+ NS270 Seminar Unit 2 Measuring Diet Presented by Stacey Day, MS, RD, LDN

+ Measuring Diet Outline Unit 2 1. Reasons, approaches and techniques to measuring diet 2. Issues in Dietary measurement 3. Estimating Portion Size

+ Reminders – Unit 2 Project Please define or describe each nutrition analysis method listed. Then answer the questions related to these methods. Give 2 pros and 2 cons for each method listed above. Things to consider: cost, ease of use, appropriateness for client, purpose for analysis. Which method is best when assessing an obese person? Which method is best when assessing a malnourished person? Please remember to include at least two references for this project. One reference can be your text book.

+ Reasons for Measuring Diet Improve human health Assess the relationship Diet – Disease Major Uses of intake data 1.Assessing and monitoring food intake 2.Formulate & evaluate policy affecting health and agriculture 3.Epidemiological Research 4.Commercial Use Lee, R., & Nieman, D. (2007). Measuring Diet. In (4 th Ed.), Nutritional Assessment (pp 77 – 114). Retrieved March 25, 2009 from

+ Reasons for Measuring Diet Assessing & Monitoring Food Intake Ensure adequacy of the food supply Estimating adequacy of dietary intakes of individuals and groups Monitor trends in nutrient consumption Estimating exposure to food additives and contaminants Lee, R., & Nieman, D. (2007). Measuring Diet. In (4 th Ed.), Nutritional Assessment (pp 77 – 114). Retrieved March 25, 2009 from

+ Reasons for Measuring Diet Formulating & Evaluating Government Health & Ag Policy Planning food production and distribution Establishing food and nutrition regulations Establishing programs for nutrition education and disease risk reduction Evaluating the success & cost effectiveness of nutrition education and disease risk reduction programs. Lee, R., & Nieman, D. (2007). Measuring Diet. In (4 th Ed.), Nutritional Assessment (pp 77 – 114). Retrieved March 25, 2009 from

+ Obesity Trends U.S. obesity trends (2008). Overweight and Obesity.

+ Obesity Trends U.S. obesity trends (2008). Overweight and Obesity.

+ Obesity Trends U.S. obesity trends (2008). Overweight and Obesity.

+ Obesity Trends U.S. obesity trends (2008). Overweight and Obesity.

+ Obesity Trends U.S. obesity trends (2008). Overweight and Obesity.

+ Reasons for Measuring Diet Conducting Epidemiologic Research Study the relationship between diet & health Identify groups at risk of developing disease because of their diet and or nutrient intake

+ Reasons for Measuring Diet Commercial Purposes Data from nutrition surveys are used by food manufacturers to develop advertising campaigns or new food products.

+ QUESTIONS??

+ Approaches Measuring Diet Various Methods Strengths/Weakness Match the method to the application. Research design Characteristics study participants Available resources

+ Methods for Measuring Intake 24-hour recall Food Record or Diary Food Frequency Questionnaires Diet History Food Accounts Food Balance Sheets

+ DIETARY MEASURING METHOD WORD SCRAMBLE I will show you a scrambled word that is a dietary measuring method “Ring in” by typing the # symbol into the text box.

+ WHAT IS THIS SCRAMBLED WORD??? 42 uhor lrcela

+ 24-Hour Recall Ask the respondent to recall in detail all of the food and drink consumed during a period of time Usually the time period is 24 hours Sometimes the time period will be 48 hours up the past 7 days

+ 24-Hour Recall Strengths Requires less than 20 minutes Inexpensive Easy to administer Low respondent burden Can provide detail info on types of food consumed Probability sampling possible More objective than dietary history Does not alter usual diet Limitations One recall is seldom representative of a person’s usually intake Underreporting/ over reporting occurs Relies on memory Omissions of dressings, sauces, and beverages can lead to low estimates of energy intake May be a tendency to over report intake at low levels and over report intake at high levels of consumption Data entry can be very labor intensive

+ WHAT IS THIS SCRAMBLED WORD??? Dofo rdyai

+ Food Record or Diary Respondent records the type and amount of all foods and beverages consumed Household measures are used to quantify portion size

+ Food Record or Diary Strengths Does not depend on memory Can provide detailed intake data Can provide data about eating habits Multiple-day data more representative of usually intake Reasonably valid up to 5 days 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.

+ WHAT IS THIS SCRAMBLED WORD??? Dofo rcefyenqu nqnsereatisui

+ Food Frequency Questionnaire This questionnaire assesses energy and/or nutrient intake by determining how frequently a person consumes a limited number of foods The respondent indicates how many times a day, week, month, or year they consume these foods

+ Food Frequency Questionnaire Strengths –Can be self administered –Machine readable –Modest demand on respondents –Relatively inexpensive for large sample sizes –May be more representative of usual 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 Limitations –May not represent usual foods or portion sizes chosen by respondents –Intake data can be compromised when multiple foods are grouped within single listings –Depend on ability of subject to describe diet

+ WHAT IS THIS SCRAMBLED WORD??? Etdi rhstyio

+ Diet History The diet history is used to assess the individuals usual dietary intake over an extended period of time

+ Diet History Strengths Assesses usual nutrient intake Can detect seasonal changes Data on all nutrients can be obtained Can correlate well with biochemical means Limitations Lengthy interview process Requires highly trained interviewers Difficult and expensive to code May tend to overestimate nutrient intake Requires cooperative respondent with ability to recall usual diet

+ WHAT IS THIS SCRAMBLED WORD??? Dofo catuncos

+ Food Accounts Food accounts are used to measure dietary intake within households and institutions where congregate feeding is practices The methods 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 The daily mean consumption per person is calculated for each food item from the total amount of food consumed during the survey period and the number of people in the household or institution

+ Food Accounts Strengths Suitable for use with large sample size 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 Limitations Does not account for food losses Respondent literacy and cooperation necessary Not appropriate for measuring individual food consumption

+ WHAT IS THIS SCRAMBLED WORD??? Dofo lanbcae etseh

+ Food Balance Sheet This method indirectly estimates the amounts of food consumed by a country’s population at a certain time It provides information on food availability rather than food consumption

+ Food Balance Sheet Strengths Can give a total view of a country’s food supplies Indicates food habits and dietary trends Sued to plan international nutrition policies and food programs May be the only data available on a country’s food consumption practices Limitations 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

+ QUESTIONS??

+ Issues in Dietary Measurement Validity Reproducibility How Many Days? Estimating Portion Sizes

+ Issues – Validity & Reproducibility Validity Ability of an instrument to measure what it is intended to measure Reproducibility The ability of a method to produce the same estimate on two or more occasions

+ Issues – How Many Days & Estimating Portion Sizes How Many Days? It is important to know how long a dietary intake must be measure before a sufficiently reliable estimate of usual intake is obtained

+ Estimating Portion Size Photographs of food Lifelike plastic food models Geometric Shapes Measuring devices

BAGEL 20 Years Ago Today 140 calories 3-inch diameter How many calories are in this bagel? NIH (2003) Portion distortion interactive quiz.

140 calories 3-inch diameter Calorie Difference: 210 calories 350 calories 6-inch diameter BAGEL 20 Years Ago Today NIH (2003) Portion distortion interactive quiz.

CHEESEBURGER 20 Years Ago Today 333 caloriesHow many calories are in today’s cheeseburger? NIH (2003) Portion distortion interactive quiz.

Calorie Difference: 257 calories 590 calories CHEESEBURGER 20 Years Ago Today 333 calories NIH (2003) Portion distortion interactive quiz.

COFFEE 20 Years Ago Coffee (with whole milk and sugar) Today Mocha Coffee (with steamed whole milk and mocha syrup) 45 calories 8 ounces How many calories are in today's coffee? NIH (2004) Portion distortion II interactive quiz.

COFFEE 20 Years Ago Coffee (with whole milk and sugar) Today Mocha Coffee (with steamed whole milk and mocha syrup) 45 calories 8 ounces 350 calories 16 ounces Calorie Difference: 305 calories NIH (2004). Portion distortion II interactive quiz.

+ Consideration for Certain Groups Young persons < 8 – guardians > 8 report on past 24 hours Recall problems Diet checklist, recall aids, surrogates Impaired vision and hearing Reading impaired Obese persons Malnourished persons

+ Consideration for Obese Persons

+ Consideration for Obese Persons Under reporting food intake Night eating Reporting what want to hear Report good day Shame/guilt/eat in secret Eating unawareness Portion under reporting May not report binges Beverages ? malnourished Food history Food frequency Grocery Receipts/restaurant receipts Digital food diary (camera) Food diary 7-14 days Teach portions and how to measure foods Use anthropometric markers ConcernsDiet Measurement

+ Consideration for Malnourished Not eating enough – low BMI Versus Lots of of calorie dense – poor nutrient dense foods – high BMI

+ Consideration for Malnourished under eating Misrepresent intake - lie Over estimate intake and portions – unintentional Obsession with numbers and intake – don’t want to exacerbate this Eat in secret May eat but throw up May eat but use laxative or over exercise Surrogate reporter or input from support persons Use biochemical markers (laboratory data and anthropometrics) Food diary Food history Digital food records ConcernsDietary Measure

+ Questions? Assignment or course related

+ Thank you