Assessment of nutritional status
Obesity management
Dietary assessment methods
Assessment of nutritional status
1. Evaluation in adulthood:
• various indices
2. Evaluation in childhood (development):
• percentile charts or percentile curves
• BMI IOTF cut-off points
Assessment of nutritional status
ADULTS
Body Mass Index (BMI)
body weight (kg)
Body Mass Index (BMI) = -------------------------(Quetelet’s index)
body height2 (m2)
The International Classification of adult underweight,
overweight and obesity according to BMI. (WHO, 1997)
BMI calculator
http://www.cdc.gov/nccdph
p/dnpa/bmi/adult_BMI/met
ric_bmi_calculator/bmi_calc
ulator.htm
Source: http://www.who.int/features/factfiles/obesity/facts/en/
Waist Circumferernce (WC)
• WC provides an independent prediction of risk over and above that of BMI.
• Waist circumference measurement is particularly useful in patients who are categorized as
normal or overweight on the BMI scale.
• High risk of obesity-related diseases:
men:
WC > 102 cm
women: WC > 88 cm
Measuring Tape Position for WC
WC measurement should be made at
the top of the iliac crest.
Abdominal fat has been shown to provide an
independent risk estimate beyond BMI alone.
Current guidelines recommend the measurement
and recording of both BMI and WC, with different
cut points for different ethnic groups.
Abdominal obesity
http://www.nhlbi.nih.gov/health-pro/guidelines/current/obesity-guidelines/e_textbook/txgd/4142.htm
Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes, 2009, 33(3):289-95. doi: 10.1038/ijo.2009.2.
Waist-Hip Ratio (WHR)
Waist circumference and waist–hip ratio are measures of abdominal obesity
and were correlated with BMI.
• Measuring hip circumference may be more difficult than measuring waist
circumference alone
• waist circumference use is favored over waist–hip ratio.
Measuring Tape Position for
hip circumference
WHR = waist / hip
Hip circumference measurement
should be taken around the widest
portion of the buttocks.
Waist circumference and waist–hip ratio: report of a WHO expert consultation, Geneva, 8–11 December 2008.
World Health Organization cut-off points and risk of metabolic complications
Combined recommendations of body mass index and waist circumference cut-off
points made for overweight or obesity, and association with disease risk
Waist circumference and waist–hip ratio: report of a WHO expert consultation, Geneva, 8–11 December 2008.
Measurement protocol
1. Use a stretch-resistant tape.
2. The tape held snugly, but not constricting, and at a level
parallel to the floor.
3. Subject stands with arms at the sides, feet positioned close
together, and weight evenly distributed across the feet.
4. Measured at the end of a normal expiration
5. Subject should wear little clothing
6. Each measurement should be repeated twice;
• if the measurements are within 1 cm of one another, the
average should be calculated.
• If the difference between the two measurements exceeds 1
cm, the two measurements should be repeated.
Waist circumference and waist–hip ratio: report of a WHO expert consultation, Geneva, 8–11 December 2008.
Variations in body fat distribution
by age, gender and ethnicity
• There is substantial evidence of gender and age variations in waist
circumference and waist–hip ratio,
• some evidence for ethnic differences.
• Compared to Europeans, Asian populations have greater visceral adipose
tissue, and African populations and, possibly, Pacific Islanders have less
visceral adipose tissue or percentage of body fat at any given waist
circumference.
Percentage of body fat
Asian > European > African, Pacific Islanders
• If higher levels of abdominal fat for a WC or WHR level are reflected in
associations with health outcomes, then lower thresholds for these
indicators might be needed for the affected populations than for
European or other reference populations.
Waist circumference and waist–hip ratio: report of a WHO expert consultation, Geneva, 8–11 December 2008.
Associations of body mass index, waist
circumference, waist–hip ratio with disease risk
Body Mass Index
Waist
Circumference
Waist-Hip Ratio
Relation Strength of
ship
evidence
Relation
ship
Strength of
evidence
Relation
ship
Strength of
evidence
CVD risk
++
convincing
++++
convincing
++++
convincing
Type 2 Diabetes mellitus
+++
convincing
+++
convincing
+++
convincing
Hypertension
+++
convincing
+++
convincing
+++
convincing
Overall mortality
0/-
probable
++++
convincing
++++
convincing
Cancer – colorectal, breast
+++
convincing
++
convincing
++
Convincing
Cancer – pancreas,
endometrium, cervix,
kidney, gallbladder
+
possible
+
possible
+
possible
Waist circumference and waist–hip ratio: report of a WHO expert consultation, Geneva, 8–11 December 2008.
Assessment of nutritional status
Body fat % (Adults, children)
triceps skinfold (mm)
biceps skinfold (mm)
subscapular skinfold (mm)
suprailiac skinfold (mm)
Equipment for measurement: CALIPER
Assessment of nutritional status
CHILDREN
Growth charts
Growth charts consist of a series of percentile curves that illustrate the
distribution of selected body measurements in children.
Percentiles: The percentage of a given population of children at a certain
age below a given value of usually height or weight. Percentile values are
always time and region specific (country, year).
Weight Status Category
Percentile Range
Underweight
Less than the 5th percentile
Healthy weight
5th percentile to less than the 85th percentile
Overweight
85th to less than the 95th percentile
Obese
Equal to or greater than the 95th percentile
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
http://www.cdc.gov/growthcharts/who_charts.htm#The WHO Growth Charts
BMI Percentile Calculator for Child and Teen
aged 2 through 19 years old
http://apps.nccd.cdc.gov/dnpabmi/Calculator.
aspx?CalculatorType=Metric
Assessment of nutritional status in children
• Extended International (IOTF) Body Mass Index Cut-Offs for
Thinness, Overweight and Obesity in Children
• The revised international child cut-offs corresponding to the
following body mass index (BMI) cut-offs at 18 years:
16
17
18.5
23
25
27
30
35
thinness grade 3
thinness grade 2
thinness grade 1
overweight
overweight
obesity
obesity
morbid obesity
BOYS
http://www.worldobesity.org/site_media/uploads
/New_Cut_off_Points_Male_Children.pdf
GIRLS
http://www.worldobesity.org/site_media/uploads
/New_cut_off_points_female_children.pdf
http://www.worldobesity.org/aboutobesity/child-obesity/newchildcutoffs/
Hungarian Body mass index for - age- percentiles 0-18 years (males)
Életkor
Születéskor
1 hónap
2 hónap
3 hónap
4 hónap
5 hónap
6 hónap
8 hónap
10 hónap
12 hónap
15 hónap
18 hónap
21 hónap
2 év
3 év
4 év
5 év
6 év
7 év
8 év
9 év
10 év
10,5 év
11 év
11,5 év
12 év
12,5 év
13 év
13,5 év
14 év
14,5 év
15 év
15,5 év
16 év
16,5 év
17 év
17,5 év
18 év
Esetszám
(N)
2 984
2 949
2 938
2 927
2 895
2 869
2 838
2 809
2 789
2 807
2 622
2 597
2 543
2 585
2 351
2 397
2 455
2 469
2 335
2 306
2 274
2 222
1 689
1 794
1 662
1 749
1 601
1 687
1 549
1 611
1 166
1 188
837
890
654
692
485
516
Átlag
x
(kg/m2)
12,80
13,95
15,29
16,04
16,50
16,71
16,85
17,13
17,24
17,19
16,97
16,78
16,57
16,35
15,93
15,67
15,56
15,66
15,91
16,37
16,89
17,50
17,83
18,17
18,54
18,85
19,22
19,52
19,79
20,00
20,28
20,52
20,75
20,99
21,35
21,57
21,76
21,90
Percentilisek (kg/m2)
Szórás
(SD)
3
10
25
50
75
85
97
1,22
1,22
1,32
1,41
1,45
1,46
1,48
1,51
1,50
1,49
1,48
1,48
1,48
1,48
1,44
1,48
1,58
1,80
1,99
2,29
2,61
2,96
3,16
3,32
3,48
3,57
3,62
3,58
3,54
3,51
3,37
3,36
3,27
3,18
3,30
3,24
3,01
3,11
10,73
11,75
12,93
13,63
14,04
14,20
14,29
14,56
14,69
14,64
14,51
14,30
14,06
13,88
13,51
13,26
13,08
13,12
13,17
13,44
13,65
13,85
13,97
14,20
14,30
14,40
14,66
14,95
15,19
15,34
15,81
16,08
16,45
16,81
17,11
17,28
17,64
17,66
11,34
12,43
13,67
14,33
14,78
14,95
15,09
15,24
15,39
15,40
15,19
15,05
14,84
14,64
14,30
13,99
13,83
13,77
13,88
14,16
14,37
14,65
14,85
14,94
15,16
15,34
15,69
15,83
16,28
16,50
16,82
17,15
17,60
17,85
18,01
18,29
18,45
18,45
12,02
13,12
14,44
15,10
15,55
15,72
15,84
16,09
16,21
16,17
15,95
15,77
15,58
15,37
15,00
14,71
14,54
14,52
14,62
14,93
15,25
15,58
15,72
15,94
16,17
16,36
16,70
17,06
17,43
17,66
18,02
18,35
18,59
18,95
19,15
19,38
19,70
19,88
12,77
13,89
15,25
15,96
16,40
16,64
16,80
17,07
17,17
17,07
16,83
16,69
16,45
16,18
15,82
15,55
15,39
15,38
15,56
15,91
16,32
16,78
17,00
17,30
17,59
17,83
18,29
18,68
18,92
19,23
19,58
19,76
20,13
20,33
20,71
20,97
21,22
21,41
13,54
14,73
16,10
16,90
17,37
17,65
17,76
18,06
18,17
18,11
17,83
17,64
17,45
17,21
16,72
16,46
16,32
16,48
16,67
17,19
17,71
18,60
19,08
19,59
20,16
20,48
20,89
21,00
21,28
21,42
21,57
21,92
21,93
22,30
22,53
22,81
23,11
23,12
13,98
15,18
16,62
17,45
17,93
18,15
18,29
18,65
18,73
18,73
18,48
18,28
18,04
17,79
17,27
17,00
16,94
17,13
17,59
18,33
19,14
20,47
20,93
21,36
21,77
22,14
22,48
22,80
23,08
23,33
23,56
23,75
23,92
24,05
24,16
24,23
24,28
24,29
15,03
16,40
17,80
18,74
19,42
19,56
19,73
20,08
20,16
20,27
20,01
19,84
19,56
19,40
18,93
18,82
18,89
19,62
20,66
21,96
23,81
25,33
26,35
26,66
27,32
27,86
28,34
28,45
28,92
29,06
29,06
29,09
28,84
28,63
29,39
29,37
29,01
29,24
© Joubert K., Darvay S., Ágfalvi R. KSH Népességtudományi Kutatóintézet
Hungarian Body mass index for - age- percentiles 0-18 years (females)
Esetszám
(N)
Életkor
Születéskor
1 hónap
2 hónap
3 hónap
4 hónap
5 hónap
6 hónap
8 hónap
10 hónap
12 hónap
15 hónap
18 hónap
21 hónap
2 év
3 év
4 év
5 év
6 év
7 év
8 év
9 év
10 év
10,5 év
11 év
11,5 év
12 év
12,5 év
13 év
13,5 év
14 év
14,5 év
15 év
15,5 év
16 év
16,5 év
17 év
17,5 év
18 év
2 701
2 661
2 653
2 622
2 602
2 577
2 543
2 519
2 480
2 495
2 325
2 292
2 261
2 303
2 094
2 127
2 206
2 209
2 102
2 077
2 071
2 022
1 555
1 641
1 531
1 614
1 494
1 586
1 448
1 525
1 137
1 160
840
883
633
691
465
520
Átlag
x
(kg/m2)
12,71
13,69
14,83
15,52
16,00
16,26
16,43
16,72
16,88
16,84
16,64
16,47
16,26
16,09
15,71
15,54
15,44
15,55
15,75
16,18
16,65
17,18
17,47
17,87
18,24
18,68
19,07
19,52
19,89
20,22
20,52
20,77
21,04
21,09
21,25
21,32
21,48
21,56
Percentilisek (kg/m2)
Szórás
(SD)
3
10
25
50
75
85
97
1,15
1,15
1,21
1,34
1,37
1,42
1,45
1,47
1,48
1,50
1,48
1,50
1,49
1,48
1,50
1,56
1,68
1,88
2,08
2,34
2,58
2,84
2,97
3,13
3,26
3,29
3,27
3,26
3,25
3,25
3,22
3,32
3,15
3,07
3,11
3,11
3,08
3,05
10,67
11,57
12,68
13,26
13,73
13,92
14,05
14,26
14,31
14,32
14,23
14,06
13,85
13,71
13,28
13,10
13,01
12,88
12,91
13,18
13,34
13,49
13,74
13,88
14,05
14,38
14,65
15,05
15,48
15,83
16,22
16,28
16,74
16,80
16,94
16,98
17,31
17,61
11,27
12,28
13,37
13,91
14,39
14,59
14,70
14,95
15,12
15,05
14,88
14,71
14,53
14,31
14,00
13,81
13,61
13,61
13,62
13,84
14,05
14,32
14,54
14,75
14,96
15,33
15,71
16,10
16,59
16,80
17,20
17,48
17,88
17,98
18,04
18,22
18,38
18,45
11,93
12,90
13,98
14,62
15,08
15,31
15,44
15,73
15,89
15,83
15,63
15,46
15,22
15,10
14,77
14,51
14,32
14,32
14,41
14,63
14,86
15,25
15,48
15,74
16,03
16,42
16,80
17,29
17,73
18,03
18,39
18,66
18,93
19,09
19,23
19,38
19,46
19,54
12,67
13,67
14,77
15,41
15,87
16,12
16,29
16,62
16,79
16,73
16,51
16,35
16,12
15,99
15,61
15,39
15,26
15,25
15,38
15,68
16,07
16,52
16,72
17,13
17,54
18,08
18,42
18,91
19,21
19,60
19,84
20,15
20,45
20,49
20,68
20,61
20,82
20,84
13,45
14,43
15,60
16,35
16,82
17,09
17,29
17,63
17,80
17,73
17,48
17,31
17,11
16,94
16,57
16,40
16,28
16,42
16,64
17,18
17,86
18,54
18,74
19,24
19,63
20,09
20,55
21,05
21,34
21,62
21,87
22,07
22,46
22,50
22,45
22,58
22,67
22,87
13,90
14,85
16,08
16,88
17,35
17,68
17,92
18,24
18,37
18,30
18,12
17,96
17,74
17,51
17,15
16,94
16,94
17,16
17,62
18,36
19,16
19,89
20,32
20,84
21,36
21,74
22,10
22,44
22,75
23,05
23,33
23,58
23,81
24,03
24,22
24,39
24,54
24,67
14,97
15,92
17,24
18,19
18,72
19,19
19,34
19,69
19,89
19,94
19,76
19,52
19,31
19,12
18,80
18,72
19,17
19,74
20,53
21,49
22,65
24,10
24,76
25,40
26,28
26,70
26,96
27,26
27,77
27,70
28,09
28,32
28,92
28,77
29,25
29,25
28,97
29,01
© Joubert K., Darvay S., Ágfalvi R. KSH Népességtudományi Kutatóintézet
Management of obesity
Limitations of anthropometric
classifications of obesity
• Although BMI and WC are useful in population studies,
• they lack sensitivity and specificity when applied to individuals.
• Several factors (e.g. cardiorespiratory fitness) may substantially modify
the mortality risk associated with a higher BMI.
• BMI alone is insufficient to guide clinical decision making in individuals.
• Does not assess the presence of concomitant comorbid conditions or
disease risk
• Reasons for limited use of BMI or WC measures in clinical practice
– limited time during office visits,
– lack of training in counseling, competing demands,
– fear of stigmatization and low confidence in ability to treat and change
patient behaviors
Complementing anthropometric parameters with a simple
disease-related and functional staging system would provide
additional clinical information to guide and evaluate treatment.
Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes, 2009, 33(3):289-95. doi: 10.1038/ijo.2009.2.
Edmonton Obesity Staging System (EOSS)
• provide additional guidance for therapeutic
interventions in individual patients.
• Current anthropometric classification systems, based
on simple clinical measures (height, weight, waist
circumference), do not accurately reflect the
presence or severity of obesity-related health risks,
comorbidities or reduced quality of life.
• EOSS includes
– medical history,
– clinical and functional assessments, simple routine
diagnostic investigations
Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes, 2009, 33(3):289-95. doi: 10.1038/ijo.2009.2.
24
25
http://www.drsharma.ca/wp-content/uploads/edmonton-obesity-staging-system-pocket-card.pdf
Obesity Treatment Algorithm
Remember
http://www.nhlbi.nih.gov/health-pro/guidelines/current/obesity-guidelines/e_textbook/txgd/algorthm/algorthm.htm
Algorithm for the stepwise management of
adult patients with overweight or obesity
Dietz WH et al. Management of obesity: improvement of health-care training
and systems for prevention and care. The Lancet, 2015.
http://dx.doi.org/10.1016/S0140-6736(14)61748-7
Cont.
Minimal intervention for obesity
(5 As)
• ASK for permission to discuss weight and
explore readiness
• ASSESS obesity related risks and 'root causes'
of obesity
• ADVISE on health risks and treatment options
• AGREE on health outcomes and behavioural
goals
• ASSIST in accessing appropriate resources and
providers
Vallis M et al.: Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician, 2013, 59(1):27-31.
1. ASK
• Ask permission to discuss weight; be nonjudgmental; explore readiness for change.
• Weight is a sensitive issue; avoid verbal cues that imply judgment; indication of
readiness might predict outcomes
Vallis M et al.: Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician, 2013, 59(1):27-31.
2. ASSESS
Assess BMI, WC, obesity stage; explore drivers and complications of excess weight.
BMI alone should never serve as an indicator for obesity interventions;
obesity is a complex and heterogeneous disorder with multiple causes— drivers and
complications of obesity will vary among individuals
Vallis M et al.: Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician, 2013, 59(1):27-31.
3. ADVISE
• Advise on health risks of obesity, benefits of modest weight loss, the need for a
long-term strategy, and treatment options.
• Health risks of excess weight can vary;
• avoidance of weight gain or modest weight loss can have health benefits;
• considerations of treatment options should account for risks.
Vallis M et al.: Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician, 2013, 59(1):27-31.
4. AGREE
• Agree on realistic weight loss expectations and targets, behavioural changes using the
SMART framework, and specific details of the treatment options.
• Most patients and many physicians have unrealistic expectations;
• Interventions should focus on changing behaviour;
• Providers should seek patients’ “buyin” to proposed treatment.
SMART—specific, measureable, achievable, rewarding, timely.
Vallis M et al.: Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician, 2013, 59(1):27-31.
5. ASSIST
• Assist in identifying and addressing barriers;
• provide resources and assist in identifying and consulting with appropriate providers;
• arrange regular follow-up.
• Most patients have substantial barriers to weight management;
• patients are confused and cannot distinguish credible and noncredible sources of
• information;
• follow-up is an essential principle of chronic disease management.
Vallis M et al.: Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician, 2013, 59(1):27-31.
Weight bias in medical education
Attitudes
• that patients with
obesity are lazy,
• non-compliant with
treatment,
• less responsive to
counselling,
• responsible for their
condition,
• have no willpower,
• deserve to be targets
of derogatory humor.
•
Feelings of discomfort, and
•
obesity treatment is
ineffective.
•
Medical students report as
a barrier to discussing
weight with patients.
Dietz WH et al. Management of obesity: improvement of health-care training and systems for prevention and care. The Lancet, 2015. http://dx.doi.org/10.1016/S0140-6736(14)61748-7
Weight biases in medical settings by
health-care professionals
• Spend less time in appointments,
• provide less education about health,
• more reluctant to do some screening tests in patients with
obesity,
• physicians report less respect for their patients with obesity,
• perceive them as less adherent to medications,
• express less desire to help their patients,
• report that treating obesity is more annoying and a greater
waste of their time.
19% of adults and 24% of parents would
avoid future medical appointments if they
perceived a doctor had stigmatised them or
their child because of their weight. (in USA)
Dietz WH et al. Management of obesity: improvement of health-care training and systems for prevention and care. The Lancet, 2015. http://dx.doi.org/10.1016/S0140-6736(14)61748-7
Weight bias & stigma
Weight management in healthcare practice
• http://www.uconnruddcenter.org/weightbias-stigma-videos-exposing-weight-bias
(Weight bias in health care)
• http://biastoolkit.uconnruddcenter.org/
– Free online toolkit
– Motivational interviewing for obesity
http://biastoolkit.uconnruddcenter.org/toolkit/Mod
ule-2/2-07-MotivationalStrategies.pdf
WHO – The 3 Fives
http://www.who.int/foodsafety/areas_work/food-hygiene/3_fives/en/
Dietary assessment methods
Measurement of dietary intake
In a research setting, an investigator able to
• gather data on individual food intake (detailed questionnaires, direct observation);
• use objective measures (clinical indicators, biomarkers for some foods and nutrients);
• estimate total energy intake.
Strength provide reliable assessments of dietary intake than, for example, a basic selfcompletion questionnaire.
Limitation unlikely to be feasible for a public health intervention.
Self-report methods: commonly used in public health to collect data on dietary intake
• Food Frequency Questionnaires (FFQ)
• 24-hour recall methods,
• Weighed and un-weighed diet records
• Diet histories.
• Data can be collected
• retrospectively (e.g. recording what was eaten that day)
• Prospectively (recorded at the time of consumption).
• Data are often collected to give an indication of habitual intake (e.g. through a FFQ).
• They can also be used to provide a snapshot of an individual’s diet during a particular time
period.
Roberts K et al.: Standard evaluation framework for dietary interventions. National Obesity Observatory, , England, 2012.
Food Frequency Questionnaire (FFQ)
Suitable usage
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The most commonly used
retrospective methods.
Used in a wide range of
dietary studies including
cross-sectional surveys,
case-control studies and
cohort studies.
May be a particularly
useful method to measure
specific dietary behaviors
and the intake of
particular food groups
(e.g. fruit and vegetables)
or selected micronutrients
which occur in a limited
number of foods (e.g.
calcium).
Pros
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Cons
Low respondent burden.
Assesses habitual consumption
over period of time.
Comparatively easy to
administer.
Can be low cost.
May be self-administered via
mail or internet.
Can be used to gather
information on a range of
foods, or designed to be
shorter and focus on foods rich
in a specific nutrient or a
particular group of foods e.g.
fruit and vegetables.
Portion size estimates can be
used to obtain absolute
nutrient intakes.
Existing FFQs can be modified
for use in new studies if the
analysis package is available.
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Possible respondent bias.
Relatively high degree of
literacy and numeracy skills are
required if self-administered.
Estimating portion sizes may be
difficult.
FFQs developed in one country
or for a specific subpopulation
are unlikely to be appropriate
for use in another country or
subgroup unless dietary habits
are very similar.
The food list may not reflect
the dietary patterns of the
population to be studied, e.g.
ethnic differences in a
population may not be
captured.
Grouping of foods into
individual items may make
answering some questions
problematic.
Roberts K et al.: Standard evaluation framework for dietary interventions. National Obesity Observatory, , England, 2012.
Weighed food diary
Suitable usage
Pros
Cons
• Suitable for collection
of detailed dietary
data at individual
level.
• Suitable for small
intervention studies.
• Measure of current
intake, therefore
cannot be used in
studies looking at
associations of past
diet with health
outcomes.
• Can provide accurate
estimates for energy,
nutrients, foods and
food groups.
• Considered the
„goldstandard”
method.
• Does not rely on
memory and recall as
recorded at point of
consumption.
• Provides exact portion
sizes.
• Detailed descriptions
of foods.
• All eating occasions
are recorded.
• Captures foods eaten
regularly.
• Time consuming and labour intensive
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for both participants and researchers.
Costly.
Dietary data input and translation into
nutrient data is complex.
Imposes biggest burden on participants
– individuals must be motivated and
compliant.
Respondent must be numerate and
literate.
Respondent may alter his/her diet to
make it easier to record.
Weighing food eaten away from home
can be difficult.
Several days of recording are necessary
because of daily variations in most
people’s diet – may be less accurate
towards end of recording time.
Foods eaten less than once or twice a
week may not be captured.
Roberts K et al.: Standard evaluation framework for dietary interventions. National Obesity Observatory, , England, 2012.
Estimated food diary
Suitable usage Pros
• Suitable for
detailed dietary
data at
individual level.
• Has been used
for large-scale
prospective
studies.
• Can provide
good estimates
of energy and
most nutrients,
foods and food
groups.
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Cons
Records food consumed on all
eating occasions, no reliance on
memory.
Portion size often well described
so estimates are usually accurate.
Surrogates can be used for those
not able to complete a written
record, e.g. parents/carers can
complete the record for young
children, and carers/adult children
for the elderly.
Meals can be photographed to aid
interpretation of portion size and
details of food items consumed.
Food consumption can be
recorded away from home
relatively easily.
Captures foods eaten on a regular
basis.
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Time consuming and costly to turn
the diaries into nutrient data.
Respondent must be literate.
Large respondent burden, although
less than the weighed method.
Respondent may alter his/her diet
to make it easier to record, or to
cover up poor eating habits.
Portion sizes of some foods may be
difficult to estimate if the
description given is inadequate.
Foods eaten less than once a week
may not be recorded.
Several days of recording are
necessary because of daily
variations in food consumption.
For children, foods eaten when not
in the presence of parents may be
missed or recorded less accurately.
Roberts K et al.: Standard evaluation framework for dietary interventions. National Obesity Observatory, , England, 2012.
Recalls
Suitable usage
Pros
Cons
• Suitable to measure
current diet at a group
level.
• Repeated recalls are
required to capture daily
variation in diet at an
individual level.
• Suitable for nutritional
surveys, intervention
studies and prospective
cohort studies.
• Respondent burden is
relatively low.
• Procedure unlikely to alter
food intake patterns.
• Responded literacy not
required.
• Interview relatively quick
(e.g. 20–30 minutes).
• Web-based applications
can be used.
• Single 24-hour recall not
representative of habitual
intake but may be useful
for group averages.
• Dependent on
respondent’s ability to
recall intake accurately.
• Possibility of recall bias.
• Expensive to administer
due to high interviewer
burden but telephone 24hour recalls can reduce
cost.
• Repeat 24-hour recalls
increase time and cost of
analysis.
Sample questionnaires
http://www.noo.org.uk/uploads/doc/vid_10415_Supplement%20Assessment%20Que
stionnaires%20%20Final%20Draft%20160311%20MG.pdf
See for example
Children: pp. 32–35, 46–52.
Adulst: pp. 64, 65–66,