Calls for stronger national diet surveys

We need to “strengthen and expand nationally representative diet and nutrition surveys”

Prof Janet Cade emphasised this statement from the WHO European Food and Nutrition Action Plan (2014) at the IV World Congress of Public Health Nutrition and XII Congress of the Spanish Society for Community Nutrition – NUTRIMAD 2018, held in Madrid in October 2018.

She had been invited to contribute to a symposium on Dietary Surveys. Other speakers covered aspects of social determinants of food choice, useful when considering who is responding to surveys and why; and reports from some larger dietary surveys in Spain.

It is clear that across Europe improving national diet surveys should be a priority. The Nutritional Epidemiology Group in Leeds has recently been awarded the status of WHO Collaborating Centre in Nutritional Epidemiology; and work from the group has shown that 36% of countries in Europe (19/53) do NOT have a National Diet Survey, with the gaps mainly in Central and Eastern Europe. National and regional nutrition policy lacks a strong evidence base. Results for countries which do provide nutrient information, shows that overall, men and older boys have higher energy intakes than women and girls. Adult women have energy intakes below UK reference intake, though under-reporting is possible. Nutrients which are above the reference intakes were fat and sodium; with fibre and folate intakes below the reference intake level for most countries.

National diet surveys provide useful data for monitoring trends and developing evidence for policy. However, studies undertaken show little uniformity in method, with varying age groups, dietary methodologies, nutrient composition databases, time frames studied, and statistical methods used. Under-reporting appears to be common, and treatment of this by study varies.

Could new technology help?

Traditional paper-based methods have been most commonly used in nutrition surveys, despite respondent and researcher burden. However, new dietary assessment technologies offer potential advantages including faster data processing, ease of use for respondents and better data quality.

myfood24 is one such tool, recent publication of a large validation study of this system using biomarkers showed that nutrient results were similar to those which could be obtained using the best current multiple-pass interview method. The underlying food composition database is unique and could be linked to other food coding languages across Europe. myfood24 is also available and being used in Germany and Denmark with local food composition tables, making it suitable for development across a range of countries.

Survey harmonisation is important for comparison and policy formation, use of a consistent dietary assessment tool would help this standardisation. There needs to be a balance between complexity of information captured in the survey and the cost and speed of delivering results. myfood24 provides an easy to use system for survey participants to complete without the need for interviewers, with immediate real-time feedback on food and nutrient results.

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