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PubMed2005

A regional food-frequency questionnaire for the US Mississippi Delta.

OBJECTIVE: To describe food sources of nutrient intake for white and African American adults in the Lower Mississippi Delta (LMD), and their use in the development of a regional food-frequency questionnaire (FFQ) based on an earlier version of the National Cancer Institute's Health Habits and History Questionnaire. DESIGN: We ranked food sources of energy, macronutrients, vitamins and minerals, and examined portion size distributions for 842 white and 857 African American residents aged 19 years and older, using 24-hour dietary intake recall data from a telephone survey of 36 LMD counties. These values were used to develop a regional FFQ, which was then field-tested with 100 subjects and revised to improve interpretability. SETTING: The LMD region of the USA. SUBJECTS: White and African American adult residents of the LMD. RESULTS: LMD African Americans obtained more of their energy and nutrient intakes from poultry, processed meat, salty snacks, fruit drinks, pork and cornbread; and less from milk, alcohol, legumes, salad dressing, butter/margarine and sweetened tea than did white residents. Regional foods not on nationally used FFQs included grits, turnip greens, okra, ham hocks, chitterlings, crawfish, catfish, cracklings, jambalaya, potato logs, chicken and dumplings, and sweet potato pie. Based on responses during field-testing, the questionnaire was also designed to add four portion sizes for each food item, presented as questions, rather than in grid format. CONCLUSIONS: Regional food use patterns differ from national patterns and furthermore differ between African American and white adults in the LMD. The resulting Delta NIRI FFQ for Adults should contribute to improved assessment of usual intake for use in studies of diet and health in this region.

Adult↗
PubMed1981

Validation of a dietary record system for the estimation of daily cholesterol intake in individual outpatients.

In order to develop a reliable system for measuring daily cholesterol intake in individual outpatients, studies were undertaken to establish the shortest time period (in days) for which it is necessary to obtain daily food intake records. Three volunteers were trained in dietary record-keeping and portion-size assessment, and instructed to self-select a low-cholesterol diet for 20 days. During the study period they maintained daily dietary records and collected dummy diets. Comparisons of cholesterol intake calculated from the dietary records (mean 144 mg/day, SD +/- 13, n = 60) to the values from chemical analysis (118 +/- 28 mg/day) demonstrated that the calculated values were higher (mean 19%). More importantly, it was found that a minimum of 9 days' records of dummy diet analyses were required in order to reach an estimate of daily cholesterol intake that varied by less than 10% from the mean of the 20-days' values. In 100 outpatients trained to adhere to a moderately low-cholesterol intake and who maintained sequential dietary records for 9 days, it was found that the mean daily intake was 251 mg/day but that individual patients exhibited substantial daily variations in cholesterol intake (average coefficient of variation = 54%, range = 8.5 to 121.2%). These results demonstrate that, under conditions of training in dietary record-keeping and portion-size assessment, adherence to a low-cholesterol diet, and with collection of at least 9 days of dietary records, a reliable quantitative estimate of daily dietary cholesterol intake can be obtained in free-living outpatient populations.

Ambulatory Care↗
PubMed2000

Comparison of the effectiveness of a telephone 24-hour dietary recall method vs an in-person method among urban African-American women.

OBJECTIVE: To examine the comparative accuracy of telephone and in-person 24-hour dietary recall methods. SUBJECTS: One hundred eighty-five African-American females, aged 40 years and older, recruited from Sunday church services in Baltimore City, Md. METHODS: Participants were trained to estimate portion size with plastic food models and a 2-dimensional food recall booklet. Dietary intake was then assessed with 2 in-person 24-hour dietary recalls and 1 telephone 24-hour dietary recall, all using a computer-assisted, multiple pass approach. Results from the 2 in-person recalls were averaged and compared with the results from the telephone recall. STATISTICAL ANALYSES: Cross-tabulation, paired t test, Pearson's correlation, chance-corrected agreement, and stepwise linear regression analyses were performed. RESULTS: There were no significant differences between the telephone and in-person methods for any nutrient. Agreement between methods was moderate for all major dietary components, with corrected correlations between methods ranging from 0.26 to 0.97 (P<.001), and kappas ranging from 0.155 to 0.372 (P<.01). Levels of low-energy reporting were high (88% telephone, 91% in-person), though there were no significant differences between methods. CONCLUSIONS: The telephone 24-hour dietary recall method appears to be comparable to the standard in-person method among older African-American women. Portion-size training in person may make subsequent telephone dietary recalls acceptable in this population.

Adult↗
PubMed2000

Validation of a dietary record routine in geriatric patients using doubly labelled water.

OBJECTIVE: To validate a 7-day estimated dietary record routine with standardized portion sizes and household measuring in a clinical setting with the doubly labelled water (DLW) method as the reference method. DESIGN: Energy expenditure was measured with deuterium ((2)H) and oxygen-18 ((18)O), and water loss was estimated by 2H dilution as part of the DLW measurements. Energy and water intake was measured with a 7 day dietary record. SETTING: Five nursing home wards in Sweden. SUBJECTS: Thirty-one geriatric patients with a mean age of 86 y. Inclusion criteria were stable body weight, defined as a maximum change of +/-4% during the last 4 months of +/-2% during the last 2 months and without any acute illness. RESULTS: The mean daily energy intake was 7.2 MJ (1727 kcal) and the mean daily energy expenditure was 6.7 MJ (1595 kcal). The mean daily water intake was 1787 ml and mean daily water loss assessed by labelled water was 1774 ml. Using the dietary record routine, the staff overestimated the patients' energy intake by 8% and water intake from food and beverages by <1% compared to DLW. CONCLUSION: The 7 day dietary record routine based on standardized portion sizes and household measuring seems to be a valid method for assessing the intake of energy and fluids by geriatric patients.

Aged↗
PubMed1987

Use of quantified and frequency indices of vitamin A intake in a case-control study of lung cancer.

Recent publications have examined the extent of food frequency data needed to estimate nutrient intakes in epidemiological studies. The need for amount (usual portion size) data to supplement information on average frequency of intake has been questioned. In a case-control study of risk factors for lung cancer, we have collected data on frequency, amount and past pattern of intake for common or rich sources of vitamin A. These data have been combined with standard content information to calculate three different types of indices: one based on frequency alone, a quantitative index that included both frequency and amount, and a past-weighted index that combined the frequency, amount and data on relative consumption in the past. Odds ratios by tercile of carotene, retinol and total vitamin A intake varied little between the frequency index and the quantified and past-weighted indices. Higher intakes of carotene and total vitamin A were associated with a lower risk for lung cancer regardless of index type. This consistency of results is explained by a stability of relative intakes regardless of index type. Spearman rank order correlation coefficients between the frequency and quantitative indices exceeded 0.90 for total vitamin A, carotene, and retinol. This stability is attributable to parallel trends of increased frequency of consumption and portion size at higher levels of nutrient intake. Because similar trends were observed in five main food groups included in these analyses, these findings may be generalizable to other nutrients.

Aged↗
PubMed2005

Food behaviors and other strategies to prevent and treat pediatric overweight.

OBJECTIVE: To summarize the evidence for the following six strategies to prevent or treat overweight among children: promoting breastfeeding, promoting physical activity, reducing TV/video viewing, increasing fruit and vegetable consumption, reducing sugar-sweetened drink consumption, and reducing portion sizes. METHODS: Summarization of the relevant literature including review articles, relevant newly published work, the Institute of Medicine's Report on Preventing Childhood Obesity and the Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity, 2001. This is not a comprehensive review. RESULTS: Evidence for the association between each strategy and overweight varies. For breastfeeding, physical activity, and TV viewing, there are large review studies. Breastfed children may have a small reduction in risk for overweight. Participation in physical activity may reduce the risk of overweight among school-aged children and adolescents. For preschool- and school-aged children, reducing TV viewing time may reduce their risk of overweight, but most studies report small significant associations. Evidence for an association between each dietary factor and overweight is limited and inconclusive. The biggest gaps in evidence are for the effectiveness of interventions using these strategies. The reviewed interventions based on increasing physical activity (n=7) were effective. Two randomized trials suggest that reducing TV viewing reduces overweight. No intervention studies were found that examined the effectiveness of changing fruit and vegetable consumption, sugar-sweetened drink consumption, or portion sizes. Further clarification of the effect of breastfeeding on obesity is needed. CONCLUSIONS: These six strategies are reasonable ways to attempt prevention or treatment of overweight in children. Strength of the evidence varies by strategy. The key finding is that more applied research is needed to determine the effectiveness of these and other strategies.

Beverages↗
PubMed2000

Low energy reporters vs others: a comparison of reported food intakes.

OBJECTIVE: To partition the food reports of low energy reporters (LERs) and non-LERs into four aspects-tendency to report a given food, frequency of reports per user, portion sizes per mention, and the qualitative (low-fat, low-sugar, low-energy) differences of the reports-in order to determine what differentiates them from one another. ASSESSMENT METHOD: Two non-consecutive 24h dietary recalls. Low energy reporting was defined as energy intake lower than 80% of estimated basal metabolic rate. SETTING: In-home personal interviews. SUBJECTS: 8334 adults from a stratified, multi-stage area probability sample designed to be representative of noninstitutionlized persons residing in households in the United States. RESULTS: Across all different types of foods, there are those food groups which LERs are less likely to report (28 of 44 food groups), those which they report less frequently when they do report them (15 of 44 groups), and those for which they report smaller quantities per mention (26 of 44). Qualitative differences in the food choices-that is, differences in fat, sugar, and/or energy content-were not so widespread (4 of 24 food groups). CONCLUSIONS: The practical application of analyses such as these is to improve the methods of gathering dietary data so that this kind of bias can be reduced. Further methodological research is needed to reduce the likelihood of respondents neglecting to mention foods and underestimating portion sizes.

Adult↗
PubMed2000

An evaluation of food photographs as a tool for quantifying food and nutrient intakes.

OBJECTIVE: To evaluate the errors incurred by young adults using single portion size colour food photographs to quantify foods and nutrients consumed at six meals on two non-consecutive days. DESIGN: Breakfast menus remained the same for the 2 days; but lunch and dinner menus varied. The amounts of food eaten by individuals were determined by weighing individual serving dishes pre- and post-consumption. The day after eating, all foods consumed were quantified in terms of fractions or multiples of the amounts shown in the food photographs. SUBJECTS: Thirty adult volunteers (15 male, 15 female), aged 18-36 years, completed the protocol for day one; 27 (90%) completed day two. RESULTS: Some foods were more difficult to quantify accurately than others. The largest error range was -38. 9% to +284.6% (cheese), whereas the smallest errors were incurred for juice (-21.5% to +34.6%, day one). All subjects who consumed muesli (day one) overestimated (+3.7% to +113.7%). No other foods were consistently over- or underestimated. For foods consumed at breakfast by the same subjects on both days, individual estimation errors were inconsistent in magnitude and/or direction. At the group level, most nutrients were estimated to within +/-10% of intake; exceptions were thiamin (+10.5%, day one) and vitamin E (-10.1%, day one; -15.3%, day two). Between 63% and 80% of subjects were correctly classified into tertiles on the basis of estimated intakes. CONCLUSIONS: Despite some large food quantification errors, single portion size food photographs were effective when used to estimate nutrient intakes at the group level. It remains to be established whether, under the conditions used in this study, more photographs per food would improve estimates of nutrient intake at the individual level.

Adolescent↗
PubMed1998

Telephone vs face-to-face interviews for quantitative food frequency assessment.

OBJECTIVE: To develop and test a quantitative food frequency method for administration by telephone. DESIGN: A comparison study of telephone and face-to-face interviews was conducted among a representative sample of the five major ethnic groups in Oahu, Hawaii. Two interviews were administered 4 to 6 months apart by trained interviewers using identical questionnaires and color photographs of food items showing three different portion sizes. The order of the interviewing methods was randomly assigned. The questionnaire included 115 food items selected to estimate 80% or more of usual dietary intakes. Frequencies and quantities of each item consumed during the past year were obtained. SUBJECTS/SETTING: Subjects were recruited from the Health Surveillance Program of the Hawaii State Department of Health and consisted of 167 men and 158 women, aged 45 to 74 years, who provided a telephone number. Eighty percent of the face-to-face interviews were conducted in the subjects' homes and 20% were conducted at the workplace or the University of Hawaii Cancer Research Center, if requested. STATISTICAL ANALYSES: The paired t test was used to compare the mean daily intakes obtained by the telephone and face-to-face methods. Agreement was measured by the intraclass correlation coefficient (ICC), Pearson correlation coefficient and weighted kappa statistic. RESULTS: The means of energy and each nutrient were slightly higher in the first interview than the second, regardless of the interviewing method. Because of close correspondence among all 3 statistical measures of agreement, only the ICCs are reported. The ICCs ranged from .61 for protein and vitamin A to .69 for dietary cholesterol among men, and from .61 for vitamin C to .74 for saturated fat among women. Agreement was not significantly affected by age, gender, ethnicity, order of interview, or educational level. APPLICATIONS: Telephone interviews to obtain quantitative food frequencies are cost-efficient methods for estimating usual dietary intakes among persons in widely scattered geographic areas. Photographs of the foods in 3 portion sizes mailed in advance help the respondents estimate amounts eaten.

Aged↗
PubMed2000

Evaluation of alternative approaches to assign nutrient values to food groups in food frequency questionnaires.

Although every food frequency questionnaire (FFQ) requires a nutrient database to produce nutrient intake estimates, it is often unclear how a particular database has been generated. Moreover, alternative methods for constructing a database have not been rigorously evaluated. Using 24-hour recalls from the 1994-1996 Continuing Survey of Food Intake by Individuals, the authors categorized 5,261 individual foods reported by 10,019 adults into 170 food groups consistent with line items on an FFQ. These food groups were used to generate 10 potential nutrient databases for a FFQ that varied by whether the authors 1) used means or medians, 2) did or did not consider age, 3) incorporated collapsing strategies for small age-gender-portion size cells, 4) excluded outliers in a regression, and 5) used weighted median nutrient density x age-gender-portion size-specific median gram weights (Block method). Mean error, mean squared error, and mean absolute error were calculated and compared across methods, with error being the difference in total observed (from recalls for each individual) and total estimated intake (from each of the 10 methods) for seven nutrients. Mean methods for assigning nutrients to food groups were superior to median approaches for all measurements. Among the mean methods, no single variation was consistently better.

Adult↗
PubMed1986

The economics of the law of effect.

A corollary of the law of effect predicts that the larger the reinforcement, the greater the rate of responding. However, an animal must eat more small portions than large portions to obtain the same daily intake, and one would predict, therefore, that when eating smaller portions an efficient animal would eat less (conserving time and energy) and/or respond faster (conserving time). The latter of these predictions was supported by the present experiments with free-feeding rats for which portion size (pellet size or duration of feeder presentation) and portion price within meals were varied. Response rate was a function of the unit price (responses/g) of food: Rats responded faster when portions were smaller or when prices were higher. Meal size and frequency were relatively unaffected by unit price, but were influenced by the price of meal initiation. The results are discussed in relation to the economic differences between traditional operant and free-feeding paradigms and to both traditional and more recent formulations of the law of effect.

Animals↗
PubMed1988

A comparison of the effects of tasting and chewing foods on the flow rate of whole saliva in man.

The objective was to determine the relative contributions from gustatory and mechanical stimulation of salivary flow in response to consumption of three foods. In a preliminary study on 6 males and 6 females the weights of normal bite-size portions and their chewing times for rhubarb pie, boiled rice, and raw carrot were established for each subject. In the main study the foods were either (a) divided into the calculated bite-size normal portions or (b) the portions were mashed (rhubarb pie), untreated (rice) or finely ground (raw carrot). The subjects chewed the foods of type (a) in the normal way but, with type (b), simply held the food between the palate and the dorsum of the tongue, with no masticatory movements (tasting). After the normal chewing time the food was not swallowed but spat into a weighed container; the volume of saliva secreted was determined from the increase in weight of the food portions. Rhubarb pie elicited a significantly higher flow rate than did the rice and carrot; the flow rates in response to tasting, as a percentage of those in response to chewing were 86.7 +/- 12.2, 79.3 +/- 17.9 and 73.4 +/- 15.4, respectively. It is concluded that in humans the effect of the gustatory stimulation of foods is much more important than the mechanical stimulation from chewing in producing the flow of saliva.

Adult↗
PubMed1987

Food habits and nutrition education--computer aided analysis of data.

Nutrition education messages should take into account the food habits of those who are to be educated. These can be revealed by computer analysis of weighed intake data, which has been collected for calculation of nutrient intakes. Seventy-six students and staff at Robert Gordon's Institute of Technology weighed their food for 1 week and the records were used to determine the frequency of consumption of foods and portion sizes, as well as nutrient intakes. There were only very minor relationships between the number of different foods chosen and nutritional variables. Nutrition students had successfully changed the frequency of consumption of certain foods relative to others and as a result consumed diets containing a lower proportion of energy from fat. Messages to non-nutrition students might profitably incorporate those beneficial changes that nutrition students had easily accomplished. This study revealed that certain (otherwise common and nutritionally unsound) food choices were not a major part of the subjects' habits, and could be given low priority in educational messages. It was suggested that foods exhibiting high variability of portion weight might be under greater individual control and hence more amenable to change. A study of the distribution of portion weights reveals information about number of slices, biscuits, etc, taken in each portion. This varied for different kinds of biscuit. It was concluded that messages should target specific foods rather than stress variation in the diet. It is suggested that educators should consider whether messages would be more effective in terms of frequency of consumption or size of portion for particular groups. The meal distribution pattern also shows which foods are most commonly consumed at home or in the canteen, hence whether education might be best directed to the individual or the caterer, respectively.

Adult↗
PubMed1982

The validity of a telephone-administered 24-hour dietary recall methodology.

This study assesses the operational feasibility and validity of a unique telephone-administered 24-h dietary recall methodology. Dietary interviews were conducted by telephone with 204 low-income elderly subjects. Food portion size estimation was done using a two-dimensional food portion visual aid the that was mailed to respondents' homes. The mean intakes and distributions of nine nutrients among males and females in the research sample were compared with those reported in the 1971 to 1974 Health and Nutrition Examination Survey. After correcting for time trends in nutrient intake, the mean intake values found in the survey were very similar to those reported by the Health and Nutrition Examination Survey. In testing the frequency distributions of intakes, only two nutrients for women and one for men had statistically significant differences. The telephone-administered dietary methodology thus produced acceptable estimates of the means and distributions of nutrient intakes among groups of individuals and has the potential of markedly reducing the cost, time, logistical, and personnel constraints associated with nutrition surveys.

Aged↗
PubMed2000

Enhancing the capacity of food consumption surveys of short duration to estimate long-term consumer-only intakes by combination with a qualitative food frequency questionnaire.

In principle, a proper risk assessment for a food chemical requires that the time-frame for food chemical intake estimates matches the time-frame for the toxicological assessments upon which the safety statements (ADI, PTWI, etc.) are based. For food additives, the toxicological assessments are based on exposure over a lifetime. While food consumption data cannot be collected over the lifetimes of individuals, the information should reflect habitual intakes as closely as possible. This study investigated the possibility of combining a 3-day food diary with a food frequency questionnaire to estimate mean consumer-only food intakes comparable to estimates based on a 14-day diary. The study population consisted of 948 teenagers and analysis was based on 32 clearly defined foods. For 47% of the foods, the difference was < or = 1 g/day. When expressed as portion sizes, 56% of the foods showed differences representing < 5% of an average portion and no food showed a difference > 14% of an average portion. When between-method differences (portions/day) were plotted against the mean of the methods, the mean between-method difference was 0.02(+/- 0.06) portions/day with limits of agreement of -0.10 to 0.14. This preliminary investigation suggests that the combined 3-day diary and FFQ method provides comparable estimates of mean consumer only intakes to a 14-day diary. Therefore, a qualitative FFQ may be a useful adjunct to a food consumption survey of short duration if estimates of longer term food intakes are required.

Adolescent↗
PubMedDate not supplied

Energy-enriched hospital food to improve energy intake in elderly patients.

BACKGROUND: It was hypothesized that energy intake in hospitalized elderly patients could be improved by increasing the density of energy of the food and that the volume of food actually consumed, even with a higher energy content than the normal, would not change with servings of high energy-dense hospital food. METHODS: Thirty-six elderly patients (52 to 96 years) of both sexes, long-term treated at two comparable wards, participated in this study. The patients were given 6 weeks of regular hospital food (RHF, 1670 kcal/d, 7.0 MJ) and 6 weeks of high-energy food (HE, 2520 kcal/d, 10.5 MJ). The volume of food was kept constant. A crossover study design was used. Food intake, energy intake, body weight, and modified functional condition (Norton scale) were measured. RESULTS: Regardless of type of food (RHF or HE) and time of day (lunch or dinner), he food portion size (volume of food) intake was the same, approximately 80% of the portions consumed. HE led to a 40% increase in energy intake (from 25 +/- 1 during RHF to 35 +/- 2 kcal/kg/d, p < .0001), which resulted in a 3.4% increase in body weight (p < .001) after 3 weeks of HE. Only minimal changes in functional condition were found. The cost of HE was substantially lower (-85%) than any other mean available for improvement of energy intake. CONCLUSIONS: A significant increase in energy intake can be achieved by higher energy density in regular hospital food and that HE does not cause a decrease in the volume of the food consumed. These findings suggest that it is the volume of food rather than the energy that limits voluntary energy intake of hospital food in elderly hospitalized patients.

Aged↗
PubMed1986

23rd Lenna Frances Cooper memorial lecture: a diet history method for research, clinical, and community use.

A structured quantitative diet history method has been developed and utilized in several cancer epidemiological studies in Hawaii. The objective was to design a questionnaire that would yield a valid and reproducible assessment of the usual frequency and quantity of food and nutrient intakes by individuals and that could be administered by trained lay interviewers. The questionnaire consists of a list of food items selected to provide an estimate of 85% or more of the intakes of particular nutrients during a usual week or month. Amounts consumed are estimated from photographs showing each item in three serving sizes. The procedures used in developing the diet history questionnaire are described. Briefly, the steps include: collection of frequency and quantitative data on foods consumed (food records) by a sample of the population, interpretation and coding of the food records, selection of food items for the questionnaire, identification of appropriate serving sizes of the selected food items, selection of a visible technique for showing different portion sizes to the subjects, establishing the reference period for the diet history, and training of the interviewers. The use of the method in various epidemiological studies, current research on dietary methodology, and applications of the method for clinical and community use are discussed.

Adult↗