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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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