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NHANES: A Potential Database for Risk
Assessment
Clifford Johnson
Centers for Disease Control and PreventionNational Center for Health Statistics
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National Health and Nutrition Examination
Survey (NHANES)
Objective
To assess the health and
nutritional status of adults and
children in the United States
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National Health and NutritionExamination Surveys
NHES I 1960-62 18-79 yearsNHES II 1963-65 6-11 yearsNHES III 1966-70 12-17 yearsNHANES I 1971-75 1-74 yearsNHANES II 1976-80 6 mo.-74 yearsHHANES 1982-84 6 mo.-74 yearsNHANES III 1988-94 2 mo. +NHANES 1999- All ages
Survey Dates Ages
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• Continuous data collection beginning in 1999
• Multi-stage probability sample
• Annual national sample of 5,000 persons
• Detailed estimates of population subgroups requires two or more years
NHANES sample design
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NHANES process
HomeExaminatio
n
Interview
MobileExaminatio
nCenter
Longitudinal Followup
Identification of sample persons
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• Broad range of health conditions
• Health care coverage and need
• Environmental and occupational exposures
• Health behaviors
• Nutrition and dietary supplements
NHANES household interview
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NHANES Mobile Exam Center
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NHANES topics
• Cardiovascular disease
• Diabetes, lower extremity disease
• Bone status, osteoporosis
• Oral health
• Vision
• Hearing and balance
• Fitness and strengthOP96S035
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NHANES topics
• Nutrition
• Anthropometry
• Mental health
• Risk behaviors
• Reproductive health
• Environmental exposures
• Infectious diseases
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• Dietary nutrient intake
• Anthropometric measurements
• Nutritional biochemistries and hematologic tests
• Physical examination
• Interview
NHANES nutrition assessments
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NHANES 1999-2001 Dietary Assessment
•24-hour dietary recall (automated )
•Second day recall on subset of persons
•Food frequency (focused)
•General questions
•Supplements/medications (detailed)
•Food security
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NHANES 2002 Dietary Assessment
•24-hour dietary recall (new USDA automated system)
•Second day recall on ALL persons (telephone)
•Food frequency (focused)
•General questions
•Supplements/medications (detailed)
•Food security
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MEC laboratory
•CBC and differential
•Pregnancy test
•Blood, urine and vaginal swab processing
•76 different vials of samples
•26 laboratories
•300 laboratory assays
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Environmental exposure measures
•Lead
•Cadmium
•Mercury
•Pesticides
•Selenium
•Cotinine
•Urinary Iodine
•Volatile organic compounds
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National Report on Human Exposure to Environmental
Chemicals
First report - 27 environmental chemicals including:
•Metals
•Cotinine
•Organophosphate pesticide metabolites
•Phthalate metabolites
Updated annually
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Dietary data for future NHANES
• Continue collection of two recalls on all sample persons
• Pilot test in 2002 of a longer food frequency questionnaire
• Monitor respondent burden
• Balance competing needs --- usual intake, total intake (nutrients vs. foods), food safety, supplement use, DHKS, food programs and health components
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NHANES web site
http://www.cdc.gov/nchs/nhanes.htm
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