Download Proposed Fruit and Vegetable Indicators

Estimating Percent Meeting
Fruit & Vegetable Recommendations
from BRFSS data
LV Moore, Kirsten Grimm, Sonia Kim, Kelley Scanlon
BRFSS FV Screener (1994-2009)
These next questions are about the foods you usually eat or drink. Please tell me
how often you eat or drink each one, for example, twice a week, three times a
month, and so forth. Remember, I am only interested in the foods you eat.
Include all foods you eat, both at home and away from home.
1) How often do you drink fruit juices such as orange,
grapefruit, or tomato?
2) Not counting juice, how often do you eat fruit?
3) How often do you eat green salad?
4) How often do you eat potatoes not including French fries,
fried potatoes, or potato chips?
5) How often do you eat carrots?
6) Not counting carrots, potatoes, or salad, how many servings
of vegetables do you usually eat?
Revised FV Screener (2011-)
During the past month, how many
times per day, week or month did
you [drink] or [eat]
1)…100% PURE fruit juices? Do not
include fruit-flavored drinks with
added sugar or fruit juice you made
at home and added sugar to. Only
include 100% juice.
2)…fruit? Count fresh, frozen, or
canned fruit.
3)…cooked or canned beans, such as
refried, baked, black, garbanzo
beans, beans in soup, soybeans,
edamame, tofu or lentils. Do NOT
include long green beans.
4)…dark green vegetables for
example broccoli or dark leafy greens
including romaine, chard, collard
greens or spinach?
5)…orange-colored vegetables such
as sweet potatoes, pumpkin, winter
squash, or carrots?
6)…OTHER vegetables? Examples of
other vegetables include tomatoes,
tomato juice or V-8 juice, corn,
eggplant, peas, lettuce, cabbage, and
white potatoes that are not fried such
as baked or mashed potatoes.
Healthy People – Food and Nutrition
Consumption objectives
Healthy People 2010
• ≥2 servings of fruit (target of 75%)
• ≥3 servings of vegetables (target of 50%)
Healthy People 2020
• Increase the contribution of fruits to the diets of the population
aged 2 years and older from 0.5 cup equivalents per 1,000
calories to 0.9 cup equivalents per 1,000 calories.
• Increase the variety and contribution of vegetables to the diets
of the population aged 2 years and older from 0.8 cup
equivalents per 1,000 calories to 1.1 cup equivalents per 1,000
calories.
Proposed Fruit &Vegetable Indicators
 Median fruit intake (times/day)
 Median vegetable intake (times/day)
 Percent meeting minimum recommendations
for fruit intake (age- & sex-specific)
 Percent meeting minimum recommendations
for vegetable intake (age- & sex-specific)
Proposed Fruit &Vegetable
Indicators
• Percent meeting minimum
recommendations requires 2 parts
– Developing linear equations to convert
BRFSS times per day into cup equivalents
– Comparing estimated cup equivalents against
minimum fruit and vegetable intake
recommendations based on Dietary
Guidelines
Part 1: Developing linear equations to convert
BRFSS times per day into cup equivalents
• NCI developed a protocol for converting
times per day into cup equivalents*
• Four steps
– Develop a food coding scheme to aggregate 24
hr recall foods into food groups that parallel
screener questions
– Estimate mentions: # times each food group
mentioned
– Estimate portion sizes: median amount
consumed, when a food group was eaten
– Model cup equivalents by portion sizes x
mentions to get the conversion equation
*Available at http://appliedresearch.cancer.gov/surveys/chis/dietscreener/scoring.html
NCI equation for converting times
per day into cup equivalents
•
E(Fruits and Vegetables1/2) = β0 + β1(NFG1P1 + NFG2P2 + ... + NFGkPk)1/2
•
Independent variable: mentions x portion sizes of food groups
•
Dependent variable: cup equivalents of fruits and vegetables from all
sources
•
Where:
– k = 6 mutually exclusive fruit and vegetable food groups (NCI: 100% fruit juice,
Fruit, Salad, Fried potatoes, Other white potatoes, Dried beans, Other
vegetables)
– NFGk = number of times/mentions per day a participant consumed food group k
– Pk = estimated median age- and sex-specific portion sizes for each food group k
(cup equivalents)
•
E(Fruits and Vegetables1/2) = β0 + β1(NFG1P1 + NFG2P2 + ... + NFGkPk)1/2
– Estimates from NHANES and above equation
– BRFSS times per day
Recalculation Rationale
• Portion sizes may have changed over time
– NCI used 1994-96 Continuing Survey of Food Intakes of
Individuals dietary recall data
– DNPAO using 24 hour dietary recall data from 2003-2004
NHANES
• 7 NCI food groups ≠ 2011 6 BRFSS questions
• Need estimates for fruit alone and vegetable alone as
well as combined
• Portion sizes are age and sex specific but other
important sociodemographic variation to consider
(race/ethnicity, socioeconomic status, etc.)
Step 1:Develop food coding scheme
and estimate cup equivalents
• Scheme must
– Be consistent with BRFSS 2011 questions
– Have extensive documentation/rationale for
transparency
• My Pyramid Equivalents Database (MPED) food
groups
– MPED translates the amounts of foods eaten in
NHANES into the number of cup equivalents
– 32 MyPyramid major groups and subgroups
– extensively documented
– correlate well with 2011 BRFSS items except for other
vegetables
Fruit and vegetable food records of participant
21005 (n=14/42; ~ 3 cup equivalents of FV)
Cup equivalents
Day Description
Fruit juice
1 White potato, chips
0
1 Potato salad with egg
0
1 Fruit drink
0.23328
1 Fruit drink
0.23328
2 White potato, french fries
0
2 Tomatoes, raw
0
2 Tomatoes, raw
0
2 Tomato catsup
0
2 Tomato catsup
0
2 Lettuce, raw
0
2 Lettuce, raw
0
2 Onions, mature, raw
0
2 Onions, mature, raw
0
2 Cucumber pickles, dill
0
Fruit
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Legumes
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Dark-green
vegetables
0
0
0
0
0
0
0
0
0
0
0
0
0
0
All
Orange
vegetables
vegetables excl legumes
0
0.882
0
0.51338
0
0
0
0
0
0.37819
0
0.2224
0
0.1112
0
0.04245
0
0.0849
0
0.0469
0
0.07272
0
0.0625
0
0.075
0
0.08388
Fruit and vegetable food records of participant
21005 (n=14/42; ~ 0.75 cup equivalents of FV)
Cup equivalents
Day Description
Fruit juice
1 White potato, chips
0
1 Potato salad with egg
0
1 Fruit drink
0.23328
1 Fruit drink
0.23328
2 White potato, french fries
0
2 Tomatoes, raw
0
2 Tomatoes, raw
0
2 Tomato catsup
0
2 Tomato catsup
0
2 Lettuce, raw
0
2 Lettuce, raw
0
2 Onions, mature, raw
0
2 Onions, mature, raw
0
2 Cucumber pickles, dill
0
Fruit
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Legumes
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Dark-green
vegetables
0
0
0
0
0
0
0
0
0
0
0
0
0
0
All
Orange
vegetables
vegetables excl legumes
0
0.882
0
0.51338
0
0
0
0
0
0.37819
0
0.2224
0
0.1112
0
0.04245
0
0.0849
0
0.0469
0
0.07272
0
0.0625
0
0.075
0
0.08388
Step 1:Develop food coding
scheme
• MPED Con’td
– No corresponding aggregation scheme to say what
food should count
– Does not help distinguish what is typically reported in
a screener
• USDA Food Survey Research Group (FSRG)
defined groups
– has extensive documentation
– Consistent with 2011 BRFSS categories
– FSRG aggregates foods based on main ingredients;
Ex. fruit juice in canned fruit does not count towards
total fruit juice
Step 1:Develop food coding scheme
• Each 7,174 different types of food NHANES participants report assigned 8 digit
food code
•
1st digit identifies one of 9 major
food groups
•
Subsequent digits identify
increasingly more specific
subgroups including
1.
milk and milk products
2.
meat, poultry, fish, and mixtures
–
5 fruit subgroups
3.
eggs
–
8 vegetable subgroups
4.
legumes, nuts, and seeds
–
4 legumes/nuts/seeds subgroups
5.
grain products
6.
fruits
7.
vegetables
8.
fats, oils, and salad dressings
9.
sugars, sweets, and beverages
•
Mixtures disaggregated into
single foods per standard
recipes
• Certain foods excluded from groups to make consistent with BRFSS screener
• Baby foods
• Dried fruit
• Condiments
• Fruits and vegetables on sandwiches (lettuce, tomato onion)
Food coding scheme for aggregating foods from NHANES 2003-04 into
BRFSS 2011 comparable categories
2011 BRFSS Question
USDA FSRG
variables
1. During the past month, how many FRUIT11 +
times per day, week or month did FRUIT35
you drink 100% PURE fruit juices?
Do not include fruit-flavored drinks
with added sugar or fruit juice you
made at home and added sugar to.
Only include 100% juice. (FRUIT
JUICE)
*Online search tool for USDA food codes :
http://www.ars.usda.gov/services/docs.htm?docid=17032
Corresponding FSRG
8 Digit Food Codes*
(611 or 612 01- 612 13
or 612 16)
+
(612 0050 or 612 14 or
612 19-612 26 or 641
0011-642 2101)
Step 1:Develop food coding
scheme
• MPED should be used in conjunction with FSRG
• For each NHANES participant
– Each food eaten disaggregated
– Only foods classified as one of the 6 FSRG food
groups contributes to mentions & portion sizes
(independent variables)
– All foods except fried potatoes and non 100% fruit
juice contribute cup equivalents (dependent variables)
Fruit and vegetable food records of
participant 21005 (n=14/42)
Cup equivalents
Day Description
Fruit juice
1 White potato, chips
0
1 Potato salad with egg
0
1 Fruit drink
0.23328
1 Fruit drink
0.23328
2 White potato, french fries
0
2 Tomatoes, raw
0
2 Tomatoes, raw
0
2 Tomato catsup
0
2 Tomato catsup
0
2 Lettuce, raw
0
2 Lettuce, raw
0
2 Onions, mature, raw
0
2 Onions, mature, raw
0
2 Cucumber pickles, dill
0
Fruit
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Legumes
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Dark-green
vegetables
0
0
0
0
0
0
0
0
0
0
0
0
0
0
All
Orange
vegetables
vegetables excl legumes
0
0.882
0
0.51338
0
0
0
0
0
0.37819
0
0.2224
0
0.1112
0
0.04245
0
0.0849
0
0.0469
0
0.07272
0
0.0625
0
0.075
0
0.08388
Fruit and vegetable food records of
participant 21005 (n=2/42)
Cup equivalents
Day Description
1 Potato salad with egg
2 Tomatoes, raw
Fruit juice
0
0
Fruit
0
0
Legumes
0
0
Dark-green
vegetables
0
0
All
Orange
vegetables
vegetables excl legumes
0
0.51338
0
0.2224
Step 2: Estimate mentions per day (NFGk)
• Count the number of times each fruit and
vegetable group mentioned in 24 hr recall
data
• No minimum threshold to count as a mention
• Sum times per day each BRFSS food group
mentioned and average over 2 days
Fruit and vegetable food records of
participant 21005 (n=2/42)
Cup equivalents
Day Description
1 Potato salad with egg
2 Tomatoes, raw
Fruit juice
0
0
Fruit
0
0
Legumes
0
0
Dark-green
vegetables
0
0
All
Orange
vegetables
vegetables excl legumes
0
0.51338
0
0.2224
Fruit and vegetable food records of
participant 21005 (n=2/42)
Mentions
Day Description
1 Potato salad with egg
2 Tomatoes, raw
Total
Fruit juice
0
0
Fruit
0
0
Legumes
0
0
Dark-green
vegetables
0
0
0
0
0
0
1 mention per day
All
Orange
vegetables
vegetables excl legumes
0
1
0
1
0
2
Step 3: Estimate portion sizes (Pk)
• When participants ate a food group, what was median
amount eaten?
• Portion size = Total amount eaten (cup equivalents) of
each food group / number of times each food group was
mentioned
• Explore variation in portion sizes by various
demographic characteristics
–
–
–
–
Age groups
Race/ethnicity
Socioeconomic status
Others
Median portion sizes (Pk)*
Food group
Legumes
Other vegetables
Male
0.74996
1.31522
Female
0.50018
1.312
Non-Hispanic White
0.50003
1.52617
Non-Hispanic Black
0.56238
1.04206
Mexican American
0.75027
0.99242
0.75
1.06501
0.32258
1.45222
Selected Demographic Characteristics
Sex
Race/Ethnicity
Other Hispanic
Other Race
*For illustration purposes only
Conversion equation
•
E(Fruits and Vegetables1/2) = β0 + β1(NFG1P1 + NFG2P2 + ... + NFGkPk)1/2
– Estimates from NHANES and above equation
– BRFSS times per day
•
Where:
– k = 6 mutually exclusive fruit and vegetable food groups (NCI: 100% fruit juice,
Fruit, Salad, Fried potatoes, Other white potatoes, Dried beans, Other
vegetables)
– NFGk = number of times/mentions per day a participant consumed food group k
– Pk = estimated median age- and sex-specific portion sizes for each food group k
(cup equivalents)
Proposed Fruit &Vegetable
Indicators
• Percent meeting minimum
recommendations requires 2 parts
– Developing linear equations to convert
BRFSS times per day into cup equivalents
– Comparing estimated cup equivalents against
minimum fruit and vegetable intake
recommendations based on Dietary
Guidelines
Step 4: Calculate percent meeting
minimum requirement
• Conversion and estimating percent meeting the
minimum requirements done simultaneously
• NCI developed 1- or 2-part nonlinear mixed models to
account for usual intake
• Model depends on whether or not the food in question
was consumed daily by almost everyone
– If food group episodically consumed, 2-part model used to
account for probability food consumed and amount eaten
– If food group ubiquitously consumed, 1-part model used to
account for only amount eaten
Estimating the percentage of population
exceeding recommendation threshold
• No single set of recommendations in Dietary Guidelines
• Varies by each person’s appropriate level of energy intake based on
sex, age, and activity level
• Estimate minimum recommendations based on age, sex, and
sedentary behavior (<30 minutes of PA)
Daily recommendations*
Sex
Women
Age (years
Vegetables
Fruit
19-30
2½ cups
2 cups
31-50
2½ cups
2 cups
1 ½ cups
19-30
3 cups
2 cups
31-50
3 cups
2 cups
51+
2½ cups
2 cups
51+
Men
1 ½ cups
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