Intervals .......
D. Algorithm for Computing the Probability of Intake
Inadequacy .....................................
E. Analysis of Error in the Estimation of Nutrient
Intake Using Three Sample Data Sets .......
X1
.... 95
... 104
110
115
120
127
129
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