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Securing the Future for Monitoring the Health,

Nutrition, and Physical Activity of Americans

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arely is legislation proposedwith a far-reaching, substantiveimpact on the science and prac-

ice of dietetics and nutrition. Theational Health, Nutrition, andhysical Activity Monitoring Act of005 (1) moving through the Housend Senate in this Congress is such aill.Knowing what Americans eat and

ow their diets and physical activityirectly affect health provides valu-ble information to direct health pro-essionals as well as policymakers onood and dietary guidance, foodafety, food labeling, food assistance,ilitary rations, and national secu-

ity (2). The National Health, Nutri-ion, and Physical Activity Monitor-ng Act of 2005 would ensure that theederal government will always col-ect and analyze data on the healthnd dietary intakes of a nationallyepresentative sample and subgroupsf the US population essential to de-isions on numerous food and nutri-ion policies. The bill also providesuthorization for funding of these es-ential federal activities and requireshe US Department of Health anduman Services (HHS) and the USepartment of Agriculture (USDA) to

eview the Dietary Guidelines formericans at least every 10 years.Data from national nutrition moni-

oring have an impact on billions ofollars in federal expenditures forood assistance, nutrition education,ioterrorism, food safety, publicealth programs, and food additivend pesticide reviews and approvals.side from the budgetary impact, theata also provide crucial information

This article was written byNancy Chapman, MPH, RD,president, N. ChapmanAssociates, Inc, and leader,Alliance for Continuing NutritionMonitoring, Washington, DC.

adoi: 10.1016/j.jada.2005.06.013

196 Journal of the AMERICAN DIETETIC ASSOCIATI

bout our nation’s health and foodupply. The use of these data is exten-ive among public and private enti-ies (Figure 1).

HE HISTORY OF NUTRITIONONITORINGeparately, the USDA and the HHSave collected data on food consump-ion and health since the 1930s and960s, respectively (Figure 2).The sampling plans, collectionethodology, coding, and other pro-

essing systems differed between thenitial USDA Food Consumption Sur-eys and the HHS National Healthxamination Survey as well as theore recent iterations of these sur-

eys. The National Nutrition Moni-oring and Related Research Act of990 (3) called for a 10-year plan tontegrate the two independent sur-eys (ie, USDA’s Continuing Surveyf Food Intakes by Individuals [CS-II] and the HHS’s National Healthnd Nutrition Examination SurveyNHANES]) on every level and re-uired these two departments to re-iew jointly all nutrition educationnd dietary guidance information re-eased by either department. The-year review and publication of theietary Guidelines for Americans waslso mandated in this 1990 Act. The990 Act expired in 2003, but the Al-iance for Continuing Nutrition Mon-toring is working with the HHS,SDA, and Congress to reauthorizend revise this valuable legislation.Prompted by the 1990 Act, theSDA Agricultural Research Service

ARS) and the HHS National Centeror Health Statistics (NCHS) of theenters for Disease Control and Pre-ention moved to harmonize the sur-eys of each agency. Beginning inanuary 2002, the ARS and NCHSave jointly conducted national nutri-ion monitoring activities under thentegrated NHANES/CSFII survey on

nationally representative popula- N

ON © 2005

ion of 5,000 annually. The USDA andHS jointly release the data every 2

ears in a report “What We Eat inmerica” and through periodic re-orts on health measures such as therevalence of obesity, spina bifida, el-vated blood cholesterols, and ele-ated blood mercury levels.The collected data have been used

o identify specific problems, craftood policies to reverse a public healthroblem, and assess the impact of theolicies on the problem. For example,he NHANES data linked high prev-lence of low serum folate in youngomen and high prevalence of spinaifida in newborns. Foods frequentlyonsumed by the target at risk popu-ation were identified, and policies toortify these foods with folic acid weredopted. Two years after the new for-ification policies were implemented,olate intakes for females increasedFigure 3) (4,5), serum folates in-reased (Figure 4) (5,6), and spina bi-da rates declined (Figure 5) (7).A similar connection has beenade between collected data on highercury levels in hair and blood and

olicies to restrict the intake of cer-ain mercury-containing fish foroung children and pregnant women.he national nutrition monitoringystem is this nation’s best and mostomprehensive method of assessingutritional health because the surveyontinuously collects usual dietarynd supplement intake and labora-ory indicators of nutrition statusrom a nationally representative USample.

MPROVEMENTS WITH THE NEWEGISLATIONecause the national nutrition moni-

oring system is essential for trackinghe health and well-being of themerican population and is espe-ially important for observing healthrends in our nation’s children, the

ational Health, Nutrition, and

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hysical Activity Monitoring Act of005, introduced by Congressmanaurice Hinchey (D-NY) and Con-

Federal nutrition programsTo focus federal nutrition programs where th

Application of data● US Department of Agriculture (USDA) u

the Food Stamp Program benefits.● Data provide indexes for programs suc

nutrients to provide target populations

Dietary guidance and nutrition educationTo devise strategies to lower the risk of heaunderstanding of specific relationships amonvulnerable groups from infancy to old age s

Application of data● USDA/US Department of Health and Hu

assessing progress toward meeting the● USDA uses the dietary data to develop● National Cancer Institute and the Produ

5 A Day goal.● USDA’s Food and Nutrition Services us

BiosecurityTo obtain reliable estimates of the prevalencattacks.

Application of data● USDA could identify segments of popu

Public and private health programsTo assess the nutritional data on the qualitydue to lower incidence of chronic diseases.

Application of data● The US Food and Drug Administration

of the food label and to formulate foodfortification, track how fortification affe

● The National Institutes of Health and oheart disease, cancer, and other diet-r

● Researchers use nutrition monitoring d

Food safety regulationsTo provide data for estimating possible intakregulating the use of certain substances.

Application of data● With passage of the Food Quality Prote

as a critical component in its risk asseresidues found on food and in water, areassessing a pesticide product. If anyFood Quality Protection Act implementaProtection Act decisions.

● The Codex Alimentarius, an internationfood additives, pesticides, food labeling

Food product development and marketingTo generate a more nutritious food supply bidentify public health problems that can be

Application of data● Farmers have bred livestock and plant● US food industry currently uses the nu

products. Monitoring data are used wh

igure 1. Uses of nutrition and health data fromy Individuals.

ressman Tom Latham (R-IA), as- n

ures that the HHS and USDA jointlynd continuously collect, analyze, andublish data from a comprehensive

are most needed.

food consumption data to develop the Thrifty

s the Supplemental Nutrition Program for Wommen, children, and infants at risk) through the

isease, cancer, diabetes, osteoporosis, and oiet, heredity, and lifestyle. To keep dietary guey realize full growth, development, health, a

n Services’ Dietary Guidelines Advisory Commetary Guidelines for Americans.

revise the MyPyramid.for Better Health Foundation use food consum

he Diet and Health Knowledge Survey in deve

f eating certain foods, which may be the veh

n at risk if specific foods are found to be con

diets and the effects of health outcomes for t

s the nutrition monitoring system to establishtification policies, define public health needs,the population, and determine consumer usehealth agencies use the nutritional status da

ed diseases.to understand factors affecting food and beve

f incidental contaminants, pesticides and natu

n Act, the Environmental Protection Agency (Eents and pesticide decisions. EPA incorporateactual pesticide use on crops to measure expg, EPA needs more USDA dietary intake data,. A reduction in available dietary intake data

olicy making organization, utilizes the food cond other critical issues.

entifying health-promoting properties of plantected through nutrient fortification, fat modific

improve nutritional composition and appeal tn monitoring system data to reformulate prod

a new additive or processing method is introd

e integrated National Health and Nutrition Exam

utrition monitoring system. Senate

August 2005 ● Journal

ponsors are expected to introduce aompanion bill in the Senate in earlyummer.

od Plan that underpins the determination of

, Infants, and Children to determine whichod package.

diet-related diseases by increasing thece current and appropriate for nutritionallyhysical well-being.

e uses dietary data in revising and

n data to track progress toward the

ing nutrition education programs.

for intentional or unintentional bioterrorist

inated.

population and reduce health care costs

serving sizes for the Nutrition Facts panelermine target and nontarget populations forietary supplements.

o identify populations at risk of obesity,

e consumption.

y occurring toxic substances as part of

) relies on USDA’s dietary consumption dataSDA data on dietary consumption, pesticidere to pesticides when registering orless, in order to enhance good science inhinder EPA’s ability to make Food Quality

mption data for policy decisions regarding

d animal foods in a balanced diet and ton, and interventions to prevent obesity.

alth-conscious consumers.s, and create new ingredients andd.

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PUBLIC POLICY NEWS

1198 August 2005 Volume 105 Number 8

nd Physical Activity Monitoring Actf 2005 reauthorizes the Nutritiononitoring and Related Research Act

nd also:

ensures that policymakers have ac-cess to full and complete informa-tion on the nutritional status andfitness levels of children, youth, andother Americans;allows data from the integratedNHANES/CSFII survey to be com-bined with information from othernutrition and health surveys to de-termine impact of federal nutritionand food safety programs and toguide other policy recommenda-tions;requires the USDA and HHS toconsult with federal agencies, aswell as state and local govern-ments, the private sector, scientificcommunities, health professionals,and the public regarding monitor-ing and research needs to deter-mine the nutritional status, fitnesslevels, diet, and health knowledgeof Americans;updates the food composition tablesused to assess diets regularly in or-der to keep pace with changes inthe food supply;makes grants available to states,public, and nonprofit entities to as-sist with the collection and analysisof nutritional and fitness data,based on methodology developed forthe integrated NHANES/CSFIIsurvey;provides competitive grants for de-velopment of uniform, cost-effectivestandards to assess nutritional sta-tus and for relating food consump-tion patterns to nutritional andhealth status;establishes budget authority forfunding the nutrition monitoringactivities at the HHS and USDA;andrequires the HHS and USDA topublish the Dietary Guidelines forAmericans at least every 10 yearsand to review jointly all other di-etary guidance and nutrition educa-tion pieces to assure consistency.

The importance of this legislationnd adequate funding for the nutri-ion monitoring activities cannot benderestimated. Human nutrition re-earch is fundamental to the healthnd well-being of every American,

HHS National Health and Nutrition Examination Survey (NHANES)

Survey Dates Ages

NHESa I 1960-1962 18-79 yearsNHES II 1963-1965 6-11 yearsNHES III 1966-1970 12-17 yearsNHANES I 1971-1975 1-74 yearsNHANES II 1976-1980 6 months to 74 yearsNHANES 1982-1984 6 months to 74 yearsNHANES III 1988-1994 2 months and olderNHANES 1999� All ages

USDA Nationwide Food Surveys

Survey Dates Ages

CPb 1935-1936 FamiliesFSc 1942 Families/singlesFCd 1948 Families with twoFC 1955 National sampleHFCe 1965-1966 Household/individualNFCSf 1977-1978 All household membersCSFIIg 1985 Females 19-50, Children 1-5,

Males 19-50CSFII 1987-88, 1989-91,

1994-96, and 1998Different samples

aNHES�National Health Examination Survey.bCP�Consumer Purchases Survey.cFS�Food Spending and Saving in Wartime.dFC�Food Consumption of Urban Families.eHFC�Household Food Consumption Surveys.fNFCS�National Food Consumption Survey.gCSFII�Continuing Survey of Food Intakes by Individuals.

igure 2. Dates and ages of individuals surveyed for data on health and nutrition by the US

igure 3. Mean folate intake for US females. Source: Third National Health and Nutritionxamination Survey (NHANES III) and NHANES 1999-2000. Estimates are based on food and

nd knowledge about the dietary hab-

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ts, nutrition and physical activitytatus, and disease patterns guides aroad range of policy decisions in theublic and private sectors. The Alli-nce for Continuing Nutrition Moni-oring represents a broad collation ofutrition and public health profes-ionals (including the American Die-etic Association [ADA]), voluntaryealth groups, consumer groups, food

igure 4. Mean serum folate for US femalexamination Survey (NHANES III) and NHANES

igure 5. Spina bifida rates in newborns in taryland, New Mexico, and New York, which

ears. Data for 1999 are preliminary. Source: Center for Health Statistics, National Vital Stat

rade associations, and commodity t

roups that have secured increases inunding for nutrition monitoring ac-ivities at USDA and NCHS and noweek quick and consensual action onhe National Health, Nutrition, andhysical Activity Monitoring Act of005.Talks with leaders on the Housegriculture Committee; the Housenergy and Commerce Committee;

Source: Third National Health and Nutrition9-2000.

United States, 1991-1999. Excludes data fornot require reporting spina bifida for some

rs for Disease Control and Prevention/Nationals System.

he Senate Agriculture Committee; t

August 2005 ● Journal

he Senate Health, Energy, Labor,nd Pension Committee; and the Sen-te Homeland Security and Govern-ental Affairs Committee have fos-

ered preliminary support for the005 nutrition monitoring legislation.he Alliance has also sought congres-ional support for the president’s006 budget which included increasesor nutrition monitoring survey re-earch, in part because of the Alli-nce’s efforts that have raised the im-ortance of these USDA and HHSctivities. The ARS human nutritionesearch budget included an addi-ional $6 million to improve the accu-acy and ethnic representation of theWhat We Eat in America” surveynd an additional $2.3 million to de-ermine the energy and nutrient con-ent of foods consumed by US minor-ty populations and address thebesity epidemic. The Budget of thenited States Government, Fiscalear 2006 also increased funds for

he Economic Research Service by5.8 million to commence a new Con-umer Data and Information System.

DA POSITIONDA continues to work with partnersepresenting industry groups, publicealth, advocacy, and other profes-ional associations to gather informa-ion and develop a strategy for ensur-ng an effective monitoring systemhat provides the data needed toake sound public health and policy

ecisions. In 2005, ADA will workith the Alliance for Nutrition Moni-

oring to secure adequate funding forhe HHS and USDA monitoring activ-ties and garner support for the Na-ional Health, Nutrition, and Physi-al Activity Monitoring Act of 2005.his new legislation will strengthenhe original act by ensuring ongoingdministration of the joint survey, re-uiring regular updating of the foodomposition database, and makinghe collected data more accessible to aider audience. The bill would also

trengthen the nutrition monitoringystem by authorizing funding for in-rastructure and technology updatesnd authorizing funding for the sec-nd-day recall (8). Dietetics profes-ionals can encourage their represen-atives and senators to sponsor andupport the National Health, Nutri-

s.

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PUBLIC POLICY NEWS

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ng Act of 2005 and assure adequateunding to carry out the nutritiononitoring activities.

eferences. National Health, Nutrition, and

Physical Activity Monitoring Act of2005. HR 2844. Available at: http://thomas.loc.gov/cgi-bin/query/z?c109:H.R.�2844:. Accessed June 22,2005.

. Woteki CE, Briefel RR, Klein CJ,Jacques PF, Kris-Etherton PM,Mares-Perlman JA, Meyers LD.Nutrition monitoring: Summary ofa statement from an American So-ciety for Nutritional Sciencesworking group. J Nutr. 2002;132:3782-3783.

. National Nutrition Monitoringand Related Research Act 1990.Pub L No. 101-445.

. Bialostosky K, Wright JD, Ste-phenson JK, McDowell M, John-son CL. Dietary intake of macro-nutrients, micronutrients, andother dietary constituents: UnitedStates, 1988-94. Vital Health Stat11. 2002;245:1-158.

. Centers for Disease Control, NationalCenter for Health Statistics. NationalHealth and Nutrition ExaminationSurvey 1999-2000. Available at:http://www.cdc.gov/nchs/about/major/nhanes/nhanes99_00.htm. AccessedMay 26, 2005.

. Wright JD, Bialostosky K, GunterEW, Carroll MD, Najjar MF, Bow-man BA, Johnson CL. Blood folateand vitamin B12: United States1988-1994. Vital Health Stat 11.1998;243:1-78.

. National Vital Statistics System,Centers for Disease Control, Na-tional Center for Health Statis-tics. Number of live births withspina bifida and rates per100,000 live births for the UnitedStates, 1991-1999. Available at:http://www.cdc.gov/nchs/products/pubs/pubd/hestats/spine_anen.htm.Accessed May 26, 2005.

. American Dietetic Association. Nu-trition Monitoring Issues Brief.Available at: http://www.eatright.org/Member/98_9118.cfm. AccessedMay 26, 2005.

200 August 2005 Volume 105 Number 8

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