Dr Alison Stephen Population Nutrition Research MRC Human Nutrition Research Cambridge, UK NATIONAL DIET AND NUTRITION SURVEY ROLLING PROGRAMME Report.

Dr Alison StephenPopulation Nutrition ResearchMRC Human Nutrition ResearchCambridge, UK

NATIONAL DIET AND NUTRITION SURVEY ROLLING PROGRAMME

Report of the Comparison Study

NDNS - Background

Previous NDNS surveys:

Children aged 1.5 - 4.5 y - fieldwork 1992-3

OPCS, DNU. Dental: Birmingham, Newcastle

People aged 65 + y - fieldwork 1994-5

SCPR, DNU. Dental: UCL

Young people aged 4-18 years - fieldwork 1997

ONS, HNR. Dental: Birmingham, Newcastle

Adults aged 19-64 years - fieldwork 2000-1

ONS, HNR.

NDNS - Review

Following review of dietary survey programme in

2002/03, FSA Board agreed to rolling programme model

for future NDNS.

Survey will run continuously with fieldwork carried out

every year

Generate data more rapidly

Track changes over time more easily

Collect additional data at short notice

More responsive to policy needs

NDNS Consortium NatCenNatCen

NDNS office - London

Operations – Brentwood

NISRA

Interviewers & Nurses

HNRHNR

NDNS office

Field lab coordination

Bioanalysis/NBL

DLW

Dietary Assessment

Sun exposure

Data Management

UCLUCLSurvey DoctorPhysical Activity

Service AgreementsService AgreementsAddenbrookesAberystwyth UniversityField Laboratories

Responsibilities – Nat Cen

General management issues

Sampling

Fieldwork

Interviews – self complete, CAPI

Dietary assessment

Physical measurement protocols & equipment (H & W, WH, MUAC,

demi-span, infant length, BP)

Physical activity - Questionnaires, Actigraph

Blood and urine collections

Administration of DLW

Briefings

Liaison with NISRA

Reports - Monthly reports to FSA, response rate, main reports

Responsibilities - HNRDietary assessment

Diet coding and editing – queries, new foods etc

Nutrient databank

Dietary data entry and analysis computer system

Dietary feedback forms for respondents

Blood and urine analysis

Recruitment of local processing labs, training

Ethics arrangements for processing laboratories

Supplies for collection and all analyses

Analysis of blood and 24h urine samples

Storage of unused blood for 10 years

Doubly labelled water

Production of samples for field

Receipt and analysis of urine

Data analysis and report writing: dietary data, blood and urine, DLW

Responsibilities – UCL

Survey doctor

Physical activity

Oral health questions

NDNS - managementProject Board

Chaired by FSA, with representatives from all 4 countries

Department of Health

External advisors: Sheila Bingham, Hilary Powers

Senior representatives of Nat Cen, HNR and UCL

Meets 4-6 times per year

NDNS Management Team

Chaired by Nat Cen

Representatives of Nat Cen, HNR and UCL – some invitees

depending on agenda items

Meet 2-3 times per year

HNR management team

Key members of HNR NDNS team – meets every 2-3 months

NDNS –main elements

Comparison Study

Jan 07– Feb 08 (fieldwork March – July 2007)

Sampling 1840 – final number 1049, 160 DLW, reasonably nationally

representative (no NI)

Run-in

Feb- March 2008

N = 5 points/month, 10 DLW, blood, urine

Main stage

April to March each year

10 points/month

Interview/Dietary assessment: Core (1000), Scot (boost to 400/y), NI

(boost to 200/y)

Blood: Core, Scot, NI

Urine: Core, Scot, NI

DLW: Core (160)

Aims of the Comparison Study

compare response rates for 4-day unweighed diary and 4

interviewer-administered 24 hour recalls

compare quality of data and degree of under-reporting achieved

test a new physical activity questionnaire

investigate feasibility of physical activity monitors for children

validate the new physical activity questionnaire against an

objective measure of energy expenditure

test questions on food consumption and social and domestic

circumstances affecting consumption

investigate feasibility of obtaining more detailed information on

food packaging

investigate feasibility of sun exposure questionnaire

Aims of the Comparison Study

compare response rates for 4-day unweighed diary and 4

interviewer-administered 24 hour recalls

compare quality of data and degree of under-reporting achieved

test a new physical activity questionnaire

investigate feasibility of physical activity monitors for children

validate the new physical activity questionnaire against an

objective measure of energy expenditure

test questions on food consumption and social and domestic

circumstances affecting consumption

investigate feasibility of obtaining more detailed information on

food packaging

NDNS Comparison StudyTable 4B Breakdown of CU-level response rates

Outcome 24-hour recall Diary All

  N % N % N %

ISSUED ADDRESSES 920   920   1840  

Ineligible 130 14 109 12 239 13

Eligible 790 86 811 88 1601 87

ELIGIBLE Cus            

Total unproductive: 379 48 375 46 754 47

Non-contact 12 2 14 2 26 2

Refused 309 39 299 37 608 38

Other reason 58 7 62 8 120 7

Partially productive CUs(<3 dietary days for all respondents)

27 3 13 2 40 2

Fully productive CUs (3+ dietary days for at least one respondent)

384 49 423 52 807 50

NDNS Comparison StudySummary of interviewer and coder feedback

both dietary assessment methods presented some

challenges in the field for interviewers and respondents

one of the main determinants of the chosen method was

the need to include two weekend days in the dietary

assessment period, which was more difficult to achieve for

recall for both interviewers and respondents

0

2

4

6

8

10

12

4-6y 7-10y 11-14y 15-18y 19-34y 35-49y 50-64y 65+y 4-6y 7-10y 11-14y 15-18y 19-34y 35-49y 50-64y 65+y

En

erg

y m

J/d

24h recall males diary males

24h recall females diary females

NDNS Comparison study Energy intake by 24h recall and estimated diary

n 14,14 9,26 16,13 23,22 36,39 52,51 44,53 38,37 12,16 14,14 14,11, 13,20 44,51 63,81 60,60 52,55

0

2.5

5

7.5

10

12.5

15

4-10y 11-15y 16-49y 50-64y 65+y 4-10y 11-15y 16-49y 50-64y 65+

En

erg

y m

J/d

Intake recall Expenditure recall

Intake diary Expenditure diary

NDNS Comparison study Tables 7A and7B -Energy intake and expenditure (DLW) for recall and diary - Males

Each cell n =8

0

2.5

5

7.5

10

12.5

15

4-10y 11-15y 16-49y 50-64y 65+y 4-10y 11-15y 16-49y 50-64y 65+

En

erg

y m

J/d

Intake recall Expenditure recall

Intake diary Expenditure diary

NDNS Comparison study Tables 7A and7B - Energy intake and expenditure (DLW) for recall and diary - Females

Each cell n =8

0

2.5

5

7.5

10

12.5

15

4-10y 11-15y 16-49y 50-64y 65+y 4-10y 11-15y 16-49y 50-64y 65+E

ne

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mJ

/d

Intake recall Expenditure recall

Intake diary Expenditure diary

NDNS Comparison study Tables 7A and7B - Energy intake and expenditure (DLW) for recall and diary

Each cell n =8

0

2.5

5

7.5

10

12.5

15

4-10y 11-15y 16-49y 50-64y 65+y 4-10y 11-15y 16-49y 50-64y 65+

En

erg

y m

J/d

Intake recall Expenditure recall

Intake diary Expenditure diary

Males Females

-100%

-75%

-50%

-25%

0%

25%

50%

75%

100%

4-10y 11-15y 16-49y 50-64y 65+y 4-10y 11-15y 16-49y 50-64y 65+

% u

nd

er,

ad

eq

ua

te a

nd

ov

er

rep

ort

ing

Under recall Adequate recall Over recall

Under diary Adequate diary Over diary

NDNS Comparison study Table 7D - % Under, adequate and over reporting - Males

Each cell n =8

-100%

-75%

-50%

-25%

0%

25%

50%

75%

100%

4-10y 11-15y 16-49y 50-64y 65+y 4-10y 11-15y 16-49y 50-64y 65+

% u

nd

er,

ad

eq

ua

te a

nd

ov

er

rep

ort

ing

Under recall Adequate recall Over recall

Under diary Adequate diary Over diary

NDNS Comparison study Table 7D - % Under, adequate and over reporting - Females

Each cell n =8

-100%

-75%

-50%

-25%

0%

25%

50%

75%

100%

4-10y 11-15y 16-49y 50-64y 65+y 4-10y 11-15y 16-49y 50-64y 65+

% u

nd

er,

ad

eq

ua

te a

nd

ov

er

rep

ort

ing

Under recall Adequate recall Over recall

Under diary Adequate diary Over diary

NDNS Comparison study Table 7D - % Under, adequate and over reporting -

Each cell n =8

-100%

-75%

-50%

-25%

0%

25%

50%

75%

100%

4-10y 11-15y 16-49y 50-64y 65+y 4-10y 11-15y 16-49y 50-64y 65+

% u

nd

er,

ad

eq

ua

te a

nd

ov

er

rep

ort

ing

Under recall Adequate recall Over recall

Under diary Adequate diary Over diary

Males Females

NDNS Comparison StudySummary of energy intake and misreporting

there were few differences in energy intake for the two methods.

Only in men aged 35-49 years was there a difference, with energy

intake for diary lower than for 24h recall

there were few differences in misreporting between methods.

Both methods had substantial under-reporting, but not in any

consistent direction

there appeared to be slightly more over-reporting with 24h recall

in young children than diary

24 h recall Diary Previous NDNS*

M F M F M F

n 62 53 75 61 856 845

Protein g 71.3 55.6 69.8 57.4 61.6 51.2

Fat g 74.6 59.9 71.4 65.7 74.7 63.1

Carbohydrate g 253 227 249 213 260 214

Total sugars g 116 106 113 95 117 97

NMES g 84 78 86 67 85 69

NSP g 12.2 10.7 11.7 10.6 11.2 9.7

Calcium mg 935 714 798 719 784 652

Iron mg 10.2 9.2 9.8 8.8 10.4 8.3

Folate µg 229 201 219 188 240 194

Vitamin C mg 97.5 96.5 86.6 75.9 75.2 71.2

NDNS Comparison study Nutrient intakes – young people 4-18 years

* 1997

24 h recall Diary Previous NDNS*

M F M F M F

n 132 167 143 192 833 891

Protein g 86.2 67.5 88.4 66.9 61.6 51.2

Fat g 86.2 64.0 83.1 63.8 86.5 61.4

Carbohydrate g 261 199 246 192 275 203

Total sugars g 115 90 102 83 118 88

NMES g 80 54 69 50 79 51

NSP g 14.6 13.1 14.3 12.6 11.2 9.7

Calcium mg 928 783 892 770 937 726

Iron mg 12.7 10.3 12.3 10.4 13.7 10.5

Folate µg 300 238 281 237 311 213

Vitamin C mg 85.2 93.2 84.9 84.4 66.5 62.0

NDNS Comparison study Nutrient intakes – adults 19-64 years * 2000/01

24 h recall Diary Previous NDNS

M F M F M F

n 38 52 37 55 632 643

Protein g 75.9 66.6 76.1 67.8 71.5 56.0

Fat g 80.5 62.5 71.1 61.5 74.7 58.0

Carbohydrate g 238 183 220 199 232 175

Total sugars g 114 85 100 94 103 79

NMES g 75 46 53 51 64 44

NSP g 14.1 12.8 15.6 14.3 13.5 11.0

Calcium mg 874 768 898 840 836 690

Iron mg 11.6 10.0 12.3 11.2 11.0 8.6

Folate µg 278 266 280 272 270 207

Vitamin C mg 88.4 95.0 99.5 88.0 66.9 60.7

NDNS Comparison study Nutrient intakes – older adults 65+ years

* 1994/5

24 h recall Diary Previous NDNS

M F M F M F

n 62 53 75 61 856 845

Protein % energy 15.0 13.8 15.1 14.3 12.9 12.9

Fat % energy 34.4 33.1 34.6 36.2 35.3 35.9

Carbohydrate % energy 50.1 53.1 49.7 49.4 51.2 50.7

Total sugars % energy 22.3 24.6 22.1 21.9 23.0 23.0

NMES % energy 15.7 17.8 16.6 15.3 16.7 16.4

NDNS Comparison study Nutrient intakes as % energy– young people 4-18 years

24 h recall Diary Previous NDNS

M F M F M F

n 132 167 143 192 833 891

Protein % energy 15.6 16.5 16.6 16.5 15.4 15.9

Fat % energy 33.9 33.9 34.3 34.3 33.5 33.5

Carbohydrate % energy 43.7 44.7 42.7 43.7 44.7 46.7

Total sugars % energy 19.1 19.9 17.4 18.6 19.1 20.2

NMES % energy 13.1 11.9 11.6 11.0 12.8 11.7

NDNS Comparison study Nutrient intakes as % energy – adults 19-64 years

24 h recall Diary Previous NDNS

M F M F M F

n 38 52 37 55 632 643

Protein % energy 14.9 17.4 16.5 17.2 15.4 16.3

Fat % energy 34.3 34.9 33.5 34.2 34.3 35.6

Carbohydrate % energy 43.4 44.2 44.0 46.2 46.4 46.9

Total sugars % energy 20.5 20.4 19.7 21.1 20.2 20.8

NMES % energy 13.2 10.9 10.1 11.0 12.6 11.3

NDNS Comparison study Nutrient intakes as % energy – adults 65+ years

NDNS Comparison StudySummary of nutrient intake

there were no substantial differences in nutrient intake by methodcarbohydrate

fat

protein

total sugars

non-milk extrinsic sugars (NMES)

non-starch polysaccharide (NSP)

calcium

iron

folate

vitamin C

results were similar to past NDNS surveys: older people (1994-95), young

people (1997) and adults (2000-01).

Respondents were offered feedback on

their diet & 84% did request feedback

Challenges

High throughput requires an

automated letter

Contents

Informative

Not too lengthy

Easy to understand

Limited by time available to

produce outputs

Feedback questionnaire to evaluate

the success of the dietary feedback

letters

Key Nutrients ReportedKey Nutrients Reported•Fat intake as % of total energy•Saturated fat intake as % total energy•NMES•Dietary fibre•Vitamin C•Folate•Calcium•Iron•Energy intake (Kcal/d)

NDNS Comparison study Dietary feedback

Fat intake is expressed as a % of total energy consumed. Some fat is essential in the diet but children and adults tend to eat too much in the UK.

To assist with the maintenance of a healthy body weight and reduce the risk of chronic diseases such as heart disease, UK guidelines state that fat should only make up 33% or less of total energy.

UK intake range

25 30 35 40 45Fat as % total energy

Your Child's Intake: 40.0 %UK Guideline: 33.0 %

NDNS Comparison study Dietary feedback

Generating Dietary Feedback LettersGenerating Dietary Feedback Letters

Recalls/Diariesediting & coding “complete”

Emily & Rachel:New food nutrient

composition data entry

Darren:input info on feedback

requested & respondent identifiers

Data output

Data checking

Individual feedback letters

Graphs

Feedback Checking

Feedback letter transfer to NatCen

Darren

Darren/Gemma

Celia

Adrian/Mark/Gemma

Birgit

Zoe

NDNS Comparison Study 2007 NDNS Comparison Study 2007 NDNS Comparison Study 2007 NDNS Comparison Study 2007

Question Yes % No % Not answ %

1. Do you think that the graphs showing your results compared with UK

guidelines for the population are easy to understand?

97 3 0

2. Do you think comparing your results with UK guidelines is useful? 98 2 0

3. Is there any other information about your diet you would like to receive? 26 68 6

5. Would you be interested in a web page for NDNS participants that lists more

information about the survey (for example results as they emerge), updates on

what the nation consumes and nutrition information and advice?

42 56 2

A % B % Not answ %

4. Some additional information we could provide would take longer to produce

e.g. No. of portions of fruit and vegetable you consume.

A) I would like to receive more information about my diet even if I have to wait

up to 12 months to receive it.

B) B) I am happy with the information provided which I receive within 3

months after completion of the dietary assessment.

32 64 4

Table 5B Response to feedback questionnaire

Feedback questionnaire: some respondent comments

“I am concerned at the unrealistic accuracy implied by some of your

analysis, eg my folate intake was reported as 381µg/d. Can you really

make assessments to 3 figures on the basis of a few days data – NO!!”

“I cannot see how this survey is of any use and seems to me to be rather a

waste of time and money especially after the depth of detail concerning

diet that is needed.”

“I am over 80 years of age, can’t I have more information in less than 12

months?”

“I was very impressed with the information returned and am very

appreciative of the extra time put in to produce this feedback. Thanks.”

Contributors to writing the Comparison Study report

HNR

Alison Stephen

Birgit Teucher

Les Bluck

Darren Cole

Emily Fitt

Adrian Mander

Rachel Woodward

Anthony Wright

Nat Cen

• Beverley Bates

• Caireen Roberts

• Helen Mackenzie

• Claire Deverill

UCL

• Jenny Mindell