DIETARY HISTORY

NUTRITIONAL ASSESSMENT

WINSTON P. CAHINDE
Eastern Visayas State University
OCTOBER 2023
 format, the third component is
commonly omitted.

Dietary history
The dietary history method
(Burke, 1947) attempts to estimate the
The time periods covered by the
usual food intake and meal pattern of
dietary history method vary. The
individuals over a relatively long period
maximum time period that can be used
of time—often a month. This interview
has not been definitely established.
method was originally designed to be
When shorter time frames (i.e., < 1 mo)
carried out by a nutritionist trained in
are used, reproducibility and validity are
interviewing techniques. More recently,
apparently higher than for longer periods
computerized versions have been
(see Section 7.1.2).
developed (Kohlmeier et al., 1997).
Measurements of food intake
Such versions provide standardized
over I-y periods are probably unrealistic
methods for data collection and probing
unless seasonal
and minimize potential interviewer bias
variations in food intake are taken into
in responses.
account.
Initially, the dietary history had
three components.
The recording of a dietary history
The first component was an
can be very labor intensive, with
interview about the usual overall eating
interviews taking up to 2 h per subject
pattern of the subject, both at mealtimes
(Slattery et al., 2000). Several
and between meals. Such information
investigators have reported that the
included detailed descriptions of foods,
dietary history tends to overestimate
their frequency of consumption, and
nutrient intakes when compared with
usual portion sizes in common
results from weighed records. Nes et al.
household measures. "What do you
(1991),
usually eat for breakfast?" is a typical
In general, because dietary
question that might have been included
histories, unlike food frequency
in the interview.
questionnaires, do not limit the variability
The second component served
in the responses, they overcome many
as a cross-check and consisted of a
of the limitations of a food frequency
questionnaire on the frequency of
questionnaire.
consumption of specific food items. This
part was used to verify and clarify the
Reproducibility
information on the kinds and amounts of
foods given as the usual intake in the
The reproducibility of a dietary
first component. Questions asked
history when used to assess usual mean
related to specific foods, such as: "Do
intakes at the group level depends on
you like or dislike milk." A 24-hour recall
the time frame used, its method of
of actual intake may also have been
administration (e.g., face-to-face or
included at this stage.
telephone interviews), the time lag of the
In the third component, subjects
method, the technique of measuring
recorded their food intake at home for
amounts of foods consumed, and the
three days. Portion sizes at this stage
population group.
were estimated using a variety of
Normally, the dietary history
techniques, including standard
yields good reproducibility when used to
measuring cups and spoons, common
obtain group mean intake information,
utensils, commercial plastic food
especially over a relatively short time
models, photographs, or real foods.
frame.
Today, the original dietary history
Some investigators suggested
method is seldom used in this three-part
that a longer period was required to
estimate the usual food intake of their
usual diets compared with Japanese-
Hawaiian women.
Note that the use of only three
possible portion sizes in the dietary
history questionnaire of Hankin et al.
(1983) may have contributed in part to
the lower variability, and thus higher
reproducibility (Block and Hartman,
1989).
Relative validity of dietary
histories
One of the major advantages of
the dietary history method is its ability to
assess meal patterns and specific
details about the preparation and
consumption of food over an extended
period of time. However, some
respondents find the task of reporting
their usual food intake and the amounts
eaten difficult. Further, for certain sub-
populations or age groups (e.g.,
adolescents), who may lack set meal
patterns, such a meal-based approach
is not useful.
Very few studies have measured
the absolute validity of the dietary
history method by comparison with
actual food intake. This is not surprising,
in view of the difficulties of monitoring an
individual's usual long-term intake.
Weighed or estimated food
records have been most frequently used
as the reference dietary method in
studies of the relative validity of dietary
histories.
A few studies have also tested
the agreement between dietary histories
and weighed records by ranking
subjects using correlation coefficients
(Mahalko et al., 1985). It appears that
for those nutrients for which day-to-day
variation in individual diets is usually
high, notably vitamin A, cholesterol, and
linoleic acid, agreement by ranking is
poor, regardless of the time frame of the
dietary history used (Table 7.8)
(Mahalko et al., 1985; Liu et al.,
1994).
Finnish investigators have
examined the relative validity of a
modified diet history for measuring food
rather than nutrient intakes.
Relative validity of dietary
histories has also been assessed by
comparing the respondent's results with
those collected from another person,
such as a spouse or parent (Kolonel at
al., 1977; Jain et al., 1980; Marshall et
al., 1980). A good agreement between
spouses has been found. In general,
however, the results of the spouse
cannot be assumed to be any more
accurate than those of the original
respondent. Furthermore, because the
same method has been used for both
the respondent and the spouse, the
spouse's recall is not an appropriate
reference method..
In their study of
contemporaneous and retrospective
estimates of food intake using a dietary
history, Van Staveren et al. (1986b) also
concluded that current food intake
affected the reporting of past food
intake. These studies emphasize the
difficulties of obtaining unbiased
estimates of retrospective food intakes,
and such difficulties must be taken into
account when interpreting the results of
studies on diet and cancer (Hebert and
Miller, 1988).
Strength of dietary history

1. Provides details of meal patterns,

individual foods consumed, and usual
food intake after completing a single
interview
2. Provides quantitative estimates of
energy and nutrient intakes
3. Useful to describe usual food or
nutrient intake over a relatively long
period of time. It can be used to
estimate the prevalence of inadequate
diets.
4. Does not rely on the literacy of the
respondent
5. Provides information on foods that are
not regularly consumed
6. Does not interfere with normal eating
habits

Limitations of dietary histories

1. Relies on respondent’s memory,

which can lead to recall bias.
2. Labor-intensive, time-consuming, may
not be suitable for young children and
elderly respondents
3. To obtain detailed information on food
intake, longer interview time are needed,
resulting in high respondent burden.
4. Portion size estimation of past meals
can be difficult, even with the use of aid.
5. Requires trained personnel with
knowledge of local food culture and
eating patterns (interview-based dietary
history.
6. Requires literate respondents with the
ability to estimate portion size (self-
administered dietary history).
7. Expensive to administer.
8. Data entry and coding is time
consuming and requires trained
personnel.