Submitted By:

Group:
Abdul hameed (0000251505)
Azeem Dilawar (0000251002)
Nourin islam (0000251158)
Uzma naveed (0000247505)
Rozina ismail (0000252289)
Program: MSC Public Nutrition
Course: Nutritional Assessment-I
Code: 3647
TUTOR MADAM ASMA AFREEN

THREE-DAY
24 hour Recall
FOOD RECORD

Ayni saba
NAME:

AGE: 32 year
Please write down all foods and beverages consumed for three 24-hour time periods. Each day starting at 12:00 am
and ending at 11:59 pm. Choose three consecutive days, including two weekdays and one weekend.
 You will be asked to record all vitamin, mineral, and herbal supplements you took at the end of each record.
 List the approximate Time the meal was consumed, Place where it was consumed (home, work, name of
restaurant, church, etc.), and the type of eating occasion or Meal (breakfast, lunch, dinner, snack, or other).
 List each Food/Beverage Item you consumed, including foods eaten between meals and all drinks, even if it is
a non-caloric item like water, coffee, tea, or sugar free gum.
 Specify Details/Ingredients/Preparation of each food or beverage consumed. See the “Three-Day Food Record
Checklist” form for details on what to include.
 Record the Amount of each food or beverage consumed. Portion sizes can be recorded in a variety of ways,
please use the method that works best for you. You can use the “Food Amounts Booklet” to help you document
portion sizes. Portion sizes can be recorded using the following standard measurements:
o Weight in grams or ounces (Not fluid ounces)
o Solid foods – use volume in cups, tablespoons or teaspoons
o Liquids – use volume in fluid ounces
o Fraction of the whole (e.g. 1/8 of 9” pie)
o Dimensions for the following shapes:
Example Shape Measurement Needed
Meatball Sphere Diameter
Meat Patty Cylinder or disk Diameter x thickness
Lasagna Rectangle or cube Length x height x width
Pie Wedge Length x height x width of
arc

Example
Time Place Meal Food/Beverage Item Details/Ingredients/Preparation Amount
Brown Sugar Instant
8:00am Ho Breakfa Oatmeal Made with water, nothing else added 2 packets
me st
Milk Skim 8 fluid oz.
Coffee Brewed, caffeinated 16 fluid oz.
Coffee Creamer Fat Free, liquid hazelnut Coffee Mate 1 Tbsp.
Frozen, thin crust, supreme pizza (Tony’s Brand) 2 slices
12:00pm Ho Lunch Pizza (See pg. 3 of Food Amounts Booklet to estimate Size D-4 each
wedge measurement)
 me
Water Tap, with ice 16 fluid oz.
Type/Brand of Supplement Reason for Taking Amount Taken Frequency of Dose
(dosage) (times/day)
One A Day Multi-Vitamin for General 1 Tablet Once per day
Women Health
Fish Oil - CVS Brand Lower Triglycerides 1 soft gel 3 soft gels per day
(1200mg)
 DAY ONE – DATE OF RECORD name ayni saba age 34 years

Time Plac Meal Food/Beverage Details/Ingredients/Preparatio Amount

e Item n
7 : 50 Home Break Khajoor one
fast
Garlic 3 colves
ajwaien One pinch
Fried egg/1/2 cup One
tea
10.30 Office Break Pea rice +vitamin 1 plate
fast c tablet 200 gram
Water One glass
2:00 Office Lunch Roti with chiken Half chapatti
qeema 2 spoon +
ketchup +mayo 2 spoon
7:00 Home Evenin Suji ka halwa Half cup
g

10:30 Dinner Achar 100 gram

gosht
chiken

PAGE 1
Please list all vitamin, mineral, and herbal supplements you took today.
Type/Brand of Reason for Taking Amount Taken Frequency of Dose
Supplement (dosage) (times/day)
Abbot Ca 1 tab One in a day

 Would you consider your intake of foods and beverages today to be typical of most days or was it
considerably more or less? Explain why if not typical?

Please list all planned physical activity performed today.

Activity Duration
Type (minutes or
hours)
Stretching and deep breathing 30 mint

PAGE 2
DAY TWO – DATE OF RECORD

Tim Plac Meal Food/Beverage Details/Ingredients/Preparatio Amount

e e Item n
10 :30 Home Break Kh joor 1
fast
Garlic clove 3 clove
Ajwaien 1 pinch
12:00 Home Lunch Pasta Vege chiken wih some spice and ketchup
1

2: 00 Home Lunch 2 Milk 1 cup

5 : 00 Home Evenin One banana one vege 1 cup

g

8: 00 Home Dinner Roti with nihari Gravey 1 small plate

PAGE 3
PAGE 4
DAY THREE – DATE OF RECORD

Tim Plac Meal Food/Beverage Details/Ingredients/Preparation Amount

e e Item
7 : 50 Home Break Khajoor one
fast
Garlic 3 colves
ajwaien One pinch
Fried egg/1/2 cup One
tea
10:30 Office Break Pea rice One
fast
banana One
Guava
2:00 Home lunch Daal chawal Fried dal and boiled rice One plate

5:00 Home Evenin One cup tea One cup

g
10:00 Home Dinner Chiken with One pate
vegetable

PAGE 5
24-Hour Dietary Recall, Food Intake Analysis
24-Hffffffff

PAGE 6
 24ffffff-Hour Dietary Recafoofff24-Hour Dietary Recall, Food Intake Analysis

24-Hour Dietary Recall, Food Intake Analysis

Name of Food Carbs protein fats fiber cholestrol Vit c Ca phosphorus iron
s.no food energy
calories

1 One khajor 6.23 gm 0.2g 0.03g 0.7g 0g 0g 3g 14.9g 0.08

23 cal

Garlic clove 13 cal 3g 0.6g 0.1g 02g 0 mg 2.81mg 16.29mg 13.77mg

2

One fried 90 cal 0.4g 6.3g 6.8g 0 184mg 29mg - 0.9mg

3 egg

Pea cooked 84 15.5g 8.8g 0.6g 0.5g - - - -

4

5 Mash ki dal 158 22.5g 10.6g 1.0 g 1.7g - - - -

6 rice 360 79.5g 6.7g 0.9g 0.4 0 0 18g 128 1.5

chapati 259 57.0g 8.8g 1.2g 0.8g

7

987 184.2 80.1 10.63 4.3

PAGE 1
 Name of Food Carbs protein fats fiber cholestrol Vit c Ca phosphorus iron
s.no food energy
calories

1 One khajor 6.23 gm 0.2g 0.03g 0.7g 0g 0g 3g 14.9g 0.08

23 cal

Garlic clove 13 cal 3g 0.6g 0.1g 02g 0 mg 2.81mg 16.29mg 13.77mg

2

One fried 90 cal 0.4g 6.3g 6.8g 0 184mg 29mg - 0.9mg

3 egg

Pea cooked 84 15.5g 8.8g 0.6g 0.5g - - - -

4

5 Mash ki dal 158 22.5g 10.6g 1.0 g 1.7g - - - -

6 rice 360 79.5g 6.7g 0.9g 0.4 0 0 18g 128 1.5

chapati 259 57.0g 8.8g 1.2g 0.8g

7

987 184.2 80.1 10.63 4.3

Name of Food Carbs protein fats fiber cholestrol Vit c Ca phosphorus iron
s.no food energy
calories

1 One khajor 6.23 gm 0.2g 0.03g 0.7g 0g 0g 3g 14.9g 0.08

23 cal

Garlic clove 13 cal 3g 0.6g 0.1g 02g 0 mg 2.81mg 16.29mg 13.77mg

2

One fried 90 cal 0.4g 6.3g 6.8g 0 184mg 29mg - 0.9mg

3 egg
PAGE 2
 Pea cooked 84 15.5g 8.8g 0.6g 0.5g - - - -
4

5 Mash ki dal 158 22.5g 10.6g 1.0 g 1.7g - - - -

6 rice 360 79.5g 6.7g 0.9g 0.4 0 0 18g 128 1.5

chapati 259 57.0g 8.8g 1.2g 0.8g

7

987 184.2 80.1 10.63 4.3

24-Hour Dietary Recall, Food Intake Analysis

Name: ABDUL HAMMED Age: 25year Sex: Male Height: 5.7” Weight: 80kg Special needs: None

Date & Day of Time Food/drink Type/How Quantit Energy Carbohydrate Protein Total Cholesterol Phosphorus Iron Calcium Vit. C Fiber
Week Prepared y Fat (mg)
(Kcal) (g) (g) (mg) (mg) (mg) (mg) (mg)
(g)
Breakfast
7:30 Buffalo Milk Boiled 200ml 214.2 9.18 15.912 8.976 38.76 210.12 0.408 352.92 2.04 0
Day. 01 9:00 Paratha Fry in oil 50g 182 19.9 4.3 10.7 0 137 2.3 21.5 0 0.95
9:00 Egg Boiled 50g 81.5 0.4 5.85 6.4 212 113.5 1.6 31.5 0 0
Tuesday - Lunch
07/03/2023 12:00 Chapatti Flour, water, 100g 259 557.0 8.8 1.2 0 56 0.9 81 0 0.8
salt
Kalool Water, kidney 250g 154 25.7 11.4 1.5 0 169 5 2.5 3.6 6.25
beans,
tomato,
onion, red
chili.
Afternoon snack
3:00 Biscuit Pack 50g 220 36.5 4.55 3.6 0 34.5 0.65 11 0 0.25
3:00 Black Tea Milk, water, 1 cup 929 59.0 22.4 2.4 0 327 24.3 319 0 8.4
black tea
Dinner

PAGE 3
7:30 Sweet rice Rice, sugar, 250g 615 116.25 11.25 10 24 57.5 1.25 1 0.75 1.25
ghee,orange
foodcolour,
,water,
cardamom,
almonds.
Total 2654.7 823.93 84.462 44.776 274.76 1104.62 36.408 820.42 6.39 17.9

PAGE 4
 24-Hour Dietary Recall, Food Intake Analysis

Name of Person: ABDUL HAMEED Age: 25Year Sex: MALE Height: 5.7”. Weight: 80kg Special Needs: None

Date & Day of Time Food/drink Type/How Quantit Energy Carbohydrate Protein Total Iron Cholesterol Calcium Vit. C Phosphorus Fiber
Week Prepared y Fat
(Kcal) (g) (g) (mg) (mg) (mg) (mg) (mg) (mg)
(g)
Breakfast
7:00 Milk Boiled 200ml 214.2 9.18 15.912 8.976 0.408 38.76 352.92 2.04 210.12 0
Day. 02 7:45 Egg Fried in oil 50g 77.5 0.4 6.1 5.6 1.35 212.5 27 0 105 0
7:45 Paratha Flour, water, 150g 546 59.7 12.9 32.1 6.9 0 64.5 0 411 2.85
Wednesday - salt
08/03/2023 Fry in oil
Lunch
12:30 Apple salad Apple and 150g 627 24.15 4.05 58.8 1.05 44.4 106.5 1.05 90 1.2
cream
Afternoon snack
3:00 Tea Water, milk, 1 cup 292 59.0 22.4 2.4 24.3 0 319 9 327 8.4
blacktea.
3:00 Biscuit Wheat flour 100g 440 73.7 9.1 7.2 1.3 0 44 0 69 0.5
Dinner
8:15 Chapatti Flour, water, 100g 259 57.0 8.8 1.2 5.6 0 81 0 56 0.8
salt
8:15 Biryani Chicken meat, 250g 593.1 71.4 27.3 20.1 2.7 28 130 5.4 250 2
Rice, onion,
tomato, garlic,
potatoes,
ghee, salt, red
chili, turmeric
power, garam
masala, water.
Total 3048.8 354.53 106.562 136.376 43.608 323.66 1124.92 17.49 1518.12 15.75

PAGE 5
 24-Hour Dietary Recall, Food Intake Analysis

Name of Person: ABDUL HAMEED Age: 25years Sex: MALAE Height: 5.7”. Weight: 80kg Special Needs: None

Date & Day of Time Food/drink Type/How Quantit Energy Carbohydrate Protein Total Iron Cholesterol Calcium Vit. C Phosphorus Fiber
Week Prepared y Fat
(Kcal) (g) (g) (mg) (mg) ()mg (mg) (mg) (mg)
(g)
Breakfast
6:50 Apple + milk shake 250ml 162 18.4 8.2 4.7 0.8 19 417 9 113 2.2
Day. 03 8:15 Paratha Fry in oil 100g 364 39.8 8.6 21.4 4.6 0 43 0 4.6 1.9
8:15 Tea Milked 1 cup 292 59.0 22.4 2.4 24.3 0 246 9 327 8.4
Thursday -
09/03/2023 Lunch
12:15 Chapatti Water, flour, 100g 259 57.0 8.8 1.2 5.6 0 81 0 56 0.8
salt
12:15 Dal masour Daal masour, 200g 19.2 25.2 10.4 5 2.2 0 1.6 6 138 1.0
ghee, garlic
salt, redchili,
turmeric
powder, water
cumin seeds
Afternoon snack
3:00 Tea Water, milk, 1 cup 292 59.0 22.4 2.4 24.3 0 319 9 327 8.4
sugar
Dinner
8:30 chapati Water, flour, 100g 259 57.0 8.8 1.2 5.6 0 81 0 56 1.9
salt
8:30 Alu ghosht Meat, ghee, 100g 120 13.0 7.0 4.0 0.5 8 1.1 1.4 12 2.0
potatoes,
tomatoes,
onion, garlic,
ginger and
coriander
leaves.
Total 1767.2 328.4 96.6 42.3 67.9 27 526.7 34.4 1033.6 26.6

24-Hour Dietary Recall, Food Intake Analysis

PAGE 6
 Name of Person: UZMA HAMID Age: 48Year Sex: FEMALE Height: 5.3” Weight: 70kg Special Needs: None

Date & Day of Time Food/drink Type/How Quantit Energy Carbohydrate Protein Total Iron Cholesterol Calcium Vit. C Phosphorus Fiber
Week Prepared y Fat
(Kcal) (g) (g) (mg) (mg) (mg) (mg) (mg) (mg)
(g)
Breakfast
7:30 Milk Boiled 200ml 214.2 9.18 15.912 8.976 0.408 38.76 352.92 2.04 210.12 0
Day. 02 8:30 Egg Fried in oil 50g 77.5 0.4 6.1 5.6 1.35 212.5 27 0 105 0
8:30 ROTI Flour, water, 100 g 250 57.0 8.8 1.2 5.6 0 81 0 56 0.8
Thursday salt
02/03/2023 Lunch
1:00 Apple Banana Apple banana 150g 250 24.15 4.05 58.8 1.05 44.4 106.5 1.05 90 1.2
guava salad guava lemon
Afternoon snack
5:00 Tea Water, milk, 1 cup 292 59.0 22.4 2.4 24.3 0 319 9 327 8.4
black tea.
5:00 Biscuit Wheat flour 100g 440 73.7 9.1 7.2 1.3 0 44 0 69 0.5
Dinner
7:30 Chapatti Flour, water, 100g 259 57.0 8.8 1.2 5.6 0 81 0 56 0.8
salt
7:30 Chicken shorba Chicken meat, 250g 560 71.4 27.3 20.1 2.7 28 130 5.4 250 2
onion, tomato,
garlic,
potatoes,
cooking oil,
salt, red chili,
turmeric
power, garam
masala, water.
Total 2,092.70 294.887 102.462 105.476 42.308 323.66 1141.42 17.49 1,163.12 13.70

PAGE 7
 24-Hour Dietary Recall, Food Intake Analysis

Name of Person: UZMA NAVEED Age: 48 years Sex: FEMALAE Height: 5.3”. Weight: 70kg Special Needs: None

Date & Day of Time Food/drink Type/How Quantit Energy Carbohydrate Protein Total Iron Cholesterol Calcium Vit. C Phosphorus Fiber
Week Prepared y Fat
(Kcal) (g) (g) (mg) (mg) ()mg (mg) (mg) (mg)
(g)
Breakfast
9:00 Mango + milk shake 250ml 162 18.4 8.2 4.7 0.8 19 417 9 113 2.2
Day. 03 9:00 Toast toasted 100g 364 39.8 8.6 21.4 4.6 0 43 0 4.6 1.9
9:00 Tea Milked 1 cup 292 59.0 22.4 2.4 24.3 0 246 9 327 8.4
Friday -
03/03/2023 Lunch
1:00 Chapatti Water, flour, 100g 259 57.0 8.8 1.2 5.6 0 81 0 56 0.8
salt
1:00 Haleem Meat, Haleem 200g 19.2 25.2 10.4 5 2.2 0 1.6 6 138 1.0
mix garlic salt,
red chili, onion
turmeric
powder, water
cumin seeds
Afternoon snack
5:00 Tea Water, milk, 1 cup 292 59.0 22.4 2.4 24.3 0 319 9 327 8.4
sugar
Dinner
7:30 Rice boiled Water, rice, 100g 259 57.0 8.8 1.2 5.6 0 81 0 56 1.9
salt, oil
7:30 Aloo ghosht Meat, cooking 100g 120 13.0 7.0 4.0 0.5 8 1.1 1.4 12 2.0
oil, potatoes,
tomatoes,
onion, garlic,
ginger and
coriander
leaves.
Total 1767.2 328.4 96.6 42.3 67.9 27 870.731 34.4 1,022.6 26.6

a 24-hour dietary recall for a 43-year-old male living in South Punjab, Layyah, Pakistan, with a weight of 74 kg, height of 1.701 meters, BMI of 25.27, BMR of 1644.25, and EER of 2548.58, with
traditional Pakistani cuisine. The table includes columns for quantity, energy (KCal), carbohydrate (g), protein (g), fat (g), and micro-nutrients commonly found in Pakistani foods.
chart with date and meal type included:
Sure, here is the revised chart with date and meal type included:
PAGE 8
 Energy Carbohydrate Protein Vitamin C
Date Meal Type Time Food Item Quantity (kcal) (g) (g) Fat (g) Vitamin A (mcg) (mg) Vitamin D (mcg) Calcium (mg) Iron (mg)
Paratha
(Whole
09/04/2023 Breakfast 8:00 AM wheat) 2 324 48.2 7.0 12.6 - - - 40 1.4
09/04/2023 Breakfast 8:00 AM Omelette 2 eggs 200 1.6 13.8 15.0 130 0.0 0.8 56 2.0
09/04/2023 Breakfast 8:00 AM Chai (Tea) 1 cup 45 0.0 0.0 5.0 - - - 14 0.2
09/04/2023 Snack 11:00 AM Samosa 1 160 20.4 4.0 7.6 - - - 16 0.8
Chicken
09/04/2023 Lunch 1:00 PM Karahi 1 serving 250 10.0 20.0 15.0 70 0.0 0.0 60 1.8
Chawal
09/04/2023 Lunch 1:00 PM (Rice) 1 cup 206 45.0 4.3 0.4 - - - 10 0.5
Raita
09/04/2023 Lunch 1:00 PM (Yogurt Dip) 1/2 cup 30 2.0 1.5 1.0 40 0.0 0.0 60 0.3
Daal (Lentil
09/04/2023 Dinner 7:00 PM Curry) 1 serving 200 15.6 12.0 6.8 20 0.0 0.0 40 1.2
Roti (Whole
09/04/2023 Dinner 7:00 PM wheat) 1 71 12.0 2.0 1.6 - - - 20 0.8
Sabzi
(Vegetable
09/04/2023 Dinner 7:00 PM Curry) 1 serving 100 10.0 2.0 3.0 300 20.0 0.0 40 1.0
Date Type of Quantity Energy Carbohydrates Vitamin A Vitamin D Calcium
Time Meal Food Item (g) (kcal) (g) Protein (g) Fat (g) (mcg) Vitamin C (mg) (mcg) (mg) Iron (mg)
10-04-23 7:00 Breakfast Paratha 100 297 35 6 15 - - 0.1 - 1.5
10-04-23 Omelette (2 eggs) 100 143 1 13 10 330 0 1.6 56 2.3
10-04-23 Tea (with milk and
sugar) 150 51 9 1 1 - - - 120 0.5
10-04-23 10:00 Snack Banana 100 89 23 1 0.3 64 8.7 0.1 6 0.3
10-04-23 Peanut Chikki 50 238 18 7 16 - - - 100 2.1
10-04-23 13:00 Lunch Chicken Curry 150 295 8 25 19 75 8 0.2 24 2.8
10-04-23 Rice 100 130 28 2 0.3 - - - 10 1.2
10-04-23 Cucumber Salad 100 15 2 1 0.2 16 4.5 - 15 0.3
10-04-23 16:00 Snack Samosa 50 200 20 5 12 - - - - -
10-04-23 Chai (with milk and
sugar) 150 51 9 1 1 - - - 120 0.5
10-04-23 19:00 Dinner Chapati 100 297 58 9 2 - - - 60 3.5
10-04-23 Aloo Gosht 150 319 11 22 23 150 15 0.2 76

PAGE 9
 Date Meal Energy Carbohydrate Protein Vitamin A Vitamin C Vitamin D Calcium Iron
Time Type Food Item Quantity (kcal) (g) (g) Fat (g) Fiber (g) (mcg) (mg) (mcg) (mg) (mg)
11-04-23 8:00 AM Breakfast Paratha 2 400 50 8 18 4 0 0 0 30 2
11-04-23 Omelette 2 eggs 160 1 12 12 0 200 0 80 2
11-04-23 Tomato 1 22 5 1 0 1 500 15 0 10 0
11-04-23 Tea with Milk 1 cup 30 3 1 1 0 50 20 0 10 0
11-04-23 Honey 1 tsp 20 6 0 0 0 0 0 0 0 0
11-04-23 11:00 AM Snack Yogurt 1 cup 120 6 8 5 0 80 2 300 0
11-04-23 Mango 1 cup 99 25 1 0 3 120 45 0 7 0
11-04-23 Chicken
1:30 PM Lunch Karahi 1 serving 350 10 20 20 3 400 20 0 50 3
11-04-23 Naan 1 320 60 10 5 5 0 0 0 10 2
11-04-23 Salad 1 cup 35 7 1 0 3 200 15 0 10 0
11-04-23 Raita 1 cup 100 4 4 8 0 80 5 0 150 1
11-04-23 4:00 PM Snack Samosa 1 250 26 5 14 2 50 10 0 20 1
11-04-23 Chutney 1 tbsp 30 5 0 0 0 50 5 0 10 0
11-04-23 7:30 PM Dinner Biryani 1 serving 500 80 15 25 5 0 10 0 50 4
11-04-23 Raita 1 cup 100 4 4 8 0 80 5 0 150 1
11-04-23 Salad 1 cup 35 7 1 0 3 200

Recommended Dietary Allowance

PAGE 10
Abstract

Diet is a significant risk factor in t he development of many chronic illnesses. The int ake of food can be evaluated through subject ive reporting as well as object ive
observat ions. Assessment of subject ive nature is possible wit h open-ended surveys, such as dietary recalls and records, or by using closed -ended survey instruments,
including the food frequency quest ions. Each approach has it s own strengths and weaknesses. Cont inuous efforts to improve the accuracy of the assessment of dietar y
intake and increase it s ut ilit y in epidemiological studies have been undertaken. This article reviews the most common methods for assessing diet and their efficacy in
studies of epidemiology.

Keywords: Dietary Assessment, questionnaire on food frequency and dietary frequency for 24 -hour recall of dietary habit s and record of diet

INTRODUCTION

Diet is a significant lifest yle-related risk factor for many chronic illnesses. Lifest yle changes in the way we eat have been shown to reduce cancer risk by one -third. Dietar y
data has proven to be helpful in cardiovascular risk predict ion. Co nsuming high-nutrient diets has been associated with a lower chance of dying from all causes. Contrary
to other danger factors (e.g. smoking) the dietary factors are difficult to assess since all people eat food regardless of th e quant it y and the type of food consumed varies
PAGE 11
among individuals, and individuals are not aware of the food they consume and how much they consume. A poor understanding of the dietary profile could be a significant
obstacle in knowing the effect of diet -related factors on healt h.

Particular biochemical markers are used as a subst itute for measuring the intake of specific nutrit ional components or nutrient s in epidemiological research. Studies have
shown that these markers are highly associated with intake levels, free of any social d esirabilit y biases and independent of memory, and not based on the subject's capacit y
to explain the quant it y and t ype of food they consume. So, these biochemical markers can provide more precise measurements than dietary intake est imates can. However,
several biomarkers have been found to provide integrated indicators of their metabolism and absorption following consumpt ion. Fu rthermore, they are also affected by
illness or homeostat ic control, which means their result s can't be translated into a total die tary intake of a person. Addit ionally, the findings based on biomarkers do not
offer dietary suggest ions to alter the dietary habit s of a person. Therefore, a direct evaluation of dietary int ake could be more accurate than biomarkers.

Of the various diet -related assessment methods among the available dietary assessment methods, the food frequency quest ionnaire (FFQ) is widely em ployed to conduct
large-scale epidemiological research since the late 1990s. Since doubts over their validit y were raised in the la te 2000s and since then, numerous modificat ions to the
assessment procedures have been made. Certain researchers have changed their focus and refocused efforts to enhance the efficiency and reliabilit y of the open -ended
assessment methods instead of improving the FFQ or finding more relevant biomarkers. Some researchers have shift ed their efforts to improve their accuracy wit h the
FFQ. The abilit y to accurately assess exposure to dietary substances wit h limited resources is an issue for researchers. We, therefore, set out to examine commo n
approaches for assessing dietary int ake and their applicabilit y for epidemiological research.

DIETARY ASSESSMENT BY OBJECTIVE OBSERVATION

Table 1 lists the various dietary assessment methods, including methods, the collected data strengths, and drawbacks when considering a more conservat ive
approach. Dietary intake can be measured through object ive assessment by using a duplicate diet method or by keeping a food consumpt ion diary by a trained research
team. A duplicate diet approach gathers duplicates of the subject's regular diet and analyzes them to determine the possible exposu res to food items. This method is
primarily ut ilized to assess the exposure to environmental pollutants like phthalates and polycyclic aromat ic hydrocarbons found in food and b everages. Food consumpt ion
records collect details about the diet of subjects who prepare and consume food at home through object iv e observat ions by skilled field workers. This met hod is helpful
in developing nat ions, particularly for those who have a low lit eracy rate or who cook a significant portion of their meals a t home. For instance, in South Korea, the
Nat ional Nutrit ion Survey carried out a survey of households using this method to measure the amount of food consumed by t he nat ion between 1969 and 19 95. Staff
members wit h training and experience observed and coded the food items consumed and prepared wit hin the household survey ed during two separate days. The data was

PAGE 12
taken at the level of the household so no informat ion about the food consumed by every person in t he household or about food consumed outside of the household was
collected. So, the individual's consumpt ion was est imated indirect ly based on the number of people in the household, their age, and the gender of household members who
ate the food recorded. As economic condit ions improve as well as the rise in eat ing out and advances in t he individual assessment of dietar y habits evaluat ion at the
individual level has become common in the context of nutrit ion epidemiology.

DIETARY ASSESSMENT BY SUBJECTIVE REPORT

Methods of assessment for dietary content that measure an individual's intake are the 24 -hour recall of dietary informat ion (24HR) as well as the diet record (DR) and the
dietary history and FFQ. The data is obtained with the aid of a cert ified interviewer, or through self -report.

It is important to note that the 24HR and DR are open-ended surveys and provide det ails about the food eaten wit hin a certain t ime. This survey is done in an extensive
interviewing st yle and generally takes between 20 and 30 minutes to complete a single -day recall. Specific informat ion about cooking methods, ingredients used in mixed
meals as well as the brand name of commercial food items may be required based on the research inquiry. The amount of food item is calculated in the context of a
standard dimensions container (e.g. cups, bowls, or glasses) and regular measuring spoons and mea suring cups as well as a 3-D food model or two-dimensional aids like
photographs. The main benefit to the 24-HR system is it places a fairly low burden is imposed on the respondents. But, the main drawback is that the informat ion relies
on the memory of the part icipants as well as the abilit y of an expert ly trained int erviewer to limit recall bias. In contrast, DR collects data by recording t he self-record of
subjects when meals is consumed, thereby reducing the dependence on a subject's memory. In order to collect reliable informat ion, however, participants have to be
trained prior to participate in the survey. Thus, a high degree of mot ivat ion is needed and an enormous burden is transferred onto the participants.

Both approaches have similar advantages. Both employ open-ended quest ions to ensure that a wealth of informat ion can be gathered and examined in a variet y of
ways. Addit ionally, both approaches are able to be applied to groups that have diverse food preferences and could be used to determ ine the t ypical intake of a particular
group of people. In several countries, such as South Korea, the 24HR is the most widely employed met hod in nat ional surveys while both are oft en used in random clinical
trials as well as cohort studies. But, these methods do ha ve their limitat ions when applied to studying chronic diseases that are major public healt h issues. The main
drawback is the fact that both methods are focused on the consumpt ion of short -term duration and long-term exposure to dietary substances. However, the long-term effect
is of part icular interest when studying chronic illnesses. To measure the average intake, several 24HRs or DRs will be required. Repeated measurements not only require
lots of t ime and resources but it can also affect the respondents' eat ing habits. Recent studies have revealed that respondents could alter their diet habits wit hout realizing
it through self-reflect ion. Some respondents might change their diet intent ionally in order to minimize the impact on their responses or choose to conceal their

PAGE 13
consumpt ion. Another issue stems from the open-ended format which demands a lot of effort during data collect ion, entry, and analysis. Each quest ionnaire must be
carefully reviewed by the research team in order to make sure that the data are in the database. After the init ial review, all meals and mixed meals consumed in accordance
to the detailed descript ions provided by the respondents should be matched and coded to the food that is most suitable in the database of food composit ion. In addit ion,
the amount of food consumed needs to be converted to their actual weight. Once t he informat ion reported has been transformed to match the weight and food code then
the actual intakes can be determined. These procedures are typically long-last ing, time-consuming, and cost ly to implement.

Despit e the limitat ions ment ioned above that are ment ioned above, various 24HRs and DRs possess inherent advantages when it c omes to studying the et iology of chronic
illnesses. The first is that both methods record the actual intake of individuals on certain days. The second reason is that the burden of memory could be less in these
methods than the FFQ that requires recall over a longer t ime (e.g. the last twelve months). Then, the typical intake may also be calculated when repeated. Due to these
strengths, cutting-edge technologies focused on reducing the burden of the respondents, improving accuracy, and enabling mult iple self -administrations are current ly
being utilized to enhance their efficacy in studies of epidemio logy. Recent ly, numerous reports have reviewed their applicat ions and their implicat ions in research and
clinical environments.

While many methods are in development, significant advances have been achieved. Interactive computer-based techniques that were developed early in dietary assessment
development, aim to create an all-encompassing method for collect ing data and entry, coding, as well as calculat ion of intakes. Examples include an Automated Mult iple
Pass Method (AMPM) to manage the 24HR for the US N ational Healt h and Nutrit ion Examinat ion Survey and the menu -driven standard 24HR program (called EPIC Soft)
for the European Prospective Invest igat ion into Cancer and Nutrit ion study, which allows part icipants to gather, inquire and analyze intake data in a standard method,
which improves the accuracy of data regardless of whether they are ut ilized in different groups. Wit h limit at ions on t iming, locat ion, as well as the number of interviewers
in every study, these tools are expensive to implement for larg e-scale epidemiological studies.

In a way, they are closely linked to the computer -driven approach Web-based technology allows researchers to gather informat ion regardless of t ime or place in the event
that internet connect ivit y is accessible. Recent ly t he Nat ional Cancer Inst itute in the US. is developing an internet -based approach known as the Automated Self-
Administered 24HR. It is built on the AMPM method. This web-based method includes an online instructional wit h digital images of the ident ificat ion o f food items and
est imat ion of portion sizes as well as a variety of audio files. Therefore, people wit h limited lit eracy levels can complete the questionnaire, and researchers are able to
collect real-t ime informat ion. Other web-based technology developed for face-to-face, standard interview management have been developed for face -to-face int erviews
for instance, the Diet Evaluat ion System (DES) which was created by South Korea.

PAGE 14
Addit ionally, applicat ions for mobile phones that permit users to record infor mat ion about their intake of food have been made available. Users can record their diets by
select ing corresponding items from a set list of beverages and foods and the amount of food consumed may be recorded using pr e-defined portions. For South Korea,
SmartDiet is an applicat ion developed to help wit h dietary management and educat ion This applicat ion has been tested for effect iveness and adequacy in clinical
situat ions. Many funct ions integrated into the mobile device are utilized to gather informat ion. In Japan, the applicat ion for mobile phones (called Wellnavi) uses the
camera of the user and their mobile phone to track all food consumed by sending pictures before and after eating to the diet i t ian. Addit ionally, recording voices like the
Spoken Diet Records applicat ion has been utilized to gather informat ion. The Nutricam program in Australia, Nutricam allows subjects to take pictures of their food and
drink prior to consumpt ion, and then verbally describe what they are describing in the image. Then, they upload the voice and image to the website to analyze. Recent ly,
a wearable device that looks like the appearance of a necklace, wit h a microphone, camera as well as other sensors has been a dded to the. This technology ut ilizes video
recording to record details about dietary intake The software then ident ifies the eat ing episodes and calculates the amount of food consumed wit h in t he recorded
video. Then, the final int ake amounts are automat ically calculated. This technique is expected to reduce the burden on subjects by using object ive observat ions but this
technology is in the experimental stage to be utilized in research.

The most advanced technologies have immense potent ial for adaptation to be a significant instrument for assessing dietary int ake in various epidemiological studies to
conservat ive open-ended techniques based on pencil and paper surveys. Table 2 highlights the strengths and weaknesses of method s for assessing dietary intake using
advanced methods. The development of software and hardware requires a lot of money in the init ial stages of research. But, only when they are ready, DRs and 24HRs
with advanced technologies can reduce costs and expenses for arranging studies and managing and storing data. It will also help improve the accuracy of data, gather data
in real-t ime and calculate intakes of dietary food automat ically, and let respondents concentrate on the assessment of their diet. Although the possibilit y of using mult i-
24HR DRs and 24HRs in epidemiological research has significant ly increased wit h the help of t he latest technologies t here are still limitat ions. The first is t hat these
techniques aren't always easy to use for certain groups th at are not aware of the latest technologies or devices. Training t he participants on how to utilize these new
technologies and how to use computers, including accessing online is necessary. Addit ionally, the technical issues in storage, data transfer batte ries, and other issues must
be addressed. The most important thing is that these new approaches do not seem to resolve the problems wit h methods that are associated wi th self-report. An earlier
study found that people st ill struggled wit h recalling their d iet and reporting it and under -reported their diet in mult iple tests, and also changed their diets when they knew
the study date beforehand. This is why open-ended methodologies that incorporate new technology are not yet extensively used as the principal method of assessment in
epidemiological studies.

PAGE 15
Dietary background

To determine the long-term healt h of a person's diet, Burke developed a dietary history method in 1947. This method requires subjects to complete a 24 -hour, 3-day food
diary and an inventory of food items they usually consume. Highly trained experts are required to gather details on the subject's t ypical diet by conduct ing deep interviews
(approximately 90 minutes in total). This method is not often employed in studies of epidemiolog y.

Food frequency questionnaire

It is FFQ is an upgraded version of the checklist used in the dietary history, which questions respondents to indicate how of ten and how much food they consumed over
an extended period. The quest ionnaire covers about 100-150 food items, the quest ionnaire is completed in 20 -30 minutes and is self-administrat ion or collected via an
interview. This technique allows the evaluation of long -term consumpt ion of food in a fairly easy, cost -effect ive, and t ime-efficient way. Therefore, a variet y of FFQs
have been extensively used as a useful tool in the 1990s. FFQs need to be specifically designed for each study group as well as research object ives because diets can be
affected by ethnicit y, preferences of individuals, culture or econo mic status, etc. The case of South Korea, approximately 20 FFQs have been created and utilized in
epidemiological studies.

The first FFQ was developed in South Korea, the first FFQ was created by modifying of FFQs that were used for Western countri es to accommodate Korean specifics of
diet. Then, certain FFQs were created in response to the opinions of diet it ians wit h experience and epidemiologists based on the nu trients present in Korean foods and the
findings of earlier studies. The most recent FFQs are being designed in a more advanced approach based on the actual data about diet that were collected through open -
ended surveys. From the diverse foods consumed by part icipants, the most informat ive food items are chosen based on the degree to which food products contribute to
specific nutrit ional int akes or how much the food items accounted for differences between people. The selected food items are categorized according to their nutrit ional
content or cooking techniques before being the food is presented in a closed manner.

In accordance wit h the goals of scient ists, FFQs may focus on the intake of particular nutrit ional elements, exposures to die tary substances that may be that are associated
with a specific illness, or assess in depth the various nutrients. For prospect ive studies, a thorough assessment is usually recommended since it permit s us to analyze the
nutrit ional components that weren't considered to be important in the init ial study but may become an important aspect in the future. A thorough assessment can also
allow us to determine the consumpt ion of various food components which could act as a source of confusion wit h respect to a m ajor diet-related issue or illness and allows
for statist ical adjust ments.

PAGE 16
In accordance wit h the manner in which fo od items are informed in FFQs food-based FFQs like those from one Harvard FFQ or dish -based FFQs were created. Korean or
Asian food is most ly comprised of mixed dishes, which are prepared using individual ingredients seasonings, spices, and cooki ng oils. Therefore food-based FFQs can
increase subject burdens and raise errors in responses when respondents do not cook their meals or are not aware of their ing redients. Addit ionally, one that is based on
food FFQ can underest imate the intake of dietary nutrient s more than food-based FFQs do due to the various seasonings (e.g. sodium, soy sauce the paste of red pepper,
soybeans, etc.).) and cooking oils majorly influencing the nutrit ion (e.g. sodium, energy, fat and b -carotene intakes as well as sodium, energy, a nd fat.) intakes are not
included when calculat ing dietary intake. This is why the approach based on food has been suggested as an alternat ive strategy to improve the assessment of dietar y
intakes in countries that have an Asian diet.

Average consumpt ion frequency is measured using open-ended quest ions but the majority of FFQs gather data from nine possible answers, ranging from zero to more than
three times every day. Different answer options are used to enhance the qualit y of data and lessen the amount of work for the subject. For food items consumed in the
summer, the subjects are usually asked how often and over how long they consumed the seasonally -based foods. For foods that are consumed frequent ly, like coffee, the
answers are collected in the form of open-ended quest ions wit hin some FFQs.

The use of quest ions in FFQs regarding portion sizes has been a source of controversy: Researchers have reported that variat i ons between individuals in the size of
portions weren't significant because this variat ion is usually less than the variat ions in consumpt ion frequency. However, in South Korea, however, informat ion on the
size of portions of certain foods may be crucial, such as rice cooked, as the variat ions between people could be largely due to the size of the food instead of the
frequency. In the past, the semi-quant itat ive FFQs gathering data on portions in an average sealed format are extensively ut ilized in epidemiological research in comparison
to the simpler FFQs that only ask about frequency or quant if iable FFQs that ask about the quant it y of food consumed using open -ended quest ions.

The FFQs, that uses an open format, must be analyzed for accuracy prior to use to assess dietary intake in research. A correlat ion coefficient ranging from 0.5 and 0.7 is
considered to be moderate; however, the majorit y FFQs are from Asian countries, which includes South Korea tend to have correl at ion coefficients that range from 0.3 to
0.5 and are lower than those from Western countries.

Certain researchers have quest ioned the merits of the use of FFQs for epidemiological research and the issue is st ill a hotly debated topic. Addit ionally, a number of
efforts to measure t ypical int akes of food accurately by using FFQs along wit h numerous 24HRs and DRs are being made. Innovat ive techniques introduced FFQs which
can be optically scanned to employ complex skip algorithms and examine mult iple aspects, as well as range checks and permit s the presentat ion of images of food items
to simplicit y in reporting the size of portions. All of these improvements enhance the qualit y of diet informat ion and increase our abilit y to capture complex informat ion.

PAGE 17
CONCLUSION

Dietary intake is hard to determine and any one met hod can't accurately measure the amount of dietary exposure. Biomarkers of nutrit ion can be used to provide an
object ive assessment of exposures to food in the anthropometric and clinical assessments and 24 -HR and DR and dietary hist ory and FFQ are based on subject ive
est imates. Many efforts have led to improvements regarding the accuracy and reliabilit y of int ake assessment techniques, and the abilit y of open -ended techniques using
a variet y of innovat ive met hods in epidemiological research has been significant ly improved. However, the newer methods require more money t han FFQs a nd the inherent
issues wit h self-reporting remain unsolved. In spite of the ment ioned limit at ions, FFQs are st ill widely ut ilized as the main diet assessment tool in epidemiological
research.

Recent ly, it was suggested that a combinat ion of techniques like the FFQ that includes Drs (or 24HR) or the FFQ that incorporates biomarker levels, can be ut ilized to
provide more precise est imates of intakes from food in comparison to individual methods. Numerous efforts are being made to increase the accuracy and eff iciency of
large-scale epidemio logical studies are ongoing.

In conclusion, the assessment of dietary methods must be chosen wit h care and in conjunct ion wit h the research's purpose hypo thesis, design, and the resources available.

REFERENCES

Baik I, Cho NH, Kim SH, Shin C. Dietary information improves cardiovascular disease risk prediction models. Eur J Clin Nutr. 2013;67:25–30.

Doll R, Peto R. The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst. 1981;66:1191–1308.

Kho M, Lee JE, Song YM, Lee K, Kim K, Yang S, et al. Genetic and environmental influences on sodium intake determined by using half-day urine samples: the Healthy Twin Study. Am J Clin
Nutr. 2013;98:1410–1416.

Kim YJ, Kim OY, Cho Y, Chung JH, Jung YS, Hwang GS, et al. Plasma phospholipid fatty acid composition in ischemic stroke: importance of docosahexaenoic acid in the risk for intracranial
atherosclerotic stenosis. Atherosclerosis. 2012;225:418–424.

Lim S, Shin H, Kim MJ, Ahn HY, Kang SM, Yoon JW, et al. Vitamin D inadequacy is associated with significant coronary artery stenosis in a community-based elderly cohort: the Korean
Longitudinal Study on Health and Aging. J Clin Endocrinol Metab. 2012;97:169–178.

PAGE 18
Nutrition epidemiology. New York: Oxford University Press; 1998.

Potischman N. Biologic and methodologic issues for nutritional biomarkers. J Nutr. 2003;133 Suppl 3:875S–880S.

Streppel MT, Sluik D1, van Yperen JF1, Geelen A1, Hofman A, Franco OH, et al. Nutrient-rich foods, cardiovascular diseases and all-cause mortality: the Rotterdam study. Eur J Clin
Nutr. 2014;68:741–747.

PAGE 19
Topic
“To develop your skills for assessment of dietary data using
communication skills and 24-hour recall Questionnaire and
food composition tables”

Abstract

The aim of this study was to assess the relative validity of an interactive 24-hour recall used in a

large randomized controlled trial among 15-month-old Malawian children. Relative validity

studies should always be done when a dietary method is applied to a new population. The

interactive 24-hour recall is a modified version of the traditional 24-hour recall. It was developed

in 1995 in order to improve the validity of 24-hour recall in measuring nutrient intake in poor

rural areas in Layya city. The modifications of the interactive 24-hour recall are designed to

make remembering food items and estimating portion sizes easier for the respondent. In the

interactive 24-hour recall, the day before the recall interview the respondents are asked to use

standard sized bowls and cups when eating, and to mark off each eaten food item on a picture

chart containing pictures of local foods. The picture chart is intended to reduce memory lapses,

and the use of cups and bowls is intended to facilitate estimating quantities of consumed foods.

Objective

For this study we using the i-24HR, two categories of objectives can be defined (Gibson &

Ferguson 2008). First, if a study aims to characterize mean intakes of a group of individuals, the

test method should yield similar mean intakes of nutrients as the reference method.
Introduction

The second United Nations Sustainable Development Goal for 2030 focuses on ending all forms

of malnutrition, particularly by addressing the nutritional needs of women and children living in

low-resource settings . Certainly, in recent years great emphasis has been placed on targeted

nutrition interventions during ‘The First Thousand Days’, the exceptionally vulnerable period

from conception through two years of age when sub-optimal nutrition can result in long-term

negative physical and developmental consequences, especially for those living in poverty .

Women of reproductive-age living in such settings are likely to be at risk of inadequate nutrient

intakes, particularly of multiple micronutrients . Yet quantitative dietary data generated from

rural areas in lowand middle-income countries (LMIC) are sparse due to the intensive and

complex work required to compile a robust food composition database (FCDB), as well as lack

of validated regional database sources. In a strong effort to overcome the latter issue, steady

work has been done over the past few years to improve the quality of several regional food

composition tables (FCTs) as shown by the International Network of Food Data Systems

(INFOODS) of the Food and Agricultural Organization (FAO) of the United Nations . This work

has been an invaluable contribution in providing a reliable framework for local FCDB

development, particularly in regions of West/ Central Africa and the Asian sub-continent. Yet

only individual raw foods are typically included, adding to the complexity of estimating the

correct nutrient composition of commonly consumed cooked foods. Thus, as part of the Women

First Preconception Nutrition Trial (WFPNT) , a large multi-site individually randomized

controlled trial (RCT), our aim was to implement a robust dietary methodology in order to

estimate the dietary adequacy and prevalence of the population ‘at risk’ of inadequate nutrient

intakes in first-trimester pregnant women living in four LMIC. Furthermore, we plan to examine
associations between dietary intakes and nutritional outcomes in this longitudinal study. To this

end, we incorporated the use of repeat 24-hr recalls and the construction of a unique local FCDB

at each of the four sites. This paper describes the dietary methods implemented here, including

the advantages and challenges faced during the process.

FOOD RECORD OR FOOD DIARY:

A food record (also called a food diary) is a self-reported account of all foods and beverages (and

possibly, dietary supplements) consumed by a respondent over one or more days (i.e., an n-day

food record). Because the instrument is open- ended, there is no limit to the number of items that

can be reported.

DISADVANTAGE:

Disadvantages of a dietary record include biases both the selection and measurement of the food.

• Some participants will change what they eat drastically during a recording period.

• This recording bias is seen as a disadvantage as a typical day is not recorded.

• In some situations this is a good problem to encounter.

• If the aim of the dietary record is to make the participant aware of what they are eating

and changing that behavior, this “bias” in data collection can be seen as an advantage.

FOOD FREQUENCY QUESTIONNERE:

Food Frequency Questionnaires (FFQ) are a type of dietary assessment

instrument that attempts to capture an individual’s usual food consumption by querying the

frequency at which the respondent consumed food items based on a predefined food list. Given

that food lists are culturally specific, FFQs need to be adapted and validated for use in different

contexts.

FFQs are a common method for measuring dietary patterns in large epidemiological studies of

diet and health. FFQs are often limited to the food items that are a source of nutrients related to

the particular dietary exposures under study, for example, fruit and vegetable consumption or

foods with high levels of saturated fat. Dietary diversity scores are a type of metric that are often

calculated from a simplified FFQ (see the description of dietary diversity metrics to learn more).

Food consumption modules of Household consumption estimate survey (HCES) that use a food

list and an extended recall period can also be considered a type of FFQ.

DISADVANTAGES:

• FFQs require substantial up-front investment to develop and validate the instrument (food

list and quantities) for a given context or country.

• Usual frequency of intake is prone to measurement error, particularly with recall periods

longer than seven days (and usual portion size questions are prone to measurement error)

• If the FFQ is too long it can be more time consuming to administer than a standard 24-

hour dietary recall and cause respondent fatigue

• Like most surveys, to capture seasonal variation data collection must span the entire year

or be repeated in multiple seasons

24- HOUR DIETARY RECALL:

A 24-hour diet recall is a dietary assessment tool that consists of a structured interview in which

participants are asked to recall all food and drink they have consumed in the previous 24 hours. It

may be self-administered. The 24-hour diet recall relies on a trained interviewer, an accurate

memory of intake, an ability to estimate portion size, and the interviewee's reliability to not

misreport. This method can be administered by telephone, is suitable for large surveys, and has a

low burden for respondents. In the interview, participants are asked to describe the foods and

drinks they have consumed in the previous 24 hours; the participant then might be asked to

provide more detail than what was initially provided. The open-ended nature of the interview is

intended to help produce the most detailed description of foods and drinks consumed over the

previous 24 hours. Details might include time of day, source of food, and portion size of food. A

24-hour diet recall is typically completed in 20–60 minutes. The 24-hour diet recall is most

accurate when administered more than once for each individual.

APPLICATIONS:

24HR data can be used to assess total dietary intake and/or particular aspects of the diet:

• The 24HR gives us detailed information on foods and beverages consumed on a given

day. The total amount of each specific food and beverage consumed is measured.

• Similar types of food and beverage items reported, such as soups or sugar- sweetened

beverages, can be grouped. Totals for each group can then be summed.

• 24HRs can be used to describe a population's intake.

• Collecting a recall for at least two non-consecutive days allows application of statistical

techniques to estimate usual dietary intake distributions for a group.

• 24HRs can be used to examine relationships between diet and health or other variables.

• Sometimes, they are used as a reference instrument to validate estimates when another

less detailed assessment instrument, such as a food frequency questionnaire, is used as the main

dietary assessment method.

• With the help of self-administered 24HRs it can be used as a main dietary assessment

instrument with or without an FFQ for diet-health studies.

• The number and timing of the 24HRs needed depends on the objectives.

• 24HRs can be used to examine relationships between some factor and diet, in which diet

is the dependent variable.

• 24HRs can be used to evaluate the effectiveness of an intervention study to change diet.

• The reason for different response due to the possibility that the intervention group and

control group may report their diets differently.

• The number and timing of the 24HRs needed depends on the intervention design and the

objectives.

ADVANTAGES:

– Being a retrospective method, the subject’s usual consumption is not altered.

– Serial recalls can estimate the usual intake at the individual as well as the community

level.

– It’s administration does not require so much time.

– High precision (capacity of the method to produce similar measures or results when the

tools is repeatedly administered in one context). Improves with increased numbers of 24hDR

administered in the same study subject (2-3 times).

– Elevated response rate.

– Can be administered to low literacy populations (via direct interviews). – Validity (the

extent to which the method or instrument measures what is supposed to be measured and is

exempt of systematic errors). It is considered as a valid instrument for the assessment of energy

and nutrients. To validate 24hDRs, the use of food records or other methods such as direct

observation of actual consumption (weighed food records, doubly labelled water, filming,

cameras, etc.) as well as certain biochemical parameters.

Literature Review

Reliable assessments of the associations between diet and health require estimation of usual diet.

Traditional methods of dietary assessment such as multiple 24-h dietary recall interviews and

food diaries can be impractical for large cohort studies often requiring costly and time-

consuming manual nutrition coding. Food frequency questionnaires (FFQs) have been used in

epidemiological studies due to their relative ease of administration and low participant burden.

However, FFQs are subject to measurement error due to imprecision with respect to portion

sizes, limited food lists, lack of detail regarding food preparation and the potential for
misclassification of participants according to intake. Multiple 24-h dietary recalls effectively

represent habitual dietary intake and have shown less bias in reporting of energy and protein

intakes when compared with FFQs using biomarker measures. Along with convenience and

scalability, incorporation of an online 24h dietary recall into large prospective cohort studies may

advance our understanding of the nutritional determinants of disease through possibly improved

assessment of diet. Ultimately, this would allow for more reliable evidence-based formulations

of health policies. A number of online dietary assessment systems have already been developed.

In the United States, Subar et al. (2010) have developed ASA24 (Automated Self-Administered

24 h Recall), which is currently being used in many studies. ASA24 is based on the USDA’s

“Automated Multiple Pass Method” (AMPM), which involves recording intake in a series of

defined “passes” to elicit a detailed recall. The AMPM has been validated against doubly-labeled

water and shown to accurately estimate mean total energy intake in “normal”-weight individuals

. While an online 24-h dietary checklist for the Layya District exists (the Oxford WebQ ), there

is currently no automated 24-h recall dietary assessment tool appropriate for the Layya city

population. To address this gap, a fully automated online 24-h dietary assessment system,

myfood24 (Measure Your Food on One Day) was developed with the flexibility to be self- or

interviewer-administered as required and to be used as either a 24-h dietary recall or a food

diary. This research acactivity aims to describe the myfood24 development process and provide

an overview of its features and functionality relating to self-administered use.

Discussion

This dietary strategy provides the opportunity to assess estimated mean group usual energy and

nutrient intakes and estimated prevalence of the population ‘at risk’ of inadequate intakes in first-
trimester pregnant women living in four low- and middle-income countries. While challenges

and limitations exist, this methodology demonstrates the practical application of a quantitative

dietary strategy for a large international multi-site nutrition trial, providing within and between-

site comparisons. Moreover, it provides an excellent opportunity for local capacity building and

each site FCDB can be easily modified for additional research activities conducted in other

populations living in the same area

Method Study Design

Dietary assessment was planned for pregnant women living in rural areas of Democratic

Republic of the Congo (DRC), Guatemala, India and Pakistan parti cipating in the WFPNT

from 2012–2017, as described earlier. Briefly, the objective of this 3-armed RCT is to determine

the benefits to the offspring of women in poor environments of commencing a daily

comprehensive maternal nutrition supplement at least 3 months prior to pregnancy (Arm 1)

versus commencing the same supplement at 12–14 week gestation (Arm 2) and to compare

offspring outcomes with those not receiving supplement (Arm 3). From each of the four sites,

240 women (total 960) were randomized from Arms 1 and 2 to receive two 24-hr dietary recalls

conducted 2–4 weeks apart once pregnancy was confirmed and prior to 12 week gestation. Of the

‘dietary’ women, half were randomized from Arm 1 and half from Arm 2, the latter group’s

diet assessed prior to commencing the supplement. A five-day training was provided at the

beginning of the study by the lead study nutritionist (RL) for local nutritionist at each site, except

Pakistan, for whom the initial training was conducted in person in Colorado, USA. Based on

recommendations from several key sources, training topics included: methodology of the

multiple-pass 24-hr recall (i.e. revisiting and checking the dietary information during the
interview); appropriate interview techniques; estimation of portion sizes; conversion of

consumed amounts to gram weight equivalents; development of generic recipes for mixed

dishes/beverages; and step-wise instructions to compile a site-specific FCDB. Process mentoring

continued on a weekly basis by distance (via Skype and email) throughout the study.

Assessment of food intakes

A food intake database was constructed based on two 24-hr recall interviews, standardized for

all sites and pretested at each location. The dietary recalls were conducted by the site nutritionist

on non-consecutive days within two weeks of each other in the participant’s home with the

following information reported: participant ID; recall day; season; type of day (e.g. usual, feast,

market, fasting); previous day’s health; food consumption time (e.g. breakfast, lunch, dinner or

snack); loca tion of food consumed (e.g. in the home, outside); food/dish name; food code; and

amount consumed (grams). Continuous monitoring by the lead study nutritionist of all data entry

provided checks to mini mize reporting errors. Locally developed picture charts served as an

aid to prompt remembrance of foods consumed and food probe questions encouraged detailed

descriptions of reported foods/beverages. For example, poultry probe questions included the kind

of bird, exact part or piece, meat plus skin or meat only, method of cooking, bones (waste

factor), etc. To estimate portion size, the participant provided the same amount of food or drink

consumed the prior day using local spoons/containers and then weighed in grams. However,

since left-over food was usually unavailable in these poorly-resourced households, photographs

displaying a graduated range of portion sizes were used frequently to obtain the best estimation

of portion amount, as well as reported number of spoon- or hand-fuls from the ‘family pot’. The

site nutritionists were also very familiar with the local market value of commonly purchased

items, e.g. 50 Congolese francs purchased approximately 30 grams of roasted peanuts. Mixed
dishes and beverages containing more than one ingredient were typically consumed by these

populations. Thus, the development of local ‘generic’ representative recipes were used to

calculate their nutrient content. For each mixed dish/beverage consumed by the study population,

5–10 local recipes were collected (amounts in grams) from several different women participants

by the site nutritionist, with particular care to ensure water and oil added during cooking were

also included in the recipe. In some situations (e.g. Pakistan), the local nutritionist watched the

recipe preparations, measuring exact quantities (grams) of ingredients used in the dish. This

process was followed by calculation of a median recipe per 100g (see Figure 1). All recipes were

checked for feasibility and accuracy of calculations by the lead study nutritionist.

Site-specific food composition database compilation

A unique FCDB was constructed at each site based on the food intake data collected from the
dietary recalls. Food names were included in both the local language and in English, with careful
description of the exact food. Food components included moisture content, energy,
macronutrients (protein, total fat and fatty acids [saturated, monounsaturated, polyunsaturated],
carbohydrate); dietary fiber; minerals (calcium, iron, zinc); vitamins including thiamine (B1),
riboflavin (B2), pyridoxal phosphate (B6), folate (B9), cobalamin (B12), choline, betaine,
ascorbic acid (C), and vitamin A (retinol activity equivalent, RAE); and an anti-nutrient
(phytate). Appropriate folate values (either food folate or dietary folate equivalent, DFE) were
chosen
based on the country’s national fortification policies. All choline and betaine values were

sourced from the current United States Department of Agriculture (USDA) National Nutrient

Database for Standard Reference, Release 28 , or the latest USDA Database for the Choline

Content of Common Foods . The 13 designated food groups included: starchy tubers and staples;

legumes and nuts; milk and dairy; organ meats; eggs; flesh foods (meat or poultry); fish and

miscellaneous small animal protein (e.g. insects); vitamin A-rich vegetables and fruit (≥ 60

RAE/100g); other vegetables and fruit; fats and oils; sweets and sugars; beverages; and

miscellaneous, e.g. fast foods. Generic recipes were assigned to the appropriate food group,

depending on the primary ingredient or content of foods significantly affecting the overall

nutrient con tent of the recipe, e.g. presence of animal-source foods. FCDB raw and cooked
nutrient values for DRC, India and Pakistan were primarily derived from recently developed

FAO-supported regional FCTs, i.e. the West African FCT was used for the DRC site FCDB

whereas the Indian and Pakistan sites utilized the Bangladesh FCT . For the Guatemala FCDB,

values were primarily taken from the USDA database , as well as from the database compiled by

the Institute of Nutrition of Central America and Panama (INCAP) , with care that food choices

from the USDA database were consistent with the Guatemalan national food fortification

policies. Finally, every effort was made to ensure the imputed values reflected the same

analytical methodology across all databases. Missing values from the West African or

Bangladesh FCTs were usually borrowed from the USDA database with adjustments to account

for differences in moisture content, unless a more precise food match was found in the World

Food Dietary Assessment System (WFDAS) . The latter also provided all phytate values;

however, moisture adjustments using the WFDAS were not possible. Additionally, a food match

code was provided for all FCDB values as described by FAO/INFOODS , indicating whether the

imputed values were an exact or similar match to the required food item. For some foods, only

raw values were available from the reference databases. Thus, when cooked values were required

for individual foods and/or recipes, raw to cooked adjustments for nutrient retention and yield

after cooking were made using appropriate retention and yield factors . These factors were

applied at the ingredient level for the recipe nutrient calculations (see Figure 2). In this method,

the contribution of each ingredient to the overall recipe

Figure 2: Method for generic recipe calculation at the ingredient level 2023

was calculated by multiplying the energy or nutrient value per 100g of each ingredient in its

consumed form (i.e. raw or cooked) by its percentage contribution to the 100g generic recipe (i.e.

ingredient contribution/ 100g), with the contribution from all ingredients added together. Then

the ‘cumulative’ energy and nutrient values for each recipe were added into the appropriate

database row. Finally, a unique food code was assigned for every individual item and generic

recipe row in each site FCDB. Upon completion, checks were planned according to

FAO/INFOODS guidelines , ensuring no required foods or values were omitted.

Statistical analyses

At the end of the WFPNT, this dietary method of conducting two 24-hr recalls in ≥100 women

per arm will allow for analyses by site (overall and by arm) including: estimation of group usual

energy and nutrient intake distributions, and determination of the percentage of the population ‘at

risk’ of inadequate nutrient intakes compared to international guidelines . Within- and between-
site comparisons will be made using a Student’s t test and analysis of variance (ANOVA),

respectively, as well as multi-variate regression models examining associations between nutrient

intake and relevant factors, e.g. maternal education, seasonal variation, etc. Analyses will utilize

STATA statistical software package 13 (Stata corporation, College Station, TX, USA) and Intake

Monitoring, Assessment and Planning Program (IMAPP) Version 1.0 (Iowa State University,

2010), with support from RTI International.

Preliminary results

To date, two 24-hr recalls have been conducted in >200 women per site (~925 total), equally distributed

between Arms 1 and 2. Further, >100 local generic recipes for mixed food/beverages have been

developed per site. All site FCDBs are currently still in progress but thus far, each unique site FCDB

contains between 260 to 350 foods, beverages, and recipes in total.

Discussion

Our study has demonstrated that with adequate initial training and ongoing supervision, local

nutritionists in four LMIC were able to conduct two standardized 24- hr recalls per dietary

participant (>200 participants/ site), as well as properly develop a site-specific FCDB. This

method will allow for quantitative assessment of the diet in first-trimester pregnant women in

these settings and their estimated risk of inadequate intakes. Furthermore, each unique FCDB

can be readily modified for other population groups, e.g. children, adolescents, etc., in the future.

Such a strategy is highly advantageous for large international RCTs, particularly in areas with

ongoing research studies. This preconception trial, for example, is part of the Global Network

(GN) for Women’s and Children’s Health Research, which has supported research activities and

capacity building in these specific regions for more than a decade and thus, the site FCDBs are
likely to be useful for other studies in the future. In recent years, the inclusion of dietary

assessment as part of large nutrition research trials has gained greater priority, as demonstrated in

the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the

Consequences for Child Health and Development (MAL-ED) study . Typically, qualitative or

semi-quantitative dietary methods (e.g. dietary history, food frequency questionnaire) have been

used for the sake of cost and minimal participant burden. Yet proper validation of these

instruments can prove challenging, especially in remote regions. Moreover, both of these

methods are limited by the difficulty in estimating their inherent source of errors , and the

within- and between-subject variability cannot be calculated . In contrast, repeated weighed food

records are the most precise method for estimating usual individual nutrient intakes, but it has a

high respondent burden and is usually too expensive and cumbersome to be used in LMIC.

However, the multiple pass 24-hr recall method has been used extensively in such settings with

the advantage of relatively low participant burden [7]. Importantly, it can provide a reasonable

reproducible estimate of the mean usual intakes of a group when conducted as done in this study

(i.e. interviews on all days of the week with non-consecutive participant interviews) [28].

Furthermore, the inclusion of a repeat 24-hr recall for all participants allows the percentage of

those ‘at risk’ of inadequate nutrient intakes to be calculated. Such analyses are possible through

the use of a robust local FCDB containing nutrient values for commonly consumed cooked

mixed dishes and beverages. The inclusion of such complex foods, in addition to individual

ingredients, allows for a more accurate estimate of nutrient intakes in these populations,

especially when FCDB nutrient values are sourced from a high quality FCT with similar foods.

Notably, the reference regional FCTs used here have all been published within the last five years,

except for the INCAP and WFDAS databases. While compilation of a site-specific FCDB is
typically considered beyond the scope of most research studies, we have demonstrated that local

nutritionists can gain the necessary understanding and skills to complete this detailed task with

comprehensive train ing and mentoring. We acknowledge a distinct advan tage of this trial has

been the continuous oversight provided by a well-trained lead nutritionist (RL), with ongoing

coaching of local nutritionists and monitoring of all databases throughout the study. However,

challenges and limitations exist, especially in determining the correct nutrient values for local

wild and cultivated edible foods consumed in remote geographical areas. In some instances,

different wild species may have the same local name and thus some ambiguity remains as to the

appropriate nutrient content of these foods. Organizations such as FAO/ INFOODS and

Bioversity International (www.bioversi tyinternational.org) are committed to identifying and

publishing nutrient values for biodiverse foods . Likewise, more high quality regional FCTs are

urgently required to ensure the nutrient values chosen for local foods are accurate. Again,

FAO/INFOODS and other groups (e.g. International Dietary Data Expansion Project, INDDEX)

are making a concerted effort to expand the work of developing regional FCTs of high standard.

Lastly, accurate determination of portion size was often very challenging in our study areas,

particularly with food consumed from the family pot. Yet through the use of a variety of memory

aids (e.g. graduated portion size photographs) and excellent familiarity with local household and

market measures, we strove to gain the most reliable information possible on amounts consumed

by participants. Additionally, while every effort was made to ensure the nutrient values sourced

between the site FCDBs reflected the same analytical methodology, a few discrepancies exist

between databases. For example, total fat was determined by the mixed solvent extraction

method in the USDA database [11] and most foods found in the West African FCT , whereas the

Soxhlet method was used for fat values in the Bangladesh FCT and for a few West African FCT
values . Finally, more than two 24-hr recalls might improve assessment of group intakes of

certain micronutrients, which may have greater variability in the day-to-day diet. A recent

Mexican study, with data from 31 cities, reported three 24-hr recalls, rather than one recall,

improved the estimation of micronutrient intakes in these urban populations. No compar ison

was made, however, between two versus three dietary recalls and as our study was conducted in

poor rural communities, we anticipate the within-sub ject variation will be lower than the

between-subject variation due to the limited number of the foods con sumed in these very

resource-poor environments . In conclusion, we developed a feasible and practical quantitative

dietary assessment method that affords the potential to gain much needed insight into the

nutritional dietary adequacy of first-trimester pregnant women in these settings, allowing for

within- and between-site comparisons. Incorporation of such diet ary methodologies into large

multi-site RCTs could be highly useful, especially in areas with ongoing research, as it provides

an excellent opportunity for local capacity building, and the site FCDB can be easily modified

for the specific population group of interest. Moreover, the application of this knowledge could

help to refine targeted interventions, as well as provide a strong research base in order to more

fully understand the dietary contribution to risk for other health outcomes and diseases in low-

resource environments.

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