Nutritional Epidemiology, Dietary Assessment and Nutrition Counseling
About This Core
Directed by Catherine M. Champagne, PhD, RDN, LDN, FADA, the Nutritional Epidemiology Dietary Assessment and Counseling Core serves two main needs at PBRC: 1) processing of dietary data collected via food frequency questionnaires, 24-hour dietary recalls, or food records and 2) delivery of lifestyle interventions which follow defined protocols via single site or multi-center trials. The MENu Database, is overseen by Catherine Champagne. The MENu database was donated to the Pennington Biomedical Foundation in October, 1992, by its owner and developer, Dr. Margaret C. Moore. The Extended Table of Nutrient Values was renamed to honor the name of its developer. The Moore Extended Nutrient Database, now known as the MENu Database, is an appropriate reflection of one of its current uses in analyzing menus and recipes for the PBRC metabolic kitchen, for school lunches in Louisiana, and for multicenter feeding trials. The MENu Database was selected for use in the National Heart, Lung and Blood Institute multi-center study of diet and lipoproteins and for the DASH and DASH-Sodium Trials. When compared to analytical laboratory values obtained from an outside Food Composition Laboratory, the MENu Database was closer to actual values than the three other databases used to calculate the same menus. Current data from additional menus analyzed still indicates good agreement between values from the MENu Database and the laboratory assays.
Diet Assessment Activities:
The current version of Moore’s Extended Nutrient Database (MENu) is MENu 6. Primary datasets used are from USDA. The total count of foods and recipes contained within the MENu food composition files comes from the following data sources:
- USDA Nutrient Database for Standard Reference, Legacy (2018). S. Department of Agriculture, Agriculture Research Service, Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference, Legacy. Version Current: April 2018.
- The Food and Nutrient Database for Dietary Studies (FNDDS 2017-2018. U.S. Department of Agriculture, Agricultural Research Service. 2020). USDA Food and Nutrient Database for Dietary Studies 2017-2018. Food Surveys Research Group Home Page, http://www.ars.usda.gov/nea/bhnrc/fsrg. Released July 2020
- Food Patterns Equivalents Database (FPED 2017-2018) Released December 2020. Bowman SA, Clemens JC, Friday JE, and Moshfegh AJ. 2020. Food Patterns Equivalents Database 2017-2018: Methodology and User Guide [Online]. Food Surveys Research Group, Beltsville Human Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland. October 2020. Available at http://www.ars.usda.gov/nea/bhnrc/fsrg
- Healthy Eating Index (HEI) 2015 can be computed from dietary intake data that is referenced to the FNDDS and FPED to determine whether or not the individual is consuming a healthy diet. References for HEI-2015 can be found at the following link: (https://epi.grants.cancer.gov/hei/developing.html#2015).
- Supplementary information from the scientific literature or other reliable food composition tables.
- User defined foods, allowing the input of nutrient data for foods needed in menus or recipes for which an appropriate food match cannot be found otherwise.
- Recipes input by users of the system at PBRC, using a unique recipe calculation system.
Analysis of dietary intakes of individuals using the Food Diary Program. While menu and recipe analysis is an important activity using the MENu system, several current research protocols use the Food Diary Program. Food Diary utilizes the MENu 6 Food Composition Files to analyze dietary intakes of individuals in research studies, including the most recent food composition files from the USDA. Often these are dietary records kept by participants in various trials or 24-hour recalls collected by the nutrition staff in the Dietary Assessment Center.
24-Hour Dietary Recall Collection Using the USDA Automated Multiple Pass Method. Catherine Champagne and her staff of dietary assessment personnel have been trained by USDA in the use of the Automated Multiple Pass Method (AMPM) and have used this in a number of trials, e.g. the POUNDS LOST Clinical Trial which was a macronutrient-based weight loss study involving PBRC and Harvard. AMPM is a computerized method for collecting interviewer-administered 24-hour dietary recalls either in person or by telephone. It is a research-based, multiple-pass approach employing 5 steps designed to enhance complete and accurate food recall and reduce respondent burden. This method is currently used in “What We Eat in America”, the dietary interview component of the National Health and Nutrition Examination Survey, and other research studies nationally.
Diet History Questionnaire from the National Cancer Institute. DHQ II is the current version of the questionnaire distributed by the NCI. PBRC has developed an online version of this questionnaire and with the Diet*Calc software developed by NCI can analyze files to interpret the DHQ data to provide nutrient and food group estimates. This food frequency questionnaire is available in two versions, one that accounts for foods consumed over the past month and one that accounts for food consumed over the last year. The printed version of the DHQ II can be used but it is lengthy at 36 pages and the data can be entered by core staff.
Dietary Counseling Activities:
A number of projects at PBRC have involved dietary counseling efforts. The Diabetes Prevention Project Outcomes Study (DPPOS) continues to follow individuals from DPP who have successfully made lifestyle changes. The Look AHEAD trial also focused on lifestyle changes in a population of diabetic individuals. The Weight Loss Maintenance (WLM) trial was designed to determine how weight loss achieved in an intensive 6-month initial phase of lifestyle change sessions was best sustained through a second phase, 30-month period of either personal contact or internet efforts. The POUNDS LOST trial utilized four different diet treatments varying in protein and fat to scientifically test these diets for weight loss effects. Subjects were asked to follow structured meal plans or exchange options in order to adhere to the dietary targets. The research dietitians/interventionists played a key role in working with these participants by conducting both group and individual sessions utilizing nutrition information and behavior change messages (a landmark paper was published in the New England Journal of Medicine February 26, 2009). Additional projects included a lifestyle program for weight loss in cancer survivors, studies on a variety of low-fat and higher fat Mediterranean diet regimens, and community interventions focused on weight control and diabetes care. Past activities also involved a weight loss program in very obese individuals, called Heads Up – a behavioral intervention which was being compared to an intervention with individuals who opt for bariatric surgery. The dietary counseling activities were extensive and the interventionists involved had a breadth of experience in dietary interventions which include lifestyle/behavioral change. These interventionists received significant training in motivational interviewing and theories of behavioral change. Initially the groups were in-person, but since this project was statewide, the latter groups were web-based. Currently our dietary counseling team is involved in several studies: 1) one study funded by Weight Watchers called POINTS where a person’s genetic code is believed to affect weight loss from diets that vary in carbohydrate and fat content; 2) another project funded by industry called EXPEND is a weight loss study patterned after the CALERIE project completed some years ago in which a person is reducing calories by approximately 25% and is counseled to stay within a zone of weight loss; and 3) the third study (EAT-2) is an overfeeding study designed to provide new insights into mechanisms that regulate human adipose tissue expansion, distribution, and function, which can greatly influence health and metabolism – the individuals are offered a weight loss program following the short term overfeeding. In addition to these, our team is involved in a study called PREMO which will evaluate if reducing meat in meals and replacing it with either potato or pulses (beans, lentils, etc.) can improve blood sugar and fats which have been shown to prevent diabetes and heart disease.