Nutrition

The choice of the appropriate tool for measuring dietary intake depends upon the purpose of the study. Diet is usually described in terms of its nutrient content. Typical food patterns, eating habits, and the use of specific foods and groups of foods can also describe diet. Many different methods can be used for assessing dietary intake; three of the most common are food frequency questionnaires, food records and twenty-four hour diet recalls. • • • Food Frequency Questionnaires Food Records Dietary Recalls

Food Frequency Questionnaires Description A Food Frequency Questionnaire (FFQ) is a limited checklist of foods and beverages with a frequency response section for subjects to report how often each items was consumed over a specified periods of time. Semi-quantitative FFQ collect portion size information as standardized portions or as a choice of portion sizes. Portion size information is not collected in non-quantitative FFQs. Calculations for nutrient intake can be estimated via computerized software programs that multiply the reported frequency of each food by the amount of nutrient in a serving of that food. Pros (Strengths) • Representative of “usual” intake • Preferable method of measuring intake for nutrients with very high day-to-day variability • Questionnaire processing is significantly less expensive than food records or diet recalls • Can be easy for literate subjects to complete as a self-administered form • Suitable for very large studies • Designed to rank individuals according to intake Cons (Weaknesses) • Retrospective method that relies upon the respondent’s memory • Cost may increase dramatically for questionnaires must be intervieweradministered, e.g., low literacy populations

Cho E. Jobe JB.• • • • Less sensitive to measures of absolute intake for specific nutrients Arbitrary groupings of foods may not correspond to perception of respondent Exclusion of foods popular to ethnic minority groups that are significant contributors of nutrients Possible response distortion of “healthy” foods (e. Brown CC. Liu S. Clifford C: Validation of a self-administered diet history questionnaire using multiple diet records. Am J Epidemiol 161: 161-169. Subar AF. Byers T. vegetables. Block G. Nutr Cancer 18: 1-29.. Sharbaugh CO. Diet History Questionnaire (DHQ): a semi-quantitative FFQ which uses an embedded question approach directed by Fran Thompson and Amy Subar at the National Cancer Institute. and cancer prevention: A review of the epidemiologic evidence. 1999. Woods M. Gibson JT. Am J Epidemiol 150: 573-579. Willett. Williamson DF. Portion size information is included as a part of the food item description rather than a separate listing. Stampfer MJ. 1992. and risk of hypertension in women. Midthune D. Thompson FE. Mittl B.g. PhD. Guire KE: Comparison of two dietary questionnaires validated against multiple dietary records collected during a 1-year period. Am J Epidemiol 154: 1089-1099. Smith AF. vegetables) Examples of Food Frequency Questionnaires • Harvard FFQ: developed by Walter Willett. Potosky A. Subar A: Fruit. Laird NM. Manson JE. Rexrode KM. Ziegler RG: Cognitive research enhances accuracy of food frequency . Hunter DJ. Rosenfeld S: Comparative Validation of the Block. J Clin Epidemiol 43: 1327-1335. J Am Diet Assoc 92: 686-693. Thompson FE. Larkin FA. Willett WC. Thompson FE. Hu FB. Manson JE. Food Frequency Citations Block G.D. 1992. Field AE. glycemic index. 2001. and his colleagues at Harvard University. McNutt S. and National Cancer Institute Food Frequency Questionnaires: The Eating at America's Table Study. Block G.1990. Subar AF. Hartman AM. 2005. fruits. Willett WC: Carbohydrate intake. McIntosh A. Oh K. glycemic load. Kipnis V. M. Colditz GA: Weight cycling. weight gain. and dietary fiber in relation to risk of stroke in women. Patterson B. • • Block FFQ: a semi-quantitative FFQ originally developed at the National Cancer Institute under the direction of Gladys Block. Hurwitz P.

htm Dr. NutritionQuest also supplies physical activity questionnaires and Behavior Change Systems for organizations. brand names and amounts consumed included specific portion sizes is included. a trained interviewer meets with the respondent to clarify food details and to review the foods and portions documented. Willett WC. Stampfer MJ. visit: http://riskfactor. visit: http://www.harvard. Rosner B. At the end of the recording period. 1983. To view documentation. beverage and/or supplements documented over a prescribed period. Food Frequency Websites • The current source of the Block FFQ is through NutritionQuest. are used by many researchers.edu/nhs/questionnaires/index. and other instruments developed by the Risk Factor Monitoring & Methods Branch of NCI.gov/tools/instruments • • Food Records Description A food record is a detailed description of the types and amounts of food. In addition to diet questionnaires. Speizer FE. software and other supporting material.questionnaire reports: results of an experimental validation study. 2002. Walter Willett and his team at the Harvard School of Public Health have developed several versions of a FFQ used in The Nurses Health Study. visit: http://www. In addition.shtml Questionnaires. recipes. The company provides several types of diet questionnaires and screeners for both children and adults. To view forms of the questionnaire. Subjects may be asked to weigh and measure foods and should be trained to record intake to the level of detail needed to describe the diet and nutrients in question.channing. Am J Clin Nutr 38: 631-639.com/index. Pros (Strengths) • Open ended design • Easy to quantify amounts . Underwood BA. Hennekens CH: Validation of a dietary questionnaire with plasma carotenoid and alpha-tocopherol levels. Food records are also known as “Food Diaries” because of the specially designed booklets that subjects use to enter the details of the food and beverages that they consume. the time of day and exact location may be required depending upon the nature of the study. usually 3 to 7 days. For more information.nutritionquest. J Am Diet Assoc 102: 212-225. the name of the meal. Information on food preparation.cancer.

three dimensional food models) • Food Record Citations Craig MR.• • • • Does not rely upon the subjects memory if used correctly Practical method to obtain information about the use of specific foods and frequency Optimal method for validating food frequency questionnaires and diet histories The act of recording dietary intake may alter eating behavior which is useful in dietary intervention programs and as a teaching tool (however. Oberman A. Shattuck AL: The prevalence and impact of 'atypical' days in 4-day food records. J Am Diet Assoc 100: 421-427. Freudenheim JL. Feng Z. Kristal AR.g. plates) or by using portion size estimation aides (e. three-. 2000. Am J Epidemiol 126: 703-713. this is considerably a disadvantage in measuring “usual intake”) Cons (Weaknesses) • Substantial burden upon the subject • Very expensive to code and analyze due to the cost of skilled personnel. glasses. (Leftover food is subtracted from the original food weight to document the exact amount consumed. 1987. George V: Associations of race/ethnicity. cups. may alter behavior • Significant decrease in the subjects recording intake as the number of reporting days increase • Validation studies indicate usual intake may be seriously underestimated. two-. education. Wardrop RL: Misclassification of nutrient intake of individuals and groups using one-. Study participants estimates the amount consumed by using commond household measures (e. Kristal AR.g. and seven-day food records. Coates RJ.g. e. Cheney CL. Examples of Food Records • Weighted Food Record: The subject weighs all food and beverages on a small household scale then records the amount eaten.. spoons.) Estimated Food Record: This is the most common example of food records used in research. Johnson NE.. underreporting thought to be common in women and obese individuals. computer hardware and software • Requires literate and motivated individuals so has limited use in many populations • Less effective in measuring “usual intake” due to heightened awareness. and dietary intervention with the validity and reliability of a food frequency ..

Millen BE. Reeves RS. Foreyt JP. Usually. Franz MM. J Am Diet Assoc 97: 742-749. To view. Lewis RD: Disagreement of energy and macronutrient intakes estimated from a food frequency questionnaire and 3-day diet record in girls 4 to 9 years of age.A. 2004. visit: http://www. Wilson AM. To view.htm Dennis Gage. discusses the importance of recording food intake in his book “The Thinderella Syndrome: A Practical Guide to Individualized Permanent Weight Loss.pdf • • Dietary Recalls Description The twenty-four hour dietary recall is the most widely used diet assessment method. Food Record Websites • Lafene Health Center of Kansas State University includes a sample food record with instructions. Am J Epidemiol 146: 856-869.questionnaire: The Women's Health Trial Feasibility Study in Minority Populations. 1998. html The University of Texas at Austin Health Promotion and Education Services provides their students with services to keep them healthy.C.thethinderellasyndrome. F. 1997.edu/lafene/foodrecordsample.D. 2001. Nichaman MZ.com/food_record_the_thinderella_syndrome. Quatromoni PA. the subject is asked to report all of the food. Goodrick GK: Nutrient intake of obese female binge eaters. Copenhafer DL: Population nutrient intake approaches dietary recommendations: 1991 to 1995 Framingham Nutrition Studies. Harrist RB. the recall is conducted by personal interview and can be completed by using a .utexas.P.edu/student/health/pdfs/dailyfoodrecordform. Cupples LA. J Am Diet Assoc 101:209-215. Included on their web site is information on Computerized Dietary Analysis which includes a food record form and instructions. McPherson RS. go to: http://www. As the name implies.k-state. Erratum in: Am J Epidemiol 148: 820. M.” His website includes a sample food record: http://www. Epstein BE. beverages and/or supplements that he has consumed for the past 24 hours or the previous day.. 1997. J Am Diet Assoc 104:373-378.

g. The interview may be face-to-face or occur via telephone. Pros (Strengths) • Least amount of burden to the participant • No literacy requirements of the participants • Does not alter the food intake behavior • Relatively rapid method of data collection. The ideal interviewer is a registered dietitian. the second pass adds detailed descriptions. Probing is useful in collecting details on how foods were prepared. butter on toast) or in retrieving eating occasions not originally reported by the subject such as snacks or coffee breaks. • Detail about intake relies upon the respondent’s memory Examples of Dietary Recalls • Three-pass recall method: The interviewer employs three distinct probing sessions (or “passes”) during the interview. The method includes standardized questions and • . Interviewers should be very knowledgeable about foods available in the marketplace. It is also useful in recovering foods that are forgotten (e. precision may be improved through the use of food models and photographs • There may be a “reporting effect” because individuals may wish to “please” the interviewer by overestimating perceived “healthy” foods and underreporting alcohol. non-nutritionists who have been trained in the use of a standardized instrument can be very effective. and the third pass was reviews for missing items. how foods are prepared and know about regional or ethnic food habits. The interview is very structured with specific probes to help the respondent remember all of the foods eaten. It is designed to elicit accurate food recall descriptions and the amount consumed by respondents.computer or by recording the intake on paper.. Automated Multiple-Pass Method (AMPM): The AMPM is a computerized dietary intake instrument that offers a guided interview of five distinct research-based steps. The first pass obtains a list of foods. The interviewer must be very well-trained as they are crucial in collecting accurate information through the use of probing questions. high calorie and high fat foods. usually 30 minutes for a trained interviewer to complete a 24-hour recall • Provides estimates of the average intake of large samples sizes that are comparable to other methods such as food records Cons (Weaknesses) • Very expensive because it requires trained and skilled interviewers • Estimation of portion sizes may be very difficult. although.

computerized software program. 2004. Sutherland B: A randomized trial of the Little by Little CD-ROM: demonstrated effectiveness in increasing fruit and vegetable intake in a low-income population. The interviewer is thoroughly trained to use an interactive. 3) Recall of time and occasion of food consumption. Schatzkin A.possible response options for foods in the U. Wakimoto P. the “Nutrition Data System for Research” (NDSR). Fraser D: DEARR study. . 2003. ingredients and preparation. and 24-hour recall questionnaires: the DEARR study. Subar AF. Schwarzfuchs D. Data from the survey is used to assess the nutritional health of Americans and is the basis of Federal nutrition policy and regulatory decisions. Block G. Troiano RP. Dietary Recall Citations Bialostosky K. J Am Diet Assoc 104: 595-603. Kipnis V. 2) Review of the quick list. Prev Chronic Dis 1: A08. NHANES. and quantity eaten. Ingwersen LA. Vardi H. developed by the University of Minnesota Nutrition Coordinating Center. 2005. Rosner BA. 2002. Shahar DR.000 Americans yearly in a national federal nutrition survey. Freedman LS: A comparison of a food frequency questionnaire with a 24hour recall for use in an epidemiological cohort study: results from the biomarker-based Observing Protein and Energy Nutrition (OPEN) study. What We Eat in America.S. Conway JM. Midthune D. 4) Food details: individuals are asked to describe foods and beverages by brand name. Wright JD. Azrad AB. Steps for this example of recall include: 1) Use of a “Quick List” where individuals are asked to briefly outline foods consumed. McDowell M. Vital Health Stat 11(245): 1-158.. where an interviewer uses memory prompts to help individuals recall forgotten foods. Fujii ML. Bingham S. The AMPM is used for collecting dietary recalls of 5. Kennedy-Stephenson J. 5) Final review of the list to make sure that nothing was omitted. • Five-step Multiple Pass Approach: The Obesity Nutrition Research Center (ONRC) of the University of Pittsburgh routinely uses this type of food recall. Schoeller DA. Shai I. J Nutr 135: 573-579. Carroll RJ. Johnson CL: Dietary intake of macronutrients. portion size. Dietary evaluation and attenuation of relative risk: multiple comparisons between blood and urinary biomarkers. Mandel R. Jul. 2004. Epub 2004 Jun 15. Kanfi A. micronutrients. Metz D. Int J Epidemiol 32: 1054-1062. and other dietary constituents: United States 1988-94. food frequency. Moshfegh AJ: Accuracy of dietary recall using the USDA five-step multiple-pass method in men: an observational validation study. Feldman N. each response option is programmed to proceed to subsequent appropriate questions.

http://scholar.usda.vt.csrees.gov/nea/food/efnep/ers/documentation/24hour-recall. http://fcs. For more information. http://www.htm A videotape on the 24-Hour Recall is available from the Oklahoma Cooperative Extension Service.lib.edu/cnep/tools/food-recall.Dietary Recall Websites • The University of Tennessee Family and Consumer Sciences Expanded Food and Nutrition Education Program has instructions posted to their website for completing the Homemaker’s 24-Hour Food Recall Form. go to: http://www.edu/theses/available/etd-1010976128/unrestricted/AppendixH.pdf An excellent source for detailed twenty-four hour recall information is the United States Department of Agriculture (USDA).htm The Virginia Polytechnic Institute and State University digital library and archives allows unrestricted access to a theses which includes detailed descriptions on the procedure.okstate.pdf • • • . Oklahoma State University for $35.edu/efnep/recallinstruc.tennessee.fcs.

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