Cross-continental national nutrition surveys: a narrative review

Many countries use national nutrition surveys (NNSs) to assess their population's health and nutrition needs. However, NNS aims, approaches, tools, and measurements vary among countries. To date, there has been no review evaluating the NNSs and their practices worldwide to help conduct future NSSs. Therefore, this narrative review was conducted to 1) explore and tabulate current NNSs in five continents (Asia, Europe, Africa, North America, and Australia) and 2) help lay the foundation for establishing clear guidelines for future NNSs. The NNSs were identified using two approaches. First, an electronic database search was conducted with key terms in PubMed database. Second, a general web-based search on the survey webpages of governmental organizations was conducted using the same key terms to identify eligible surveys. The review included general adult population (≥ 18 years) with a cross-sectional design, excluding NNSs related to household-only surveys, specific age groups, or insufficient sample sizes. A total of 41 NNSs were identified in 37 countries across four continents: Asia (n = 15), Europe (n = 21), North America (n = 3), and Australia (n = 2). Broad differences between the surveys were identified, including survey purposes and designs, definitions of geographic areas and target groups, and dietary assessments. Currently, there are 26 ongoing NNSs, while 15 have ended. Among the ongoing NNSs, the cycles of the surveys were either at regular intervals (n = 8) or irregular intervals (n = 8). Of the 41 surveys, 24-h dietary recalls were used in 27 surveys, while only 6 surveys used diet diaries and 8 surveys relied on FFQs. Some surveys (n = 17) utilized multiple tools to assess dietary intake. Most of the surveys that assessed biochemical status (n = 12) focused on blood glucose, haemoglobin A1c (HbA1c), and lipid status, whereas some surveys (n = 6) tested for vitamin and mineral status in blood and/or urine samples. The review identified key characteristics, time frames, sampling methods, and dietary and physical assessment methods obtained from different surveys worldwide. The information organized in this review will be important for researchers, policymakers, and public health programme developers in developing and improving NNS.

Sodium, added sugar and saturated fat intake in relation to mortality and CVD events in adults: Canadian National Nutrition Survey linked with vital statistics and health administrative databases

This study aimed to determine whether higher intakes of Na, added sugars and saturated fat are prospectively associated with all-cause mortality and CVD incidence and mortality in a diverse population. The nationally representative Canadian Community Health Survey-Nutrition 2004 was linked with the Canadian Vital Statistics - Death Database and the Discharge Abstract Database (2004-2011). Outcomes were all-cause mortality and CVD incidence and mortality. There were 1722 mortality cases within 115 566 person-years of follow-up (median (interquartile range) of 7·48 (7·22-7·70) years). There was no statistically significant association between Na density or energy from saturated fat and all-cause mortality or CVD events for all models investigated. The association of usual percentage of energy from added sugars and all-cause mortality was significant in the base model with participants consuming 11·47 % of energy from added sugars having 1·34 (95 % CI 1·01, 1·77) times higher risk of all-cause mortality compared with those consuming 4·17 % of energy from added sugars. Overall, our results did not find statistically significant associations between the three nutrients and risk of all-cause mortality or CVD events at the population level in Canada. Large-scale linked national nutrition datasets may not have the discrimination to identify prospective impacts of nutrients on health measures.

Adherence to food-based dietary guidelines among adolescents in Germany according to socio-economic status and region: results from Eating Study as a KiGGS Module (EsKiMo) II

OBJECTIVE

Dietary habits developed during childhood and adolescence are likely to continue into adulthood. An unbalanced diet may cause nutrient deficiencies and excessive energy intake; these enhance the risk for developing overweight and obesity and their co-morbidities. In the present analysis, food consumption of adolescents is described and evaluated against German food-based dietary guidelines with special focus on socio-economic status (SES) and region of residence.

DESIGN

Within the 'German Health Interview and Examination Survey for Children and Adolescents' (KiGGS Wave 2), the cross-sectional 'Eating Study as a KiGGS Module' (EsKiMo II) was conducted from 2015 until 2017 to provide data about dietary behaviour.

SETTING

Germany.

PARTICIPANTS

1353 adolescents aged 12-17 years from a nationwide representative sample with food consumption data from computer-assisted dietary history interviews.

RESULTS

The median consumption of fruits, vegetables, starchy foods and milk/dairy products among adolescents in Germany was below the recommendation. The median consumption of both meat/meat products and unfavourable foods, like confectionery, which should be consumed sparingly, was about 1·5 times the recommended amount. The total amount of beverages consumed by most adolescents was above the minimum amount recommended. Soft drink consumption of adolescents with a low SES was three to five times higher than soft drink consumption of adolescents with a high SES.

CONCLUSIONS

The results indicate the need for an improvement of dietary habits among adolescents in Germany. Further approaches to promote healthy diets in Germany should be continued, and the focus on social inequalities should be strengthened.

The effect of increasing intakes of plant protein on the protein quality of Canadian diets

The 2015 Canadian Community Health Survey was used to investigate the protein content and protein quality of the diets consumed by adults (≥19 years) when plant protein is increased. Individuals (n = 6498) were allocated to quartiles of increasing proportions of protein from plant foods (Quartile 1: 0-24.9%; Quartile 2: 25%-49.9%; Quartile 3: 50-74.9%; Quartile 4: 75-100%). The Protein Digestibility Corrected Amino Acid Score (PDCAAS) of diets were estimated using indispensable amino acid concentrations of foods and an assumed digestibility coefficient of 0.8. Corrected protein intakes were determined by aggregating foods consumed over 24 hours and as the sum of corrected protein consumed at eating events within six 4-hour time intervals. Most individuals (51%) consumed 25-49.9% of protein from plant foods. Cereal-based foods represented the majority of plant protein consumed. PDCAAS of diets remained ≥0.87 for quartiles 1-3, but decreased (p < 0.0001) to 0.71 ± 0.018 in quartile 4 vs. quartile 2 (0.96 ± 0.004). Corrected protein intakes in quartile 2 (80.66 ± 1.21 g/day; 1.07 ± 0.03 g protein/kg body weight) decreased to 37.13 ± 1.88 g/day (0.54 ± 0.03 g/kg body weight) in quartile 4 (p < 0.0001). Aggregated daily corrected protein intake strongly correlated (r = 0.99; p < 0.001) with the sum of corrected protein consumed within time intervals. Intra-time interval analysis revealed that the relative proportions of animal and plant proteins changed at eating events over 24 hours and did not reflect the allocation to quartiles based on the daily proportion of plant protein consumption. Various tools should be explored and developed to assist Canadians in effectively incorporating plant protein foods into dietary patterns. Novelty: Corrected protein intakes decreased as plant protein consumption increased. PDCAAS was ≥0.87 for diets with ≤74.9% plant protein.

Food group intake at self-reported eating occasions across the day: secondary analysis of the Australian National Nutrition Survey 2011-2012

OBJECTIVE

To examine core and discretionary food and beverage intake at eating occasions, and to explore the variation in consumption by age and gender in Australian adults and children.

DESIGN

The study utilised one 24-h dietary recall with self-reported eating occasions from a nationally representative sample of Australians. Average servings of each food group for age and gender subpopulations were compared with the Australian Dietary Guidelines. The percentage contribution of each eating occasion to total daily food group intake and typical composition of eating occasions were described. Frequently consumed discretionary foods were reported for eating occasions by age and gender.

SETTING

2011-2012 Australian National Nutrition and Physical Activity Survey.

PARTICIPANTS

12 153 Australian people aged 2 years and above.

RESULTS

Grains were consumed in equal proportions throughout the day across all age and gender subgroups, while remaining core food groups were unequally distributed, featuring more prominently at specific eating occasions. Children consumed two-thirds of their fruit intake as snacks, and up to three quarters of adults' vegetable and meat intake was consumed at dinner. Children consumed more of their discretionary intake at mid-meals, while adults consumed a greater proportion as part of a main meal.

CONCLUSIONS

The present study provides a detailed understanding about when food groups are consumed, the 'typical' meal composition across the day, and how consumption patterns and compliance with dietary guidelines differ by age group and gender. These findings can assist in developing more specific nutrition messages which may help to achieve greater improvements in population dietary intake.

Vegetable Protein Intake was Inversely Associated with Cardiovascular Mortality in a 15-Year Follow-Up Study of the General Japanese Population

AIM

To examine the relationship between the intake of dietary vegetable protein and CVD mortality in a 15-year follow-up study of a representative sample of the Japanese population.

METHODS

A total of 7,744 participants aged 30 years or older (3,224 males and 4,520 females) who were free of CVD at baseline were included in this analysis. Vegetable protein intake (% energy) was assessed using a three-day semi-weighed dietary record at baseline. Multivariable-adjusted hazard ratios (HRs) were calculated using Cox's proportional hazards model after adjusting for confounding factors.

RESULTS

The total person-years studied were 107,988 with a mean follow-up period of 13.9 years. There were 1,213 deaths during the follow-up period, among which 354 (29.2%) were due to CVD. Vegetable protein intake was associated inversely with CVD and cerebral hemorrhage mortality, with the HRs for a 1% energy increment in vegetable protein intake being 0.86 (95% CI, 0.75-0.99) and 0.58 (95% CI, 0.35-0.95), respectively. In the subgroup analysis of participants with or without hypertension, the inverse association between vegetable protein intake and CVD mortality was more evident in the nonhypertensive group, with the HRs for CVD and stroke being 0.68 (95% CI, 0.50-0.94) and 0.50 (95% CI, 0.30-0.84), respectively.

CONCLUSIONS

Vegetable protein intake may prevent future CVD, particularly in nonhypertensive subjects in the Japanese population. However, further studies are necessary to examine the biological mechanisms of this effect.

Discretionary intake among Australian adults: prevalence of intake, top food groups, time of consumption and its association with sociodemographic, lifestyle and adiposity measures

OBJECTIVE

To profile discretionary food and beverage (DF) consumption among Australian adults.

DESIGN

Cross-sectional analysis. Dietary and sociodemographic data were used to profile DF intake. Prevalence of DF consumption, DF servings (1 serving=600 kJ), nutrient contribution from DF and top DF food groups by self-reported eating occasions were determined. DF consumers (&gt;0 g) were classified according to quartile of DF intake and general linear models adjusted for age and sex were used to determine associations.

SETTING

2011-12 National Nutrition and Physical Activity Survey (NNPAS).ParticipantsAdults aged ≥19 years (n 9341) who participated in the NNPAS 2011-12.

RESULTS

Most adults consumed DF (98 %) and over 60 % exceeded 3 DF servings/d, with a mean of 5·0 (se 0·0) DF servings/d. Cakes, muffins, scones, cake-type desserts contributed the most DF energy (8·4 %) of all food groups, followed by wines (8·1 %), pastries (8·0 %) and beers (6·1 %), with all these food groups consumed in large portions (2·3-3·0 DF servings). Lunch and dinner together contributed 45 % of total DF energy intake. High DF consumers had an average of 10 DF servings, and this group contained more younger adults, males, low socio-economic status, lower usual fruit intake and higher mean waist circumference, but not higher BMI.

CONCLUSIONS

A focus on DF consumed in large portions at lunch and dinner may help improve interventions aimed at reducing DF intake and addressing negative adiposity-related measures found in high DF consumers.

Association between breakfast composition and abdominal obesity in the Swiss adult population eating breakfast regularly

BACKGROUND

Evidence from experimental and observational studies is limited regarding the most favorable breakfast composition to prevent abdominal fat accumulation. We explored the association between breakfast composition (a posteriori derived dietary patterns) and abdominal obesity among regular breakfast eaters from a Swiss population-based sample.

METHODS

The cross-sectional survey assessed diet using two 24-h dietary recalls in a nationally representative sample of adults aged 18 to 75 years. We derived dietary patterns using principal component analysis based on the intake of 22 breakfast-specific food groups. All regular breakfast eaters were predicted an individual score for each identified pattern, and then classified into tertiles (T1, T2, T3). We defined abdominal obesity as waist-to-hip ratio (WHR) ≥ 0.9 in men and ≥ 0.85 in women. Logistic models were adjusted for sociodemographic characteristics, relevant nutrition- and health-related behaviors, and diet quality during the rest of the day.

RESULTS

Of the 2019 included survey participants, 1351 (67%) were regular breakfast eaters. Among them, we identified three breakfast types: 1) 'traditional' - white bread, butter, sweet spread, 2) 'prudent' - fruit, unprocessed and unsweetened cereal flakes, nuts/seeds, yogurt, and 3) 'western' - processed breakfast cereals, and milk. The 'prudent' breakfast was negatively associated with abdominal obesity. After full adjustment, including diet quality during the rest of the day, the association was weaker (T3 vs. T1: OR 0.72, 95% CI: 0.47 to 1.08). People taking a 'prudent' breakfast (in T3) had 1.2% lower WHR compared to people taking a breakfast distant from 'prudent' (in T1) (P = 0.02, fully adjusted model with continuous log-WHR). We found no association between 'traditional' or 'western' breakfasts and WHR (OR 1.00, 95% CI: 0.67 to 1.50 and OR 1.16, 95% CI: 0.79 to 1.71, respectively). Findings were in the same directions for the three breakfast types when defining obesity with waist circumference, waist-to-height ratio, or body mass index (≥ 30 kg/m2, for 'prudent' breakfast: OR 0.51, 95% CI: 0.31 to 0.85).

CONCLUSIONS

Regular breakfast consumers had less abdominal obesity if their breakfast was composed of fruit, natural cereal flakes, nuts/seeds and yogurt. This association was partly explained by their healthier diet during the rest of the day.

TRIAL REGISTRATION

ISRCTN16778734 .

Lessons Learnt About Conducting a Multilingual Nutrition Survey in Switzerland: Results from menuCH Pilot Survey

This paper informs about the implementation of the first trilingual Swiss nutrition pilot survey and lessons learnt in terms of recruitment, participation, data collection feasibility, and data management. The population-based cross-sectional nutrition pilot survey took place between June and November 2013. Six trained dietitians interviewed 276 adults aged 18-75 years residing in the cantons of Bern (German), Vaud (French) or Ticino (Italian). Food consumption was assessed with two non-consecutive computer-assisted 24-Hour Dietary Recalls (24HDR), applying a trilingual version of GloboDiet® adapted to specific requirements of Switzerland. The first interview was face-to-face and included anthropometric measurements while the second was by phone. Quality controls consisted mainly in the descriptive analysis of data at food level, and the observation and rating of 21 interviews (4%) by coordinators. Net participation rate was 29%. Participants and non-participants were similar: mean [±SD] age was 49±16 and 47±16 years, and women proportion 49.6% and 49.8%, respectively. Training and data collection proved feasible and deliverable in the six months using the newly developed survey instruments. Dietitians followed the standard operating procedures. Quality controls on food consumption data showed comparable results between face-to-face and phone 24HDR, and across dietitians (median number of reported food items per 24HDR: 27). Procedures to transfer and clean food consumption data were developed. The implementation concept proved applicable in the trilingual Swiss context. Additional resources were planned for increasing participation rate and facilitating data cleaning.

Consumption patterns of meat, poultry, and fish after disaggregation of mixed dishes: secondary analysis of the Australian National Nutrition and Physical Activity Survey 2011-12

Background

With the increased consumption of mixed dishes, the need for more precise quantitative data on individual food components is becoming more important. This paper aims to examine the consumption of meat, poultry, and fish before and after disaggregation of mixed dishes, and its contribution to energy and nutrient intakes in a representative sample of Australians.

Methods

This study utilised a 24-h recall of 12,153 people aged two years and over participating in the 2011–12 National Nutrition and Physical Activity Survey. Consumption of meat/poultry/fish was examined before and after disaggregation of mixed dishes where all meat products and mixed dishes were separated into individual food components. Comparison between these two methods was undertaken for consumption data and contribution to energy and nutrient intakes, reported by meat type.

Results

Disaggregation of mixed dishes resulted in lower estimated intakes of red meat (9%), poultry (25%), and fish (18%) but higher estimates of processed meat (17%). Meat/poultry/fish contributed approximately 25% of total energy intake, 49% protein, 29% saturated fat, 26% iron, and 38% of zinc intake after disaggregation, which was significantly higher than their contributions reflected in survey data containing mixed dishes. Per-capita consumption of all meat/poultry/fish was 118 g/day for children and 162 g/day for adults, with chicken and beef being the highest contributors.

Conclusion

These findings provide a detailed picture of meat/poultry/fish consumption in Australia, and emphasise the need for population studies to disaggregate reported food information to provide a more precise estimate of consumption.

Electronic supplementary material

The online version of this article (doi:10.1186/s40795-017-0171-1) contains supplementary material, which is available to authorized users.

Secular changes in intakes of foods among New Zealand adults from 1997 to 2008/09

OBJECTIVE

To examine changes in the food choices of New Zealand (NZ) adults, between the 1997 National Nutrition Survey (NNS97) and the 2008/09 NZ Adult Nutrition Survey (2008/09 NZANS).

DESIGN

The 2008/09 NZANS and the NNS97 were cross-sectional surveys of NZ adults (aged 15 years and over). Dietary intake data were collected using a computer-based 24 h diet recall. Logistic regression models were used to examine changes over time in the percentage reporting each food group, with survey year, sex and age group (19-30 years, 31-50 years, 51-70 years, ≥71 years) as the variables.

SETTING

NZ households.

SUBJECTS

Adults aged 19 years and over (NNS97, n 4339; 2008/09 NZANS, n 3995).

RESULTS

In the 2008/09 NZANS compared with NNS97, males and females were less likely to report consuming bread, potatoes, beef, vegetables, breakfast cereal, milk, cheese, butter, pies, biscuits, cakes and puddings, and sugar/confectionery (all P<0.001). In contrast, there was an increase in the percentage reporting rice and rice dishes (P<0.001), and among females a reported increase in snacks and snack bars (e.g., crisps, extruded snacks, muesli bars; P=0.007) and pasta and pasta dishes (P=0.017). Although food choices were associated with sex and age group, there were few differential changes between the surveys by sex or age group.

CONCLUSIONS

For all age groups there was a shift in the percentage who reported consuming the traditional NZ foods, namely bread, beef, potatoes and vegetables, towards more rice and rice dishes. Declines in the consumption of butter, pies, biscuits, cakes and puddings are congruent with current dietary guidelines.