Dietary

M Popkin,

in older Americans,

Pamela

ABSTRACT

This

sons aged

65 y surveyed

study

S Haines,

and

Ruth

compares

dietary

1977-78

Nationwide and pork,

Food Consumption Surveys. whole milk, and white bread decreased

in low-fat

beef, pork,

grain

breads. (fruits,

high-fiber

with

and fish, low-fat

consumption

and fat (high-fat

ofcalories fiber

poultry

However,

desserts,

cereals,

milk,

of many butter,

and

increases

and whole-

important and

sources

margarine)

vegetables)

changed

and little

be-

tween 1977 and 1987. The food-consumption trends translated into modest changes in overall nutrient intake. Gender differences were small and contradict the prevailing feeling that women are changing their diets more rapidly than are men. The authors suggest that public health messages have focused too heavily on foods to avoid while not giving adequate guidance for how to plan and prepare meals that will enable older Americans to meet the current diet and health recommendations. Am J C/in Nutr

l992;55:823-30.

KEY derly

WORDS Food consumption people, fat and fiber intake

trends,

nutrition

of el-

popular

press,

government

publications,

and

scholarly

lit-

erature. Nutritional priorities for addressing diet-disease associations have included the reduction ofdietary cholesterol, total fat, and animal fat and an increase in consumption of fruits, vegetables,

whole

grains,

and

evidence

exists

that

in the direction

in serum aged

that

20-74

experts

some and

aged

for

the

advocate.

period

199

in dietary

fiber intake until

the

1).

mid

y (KC

Virtually

because

between

in women

that

increased

their

diet

1960

and

people aged

aged

Reidy,

BM

Popkin,

no information of a lack ofdata

Nuir

al (5) found

Printed

in USA.

will

12.6%

of Amergroup, of 60 million

be in this

that

70%

of healthy

women

and

age

men

cated that they were concerned Patterson and Block (6) studied

about cholesterol how well the diets

in the second

and

vey

National

(NHANES

Health

II) study

Nutrition

(1 976-1980)

>

65 y mdi-

in their

diet.

of participants

Examination

consumed

Sur-

foods

recom-

mended as possibly protective against cancer and reported that older people were closer to the guidelines than younger people and that women were closer than men. However, focus group discussions with older people conducted by the Public Health Service and the Administration on Aging reveal that many people knew

what

not

to eat but

trends

were

unable

to describe

what

consti-

(7).

research

on adult

in an important

segment

women

by examining

ofsociety,

men and women aged 65 y. Because it has that women are leading the way in consuming diets, we examine differences in food-group trends women and men. Finally, we report selected trends to provide a context in which to interpret trends.

Survey

American

suggested more healthful between older

been

nutrient-intake

the food-group

design

sample to in

unpublished

American

1

Society

2

48 coterminous

From

the Department Hill.

Supported

Foundation,

states.

were conducted,

of participants

at Chapel

exists on trends on dietary fiber

© 1992

in the

four waves

1980s.

l992;55:823-30.

19.6%

an increase of 29 million to a total population aged > 65 y (3). Several studies indicate that older people are interested in their health and are willing to change their behaviors to improve their health; some believe their willingness to adopt healthful behavior exceeds that of any other age group (4). Goodwin et

holds

19-50

consumption were important

egg consumption

US population:

of the by 2025,

The Nationwide Food Consumption Surveys of 1977-1978 (NFCS77) and 1987-1 988 (NFCS87) select samples from stratified-area probability samples ofioninstitutionalized US house-

in US adults

Until recently, little attention was paid to the nutritional status and nutrition-related needs of older individuals in this country (JT Dwyer, unpublished observations, 1990). This group is the J C/in

segment 65 y and

Reductions

in the elderly

Similarly,

indication reduced

I 9-50

observations,

Am

are

Methods

fiber.

altered

and fat intake

were greatest women.

of dietary

have

of shifting patterns of food intake from 1977 During the same period, fat intake also decreased

women

in foods

sources

health

reported

declines

y, particularly

components 1985 (2).

other

Americans

concentrations

y were

y there has been oflower-fat foods

adult

public

cholesterol

1980 (1). These 65-74

growing

icans

food-group

Concern for reducing fat and cholesterol intake and improving the healthfulness of diet was a theme of the l980s, reflected by the emphasis on these issues by all forms of media, including

Some

fastest

tuted a balanced diet We build on previous

Introduction

the

98713

E Patterson

practices of perand 1987-88 Intakes ofhigh-fat beef

as part ofthe

1 977-i

by

The

Washington,

For

(8, 9). In NFCS77

ofNutrition, International

NFCS77

one per season,

The University Life

and

NFCS87,

each on a different and NFCS87 the in-

Science

ofNorth

Carolina

Institute-Nutrition

DC.

3 Address reprint requests to BM Popkin, CB# 8120 University Square, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514. Received August 5, 1991. Accepted for publication October 30, 1991.

for Clinical

Nutrition

823

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Barry

changes

824

POPKIN

El

AL

89.6%

resent

dividual

food-intake

family

members’

vidual

dietary

through odology

phase

covered

intakes intake

were

data

to that

Both

obtained

year, and individual for 3-d periods. Indi-

for 3 consecutive

a mix of 24-h recall of individual dietary

is similar

the entire

days

and 2-d food record. intake measurement

surveys

The methin NFCS87

stratified-area response

(PSUs)

differed

factors

were

designed

samples

of the

rates

for the

as self-weighting,

household

and of

every

sample

level.

proportional

individual

ratio

rate

factors within

it and

aged > 19 y. There in NFCS in 1987 (< 35%)

consider

was than

a much in 1977

comparability

of the

samples

studied

in 1977 and

90.1%

1987,

and

89.8%

of dietary

respectively.

analysis

uses the USDA Nutrient Data Bank, 1987-88, for use with the NFCS87 to compute nutrient of all the dietary data collected in 1977 and 1987. A

specifically

content Linkage

70%). We feel that to consider such data as a large sample of the US population, let alone as representative of the noninstitutionalized older American population, it is important to use the weights for descriptive statistics. (For multivariate analyses where persons with large weights in cells with few cases can inappropriately affect the results, it would be appropriate to exelude the weights.) This is particularly true for trends analyses

where

This

USDA-developed

of the

of fat and

analyses

each

to the colwere applied

in a PSU

individuals

nonresponse

Nutrient

units

The weighting

to the

expected number of completed schedules lected number ofschedules. These weighting undersampling

For

population

significant

to be

multi-

US population.

various

at a statistically calculated

fiber consumed

updated

were

88.3%

linking

(USDA

program

Nutrient

Database

System) was used to match food codes in the 1977 NFCS data with the updated 1987 food codes and nutrient data. The nutrient database update included two types of changes: improvements

in the

quality

of the

food-composition

data

and

real changes 1987 nutrient

in the nutrient composition of foods. Use of the database makes it possible to study trends in food components, such as saturated fatty acids and dietary fiber, that were not available in the original 1977 nutrient database. However, this important advantage is counterbalanced with the bias introduced by concurrent changes in the food supply. Between 1977

and

1987

a frequently

cited

change

in the

food

supply

is

the closer trimming of fat from cuts of meat at the retail level. Use of 1987 nutrient level for 1977 meats will tend to result in a conservative estimate of fat consumption from these sources in 1977.

is important.

Results Sample Food-group We selected

a sample

ofpersons

aged

NFCS77 and NFCS87 obtained l-d food records for up to 3 consecutive all 3 d ofintake

it is recognized

records

that

were

this

may

used

result

analysis.

a l-d, 24-h recall and two days. Only individuals

Both

with

65 y for this

in this analysis. in an

Although

unknown

selectivity

this sample is desirable for two reasons. First, to interpret the percentage ofthe population consuming from a food group, bias,

it is necessary

surveys.

that

a consistent

Second,

variation

is a serious

1 1), and

the

average males and

for

and 618

Food The

in the partment

this

can

unit

shown with

days ofdietary-intake ofpeople

females

(total

females

(total

that

assessing

when

be dealt

analysis

1655

grouping

have

difficulty

problem

of multiple

available

temporal

researchers

aged

2667)

and

be used

for both

intraindividual usual intake (10,

partly

by

use of the data. The 3-d sample 65 y is for 1977, 1012

for 1987,

430

males

1048).

scheme

groups. Initial major used by the USDA.

food groups were Mixed meat-based

based on entrees

were assigned to the appropriate meat category (eg, chicken a la king to chicken) whereas non-meat-based mixed foods were assigned to the grain-based food group (eg, macaroni and cheese). Fat and dietary fiber thresholds were used to separate major food groups into more distinct, nutrient-based food groups. Fifty-six food groups were developed that reflect the total diet. Food group names and characteristic foods appear in Appendix A. The characteristic foods were those most frequently consumed in each

food

in this

analysis.

group. This

A subgroup subset

make substantial contributions food groups in which major

of 43 food

reflects

interest

groups

is presented

in food

groups

that

to fat and dietary fiber intake or trends occurred. These groups rep-

trends

column

gives

at least column by those the 3 d.

one item from the food group over a 3-d period. The for grams per user per day gives average consumption consuming at least one item from a food group over The last two columns show changes or trends in the

percentage

the

proportion

consuming

of elderly

and

gram

people

per

user

who

consumed

1 977

between

and

1987.

Often

it is helpful

population

to have

consumption

10 food-group for adults

food grouping system used separates virtually all foods Individual Food Consumption Surveys of the US Dcof Agriculture (USDA) into 56 useful descriptive and

nutrient-based food groupings

consumption

Overview. The focus of this research is on trends in eating patterns in older Americans from 1977-1978 to 1987-1988. Table I shows the nutrient-based food groups of interest and assesses consumptions in two ways. The percentage-consuming

contributors

aged

a summary

patterns.

65 in 1987

to energy, and

measure

In Table the

to examine

2 we present

total

the top

fat, and dietary

relative

rankings

in

fiber 1977

and 1987. Such a population-based measure reflects not only the contribution offoods that are rich sources ofa nutrient (such as high dietary fiber ready-to-eat cereals) but also the contribution offoods consumed either frequently or in large quantities (such as the contribution of white bread to fiber intake). As expected, the primary sources of energy, total fat, and dietary fiber frequently do not overlap. With minor exceptions, the top 10 sources ofenergy, fat, and fiber in 1977 remain in the top 10 in 1987. High-fat desserts and medium-fat beefand pork remain major sources of calories from 1977 to 1987. However, high-fat beef and pork and eggs fell out ofthe top 10 contributors to calories in 1987. With only minor shifts in rank, butter and margarine, high-fat desserts, and medium-fat beefand pork are the top three contributors to the population fat intake in 1977 and 1987. Sources of dietary fiber remained virtually unchanged from 1977 to 1987, with noncitrus fruits, high-fiber ready-to-eat cereals, whole-grain breads,

and

to fiber

intake.

low-fiber

vegetables

being

the

top

four

contributors

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stage, survey,

larger (nearly

obtained

of NFCS77.

USDA

to every

were

and

DIETARY TABLE I Food-group

consumption

patterns:

1977-1978

NFCS

CHANGES

and

IN OLDER

1987-1988

NFCS

(weighted)

adults

Amount consumed

Percent consuming

group

Percent consuming

g.uer’.d’

Low-fat milk and milk products High-fat milk and milk products Low-fat cheeses High-fat cheeses Low-fat beefand pork Medium-fat beefand pork High-fat beefand pork Low-fat poultry High-fat poultry Low-fat fish High-fat fish Bacon Low-fat luncheon meats and hot dogs High-fat luncheon meats and hot dogs Butter and margarine Low-fat salad dressings High-fat salad dressings Low-fat desserts High-fat desserts High-fat salty snacks Eggs and egg dishes

30.47 60.81 15.87 34.93 29.06 60.73 38.82 19.02 34.01 15.08 16.91 30.20 13.80 36.88 75.45 2.32 47.13 26.43 62.68 37.23 62.99

216.32 213.98

Legumes

20.04

Low-fat, low-fiber breads Low-fat, high-fiber breads High-fat, high-fiber breads Pasta,rice,andcereals Low-fiber ready-to-eat cereals High-fiber ready-to-eat cereals Low-fat grain mixed dishes High-fat grain mixed dishes

70.46 44.25 8.62 43.84 28.06 28.30 5.18 12.20

79.34 ± 2.81 42.84 ± 0.68 43.57 ± 0.96 40.67 ± 2.71 113.90±2.92 14.86 ± 0.37 25.65 ± 0.83 88.51 ± 7.73 68.46 ± 2.73 142.71 ± 2.46 139.49 ± 2.99 109.60 ± 4.88 179.22 ± 9.30 74.80 ± 1.39 50.52 ± 1.75 61.23 ± 1.53 96.85 ± 1.72 56.63 ± 1.34 469.02 ± 6.61 305.55 ± 6.64 190.68 ± 6.90 205.84±25.92

fruitsandjuices

54.04

Other fruits Noncitrus fruitjuices Fruit drinks Low-fat potatoes High-fat potatoes Green and orange vegetables Low-fiber other vegetables High-fiber other vegetables Coffee

64.68 13.99 12.22 60.32 27.48 43.15 84.79 49.52

Tea

44.87

Regular soft drinks Dietsoftdrinks

16.02 4.54

S

SE. SEs were based

85.87

on weighted

means

Change

6.l3 ± 4.93

Percent consuming

g#{149}user’#{149}d

% ±

Amount consumed

44.31 46.33

245.23 177.57

± 10.26 ± 8.17

%

g#{149}user’#{149}d

13.84 -14.48

56.22

± 2.77

18.71

49.55

± 3.52

2.84

21.55 96.32 69.91 53.55 56.29 56.74 48.47 53.24 12.44 26.98 30.01 10.43 12.37 10.80 81.45 70.72 10.89

± 0.60

35.85

18.63

± 0.64

0.92

3.27

34.16

74.55

± 4.13

5. 10

± 1.29 ± 1.19 ± 1.95 ± 1.26 ± 2.02 ± 1.99 ± 0.45 ± 1.18 ± 0.80

56.90 24.49

59.08 51.60

± 1.71

33.40

55.61

± 2.33

34.65 25.26 14.34 24.49 16.81 35.28

51.96 50.07 50.53 10.30 26.82 27.27

± ± ± ± ± ±

± 0.25

75.13

10.76

± 0.50

± 1.34 ± 0.33

3.22 46.73

12.10 12.84

±

45.04

± 0.73

but not adjusted

±

±

2.64

26.09

1.51 ± 0.37

for design

Proportion consuming. Major shifts in the proportion of the population consuming from food groups are summarized in Table 3. The largest increases were in the lower-fat products and the largest decreases in the higher-fat products. An examination ofthe major shifts in percentages consuming food sources of fat and cholesterol over 3 d reveal interesting changes in behaviors. The largest trends occurred in milk and meat groups. The proportion of US elderly people consuming whole milk decreased whereas the number of low-fat milk con-

53.07 21.1

2.13 2.50 2.81 0.51 1.55 1.05 1.23

± 0.55 ± 3.56 69.63 ± 2.30 13.64 ± 0.66 39.19 ± 1.10 82.64 ± 4.58 41.21 ± 1.24 42.36 ± 1.30 30.06 ± 3.51 129.10±4.20 17.97 ± 1.60 29.01 ± 1.02 94.83 ± 6.41 79.54 ± 4.29 147.05 ± 3.86 138.51 ± 4.04 134.86 ± 9.69 152.61 ± 8.70 72.83 ± 1.97 75.46

61.94 40.58

±

± 3.07

1

54.96 53.41 1 1.92 41.34 23.36 29.05 1 1.33 20.67 52.46 74.61 13.82 14.42 63.37

Amount consumed

-3.83 -14.34 14.38

0.64 10.17 -2.57 -5.72 3.00 -1.60 -0.32 0.91

-0.40 -0.34 -0.74 3.34 -9.92 1.07 -15.50 9.16 3.31 -2.50 -4.70 0.75 6.15 8.47 -1.58 9.93 -0.16 2.20

29.09 -36.41 -6.67

-2.92 -21.77

-10.82 -1.95 -0.68

-4.78 1.60 -2.70 -2.14 -0.16 -2.74 0.34 -0.27

2.04 -5.99 -1.09 2.75 -5.85 3.29 -1.63 -1.21 -10.61 15.20 3.12 3.36 6.32 1 1.09 4.34 -0.99 25.26 -26.60

3.05

-1.97

27.81

45.64

± 1.88

0.33

-4.88

45.04

56.62

± 2.05

1.89

-4.61

88.08 49.83 79.19 39.35 25.51 15.04

95.54 ± 2.67 55.03 ± 2.08 485.25 ± 12.00 297.29 ± 1 1.55 229.26 ± I 1.48 206.79± 13.48

3.28 0.3 1 -6.67 -5.52 9.49 10.51

-1.31 -1.60 16.23 -8.26 38.58 0.95

effects.

sumers increased. High-fat beef and pork consumers decreased whereas there was an increase in the proportion consuming lowfat poultry, low-fat fish, and low-fat beef and pork. There was a decrease in the number ofusers ofthe traditional breakfast items of eggs and bacon. However, little change was observed in the proportion consuming butter and margarine, salad dressing, cheeses, salty snacks, or rich desserts. The trends in eating behavior with regard to fiber intake are less straightforward. The proportion of US elderly people con-

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%

Citrus

65 y 1987

1977

Food

825

AMERICANS

826

El

POPKIN

TABLE 2 Major sources

ofenergy,

fat and fiber for US men and women

aged

AL

65 y in 1987 with

1977 and

Energy

1987 rankings

Fiber

Fat

Rank Foodgroup

Rank

Rank

87

NFCS87

(weighted)

77

NFCS87

77

NFCS87

%

87

77

%

High-fatdesserts Medium fat beefand pork High-fat, low-fiber breads Noncitrus fruits Low-fat, low-fiber breads (white) Low-fat, high-fiber breads (wholegrain)

8.1 5.3 4.5

1 2 3

1 2 5

4.3

4

7

1 1.1

1

1

4.0

5

3

3.6

10

9

3.8

9.1

4

2

3.5

6 7

9

Butter and margarine

8

9.5

1

2

8 9

4

4.3

7

5 5.7

7

7

6 10

4.9 4. 1

4 8

4 6

4.4

6

7

4.0 4.7

9 5

8 9 10 9.2 9.3 7.7 6.5 4.9 4.8

3 2 5 6 8 9

3 4 5 6 8 10

High-fat milk and milk products (whole milk) Low-fat milk and milk products Low-fat potatoes High-fat beefand pork Eggs and egg dishes Luncheon meats and hot dogs High-fat poultry Salad dressing High-fat cheeses Low-fiber vegetables High-fiber ready-to-eat cereals

High-fiber

3.3 3.1 3.0

9.2 8.2 3.4

2 3 10

3 1

10

other vegetables

Legumes Green and orange vegetables Pasta, rice, and cereals

suming comitant

low-fat, low-fiber bread (white) decreased with a conincrease in low-fat, high-fiber bread (whole wheat). A

greater

number

of elderly

people

also

consumed

higher-fat

low-fiber sweet-type breads. Despite the media to high-fiber ready-to-eat cereals, a very slight was

seen

to-eat

in the

cereals

consuming was

number combined

and

sumption based

with

low-fiber

observed

rice,

of people

in the

cereals.

proportion

consuming

category.

were observed

for foods

category.

groups containing fruit category.

The

dietary

high-fiber

decline

ready-to-eat

cooked-cereal

mixed-dish

consuming

a modest

A very

number

modest

decline

in the

increases

in the low- and high-fat largest

increase

fiber was observed

women.

in users

very little

change.

consumption

citrus

fruit.

Trends

observed in consumption or margarine, or high-fat

10 sources Similarly,

etable

three

product

In general, were

not

shifts large,

in mean

grams

consumed

ofa

population

is but

one

as much

changes. from 1977

aspect

patterns poultry

is the abvirtually of high-fat for men or

accounted

for 3

at 9.2%, 9.5%, and 4.0% of dietary fiber showed in legumes, fruit, and vegexcept

for increases

in non-

per user per day consuming

of consumption

to

with

consumed.

1987.

However,

a few

changes

echoed

the

food-

group consumption findings. For instance, in foods contributing to fat intake, for people consuming high-fat milk, average consumption decreased by 36.4 g. Low- and medium-fat beef and pork consumption decreased by 21.8 and 10.8 g respectively. However, consumption increased by 29.1 g by those using lowfat milks.

in the noncitrus-

categories

of dietary fat many sources

The proportion group

grainof food

in conjunction

of foods

categories per user

Gender

In 1987 these

of the top respectively.

pasta, in con-

Perhaps as important as the trends in consumption sence of change in many product areas. For example, no change was desserts, butter

ready-

in the

foods

However,

but

attention given overall increase

trends in the quantities of specific Changes in mean gram consumed per day are summarized in Table 4 and did not show variability as the results on food-group consumption That is, usual portion sizes did not appear to vary much

considered

food trends.

from This

a food must

be

results

In many areas ofconsumption, men and women had common consumption trends. For example, men and women were likely to report similar trends in beefand pork consumption between 1977

creased

and

1987.

Significant

numbers

of men

and

women

de-

consumption ofthe high-fat meat cuts, with modest increases in consumption ofthe low-fat cuts. Approximately 14% more of both men and women reported consuming low-fat poultry products and neither group reported any decline in consumption ofthe high-fat poultry items. Similar numbers of men and women decreased consumption of egg and egg dishes and bacon products. Men were equally as likely as women to consume fewer white-bread products and more whole-grain-bread products.

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%

87

DIETARY

CHANGES

TABLE 3 Changes in proportion of US elderly people consuming groups, 1977-1978 to 1987-1988 (weighted)

selected

IN OLDER

food

827

AMERICANS

TABLE

4

Changes

for US elderly

people,

1977-1987

to 1987-1988

Change Change

and food group consuming

> 10%

consuming

Low-fat, High-fat High-fat

in percentage

g. user’ Increases > 10 g.user #{149}d Regular soft drinks Low-fat milk and milk products Noncitrus fruit juices Coffee

14.4 13.8

10.5 10.2 consuming

High-fat

grain-based mixed dishes 10 g.user #{149}d High-fat milk and milk products Fruit drinks Low-fat beef and pork Medium-fat beef and pork High-fat, high-fiber breads

9.5

Decreases

9.2 8.5 6.7 6.2 5.1 consuming 6.7 5.7 5.5

of population

and

14.5

might daily based

15.5 14.5 14.3

and

a number

of gender

trends.

Table

differences

5 identifies

were

the

observed

largest

five servings

products.

in

women. was greater

genders

high-fat

oftotal

Similarly, for men luncheon

fat. Although

meats

declined

meats

numbers

in both

luncheon-meat bers of female more

the decrease between 1977

women

than

are

genders,

consumption consumers. men

one

of the

the

top

conboth

10 sources

ofhigh-fat

luncheon

increase

in low-fat

entire

was attributed to increased numA less healthy trend is that in 1987

shifted

36.4 26.6 21.8 10.8 10.6

to consumption

however,

are considerably

of individuals offruits

and

below

consuming vegetables

declining

intakes

that

the recommended and

in both

servings

men

of grain-

and

women,

of men exceeded the daily threshold of 300 and 1987. The mean cholesterol intake for was < 300 mg in 1977 and continued to de-

in 1987.

differences

in whole-milk and 1987. For

ofconsumers

dine

g for men

Although

cholesterol intakes mg in both 1977

between men and women. In 1977, more women than men consumed low-fat and skim milk, but by 1987 the proportion of men aged 65 consuming low-fat and skim-milk products exceeded sumers

15.7

be expected

women, However,

>

9.9

low-fiber breads milk and milk products beef and pork

consumption

38.6 29.1 25.3 16.2 15.2 1 1.1

Pasta, rice, and cereals

9.9

d’

of high-fat

salty

Discussion The discussion of diet in the aging population often centers on the extent of undernutrition and dietary deficiency and the determinants ofinsufficient food intake (JT Dwyer, unpublished observations, Americans

with

1990). Fewer authors have examined diets of older respect to their healthfulness in light of practices

that may lead to chronic disease. Murphy et al (13) examined diets of individuals aged 55 surveyed as part of the National Health and Nutrition Examination Survey 1971-74 (NHANES I) and the NHANES I Epi-

snack foods. Men continued to consume a higher proportion of dietary fiber from legumes than did women but the differences narrowed between 1977 and 1987. In contrast, the modest increase in

demiologic

numbers

ofconsumers

offsetting

trends

Top gender differences in proportion of US elderly people consuming selectedfood groups, 1977-1978 to 1987-1988 (weighted)

this

product

ofhigh-fiber

in which category

likely

to consume

sume

the

more in

pasta

high-fiber

ready-to-eat women

1987. than

starchy

but

cereals

fewer

reflected

men

consumed

Fewer

men

than

women

but

more

were

likely

rice

vegetables

in 1987

than

sistently

nutrient

healthful

dietary

changes and

guidance

in the

(Table

6). The

sistent with recently published et al (12), but the magnitude 1987

is modest.

saturated 1987,

Although

fat declined values

respectively.

1987

fiber

unweighted of difference and

recommended intakes

suggested absolute

were

by

national

ofenergy

are

con-

by Wright 1977 and from

fat and

women

between 1977 and levels of 30% and 10%,

of 1 1.6 and

12.2

g for women

10 y

Cha nges in percent consuming group

Males

Females %

are con-

values

estimates between

administered

in 1977.

in this sample

direction

the percentage

for men

still exceed Dietary

observed

(NHEFS),

5

Food

mean

Survey

to con-

Nutrients The

TABLE

Follow-Up

Low-fat milk and milk products High-fat milk and milk products Low-fat luncheon meats and hot dogs Low-fat fish High-fat salty snack High-fiber ready-to-eat cereals Pasta, rice, and cereal High-fiber other vegetables

17.8 -

1 8.8

-0.9 14.0 -0.0 -4.1 -7.4 4.3

1 1.0 -

I 1.4

5.8 7.5 5.8 4.2 1.0 -2.6

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10% increase in percentage of population Low-fat poultry Low-fat milk and milk products Diet soft drinks Low-fat fish 5-10% increase in percentage of population Other fruits Regular soft drinks Low-fat, high-fiber breads High-fat, grain-based mixed dishes High-fat, low-fiber breads Low-fat, grain-based mixed dishes Low-fat beef and pork 5- 10% decrease in percentage of population Eggs and egg dishes Coffee Bacon Tea decrease

Amount

Percent

>

(weighted)

828

El

POPKIN

TABLE Changes

6 in nutrient

intake

for US elderly

people

by gender,

1977-1978

AL

to 1987-1988

(weighted)

Female Nutrient intake

1977

Male 1987

Change

1977

Total 1987

Change

1977

1987

Change

Energy

Dietary

fiber

5876.0 ± 45.6* 1404.4 ± 10.9 58.3 ± 0.5 37.1 ± 0.2 13.5±0.1 46.2 ± 0.2

(g)

Cholesterol

270.5

later.

They

concluded and

were

reported

and

vegetables.

ofsweets

that

cheeses

was little change

± 3.6

the

in overall

were

with two

the

poultry

products,

be asked ofUS

the

if

elderly

to other American population dietary trends ofwomen aged trends levels

in whole and for proportion

comparable It appears into

(2). that

low-fat using

older

fat beef, pork, and agenda for healthful translate reason

into modest that nutrient

contributors bution parent

beef

to fat intake substitution

without

The

fiber

13.6

± 0.2

0.8

266.7

± 4.7

-53.1

intakes

or nu-

but were not adjusted

number

for design

of servings

time

but

of

that

there fruit

of servings

findings proven Except

sizes

in overall

regarding given

et in-

vegetables

behaviors and

fiber

intake

its suggested

health

lack with 1985,

high-

nutritionist’s trends intakes. One the three top

desserts, contri-

cereals,

most

trends

to affect

change

since

to cancer and heavy consuming

for fiber-rich

1977)

and

heart

media more

emhigh-

foods

were

unimpressive.

The gender between

the

conventional trend

setters

results sexes wisdom

were more than

for that

in nutritional

the women change.

remarkable differences (at least

for the similarities and

empirically

1988

USDA

Bridging

Study

was

designed

to

contradict

in this age range)

the are

probes),

food

coding,

weight-to-volume

conversion factors at the food level, and nutrient databases (14). One of the primary research questions of the bridging survey was to determine whether interviewing and coding differences across the surveys resulted in differences in the frequency with which meat and poultry items were reported as eaten without fat or skin. Between the NFCS77 and the NFCS87, coding rules regarding

reported

meat

and

poultry

consumption

were

not

changed. trimmed as “both

That is, responses that did not specify whether fat was from meat or whether poultry was skinned were coded fat and lean eaten” in both surveys. Although the NFCS77 food instruction booklet used by interviewers contained explicit probes for whether the skin on poultry and the fat on meat had been eaten, greater emphasis was placed on these probes in NFCS87. The study suggests that differences in probing contributed to an increase in reporting of0.06 meat and poultry items with fat and/or skin not eaten per person per day (from 0.15 using 1977 interviewing techniques to 0.21 using 1987 interviewing techniques).

items

intake.

(little

The

(including

messages

in their

trends.

consumption

procedures

from

high-fat

related

real

the NFCS77

fat-

at all fat are very

not be adequate

relation

including

to a number

consti-

are similar

away

change

may

of factors,

could be at-

43

compared 1977 and

trends

dietary-fat

1987-1988

test for the effects ofprocedural differences between and NFCS87, specifically differences in interviewing

(or

1987

beef and pork sizes of users

value for constipation, for a handful of women

ready-to-eat

Murphy

we identify groupings.

not

and

changes, changes in survey methodology, and potential nonrandom response bias in the 1987 data. In the examination of trends in dietary fat and food sources offal, it has been suggested that assumptions regarding the coding of meats and poultry may influence the estimated fats and fat-

margarine,

did

in food

1977-1978

tributed

are on any food-consumption

and

pork)

ofdifferences

and

are translating

(butter and

The magnitude

Increases

and

The

observed

trient intakes between

legumes,

food-frequency

milks and and serving

effects.

products.

groups. When 19-50 y between

in portion

changes

surprising

disease, phasis.

± 0.1

± 3.4

from 1977 to 1987 (almost 30%). The apof high-fat items with lower-fat alternatives

alterations

the desired

12.8

319.8

changes in overall nutrient trends may be modest is that

to fat intake

medium-fat

-1.6 -1.1 2.0

1.2

1977

milk consumption change. These

-3.0

-68.9

dietary

behaviors.

± 0.9

36.0 ± 0.2 12.5±0.1 47.3 ± 0.3

± 8.3

all fruits

Americans

food-consumption

64.2

± 0.3

of fish,

between

± 0.6

15.7

of meat

positive

37.6 ± 0.1 13.6±0.1 45.3 ± 0.2

-45.6 -10.9

320.2

In contrast, food

people

67.2

-2.0 -1.4 2.1

± 72.0 ± 17.2

± 0.2

used a food-grouping scheme trends. All milk products, all

and

-3.1

6616.2 1581.3

± 6.1

are difficult.

meat

± 1.5

36.2 ± 0.3 12.4±0.1 46.1 ± 0.4

± 45.2 ± 10.8

14.5

nonquantified

tute 3 of the 18 food groups. sensitive and dietary-fiber-sensitive

76.3

6661.8 1592.2

389.1

study

present

dissimilar,

± 1.0

63.6 15.2

0.6

in number

in the two surveys and many important dietary

It may

38.3 ± 0.2 13.8±0.1 44.0 ± 0.3

± 120.5 ± 28.8

-42.1

reported

struments that hides

thereof)

79.7

-1.3 -0.9 1.9

alcohol.

Comparisons

and

-2.8

7828.7 1871.1

± 4.9

over

servings

± 78.7 ± 18.8

± 0.2

means

servings

Declines

and

± 0.9

7765.1 1855.9

12.2

slightly

capita

-126.4 -30.2

228.4

per capita

increased

in per

al (1 3) used

are

55.5

SE. SEs were based on weighted

all milks

7.0 ± 16.7 ±

35.8 ± 0.3 12.6±0.1 48.1 ± 0.3

1 1.6 ± 0.1

(mg)

S

and

5749.6 1374.2

Similarly,

a decline

introduced

as eaten

with

was

observed

in meat

and

poultry

skin not specified (from 0.42 per day with 1977 methods to 0.32 with 1987 methods). These results suggest to us that differences in fat probing may have contributed to some overestimation of fat intake from meat consumption in 1977. However, from these results it is also clear that it would be inappropriate to assume that all or even most of meat and poultry consumed in 1977-1978 was either skinned or trimmed, as was suggested (CE Woteki, MG Kovar, H Riddick, unpublished observations, 1984). In addition, we can examine the bridging survey for evidence of bias

reported

because

fat and/or

of differences

in nutrient

databases

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(U) (kcal) Fat (g) Fat (%) Saturatedfattyacid(%) Carbohydrate (%)

DIETARY

CHANGES

IN OLDER

and the weight-to-volume conversions. Ifwe examine the extent of difference in overall fat intake attributed to use of 1987 vs 1977 nutrient composition and weighting factors, the estimate for women aged 20-49 y is 24.1 vs 24.3 g fat at the 10th percentile, 59.2 vs 63. 1 g at the 50th percentile, and 123.2 vs I 21.2 g at the

90th

percentile.

We

estimate

that

this

translated

to a

ofhouseholds aged 15-24

aged < 41 y and without y. Although no exact figures

children, and participants are available for response

rates ofelderly people, it appears reasonable to assume that they are fairly well represented except for the very poor or very rich. As for self-selection bias, if respondents and nonrespondents have systematically different behaviors, then survey results may be influenced. Bethlehem (16) showed how reweighting can reduce the potential for nonresponse bias, and all results reported here are weighted. It remains possible, however, that respondents with

demographic

and

socioeconomic

characteristics

identical

to those of nonrespondents have systematically different eating behavior. Although caution must be exercised when interpreting these data, as noted by the US General Accounting Office (17), the NFCS87 is the only survey available on individual diets over the last decade and the data are critical for many users. In conclusion, results of focus groups of older Americans mentioned

in the

introduction

are

reflected

in results

of this

study. Elderly Americans knew what not to eat but were not able to describe what constitutes a healthy diet. In this study a number ofpositive dietary changes are observed, particularly in foods where the presence of fat is obvious (eg, meats, poultry, and dairy products). However, this risk-avoidance behavioral pattern is not accompanied by strong, consistent, health-seeking behaviors, ie, consumption ofmore fruits, vegetables, and whole grains. Perhaps the diet and health messages have focused too heavily on foods to avoid while not giving adequate guidance for how to plan, shop for, and prepare healthful meals that will enable individuals to meet the current diet and health recom-

These

results

are consonant

with

Improving America our attention on the need

Medicine

which

focuses

hesive

and

practical

approach

to

a recent

Institute

‘s Diet and Health, to develop a more co-

report

nutrition

education

for

the

LI

country(l8).

We acknowledge the assistance ofSuzanne Harris and the International Life Science Institute-Nutrition Foundation Subcommittee on Nutrition and Aging in developing this research. We also thank them for assistance in clarifying some ofthe important issues. We thank David Guilkey for his assistance in addressing issues of weights and Phil Bardsley for his extensive computer assistance. References 1 . National

Center for Health Statistics. Trends in serum cholesterol levels among US adults aged 20 to 74 years. JAMA 1987;257:93742. 2. Popkin BM, Haines PS, Reidy KC. Food consumption ofUS women: patterns

and

determinants

between

1977

and

1985.

Am

J Clin

Nutr

l989;49: 1307-19. 3. Martin LG. Population aging policies in East Asia and the United States. Science l991;l51:527-31. 4. Heckler MM. Health promotion for older Americans. Public Health

Rep l985;I00:225-30. 5. Goodwin JS, Leonard AG, Hooper EM, Garry PJ. Concern about cholesterol and its association with diet in a group ofhealthy elderly. Nutr Res 1985;5:141-8. 6. Patterson BH, Block G. Food choices and the cancer guidelines. 7.

Am J Public Health l988;78:282-6. 5K. Aging and health promotion:

market research for public

Maloney

education. Executive Service, 1984.

summary.

Washington,

DC:

Public

Health

Peterkin B, Rizek RL, Tippett KS. Nationwide food consumption survey, 1977. Nutr Today 1988{n/Feb: 18-24. 9. Rizek RL. The 1977-78 nationwide food consumption survey. Fam 8.

Econ Rev l978;4:3. Beaton GH, Milneri, Corey P, et al. Sources ofvariance in 24-hour dietary recall data: implications for nutrition study design and interpretation. Am J Gin Nutr l979;32:2546. 1 1. Hartman AM, Brown CC, Palmgren J, et al. Variability in nutrient and food intakes among older middle-aged men. Am J Epidemiol l990;l32:999-1012. 10.

12.

Wright

HS,

Guthrie

HA,

Wang

MQ,

Bemardo

V. The

1987-88

nationwide food consumption survey: an update on the nutrient intake of respondents. Nutr Today May/June:2l-7. 13. Murphy SP, Everett DF, DresserCM. Dietary patterns. In: CornoniHuntley JC, Huntley RR, Feldman ii, eds. Health status and well. being of the elderly. National Health and Nutrition Examination Survey-I

epidemiologic

follow-up

versity Press, 1990:185-209. 14. Guenther PM, PerloffBP. 1977

and

estimates Bridging

1987

in the

study.

Effects

Nationwide

of food and nutrient Study. Washington: US

(NFCS report 15. Life Sciences

87-M-1.) Research

New

York:

Uni-

ofprocedural differences between Food Consumption Survey on intakes: results of the USDA 1988 Department

ofAgriculture,

Office. Impact of nonresponse Nationwide Food Consumption

data from the 1987-88 thesda, MD: Federation

Oxford

ofAmerican

Societies

1990.

on dietary Survey.

for Experimental

BeBi-

ology, 1991. 16. Bethlehem JG. Reduction of nonresponse bias through regression estimation. J Offic Stat l988;4:25l-60. 1 7. US Government Accounting Office. Nutrition monitoring: mismanagement of nutrition survey has resulted in questionable data. Washington,

DC:

GAO,

18. Institute of Medicine. ington DC: National

1991.

Improving Academy

(GAO

RCED-91-l

America’s Press,

1991.

17.)

diet and health.

Wash-

Downloaded from https://academic.oup.com/ajcn/article-abstract/55/4/823/4694328 by East Carolina University user on 03 January 2019

difference in energy from fat of 146.4 Id (35 kcal) at the 50th percentile. However, the estimates of energy intake at the 50th percentile for this cohort of women also differed, from 6259.3 Id (1496 kcal) using 1987 nutrient-composition data to 6322.0 Id (151 1 kcal) using 1977 data, making estimates of percent of energy from fat closer than might appear from just examining the grams of fat differences. We have chosen not to attempt to adjust the values for selected food codes, in part because we do not know the true nature and extent of other food-supply changes and in part because of a desire to maintain methods that might be easily replicated by other investigators. We believe the methodologic advantages of using 1987 nutrient-composition data outweigh disadvantages. The bias introduced in the estimation of fat and fat-containing food trends is that the method we use produces more conservative estimates of fat intakes in 1977 (2% lower), which will bias our hypotheses of declining fat intakes over time towards the null. Another concern in trends analyses is the low response rate for NFCS87. Participation by households drawn into the sample was < 35%, primarily because of heavy respondent burden and low remuneration. Low response rates may affect the accuracy of a survey estimate through a decrease in the sample and potential self-selection bias. The Life Sciences Research Office (15) reviewed the impact of nonresponse and noted low representation from economically poorer and richer households, households with working female heads ofhouseholds or female heads

mendations. of

829

AMERICANS

830

POPKIN

APPENDIX Food

system

Food

group

Low-fat High-fat Low-fat High-fat

High-fat

beefand

Low-fat High-fat

poultry poultry

milk products milk products

skim

foods

milk

milk cheese

American, cheddar Ham, beef roast (lean only) Lean ground beef, beef roast (fat content not specified) Regular ground beef, beef pot roast Skinned chicken breast, turkey Chicken or turkey salad, chicken or turkey pot pie, fried chicken leg (not specified as to skin) Tuna (canned)

pork and pork

fish fish

Food

group

Representative

Legumes Low-fat, Low-fat,

low-fiber high-fiber

breads

High-fat,

low-fiber

breads

breads

Low-fiber

ready-to-eat

cereals

High-fiber

ready-to-eat

cereals

Low-fat, dishes

grain-based

meats

mixed

grain-based mixed dishes Citrus fruits and juices Other fruits High-fat,

meats

dressings

desserts desserts

High-fat salty snacks Eggs and egg dishes

Cornbread,

Oatmeal, Cornflakes, Shredded wheat Spaghetti sauce

and

Pork sausage, bologna, beef hot dog Margarine, butter Low-calorie French and Italian dressings Mayonnaise, Italian and French

Gelatin

dessert

Ice cream, apple pie, butter or sugar cookies, cakes Saltines, potato chips Fried egg, boiled egg, omelet

bran

muffin

rice

wheat flakes wheat, bran cereal, flakes with tomato and meat

Macaroni

and

cheese,

thin-crust

pizza Orange juice

Banana,

apple, strawberries,

cantaloupe

Noncitrus fruit juices Fruit drinks

Apple juice, Cranberry

cranberry cocktail,

apple juice drink, Low-fat

potatoes

High-fat

potatoes

Green

and orange

Low-fiber

other

vegetables

vegetables

dressings

Low-fat High-fat

Pinto beans, pork and beans White bread Wheat or cracked wheat bread

flavored

dressings

salad

and

method not specified) Bacon Sliced ham, turkey ham

foods

Rolls (white, soft)

High-fat, high-fiber breads Pasta, rice, and cereals

Fried perch, fish (cooking

Butter and margarine salad

2% Milk,

Whole Cottage

pork

Bacon Low-fat luncheon hot dogs High-fat luncheon hot dogs

High-fat

Representative

High-fiber Coffee

other vegetables

Tea soft drinks Diet soft drinks Regular

juice cranberry-

fruit-

drink

Baked potato, mashed potato Home fries, potato salad, French fries Carrots, broccoli, spinach Lettuce, tomatoes (raw), lettuce salad, onions, celery (raw), green beans Green peas, corn Coffee (ground and instant) Tea Soft drink (cola) Soft drink (cola, sugar-free)

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milk and milk and cheeses cheeses Low-fat beef and Medium-fat beef

Low-fat

AL

A

grouping

Low-fat High-fat

El