International harmonisation of dietary monitoring ......Other aspects that need to be harmonized sampling protocols, additional questionnaires, anthropological measurements, food classification,

1 15 May 2012

International harmonisation of dietary monitoring – dietary assessment & beyond

Marga Ocké

RIVM, the Netherlands

2 International harmonisation of dietary monitoring – dietary assessment & beyond | 15 May 2012

Content

1. Introduction

2. Requirements

3. Lessons from EFCOSUM

4. Lessons from EFCOVAL

5. Conclusions

International harmonisation of dietary monitoring – dietary assessment & beyond | 15 May 2012

3

Introduction - rationale

Dietary monitoring data are essential for:

● the development and evaluation of food and nutrition policies

● dietary exposure assessment and subsequent risk management.

International harmonisation of dietary monitoring important.

● Large global burden of nutrition-related diseases

● Dietary risk assessment is increasingly done at international level.


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Introduction - problem

Food consumption surveys are usually organised at the national level.

differences in methodologies

limited comparability across countries

0

2

4

6

8

10

12

14

adult childrenn

of

cou

ntr

ies

24-h recall record

Figure: Number of EU-countries that use diet recall and record method for dietary monitoring in adults and children (Source: EFSA comprehensive database)


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Objective

Aim: address harmonisation of dietary monitoring

Dietary assessment and other aspects

Critical factors


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Requirements for food consumption surveys

1. the methodologies are applicable to and feasible for the study populations involved and for conducting organisations;

2. the collected data are valid

3. the study population is representative for the target population.

4. tools and methodologies should be harmonised

5. ‘voluntary situation’: advantages > disadvantages

In international studies the first three requirements

are even greater challenges as compared to

national surveys.

For harmonized surveys


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EFCOSUM: European Food Consumption Survey Method

● 2000-2002, EU funded

Aim:

● to define a method for monitoring food consumption in nationally representative samples of all age-sex categories in Europe in a comparable way

Conclusion:

● For reliable and comparable dietary assessment, the EFCOSUM group advised the use of at least two non-consecutive 24-h dietary recalls for adults.

Biro et al., EJCN 2002


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EFCOSUM: inventory on software for 24-h recalls

● EPIC-Soft software preferred to standardise the 24-h diet recalls.

● Where EPIC-SOFT software can not be used, EPIC-SOFT procedures are to be followed © developed by IARC

Slimani & Valsta, EJCN 2002


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Critical aspects to be standardised in 24-diet recall

● steps to conduct a structured interviews

● procedures to describe, quantify, probe and calculate food and supplement intakes

● quality controls before, during and after data collection

● procedures to classify, store, retrieve and export data

EPIC-Soft © screen shot


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Standardisation of handling foods and recipes

● Yoghurt with fruit, or

● Yoghurt, skimmed,sugar sweetened, vitamin D enriched, raspberry, plastic package,

Important for assessment of specific components

● Pizza, or

● Dough, cheese, tomato sauce, ham, mushroom, sweet pepper, etc.

Important for food (group) comparisons

● Standard Minestrone soup for everyone, or

● Individual Minestrone soup if recipe is known

Important for insight in variation in consumption


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EFCOSUM: limitations of EPIC-Soft (2002)

● To be reprogrammed on a modern Windows environment

● To develop an easier system maintenance of the EPIC-SOFT databases

● To integrate specific-requirements for pan-European surveys

● Versions are not available for all EU countries

● To be adapted to different population groups (e.g. adolescents, ethnic groups, as a data entry system for children)

● To be validated at individual level and on representative samples


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•2006-2009

•EU funded

EFCOVAL European Food Consumption and Validation

www.efcoval.eu

FOOD-CT-2006-022895

http://www.efcoval.eu/


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EFCOVAL: activities around dietary assessment

Activities around the dietary assessment method

● EPIC-Soft was validated and further developed to estimate the intake of foods, nutrients and chemicals in the context of pan-European food consumption surveys.

● For children a combination of a food diary with an EPIC-Soft 24-h recall was tested.

● Advantages, limitations, possibilities and bottlenecks to use EPIC-Soft in pan-European food consumption surveys were mapped.

De Boer et al., 2011

Poster nr 130 today!

http://www.nature.com/ejcn/journal/v63/n9/


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EFCOVAL: validation ● Validation of 2x non-consecutive

24-hr diet recalls using EPIC-Soft

● 600 men and women aged 45-60 y in BE, CZ, FR, NL, NO

● using biomarkers for intake

● Conclusion: method is suitable to estimate the usual intake distributions of protein, potassium, fish, fruit & vegetables of EU adult populations

● Crispim et al., BJN 2011

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5

10

15

20

%

BE CZ FR NL NO

men women

Figure: mean level of underestimation (%) in protein intake by 24-h diet recalls versus urinary N-excretion


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EFCOVAL: dietary assessment in children

Method

● 2x24-h diet recall with school children and one parent

● Using EPIC-Soft combined with a food recording booklet and involvement of other proxy persons prior to the interview

Conclusion

● The food recording book is an advantage for catching the out of home eaten foods

● The child is knowledgeable about own diet – must be involved in the interview

● The parent is needed for details and for helping the youngest with remembering and describing

Trolle et al., EJCN 2011


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EFCOVAL: advantages and limitations of EPIC-Soft

standardised, detailed, tested, flexible, validated EPIC-Soft

platform

Link with food composition table

High requirements: time and expertise needed

Ocké et al. EJCN 2011


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EFCOVAL conclusions on possibilities and barriers for a pan-European food consumption survey

● Convince & motivate European authorities and national governments of added value to collect individual-level food consumption data standardized across countries

● Collaboration between national and international organizations is needed

● Individual countries

– Some countries need capacity building

– Some countries reluctant to change methodology because of time trend objectives

– Some countries already work with EPIC-Soft or are ready to start


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Other aspects that need to be harmonized

● sampling protocols,

● additional questionnaires,

● anthropological measurements,

● food classification,

● statistical models to estimate dietary exposure from the collected data,

● food composition tables,

● biomarker measurements.

● This session international harmonisation

● Workshops on usual intake modelling


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Evaluation of status with regard to requirements

Requirements Evaluation

Feasible & applicable

OK for many EU Member States, in some countries capacity building needed, need of set of minimum requirements

Valid Validity is known but moderate, common limitations of self-reporting

Representative Representativeness considered moderate, low response rates problem, national population register not available in all EU member states

Harmonised Tools are available, coordinating organisation needs to take decisions

Advantages > disadvantages

OK for EFSA and some European Union member states, but not for all. Largest bottle-neck


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Conclusions from experience in Europe

● Harmonisation of dietary monitoring is a major challenge;

● Sometimes changes in existing procedures have to be made that are not optimal for the local situation.

● Sufficient time needed to come to consensus, develop, test, and validate all tools and materials, capacity building and training.

● Strong coordination and commitment from many stake holders is needed.


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Thank you for your attention!

Acknowledgements:

– collaborators in EFCOSUM and EFCOVAL project

– collaborators in PANCAKE project

– Nadia Slimani, IARC

– Evelien de Boer & Caroline van Rossum, RIVM

– Liisa Valsta, EFSA

Acknowledgements: The Community funding under the Sixth Framework Program for the EFCOVAL project is acknowledged (FOOD-CT-2006-022895). The content of the presentation reflects only the author’s view and the Community is not liable for any use that may be made of the information contained therein.

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International harmonisation of dietary monitoring ......Other aspects that need to be harmonized sampling protocols, additional questionnaires, anthropological measurements, food classification,