Achievement of Dietary Goals -- Kansas, 1993

Fat intake and other dietary factors are associated with increased risk for important chronic diseases, including cardiovascular disease and cancer (1-4). To characterize the nutritional behaviors of residents of Kansas, the Kansas Department of Health and Environment (KDHE) conducted a nutrition assessment survey in 1993 and has used the results as a baseline for monitoring progress toward attaining Healthy Kansans 2000 (HK2000) nutrition objectives. This report summarizes selected findings from the nutrition survey relative to three HK2000 objectives: 1) increase to 35% the proportion of adults who consume five or more daily servings of fruits and vegetables; 2) increase to 40% the proportion of adults whose dietary fat intake constitutes less than 30% of their total food-energy intake (a lower fat diet); and 3) increase to 70% the proportion of adults who consume greater than or equal to 600 mg of calcium daily (75% of the Recommended Dietary Allowance for adults aged greater than or equal to 25 years {5}).

A representative sample of 1387 civilian, noninstitutionalized adults (aged greater than or equal to 18 years) was selected using a random-digit-dialing telephone method; 1119 (80.6%) completed the survey, and 268 (19.3%) persons refused or were unable to respond. The interviews were completed during June-July 1993. Participants responded to an interviewer-administered 24-hour dietary recall for the day before the call. Food portion sizes were estimated (e.g., a small apple is the size of a tennis ball), and a mention of a fruit or vegetable was used as a surrogate for a serving. Food Intake and Analysis Software was used to estimate nutrient amounts reported in the 24-hour dietary recall data (6). Point estimates were weighted by the age and sex of the Kansas population and by the number of adults in each household.

Overall, few (12.5%) respondents reported eating five or more fruits and vegetables during the previous day Table_1; the prevalence of this behavior was higher among women (15.2%) than men (9.7%), and increased directly with age (persons aged 18-34 years: 7.0%; persons aged 35-64 years: 12.8%; and persons aged greater than or equal to 65 years: 20.7%) and education (persons with less than or equal to 12 years of education: 9.5%; persons with 13-15 years: 12.1%; and persons with greater than or equal to 16 years: 18.4%).

Nearly one third (29.8%) of respondents acquired less than 30% of their total food-energy intake from fat. The prevalence of this behavior was higher among women (33.4%) than men (26.5%), but did not vary by age or education. Approximately one half (47.9%) of respondents consumed greater than or equal to 600 mg of calcium. The prevalence of this behavior was lower in women (40.7%) than men (55.3%) and varied inversely with age (persons aged 18-34 years: 56.3%; persons aged 35-64 years: 44.7%; and persons aged greater than or equal to 65 years: 41.7%). Reported by: K Fitzgerald, MS, J Johnston, MS, P Marmet, MS, K Pippert, Bur of Chronic Disease and Health Promotion, A Pelletier, MD, Acting State Epidemiologist, Kansas Dept of Health and Environment. Div of Field Epidemiology, Epidemiology Program Office; Div of Health Promotion Statistics, National Center for Health Statistics; Div of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that most respondents did not meet the HK2000 goals, which were based on national nutrition guidelines (7) and were similar to the national health objectives for the year 2000 (4). Because national nutrition surveys (4) do not provide state-specific estimates and are often available only after prolonged periods, state population-based dietary surveys, such as that in Kansas, are essential for providing state-specific data to measure the effect of interventions and for monitoring progress toward state-specific year 2000 goals. The survey methodology used in Kansas may serve as a model for other states to establish baselines and to monitor the impact of interventions. KDHE plans to conduct these or similar surveys every 3-5 years.

The survey results from Kansas are subject to at least two limitations. First, because participants were interviewed during summer months when consumption of fruits and vegetables is likely to be higher than during other seasons of the year (8), reported fruit consumption may have been higher than if the survey had been conducted during other seasons. Second, 24-hour recall surveys may be less representative than multiple-day recall surveys because the actual amount of food consumed may differ from the usual intake of the respondent (9).

The results of the survey in Kansas are being used as a baseline for monitoring progress among statewide interventions. Kansas LEAN ("Low-fat Eating for America Now"), a state health department program involving a coalition of businesses, health agencies, schools and others, is working to improve dietary habits through interventions such as the statewide worksite promotion "Take the Challenge, Be a Leaner Eater" to reduce the proportion of total food-energy intake from fat. In addition to interventions targeted toward adults, Kansas LEAN emphasizes the education of children about appropriate nutrition. Long-term nutritional habits can be improved by introducing new foods to children, lowering the fat content of school lunches, and educating children (10). For example, a "Check Your Six" program targeted toward fifth-grade and preschool-aged children has been initiated to increase the quantity of grain products consumed.

References

1. Schaefer EJ, Lichtenstein AH, Lamon-Fava S, McNamara JR, Ordovas JM. Lipoproteins, nutrition, aging, and atherosclerosis. Am J Clin Nutr 1995;61(suppl):726S-40S.

2. Block C, Patterson B, Subar A. Fruit, vegetables and cancer prevention: a review of the epidemiologic evidence. Nutr Cancer 1992;18:1-29.

3. Bunker VW. The role of nutrition in osteoporosis. Br J Biomed Sci 1994;51:228-40.

4. Public Health Service. Healthy people 2000; national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

5. National Research Council. Recommended dietary allowances. 10th ed. Washington, DC: National Academy Press, 1989.

6. University of Texas Health Science Center. Food intake analysis system, version 2.2 {Computer software}. Houston, Texas: University of Texas Health Science Center, 1993.

7. US Department of Agriculture/U.S. Department of Health and Human Services. Nutrition and your health: dietary guidelines for Americans. 3rd ed. Washington, DC: US Department of Agriculture/US Department of Health and Human Services, 1990:25-6.

8. Sugarman S, Ballew C, Lai G. Seasonal produce consumption in Chicago Hispanic women. J Am Diet Assoc 1992;92(suppl):874.

9. Thompson FE, Byers T. Dietary assessment resource manual. J Nutr 1994;124(suppl):2246S-7S.

10. Institute of Medicine. Improving America's diet and health: from recommendations to action. Washington, DC: National Academy Press; 1991.

Table 1.  Weighted estimates of selected nutritional behaviors, by sex, age, and education
level -- Kansas Nutritional Assessment Survey, 1993
===========================================================================================
                 >=5 servings of             <=30% of calories           >=600 mg
               fruits and vegetables              from fat           calcium intake *
               ---------------------         -----------------      -------------------
Category        %      (95% CI +)              %      (95% CI)         %   (95% CI)
-------------------------------------------------------------------------------------------
Sex
  Male          9.7     (+/-2.7)             26.5     (+/-4.2)        55.3  (+/-4.8)
  Female       15.2     (+/-3.1)             33.4     (+/-4.0)        40.7  (+/-4.1)

Age group (yrs)
  18-34         7.0     (+/-2.7)             30.8     (+/-5.5)        56.3  (+/-5.9)
  35-64        12.8     (+/-3.1)             26.9     (+/-3.9)        44.7  (+/-4.4)
   >=65        20.7     (+/-5.5)             36.7     (+/-6.8)        41.7  (+/-7.0)

Education (yrs)
   <=12        9.5     (+/-2.7)              26.8     (+/-4.3)        45.5  (+/-4.8)
  13-15        12.1     (+/-3.5)             31.8     (+/-5.4)        45.3  (+/-5.7)
   >=16        18.4     (+/-5.0)             32.5     (+/-5.9)        54.5  (+/-6.2)

Total          12.5     (+/-2.1)             29.8     (+/-2.9)        47.9  (+/-3.2)
-------------------------------------------------------------------------------------------
* Weighted estimates based on nonpregnant and nonlactating participants (n=1101).
+ Confidence interval.
===========================================================================================

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