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Appropriate uses of the AMPM diet survey method
Alanna MoshfeghFood Surveys Research Group
USDA/ARS Beltsville Human Nutrition Research Center
Joint Federal Agency Diet & -Omics WorkshopUSDA George Washington Carver Center
Beltsville, MD, March 31, 2009
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Topics to Address
• Automated Multiple Pass Method
• AMPM Validation Study
• Related databases
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Dietary Interview Component of NHANES
2 days of dietary intake dataday 1 in-personday 2 telephonebilingual dietary interviewers
Dietary Collection:
Method: USDA’s Automated Multiple Pass Method
National Survey: What We Eat in America, NHANES
9,000+ individuals for 2-year release
AMPM used continuously since 2002
Sample:
Use:
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AMPM Uses• What We Eat in America, NHANES 2002+• Statistics Canada 2004 Canadian Community Health Survey• ARS Doubly labeled water study of non-obese women• FNS School Nutrition Dietary Assessment Study III• ERS Behavioral Economics Influences on Food Consumption• NIA HANDLS (Healthy Aging in Neighborhoods of Diversity Across Lifespan) • EPA Upper Columbia River Human Health Risk Assessment and
Remedial Investigation/Feasibility Study• DOD Healthy Eating and Active Living in TRICARE Households Study• NCI Five A Day Fruit and Vegetable Study
ASA 24 development• universities UMD, JHU, UVT , Univ Puerto Rico
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Quick ListStep 1
Forgotten FoodsStep 2
Time & OccasionStep 3
Detail CycleStep 4
Final ProbeStep 5
USDA Automated Multiple Pass MethodCollects listing of all foods & beverages
Probes for forgotten food items in 9 categories
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Type of foods %
beverages 40 sweets 20 fruits, vegetables, cheese 15savory snacks 13 breads and rolls 9 anything else 2
ForgottenFoods
50% of respondents remembered foods
Quick List
Time &Occasion
Detail Cycle
Final Probe
Importance of “Forgotten Foods”
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Quick ListStep 1
Forgotten FoodsStep 2
Time & OccasionStep 3
Detail CycleStep 4
Final ProbeStep 5
USDA Automated Multiple Pass MethodCollects listing of all foods & beverages
Probes for forgotten food items in 9 categories
Collects for each food & beverageSorts foods into chronological order and
groups foods by eating occasion
Collects description of each food, additions,amount eaten, source, & whether eaten at home
Reviews each occasion and intervals between occasions
Provides final opportunity to recall foods
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Quick List
ForgottenFoods
Time &Occasion
Detail Cycle
Final Probe
68
6
3
22
1
78
6
3
13
<1
14
3
11
70
2
(15)
percent
Foods Reported
Energy InterviewLength
(20-30 min.)
Contribution by StepContribution by Step
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Contribution by StepAMPM Validation Study
• Compare estimated energy intake to objective measure of expenditure [Doubly labeled water technique]
Objective: Validate AMPM
• 524 adults, 30-69 yrs, from Washington, DC metro area• 5 cohorts, July 2002 – June 2004• 14-day study period for each subject• Three 24-hr recalls collected using AMPM
- first in person, others by telephone- two week day, one weekend day
• Numerous other health and physical activity measures• Repeatability Study on sub sample of 49 subjects
Study Design
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Contribution by StepDoubly labeled Water Technique
Doubly labeled water contains:• 2 stable, non-radioactive, naturally occurring isotopes • 2H2O (deuterium) and H2
18O (oxygen-18)
Method• Dose each individual with enriched amount of isotopes
~0.10 g 2H2O/kg body wt~0.08 g H2
18O/kg body wt• Equilibrates in body over extended period• Isotopic enrichment in urine provide non-subjective way
to accurately estimate energy expenditure
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Contribution by StepExclusion Criteria
• Not in generally good health• Not weight stable• Actively pursuing weight loss/gain• Medication use affecting food intake, appetite, or
water balance • Pregnant and/or lactating• Diabetic• Nutrition professional• Not in local area before and during their data
collection period
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0
20
40
60
80
100
non-HisWhite
non-HisBlack
Hispanic Other
Age Race-ethnicity
0
20
40
60
80
100
30s 40s 50s 60s
0
20
40
60
80
100
some/highschool degree
some/collegedegree
graduatedegree
0
20
40
60
80
100
<25.0 25.0-29.9 >30.0
Education BMI (kg/m2)
Subject CharacteristicsMales females
%
%%
%
Source: Moshfegh et al, AJCN 2008:88:324-32
n=262 n=262
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Male FemaleMonday 15 13Tuesday 14 15Wednesday 16 14Thursday 14 16Friday 14 13Saturday 13 15Sunday 15 15
Distribution by Day Of WeekFor Dietary Recalls
Source: Moshfegh et al, AJCN 2008:88:324-32
% %
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Mean Daily Measured Energy Intakes by AMPM
0
500
1000
1500
2000
2500
3000
3500
Malesn=262
Femalesn=262
1 32Day
1 32Day
kcal/d
Source: Moshfegh et al, AJCN 2008:88:324-32
Mean daily energy intakes remainedfairly constant across the three recall days.
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0
500
1000
1500
2000
2500
3000
3500
FemalesMales
Results of AMPM Validation Study
kcal/d
*
*
* Significant at <5%Source: Moshfegh et al, AJCN 2008:88:324-32
TEE (x, 95% CI)doubly labeled water
EI (x, 95% CI)AMPM 3-day average
_ _
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0
500
1000
1500
2000
2500
3000
3500
FemalesMales
TEE (x, 95% CI)doubly labeled water
EI (x, 95% CI)AMPM 3-day average
Results of AMPM Validation Study
kcal/d
*
*
* Significant at <5%Source: Moshfegh et al, AJCN 2008:88:324-32
Energy intake was under-reported by: 11% overall<3% for normal weight16% for over weight
FemalesMales FemalesMales FemalesMales
BMI < 25 BMI > 30BMI 25 – 29.9
*
*
*
*
(n=94) (127) (114) (79) (54) (56)
_ _
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Males FemalesAllNormal weightOverweightObese
187
1934
22142535
Percent of Low Energy Reporters*
Source: Moshfegh et al, AJCN 2008:88:324-32
*LERs defined as subjects with values below 95% CI of log EI/TEE: <0.72
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Contribution by StepAMPM Validation Study Conclusions
• AMPM assessed mean energy intakes within 11% of energy expenditure in a large sample of adults, and
• < 3% in normal-weight subjects.
• Further research is needed to determine what may be contributing to the underreporting observed in overweight and obese subjects.
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USDA Dietary Intake Data SystemAutomated Multiple
Pass Method
Post InterviewProcessing System
Survey Net
method for collecting 24-hour dietary recalls
automates food codingformats data from AMPM for Survey Net
supports manual coding, quality review, and nutrient analysis
Food & Nutrient Database for Dietary Studiessupports coding and analysis of food dataFNDDS
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USDA Food and Nutrient Database for Dietary Studies
• 7,000+ foods and descriptions
• 30,000+ portions and weights
• Food Coding Scheme for >70 USDA Food Groups
• values for 64 nutrients/components
• USDA National Nutrient Database for Standard Reference
• Best used for group data analysis, not individual analysis
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Contribution by StepSpecial Purpose Databases
• FNDDS foods further defined to support specialized research and policy needs
• MyPyramid Equivalents Database – translates foods in FNDDS into 32 MyPyramid food groups defined by USDA Center for Nutrition Policy and Promotion
• Food Commodity Economic Database – translates foods in FNDDS into 65 food commodities at the retail level defined by USDA Economic Research Service