Diet and Activity Assessment Food frequency Questionnaires 24 hour food recalls Biomarkers International Physical Activity Questionnaires

Self-reported Methods Error -Poor recall, not quantitative, or not representative Bias -social desirability bias – tend to over report what we think we should do and underreport what we think we shouldn’t -especially problematic for “bad” foods

Assessment of individual intakes Food frequency questionnaire (FFQ) Report usual frequency of consumption of each food item from a list of food items in reference to a specified period (past wk/mo/yr) Face to face interview, telephone or by self administration Describes dietary patterns or food habits not nutrient intake Semi quantified tools can obtain information on portion size using household measures FF is a retrospective review of intake frequency – that is food consumed per day, week, per 15 days, per month. For ease of evaluation the FFQ chart organizes foods into groups that have common nutrients. Because the focus of FFQ is the frequency of consumption of food groups rather than of specific nutrients, the information obtained is general – not specific for certain nutrients. During illness food consumption patterns change depending on the illnness and therefore it should be completed before hopsitalization, depending upon the purpose for which it is done.

FFQ Food frequency questionnaires (FFQ) are designed to assess habitual diet by asking about the frequency with which food items or specific food groups are consumed over a reference period (e.g. 6 months or a year) FFQs may be based on an extensive list of food items or a relatively short list of specific foods. The foods listed should be a) major sources of a group of nutrients of particular interest or b) foods which contribute to the variability in intake between individuals in the population, and c) commonly consumed in the study population. The length of the list of foods can range from about 20 to 200 items. Questionnaires can be self-administered using paper or wev-based formats, or interviewer administered, either face-to-face or telephone interview

FFQ Most nutrition research is interested in the usual intake of the individual They can and do differ in critical areas The full-length Block questionnaires (e.g. Block98, Block2005) have been shown to come quite close to the point estimates produced by multiple days of diet recalls and records. Very long food lists will tend to overestimate, while short lists will tend to underestimate. Are food frequency questionnaires usable for examining an individual's diet? There is controversy about this question.

NHANES FFQ National Health and Nutrition Examination Survey

Assessment of individual intakes : 24 dietary recall Get an accurate and complete listing of all food/drink individual consumed within last 24 hrs Specifically: What food/drink was consumed? How much was consumed? Time it was consumed? How was it prepared? How was it served? Details of food (e.g low fat, 1%, whole, milk powder, preparation, ) There are 3 types of dietary assessments, and the easiest and most economical one to administer is the 24 hour diet recall. The 24 hr recall requires individuals to remember the specific foods and amounts of foods they consumed in the past 24 hours; the information is then analyzed by the person or professional analyzing the information. Food intake per person or per consumption unit is calculated taking into account the age , sex and the number of family members. Probing techniques: Food probe – type of food (type of milk) form purchased (fresh/frozen/canned/dry); method of preparation (boiled/baked/fried/breaded); brand name (commercial/ready to eat/brand0; parts eaten (whole item/half); ingredients(if mixed dish, what ingredients used and amounts; addition to foods ( was anything added to food during preparation or at the table; was any dressing added, cream or sugar?) The 24-hour recall consists of obtaining information on food and fluid intake for the previous day or previous 24 hours. The 24-hour recall is based on the assumption that the intake described is typical of daily intake. Although the 24-hour recall is one of the easiest methods for collecting information regarding the patient’s intake, it is prone to error:

Single 24 hour recall This is the method of choice if the purpose of the study is simply to describe the average intake of a group. It provides a mathematically accurate group mean. Does not provide a good estimate of an individual's usual intake for any individual member of the group. It can also be used to examine whether two groups have similar mean intakes--for example, the baseline levels of an intervention and a control group.

Multiple 24 hour recalls If dietary intake over a number of days is collected, the data begins to approximate an individual's usual intake. Generally, at least three days of diet data are required for the most stable nutrients, i.e. percent of calories from fat. Other macronutrients require more, and micronutrients such as vitamin C and vitamin A require many more days.

Setting the stage for the Interview The following steps will help in eliciting truthful and complete information: Explain to participant that you need to know only what she/he actually ate. She/he should not feel embarrassed about any food, as there are no "good" or "bad" foods. No one eats just the right foods all the time. 2. Do not express in words or facial expressions either approval or disapproval of foods which homemaker mentions. 3. Do not ask leading questions that would lead homemaker to feel she/he “should” have had a certain item and, thus, say she/he did. http://www.csrees.usda.gov/nea/food/efnep/ers/documentation/24hour-recall.pdf

24-hour Food Recall Kit Purpose of the FOOD RECALL KIT: To assist paraprofessional/interviewer in taking the food recall and estimating the amounts more accurately. The Food Recall Kit should contain the following items: Cup - One 8-oz. plastic measuring cup Bowls - 2 different shapes - each holding 2 cups Small sauce dish - about 1/2 cup Plastic ruler - 6" works well and may be less cumbersome than a 12" ruler. Standard measuring spoons: - 1 tablespoon - 1 teaspoon - 1/2 teaspoon - 1/4 teaspoon *Plastic Container of 2 to 3 cups rice (with tight fitting lid) *Plastic Container of 2 to 3 cups dried beans (with tight fitting lid) * To reduce the weight of the Food Recall Kit, dry cereal may be used instead

More for the kit 10 Shapes on cardboard or plastic as described in the following chart. Identification Size To Be Measured A 1" square Cheese, fudge B 2" square Brownies, Cornbread C 1/16 layer cake Cake D 1/12 layer cake Cake E 1/8 of a 9" pie Pie, quiche F 1/7 of a 9" pie Pie, quiche G 1/6 of a 9" pie Pie, quiche H 3" square Sheet cake, Cornbread I 4" circle Danish, pancake J 1/4 of 12" pizza Pizza Additional shapes of various cuts of meats by: Ruby H. Cox, Ph.D., R.D. (1/93)

During the food recall Start with the most recent meal or snack and work backwards First get a list of all food eaten, but not amounts – use probing questions, i.e. “what else did you have with this meal?” Second, go back through and find out amounts If ate at a restaurant, get the name of the restaurant

To get more information on the type of food Encourage the participant to describe foods as clearly as possible. Describe combination dishes carefully. Mixtures such as sandwiches, soups, stew, pizza, casseroles, etc. can be prepared in many ways. Ask to see packages, if available, on pre-packaged foods, and record brand name and other pertinent information.

ASA 24 https://asa24.nci.nih.gov/researcherSite/ASA242013.aspx

Biomarkers Objective Pros – less error Not many: - Double labeled water for total energy input -24 hour urinary nitrogen for total protein intake. Stable isotopes ratios -13C/12C, 15N/14N, 3H/1H, 18O/16O, 34S/32S

International Physical Activity Questionnaires The purpose of the International Physical Activity Questionnaires (IPAQ) is to provide a set of well-developed instruments that can be used internationally to obtain comparable estimates of physical activity. There are two versions of the questionnaire.  The short version and the long version . http://www.ipaq.ki.se/downloads.htm