GOLLIS UNIVERSITY

Nutrition And Dietetics

Unit two
Nutritional Assessment

DIETARY ASSESSMENT METHODS

Lecturer: Abdirahman O. Moumin

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INTRODUCTION
• estimating an individual’s usual dietary and nutrient intake is
difficult.
• The task is complicated by weaknesses of data-gathering
techniques, human behavior, the natural tendency of an
individual’s nutrient intake to vary considerably from day to
day, and the limitations of nutrient composition tables and
databases. Despite these weaknesses, nutrient intake data are
valuable in assessing nutritional status when used in conjunction
with anthropometric, biochemical, and clinical data.

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• Dietary assessment is used in determining the extent of
malnutrition in a population, developing nutrition
intervention and consumer education programs,
constructing food guides, devising low-cost food
plans, and providing a basis for food and nutrition
legislation.

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Reasons for Measuring Diet

• Why measure diet? The ultimate reason is to improve human

health.
• Nutritional problems are at the root of the leading causes of
death.
• Food and nutrient intake data are critical for investigating the
relationships between diet and these diseases, identifying
groups at risk for nutrient deficiency or excess, and
formulating food and nutrition policies for disease reduction
and health promotion.
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Techniques in Measuring Diet

•Measurement of dietary intake usually is conducted for one of three

purposes:

1. To compare average nutrient intakes of different groups

2. To rank individuals within a group, and
3. To estimate an individual’s usual intake.
• These techniques have also been categorized as meal-based (food record
and 24-hour recall) and list-based (food frequency questionnaire).
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24-Hour Recall
• In the traditional dietary recall method, a trained interviewer asks the
respondent to recall in detail all the food and drink consumed during a
period of time in the recent past. The interviewer then records this
information for later coding and analysis.
• In most instances, the time period is the previous 24 hours. Thus, the
method is most commonly known as the 24-hour recall. Occasionally,
however, the time period is the previous 48 hours, the past 7 days, or,
in rare instances, even the preceding month. However, memories of
intake may fade rather quickly beyond the most recent day or two, so
that loss in accuracy may exceed gain in representativeness.

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• In addition to recording responses, the interviewer helps the
respondent remember all that was consumed during the period in
question and assists the respondent in estimating portion sizes of foods
consumed. A common technique of the 24-hour recall is to begin by
asking what the respondent first ate or drank on last awakening.

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 Strengths and Limitations of the 24-Hour Recall
Strength Weakness

 Requires less than 20 minutes to administer  One recall is seldom representative of a person’s usual
 Inexpensive intake
 Easy to administer  Underreporting/over reporting occurs
 Can provide detailed information on types of food consumed  Relies on memory
 Low respondent burden  Omissions of dressings, sauces, and beverages can lead to
 Probability sampling possible can be used to estimate nutrient low estimates of energy intake
intake of groups  May be a tendency to over report intake at low levels and
 Multiple recalls can be used to estimate nutrient intake of underreport intake at high levels of consumption
individuals  Data entry can be very labor intensive
 More objective than dietary history
 Does not alter usual diet
 Useful in clinical settings

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Food Record or Diary

• In this method, the respondent records, at the time of consumption, the

identity and amounts of all foods and beverages consumed for a period
of time, usually ranging from 1 to 7 days. Food and beverage
consumption can be quantified by estimating portion sizes, using
household measures, or weighing the food or beverage on scales. In
many instances, household measures such as cups, tablespoons, and
teaspoons or measurements made with a ruler are used to quantify
portion size.

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• Certain items, such as eggs, apples, or 12-oz cans of soft
drinks, may be thought of as units and simply counted. This
method is sometimes referred to as the estimated food
record because portion sizes are estimated (that is, in terms
of coffee cups, dippers, bowls, glasses, and so on), or
household measures are used. When food is weighed, the
record may be referred to as a weighed food record.

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• The food record does not depend on memory because the respondent
ideally records food and beverage consumption (including snacks) at
the time of eating. In addition, it can provide detailed food intake data
and important information about eating habits (for example, when,
where, and with whom meals are eaten and the respondent’s mood
when choosing certain foods).
• Food records have several limitations. They require a literate and
cooperative respondent who is able and willing to expend the time
and effort necessary to record dietary intake. However, such a
respondent may not be representative of the general population.

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 Comparison of the Estimated Food Record and the Weighed Food Record
Estimated Food Record
 Amounts of food and leftovers are measured in household 
measures (cups, tablespoons, teaspoons) or estimated using
such measures as coffee cups, bowls, glasses, and dippers
 The researchers then quantify these measures by volume and 
weight
 Considered less accurate than the weighed food record
 Considered an acceptable method for collecting group intake
data
 Puts less burden on the respondent than the weighed food
record and thus cooperation rates are likely to be higher,
especially over long recording periods
 As effective in ranking subjects into thirds and fifths as
weighed records
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Weighed Food Record
Food and leftovers are weighed using scales or computerized
techniques supplied by researchers
 Considered more accurate than the estimated food record
Preferred by some researchers for gathering data on individuals
 Requires a greater degree of subject cooperation than the estimated
food record and thus is likely to have a greater impact on eating
habits than the estimated food record.
 Cost of scales may be prohibitive in some instances.
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 Strengths and Limitations of the Food Record
Strengths
 Does not depend on memory
 Can provide detailed intake data
 Can provide data about eating habits
 Multiple-day data more representative of
usual intake
 Reasonably valid up to 5 days
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Limitations
 Requires high degree of cooperation
 Response burden can result in low response rates when
used in large national surveys
 Subject must be literate
 Takes more time to obtain data
 Act of recording may alter diet
 Analysis is labor intensive and expensive
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Food Frequency Questionnaires

• Food frequency questionnaires assess energy and/ or

nutrient intake by determining how frequently a person
consumes a limited number of foods that are major sources of
nutrients or of a particular dietary component in question.
• It simply asks how many times a year, month, week, or day a
person eats bread or pasta. This is sometimes referred to as a
simple or non-quantitative food frequency questionnaire
format.

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• The semi-quantitative food frequency questionnaire
gives respondents an idea of portion size. It asks how
many times a year, month, week, or day a person eats a
slice of bread or a 1/2 cup serving of ice cream. In
addition to asking the frequency of consumption, the
quantitative food frequency questionnaire asks the
respondent to describe the size of his or her usual serving
as small, medium, or large relative to a standard serving.

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• Food frequency questionnaires known as “screeners” have
been developed to assess intake of calcium, dietary fiber,
fruits and vegetables, and percent energy from fat. Screeners
are particularly useful in situations that do not require
assessment of the total diet or quantitative accuracy in dietary
estimates and in situations in which financial resources are
limited.
• They are commonly used in epidemiologic research
investigating the relationship between diet and such
conditions as cancer and cardiovascular disease but are not
considered substitutes for more definitive approaches to
measuring diet, such as multiple 24-hour recalls.
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Willett Questionnaire
• It is self-administered and machine readable, thus making it
convenient for use in large epidemiologic studies. Foods
included in the questionnaire are those that are major sources
of the nutrients, foods, and food components of interest to the
researchers. Open-ended questions are also included to
identify specific brands of margarine, ready-to-eat cereals,
cooking oils, vitamin/mineral supplements, and other foods
eaten at least once per week.

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Block Questionnaires

•Over the past 3 decades, Dr. Gladys Block has developed a series of self-
administered, scannable quantitative food frequency questionnaires and screeners
that are based on an earlier food frequency questionnaire known as the Block Health
Habits and History Questionnaire (HHHQ). The HHHQ was designed to collect data
on diet and well-established risk factors for cancer and total mortality, and it has
proven useful in assessing total dietary intake.

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Diet History Questionnaire

• The Diet History Questionnaire (DHQ) is a freely available,

self-administered, food frequency questionnaire developed
by staff at the U.S. National Cancer Institute’s Risk Factor
Monitoring and Methods Branch. It can be used by
researchers, clinicians, or teachers without permission

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 Strengths and Limitations of Food Frequency Questionnaires

Strengths Limitations
 Can be self-administered  May not represent usual foods or portion
 Machine readable sizes chosen by respondents
 Modest demand on respondents  Intake data can be compromised when
 Relatively inexpensive for large sample multiple foods are grouped within single
sizes listings.
 May be more representative of usual  Depend on ability of subject to describe diet
intake than a few days of diet records
 Design can be based on large population
data
 Considered by some as the method of
choice for research on diet-disease
relationships
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Diet History
•Diet history is used to assess an individual’s usual dietary intake over an extended period of time,
such as the past month or year. Traditionally, the diet history approach has been associated with the
method of assessing a respondent’s usual diet developed by B. S. Burke during the 1940s.
Burke’s original method involved four steps:
1. Collect general information about the respondent’s health habits,
2. Question the respondent about his or her usual eating pattern,
3. Perform a cross-check on the data given in step 2, and
4. Have the respondent complete a 3-day food record.

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• A trained nutritionist begins the interview by asking questions about
the number of meals eaten per day; appetite; food dislikes; presence or
absence of nausea and vomiting; use of nutritional supplements;
cigarette smoking; habits related to sleep, rest, work, and exercise; and
so on. This allows the interviewer to become acquainted with the
respondent in ways that may be helpful in obtaining further
information. This is followed by a 24-hour recall, in which the
interviewer also inquires about the respondent’s usual pattern of eating
during and between meals, beginning with the first food or drink of
the day.

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• he interviewer records the respondent’s description of his or
her usual food intake, including types of food eaten, serving
sizes, frequency and timing, and significant seasonal
variations. With the respondent’s stated usual dietary
practices recorded, the interviewer then cross-checks the data
by asking specific questions about the respondent’s dietary
preferences and habits.

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 Strengths and Limitations of the Diet History Method

Strengths Limitations

 Assesses usual nutrient intake  Lengthy interview process

 Can detect seasonal changes
 Data on all nutrients can be obtained
 Can correlate well with biochemical
measures
 Requires highly trained interviewers
 Difficult and expensive to code
 May tend to overestimate nutrient intake
 Requires cooperative respondent with ability to
recall usual diet

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Food Accounts

• Food accounts are used to measure dietary intake within households

and institutions where congregate feeding is practiced, such as penal
institutions, nursing homes, military bases, and boarding schools. The
method accounts for all food on hand in the home or institution at the
beginning of the survey period, all that is purchased or grown
throughout the period, and all that remains by the end of the survey.
Inventories establish amounts of food on hand at the beginning and
ending of the survey period, and invoices or other accounting methods
provide records of food purchased or obtained from a farm or garden.

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 Strengths and Limitations of the Food Account Method

Strengths Limitations

 Suitable for use with large sample sizes
 Can be used over relatively long periods
 Gives data on dietary patterns and habits
of families and other groups
 Less likely to lead to alterations in diet than
some other methods
 Relatively economical
 Does not account for food losses
 Respondent literacy and cooperation
necessary
 Not appropriate for measuring individual food
consumption

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 Food Balance Sheets
• The food balance sheet is a method of indirectly estimating the amounts
of food consumed by a country’s population at a certain time. It provides
data on food disappearance (sometimes referred to as food availability)
rather than actual food consumption. It is calculated using beginning and
ending inventories, figures on food production, imports and exports, and
adjustments for nonhuman food consumption (for example, cattle feed, pet
food, seed, and industrial use). Food disappearance can be thought of as
the amount of food that “disappears” from the food distribution system.
Much of this is purchased by consumers at supermarkets; however, a
considerable amount is lost due to spoilage.

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 Strengths and Limitations of the Food Balance Sheet
Strengths
 Can give a total view of a country’s
food supplies
 Indicates food habits and dietary trends
 Used to plan international nutrition
policies and food programs
 May be the only data available on a
country’s food consumption practices
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L imitations
 Accuracy of data may be questionable
 Only represents food available for
consumption
 Does not represent food actually consumed
 Does not indicate how food was distributed
 Does not account for wasted food
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Considerations for Certain Groups
• Adaptations in dietary measurement can be made for certain groups, such as young persons,
the reading impaired, individuals having problems recalling their diet, persons who are
visually or hearing-impaired, and the obese.
1. Young persons
 Dietary intake data on children under 8 years of age are best obtained from the person responsible
for meals.
 For information on food eaten away from home, interview the child in the presence of the parent or
guardian.
 Data on meals eaten at school, kindergarten, or day care center can be obtained from those
responsible for their meals.
 Reliable data on intake in the previous 24 hours can be obtained from children 8 years of age and
older.

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 2. Persons with recall problems
 There appears to be no firm evidence that memory of past diet is impaired during aging
despite popular belief to the contrary.
 The ability to recall past diet may be more a function of how much attention is paid to
what is eaten.
 Diet recall can be helped through the use of checklists and visual aids, such as food
models and photographs.
 Information obtained from surrogates (spouse, sibling, or caregiver) can improve the
quality of data.
 Reproducibility of recall of diet many years in the past by older persons has been shown
to be good but is reduced by older age, cognitive impairment, and sex.

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 5. The obese
 Several studies have questioned the validity of reported energy intake in obese
persons, indicating a tendency to underreport energy intake using the dietary
history and food records.

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 3. Persons with impaired vision or hearing
 Intake measurement instructions can be communicated to the visually impaired through large-
print materials, tape recordings, radio, telephone, personal interview, and Braille.
 Some visually impaired persons have video equipment that will enlarge print to a readable size.
Data can be collected through personal interview, by telephone or tape recorder, or over specially
equipped computer systems.
 Communication of instructions to and collection of data from hearing-impaired persons is easily
done with self-explanatory and well-prepared printed materials.
 Use of an interpreter of sign language and visual aids, such as food models or photographs, can
be helpful. Verbal responses to an interviewer can facilitate collection of data.

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 4. Persons who cannot read well
 Personal and telephone interviews, digital imaging methods, and computerized or
web-based systems with visual and audio prompts can all be used in collecting
dietary intake data from the reading-impaired.
 Persons with limited reading ability may be able to use printed materials having
an appropriate vocabulary.
 Food models, photographs, and digital images are especially helpful.

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