Nutrient Reference Values

Assessing Dietary Intake

Methods of dietary intake assessment

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Measuring food intake before commencing a weight loss program is a great way to work out which aspects of food intake and dietary habits to focus on first.

Here are examples of some methods that can be used to assess food intake.

The 24 hour recall method is a recall of all foods eaten and beverages consumed over a 24 hour period.

This is recorded by trained interviewer over the phone or in person, or can be self-reported using an online program.

24-hr recalls gather important information regarding portion size.

A food record can either be weighed or estimated.

It is a record of all food and drinks consumed.

The weight or volume of the food, the brand, preparation or cooking method, and time of day consumed should all be recorded.

A food record is usually kept over 3 or 4 days, including one weekend day and can be useful for learning portions due to the use of measuring cups and spoons.

Food records are the most common method used by individuals.

There are many popular smartphone apps that help you keep one.

You can also keep a food record on paper.

A Food Frequency Questionnaire (or FFQ) is a paper or online questionnaire designed to obtain information about longer-term food intakes.

FFQs are usually self-administered and individuals are asked to report how often they usually eat or drink certain foods over a specified time period such as 3, 6, or 12 months.

FFQs can be completed at several points in time to assess changes in intake of different food groups, macro- and micronutrients and often compare your results to dietary recommendations.

An FFQ can generate a score to indicate how closely someone’s usual intake aligns with their country’s healthy eating guidelines.

24-hour recall method

Overview

A 24-hour recall is a recall of all food and drinks consumed over a 24-hour period. This is usually a recall of the 24-hours prior to the assessment. It is a structured interview with intake usually recorded by a trained interviewer over the phone or in person but can also be completed by the individual. A 24-hour recall collects information on types and brands of foods as well as information on portion sizes.

Advantages

        • Can quantify intake for a one day period
        • Low participant burden

Disadvantages

        • Provides information on only one day and therefore may not reflect average food consumption
        • Relies on memory
        • Less likely to be an indicator of usual intake in people that have a varied pattern of intake
        • Requires skilled interviewer

Examples

In Australia, Canada and the USA, the 24-hour recall method can be self-administered online using an automated system call the  ASA24 .

Interview with an Expert

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Clare: I’d like to introduce our special guest today Dr. Sharon Kirkpatrick.

She’s an expert in dietary methodology.

She’s a nutrition researcher and she’s also a dietitian in Canada.

And she’s going to help us work out which method of measuring your food intake is most helpful when it comes to trying to improve your eating habits.

Welcome Sharon.

Sharon: Thank you. Clare.

Clare: Can you tell us, of all the different methods of recording dietary intake, if someone’s really trying to improve their eating habits?

What do you think gives them the most information or is the best one for them to use.

Sharon: So if we think about intake on a given day either we’re looking backwards and recalling what we had yesterday or we’re reporting or recording in real time. And that’s called the food record.

So people can use paper and pencil or a mobile app and keep track of everything that they eat and drink at each given occasion.

Sometimes they could also weigh each item to get a better sense of portion sizes.

Clare: Do you think that’s helpful for people in terms of learning about the quality of the food that they’re eating?

Sharon: Yes I think it can help people to figure out, sort of their patterns of eating.

So the meals and snacks that they’re having the times of day and also the different types of foods and drinks that they might be consuming at different times of day.

Think about maybe swaps they can make so switching out something that maybe is not providing a lot of nutrients for something that like fruits and vegetables or whole grains.

Clare: So when people start on a healthy lifestyle program and they suddenly find out it’s a really good idea to keep a record of their food intake.

Does that very act of recording what you’re eating, does that change what they eat? And is that a problem?

Sharon: Actually it does and we call that reactivity in research where people actually react to the act of recording for research purposes that can be a problem because we want to know what you actually eat drink on a given day but when you’re trying to make changes and to achieve a healthier diet that actually can be a helpful thing as you’re tracking can motivate you to make changes as well.

There is something we call social desirability bias.

So we have a sense of what is healthy and what is less healthy and we kind of all want to believe that we’re more towards the healthy side and that’s how we want to present ourselves right so we can make changes to your to what we’re actually doing so that we can stick with that image of ourselves and that can be helpful when you’re trying to move towards healthier patterns.

Clare: That’s really interesting.

Thanks for that.

So from what you’ve said it sounds like when someone’s embarking on a healthy lifestyle program. And they’re trying to eat more healthfully, keeping food record is a really good idea.

It might make you change what you’re eating but that’s not a problem.

Sharon: Yeah I think that’s not a problem if your goal is to achieve healthier eating it can be a problem for figuring out maybe what your original patterns were.

But in terms of an individual you’re not too concerned with that if you’re able to move over to some healthier patterns.

Clare: Now it sounds like it’s a lot of work but it’s initially worth the effort to keep a food record.

But are there any of the shorter or more brief ways that people can get a bit of feedback, about what they’re eating.

Sharon: That’s a good point and I think it can be helpful for people at the beginning to do something more comprehensive and complete like a food record.

But as they get going and sort of get a better sense of what their eating patterns look like perhaps they could switch over to some kind of app.

I know that you have the Australian Healthy Eating Survey and other countries also have similar kinds of programs.

So in Canada for example Dietitians of Canada has developed something called the Eat Tracker that people can use on a given day or several days to record what they’re eating and drinking.

They actually get some feedback in terms of how that matches up to dietary guidance so they can get a sense of if they’re eating enough fruits and vegetables and that kind of thing.

Clare: Okay, so it sounds like it’s a really good idea, in the country where you live, to check in with your dietitians association to see if they’ve got a free brief app or tool or ask around to find out what other tools apart from the weighed food record will be helpful for monitoring your food intake.

Sharon: Certainly I think there’s a lot of different tools out there and one thing to keep in mind, I should clarify that the Eat Tracker that I mentioned isn’t necessarily a brief tool but it does give you sort of a quick way to do that food recording and you could choose how little or how much detail you want to provide.

But in various countries you can access all kinds of different apps for tracking your diet and with those it’s important to think about where they came from, who developed them, where the information is coming from.

Some of them are actually crowdsourced.

So if you were to report something that wasn’t in the database you would be prompted to enter in the nutrition information from the label.

And so, the accuracy of those kinds of things can differ.

So it’s also important to kind of think about what are your goals and does that line up with the app some of them can be quite narrowly focussed around achieving a particular body shape and size and that may not be your emphasis.

Maybe it’s more in achieving healthy eating overall.

Clare: So it sounds like we’re in agreement though that some sort of recording or monitoring can be helpful in those initial stages particularly of trying to change your food intake and improve your eating habits.

Sharon: I think the research would support that.

There have been some reviews that have looked at different studies and found that there is some evidence to support self-monitoring and in fact in intervention studies researchers use food records to help their participants to make those changes that they’re helping them make.

Clare: And that was what the next question I was going to ask you.

So does monitoring your food intake, does that predict success in terms of being able to change your lifestyle?

Is it worth the effort? That’s what I’m asking.

Sharon: I think it does and particularly initially I think we, with anything we need more research to better understand the long term implications.

But I think it can give people that sort of jumpstart that they need to get a better sense of what their goals should be and the types of changes that they might want to think about making and also to keep those realistic.

I guess one other thing to mention, as well as keeping your eye on overall eating pattern as opposed to getting really caught up in a particular dietary component like Calorie counting or focussing solely on sugars without thinking about the overall healthfulness of the diet.

Clare: That’s really interesting.

Sharon thanks for taking the time to be with us today and for your expertise in dietary assessment.

Sharon: Thank you.

Clare: Thank you.

Diet History

Overview

A diet history is similar to a 24 hour recall but food intake is assessed based on the range of foods that may typically be consumed, rather than simply what was eaten in the previous 24 hours. A diet history also assesses how often they’re eaten and how much of the food or drink is consumed. It takes more time than a 24 hour recall and is usually a structured interview performed by a health professional.

Advantages

      • Can quantify usual food intake
      • Low participant burden

Disadvantages

      • Relies on memory
      • Requires skilled interviewer

Example

The following video is an example of the Diet History.

Food record (weighed or unweighed)

Overview

A food record is a measure of all food and drinks that are consumed. They can be measured food records where portions of food and drinks are measured using kitchen scales or measuring cups and spoons. Food records can also be estimated but this method is less accurate. Besides the amount of food or drink recorded, the brand, preparation or cooking methods and the time of day is also noted.

Food records are usually kept over multiple days (typically 4-7 days, including at least one weekend day).

Advantages

      • Doesn’t rely on participants memory
      • Allows for full description of dietary intake
      • Weighed record collects accurate quantities

Disadvantages

      • Involves high participant responsibility for record keeping which may result in incomplete or inaccurate records
      • May cause the participant to change their usual intake (either on purpose or subconsciously)
      • Issues with participant under-reporting intakes
      • Recording of food weights requires access to measuring utensils and kitchen scales

Examples

Food records can be written using paper and pen or they can be recorded using a website or smartphone application.

Here is a Food Record template you can use.

Food Frequency Questionnaire

Overview

A food frequency questionnaire is designed to obtain information about longer term food intakes. FFQs are self-administered questionnaires that contain a list of foods and individuals are asked to report how often they usually eat or drink these foods or drinks over a specified time such as 3, 6, or 12 months. FFQs can be paper-based or online. The online versions provide immediate feedback including micro- and macronutrient intake and proportions of core and discretionary food intake.

Advantages

      • Low cost
      • Easy to administer (can be administered by interviewer if necessary)

Disadvantages

      • People with limited reading ability or visual impairment may require a facilitator to complete the record on their behalf
      • Less accurate than 24hr recalls and food records due to making assumptions about serving sizes

Examples

The Australian Eating Survey is a good example of a FFQ.
Another example is Block FFQs: nutritionquest.com.

Food Checklist, Diet Quality Score or Variety Indexes

Overview

Diet Quality Scores and Variety Indexes are dietary assessment tools that are usually derived from a subset of the FFQ questions to generate a score, with the result then indicating how closely the person’s usual intake aligns with their country’s healthy eating guidelines. Food checklists are used to complement other assessment tools. These contain a brief checklist of the foods commonly forgotten in recording a 24-hr recall or diet history

Advantages

      • A diet quality score is a quick tool to assess food group intake
      • Some are available online, which makes them very accessible and some are only used in research
      • Food checklists can be completed at future time points to assess changes in food intake
      • Low participant burden
      • Can improve the information collected from other methods
      • Provide fast feedback

Disadvantages

      • Checklist not appropriate for use on its own
      • Less detailed information than other assessment methods
      • Information on portion size not collected

Example

View the Healthy Eating Quiz
The healthy eating quiz is a diet quality score that provides feedback on how much variety you have in your usual eating patterns. It currently contains a list of Australian foods however, people from other countries can access the quiz. You need to keep in mind some of the common foods from your country may not be listed. Click on the link above to take you to the Healthy Eating Quiz.

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