Daily Dietary Fat and Total Food-Energy Intakes -- Third National Health and Nutrition Examination Survey, Phase 1, 1988-91

Excessive dietary fat intake has been linked to increased risk for obesity, coronary heart disease, and certain cancers (1,2). The Third National Health and Nutrition Examination Survey (NHANES III), conducted by CDC's National Center for Health Statistics (NCHS), provides data to monitor changes in the dietary, nutritional, and health status of the U.S. population (3) and to track progress toward achieving the national health objectives for the year 2000, including that related to dietary fat intake (1). This report uses data from NHANES III, Phase 1 (October 1988- October 1991), to present findings about daily total food-energy, total dietary fat, and saturated fat intakes for the U.S. population.

NHANES III (1988-94) uses a highly stratified multistage probability design to obtain a sample of the civilian, noninstitutionalized U.S. population aged greater than or equal to 2 months. The survey comprises two 3-year nationally representative phases with oversampling of children aged 2 months-5 years, persons aged greater than or equal to 60 years, blacks, and Mexican Americans (4). Total food energy intake (TFEI) was defined as all nutrients (i.e., protein, fat, carbohydrate, and alcohol) derived from consumption of foods and beverages (excluding plain drinking water), measured in kilocalories (kcal). Total dietary fat intake was defined as all fat (i.e., saturated and unsaturated) derived from consumption of foods and beverages, measured in grams. Daily TFEI was estimated for each respondent using a 24-hour dietary-recall interview coded reliable and complete. Nutrient estimates were computed and coded using the United States Department of Agriculture (USDA) Survey Nutrient Data Base (SNDB); estimates were not computed for nursing infants and children or for recalls coded unreliable or incomplete.

Of the 20,277 persons selected for the survey, 17,467 (86%) were interviewed, and 15,630 (77%) underwent a standardized physical examination. Of those examined, 14,801 (95%) had a complete and reliable 24-hour dietary recall, resulting in an overall analytic response rate of 73%. Data were weighted to account for survey design and nonresponse.

A computer-based, automated dietary interview and coding system (5) was used to collect all 24-hour dietary recalls. Respondents reported their TFEI during the preceding 24 hours (midnight to midnight). Proxy respondents reported for infants and children aged 2 months-11 years and for respondents who were unable to self-report (6).

During 1988-91, the overall mean daily TFEI for the population aged greater than or equal to 2 months was 2095 kcal (range: 877- 2533 kcal) (Table_1). For persons aged greater than or equal to 2 years, 34% (82 g) of their TFEI was from total dietary fat; 12% (29 g) was from saturated fat (Table_1). Mean daily TFEI was higher for males than for females (Table_2), page 123). The overall mean percentages of TFEI derived from total dietary fat and from saturated fat did not differ by sex (Table_2), page 123).

Reported by: C Lenfant, MD, N Ernst, National Heart, Lung, and Blood Institute, National Institutes of Health. Div of Health Examination Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: The findings from NHANES III in this report update national population estimates of daily dietary fat and TFEIs. Since NHANES II (1976-80), the mean percentages of TFEI derived from total dietary fat and from saturated fat have decreased (7), sustaining a trend observed since the mid-1960s (8). Mean serum cholesterol level for adults also decreased from NHANES II to NHANES III (9).

One national health objective for the year 2000 is to reduce dietary fat intake to an average of 30% or less and average saturated fat intake to less than 10% of calories among persons aged greater than or equal to 2 years (baseline: 36% of calories from total fat and 13% from saturated fat for persons aged 20-74 years in 1976-80; 36% and 13%, respectively, for women aged 19-50 years in 1985) (objective 2.5) (1). Although the findings in this report indicate a decline in the mean percentage of TFEI derived from total dietary fat and from saturated fat, these intake levels remain higher than the year 2000 objective.

At least three changes in the dietary methodology used for NHANES III may account for the differences in total dietary fat and saturated fat intakes when compared with NHANES II. First, automated data collection for NHANES III standardized and improved data quality. Second, the NHANES III protocol was specifically designed to probe for information about food sources of dietary fat; additional questions ensured that a complete 1-day recall of food intake could be obtained. Third, different nutrient databases were used for NHANES II and NHANES III; therefore, the impact on nutrient estimates of changes in food-composition data could not be readily assessed. In the future, completion of the trends database for the SNDB and redesign of the National Nutrient Data Bank should facilitate interpretation of changes in food-consumption patterns.

Previous studies have documented that, when large-scale surveys of food-consumption employ 24-hour recalls, TFEI is underreported by as much as 25% (10). However, the differential effect of this underreporting on specific food components and on population subgroups is not well understood. During NHANES III, Phase 1, mean TFEIs were approximately 100-300 kcal higher for persons aged greater than or equal to 12 years of both sexes and in all age groups compared with those during NHANES II (1976-80), suggesting either a true increase in TFEI or substantial improvements in the collection of more complete dietary-recall data during NHANES III. The hypothesis of real increases in TFEI during NHANES III is supported by a substantial increase in overweight among U.S. adults.

The findings in this report can assist in tracking progress toward achieving the goals of public health initiatives aimed at reducing and modifying total dietary fat and saturated fat intakes. Additional changes in diet are necessary for the U.S. population to further reduce total dietary fat and saturated fat intakes as well as serum cholesterol levels and overweight. Subsequent analyses of NHANES III will be used to elucidate differences and changes in dietary fat intakes by socioeconomic status and race/ ethnicity; identify population subgroups at risk for high dietary fat intakes; assess food sources of dietary fat; and examine the interrelation between total dietary fat and saturated fat, serum cholesterol level, and other health variables.

References

1. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50213.

2. Public Health Service. The Surgeon General's report on nutrition and health. Washington, DC: US Department of Health and Human Services, Public Health Service, 1988; DHHS publication no. (PHS)88-50210.

3. Woteki CE, Briefel R, Hitchcock D, Ezzati T, Maurer K. Selection of nutrition status indicators for field surveys: the NHANES III design. J Nutr 1990;120(suppl):1440-5.

4. Ezzati TM, Massey JT, Waksberg J, Chu A, Maurer KR. Sample design: Third National Health and Nutrition Examination Survey. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, NCHS, 1992. (Vital and health statistics; series 2, no. 113).

5. McDowell M, Briefel RR, Warren RA, Buzzard M, Seskanich D, Gardner S. The dietary data collection system: an automated interview and coding system for NHANES III. In: Proceedings of the 14th National Nutrient Databank Conference. Ithaca, New York: CBORD Group, Inc, 1990.

6. Westat, Inc. NHANES III dietary interviewer's manual, prepared for the National Center for Health Statistics. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, September 1992.

7. Life Sciences Research Office, Federation of American Societies for Experimental Biology. Nutrition monitoring in the United States: an update report on nutrition monitoring. Washington, DC: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (PHS)89-1255.

8. Stephen AM, Wald NJ. Trends in individual consumption of dietary fat in the United States, 1920-1984. Am J Clin Nutr 1990;52:457-69.

9. Johnson CL, Rifkind BM, Sempos CT, et al. Declining serum total cholesterol levels among US adults. JAMA 1993;269:3002-8.

10. Bingham SA. The dietary assessment of individuals: methods, accuracy, new techniques, and recommendations. Nutrition Abstracts and Reviews 1987;57:705-42.

Table_1
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TABLE 1. Mean daily total food-energy intake (TFEI) * and mean percentages of
TFEI from total dietary fat + and from saturated fat, by age group -- Third
National Health and Nutrition Examination Survey, Phase 1, 1988-91
==========================================================================================
                                            % TFEI from total       % TFEI from
                          Daily TFEI           dietary fat         saturated fat
Age group      Sample   ---------------    -------------------    ---------------
  (yrs)         size     No.   (SE &)       %           (SE)       %       (SE)
---------------------------------------------------------------------------------
 2-11 mos @      871     877  (+/-10.9)    37.2       (+/-0.3)    15.8   (+/-0.1)
 1- 2 @        1,231    1289  (+/-21.2)    33.7       (+/-0.4)    13.9   (+/-0.2)
 3- 5          1,547    1591  (+/-20.5)    33.0       (+/-0.3)    12.6   (+/-0.1)
 6-11          1,745    1897  (+/-25.0)    34.0       (+/-0.4)    12.8   (+/-0.2)
12-15            711    2218  (+/-48.8)    33.4       (+/-0.6)    12.2   (+/-0.2)
16-19            765    2533  (+/-88.2)    34.5       (+/-0.4)    12.4   (+/-0.2)
20-29          1,682    2484  (+/-44.4)    34.0       (+/-0.4)    12.0   (+/-0.2)
30-39          1,526    2372  (+/-43.4)    34.4       (+/-0.4)    11.9   (+/-0.2)
40-49          1,228    2146  (+/-44.5)    34.4       (+/-0.5)    11.6   (+/-0.2)
50-59            929    1967  (+/-30.7)    34.7       (+/-0.4)    11.6   (+/-0.2)
60-69          1,106    1822  (+/-39.0)    33.0       (+/-0.3)    11.2   (+/-0.2)
70-79            851    1624  (+/-25.3)    32.9       (+/-0.5)    11.2   (+/-0.3)
 >=80            609    1484  (+/-27.4)    32.0       (+/-0.3)    11.0   (+/-0.2)

Total         14,801    2095  (+/-20.0)    34.0       (+/-0.2)    12.0   (+/-0.1)

  >=2         13,314    2123  (+/-20.4)    33.9       (+/-0.2)    11.9   (+/-0.1)
---------------------------------------------------------------------------------
* Defined as all nutrients (i.e., protein, fat, carbohydrate, and alcohol) derived from
  consumption of foods and beverages (excluding plain drinking water), measured in
  kilocalories (kcal).
+ Defined as all fat (i.e., saturated and unsaturated) derived from consumption of foods
  and beverages, measured in grams.
& Standard error.
@ Excludes nursing infants and children.
==========================================================================================

TABLE 2. Mean daily total food-energy intake (TFEI) * and percentages of TFEI
from total dietary fat + and from saturated fat, by age group and sex -- Third
National Health and Nutrition Examination Survey, Phase 1, 1988-91
==================================================================================
                                             % TFEI from total     % TFEI from
                             Daily TFEI         dietary fat       saturated fat
Sex/Age          Sample   ----------------   -----------------   ---------------
 group (yrs)      size     No.    (SE &)       %       (SE)       %       (SE)
--------------------------------------------------------------------------------
Males
   2-11 mos @     439      903  (+/- 13.3)    36.9   (+/-0.4)    15.8   (+/-0.2)
   1- 2 @         601     1339  (+/- 26.3)    33.5   (+/-0.5)    13.8   (+/-0.2)
   3- 5           744     1663  (+/- 26.5)    32.8   (+/-0.4)    12.6   (+/-0.2)
   6-11           868     2036  (+/- 44.4)    33.9   (+/-0.3)    12.8   (+/-0.2)
  12-15           338     2578  (+/- 75.4)    33.1   (+/-0.8)    12.4   (+/-0.3)
  16-19           368     3097  (+/-114.4)    34.6   (+/-0.7)    12.6   (+/-0.2)
  20-29           844     3025  (+/- 66.5)    34.0   (+/-0.5)    12.0   (+/-0.2)
  30-39           735     2872  (+/- 88.4)    34.6   (+/-0.6)    11.9   (+/-0.3)
  40-49           626     2545  (+/- 54.4)    33.9   (+/-0.5)    11.4   (+/-0.2)
  50-59           473     2341  (+/- 51.5)    35.7   (+/-0.6)    11.8   (+/-0.2)
  60-69           546     2110  (+/- 57.7)    33.3   (+/-0.6)    11.3   (+/-0.3)
  70-79           444     1887  (+/- 39.7)    33.8   (+/-0.5)    11.6   (+/-0.2)
   >=80           296     1776  (+/- 35.7)    33.3   (+/-0.6)    11.4   (+/-0.2)

  Total          7322     2478  (+/- 30.3)    34.1   (+/-0.3)    12.1   (+/-0.1)

    >=2          6594     2518  (+/- 29.5)    34.1   (+/-0.3)    12.0   (+/-0.1)

Females
   2-11 mos @     432      850  (+/- 15.0)    37.6   (+/-0.5)    15.9   (+/-0.2)
   1- 2 @         630     1236  (+/- 26.5)    34.0   (+/-0.5)    13.9   (+/-0.2)
   3- 5           803     1516  (+/- 23.8)    33.1   (+/-0.4)    12.6   (+/-0.2)
   6-11           877     1753  (+/- 20.4)    34.2   (+/-0.5)    12.7   (+/-0.2)
  12-15           373     1838  (+/- 48.4)    33.7   (+/-0.7)    12.0   (+/-0.2)
  16-19           397     1958  (+/- 70.3)    34.4   (+/-0.7)    12.3   (+/-0.4)
  20-29           838     1957  (+/- 32.3)    34.0   (+/-0.4)    11.9   (+/-0.2)
  30-39           791     1883  (+/- 37.0)    34.2   (+/-0.4)    11.9   (+/-0.2)
  40-49           602     1764  (+/- 35.7)    34.9   (+/-0.7)    11.8   (+/-0.2)
  50-59           456     1629  (+/- 32.2)    33.8   (+/-0.6)    11.4   (+/-0.2)
  60-69           560     1578  (+/- 38.3)    32.8   (+/-0.6)    11.0   (+/-0.3)
  70-79           407     1435  (+/- 28.5)    32.3   (+/-0.7)    10.8   (+/-0.4)
   >=80           313     1329  (+/- 26.8)    31.3   (+/-0.4)    10.8   (+/-0.2)

  Total          7479     1732  (+/- 14.5)    33.9   (+/-0.3)    11.9   (+/-0.1)

    >=2          6720     1751  (+/- 15.0)    33.8   (+/-0.3)    11.8   (+/-0.1)
--------------------------------------------------------------------------------
* Defined as all nutrients (i.e., protein, fat, carbohydrate, and alcohol)
  derived from consumption of foods and beverages (excluding plain drinking
  water), measured in kilocalories (kcal).
+ Defined as all fat (i.e., saturated and unsaturated) derived from consumption
  of foods and beverages, measured in grams.
& Standard error.
@ Excludes nursing infants and children.
==================================================================================

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