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 ood requency !uestionnaire "!# is a limited checklist of foods and be$erages
with a frequency response section for sub%ects to report how often each items was
consumed o$er a specified periods of time. &emi-quantitati$e ! collect portion si'e
information as standardi'ed portions or as a choice of portion si'es. (ortion si'e
information is not collected in non-quantitati$e !s. )alculations for nutrient intake
can be estimated $ia computeri'ed software programs that multiply the reported
frequency of each food by the amount of nutrient in a ser$ing of that food.
(ros "&trengths#
*epresentati$e of +usual, intake
(referable method of measuring intake for nutrients with $ery high day-to-day
$ariability
!uestionnaire processing is significantly less e-pensi$e than food records or diet
recalls
)an be easy for literate sub%ects to complete as a self-administered form
&uitable for $ery large studies
Designed to rank indi$iduals according to intake
)ons ".eaknesses#
*etrospecti$e method that relies upon the respondent/s memory
)ost may increase dramatically for questionnaires must be inter$iewer-
administered, e.g., low literacy populations
0ess sensiti$e to measures of absolute intake for specific nutrients
Arbitrary groupings of foods may not correspond to perception of respondent
1-clusion of foods popular to ethnic minority groups that are significant
contributors of nutrients
(ossible response distortion of +healthy, foods "e.g., fruits, $egetables#
1-amples of ood requency !uestionnaires
2ar$ard !3 de$eloped by .alter .illett, M.D. and his colleagues at 2ar$ard
4ni$ersity. (ortion si'e information is included as a part of the food item
description rather than a separate listing.
5lock !3 a semi-quantitati$e ! originally de$eloped at the 6ational )ancer
7nstitute under the direction of 8ladys 5lock, (hD.
Diet 2istory !uestionnaire "D2!#3 a semi-quantitati$e ! which uses an
embedded question approach directed by ran Thompson and Amy &ubar at the
6ational )ancer 7nstitute.
ood requency )itations
5lock 8, Thompson 1, 2artman AM, 0arkin A, 8uire 913 )omparison of two dietary
questionnaires $alidated against multiple dietary records collected during a :-year
period. ; Am Diet Assoc <=3 >?>-><@, :<<=.
5lock 8, .oods M, (otosky A, )lifford )3 Aalidation of a self-administered diet history
questionnaire using multiple diet records. ; )lin 1pidemiol B@3 :@=C-:@@D,:<<E.
5lock 8, (atterson 5, &ubar A3 ruit, $egetables, and cancer pre$ention3 A re$iew of the
epidemiologic e$idence. 6utr )ancer :?3 :-=<, :<<=.
ield A1, 5yers T, 2unter D;, 0aird 6M, Manson ;1, .illiamson D, .illett .), )oldit'
8A3 .eight cycling, weight gain, and risk of hypertension in women. Am ; 1pidemiol
:DE3 DC@-DC<, :<<<.
Fh 9, 2u 5, )ho 1, *e-rode 9M, &tampfer M;, Manson ;1, 0iu &, .illett .)3
)arbohydrate intake, glycemic inde-, glycemic load, and dietary fiber in relation to risk
of stroke in women. Am ; 1pidemiol :>:3 :>:-:><, =EED.
&ubar A, Thompson 1, 9ipnis A, Midthune D, 2urwit' (, Mc6utt &, Mc7ntosh A,
*osenfeld &3 )omparati$e Aalidation of the 5lock, .illett, and 6ational )ancer 7nstitute
ood requency !uestionnaires3 The 1ating at AmericaGs Table &tudy. Am ; 1pidemiol
:DB3 :E?<-:E<<, =EE:.
Thompson 1, &ubar A, 5rown )), &mith A, &harbaugh )F, ;obe ;5, Mittl 5, 8ibson
;T, Hiegler *83 )ogniti$e research enhances accuracy of food frequency questionnaire
reports3 results of an e-perimental $alidation study. ; Am Diet Assoc :E=3 =:=-==D,
=EE=.
.illett .), &tampfer M;, 4nderwood 5A, &pei'er 1, *osner 5, 2ennekens )23
Aalidation of a dietary questionnaire with plasma carotenoid and alpha-tocopherol
le$els. Am ; )lin 6utr @?3 >@:->@<, :<?@.
ood requency .ebsites
The current source of the 5lock ! is through 6utrition!uest. The company
pro$ides se$eral types of diet questionnaires and screeners for both children and
adults. 7n addition to diet questionnaires, 6utrition!uest also supplies physical
acti$ity questionnaires and 5eha$ior )hange &ystems for organi'ations. or
more information, $isit3 http3IIwww.nutritionquest.comIinde-.htm
Dr. .alter .illett and his team at the 2ar$ard &chool of (ublic 2ealth ha$e
de$eloped se$eral $ersions of a ! used in The 6urses 2ealth &tudy. To $iew
forms of the questionnaire, $isit3
http3IIwww.channing.har$ard.eduInhsIquestionnairesIinde-.shtml
!uestionnaires, and other instruments de$eloped by the *isk actor Monitoring
J Methods 5ranch of 6)7, are used by many researchers. To $iew
documentation, software and other supporting material, $isit3
http3IIriskfactor.cancer.go$ItoolsIinstruments
Food Records
Description
A food record is a detailed description of the types and amounts of food, be$erage
andIor supplements documented o$er a prescribed period, usually @ to C days. ood
records are also known as +ood Diaries, because of the specially designed booklets
that sub%ects use to enter the details of the food and be$erages that they consume.
7nformation on food preparation, recipes, brand names and amounts consumed
included specific portion si'es is included. 7n addition, the name of the meal, the time of
day and e-act location may be required depending upon the nature of the study.
&ub%ects may be asked to weigh and measure foods and should be trained to record
intake to the le$el of detail needed to describe the diet and nutrients in question. At the
end of the recording period, a trained inter$iewer meets with the respondent to clarify
food details and to re$iew the foods and portions documented.
(ros "&trengths#
Fpen ended design
1asy to quantify amounts
Does not rely upon the sub%ects memory if used correctly
(ractical method to obtain information about the use of specific foods and
frequency
Fptimal method for $alidating food frequency questionnaires and diet histories
The act of recording dietary intake may alter eating beha$ior which is useful in
dietary inter$ention programs and as a teaching tool "howe$er, this is
considerably a disad$antage in measuring +usual intake,#
)ons ".eaknesses#
&ubstantial burden upon the sub%ect
Aery e-pensi$e to code and analy'e due to the cost of skilled personnel,
computer hardware and software
*equires literate and moti$ated indi$iduals so has limited use in many
populations
0ess effecti$e in measuring +usual intake, due to heightened awareness, may
alter beha$ior
&ignificant decrease in the sub%ects recording intake as the number of reporting
days increase
Aalidation studies indicate usual intake may be seriously underestimated, e.g.,
underreporting thought to be common in women and obese indi$iduals.
1-amples of ood *ecords
.eighted ood *ecord3 The sub%ect weighs all food and be$erages on a small
household scale then records the amount eaten. "0efto$er food is subtracted
from the original food weight to document the e-act amount consumed.#
1stimated ood *ecord3 This is the most common e-ample of food records used
in research. &tudy participants estimates the amount consumed by using
commond household measures "e.g., spoons, cups, glasses, plates# or by using
portion si'e estimation aides "e.g., three dimensional food models#
ood *ecord )itations
)raig M*, 9ristal A*, )heney )0, &hattuck A03 The pre$alence and impact of GatypicalG
days in B-day food records. ; Am Diet Assoc :EE3 B=:-B=C, =EEE.
reudenheim ;0, ;ohnson 61, .ardrop *03 Misclassification of nutrient intake of
indi$iduals and groups using one-, two-, three-, and se$en-day food records. Am ;
1pidemiol :=>3 CE@-C:@, :<?C.
9ristal A*, eng H, )oates *;, Fberman A, 8eorge A3 Associations of raceIethnicity,
education, and dietary inter$ention with the $alidity and reliability of a food frequency
questionnaire3 The .omenGs 2ealth Trial easibility &tudy in Minority (opulations.
Am ; 1pidemiol :B>3 ?D>-?><, :<<C.
1rratum in3 Am ; 1pidemiol :B?3 ?=E, :<<?.
Millen 51, !uatromoni (A, ran' MM, 1pstein 51, )upples 0A, )openhafer D03
(opulation nutrient intake approaches dietary recommendations3 :<<: to :<<D
ramingham 6utrition &tudies. ; Am Diet Assoc <C3 CB=-CB<, :<<C.
*ee$es *&, Mc(herson *&, 6ichaman MH, 2arrist *5, oreyt ;(, 8oodrick 893
6utrient intake of obese female binge eaters. ; Am Diet Assoc :E:3=E<-=:D, =EE:.
.ilson AM, 0ewis *D3 Disagreement of energy and macronutrient intakes estimated
from a food frequency questionnaire and @-day diet record in girls B to < years of age.
; Am Diet Assoc :EB3@C@-@C?, =EEB.
ood *ecord .ebsites
0afene 2ealth )enter of 9ansas &tate 4ni$ersity includes a sample food record
with instructions. To $iew, go to3
http3IIwww.k-state.eduIlafeneIfoodrecordsample.htm
Dennis 8age, M.D., .A.).(. discusses the importance of recording food intake in
his book +The Thinderella &yndrome3 A (ractical 8uide to 7ndi$iduali'ed
(ermanent .eight 0oss., 2is website includes a sample food record3
http3IIwww.thethinderellasyndrome.comIfoodKrecordKtheKthinderellaKsyndrome.h
tml
The 4ni$ersity of Te-as at Austin 2ealth (romotion and 1ducation &er$ices
pro$ides their students with ser$ices to keep them healthy. 7ncluded on their web
site is information on )omputeri'ed Dietary Analysis which includes a food
record form and instructions. To $iew, $isit3
http3IIwww.ute-as.eduIstudentIhealthIpdfsIdailyfoodrecordform.pdf
Dietary Recalls
Description
The twenty-four hour dietary recall is the most widely used diet assessment method. As
the name implies, the sub%ect is asked to report all of the food, be$erages andIor
supplements that he has consumed for the past =B hours or the pre$ious day. 4sually,
the recall is conducted by personal inter$iew and can be completed by using a
computer or by recording the intake on paper. The inter$iew may be face-to-face or
occur $ia telephone.
The inter$iewer must be $ery well-trained as they are crucial in collecting accurate
information through the use of probing questions. The ideal inter$iewer is a registered
dietitian; although, non-nutritionists who ha$e been trained in the use of a standardi'ed
instrument can be $ery effecti$e. 7nter$iewers should be $ery knowledgeable about
foods a$ailable in the marketplace, how foods are prepared and know about regional or
ethnic food habits.
The inter$iew is $ery structured with specific probes to help the respondent remember
all of the foods eaten. (robing is useful in collecting details on how foods were
prepared. 7t is also useful in reco$ering foods that are forgotten "e.g., butter on toast# or
in retrie$ing eating occasions not originally reported by the sub%ect such as snacks or
coffee breaks.
(ros "&trengths#
0east amount of burden to the participant
6o literacy requirements of the participants
Does not alter the food intake beha$ior
*elati$ely rapid method of data collection; usually @E minutes for a trained
inter$iewer to complete a =B-hour recall
(ro$ides estimates of the a$erage intake of large samples si'es that are
comparable to other methods such as food records
)ons ".eaknesses#
Aery e-pensi$e because it requires trained and skilled inter$iewers
1stimation of portion si'es may be $ery difficult; precision may be impro$ed
through the use of food models and photographs
There may be a +reporting effect, because indi$iduals may wish to +please, the
inter$iewer by o$erestimating percei$ed +healthy, foods and underreporting
alcohol, high calorie and high fat foods.
Detail about intake relies upon the respondent/s memory
1-amples of Dietary *ecalls
Three-pass recall method3 The inter$iewer employs three distinct probing
sessions "or +passes,# during the inter$iew. The first pass obtains a list of foods,
the second pass adds detailed descriptions, and the third pass was re$iews for
missing items.
Automated Multiple-(ass Method "AM(M#3 The AM(M is a computeri'ed dietary
intake instrument that offers a guided inter$iew of fi$e distinct research-based
steps. 7t is designed to elicit accurate food recall descriptions and the amount
consumed by respondents. The method includes standardi'ed questions and
possible response options for foods in the 4.&.; each response option is
programmed to proceed to subsequent appropriate questions. The AM(M is
used for collecting dietary recalls of D,EEE Americans yearly in a national federal
nutrition sur$ey, .hat .e 1at in America, 62A61&. Data from the sur$ey is
used to assess the nutritional health of Americans and is the basis of ederal
nutrition policy and regulatory decisions.
i$e-step Multiple (ass Approach3 The Fbesity 6utrition *esearch )enter
"F6*)# of the 4ni$ersity of (ittsburgh routinely uses this type of food recall. The
inter$iewer is thoroughly trained to use an interacti$e, computeri'ed software
program, the +6utrition Data &ystem for *esearch, "6D&*#, de$eloped by the
4ni$ersity of Minnesota 6utrition )oordinating )enter. &teps for this e-ample of
recall include3 :# 4se of a +!uick 0ist, where indi$iduals are asked to briefly
outline foods consumed. =# *e$iew of the quick list, where an inter$iewer uses
memory prompts to help indi$iduals recall forgotten foods. @# *ecall of time and
occasion of food consumption. B# ood details3 indi$iduals are asked to describe
foods and be$erages by brand name, ingredients and preparation, portion si'e,
and quantity eaten. D# inal re$iew of the list to make sure that nothing was
omitted.
Dietary *ecall )itations
5ialostosky 9, .right ;D, 9ennedy-&tephenson ;, McDowell M, ;ohnson )03 Dietary
intake of macronutrients, micronutrients, and other dietary constituents3 4nited &tates
:<??-<B. Aital 2ealth &tat ::"=BD#3 :-:D?, ;ul. =EE=.
5lock 8, .akimoto (, Met' D, u%ii M0, eldman 6, Mandel *, &utherland 53 A
randomi'ed trial of the 0ittle by 0ittle )D-*FM3 demonstrated effecti$eness in
increasing fruit and $egetable intake in a low-income population. (re$ )hronic Dis :3
AE?, =EEB. 1pub =EEB ;un :D.
)onway ;M, 7ngwersen 0A, Moshfegh A;3 Accuracy of dietary recall using the 4&DA
fi$e-step multiple-pass method in men3 an obser$ational $alidation study. ; Am Diet
Assoc :EB3 D<D->E@, =EEB.
&chat'kin A, 9ipnis A, )arroll *;, Midthune D, &ubar A, 5ingham &, &choeller DA,
Troiano *(, reedman 0&3 A comparison of a food frequency questionnaire with a =B-
hour recall for use in an epidemiological cohort study3 results from the biomarker-based
Fbser$ing (rotein and 1nergy 6utrition "F(16# study. 7nt ; 1pidemiol @=3 :EDB-:E>=,
=EE@.
&hai 7, *osner 5A, &hahar D*, Aardi 2, A'rad A5, 9anfi A, &chwar'fuchs D, raser D3
D1A** study. Dietary e$aluation and attenuation of relati$e risk3 multiple comparisons
between blood and urinary biomarkers, food frequency, and =B-hour recall
questionnaires3 the D1A** study. ; 6utr :@D3 DC@-DC<, =EED.
Dietary *ecall .ebsites
The 4ni$ersity of Tennessee amily and )onsumer &ciences 1-panded ood
and 6utrition 1ducation (rogram has instructions posted to their website for
completing the 2omemaker/s =B-2our ood *ecall orm.
http3IIfcs.tennessee.eduIefnepIrecallinstruc.htm
A $ideotape on the =B-2our *ecall is a$ailable from the Fklahoma )ooperati$e
1-tension &er$ice, Fklahoma &tate 4ni$ersity for L@D. or more information, go
to3 http3IIwww.fcs.okstate.eduIcnepItoolsIfood-recall.htm
The Airginia (olytechnic 7nstitute and &tate 4ni$ersity digital library and archi$es
allows unrestricted access to a theses which includes detailed descriptions on
the procedure.
http3IIscholar.lib.$t.eduIthesesIa$ailableIetd-:E:E<C-
>:=?IunrestrictedIAppendi-2.pdf
An e-cellent source for detailed twenty-four hour recall information is the 4nited
&tates Department of Agriculture "4&DA#.
http3IIwww.csrees.usda.go$IneaIfoodIefnepIersIdocumentationI=Bhour-recall.pdf