# Presentation: 552264

## Dietary Exposures Used in the  Epidemiology of CancerV/CDE Use Case ExampleLeo Cheung, Ph.D. & Lynne Wilkens, Dr.P.H.

**caBIG V/CDE WS Meeting, Bethesda, MD. July 19, 2004**

## Outline  

**Use Case Name: **
**Dietary Exposure Used in the Epidemiology of Cancer**
**Use Case 1: Food Composition Table (FCT)**
**Use Case 2: Household Measurements Table**
**Use Case 3: Supplement Composition Table (SCT)**
**New Use Case 1: Publication of Unified Vocabulary set of names, definitions and measures of nutrients, foods and supplements**
**New Use Case 2: Integration of CRCH’s FTC & SCT, and Publication of the Unified Database**

## Background: Dietary Exposures Used in Epidemiology of Cancer

**Nutritional epidemiology is the study of cancer frequency, distribution and determinants – with ****nutritional ****exposure**
**Investigates the role of nutrition, learns how diet influences health & answers questions about diet-cancer relationships**
**Goal is to measure individual’s long term diet accurately and relate it to risk for cancer**
**A vocabulary and CDE set is required to describe the necessary elements for estimating diet**

## Overview

**Generally, we have measured long-term diet by a dietary intake assessment**
**Food diary or 24 hour recall (what did you eat?)**
**Food frequency ****questionnaire (FFQs: ****how often do you eat these food items during a specified time period?)**
**Other measures: Biomarkers of intake, Nutritional markers such as Body Mass Index**
**Will focus here on dietary intake measured from recalls or FFQs**

## Use Case Model

**Food**
**Diary / **
**Recall**

**Daily Freq for **
**Food Code**

**Serving Size for**
**Food Code**

**Grams for**
**Food Code**

**FCT Household**
**Measures Table**

**Number of Units for**
**Dosage for Supplement**
** ****Code**

**Daily Grams **
**For Food Code**

## Use Case Model (continued)

**Number of Units for**
**Dosage for Supplement**
** ****Code**

**Daily Grams **
**For Food Code**

**Daily Dietary**
**Components For**
**Food Code**

**Food Composition**
**Table (Dietary**
**Components per 100 **
**Grams by Food Code)**

**Daily Dietary**
**Components For**
**Supplement**
** ****Code**

**Supplement**
**Composition Table**
**(Dietary Components **
**per Dosage)**

## Use Case 1

| Use Case: | Food composition table |
| --- | --- |
| Case: 	  | Gives amount of nutrients and other dietary exposures in specific foods |
| Background:  | Needed to convert frequency and portion of foods consumed into daily dietary components consumed  |
| Problem: | The relationship between specific foods and nutrients and dietary components needs to be represented.

Unique foods need to be specified in enough detail to describe the food and to distinguish specific types with different nutrient composition (fresh versus canned).

Some foods are simple, such as apples, while others are complex mixtures such as beef tacos. |

## Use Case 1 continued

| Use Case: | Food composition table |
| --- | --- |
| Problem, continued: | The following data are needed:
    Unique food code, including simple and complex foods
    Food description, 
        including cooking method and type of processing
    Dietary component code
    Amount of dietary component per 100 grams of food
    Units for dietary component

   Alias food description (e.g., cheddar and Tillamook)

    For complex foods: 
      List of food codes included
       Proportional distribution by food code  |

## Use Case 1 continued

| Use Case: | Food composition table |
| --- | --- |
| Solution: | USDA food specification will be used as a basis for the food composition table.

New unique food codes will be created, as foods from other sources, are added.

Retain food code from source, such as USDA food code.  |
| Action: | Hierarchical data base structure is created with following tables: food composition table, units table for dietary components, alias food table, recipe composition table. |

## Use Case 2

| Use Case: | Household measurements table |
| --- | --- |
| Case: 	  | Gives weight in grams for specific foods by amount |
| Background:  | Needed to convert portion of foods to grams, which can then be converted to amount of dietary components consumed |
| Problem: | The relationship between specific foods and grams weights needs to be represented.

Unique foods need to be specified in enough detail to describe the food and to distinguish specific types with different gram weights (fresh versus dried).

Some types of household measures are common, such as cups, while others are unique to food, such as 10” unit for banana, or 10 ounces for steak. |

## Use Case 2 continued

| Use Case: | Household measurements table |
| --- | --- |
| Problem, continued: | The following data are needed:
    Unique food code, including simple and complex foods
    Number of type of household measure
    Type of household measures
    Equivalent weight in grams  |
| Solution: | USDA food specification will be used as a basis for the food composition table.

Additional household measures of food are weighed.  |
| Action: | Household measures table was created with same indices as food composition table. |

## Use Case 3

| Use Case: | Supplement composition table |
| --- | --- |
| Case: 	  | Gives amount of nutrients and other dietary exposures in specific dietary supplements |
| Background:  | Needed to convert frequency, brand and dosage of supplements consumed into daily dietary components consumed |
| Problem: | The relationship between specific supplements and nutrients and dietary components needs to be represented.

Unique supplements need to be specified in enough detail to describe the composition of the supplement.  For single supplements, such as 500 mg of Vitamin C, dose and type is specific enough; brand is not needed.  However, for supplements with multiple vitamins and minerals, brand, name and date is needed. |

## Use Case 3 continued

| Use Case: | Supplement composition table |
| --- | --- |
| Problem, continued: | Often, individuals can not give all information about supplements.  Therefore, default supplement records are created for each type of supplement to be used when not all information is provided.

The following data are needed:
    Unique supplement code
    Supplement name, 
         including dosage for single supplements
    Brand (for multiple vitamins)
    Date manufactured
    Dietary component code
    Amount of dietary component per 1 dosage
    Units for dietary component
    Dosage composition (e.g., 1 packet, 1 pill) |

## Use Case 3 continued

| Use Case: | Supplement composition table |
| --- | --- |
| Solution: | There is no standard on which to base the supplement composition table.  A new system modeled on the food composition table (Use Case 1) was developed.

This data base is constantly updated with new formulations, based on manufacturer’s information. However, old formulations have to remain on the data set, as people consume supplements purchased several years ago.   |
| Action: | The supplement composition table was created. |

## New Use Cases

## New Use Case 1

**Background: Each research group has developed a unique system for assessing dietary intake, generally based on one of the external standards (e.g., USDA)**
**If there was a unified set of vocabularies, based on the external standards, the applications could be made more uniform**
**Use Case: Publication of unified vocabulary set of names, definitions and measures of nutrients, foods and supplements, based on external standards and CRCH databases**

## New Use Case 1Problem Statement

**Preparation of reliable food and supplement data requires precise nomenclature and description of foods and supplements. It is difficult to compare nutritional status of individuals or to conduct nutritional epidemiological research without a coherent description of foods and supplements. **
**CHALLENGES:**
**Major ambiguities in the exact identification of nutrients, foods, supplements, units, and analytic measuring and sampling methods**
**Different standardizations often were derived from cultural and behavioral differences, settling them is particularly challenging**
**Availability of different technological means often leads to different schemes for measurement and sampling**

## New Use Case 1Possible Solution

**“****Publish” in one place the major standards for nutritional epidemiology of cancer**
**National Standards: U.S. Department of Agriculture (USDA) National Database for Standard Reference Release 16-1**
**International Standards: **
**(1) International Network of Food Data Systems (INFOODS) Guidelines by United Nations Food and Agriculture Organization (UN FAO). **
**(2) The International Framework for Food Descriptions (LanguaL) by the Center for Food Safety and Applied Nutrition of U.S. Food and Drug Administration (FDA), originally. It has recently been developed in collaboration with NCI and European LanguaL partners, its web site is currently hosted by the Danish Institute for Food and Veterinary Research.**
**CRCH adopted mostly USDA’s standards, added additional definitions, and made modifications**

## New Use Case 2

**Background: CRCH has developed a food composition table and a supplement composition table.  New foods are fortified with supplements and new supplements are infused with foods.  Therefore, it would be advantageous to combine the two systems.**
**Use Case: Integrating CRCH Food Composition Table Database and Supplement Composition Table Database**
**Use Case: “Publish” the unified database (names, units) for others to use**

## New Use Case 2Problem Statement

**There is an urgent need to accurately estimate total intakes from foods, including fortified foods and dietary supplements, so that intakes can be related to health outcomes**
**CHALLENGES:**
**Different structures in different databases**
**Supplements can be extracts and concentrates, and in varying types (e.g. tablet, capsule, softgel, gelcap, powder, liquid) **
**Formulations of supplements change over time, necessitating retaining date of manufacturer**
**Multiple forms of supplement used in a single product (e.g. Tricalcium Phosphate and Calcium Lactate)**
**Limited supplement information provided by manufacturer, e.g. amount of some supplement components may not be available**

## New Use Case 2Possible Solution 

**Develop a single master database to track nutrient and non-nutrient composition of foods and supplements. Currently, no such database exists.**
**Perhaps keep composition of foods by release date from source as is done for supplements**
**Could create a dose of 100 grams for foods to make records more similar**

## Actions for New Use Cases 1 & 2

**CRCH needs assistance in understanding the structure of NCI thesaurus and meta-thesaurus which provide definitions and cross links between medical terms**
**Make the thesaurus more useful for epidemiologists, in particular assist with adding more functionality in nutrition**
**CRCH proposes to serve as a liaison to the FAO and USDA, helps organize and/or harmonize information for caBIG as well as NIH consumption**
**Learn NCI’s existing set of nutritional components concepts used for cancer prevention research (e.g. studies on the links between nutrition and gene expression), as CRCH also has a strong interest in studying nutrient-gene  interactions **

## Acknowledgements 

**Nutrition Shared Resource **
**	**** ****	****Suzanne Murphy, Ph.D., R.D. (Director)**
**	****	****Donna Au, M.P.H., R.D.**
**Computer Information System Staff**
**	****	****Maj Earle, B.A. (Manager)**
**	****	****Yun Oh Jung, B.S.**