# Presentation: 249801

## Focus Area 19: Nutrition and Overweight Progress Review

**Focus Area ****19: ****Nutrition and Overweight**** ****Progress Review**

**Edward J. Sondik****National Center for Health Statistics**
**April 3, 2008**

## Diet is associated with
heart disease
stroke
some cancers
type 2 diabetes
overweight and obesity
osteoporosis
Diet-related conditions contribute to
reduced quality of life
premature death
substantial medical costs
lost productivity

**Nutrition and Overweight**

**Diet**** is associated with**
**heart disease**
**stroke**
**some cancers**
**type 2 diabetes**
**overweight and obesity**
**osteoporosis**
**Diet-related conditions contribute to**
**reduced quality of life**
**premature death**
**substantial medical costs**
**lost productivity**

## Highlighted Objectives

**19-5.  ****	****Fruit consumption**
**19-6.  ****	****Vegetable consumption**
**19-7.  ****	****Grain**** product**** consumption**
**19-10.****	****Total sodium intake**
**19-11.****	****Total calcium intake **

**Improving**

**Getting worse**

**Little or no ****progress*******

**Highlighted Objectives**

- *Percent of targeted change achieved is between -10% and 10%, or change not statistically significant.

**Notes:**
The interagency work group for this focus area selected 6 objectives to highlight:
19-3 which aims to reduce the proportion of children and adolescents who are overweight or obese; 
19-5, 6, & 7 which aim to increase the proportion of people 2+ years who meet objectives for fruit, vegetable and grain consumption; 
19-10 which aims to increase the proportion of people 2+ years who consume 2400 mg or less of sodium daily; and 
19-11 which aims to increase the proportion of people 2+ years who meet dietary recommendations for calcium.
Overall progress:
19-3  Overweight or obesity in children and adolescents, getting worse
19-5  Fruit consumption, little or no progress
19-6  Vegetable consumption, little or no progress
19-7  Grain product consumption, little or no progress
19-10  Total sodium intake, little or no progress
19-11  Total calcium intake, improving

## Child and Adolescent Overweight

** **

**Child and Adolescent Overweight**

**1988-94**

**2003-06**

**2010 Target: 5%**

**   ****Decrease desired**

- Note: I= 95% confidence interval. Overweight is defined for ages 6-19 years as BMI ≥ gender- and age-specific 95th percentile from the 2000 CDC Growth Charts for the United States. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races.  For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**Obj. 19-3c**

**Total             White       Black     Mexican         Female      Male**
-                                                  **American  **

**Percent**

**4030**
**20**
**10**
**0**

**Notes:**
Substantial increase from 11% in 1988-94 to 17% in 2003-06, moving away from 2010 target of 5%
Increase in overweight for all 3 race/ethnic groups which can be assessed by NHANES. In 2003-06, 22% of black and Mexican American children and adolescents were overweight compared to 15% of non-Hispanic white.  
Increase occurred for both males and females 

## Child and Adolescent Overweight

** **

**Child and Adolescent Overweight**

**1988-94**

**2003-06**

**2010 Target: 5%**

**   ****Decrease desired**

- * Statistically unreliable.  ** Baseline data are for 1991-94.
- Note: I= 95% confidence interval. Overweight is defined for ages 6-19 years as BMI ≥ gender- and age-specific 95th percentile from the 2000 CDC Growth Charts for the United States. Higher income is defined as > 130 % poverty threshold, and lower as ≤ 130%.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**Obj. 19-3c**

**Total                 Higher        Lower                 With        Without**
**                                  ****Income                              Disabilities****

**Percent**

*****

**4030**
**20**
**10**
**0**

**Notes:**
Increase in overweight occurred with both higher and lower income levels  
In 2003-04, more lower income youth were overweight (20%) compared to higher-income (16%)
In 2003-04 more youth with disabilities were overweight (28%) compared with those without disabilities (17%) 

## Child and Adolescent Overweight

**1963-67****       1971-74  1976-80                   1988-1994                      2003-06**
**           ****1966-70                                                                        1999-2002**

**Percent**

**2010 Target: 5%**

**   ****Decrease desired**

- *Data for 1966-70 are for adolescents 12-17 years of age.
- Note: Overweight is defined as BMI ≥ gender- and age-specific 95th percentile from the 2000 CDC Growth Charts for the United States.
- Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Health and Nutrition Examination Surveys I, II, III and National Health and Nutrition Examination Survey, NCHS, CDC.

**Obj. 19-****3a, b**

**1963-6****5       1971-74  1976-80                   1988-1994                      2003-06**
**         ****1966-70*                                                                           1999-2002**

**Child and Adolescent Overweight**

**Male 12-19**
**Male 6-11**
**Female 12-19**
**Female 6-11**

**4030**
**20**
**10**
**0**

**Notes:**
Prevalence of overweight among children and adolescents remained at or below the 2010 target of 5% until 1976-80, when it began a sharp increase.  

## Prevalence of Adolescent Overweight

**2003**

**2005**

**Prevalence of Adolescent Overweight**

- Note: Data are for high school students in grade 9 – 12.  Overweight is defined as ≥ 95th percentile for body mass index, by age and sex, on the basis of reference data, based on self-reported weight and height.
- Source: Youth Risk Behavior Survey, NCCDPHP, CDC.

**Notes:**
Maps indicate increase in overweight among adolescents, grade 9-12, from 2003 to 2005 
For most states, adolescent overweight appears a significant concern.  In 2005, only 4 of the 39 states with data reported that less than 10 percent of high school students were overweight.

## Adult Obesity

** **

**2010 Target: 15%**

**   ****Decrease desired**

**1988-94**

**2003-06**

**Percent**

**Obj. 19-****2**

**60**
**40**
**20**
**0**

** ****White        Black**

**Female                                                Male**

- Note: I = 95% confidence interval. Data are for ages 20 years and over, and age adjusted to the 2000 standard population. Obesity is defined as BMI ≥ 30.0. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races.  For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**Adult ****Obesity**

**Mexican**
**American**

** ****White        Black**

**Mexican**
**American**

**Notes:**
Prevalence of adult obesity increased for all 3 race/ethnic groups which can be assessed by NHANES.  
Among females, black non-Hispanic females had the highest prevalence of 53% in 2003-06, compared to 32% of white non-Hispanic females.
Among males, prevalence of obesity in 2003-06 ranged from 29% in Mexican American to 35% in non-Hispanic black.

## Trends in Adult Obesity

**1960-62****                           1976-80                 1988-94                     2003-06 **
**                          ****1971-74                                                        1999-2002**

- Note: Data are for ages 20 years and over, and age adjusted to the 2000 standard population. Obesity is defined as BMI ≥ 30.0.
- Source: National Health Examination Survey, National Health and Nutrition Examination Surveys I, II, III and National Health and Nutrition Examination Survey, NCHS, CDC.

**Obj. 19-****2**

**Trends in Adult Obesity**

**2010 Target: 15**

**   ****Decrease desired**

**Female **
**Male**
**Total**

**Percent**

**60**
**40**
**20**
**0**

**Notes:**
Similar to a trend observed among children and adolescents, prevalence of obesity among adults showed a sharp increase beginning 1976-80.  Prior to 1976-80, prevalence of obesity among adults remained at or below the 2010 target of 15%.

## Fruits, Vegetables and Grains Consumption, 2003-04

**Percent**

**Fruits****: 2+ servings             Vegetables                           Grains **

**75**
**50**
**25**
**0**

**Fruits, Vegetables and Grains Consumption, 2003-04**

**Objs. 19-5****, ****19-6**** & 19-7**

- * Statistically unreliable.
- Note: I = 95% confidence interval. Data are for 2 years and over excluding pregnant or lactating women and breast-fed children, and are age adjusted to the 2000 standard population. One serving has been calculated as two-thirds of a standard serving for all children age 2-3.  The categories black and white includes persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**   ****Increase desired**

**Total****        White        Black**

**Mexican American**

**3+ Servings                              6+ Servings**

**Notes:**
In 2003-04, there was little or no progress in meeting the objectives for fruit, vegetable, and grain consumption compared to the 1988-1994 baseline.  40% consumed 2 servings of fruit, falling short of the 2010 target of 75%.  

## Fruits, Vegetables and Grains Consumption, 2003-04

**Percent**

**Fruits****: 2+ servings   Vegetables: 3+ servings   Grains: 6+ servings**

** *****    ***

*****

**75**
**50**
**25**
**0**

**2010 Target**

**Fruits, Vegetables and Grains Consumption, 2003-04**

**Objs. 19-5****, ****19-6**** & 19-7**

- * Statistically unreliable.
- Note: I = 95% confidence interval. Data are for 2 years and over excluding pregnant or lactating women and breast-fed children, and are age adjusted to the 2000 standard population. One serving has been calculated as two-thirds of a standard serving for all children age 2-3.  The categories black and white includes persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**   ****Increase desired**

**Total****        White        Black**

**Mexican American**

**  ****With 1/3 Dark Green/Orange     With 3+ Whole Grain**

**Notes:**
Americans had greater difficulty meeting the recommendation of 1/3 servings from dark green/orange vegetables (9%) than 3+ servings of total vegetables (47%)
Americans had greater difficulty meeting the recommendation of 3+ servings from whole grains (3%) than 6+ servings of total grains (54%) 

## Proportion of Vegetable Servings2003-04 

**Obj. 19-****6**

- Notes: Excludes pregnant or lactating women and breast-fed children. One serving has been calculated as two-thirds of a standard serving for all children age 2-3.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**Tomatoes 22%**

**Other vegetables 39%**

**Legumes 6%**

**Potatoes 23%**

**11%**

**Children 2-19 years**

**Adults 20 years and over**

**Tomatoes 27%**

**Other vegetables 28%**

**Legumes 6%**

**Potatoes 31%**

**Dark green or orange vegetables**

**Proportion of Vegetable Servings****2003-04**** **

**7%**

_**Target**_
**33%**** dark green**** or orange vegetables**

**Notes:**
Objective 19-6 aims to increase the proportion of Americans who consume at least 1/3 of their vegetables from dark green or orange vegetable.  
Proportion of vegetable servings that are dark green or orange is 7% for children aged 12-19, and 11% for Adults aged 20 years and over.

## Proportion of Grain Servings2003-04

**Children 2-19 years**

**Adults 20 years and over**

_**Target**_
**50% ****whole grain**

**Proportion of Grain Servings****2003-04**

**Obj. 19-7**

- Notes: Excludes pregnant or lactating women and breast-fed children. One serving has been calculated as two-thirds of a standard serving for all children age 2-3.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**Other grains 93%**

**Whole grain**

**7%**

**Other grains 90%**

**10%**

**Notes:**
Current dietary guidance recommends that Americans consume at least half their grains from whole grains.
This slide shows that intake of whole grains is very low relative to total grain product consumption for both youth and adults (7% for children aged 12-19, 10% for Adults aged 20 years and over).

## Total Usual Sodium Intake

**Percent**

**1988-94       2003-04       2010 Target: 65%**

**75**
**50**
**25**
**0**

**    ****Increase desired**

**Total Usual Sodium Intake**

**Objs. 19-****10**

- Note: I = 95% confidence interval. Data are for 2 years and over excluding pregnant or lactating women and breast-fed children, and are age adjusted to the 2000 standard population. Total sodium intake is from food, supplements, tap water and salt added at table. Respondents were asked to select only one race prior to 1999.  For 1999 and later years, respondents were asked to select one or more races.  For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**2,400mg of Sodium or Less**

** ****Total      White  Black**

**From Food 94.2%**

**Added at Table 5.2%**

**From **
**Tap Water **
**0.6%**

**Sources of Sodium Intake Ages 2 and over, 2003-04**

**From Supplements**
**0%**

**Mexican**
**American**

**Notes:**
Decreasing sodium intake may reduce the risk of elevated blood pressure. 
In 2003-04, there was little or no progress in reducing Americans’ daily consumption of sodium to 2400 mg or less; only 13% met this recommendation compared with 15% in 1988-94 baseline.
The estimates of total sodium intake include sodium from food, salt added at the table, tap water, and dietary supplements.  As might be expected, food contributed the most sodium (94.2%) - with other reports noting that processed foods contribute most of that. Salt use at the table contributed a small but not inconsequential amount (5.2%), with very little sodium contributed by tap water (.6%) or dietary supplements (0%). 

## Total Usual Potassium Intake

**Percent**

**1988-94       2003-04**

**10**
**5**
**0**

**    ****Increase desired**

- *  Institute of Medicine, National Academies, Food and Nutrition Board, Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate, 2004.  ** Statistically unreliable.
- Note: I = 95% confidence interval. Data are for 2 years and over excluding pregnant or lactating women and breast-fed children, and are age adjusted to the 2000 standard population. Total potassium intake is from food and supplements. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races.  For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**From **
**Food 99.4%**

**Sources of Potassium Intake Ages 2 and over, 2003-04**

- **

- **

**Total Usual Potassium Intake**

**From Supplements  0.6%**

** ****Total      White  Black**

**Mexican**
**American**

**100% of Adequate Intake* or More**

**Notes:**
Current dietary guidance states that another dietary measure to lower blood pressure is to consume a diet rich in potassium.  Consequently, the work group decided to look at Americans’ intake of potassium in relation to recommendations. 
This slide indicates that potassium intake decreased in the last two decades, and that in 2003-04---very few Americans had potassium intakes above the Adequate Intake values established by the Institute of Medicine. 
It also shows that very little potassium was contributed by dietary supplements.
Current dietary guidance recommends that potassium come from food sources, and identify fruits and vegetables - including leafy green vegetables, fruit from vines, and root vegetables - as rich in potassium.  It may be noted that the relatively low potassium intakes are consistent with majority of Americans not meeting recommendations for fruit and vegetable consumption.

## Total Usual Calcium Intake

** **

**75**
**50**
**25**
**0**

**Percent**

- * Institute of Medicine, National Academies, Food and Nutrition Board, Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride, 1997.
- Note: I = 95% confidence interval.  Data exclude pregnant or lactating women and breast-fed children. Data for total are for 2 years and over, and age adjusted to the 2000 standard population. Total calcium intake is from food, supplements and antacids.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**Obj. 19-1****1**

**Total                     Female                                    Male**

**Total Usual Calcium Intake**

**2-11**

**12-19**

**20-39**

**40-59**

**60+**

**   ****Increase desired**

**2010 Target: 74**

**100% of Adequate Intake* or More**

**Notes:**
Objective 19-11 is to increase the proportion of people 2+ y who meet dietary recommendations for calcium.
In preparing for this progress review, the work group changed the operational definition for “meet dietary recommendations for calcium” from > 77%  AI to > 100% AI (Refer to Tracking HP updates for more information).
Calcium intake increased from 1988-94 to 2003-04, but still the majority of people did not have intakes above Adequate Intake values.  Female adolescents have the lowest calcium intakes compared to recommendations.

## Sources of Calcium Intake, 2003-04

**Females 51 and over**

**Males 51 and over**

**Obj. 19-****11**

- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**From Supplements**

**From Antacids**

**Sources of Calcium Intake, 2003-04**

**From Food 66%**

**32%**

**2%**

**15%**

**From Food 83%**

**3%**

**Notes:**
The contribution of dietary supplements to total calcium intake varied by age and gender, with the greatest contribution for women 51 and older.  
The percent of calcium intake by females aged 51+ that is from food (66%), from supplements (32%) and from antacids (2%).  
The percent of calcium intake by males aged 51+ that is from food (83%), from supplements (15%) and from antacids (3%).  
The substantial contribution of dietary supplements to total calcium intake for older women illustrates the importance of collecting data on nutrient intake from all sources including dietary supplements.
For these older women and men, only a small amount of calcium came from antacids. 

## Summary

**Fruit, vegetable and grain objectives, total usual sodium intake showed little or no progress. **
**Total usual calcium intake moved toward the target.**
**The weight status and diets of Americans remain an important public health and economic concern. **

**Summary**

## Progress Toward 2010 Targets

**19-11.****	****Total calcium intake**
**19-18.****	****Food security**

_**Target Met**_
**No Objective**

_**Moved Away from Target**_
**19-1.****	****Healthy weight**** in adults **
**19-2.****	****Obesity**** in adults  **
**1****9-****3.****	****Overweight or obesity****, 6-19 years**
**19-9.****	****Percent calories from total fat**
**19-12b.****	****Iron deficiency, 3-4 years **
**19-12c.****	****Iron deficiency, non-pregnant females 12-49 years **
**19-13.****	****Anemia in low-income pregnant females in 3rd trimester **
**19-17.****	****Diet and nutrition counseling**

**Progress Toward 2010 Targets**

_**Little or No Progress***_
**19-4.****	****Growth retardation**** among ****low-income**** children **
**19-5.****	****Fruit consumption**
**19-6. ****	****Vegetable consumption**
**19-7.****	****Grain product consumption**
**19-8.****	****Percent calories from saturated fat **
**19-10.****	****Total sodium intake**
**19-1****2a.****	****Iron deficiency, 1–2 years**

_**No Data**_
**19-14.****	****Iron deficiency in pregnant females**

_**Baseline Only**_
**19-16.****	****Worksite counseling**

_**Deleted at Midcourse Review**_
**19-15.****	****Meals and snacks at school**

- *Percent of targeted change achieved is between -10% and 10%, or change not statistically significant.

## Acknowledgements

**Sarah Cusick, NCCDPHP/CDC**
**Kevin Dodd, NCI/NIH**
**Joseph Goldman, ARS/USDA **
**Van Hubbard, DNRC/NIH**
**Clifford Johnson, NCHS/CDC**
**Margaret McDowell, NCHS/CDC**
**Kathryn McMurry, ODPHP**
**Alanna Moshfegh, ARS/USDA**
**Mark Nord, ERS/USDA**
**Barbara Schneeman, FDA **
**Bettylou Sherry, NCCDPHP/CDC**
**Pamela Starke-Reed, DNRC/NIH**
**Jean Williams, NCHS/CDC**

**Data Contributors and ****Federal Interagency Work Group**

**Acknowledgements**

## Progress review data and slides

**Progress review data and slides**
**can be found on the web at:**

**http://www.cdc.gov/nchs/**
**hphome.htm**