Assuring Pediatric Nutrition in the Community

FREQUENTLY USED GUIDELINES:
Assessing Nutritional Status - Evaluating Dietary Intake

Methods of data collection

24 hour recall
3- and 7- day food records
Diet history
Food frequency questionnaire

Questions to ask

Nutrient intake
Behaviors, relationships, attitudes
Feeding skills and development

Standards to evaluate adequacy of intake

References

How do I assess diet?
Several tools are available to aid in diet assessment: recall, food record, diet history, food frequency questionnaire. Each tool has strengths and limitations. Ideally, more than one method is used to assess diet adequacy. When this is not possible, select the tool best suited to the situation.

In general, the assessment should address nutrient intake, behavior / relationships / attitudes, and feeding skills and development.

What is a 24-hour recall?
The 24-hour recall is the most commonly used method of obtaining information about a child’s intake and is useful as a screening tool. Parents/caregivers are asked to describe the types and amounts of food eaten by the child in the previous 24 hour period. This may not represent a typical day’s intake, and thus, the recall may not accurately describe a child’s nutrient intake.

Food models are useful for estimating portion sizes, but errors are common. Also, parents tend to forget about (or be unaware of) foods eaten between meals. The 24 hour recall is helpful during clinic follow-up to measure adherence to dietary recommendations.

What are 3- and 7-day food records?
This method requires parents/caregivers to record all foods offered to and eaten by their child in a 3 or 7 day period. To provide accurate intake information, foods should be weighed or measured and methods of food preparation (e.g., baked, sautéed, steamed) described.

Food models are helpful in conveying portion sizes to parents, but errors are common. Another common error is omitting foods that are added to other foods; e.g., butter, jelly, ketchup. Many parents find it difficult to record their child’s intake; before using this tool, the clinician should evaluate the parents’ willingness (and ability) to complete the food record.

A 7 day record provides more representative information than a 3 day food record. If 3 days are recorded, include one weekend day. It is helpful to review the completed food record with the caregivers to clarify foods and portion sizes.

What is a diet history?
A diet history is a detailed interview with parents or caregivers that provides information about a child’s feeding history and usual pattern of food intake. A diet history can be used in combination with a 24 hour recall, food record, or food frequency questionnaire to obtain a fair picture of a child’s nutritional intake.

This method of data collection is time consuming; it will typically require an hour. The interviewer must gain the confidence of the parent providing information and be able to evaluate the accuracy and reliability of the answers. When a diet history is used alone, a child’s intake is often overestimated.

What is a food frequency questionnaire?
Of the tools used to assess intake, the food frequency questionnaire uses the least amount of interview time. Caregivers complete a questionnaire (usually a checklist) identifying which foods their child eats, as well as estimating the amount of food eaten in a specified amount of time; e.g., day, week. This method often overestimates a child’s intake. It is useful as a screening tool for assessing the dietary intakes of groups of people. Because it is not time consuming, parents are often more willing to complete a food frequency questionnaire than a food record.