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Dietary assessment

methods in nutrition
epidemiology
Rahayu Indriasari, SKM,
MPHCN, PhD

Introduction
Nutrition epidemiology investigate
relationships between diet and risks
of diseases
Diet is a major lifestyle-related risk
factor (exposure) of a wide range of
chronic diseases or nutritional
problems
Dietary assessment is important in
nutritional epidemiology studies

Dietary assessments methods

24 dietary recall
Get an accurate and complete listing of
all food/drink individual consumed
within last 24 hrs
Specifically:
What food/drink was consumed?
How much was consumed?
Time it was consumed?
How was it prepared?
How was it served?
Details of food (e.g low fat, 1%,
whole, milk powder, preparation, )

24 hour recall :
Recall all the foods and beverages consumed the
previous day or 24 hours prior to the interview
Interviewers should be knowledgeable about foods
available in the market
Regional and ethnic preparations and methods
Interview conducted face to-face, structured w/o
probing questions
Estimates of portion size are made using standardized
cups and spoons
Record of food amounts converted into nutrient
intakes using food composition tables

Dietary records
Record all foods and beverages consumed over a specific
time period (3-4 d)
Amount consumed determined by weighing with a scale or
measuring volume using standard cups and spoons
Specific/special foods may be recorded (fat, vitamin A, iron
rich)
Total energy intake will require all foods to be recorded.

Food Diary : DAY


Meal

Foods
( list )

Breakfast
Snack
Lunch
Tea
Dinner
Food supplements : Name
(cans/d)
Vitamins/minerals supplement :.

Amount
eaten

How
prepare
d

Where
eaten
(home,
work, etc)

Diet history
Collection of information on frequency of
intake of various foods and usual meal
pattern
Entails detailed listing of foods and
beverages
consumed at each eating session
3 d - diet record as an independent
check on food intake
Methods of preparation

Food frequency questionnaire (FFQ)


Report usual frequency of consumption of each
food item from a list of food items in reference
to a specified period (past wk/mo/yr)
Face to face interview, telephone or by self
administration
Describes dietary patterns or food habits not
nutrient intake
Semi quantified tools can obtain information on
portion size using household measures

FFQ - Examples : For each item indicate with a check mark the category that
best describes the frequency with which you usually eat that particular food;
complete questionnaire might contain more than 100 items

Food item

> 1/d

1/d

Beef
Fish
Liver
Poultry
Eggs
Dried beans
Green leafy
vegetables

Enter other foods not listed


that are eaten regularly
1.------------2. -------------

3. -----------

3-6
times/w
k

1-2/wk

2/mth
or less

Never

Example of semi quantitative


FFQ
Food

Mediu
m
servin
g

Apples,
apple sauce

1 or
cup

Banana

1
mediu
m

Papaya

mediu
m

Water melon 1 slice


Orange

1
mediu
m

Serving
S

How often ?
D

Strengths and limitations of dietary


assessment methods
Method

Strengths

Limitations

Food record

Does not rely on memory; open


ended

24 hr recall

Immediate recall period, easy to


obtain information; since
interviewers administer tool &
records the responses, literacy is
not a problem, respondent burden
minimal; does not alter intake
Inexpensive
; preferred
behavior; wide
range offor
use
nutrients with high day-to-day
variability; does not alter intake
behavior; lower respondent
burden; epidemiological research
to study diet-disease relationships

High participation burden;


requires literacy; may alter
intake behaviour ( ??
community
use )
Relies on memory; requires skilled

FFQs

Food habit
questionnaire

Rapid &low cost; does not alter


intake behaviour

Diet history

No literacy needed;

interviewer; does not reflect the


usual dietary intake ; tendency to
over report low intakes and under
report high intakes ( need for

food list, std menu types; need


for
community
based
Relies
on memory;
requires
training )

complex calculations to
estimate frequencies; requires
literacy, doe not quantify intake
( need for exhaustive food
list; need for manual tally
type calculations)
may rely on memory; may
require trained interviewer
( need for food list; std
menu types; community
based training)
Relies on memory; may require
trained interviewer ( need for
food list & community based
training

Measurement error in dietary


assessment
Defined as : differences between the
(measured) intake and the true intake
Divided into: systematic error and random error
Systematic error observed intake
overestimates or underestimates the true intake
-> cause bias in RR for quantitative differences
in intake
Random error not related to true intake
-> lead to underestimation of measures of
association

SOURCES OF ERROR IN DIETARY ASSESSMENT


METHODS (INDIVIDUAL INTAKES)
Source of
error

Weighed
food
records

Estimated
24 hr recall
food weight
records

Dietary
history and
FFQs

FCT /recipe
books
Food coding
Wrong
weight of
foods

Reporting
error

Variation of
diet with
time

Wrong
frequency

Modified
eating
pattern

Response

Source:
Anna Ferro

Luzzi in FAO, 2002