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Conclusions and Recommendations The Food and Drug Administration has need of reliable data concerning individual food consumption. These data are important for adequate assess- ment of the safety and wholesomeness of the U.S. food supply, for assess- ment of the effect of incidental contaminants and food additives, and for development of food fortification policies and nutritional quality criteria for food products. FDA must also be concerned with putative linkages between food consumption patterns and health. An ability to forecast the effect of changes in food consumption patterns on nutrient intake and on health and productivity would aid the agency in formulation of sound policies and programs with respect to food fortification, consumer education, nutrition and food intervention, and the like. In the final analysis, the need for food consumption data stems from concern for health promotion and prevention of adverse health response in the population. Systems currently in use in the United States do not meet the needs of FDA. While the system proposed in this report is intended to meet the specific needs of FDA, it may well prove useful to other government agen- cies and institutions engaged in monitoring food consumption, nutritional status, and health. The proposed system is based on continuous determination of the usual pattern of food intake of individuals and population groups. This informa- tion plus information on variation in food intakes and food composition data can be used to determine the usual pattern of nutrient intake and its varia- tion. It is not possible from dietary data alone to assess nutritional status. However, it is possible, with current knowledge of human requirements, to assess the individual's risk of inadequate status based on intake of certain 38

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Conclusions and Recommendations 39 nutrients and to predict for a normally distributed population the preva- lence of individuals who have intakes below requirements. It is also possible to estimate the risk of excessive intake of nutrients and of natural or added food components, if there is knowledge of the association between level of intake and risk of toxicity. The health and nutritional status of individuals cannot be predicted from dietary data alone. However, if dietary data can be linked to existing health data, health status indicators believed to be associated with food or nutrient intake can be identified. Data from appropriate studies of the food con- sumption patterns of individuals in a group could then be used to predict the prevalence of individuals with increased risk to health from a particular pattern of food or nutrient intake. Economic considerations and other factors may influence decisions as to adoption of the proposed system. In addition, certain data bases are not currently adequate. However, the Committee believes the method proposed is sound and information gathered thereby would be significantly better than that derived from methods that are currently in use. The Committee recommends that an ongoing system be developed and implemented by the federal agencies that have major interests in food con- sumption and health. The system should encompass the following compo- nents or subsystems: a continuous collection, processing, and review of food intake data from a stratified probability sample of consumption data; the collection of health data from currently available sources and their collation for population strata analogous to those from which dietary infor- mation is derived; and ongoing examination of available aggregate data from commercial and governmental sources on market food disappearance, from regional and economic strata comparable to the above. Ideally, a lead federal agency should take responsibility for collating, analyzing, and reporting information from these three subsystems. This agency must have adequate personnel and fiscal resources to undertake special data analyses as needed. Several areas require special consideration for implementation of an effi- cient and reliable system. The Committee recommends that research be initiated to determine the measurement frequency required for stipulated levels of reliability of the estimate of usual food intakes of individuals in a population and for estimation of the extremes of food consumption patterns. A group experienced in design should be charged with the development of an optimal sampling frame and stratification design to meet the needs of the system.

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40 ASSESSING CHANGING FOOD CONSUMPTION PATTERNS Several data bases require further development. It will be necessary to assign responsibility to specific individuals or organizations to develop the requisite data base from existing information. The Committee makes the following specific recommendations for the establishment of the proposed system: 1. This system be established as an ongoing operation, capable of rapid data processing and of collating and analyzing data on a continuing ("mov- ing average") basis. 2. AS the system is developed, a special advisory group be convened to address the question of precision of food identification and coding in the collection and storage of current and future food consumption data. 3. In order to increase the potential for identifying meaningful relation- ships between food consumption and health status, available statistics be examined to identify population segments whose health indicators appear to be abnormal relative to the population average and to the average of other subgroups. 4. A task force consider the existing sources of health status information and devise an effective approach to the identification and transfer of data to the proposed system. 5. The uses of aggregate data bases to supplement information needed for a total overall monitoring system be identified. 6. Interagency discussions be undertaken with the objective of develop- ing a coordinated system.