DIETARY BEHAVIOURS

Definition

Depending upon the survey, this topic covers selected dietary indicators relating to the type of milk consumed, usual daily intake of fruit and vegetables and use of salt. It also covers broader dietary information on all food and drink consumed in the 24 hours prior to interview. Information on type of diet currently on can be found in the Body Mass and Physical Measurements topic.

Population

Information was collected for persons aged 2 years and over in the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) and the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSINPAS).

Methodology

Information about dietary behaviours was collected in both the NATSIHS and the NATSINPAS surveys. Information on dietary behaviours (fruit and vegetable intake and milk consumption) was first published in the First Results publication, based on the NATSIHS only sample of approximately 8,800 people aged 2 years and over. Updated results on fruit and vegetable intake for the larger combined, NATSIHS and NATSINPAS sample, known as the Core sample, of approximately 12,900 people aged 2 years and over were published in the Updated Results publication. For comparison of dietary behaviours with NATSIHS only items, the NATSIHS file should be used and similarly for comparison with NATSINPAS only items, the NATSINPAS file should be used. However, for the most accurate information for fruit and vegetable intake alone or comparison with other items collected in the Core, the Core file should be used. For more information on the structure of the AATSIHS, see the Structure of the Australian Aboriginal and Torres Strait Islander Health Survey page of this Users' Guide.

Fruit and vegetables

Respondents were asked to report the number of serves of vegetables and fruit they usually ate each day. For the purposes of this survey the following definitions were used.

A serve of vegetables was defined as:

• half a cup of cooked vegetables
• one medium potato
• one cup of salad vegetables - approximately equivalent to 75 grams.

All types of vegetables were included, but legumes were excluded. Tomatoes were included as a vegetable rather than a fruit.

A serve of fruit was defined as:

• one medium piece or two small pieces of fruit
• one cup of diced fruit
• quarter of a cup of sultanas
• four dried apricot halves - approximately 150 grams of fresh fruit or 50 grams of dried fruits.

Fruit and vegetable juices were excluded.

Prompt cards were used to assist respondents in understanding the concept of a serve, showing pictorial representations. One prompt card showed three pictorial examples of single serves of different vegetables and another card showed three pictorial examples of single serves of fruit. If respondents had difficulty in reporting, interviewers were encouraged to prompt in terms of asking respondents about their usual consumption of vegetables and fruit at breakfast, lunch and dinner, and for snacks.

The National Health and Medical Research Councils Australian Dietary Guidelines have been released in 2003 and 2013. Data from the NATSIHS and NATSINPAS have been derived based on both of these guidelines for comparisons to previous survey results and future survey results.

Whether vegetable and fruit consumption met the recommended 2003 guidelines was derived for respondents 4 years and over according to the following numbers of servings (based on recommendations from the National Health and Medical Research Councils Australian Dietary Guidelines (2003).

NHMRC Australian Dietary Guidelines (2003)
Age groups	Recommended daily serves of vegetables	Recommended daily serves of fruit
4-7 years	2	1
8-11 years	3	1
12-17 years	4	3
18 years and over	5	2

Note that the following modifications have been made to those presented in the Guidelines:

• 18 year olds have been grouped with adults rather than the 12-17 year olds
• pregnant or breastfeeding women have been applied the same cut-offs as adults.

Whether vegetable and fruit consumption met the recommended 2013 guidelines was derived for respondents 2 years and over according to the following numbers of servings (based on recommendations from the National Health and Medical Research Councils Australian Dietary Guidelines (2013)).

NHMRC Australian Dietary Guidelines (2013) - AATSIHS variation
Age groups	Recommended daily serves of vegetables	Recommended daily serves of fruit
2-3 years	21	1
4-8 years	41	11
9-17 years	52	2
18 years and over (excl. males 18-49)	53	2
18-49 year old males	6	2

1 Actual guidelines have an additional ½ serve.
2 Actual guidelines for males aged 12-17 years have an additional ½ serve.
3 Actual guidelines exclude males aged 19 to 50 years and males 51 to 70 have an additional ½ serve.

Note that the following modifications have been made to those presented in the actual 2013 NHMRC Guidelines:

• 18 year olds have been grouped with adults rather than the 9-17 year olds, and 50 year old males have been grouped with males 51 years and over rather than the 18-49 age group, to be consistent with standard age groupings in outputs
• pregnant or breastfeeding women have been applied the same cut-offs as adults
• where the guidelines specify 1/2 serves, these have been rounded down to the closest full serve as only full serves were collected.

Note that this section does not relate to calculations possible using foods reported as consumed in the 24-hour dietary recall in the NATSINPAS.

Salt

Respondents were asked how often salt was added to their meals during cooking, or to a meal at the table and whether the salt was iodised (i.e. containing iodine).

The response categories for how often salt was added are different between the NATSIHS and NATSINPAS. In NATSIHS the categories were:

• Yes usually
• Yes sometimes
• No
• Don’t know.

For NATSINPAS the categories were:

• Yes very often
• Yes occasionally
• Yes rarely
• No
• Don’t know.

Therefore data has not been combined to produce data for the Core. Care should be taken when comparing with other ABS surveys to ensure the correct survey data is used based on the output categories required (for more details see the Comparability statements below).

Respondents in the NATSINPAS were also asked an additional question regarding type of salt added during cooking or at the table as part of the 24-hour dietary recall.

Milk

Respondents in the NATSIHS were asked to report the main type of milk they usually drink:

• whole/full cream
• low/reduced fat
• skim
• powdered milk - regular (full fat)
• powdered milk - skim (reduced fat)
• soy milk - regular (full fat)
• soy milk - skim (reduced fat)
• evaporated milk - regular (full fat)
• evaporated milk - skim (reduced fat)
• other type of milk (specify)
• does not drink milk
• don't know.

24 hour dietary recall

NATSINPAS respondents were asked to participate in a 24-hour dietary recall. This involved listing all the food and drink they had consumed in the last 24 hour period, from midnight to midnight the day prior to the interview. The aim of the 24-hour dietary recall is to estimate total intake of food, beverages, food energy, nutrients and non-nutrient food components consumed by the Aboriginal and Torres Strait Islander population to assess dietary behaviours and the relationship between diet and health.

Where possible, approximately 9 days after the first interview, respondents in non-remote areas were telephoned and asked to participate in a second 24-hour dietary recall.

More detailed information about the 24-hour dietary recall methodology and data items will be released in this Users’ Guide at the time of the first release of the NATSINPAS Nutrition data.

Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the Downloads page of this product.

Interpretation

Points to be considered in interpreting data for this topic include the following:

• Data recorded in the NATSIHS on the type of milk usually consumed is based on the information provided by respondents against a defined classification of milk type and fat content categories.
• Questions on intake of fruit and vegetables are based on short questions used in the 1995 National Nutrition Survey (NNS). The questions are complex, as respondents needed to understand and apply the inclusions/exclusions, understand the concept of a serve and assess their consumption levels accordingly, and think about their total consumption in what would constitute a usual day. Interviewers were instructed to prompt/assist respondents in a standard way if necessary.
• The 2003 and 2013 NHMRC Australian Dietary Guidelines include legumes as part of the daily recommended servings of vegetables, however the 2012-13 survey excluded legumes.
• In 2013, the NHMRC released updated Australian Dietary Guidelines. The new guidelines have different recommended numbers of servings of fruit and vegetables. They also have an added age group of children aged two to three years, and more categories based on age and sex than the 2003 guidelines. Several age recommendations in the new guidelines also include half servings. For example, the recommended number of servings of fruit for children aged 4-8 years is 1 ½.. Since questions in the 2012-13 survey were developed before the release of these guidelines, the NATSIHS and NATSINPAS do not include half servings and therefore adherence to these new guidelines cannot be accurately assessed for some age groups. In these instances, ½ serves have been rounded down to the closest full serve.

Comparability with 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS)

Dietary behaviour for common data items are considered comparable between the 2004-05 NATSIHS. It should be noted that this data was only collected for persons 12 years and older in the 2004-05 NATSIHS. In addition, the number of serves of fruit and vegetables was only collected in the 2004-05 non-remote interview. Less than one serve and one serve were not separated in 2004-05 non-remote and as such the 2012-13 categories of one serve and less than one serve should be grouped for any comparisons.

For comparability with remote in 2004-05, which instead of serves collected whether usually eats fruit and whether usually eats vegetables each day, the serves data items for 2012-13 should be grouped to produce data for those who usually have some amount of fruit and vegetables each day and those that do not. Care should be taken to ensure that the correct population has been selected when making comparisons as well as care taken when interpreting data with 2004-05 remote data.

Furthermore, a slightly reduced number of milk types were collected in 2004-05 to those collected in 2012-13 NATSIHS and this should be considered when making comparisons.

Only one question was asked in 2004-05 about whether the respondent added salt to their meal after it was cooked. This is considered to be comparable with the same question used in 2012-13 NATSIHS.

Comparability with 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS)

Dietary behaviour was not collected from adults in the 2008 NATSISS. For children aged 1 to 14 years in NATSISS, the number of days they usually eat fruit and usually eat vegetables in a day were collected. This is not comparable to data collected 2012-13 NATSIHS. However, for children aged 1 to 14 years in non-remote areas who identified they usually eat fruit or vegetables in a day, the number of serves they usually eat was collected and is considered comparable with 2012-13. Note that for number of serves, less than one serve and one serve were not separated in 2008 and as such the 2012-13 categories of one serve and less than one serve should be grouped for any comparisons.

Comparability with 2011-12 Australian Health Survey (AHS)

Dietary behaviour for common fruit and vegetable serves data items are considered directly comparable between the 2011-12 AHS and 2012-13 AATSIHS.

Data on milk consumption was separated into two separate questions for NHS – one asked the type of milk the respondent usually consumed and the second asked about the fat content of the milk usually consumed. These were combined into one question for the NATSIHS (with additional categories not collected in NHS) and were not collected in the NATSINPAS or NNPAS. Care should therefore be taken when comparing milk consumption between the NHS and NATSIHS.

Whether salt used is iodised is considered comparable between AATSIHS and AHS surveys. However, how often salt is added to meals during cooking and at the table are only comparable between NATSINPAS and the AHS. NATSIHS is considered to not be comparable due to the use of different response categories.

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