Methodological Considerations in Assessing Dietary Sodium Intake in the Population using What We Eat in America, NHANES. Alanna J.

Transcription

1 Methodological Considerations in Assessing Dietary Sodium Intake in the Population using What We Eat in America, NHANES Alanna J. Moshfegh Food Surveys Research Group Beltsville Human Nutrition Research Center Agricultural Research Service, USDA IOM Workshop on Perspectives on Dietary Sodium and Health Washington, DC December 5, 2012

2 Acknowledgements FSRG Staff Joseph Goldman Kathy Hoy Carrie Martin Donna Rhodes Rhonda Sebastian Nutrient Data Laboratory Center for Disease Control Atlanta Food and Drug Administration

3 Topics to Address Method for estimating sodium in the US population Challenges of estimating sodium in the diet Updates to WWEIA -- collection and nutrients

4 Dietary Intake Method Two 24-hour dietary recalls - day 1 in person, day 2 by telephone USDA Automated Multiple-Pass Method - 5 step method - administered by trained interviewers - validated for energy and sodium intakes

5 Step 1 USDA Automated Multiple Pass Method Quick List Collects listing of all foods & beverages Step 2 Forgotten Foods Probes for forgotten food items in 9 categories Step 3 Time & Occasion Collects for each food & beverage Sorts foods into chronological order and groups foods by eating occasion Step 4 Step 5 Detail Cycle Final Probe Collects: description of each food & amount eaten additions source whether eaten at home Reviews: each occasion intervals between occasions Provides final opportunity to recall foods

6 IOM Report Recommendations... for monitoring and surveillance Identification of foods to be monitored Regular tracking of sodium content of foods Evaluation of changes in sodium intake Reporting results in timely manner

7 Challenges of Sodium Monitoring New foods in the marketplace Food reformulations Sodium variability within food types/brands Survey participants ability to report details specific to the sodium initiative ~ 35% of calories from restaurants, fast food establishments, and other away from home sources

8 Sources of Sodium in the Diet Processing 77% Inherent in foods 12 Salt added at the table 6 Salt added in cooking 5 Inherent in water <1 Source: Mattes et al, J Am Coll Nutr, 1991:10(4):383-93

9 Sources of Sodium in the Diet Processing 77% Inherent in foods 12 Salt added at the table 6 Salt added in cooking 5 Inherent in water <1 Source: Mattes et al, J Am Coll Nutr, 1991:10(4):383-93

10 Strategy for Updates... Automated Multiple-Pass Method > 21,000 questions across ~130 categories of foods Comprehensive review and update launched in 2008 Thus far, reviewed AMPM questions for foods and beverages = 2/3 of intake implemented for and WWEIA, NHANES collection Focus of the review and changes as related to Na... foods that are major contributors to Na in diet enhancing capture of foods lower in Na adding questions on use of salt at the table for the previous 24 hours

11 Strategy for Updates... Food and Nutrient Database for Dietary Studies FNDDS (WWEIA, NHANES) 1.0 ( ) 2.0 ( ) 3.0 ( ) 4.1 ( ) 5.0 ( ) 6.0 ( ) in preparation Codes 6,974 6,940 6,921 7,174 7,253 est. 7,554 SR* SR 16-1 SR 18 SR 20 SR 22 SR 24 SR 26 Nutrients * USDA National Nutrient Database for Standard Reference, developed and maintained by Nutrient Data Laboratory, ARS, USDA 125 sentinel foods have been identified and will serve as primary indicators of change in sodium content of foods (USDA, CDC, FDA collaboration). Regular tracking and analysis of these sentinel foods will serve to inform the monitoring and composition work at FSRG and NDL. Documentation about sentinel foods and the tracking of Na values are planned to be on the Nutrient Data Laboratory website.

12 Sentinel Foods No. of foods Selected Examples Mixed dishes 28 Pizza; pasta-based dishes; chili; egg roll Grain products 18 Bread; rolls; tortilla; bagel; taco shell; RTE cereals; pancakes; biscuit Vegetable dishes, beans 16 Canned corn; French fries/fz and ff; potato salad Chicken, seafood, pork 15 Nuggets/fz and ff; rotisserie; brd fish fille;, fried shrimp; pork chops Cured/processed meats 10 Deli ham/turkey; bologna; bacon; hot dog/corndog; salami Fast food sandwiches/ Mexican type dishes 9 Double cheeseburge; hamburger; beef taco; bean burrito Cheeses 7 Cheddar; fried mozzarella sticks; nacho cheese dip; cottage cheese Soups/broths 7 Tomato soup; ramen noodle soup; chicken noodle soup/broth Savory snacks/crackers 7 Pretzels; potato chips; popcorn; tortilla chips Cakes, cookies, pastry 6 Doughnut; cinnamon bun; chocolate chip cookie Nuts, peanut butter 2 Peanuts; peanut butter

13 Sources of Sodium in the Diet Processing 77% Inherent in foods 12 Salt added at the table 6 Salt added in cooking 5 Inherent in water <1 Source: Mattes et al, J Am Coll Nutr, 1991:10(4):383-93

14 Salt at the Table Questions to determine usual use of salt at the table... ask: how often is salt added to food at the table never 39% rarely occasionally very often ask: type of salt used at the table ordinary salt 89% lite salt salt substitute other/don t know 4 <1 1 not quantified In 2013, questions added to determine use of salt at the table yesterday Source: What We Eat In America, NHANES , n=9165; , n=9118; , n=9618; unweighted

15 Sources of Sodium in the Diet Processing 77% Inherent in foods 12 Salt added at the table 6 Salt added in cooking 5 Inherent in water <1 Source: Mattes et al, J Am Coll Nutr, 1991:10(4):383-93

16 Salt Used in Cooking Sodium values were adjusted for foods likely to be home prepared and of a type that salt is added during home preparation. Eligible foods - meats, eggs, vegetables, beans, rice, pastas, cereals, mixtures ~1900 foods out of ~7500 total These eligible foods had their salt content adjusted based on two criteria: 1. respondent s answer to household use of salt in cooking as occassionally or less often 2. eligible foods were reported and their source was from the store (using the food source of store as a proxy for home preparation) Adjustment applied to all USDA nationwide food surveys since 1985 and WWEIA, NHANES to give credit to survey respondents reporting their households cooked/prepared foods with salt only occasionally or less often.

17 Salt Used in Cooking How often is ordinary salt or seasoned salt added in cooking or preparing foods in your household? Response Sodium adjustment to eligible foods Respondents never/rarely optional salt removed 27% occasionally half the optional salt removed 35 very often no adjustment 38 Source: What We Eat In America, NHANES , 1 day, n=9,118, unweighted

18 Salt Used in Cooking Sodium values adjustment discontinued for WWEIA, NHANES Rationale: Use of store purchase as a proxy indicator of home preparation no longer appropriate. Questionable if every respondent has knowledge about household food preparation practices of use of salt in cooking. Data from the USDA AMPM Validation Study show dietary recall estimates of sodium intake with salt not adjusted compare favorably to estimates from urinary sodium. 33-page document describing the procedures of salt adjustment and rationale for discontinuation is on the FSRG website.

19 Mean Na intakes based on dietary recall and urinary excretion Two 24h recalls collected using the AMPM, salt in cooking unadjusted Two 24h urines collected during the same 24h period Males n=232 Females n=233 Reported Na intake 4221 mg/d 3180 mg/d Urinary Na biomarker 4541 mg/d 3526 mg/d Reporting accuracy Sodium biomarker = 24h urinary Na/0.86 Source: Rhodes DG, Murayi T, Clemens JC, Baer DJ, Sebastian RS, Moshfegh AJ. The US Department of Agriculture Automated Multiple-Pass Method accurately assesses population sodium intakes. (in review).

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21 Discontinuation of Data Processing Step: Salt Adjustment on Designated Foods Likely To Be Home Prepared Rhonda S. Sebastian, Cecilia Wilkinson Enns, Lois C. Steinfeldt, Joseph D. Goldman, and Alanna J. Moshfegh

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25 Sodium Intakes of Americans daily average in mg 4000 mg Source: What We Eat In America, NHANES, , , , , ; individuals 2 yrs+ (excluding breast-fed children), day 1 dietary intake data, weighted

26 Sodium Intakes of Americans daily average in mg 4000 mg * * not adjusted Source: What We Eat In America, NHANES, , , , , ; individuals 2 yrs+ (excluding breast-fed children), day 1 dietary intake data, weighted

27 In summary... Continual updates and enhancements are being addressed in WWEIA, NHANES to reflect food supply and market changes. Sodium is a major focus for these updates. Discontinuation of salt adjustment in WWEIA, NHANES must be considered in monitoring sodium intake and assessing the impact of sodium reduction strategies. Information on the AMPM methodology, the Food and Nutrient Databse for Dietary Studies, summarized data tables and reports on WWEIA, NHANES plus more are available on the FSRG website at:

28 Thank you