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PubMed1991

Question-induced cognitive biases in reports of dietary intake by college men and women.

In two experiments, investigated how variations in questionnaire structure influence respondents' reports of two aspects of dietary intake--the frequency with which various food items are eaten and the sizes of the portions that are eaten. In Experiment 1, approximately 400 subjects, prior to making a frequency judgment, were asked to think either about a specific occasion or about all the occasions on which they had eaten a particular food. The thoughts that preceded the frequency judgment influenced that judgment: Thinking of the range of occasions on which a food is consumed resulted in higher frequency estimates than thinking only of the most recent occasion. In Experiment 2, the same subjects made judgments about their typical portion sizes of several foods relative to described standards. For only one of eight foods were estimates properly and significantly affected by differences among the described standards. These results suggest that respondents are not particularly sensitive to portion-size definitions. We consider the implications of these phenomena for the development of a general theory of the cognitive processes that subserve health-survey responding.

Adult↗
PubMed1990

Validation of mothers' reports of dietary intake by four to seven year-old children.

The validity of mothers' recall of four to seven year-old children's diet was assessed among 46 first generation Latino immigrant families from the Dominican Republic by comparing intake recalled by the mother to unobtrusive home observations of children. Correlations were moderate to high for calories and for most nutrients. There were no differences in mean intake of total calories or in intake of most macronutrients and micronutrients assessed. At least two-thirds of the children in the lowest (or highest) quintile based on home observations were correctly classified into the lowest or second lowest (or highest) quintiles based on mother's reports for calories and most nutrients. For all food items that were both observed and reported, 51 percent of reported portion sizes were equivalent to observed portion sizes, 15.5 percent were smaller, and 33.5 percent were larger. There was fair to good agreement on the number of food items eaten, with the exception of vegetables. Mothers' recall appears to be useful for classifying children by intake of calories, macronutrients and micronutrients, but provides a somewhat less accurate measure of actual foods eaten, portion sizes, and nutrient levels consumed.

Child↗
PubMed1984

Selection and quantification of typical food portions by young adults.

This study was designed to assess (a) the amount of food young adults selected as an average portion and (b) the accuracy with which they could, without the assistance of food models or probing by an interviewer, describe the amount in quantifiable terms. One hundred and forty-seven adults between 18 and 30 years of age selected average portions of either breakfast or lunch items and then described the amount. Selected amounts of butter on toast, sugar on cereal, milk as a beverage, and tossed salad corresponded closely with generally accepted standard portion sizes. For dry cereal, orange juice, tuna salad, and fruit salad, selected portions were above accepted standards, but the portion for salad dressing was below the standard. Men almost consistently selected larger portions than did women. The ability to describe the amount chosen without the aid of measuring devices was poor, with from 8% to 68% of respondents being able to estimate individual items within +/- 25% of actual amount; from 0 to 67% overestimated portion size by more than 51%; and from 0 to 25% underestimated by more than 51%. The results suggest a need to provide respondents with help in estimating portion sizes or to develop alternative methods of assessing dietary intake that do not assume an ability to describe portion size accurately.

Adolescent↗
PubMed2000

The development and testing of a food portion photograph book for use in an African population.

OBJECTIVE: To develop and test a book of photographs of commonly eaten foods to be used as a visual aid in the description of portion sizes in a large cross-sectional study on the health profile of Africans in transition (THUSA - Transition, Health and Urbanization in South Africa). SETTING: Clinics in the North West Province of South Africa. PARTICIPANTS: One hundred and sixty-nine adult African volunteers DESIGN: Data on commonly eaten foods, preparation methods, recipes and portion sizes were collected in a pilot study. Colour photographs, taken of foods prepared by the researchers and measured into three or four portion sizes, were enlarged and put together in a book. The food portion photograph book (FPPB) was tested by presenting subjects with a portion of real food and asking them to estimate the portion size by matching it with one of the portion photographs. MAIN RESULTS: Of 2959 portions tested, 68% were accurately estimated (estimated weight within 10% of actual weight). Clearly defined solid foods were better estimated than foods that had an amorphous appearance. Accuracy of estimation was not affected by gender, age or education. CONCLUSION: The FPPB was accepted as a useful and convenient visual aid to estimate portion sizes in the cross-sectional dietary intake study.

Journal Article↗
PubMed1992

Effects of different designs and extension of a food frequency questionnaire on response rate, completeness of data and food frequency responses.

The authors studied how the introduction of several modifications to a basic food frequency questionnaire can influence the results of dietary surveys. Modifications covered eight combinations based on three levels: increasing versus decreasing order of frequency categories; questionnaires without versus with questions about portion sizes, and questionnaires without versus with extra non-dietary questions. The sample included 6783 women between the ages of 40 and 70 years who took part in mammography screening. The women were randomly assigned to one of the eight study groups. All of the women in each group received one of the eight differently modified questionnaires. The forms extended in length by extra non-dietary questions and portion size categories resulted in a 20% higher total non-response compared to the shorter basic form. Partial non-response was significantly lower for all four questionnaire types that included portion sizes. When portion sizes were included in the questionnaire, the reported mean frequency of consumption was significantly reduced for fat (-10 times per month), milk (-6), bread (-5), vegetables (-2) and fish (-0.4). The decreasing order of responses to the frequency categories was associated with a statistically significant increase in the frequency responses for bread (2.6 times per month), vegetables (2) and fish (0.6). These data provide evidence that the design and extension of food frequency questionnaires influence the results of dietary studies.

Adult↗
PubMed2002

Food portions are positively related to energy intake and body weight in early childhood.

OBJECTIVE: To identify portion sizes (quantity ingested at a meal/snack) of foods commonly consumed in early childhood, temporal stability, and relations to energy intake, weight status, and sociodemographic characteristics. STUDY DESIGN: Three samples were evaluated: the Continuing Survey of Food Intakes by Individuals, 1994 to 1996, 1998 (CSFII 94-96, 98) (n = 1039), the Nationwide Food Consumption Survey, 1977 to 1978 (NFCS 77-78) (n = 1045), and a longitudinal sample (n = 55) studied from 12 to 18 months. The CSFII 94-96, 98, and NFCS 77-78 samples were compared to evaluate secular trends. Change from 12 to 18 months was assessed in the longitudinal sample. Relations of portion size to other relevant variables were evaluated in the CSFII 94-96, 98 sample. RESULTS: In recent decades, portions remained remarkably similar for most foods. An exception was for meat portions, which were smaller in recent samples. Portions were longitudinally stable for most foods but increased for milk, bread, cereal, juice, and peanut butter. Body weight was positively related to energy intake and portion size but not number of eating occasions and/or foods. Sociodemographically, portion size was inversely related to number of eating occasions and/or foods. CONCLUSIONS: Children regulate energy intake largely through portion size. Sociodemographic patterns may have implications for later weight status.

Anthropometry↗
PubMed2003

Self-administered food frequency questionnaire used in the 5-year follow-up survey of the JPHC Study: questionnaire structure, computation algorithms, and area-based mean intake.

In this section we described the structure of the self-administered semiquantitative food frequency questionnaire used in the 5-year follow-up survey of the JPHC study, the computation algorithms, and the area-based mean intakes of nutrients and food groups in the subjects of the validation study. The FFQ consists of five sections: 1) semiquantitative frequency questions for rice and miso (fermented soybean paste)-soup, 2) those for alcoholic beverages, 3) those for vitamin supplements, 4) those for foods and beverages, and 5) questions on dietary and cooking behaviors. From the questions, intakes of nutrients and foods by food groups were computed. Although most of them were computed from the frequency and relative portion size indicated in the replies, together with the fixed portion size, a seasonal coefficient was added in the computation of vegetables and fruits. Only frequency of intake and fixed portion size were used for computation of beverages. Sugar and cream added in coffee and tea were computed from the frequency of coffee and tea intake. The intakes of cooking oil, cooking salt (sodium), and salt in noodle-soup were estimated from the questions of relative preference of oil, salt, and noodle-soup.

Algorithms↗
PubMed2002

An audit of nutritional care delivered to elderly inpatients in community hospitals.

BACKGROUND: There is continuing concern over the lack of attention to the nutritional needs of older people in hospitals. A 2-year audit project was undertaken to examine the nutritional care of inpatients in Leicestershire Community Hospitals. METHOD: The methods used included analysis of menu cycles; observation of meal and drink provision, wastage, supplement usage and portion sizes; and patient satisfaction questionnaire examination. RESULTS: Patient menus were nutritionally inadequate for energy, fibre and vitamin D, and protein levels were variable. The percentage of meal wastage and inadequate portion sizes were of concern. Patient satisfaction results were overall positive. CONCLUSION: Patient energy intakes are a major concern with low calorie provision from menus exacerbated by a deficit in recommended portion sizes and a high percentage of meal wastage. Routine audits need to be implemented to monitor both portion size and meal wastage, and to address patient satisfaction issues to improve the overall intakes of patients. Multidisciplinary team input is required to address the above issues and additional recommendations to promote nutrition as a key component in clinical care.

Aged↗
PubMed2004

Is 'five-a-day' an effective way of increasing fruit and vegetable intakes?

OBJECTIVES: To assess whether the amount of fruits and vegetables consumed depends on the serving size or on how often fruits and vegetables are eaten. DESIGN: Estimation of the weight of serving sizes and the number of fruits and vegetables eaten daily, using a validated food diary method. SETTING: Free-living men and women participating in the Norfolk arm of the European Prospective Investigation into Cancer and Nutrition (EPIC). SUBJECTS: Two hundred and sixty-nine men and women sampled from EPIC-Norfolk to participate in a study of simple methods of assessing fruit and vegetable intakes. RESULTS: The average portion of all fruits and vegetables measured was 87 g, close to the standard portion size of 80 g used as the basis of '5-a-day' recommendations. There was a wide variation; the average portion size for baked beans was 147 g while for lettuce it was 26 g. The 20th and 80th percentiles also showed a large range, e.g. 39-72 g for carrots and 60-150 g for strawberries. Women ate more fruit than did men but fewer vegetables, so the total amount of fruit and vegetables eaten by men and women was the same. High consumers of fruits and vegetables (> or =400 g day(-1)) ate them approximately 5 times a day whilst low consumers (<400 g day(-1)) ate them less often (approximately 3 servings per day, P<0.01). Portion size differed little between high and low consumers. CONCLUSIONS: Frequency of intake is more important than portion size when distinguishing between high and low consumption of fruits and vegetables. Therefore, to increase intakes, low consumers should eat fruits and vegetables more often. This endorses the '5-a-day' healthy eating message.

Adult↗
PubMed2002

Validity of children's food portion estimates: a comparison of 2 measurement aids.

BACKGROUND: Policy and clinical decisions regarding children's nutrition are often based on dietary intake estimates from self-reports. The accuracy of these estimates depends on memory of both the type of food eaten and the amount consumed. Although children's self-reports of food intake are widely used, there is little research on their ability to estimate food portions. OBJECTIVE: To assess the validity of children's estimates of the food portions they consume by means of 2 types of measurement aids: standard 2-dimensional food portion visuals and manipulative props. DESIGN: Randomized controlled trial. PARTICIPANTS: Fifty-four African American girls aged 8 to 12 years. MAIN OUTCOME MEASURES: Girls were served a standard meal and actual intake was assessed by weighing food portions before and after the meal. On completion of the meal, dietitians collected food recalls and portion size estimates from the girls by means of both manipulative props and 2-dimensional food portion visuals, administered in a randomized order. RESULTS: Absolute value percentage differences between actual and estimated grams of food consumed averaged 58.0% (SD, 102.7%) for manipulative props and 32.8% (SD, 72.8%) for 2-dimensional food portion visuals. Spearman correlations between actual and estimated intakes with both portion size measurement aids were high (range, r = 0.56 to 0.79; all P<.001), with the exception of bread intake (r = 0.16, P =.43). Correlations with actual intakes did not differ significantly between the 2 methods. CONCLUSIONS: Children's self-reported portion size estimates are appropriate for ranking children's relative intakes, but they result in sizable errors in quantitative estimates of food and energy intakes. Caution should be used in interpreting quantitative dietary intake estimates derived from children's self-reports.

Black or African American↗
PubMed1991

The validity of a food use questionnaire in assessing the nutrient intake of physically active young men.

The validity of a self-administered food use questionnaire, comprising 122 questions on food items or dishes and designed especially to assess the intake of micronutrients, was evaluated using a 7-day food record (7DR) as a reference method. The subjects kept the food record after they filled in the questionnaire. Eighty-four male athletes participated in this study. The nutrient intake from the food use questionnaires was calculated in two ways: (i) in questionnaire 1 (FUQ-1), the portion size reported by the subjects was used, and (ii) in questionnaire 2 (FUQ-2), a 'typical' portion size was used regardless of the subject's report. In FUQ-1, the reported nutrient intake tended to be overestimated in comparison to the 7DR, whereas in FUQ-2 comparable results on a group level for all nutrients, except for proteins and fats, were obtained. The percentage of subjects similarly classified into tertiles (7DR vs. FUQ-1 or FUQ-2) varied between 37 and 54 per cent. The results show that the food use questionnaire agreed well with the food record on a group level, if a typical portion size was used. However, the agreement on an individual level was not quite as good.

Adult↗
PubMed2005

Texas school food policy changes related to middle school a la carte/snack bar foods: potential savings in kilocalories.

The potential impact of a school food policy change reducing sweetened beverage and high-fat, salty, and sweet food portions on energy consumption of middle-school students was assessed. Snack bar sales for one school year were obtained from 23 schools. Energy content was calculated for each item and energy savings from reduced portion size was determined. Per student, about 111 kcal per day was purchased; 47 kcal per day was saved when reduced portion sizes were substituted for the large servings. These findings should provide some assurance that changes in food portion sizes in school food environments could impact energy balance.

Carbonated Beverages↗
PubMed2003

Selective underreporting of energy intake in women: magnitude, determinants, and effect of training.

OBJECTIVE: The aim of this study was to quantify underreporting of energy intake in Brazilian women; identify underreporting determinants; find out if underreporting was selective and; test if a motivational multimethod training, in combination with providing the subjects some results from the prior recording period, was able to reduce underreporting. DESIGN: Energy intake (EI) was assessed by a 7-day diet record. Energy expenditure (EE) was calculated by heart rate monitoring. EI:EE ratio lower than one in subjects who did not lose weight in one month was considered underreporting. Underreporting was correlated with anthropometric, behavioral, and psychological parameters. Food and nutrient consumption was compared between underreporters and non-underreporters. A focus group investigated the main causes of underreporting. Subjects were told that the earlier food records' results were unrealistic and submitted to a motivational training. Then, they were reevaluated for underreporting. SUBJECTS: Subjects were recruited by advertisements for a physical activity program. Thirty-eight healthy women, 13 normal-weight (34%), 13 overweight (34%), and 12 obese (32%), enrolled in the study. Three subjects (2 normal-weight and 1 obese) (8%) withdrew. STATISTICAL ANALYSIS PERFORMED: Analysis of variance, paired t tests, and simple linear regression. RESULTS: Seventeen women (49%) underreported their EI by 21%. A significant negative correlation was found between social desirability and EI:EE. Undereating, errors in portion sizes estimation and the inconvenience of having to record everything that was eaten seemed to explain underreporting. Mean portion sizes did not differ for underreporters and non-underreporters. Fewer self-reported years of education was correlated with underreporting only among normal-weight women. Training and confrontation with earlier results reduced underreporting rate to 33%, but did not affect macronutrient densities. Applications/conclusions Subjects tended to report their intake in a socially desirable way, by eating or reporting less frequently foods considered unhealthful or fattening, like sweets and fried foods. Inclusion of social desirability score as a covariate in studies that rely on self-reports of food intake may be useful. A motivational training program, developed in such a way that subjects are comfortable reporting intake of foods considered socially undesirable, in combination with confrontation with earlier results of dietary assessment and use of portion size measurement aids, can be used to attenuate underreporting.

Adult↗
PubMed2001

A culture-sensitive quantitative food frequency questionnaire used in an African population: 1. Development and reproducibility.

OBJECTIVE: To develop and assess the reproducibility of a quantitative food frequency questionnaire (QFFQ) sensitive to the culture of the African population of the North West Province, South Africa. DESIGN: A cross-sectional study. SETTING: A community-based field study in a population stratified according to level of urbanization from deep rural to urban upper class. SUBJECTS: A total of 144 (99 women and 45 men) residents of the North West Province, aged between 15 and 65 years. participated in the study. METHODS: A culture-sensitive. 145-item interviewer-administered QFFQ was designed to cover the whole diet. Portion sizes were estimated from a food portion photograph book (FPPB) showing foods in three portion sizes. The QFFQ was administered twice, 6-12 weeks apart. RESULTS: Spearman rank correlation coefficients between the two administrations varied from 0.14 for calcium to 0.75 for alcohol. The mean percentage difference between intakes was 8.5 (standard deviation= 9.9). Energy. protein, carbohydrate and calcium gave differences within 10%. Few significant differences among correlation coefficients or percentage difference for gender, age group or strata of urbanization were present. Bland-Altman plots showed significant proportional bias for protein, fibre and vitamin C. More than 70% of the participants were classified into adjacent quintiles for all nutrients. For food groups, correlation coefficients ranged from 0.25 for milk to 0.45 for vegetable and maize meal groups and 809/a of participants were classified into adjacent quintiles. CONCLUSIONS: The QFFQ appeared to be a reproducible dietary intake assessment instrument.

Adolescent↗
PubMed1997

The Dutch EPIC food frequency questionnaire. I. Description of the questionnaire, and relative validity and reproducibility for food groups.

BACKGROUND: A self-administered food frequency questionnaire was developed for the Dutch cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Habitual consumption of 178 food items can be calculated from the questionnaire data. METHODS: Reproducibility and relative validity for food group intake were investigated in a population of 121 Dutch men and Women. The questionnaire was administered three times at 6-month intervals in order to determine the reproducibility. To assess the relative validity 12 monthly 24-hour recalls served as the reference method. RESULTS: Spearman rank order correlation coefficients between estimates of food group intake assessed by repeated questionnaires ranged from 0.45 to 0.92. For men, Spearman correlation coefficients between estimates of food group intake based on the questionnaire and those based on 24-hour recalls ranged from 0.21 for cooked vegetables to 0.78 for sugar and sweet products, with a range of 0.61. For women the median was 0.53, with a minimum of 0.31 for vegetables and a maximum of 0.87 for alcoholic beverages. The photographs in the questionnaire for the estimation of portion sizes contributed little to the relative validity of the ranking of subjects. However, on the group level most median food group estimates based on photographic portion sizes were closer to the median intakes as assessed by 24-hour recalls than those based on standard portion sizes. CONCLUSIONS: The questionnaire seems adequate for ranking Dutch EPIC subjects according to intake of most food groups, although the relative validity for some food groups, such as vegetables and fish, remains of concern.

Adult↗
PubMed2000

24-hour history is more closely associated with vitamin A status and provides a better estimate of dietary vitamin A intake of deficient Indonesian preschool children than a food frequency method.

OBJECTIVES: To determine if the Simplified Dietary Assessment to Identify Groups at Risk of Inadequate Intake of Vitamin A developed by the International Vitamin A Consultative Group (IVACG) correctly classified a group of vitamin A-deficient children as being at risk, and to see if a food frequency questionnaire (FFQ) or 24-hour history (24HH) yielded estimated dietary vitamin A intakes most closely associated with vitamin A status. DESIGN: Forty-seven foods were identified as contributing most of the vitamin A to the diet of the study population. For each food, usual portion sizes were determined during a pilot study. Intake was calculated from data collected by FFQ and 24HH. Four modifications of the 24HH analysis were made to determine if this method of analysis could be simplified. SUBJECTS/SETTING: Subjects were 265 Indonesian children with or at high risk of developing xerophthalmia. RESULTS: Mean and median intakes of vitamin A based on the 24HH analysis were 50% and 27% of the US Recommended Dietary Allowance, respectively, which accurately identified the study sample as being at risk. Dietary intake based on the 24HH was significantly associated with serum retinol concentration (P = .01, trend test). Eliciting portion sizes during the 24HH was not necessary once the usual portion sizes consumed by the population were estimated in the pilot study. Mean and median intakes of vitamin A based on the FFQ were 150% and 118% of the Recommended Dietary Allowance, respectively, which suggests that the FFQ overestimated intake. Intake based on the FFQ was not correlated with serum retinol concentration. CONCLUSIONS: Our findings do not support the IVACG recommendation that the FFQ be regarded as more reliable than the 24HH when the 2 methods produce different conclusions, nor the recommendation of some users of the method that the 24HH be dropped from the assessment method.

Child Nutrition Disorders↗
PubMed2006

Potential of an analog scaling device for measuring fullness in children: development and preliminary testing.

Improving children's abilities to recognize when they are full is one strategy to prevent overweight, but currently, there are few validated instruments to assist this process. In the present study, we developed and tested the potential of an analog scaling device for quantifying sensations such as fullness in 4-5 year old children. The device was a picture of a doll with a rectangular stomach over which a sliding bar could be moved to communicate rated fullness levels. Eleven 4-5 year old children were shown pictures of French fries and fruit salad in five varying portion sizes that increased in diameter exponentially by a power of 1.5, ranging from 5.2 to 18.5 cm. Success in using the device was predefined as an increase in ratings as a function of increasing portion size, in at least one of two trials. Eight children were successful with the fries, and ten were successful with the fruit salad. Mean ratings across children were significantly different from each other for both foods. These data show that children can be trained to use an analog scale to quantify differences in portion sizes of foods. Future experiments will validate this scaling procedure for measuring fullness in real eating situations. If successful, this methodology might have applications to the measurement of other bodily sensations in young children.

Child, Preschool↗
PubMed1987

Evaluation of two food frequency methods of measuring dietary calcium intake.

To assess the ability of food frequency methods to measure current dietary calcium intake in elderly women, the authors administered two types of food frequency instruments to 37 randomly selected women who attended two senior citizens centers in San Francisco, and they compared those responses to seven-day food records. A 34-item food frequency instrument (with portion sizes rated as small, medium, or large) correlated well (r = 0.76) with the estimated calcium intake from seven-day records. Limiting the instrument to the top 15, 10, or five foods that contribute to dietary calcium intake had little effect on this correlation (r = 076, 0.75, and 0.67, respectively). Rating all portions as "medium" reduced these correlations somewhat. An 18-item instrument, which asks respondents to rate portion sizes in ounces or cups, did not correlate as well with the seven-day records (r = 0.49). The authors conclude that brief food frequency instruments which rate portion sizes on a simple qualitative scale may be suitable for many clinical uses and adequate for some types of epidemiologic studies of calcium intake in elderly women.

Aged↗