Assessingdiets of childrenand adolescents@3

Helaine RH Rockett and Graham A Colditz

ABSTRACT Because of the increased interest in the diets of We discuss past and current studies of the diets of young
children and adolescents and the possible relation between those people, as well as the future of nutritional epidemiologic in
diets and adulthood diseases, we reviewed nutritional assessment vestigation in children.
methods used specifically in young people. The assessment of
diets of individual children and adolescents has evolved from
Hasse's study of Swiss and Russian girls in 1882 to Burke's PAST
development of the dietary history to the Ten State Nutrition
One of the first works on children's nutrient intakes was
Survey. Currently, various government-sponsored surveys and
published in 1882 by Hasse, who studied the diets of Swiss and
several other assessment programs are studying the nutritional
Russian girls aged 2—1
1 y (5). The girls' food was weighed and
status of children and adolescents. We discuss the methods used in
reported for 3 or 6 d. A duplicate of each food consumed was
these investigations, compare the available dietary assessment
analyzed for energy, protein, carbohydrate, and fat contents.
tools (the dietary record, 24-h dietary recall, and food-frequency
Fifty years later, Widdowson (5) observed that British children
questionnaire), describe the development of a new food-frequency
were eating amounts of protein, carbohydrate, and fat similar to
questionnaire (the Youth-Adolescent Questionnaire), and review
those reported by Hasse. During the subsequent decades, chil
new approaches. The data emerging from reproducibility studies
dren's diets were studied by several researchers, includ
suggest that food-frequency questionnaires provide enough accu
ing Herbst, MUller, and Shutz in Germany; Sundstrom and
racy in studies of adolescents to permit individual diets to be
Tigerstedt in Finland; and Gephart, HoD, and Fales in the
related to subsequent health outcomes. Am J Clin Nutr
United States (5).
1997;65(suppl): 1116S—22S.
The aim of many early nutrition researchers was to deter
mine the food requirements of children. These investigators
KEY WORDS Children, adolescents, dietary assessment,
concentrated primarily on energy, usually assuming that in
food-frequency questionnaire, dietary recall, dietary record
takes were equivalent to the body's requirement (5). However,
as interest in protein increased and essential minerals and
vitamins were discovered, assessment of individual diets re
INTRODUCTION vealed variability that had potential links to general health. In
the l930s, Widdowson and McCance (in Great Britain) devel
In light of the growing awareness of the possible connection oped a weighed-food method to record what individuals ate at
between the diets of children and adolescents and diseases of home (5). The technique was used in Widdowson's study of
adulthood, the diets of young people have recently received individual children's diets, in which 1 wk of food intake was
increased attention. Heart disease, cancer, and osteoporosis are recorded by or for 1028 children aged 1—18y in 1936—1939
among the diseases that have been suggested to have their
(5).
origin in childhood eating habits (1). The monograph Healthy In the l940s, Burke (6) (Harvard School of Public Health)
People 2000 (2) identified children as a population group in developed the dietary history method for the Longitudinal
which the intake of total and saturated fat should be decreased, Studies of Child Health and Development. Burke's method for
calcium intake increased, and general dietary improvements determining the intake of an individual involved recording
made to decrease the prevalence of obesity (3) (Appendix A). dietary habits and the amount and frequency of foods con
The study of diets of adults poses methodologic problems sumed, as well as several 24-h dietary recalls. This method was
relating to the accuracy of assessment. Dietary studies in chil used extensively by Beal (7, 8) in the Denver Infant and Child
dren have an additional dimension of difficulty because chil Study of the 1950s. Among 38 children followed from infancy
dren' s cognitive ability to record or remember their diets (4), as
well as their limited knowledge of food and food preparation,
I From Brigham and Women's Hospital and the Channing Laboratory.
must be addressed. Moreover, as children grow, they eat more
Harvard Medical School. Boston.
food away from home and the contribution of this consumption
2 Supported in part by the National Institutes of Health (grants DK
to overall nutrient intake must be included. In addition, the age 42600 and DK 46834). GAC was the recipient of a Faculty Research
of the group being studied influences the study methods used Award from the American Cancer Society.
and who records the diet. All these factors have been consid 3 Address reprint requests to HRH Rockett, Channing Laboratory, 181

ered by investigators in the design and implementation of Longwood Avenue, Boston, MA 021 15. E-mail: helaine.rockett
studies of children's diets with use of the available methods. @channing.harvard.edu.

1116S Am J C/in Nutr 1997:65(suppl):lll6S—22S. Printed in USA. ©1997 American Society for Clinical Nutrition

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 ASSESSING DIETS OF CHILDREN AND ADOLESCENTS
through 8 y of age with use of dietary histories recorded every
3 mo, Beal found a wide range of intakes, even though the
subjects had similar socioeconomic and cultural backgrounds.
She also observed that individual children had a unique intake
throughout the study and that this could vary from the intake of
other members of their families (8).
In the l960s, the US government, under the assumption that
an individual's health might be related to his or her nutritional
status, started several national surveys of individual nutrient
intake with the purpose of characterizing the nutritional status
of the American public. The nutritional status of children and
adolescents was assessed in the Ten State Nutrition Survey (9),
which used 24-h recalls to record dietary information in 10
states representing all geographic regions of the country. Dun
ing the 1970s, two national surveys ofdietary intake began: the
National Health and Nutrition Examination Survey (NHANES)
and the Nationwide Food Consumption Survey (NFCS) (10,
I I ). These surveys represented repeat cross-sectional data
sources for children's eating habits. A single 24-h dietary recall
was used in NHANES, whereas the NFCS made use of 3 d of
food records. The surveys provided estimated mean intakes of
nutrients for the study population.
One of the first longitudinal investigations to examine chil
dren's diets was the Bogalusa Heart Study, which is still under
way. It was begun in 1973 to study children's eating habits and
the development of coronary artery disease and hypertension in
school children in Bogalusa, LA (12). Nutritional assessment
of individual diets was initially done by means of repeated 24-h
recalls. However, various quality control measures were sub
sequently introduced, including protocols for interviewing and
the training of interviewers, the use of food models and pic
tunes, school lunch analysis, verification of home recipes, and
duplicate recalls (12—15).
In Europe, several government-sponsored nutrition studies
were also started in the l970s. The Amsterdam Growth and
Health Longitudinal Study has investigated the relation be
tween nutrition and biological maturation since 1976 (16). This
study uses cross-checked dietary histories for 200 boys and
girls during the 9 y of their adolescence. Persson et al (17)
assessed the dietary habits of Swedish infants and children by
using a variety of tools, including dietary recalls, dietary his
tories, and food-frequency questionnaires. In 1985 the Dietary
Habits in Denmark Study conducted a national dietary survey
of 2242 persons aged 15—80y. The investigation used person
to-person interviews in which the subjects recalled the preced
ing 28 d of intake with use of a structured, precoded interview
form (18, 19).
PRESENT
Today, dietary histories, records, and recalls continue to be
used for dietary assessment, and a few studies have revised
food-frequency questionnaires for use in children. In the
United States, government surveillance of nutrition continues
with NHANES III, the Hispanic Health and Nutrition Exami
nation Survey, and the NFCS. NHANES III, which was con
ducted in 1988—1994, examined a sample size of 32 000 people
(14 000 children) with a 24-h dietary recall and a 62-item
food-frequency questionnaire (20, 21). NHANES III is a more
current survey of Hispanic diets. The Hispanic Health and
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11 17S
Nutrition Examination Survey studied 14 000 people (3436
children) in 1982—1984 by means of a 24-h dietary recall and
a 22-item food-frequency questionnaire (20, 22).
The 1987—1988NFCS, the second food-consumption sur
vey, gathered data on 10 000 people (3000 children) with use
of a 24-h recall and a 2-d dietary record (20, 23). The Con
tinuing Survey of Food Intakes by Individuals (CSFII) began in
1985. The CSFII, which is part of the NFCS, is an interim
survey that is conducted between the larger NFCS surveys,
which are done every 10 y. The CSFII uses 24-h recalls and
food diaries. The 1985—1986 CSFII surveyed 10 900 people
(3600 children, but only those 1—5y old) (24, 25). The 1989—
1991 CSFII gathered data on 15 128 people (4680 children, not
including those being breast-fed) (26). CSFII 1994—1996 is
projected to interview 15 000 persons (first-year results were
5540 persons, 2229 of whom were children) (US Department
of Agriculture NFCS CSFII, advance data, 1995). The purpose
of these studies is to estimate population means and reference
values for dietary intake.
Nutritional research studies relating dietary intake to disease
or growth require assessments of the long-term intake of mdi
viduals. One investigation that continues to provide such as
sessments is the Bogalusa Heart Study. This study currently
uses both 24-h dietary recalls and a 64-item food-frequency
questionnaire (14). The questionnaire was developed to aug
ment the study's use of 24-h recalls as a tool for 7—12thgraders
to describe their eating habits. To show the ability of the
questionnaire to assess adolescents' diets, Frank et al (14)
compared it with seven 24-h recalls. Agreement between the
two tools averaged 50% with respect to both quantities and
frequencies of food. The recalls, however, generally had higher
reported quantities and frequencies than did the questionnaire.
Several other validation studies designed to determine the
accuracy of self-reported methods for assessing the nutrient
intake of older children and adolescents over time have been
completed or are in progress (Table 1). In the Gimme5 study,
a school intervention program to promote consumption of fruit
and vegetables, investigators (27, 28) are surveying fourth and
fifth graders with a 7-d food record completed in the schools
and a food-frequency questionnaire. Domel et al (28) compared
weekly and monthly fruit and vegetable food-frequency ques
tionnaires with food records and observed no significant rela
tion with the higher intakes reported on the questionnaires.
Earlier, Baranowski et al (29) in the Family Health Project
found a high percentage of agreement (82.9% for all foods)
between children's self-reported frequencies and meal
observations.
Lytle et al (30) examined the diets of 49 8- to I0-y-old
children in California, Minnesota, and Texas by using obser
vation and food-record-assisted 24-h dietary recalls. This is a
validation study for the large clinical study, Child and Adoles
cent Trial for Cardiovascular Health (CATCH) (27, 30), a
school- and family-based intervention program with the goal of
lowering serum cholesterol concentrations and dietary intakes
of fat and sodium. For total energy, protein, carbohydrate, total
fat, saturated fat, monounsaturated fat, polyunsaturated fat, and
sodium, the Pearson correlations between the record-assisted
recalls and the observations ranged from 0.41 to 0.79; the mean
was 0.62 (30).
Crawford et al (31) studied 58 girls in Berkeley, CA;
Cincinnati; and Washington, DC, using observation along with
 lll8S ROCKEU AND COLDITZ

TABLE 1
Youth and adolescent dietary validation studies'

Investigator, or school . or
. Instrument validationItems analyzedCorrelations
agreementBaranowski
reference, and studyAge grade of subjects. percentage
(27—29)FHP
(n = 24)9—1 1 y7-d Record compared with for high-sodium foods to 85.3%
foodsGimme5 observationFoods79.7% for high-potassium
(n = 180)29—11 yFFQ compared with 7-d recordFoods—0.01 for total vegetables to 0.25 for
fruitLytle
30)CATCH
(27,
(n = 49)8—10 yl-d Record-assisted 24-h recall for percentage of energy from
compared with observationNutrients0.41 polyunsaturated fatty acids to 0.79
for percentage of energy from
acids5 saturated fatty
a Day (n = 77)4th gradeObservation compared with food
records(Ongoing)(Ongoing)Crawford
31)GHS(27,
(n = 58)9—10 yObservation compared with 24-h recall: 0.46 for carbohydrate to
recall or FFQ or 3-d recordNutrients24-h 0.79 for saturated fatty acids; 3-d
record: 0.78 for carbohydrate to 0.94
for protein: 5-d FFQ: 0. 11 for
carbohydrate to 0.50 for saturated
acidsColditz fatty
(current)YAQ
(n = 275)9—17
folateNicklas yThree 24-h recalls compared for sodium to 0.58 for
with FFQNutrients0.21
(12—15)Bogalusa
Heart Study (n = 22)15—17 ySeven 24-h recalls compared for bread and vegetables to 78%
dressingPersson with FFQFoods26% for milk and salad
(17)Dietary
availableChildren
Habits of Swedish13 y24-h Recall compared withFoodsNot
historyDietary
(n = 261)diet
availableChildren
Habits of Swedish13 yFood record compared withFoodsNot
(n = 15)chemical analysis
‘¿
FHP, Family Health Project; FFQ, food-frequency questionnaire; CATCH, Child and Adolescent Trial for Cardiovascular Health; GHS, National Heart,
Lung and Blood Institute Growth and Health Study; YAQ, Youth-Adolescent Questionnaire.
2 Gimme5 is part of the 5 a Day program to promote consumption of fruit and vegetables.

a 24-h dietary recall, a 5-d food-frequency questionnaire, or a The 24-h dietary recall—a snapshot of a person's eating
3-d food record. The unobtrusive observations took place dur habits—involves a short interview that avoids the dietary
ing lunch, and their results were compared with those of one of record's drawback of requiring that subjects be literate and
the three methods assigned to the girl observed. The 3-d record motivated. Because diet is known to vary from day to day,
had higher Spearman correlations (0.86) than did either the however, examining intake during only 24 h in a person's life
recall (0.62) or the questionnaire (0.32). This investigation was does not yield an accurate picture of his or her diet. The method
part of the ongoing longitudinal National Heart, Lung and does provide population means for intakes.
Blood Institute Growth and Health Study of 2379 girls, who are The food-frequency questionnaire estimates a person's usual
enrolled at the age of 9 y (31). Because of the limited number intake over a specified period (longer than 24 h). It can be
of validation studies of self-reported dietary assessment meth self-administered and machine-readable, thereby reducing time
ods in subjects in this age group and the varying results of such and costs involved in administration and analysis. The ques
studies, evaluations of methods for assessing individual long tionnaire does not, however, retrieve unique details of an
term intake in this group are still needed. individual's diet unless specifically designed to do so. As a
result, its principal advantage is in ranking the diet of an
Comparison of current methods individual, not in quantifying individual intake.
As used in the validation studies described above, dietary
records, 24-h recalls, and food-frequency questionnaires all Development of the Youth-Adolescent Questionnaire
have strengths and weaknesses. The dietary record, considered Because of the important role of diet in growth, the possible
the gold standard for dietary assessment, provides an accurate relation between diet during childhood and adolescence and
quantitative account of a person's diet during a specific period. diseases in adulthood, and the increasing obesity in young
However, completion of the record is a demanding task for the people, we undertook an investigation with the goal of improv
subject, who must be literate (if the record is written) and ing the assessment of adolescents' diets in epidemiologic stud
motivated. As a result, studies using dietary records have a bias ies. We began with a reproducibility study and subsequently
toward enrolling educated participants. conducted a validation study using a specially designed food

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 ASSESSING DIETS OF CHILDREN AND ADOLESCENTS 1 1 l9S

frequency questionnaire for children that we developed from
Willett' 5 preliminary children's semiquantitative food
frequency questionnaire (SFFQ) (32, 33). This “¿original― chil
dren's SFFQ, designed in 1986, followed the same format as
the validated Nurses' Health Study food-frequency question
name for adults (32—34). It is a self-administered instrument
listing 116 food items and is modified from the adult version to
include ice cream sundaes, milk shakes, candy bars, corn chips,
and onion rings. As in the adult version, the questions are based
on recall of one's diet in the past year. The original children's
SFFQ has been used in several clinic-based studies.
In 1990 the original children's SFFQ was pilot-tested in a
school-based population study (in Lynn, MA), in which less
intensive training and supervision of responders was possible
than in a clinic-based investigation. During a 6-wk period, the
questionnaire was administered to a multiethnic sample of 552
girls in grades 5—12. The SFFQ
ences in food consumption. For example, pizza and soft drinks
were the largest contributors to energy intake in white and
black adolescent subjects, whereas rice made the largest con
tribution to total energy intake in Asian respondents. Ethnic
differences in sources of iron were also shown. In Asians those
sources included white rice, cold cereal, and tofu. In Hispanics
they were white rice, cold cereal, and cooked cereal, and in
whites and blacks they were breakfast cereals, pizza, and beef.
After the Lynn pilot study, a reevaluation of the original
children's SFFQ produced the preliminary Youth-Adolescent
Questionnaire (YAQ). This instrument included 27 snack items
as a separate category, without any differentiation between
home and commercially prepared items, as had been included
in the adult version for cake, cookies, and sweet rolls. Several
foods often consumed by children and adolescents were added,
such as chicken nuggets, turkey, chicken or turkey sandwich,
grains, tacos, and instant-breakfast drink. Also included were
questions about the frequency of snacks on school days and
weekends or vacations and the frequency of meals and snacks
consumed away from home. The extra emphasis on snack
foods was based on a literature review and a focus-group
discussion, both of which suggested that snacks constitute an
important portion of the diet of adolescents.
Thus, the preliminary YAQ using the format of the original
Nurses' Health Study instrument lists 151 foods. A standard
serving size is given for each food, with natural portions (eg,
bread: slice; apple: I) used when appropriate. There are nine
frequency categories for the amount eaten, ranging from “¿never
or less than once per month―to “¿6+ per day.―The frequency
score is multiplied by the nutrient content of the corresponding
food and summed to yield the total nutrient score for each
subject.
Our reproducibility study was conducted with a multiethnic
sample of 178 young people aged 9—18y who completed the
YAQ twice at an interval of 1 y (35). The correlations for
nutrients ranged from 0.24 for protein to 0.79 for folate and
0.92 for carotene (0.90 for vitamin A) (Table 2); for foods,
revealed distinct ethnic differ they ranged from 0.38 for meats to 0.57 for soda (Table 3). The
mean correlation was higher in girls than boys for nutrients and
foods, but we did not observe any consistent patterns that
depended on the age of the participants. The means, SDs, and
medians for energy and nutrients are shown in Table 4. The
values were comparable for the two administrations of the
YAQ. Because energy intake was lower on the second admin
istration, all absolute values for the nutrients were lower;
however, the composition of the diet remained stable. Overall,
the data suggest that a self-administered food-frequency ques
tionnaire has a reasonable ability to assess older children's and
adolescents' eating habits over time.
We are currently completing a validation study of an updated
YAQ which has a layout that makes completion of the ques
tionnaire simpler. Each food item has its own question and
response choices. The response categories for frequency of
consumption vary according to the food, in contrast to typical
food-frequency questionnaires, which have the same categories
for all foods. Each food portion size was determined by review
of the serving sizes in US Department of Agriculture hand
books (36), the NFCS's list of commonly eaten foods (1 1),
Willett et al's food-frequency questionnaire (32, 33), and the

TABLE 2
Pearson correlations for nutrients assessed by two food-frequency questionnaires administered 1 y apart'

(y)MaleFemale9—I
516—18Nutrient(11= TotalSex2Age 21 3—1
178)(n= 75)(,z=
25)Energy0.480.390.490.470.570.17Protein0.240.280.200.290.200.37Fat0.440.320.510.500.290.65Carbohydrate0.350.280.390.500.1 1(X))(‘1= 88)(‘: = 65)(n=

10.57Fiber0.500.460.530.520.490.49Calcium0.570.370.660.520.630.52Iron0.260.280.260.090.360.45Carotene0.920.920.920.890.950.93Folate0.790.790.780.790.820.82Vitamin

A0.900.870.900.840.930.90Animal
protein0.630.580.660.610.690.64Mean
correlation0.550.500.570.550.550.59
‘¿
Exclusion criteria of < 2092 and > 20 920 kJ/d eliminated I I respondents from analyses; specific nutrients were adjusted for total energy intake with
use of regression analysis. and nutrient intakes were log@-transformed to improve normality.
2 Sex of three subjects was not recorded.

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 1120S ROCKEU AND COLDITZ

TABLE 3
Pearson correlations for food groups assessed by two food-frequency questionnaires administered I y apart'

(y)MaleFemale9—1
3—1516—18Food TotalSex2Age 21
group(n=
25)Snacks0.480.460.500.450.570.37Meats0.380.230.450.250.530.43Baked 178)(n75)(n= 100)(n= 88)(,‘ = 65)(,i=

cereals0.470.400.540.460.540.38Fruit
goods and
vegetables0.480.390.570.360.660.48Fruit0.500.490.520.400.690.39Vegetables0.480.440.520.410.630.26Milk0.560.430.600.680.400.54Soda0.570.690.500.460.700.47Mean
and

correlation0.490.440.530.430.590.42
‘¿
Exclusion criteria of < 2092 and > 20 920 kJ/d eliminated 10 respondents from analyses; nutrient intakes were log@-transformed to improve normality.
2 Sex of three subjects was not recorded.

natural serving size (eg, slice of bread), and given final ap
proval by a group of researchers that included a dietitian, an
epidemiologist, and a pediatrician. An additional change from
the Willett food-frequency questionnaire and the preliminary
YAQ was the grouping of foods in serving units (eg, “¿ham
burger―includes hamburger and roll; “¿spaghetti―
includes pasta
and sauce).
The validation study includes 273 young people aged 9—18y
who completed the new YAQ twice (at the beginning and end
of the validation study) and three 24-h recalls.
findings for mean intakes are shown in Table 5.
Other new methods
Other investigators are also exploring the application of new
methods for the measurement of children's diets. The nutrition
evaluation scale system is a computerized scale connected to a
portable computer that has a modem, a bar-code terminal, and
a bar-code reader (37). The subject puts the food on the scale,
finds the food in the code book, scans the bar code for the food,
and then proceeds to the next food. One drawback to this
system is that it is difficult to transport, which may limit its
applicability for highly mobile young people.
Another currently available method of assessing children's
eating habits is videotaping of meals. This technique may
provide more accurate information about what and how chil
dren eat than other assessment methods. Brown et al (38)
videotaped elderly Catholic nuns eating and found positive
correlations between estimates of food intake based on the
videotape and direct measurements of food. Videotaping can
address issues common to dietary analysis in elderly persons
and children: the memory of the subjects, the need for efficient
The initial but unintrusive data gathering and relative convenience for
subjects, and large-scale application where a common eating
area exists (38).
FUTURE
New approaches to the assessment of children's diets are
beginning to appear. The use of computer modems and the
“¿informationhighway― to connect researchers to their subjects
provide a direct, unobtrusive way to obtain 24-h dietary recalls,
dietary records, or responses to food-frequency questionnaires.
Another method involves the use of tape recorders that use

TABLE 4
Nutrient intakes during the first and second administrations (I y apart) of the Youth-Adolescent Questionnaire (YAQ) in I 78 youths and adolescents

YAQ1YAQ2Mediani
SDMedianNutrienti ±
range)'Energy ±SD(interquartile range)'(interquartile

523)Protein
(kJ)10 372 ±375310 284 (7280—13309)9288 ±343928899 (6640—1
1
1—107)Fat
(g)96 ±3795 (65—121)88 ±34284 (6
(48—87)Carbohydrate
(g)77 ±3374 (53—98)70 ±30@65
(217—381)Fiber
(g)354 ±141339 (248—442)313 ±1312298
(g)21
(13—24)Calcium ±1020(14—26)19 ±9217
(mg)1247 ±6381204
(665-1429)Iron(mg)16±814(10—20)15±813(9—18)Carotene(744—1631)1096 ±54421048

(@.tg)4636
(2209—5202)Folate ±38483700 (1993—6077)4427 ±39433523
(fLg)415
(222—457)Vitamin ±227369 (253—498)367 ±201334
(2988—6665)Animal
A (jig)5850 ±40725035 (3030—7512)5435 ±42724504
protein (g)7 1 ±3068 (48—88)65 ±276 1 (46—81)
‘¿
Interquartile range of 25% to 75% of the population.
2 Significantly different from YAQ 1, P < 0.05 (paired t test).

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 ASSESSING DIETS OF CHILDREN AND ADOLESCENTS ll2lS
TABLE 5 of the Medical Research Council. London. United Kingdom: His
Nutrient intakes calculated from first and second 24-h recalls and first Majesty's Stationery Office, 1946—1947. (Report no. 254—259.)
Youth-Adolescent Questionnaire (YAQ 1)' 6. Burke BS. The dietary history as a tool in research. J Am Diet Assoc
1947;23:1041—6.
1Energy
NutrientRecalls 1 and 2YAQ 7. Beal VA. Nutritional intake of children. I. Calories, carbohydrates, fat
(kJ)9142
2757Protein ±28209673 ± and protein. J Nutr l953;50:223—34.
(g)79
272Fat(g)76±3179±26Carbohydrate ±3088 ± 8. Beal VA. Dietary intake of individuals followed through infancy and
childhood. Am J Public Health 1961 ;5 1: 1107—17.
92Fiber (g)302 ±98315 ± 9. US Department of Health, Education and Welfare. Ten State Nutrition
(g)15
72Calcium ±720 ± Survey, 1968—1970.
Washington, DC: US Government Printing Of
(mg)1
5062Iron(mg)19± 127 ±4871246 ± flee, 1972. IDHEW publication (HSM) 72 8133.1
1119±10Carotene 10. Kimm SY, Gergen PJ, Malloy M, Dresser C, Carroll M. Dietary
21712Folate().Lg)2665 ±36253546 ± patterns of US children: implications for disease prevention. Prey Med
(fLg)402
225Vitamin ±271410 ± 1990; 19:432—42.
A (@.tg)3631
25872Animal ±39824756 ± 11. Pao EM, Fleming KH, Gunther PM, Mickle SJ. Foods commonly
protein (g)54 ±2661 ±212 eaten by individuals: amount per day and per eating occasion.
Washington, DC: US Government Printing Office, 1982. IHome eco
‘¿@
± SD. pi = 273. nomics research report 44.J
2 Significantly different from the means of recalls 1 and 2, P < 0.05 12. Frank GC, Hollatz AT, Webber LS, Berenson GS. Effect of inter
(1 test). viewer recording practices on nutrient intake—BogalusaHeart Study.
J Am Diet Assoc 1984;84:1432—9.
13. Frank GC, Berenson GS, Schilling PE, Moore MC. Adapting the 24-hr
recall for epidemiologic studies of school children. J Am Diet Assoc
1977;7l:26—3l.
computer chips. These are ideal for children because of their
14. Frank GC, Nicklas TA, Webber LS, Major C, Miller JF, Berenson GS.
convenience (small size), ease of use and efficiency (it is faster
A food frequency questionnaire for adolescents: defining eating pat
to talk than to write), the minimal cognitive ability required to
terns. J Am Diet Assoc 1992;92:3l3—8.
use them, and children's inevitable interest in a new gadget. 15. Fams RP, Nicklas TA, Webber LA, Berenson GS. Nutrient contribu
Another possibility is creation of a videotape that presents tion of the school lunch program: implications for healthy people
information, on a child's level, on how to keep a dietary record 2000. J Sch Health l992;62:l80—4.
or complete a food-frequency questionnaire. All these methods, 16. Post GB, Kemper HC. Nutrient intake and biological maturation
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APPENDIX A
Hea/thy Youth 2000 objectives'

1) Reduce average dietary fat intake to 30% of energy and average saturated fat intake to < 10% of energy in people aged 2 y.
2) Increase calcium intake so 50% of persons aged 12—24y consume three or more servings of foods rich in calcium daily.
@ 3) Reduceoverweightto a prevalenceof 15%in adolescentsaged12—19
y.
4) Increaseto 30% the peopleaged 6 y who engageregularly,preferablydaily, in light-to-moderatephysicalactivity for 30 min/d.
5) Increase to 50% the proportion of overweight people aged 12 y who have adopted sound dietary practices combined with regular physical
activity to attain an appropriate body weight.
6) Increase to 90% the proportion of school lunch and breakfast services and child-care food services with menus that are consistent with the
nutrition principles outlined in Dietary Guide/ines for Americans.2
7) Increase to 75% the proportion of the nation's schools that provide nutrition education from preschool through the I 2th grade, preferably as part
of quality health education in the school.
8) Increase to 75% the proportion of primary care providers who provide nutrition assessment and counseling, referral to qualified nutritionists or
dietitians, or both.
‘¿
Adapted from American Medical Association, Department of Adolescent Health. Healthy youth 2000: national health promotion and disease prevention
objectives for adolescents. Chicago: American Medical Association, 1990.
2 US Department of Agriculture, US Department of Health and Human Services. Nutrition and your health: dietary guidelines for Americans. 3rd ed.

Washington, DC: US Government Printing Office, 1990.

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