DEFINITION OF DIETARY INTAKE ASSESSMENT

The self-report of dietary intake by overweight children and adults has been shown to be inaccurate.
Researchers have shown that food records from overweight pediatric patients tend to underestimate
caloric intake when compared with actual energy expenditure [20]. The assessment of the dietary
intake of overweight children and adolescents can be performed using a global assessment that is
composed of self-administered 3-day food records, nutrition questionnaires, and a dietary interview
performed by a registered dietitian [21] or other health professional. By using self-report coupled
with a dietary interview, the resulting nutritional intake data can be more reliable for the practitioner.
The use of either the global assessment or an individual component will depend on personnel, time
constraints, technology, and clinical care needs.
The global assessment requires the child or adolescent and family to be trained in the recording
of a 3-day food record (2 weekdays and 1 weekend day). The training includes educating the child
and family on how to list (including times and places the foods were consumed) and describe
(portion size, brand, food preparation) all foods and beverages consumed over the 3-day period.
The recorders need to know how to record accurate portion sizes or amounts of all food consumed
inside and outside of the home. A packet containing contact information for a person of whom the
family can ask questions related to the food records, food recording sheets, written instructions,
and pictorial methods of describing foods will improve the quality of the records. For younger
children in daycare centers or at babysitters’ homes, the caretaker needs to be involved in this food
recording process. Adding questions to the end of each day’s recording that prompt for missing
items, assessment of daily intake (less, more, or typical), and completeness of record (complete,
incomplete) can improve accuracy and analysis. The practitioner can explain to the family that the
purpose of the record is to accurately represent what the child or adolescent is eating rather than
judge whether his or her diet is “good or bad.” Adolescents may prefer to complete their records
on their own with the understanding that the analysis will be kept confidential and not shared with
their parents. If the child or adolescent spends time in two households, two sets of food records
may be warranted.
The food records offer the child or adolescent and family the opportunity to actually reflect on
what types and amounts of foods are eaten, as well as where they are consuming these foods. This
simple form of self-monitoring can be very enlightening for the child or adolescent, family, and
practitioner. In research settings, a 24-hour multiple-day food record pass may be used. In this
case, the child, adolescent, and family receive similar training to that above, but the dietary intake
data is collected by means of a 24-hour food recall and 24-hour food record, reviewed by a dietitian
either in person or via telephone. This method was found to be more reliable for group intakes
than for individual intakes [22].
The food records can be returned before the counseling session and analyzed with computer
software. Several nutrient analysis programs are available, and their features vary according to their
cost. The practitioner must determine the needs of the practice such as client education, clinical
care, research, or a combination of these. If the records are to be used for research, then the accuracy
and scope of the database; the flexibility of analysis of meals, snacks, foods, and food components;
and the ease of export of nutritional data for statistical analysis using commercial software would
be of concern to the researcher. In clinical care situations, the accuracy of the database, ease of
data entry, cost, and client education reports would be of greater importance. Some practitioners
may choose not to formally analyze the food records but, rather, to clinically review them to assess
for overall dietary quality.
Nutritional questionnaires include food frequency questionnaires that inquire how many times
in a specified time period a person consumes certain foods, beverages, or food groups. The format
of the questionnaire can require the respondent to provide a written answer to a question or circle
a response on a scale. The answers to the questions can be used in conjunction with a Likert Scale,
which can be used to score the questionnaire. The score can then be used to evaluate the quality
of the diet. Limitations of this method include the validity of the measurement or questionnaire
and the scope of the nutrient information obtained. The advantage of nutritional questionnaires is
that they are easy to administer, require minimal patient training, are inexpensive, and can be
designed to address specific eating patterns and food consumption. Health professionals, other than
registered dietitians, may find this measure easier to interpret than a formal food record nutrient
analysis.
The third component of nutrient intake assessment is a dietary interview. The dietary interview
is usually conducted by a registered dietitian or other health professional with nutrition training.
The interview comprises a nutrition history of allergies, supplements, medications, and past feeding
practices; recent changes to child or adolescent or family diets; typical intake for meals and snacks
for weekdays and weekends, including foods and beverages eaten inside and outside the home;
schedule of meals/snacks; current feeding practices; and child or adolescent and family nutritional
concerns or conflicts. If the child or adolescent spends time in multiple households or has multiple
caretakers, all parents or caretakers should be interviewed either in person or by phone when possible.
Feeding practices that have been related to overweight in children and adolescents have been
identified. They include parental restriction of childhood eating [23], speed of eating [24–26],
increased portion size [27], increased consumption of soda [28], and frequency of fast food meals
[5]. Children ages 6 to 11 years consume on average only 2.5 servings of fruit and vegetables per
day, which is only half of their recommended 5 servings per day. Data from the National Health
and Nutrition Examination Survey (NHANES) III survey indicate that adolescents consume less
than one third of their recommended fruit and vegetable intakes [3]. Data from the 1994–1996 and
1998 U.S. Department of Agriculture Continuing Survey of Food Intakes by Individuals for youth,
ages 6 to 17 years, indicate that individuals with increased consumption of sugar-sweetened
beverages, sugars and sweets, and sweetened grains had a decreased likelihood of meeting the
dietary reference intakes for calcium, folate, and iron [29].
The information from the dietary intake assessment should identify overly consumed, highcalorie,
nutrient-sparse foods and beverages; locations and times that these foods are consumed;
feeding practices that promote the overconsumption of these foods; and child or adolescent and
family awareness of these eating behaviors. In addition, nutrient intake deficiencies such as inadequate
intakes of calcium, fiber, iron, folic acid, and fat-soluble and water-soluble vitamins should
become apparent. Identifying obesegenic feeding practices and nutrient intake deficiencies can aid
the practitioner, child or adolescent, and family to develop strategies to modify these eating behaviors.