Iron Deficiency is Related to Depressive Symptoms in United States Nonpregnant Women of Reproductive Age: A Cross-Sectional Analysis of NHANES 2005-2010.

BACKGROUND: Findings of the association between iron status and depressive symptoms in nonpregnant women of reproductive age (WRA) are equivocal, limited by a small sample size, or did not consistently control for confounders. OBJECTIVE: We tested the association between iron status and depressive symptoms in WRA with the NHANES data (2005-2010). METHODS: Nonpregnant WRA (20-44 y) with complete data on iron (ferritin and transferrin receptor (TfR)) and anemia (hemoglobin) biomarkers, depressive symptoms (Patient Health Questionnaire-9), and sociodemographic variables were included. Logistic and negative binomial regressions were used to estimate presence (odds ratios) and magnitude (prevalence ratios), respectively, for depressive symptoms by iron deficiency (ID)/anemia/ID anemia in the total sample and stratified by poverty:income ratio (≤ 1.85 or >1.85). RESULTS: Among 2516 females, the prevalence of ID was 8 to 16% (depending on the iron biomarker used), of anemia 8%, of which 52 to 65% were also ID. The prevalence of depressive symptoms was 10%. Crude logistic models showed that females with ID (TfR ≥ 8.3 mg/L or body iron <0 mg/kg) from the total sample had 1.82 (95% confidence interval [CI]: 1.24, 2.68) and 1.62 (95% CI: 1.05, 2.48), respectively, higher odds of depressive symptoms than females with iron sufficiency; these associations were attenuated after adjustments for confounders. Adjusted negative binomial models showed that females with ID (TfR ≥ 8.3 mg/L) from the total and low-income samples showed 1.19 (95% CI: 1:00, 1.40) and 1.27 (95% CI: 1.03, 1.58), respectively, higher prevalence ratios of depressive symptoms scores than females with iron sufficiency. CONCLUSIONS: These nationally representative data indicate that nonpregnant WRA with ID (based on high TfR) in the United States have higher prevalence of somatic depressive symptoms scores than those with iron sufficiency, especially if they are of low income.

Awareness of the MyPlate Plan: United States, 2017-March 2020.

Objective-The United States Department of Agriculture's MyPlate is based on the Dietary Guidelines for Americans and serves as the primary educational tool to communicate federal dietary guidance. This report presents the percentage of adults who have heard of MyPlate and who have tried MyPlate along with their associations with self-rated diet quality.

Perspective: Human Milk Composition and Related Data for National Health and Nutrition Monitoring and Related Research.

National health and nutrition monitoring is an important federal effort in the United States and Canada, and the basis for many of their nutrition and health policies. Understanding of child exposures through human milk (HM) remains out of reach due to lack of current and representative data on HM's composition and intake volume. This article provides an overview of the current national health and nutrition monitoring activities for HM-fed children, HM composition (HMC) and volume data used for exposure assessment, categories of potential measures in HM, and associated variability factors. In this Perspective, we advocate for a framework for collection and reporting of HMC data for national health and nutrition monitoring and programmatic needs, including a shared vision for a publicly available Human Milk Composition Data Repository (HMCD-R) to include essential metadata associated with HMC. HMCD-R can provide a central, integrated platform for researchers and public health officials for compiling, evaluating, and sharing HMC data. The compiled compositional and metadata in HMCD-R would provide pertinent measures of central tendency and variability and allow use of modeling techniques to approximate compositional profiles for subgroups, providing more accurate exposure assessments for purposes of monitoring and surveillance. HMC and related metadata could facilitate understanding the complexity and variability of HM composition, provide crucial data for assessment of infant and maternal nutritional needs, and inform public health policies, food and nutrition programs, and clinical practice guidelines.

Frequency of Eating in the US Population: A Narrative Review of the 2020 Dietary Guidelines Advisory Committee Report.

Background: A person's daily nutrient intake and overall nutritional status are determined by a complex interplay of the types and amounts of foods ingested in combination with the timing and frequency of eating. Objectives: The aim was to summarize frequency of eating occasion data examined by the 2020 Dietary Guidelines Advisory Committee, the macronutrient contributions they provide, and meal frequency relative to dietary quality among the US population (≥2 y), with a focus on sex, age, race/Hispanic origin, and income. Methods: Demographic and 24-h recall data from the 2013-2016 NHANES were examined. An eating occasion was defined as "any ingestive event (e.g., solid food, beverage, water) that is either energy yielding or non-energy yielding"; all eating occasions were further divided into discrete meals and snacks. Frequency of meals and snacks was defined as "the number of daily EOs [eating occasions]," respectively. Diet quality was assessed via the Healthy Eating Index (HEI)-2015. Results: Most Americans consume 2 (28%) to 3 (64%) meals on a given day and >90% consume 2 to 3 snacks on that day. Adult, Hispanic, and non-Hispanic Black and lower-income (<131% family poverty-to-income ratio) Americans had a lower frequency of eating than children or adolescents, non-Hispanic White, and non-Hispanic Asian Americans and higher-income Americans, respectively. Americans who reported 3 meals on a given day consumed a diet higher in dietary quality than Americans who consumed 2 meals on a given day (HEI-2015: 61.0 vs. 55.0), regardless of population subgroup. Conclusions: The frequency of the types of eating occasions differs according to age, race and Hispanic origin, and income. Dietary quality is associated with the number of meals consumed. Healthy dietary patterns can be constructed in a variety of ways to suit different life stages, cultural practices, and income levels; improved diet quality and careful consideration of nutrient density when planning meals are warranted.

Vitamin D status and prevalence of metabolic syndrome by race and Hispanic origin in US adults: findings from the 2007-2014 NHANES.

BACKGROUND: Vitamin D status has been found to be inversely associated with metabolic syndrome (MetS) in some studies. Vitamin D status varies by race and ethnicity, and the association of MetS with vitamin D status in US adults and by race and Hispanic origin has not been evaluated extensively. OBJECTIVES: We aimed to examine the associations between vitamin D status and MetS overall, and across race and Hispanic origin groups, in a nationally representative sample of US adults who participated in the NHANES from 2007 to 2014. METHODS: The total sample included 8639 adults, ≥20 y of age. Serum vitamin D was measured using a standardized LC-tandem MS method and was categorized using data-driven tertiles. MetS was defined using measured waist circumference, triglycerides, HDL cholesterol, blood pressure, and fasting glucose. Multivariable logistic regression models were fitted [accounting for sociodemographic and lifestyle factors, dietary supplement use, and BMI (in kg/m2)] to examine the associations of serum vitamin D with MetS among adults overall, and by race and Hispanic origin. RESULTS: Serum vitamin D in the lowest tertile (≤56 nmol/L) was significantly associated with increased odds of MetS compared with the highest tertile (>77.9 nmol/L) (fully adjusted model OR: 1.85; 95% CI: 1.51, 2.27). Inverse associations were noted for all race-Hispanic origin groups: non-Hispanic white (NHW) (OR: 2.24; 95% CI: 1.67, 3.01), non-Hispanic black (OR: 1.56; 95% CI: 1.06, 2.29), and Hispanic (OR: 1.48; 95% CI: 1.03, 2.14) adults. CONCLUSIONS: Lower vitamin D status was significantly associated with MetS among US adults after adjusting for sociodemographic and lifestyle factors, dietary supplement use, and BMI. This finding was noted across all race and Hispanic origin groups, although the strength of the association varied, being strongest for NHW adults.

The Contribution of Discrete Vegetables, Mixed Dishes, and Other Foods to Total Vegetable Consumption: US Ages 2 Years and Over, 2017-2018.

BACKGROUND: The 2020-2025 Dietary Guidelines for Americans recommend intake of a variety of vegetables, including dark green, red, and orange vegetables and starchy and other vegetables. OBJECTIVES: This study aims to describe sociodemographic differences in the contribution of different categories of vegetables and the form in which they are consumed (ie, discrete vegetables, mixed dishes, and other foods such as savory snacks to total vegetable intake on a given day). DESIGN: This is a cross-sectional, secondary analysis of the 2017-2018 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING: This study included the data of 7122 persons aged 2 years with reliable day 1 24-hour dietary recalls. MAIN OUTCOME MEASURES: Serving equivalents of vegetables from 20 discrete categories of vegetables and from mixed dishes and other foods as a percentage of total vegetables. STATISTICAL ANALYSES: Pairwise differences by age, sex, race, Hispanic origin, and family income were examined using univariate t statistics, and trends by age and income were examined using orthogonal polynomials. RESULTS: Mean serving equivalents of vegetables was 1.4 cups. The serving equivalents increased with age among youth, was higher among non-Hispanic Asian (NHA) persons than other subgroups, and increased with increasing family income. Overall, discrete vegetables contributed 55.2% of total vegetable intake, and the contribution increased with age in adults and with increasing family income. The top 5 discrete vegetable contributors were other vegetables and combinations, french fries and other fried white potatoes, lettuce and lettuce salads, mashed potatoes and white potato mixtures, and baked or boiled white potatoes. Nonstarchy discrete vegetables contributed more to total vegetables for adults (37.6%) than youth (28.0%), and the contribution increased with increasing family income. On the other hand, the contribution of mixed dishes and other foods decreased with increasing family income. CONCLUSIONS: Discrete vegetables only contributed 55.2% of total vegetable intake, and the top sources were not varied. Three of them potato based, which may explain the reported low vegetable intake, relative to the 2020-2025 Dietary Guidelines for Americans. More than one-third of vegetables consumed were nonstarchy discrete vegetables, many of which are high in vitamins. Nonstarchy discrete vegetable intake was higher in adults than youth and increased with family income.

The National Health and Nutrition Examination Survey (NHANES), 2021-2022: Adapting Data Collection in a COVID-19 Environment.

The National Health and Nutrition Examination Survey (NHANES) is a unique source of national data on the health and nutritional status of the US population, collecting data through interviews, standard exams, and biospecimen collection. Because of the COVID-19 pandemic, NHANES data collection was suspended, with more than a year gap in data collection. NHANES resumed operations in 2021 with the NHANES 2021-2022 survey, which will monitor the health and nutritional status of the nation while adding to the knowledge of COVID-19 in the US population. This article describes the reshaping of the NHANES program and, specifically, the planning of NHANES 2021-2022 for data collection during the COVID-19 pandemic. Details are provided on how NHANES transformed its participant recruitment and data collection plans at home and at the mobile examination center to safely collect data in a COVID-19 environment. The potential implications for data users are also discussed. (Am J Public Health. 2021;111(12):2149-2156. https://doi.org/10.2105/AJPH.2021.306517).

Diet during pregnancy: Influence of social characteristics and migration in the ELFE cohort.

Better adherence to dietary guidelines during pregnancy is supposed to result in healthier perinatal outcomes. We aim to characterize the diets of pregnant women by hypothesis-driven and exploratory approaches and describe potential social determinants. Analyses included 12 048 mothers from the French nationwide ELFE birth cohort. Dietary intake over the last three months of the pregnancy was assessed by a food frequency questionnaire. Two hypothesis-driven scores (the Diet Quality score, based on benchmarks derived from the National Health and Nutrition Program Guidelines, and the PANDiet score, based on nutrient intake) were calculated. Exploratory dietary patterns were also identified by principal component analysis. Multiple linear regressions were used to assess associations of maternal social characteristics with dietary patterns, accounting for the possible effect modification by their migration status. Five dietary patterns were identified: the Western, Balanced, Bread and toppings, Processed products, and Milk and breakfast cereals. Younger maternal age, single motherhood, unemployment and the presence of older children in the household were related to a suboptimal diet during pregnancy. The less acculturated the women were, the healthier and less processed their diets were, independent of their socio-economic position. Several social determinants of the quality of women's diets were however moderated by their migration status. These findings shed light on the relations between indicators of social vulnerability, such as single motherhood and unemployment, and poorer diet quality. Given the reduced diet quality that accompanies the acculturation process, it is of paramount importance to identify the specific factors or obstacles that affect migrant women in maintaining their diet quality advantage over the majority population.

Fast Food Intake Among Children and Adolescents in the United States, 2015-2018.

Fast food has been associated with higher caloric intake and poorer diet quality in children and adolescents (1). In 2011-2012, children and adolescents aged 2-19 years consumed on average 12.4% of their daily calories from fast food on a given day (2). This report presents 2015-2018 estimates of the percentage of calories consumed from fast food on a given day among U.S. children and adolescents by demographic characteristics and trends since 2003.

Breakfast Intake Among Children and Adolescents: United States, 2015-2018.

The American Academy of Pediatrics recommends that children and adolescents consume breakfast for healthier body weights, improved nutrition, better memory, better test scores, and better attention spans (1). This report describes breakfast consumption among children and adolescents by sex, age, race and Hispanic origin, and family income level. Foods and beverages frequently consumed for breakfast, as well as trends in breakfast consumption over the last decade, are also reported.

Nonalcoholic Beverage Consumption Among Adults: United States, 2015-2018.

Beverages play a substantial role in meeting total water intake needs and are a major contributor to overall nutrient and caloric intake for the U.S. population (1,2). The 2015-2020 Dietary Guidelines for Americans recommend that water, fat-free and low-fat milk, and 100% juice be the primary beverages consumed (2). This report provides estimates of the contribution of beverage types to total nonalcoholic beverage consumption, by grams, for U.S. adults.

Nutrition Monitoring of Children Aged Birth to 24 Mo (B-24): Data Collection and Findings from the NHANES.

The first 2 y of life are characterized by several transitions that can affect growth, development, and eating patterns long term. These include a shift from a primarily milk-based eating pattern to introduction of complementary foods at ∼4-6 mo of age, and passage to family-meal patterns in toddler years. Recognizing the importance of this critical period, the Dietary Guidelines for Americans from 2020 onwards will include guidance for children aged birth to 24 mo (B-24). Few large-scale surveys provide comprehensive, nationally representative, quantitative, recent data on infant and toddler nutrition in the United States. The continuous NHANES has collected data relevant to this initiative since 1999 using standardized interview and examination protocols. These include data on infant feeding practices, dietary intakes (foods, beverages, and supplements), anthropometry, and blood-based nutritional status on nationally representative samples of infants and toddlers. NHANES data can be used to describe large group-level consumption patterns, as well as trends over time for B-24 children overall, and by demographic groups (e.g., race-ethnic and income groups). In addition, NHANES data can be analyzed to examine adherence to nutrition-related recommendations, such as those from the American Academy of Pediatrics (AAP), and to track Healthy People 2020 objectives. This paper provides an update on NHANES nutrition monitoring in B-24 children since our previous publication (which provided details through NHANES 2009-2010) and describes data collection since 2010 and plans for upcoming cycles. It also describes key NHANES-based findings published in the last 5 y on infant feeding practices, dietary intakes and supplement use, and nutritional status of US children aged <2 y. Findings related to existing recommendations, such as from the AAP, are presented when available. This information can inform researchers and policymakers on the state of nutrition in the US B-24 population and its subgroups of interest.

Contribution of Whole Grains to Total Grains Intake Among Adults Aged 20 and Over: United States, 2013-2016.

Total grains intake comes from whole grains and refined grains. Whole grains contain the entire grain kernel (bran, germ, and endosperm) (1). A higher intake of whole grains is linked with a lower risk of cardiovascular disease, cancer, and mortality (2). The "2015-2020 Dietary Guidelines for Americans" recommend that at least one-half of total grains intake be from whole grains (3). This report provides estimates of the percentage of total grains intake consumed from whole grains sources, for adults aged 20 and over who reported consumption of grains (98.6%) on a given day during 2013-2016.

Dietary Supplement Use among Infants and Toddlers Aged <24 Months in the United States, NHANES 2007-2014.

BACKGROUND: Limited nationally representative data are available on dietary supplement (DS) use and resulting nutrient exposures among infants and toddlers. OBJECTIVE: This study evaluated DS use among US infants and toddlers to characterize DS use, estimate nutrient intake from DSs, and assess trends in DS use over time. METHODS: Using nationally representative data from NHANES (2007-2014) and trends over time (1999-2014), we estimated prevalence of DS use and types of products used for US infants and toddlers aged <2 y (n = 2823). We estimated median daily intakes of vitamins and minerals consumed via DSs for all participants aged <2 y, by age groups (0-11.9 mo and 12.0-23.9 mo), and by feeding practices for infants 0-5.9 mo. RESULTS: Overall, 18.2% (95% CI: 16.2%, 20.3%) of infants and toddlers used ≥1 DS in the past 30 d. Use was lower among infants (0-5.9 mo: 14.6%; 95% CI: 11.5%, 18.1%; 6-11.9 mo: 11.6%; 95% CI: 8.8%, 15.0%) than among toddlers (12-23.9 mo: 23.3%; 95% CI: 20.4%, 26.3%). The most commonly reported DSs were vitamin D and multivitamin infant drops for those <12 mo, and chewable multivitamin products for toddlers (12-23.9 mo). The nutrients most frequently consumed from DSs were vitamins D, A, C, and E for those <2 y; for infants <6 mo, a higher percentage of those fed breast milk than those fed formula consumed these nutrients via DSs. DS use remained steady for infants (6-11.9 mo) and toddlers from 1999-2002 to 2011-2014, but increased from 7% to 20% for infants aged 0-5.9 mo. CONCLUSIONS: One in 5 infants and toddlers aged <2 y use ≥1 DS. Future studies should examine total nutrient intake from foods, beverages, and DSs to evaluate nutrient adequacy overall and by nutrient source.

Seafood Consumption in the United States, 2013-2016.

The 2015-2020 Dietary Guidelines for Americans (1) recommend consuming two servings of seafood, including fish and shellfish, per week. Consuming approximately 8 ounces of a variety of seafood weekly is associated with reduced cardiac deaths (2). This report describes the percentage of U.S. adults and youth who reported consuming seafood at least two times per week by sex, age, and race and Hispanic origin during 2013-2016. Trends in the percentage of adults and youth who consumed seafood at least twice weekly, from 2005-2006 through 2015-2016, are also presented.

Fast Food Consumption Among Adults in the United States, 2013-2016.

Fast food is a part of the American diet and has been associated with high caloric intake (1), and poor diet quality (2). Time, financial resources, price, and availability influence fast food consumption (3). This report presents data on the percentage of adults who consumed fast food on a given day in the United States during 2013-2016.

Screen time behaviours and caffeine intake in US children: findings from the cross-sectional National Health and Nutrition Examination Survey (NHANES).

BACKGROUND: Screen time (ST) behaviours, for example, television (TV) watching and computer use, among youth are associated with unhealthy eating, and these patterns track over time. A positive association between ST and TV watching with consumption of caffeinated foods and beverages has been described in national samples of children in a few European countries. The association of ST behaviours with caffeine intake has not been previously reported. We examined whether ST behaviours were associated with caffeine intake on a given day (% consumers and amount consumed) in a nationally representative sample of US children. METHODS: Data on 3421 children (ages 6-11 years) from the cross-sectional National Health and Nutrition Examination Survey 2007-2012 were used. Time spent on TV watching and computer use was determined using questionnaires. Dietary intake was assessed using a 24-hour recall by trained interviewers. Caffeine intake (mg) was estimated by using updated food and nutrient databases. Caffeine consumption was examined in relation to time spent (≥2 vs<2 hours/day) on ST behaviours. RESULTS: Children who watched TV ≥2 hours/day had significantly higher (~45% more) caffeine intake. Total ST or computer use was not associated with caffeine consumption in school-aged children. CONCLUSION: TV watching was positively associated with caffeine intake in school-aged children, suggesting the need for continued monitoring of ST and caffeine intake behaviours in children and adolescents as well as examining the correlates of these behaviours to inform nutrition and health policies.

Federal Monitoring of Dietary Supplement Use in the Resident, Civilian, Noninstitutionalized US Population, National Health and Nutrition Examination Survey.

Objective: This review summarizes the current and previous data on dietary supplement (DS) use collected from participants in the National Health and Nutrition Examination Survey (NHANES), describes the NHANES dietary supplement database used to compute nutrient intakes from DSs, discussed recent developments and future direction, and describes many examples to demonstrate the utility of these data in informing nutrition research and policy. Background and History: Since 1971, NHANES, has been collecting information on the use of DSs from participants. These data are critical to national nutrition surveillance and have been used to characterize usage patterns, examine trends over time, assess the percentage of the population meeting or exceeding nutrient recommendations, and to help elucidate the sources contributing nutrients to the diet of the US population. Rationale: Over half of adults and about one-third of children in the United States use at least one dietary supplement in the past 30 days. Dietary supplements contribute to the dietary intake of nutrients and bioactive compounds in the US and therefore need to be assessed when monitoring nutritional status of the population and when studying diet-health associations. Recent Developments: With the recent development and availability of the Dietary Supplement Label Database (DSLD), a comprehensive DS database that will eventually contain labels for all products marketed in the US, NHANES DS data will be more easily linked to product information to estimate nutrient intake from DS. Future Directions: Over time, NHANES has both expanded and improved collection methods. The continued understanding of sources of error in collection methods will continue to be explored and is critical to improved accuracy. Conclusions: NHANES provides a rich source of nationally representative data on the usage of dietary supplements in the US.

Overview of Asian American Data Collection, Release, and Analysis: National Health and Nutrition Examination Survey 2011-2018.

Data System. The National Health and Nutrition Examination Survey (NHANES), conducted by the National Center for Health Statistics, is a cross-sectional survey on the health and nutritional status of US adults and children. Data Collection/Processing. A complex, multistage probability design is used to select a sample representative of the US civilian, noninstitutionalized population. NHANES includes in-home interviews, physical examinations, and biospecimen collection. About 5000 persons are examined annually. Since 2011, NHANES has been oversampling Asian Americans in addition to traditionally oversampled groups, including Hispanics and non-Hispanic Blacks. Data Analysis/Dissemination. Data are publicly released online in 2-year cycles. Some data, because of disclosure risk, are only available through the Research Data Center. Data users should read documentation, examine sample sizes and response rates, and account for the complex survey design. With publicly released data, analyses of Asians as a single group is only possible; some Asian subgroup analyses may be conducted through the Research Data Center. Public Health Implications. Oversampling Asians in NHANES 2011-2018 allows national estimates to be computed on health conditions, nutrition, and risk factors of public health importance on this growing subpopulation of Asian Americans.