Vital and Health Statistics Dietary Methodology Workshop for the Third National Health and Nutrition Examination Survey Series 4: Documents and Committee Reports No, 27 The Dietary Survey Methodology Workshop (March 16–1 8, 1986) was sponsored by the National Center for Health Statistics for the purposes of reviewing, evaluating, and making recommendations for the selection of dietary methodologies for the third National Health and Nutrition Examination Survey (NHANES Ill), Presented are the background papers, consensus statements, and rationale for the dietary methodologies selected for NHANES Ill, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control National Center for Health Statistics Hyattsvllle, Maiyland March 1992 DHHS Publication No, [PHS] 92-1464 Copyright Information Perm}sston has been oota(ned from the copyrtght holders to rep.educe cert~irr quoted material in llms repot+, Further reproduction of th!s rnaterlal IS p,otl, mtcc! ,wlth out speclf!c permission of the copyright holders All other matertal contatned In the report IS In the public domain and may be used and reDrln!cd wthout special permission: cl:at!on as to source, ho’wcver, IS appreclatcc Suggested Citation Briefel RB, Sempos CT, eds. Detary methodology workshop for the (h-d Nat!onal Health and Nutrition Examlnallon Survey. National Center for Hca’tt- Statlstlcs Vital Health Stat 4(27) 1992 Library of Congress Cataloging-in-Publication Data Dietary methodology workshop far !he third Natlo”al Heal!h arid Nu!rlI{or2 Examination Survey (1986: Airlle, Va ) Proceedings of the Dietary Survey Methodology Workshop for the Th, rc National Health and Nutrition Examination Sutvey/sponsorec by the Nat’onal Center for Health Statistics. p cm. – (Vital and health statistics. Series 4, Documents and committee reports ; no. 27) (DHHS oubllcation ; no. (PHS) 92- 1464) The Workshop was held in Arlte, Va from Mar. 16 to 18, 1986 Includes b(bllographlcal references ISBN 0-8406 -0441-6 1. Nutrition surveys-United States Methodology Congresses 2 Diet–Un/ted States–Congresses, 3. Quest\ onnalres. Congresses 4 Food habits–Unted States–Congresses, 5, National Health and Nutrlt:on Examination Survey (U. S.) –Congresses 1, Nat!onal Center for Health Stat! st}cs (U S ) Il. Title Ill. Seres. IV Series: DHHS pubkatlon ; no (PHS) 92 1464. [DNLM 1, National Health and Nutntlon Exam\ nal!on Survey (US ) 2. D?.la Collection – methods -- congresses 3 Health Surveys Umted States congresses 4. Nutrition Survey s- Un!ted States congresses. W2 A N148vd no, 27] HA37. U1693 no, 27 [TX359] 362.1 ‘0723 S- dc20 [363 82’0723] DNLM/DLC ‘or Library of Congress 90 1338 CID National Center for Health Statistics Manning Feinleib, M.D., Dr.P.H., Director Jacob J. Feldman, Ph,D,, Associate Director for AnaZysis and Epidemiology Gail F, Fisher, Ph.D., Associate Director for Planning and Extramural Programs Peter L, Hurley, Associate Director for Vital and Health Stat&ics Systems Robert A, Israel, Associate Director for International Statistics Stephen E. Nieberding, Associate Director for Management Charles J, Rothwell, Associate Director for Data Processing and Services Monroe G. Sirken, Ph.D., Associate Director for Research and Methodology David L, Larson, Assistant Director, Atlanta Division of Health Examination Statistics Robert S. Murphy, Director Kurt Maurer, Ph.D., Deputy Director Ronette R, Briefel, Dr,P,H., Coordinator for Nutrition Monitoring and Related Research Clifford Johnson, Chiej Nutrition Statistics Branch Katherine M, Flegal, Ph.D., Chief Medical Statistics Branch Christopher Sempos, Ph.D., ChieJ Longitudinal Studies Branch Vicki L. Burt, Chief Survey Planning and Development Branch Jean Findlay, Acting Chie$ Survey Operations Branch Robert Krasowski, ChieJ Computer Systems and Programming Branch Foreword by Catherine E, Woteki, Ph. D., R.D., National Center for Health Statistics How to determine what people eat has been a topic of March 1986, that was a fundamental part of the planning intense research and debate in recent years, Because the of the dietary assessment component of the survey, methods available for use in stuveys rely on the respondent’s The workshop participants were faced with the under- ability to recall and describe what was eaten, they are lying question of choosing dietary methods that would: subject to errors of omission and commission that can limit the usefulness of the information for population ● Fulfill the mission of the National Center for Health estimates and for longitudinal studies of eating habits and Statistics to monitor the nutritional status of the later disease experience. population. In 1985, when we at the National Center for Health ● Provide baseline data on diet that would be useful in Statistics began planning the third National Health and longitudinal studies of diet and health. Nutrition Examination Survey (NHANES III), we took it as an opportunity to evaluate the methods that had been The workshop was organized to address statistical issues used over the preceding 25 years in our various health unique to dietary survey design, dietary methods most examination surveys. We sought the opinions of many appropriate for nutrition monitoring purposes, and those people in the Public Health Service and other government most appropriate for assessing relationships with energy agencies, in academic research institutions, and in industry balance and three chronic diseases (cancer, cardiovascular tihout health and nutrition topics to be included in the disease, and osteoporosis). Many of the recommendations survey as well as the specific methods to be used to collect stemming from this workshop were incorporated into the information, As part of this effort, we sponsored several design of NHANES III. workshops to review, evaluate, and make recommenda- The papers and consensus statements developed for tions about what to include in the survey, This report the workshop and contained in this volume will be useful contains the background papers and consensus statements to others who are planning surveys or to anyone who is from a workshop on dieta~ survey methodology, held in interested in dietary assessment methods, .. Ill Acknowledgments It is a pleasure for the cochairpersons to acknowledge the many staff of the National Center for Health Statistics the significant contributions of the authors of the papers; who made the workshop possible, especially Dr. Anne the discussants; Dr. Lenore Kohlmeier, who served as Looker, Dr. Robert Kuczmarski, Dr. Deborah Winn, moderator; and the attendees to the success of the Dr. Stacey FitzSimmons, Mr. Dale Hitchcock, and Ms. NHANES III (third National Health and Nutrition Exam- Nancy Hamilton. ination Survey) Dietary Survey Methodology Workshop We also wish to acknowledge the Publications Branch and to the planning process for NHANES 111, We also of the National Center for Health Statistics for assistance want to acknowledge the contributions of Dr. Manning with the final preparation of this report. Finally, special Feinleib; the Workshop Planning Committee, namely Dr. acknowledgment is given to Ms. Sharon Stewart for her Lenore Kohlmeier, Mr. Robert Murphy, Dr. Catherine patient and professional technical and editorial assistance Woteki, Mr. Clifford Johnson, and Dr. Kurt Maurer; and during the preparation of this report, v Foreword by Catherine E. Woteki . m““” Acknowledgments . v Introduction by Ronette R. Briefel and Christopher T. Tempos,,.....,.. I Chapter l, Statistical issues related tothedesign ofdieta~sumey methodolo~ for N~NESIII by Kiang Liz{..,, 3 First discussant's remarks about statistical issues by Hare/d A. Kahn, . 15 Second discussant’s remarks about statistical issues in design byGeo~e H. Beaten . 17 Chapter 2. Dietary assessment issues related to cancer for NHANESHI by Gladys Block . 24 Chapter 3. Dietary methods in cardiovascular disease critique by Patricia J. Elmer. 32 Chapter 4. Dieta~methodolo~ issues related toenerW balance measurement for NmSIII@Dorot@Bbir . 43 Chapter 5, Critique ofstudiesof the relationship between diet and osteoporosis by Nancy E. Johnson . -5I Chapter 6. Dietary methodo10gies for food and nutrition monitoring by Elizabeth A. Yetley, Arietta M. Beloian, and C’hrhtineJ,Lewis . ,, .,.,.. 58 First discussant’s remarks about monitoring by EleanorM. Pao.. 68 Second discussant’s remarks about State and local perspectives by Susan B. Foerster ..,.,.....,.....,,,. 71 Chapter 7, Working group consensus statements . 76 Chapter S. Dietary methodology considerations for NHANES III by Lenore Kohlmeier . 81 Chapter 9, Process and rationale forselecting dietarymethods for NHANESIII by Christopher T. Sempos, Ronette R. Briefel, CliffordJohnson, and Catherine E. Woteki . 85 Appendixes I. NHANESIII Dietary Survey Methodology Workshop program . 91 IL NHANESIII Dietary Survey Methodology Workshop Planning Committee . 92 111. Directory ofworkshop participants . , !...,,,., . ,. .,, 93 IV. Outline ofstatistical issues related to NWESIII dietaVsuwey methodolo~ . 96 v, Outline ofdietary methodology issues for presenters, . 97 VI. Prospectus forworkshop . 98 VH,NHANE SIIIsurveydesign. 100 VIII. Measuring dietarypatternsin surveys by Catherine E. Woteki ..,., . 101 vii Symbols --- Data not available . Category not applicable Quantity zero 0.0 Quantity more than zero but less than 0.05 z Quantity more than zero but less than 500 where numbers are rounded to thousands * Figure does not meet standard of reliability or precision ,,, VIII Dietary Methodology