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FN 3344 > Lecture 5 - Dietary Assessment > Flashcards

Lecture 5 - Dietary Assessment Flashcards

1
Q

What are the steps to evaluate the diet?

A
  1. Information on dietary intake
  2. Quantification of energy & nutrient intake
  3. Evaluation of diet adequacy
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2
Q

What information can you gather from a dietary intake?

A 
Food quantity and quality
Variety
Resources to get food
Preferences
Dietary Supplements
Medication
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3
Q

What factors influence food intake?

A

Heath Status
Food availability
Food Selection & Preparation abilityies
Eating pattern/lifestyle habits
Culture/Ethnicity & Religion
Education & Experience on healthy eating
Community/Political/Socio economic
Dietary restrictions
-all have an impact on dietary beliefs & habits

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4
Q

What are the 5 dietary assessment methods?

A 
24hr recall
Food Frequency Questionnaire
Food Records
Direct Observation
Diet History
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5
Q

What is the 24hr recall?

A

Tool asking individuals about their intake of food and beverages during the previous 24hr

  • retrospective
  • ask if its typical/usual intake
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6
Q

How do you start a 24hr recall/

A

Asking what they first ate or drank when they woke up

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7
Q

What are advantages of 24hr recall?

A 
Fast to administer
Low Cost
Minimally Burdensome for client
Client does not need to read and write
Only a small influences in changing the dietary behaviour reported by client
-with competent interviewer
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8
Q

What are the limitations of 24hr recall?

A

Relies on memory
Tends to overestimate low consumption and underestimate high consumption
High variation among interviewers
Necessary to conduct more than once to estimate AVERAGE intake
Interviewer should be competent and experienced
Interviewer should be standardized and follow a protocol to reduce variability

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9
Q

What is a food frequency questionnaire?

A

Asking individuals to complete a survey of their food and beverage intake over a period of time

  • reetrospective
  • include food/beverage list and consumption frequency
  • non-quantitative/semi-quantative/ quantiotative
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10
Q

Who administers food frequency interview?

A

By interviewer or see administered

-most used in large survey

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11
Q

What are the advantages of FFQ?

A 
Minimally burdensome for patient
Fast to administer
Low Cost
Reflects casual consumption of patient
Allow to look at intake of particular nutrient
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12
Q

What are the limitations of FFQ?

A

Gives mostly qualitative data (food type)
Relies on patient recalling info
Requires patient to be able to read and write
Mentally harder for patient to answer (recall up to 1 year)
-Q’s about intake not related to meals

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13
Q

What is a food intake record?

A

Asking individuals to record their food and beveage intake over a certain number of days

  • Retrospective/prospective
  • Some ask to weigh food to record
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14
Q

What are the advantages of FI?

A

Does not rely on patient recalling all info
Reflect usual consumption of patient
More precise than 24hr recall, because accuracy increased with # of days
Including a weekend day accounts for a possible change of eating behaviour on weekends

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15
Q

What are the limitations of FI?

A

Highly burdensome for patient
Patient Musy ne able to read and write
Patient may modify pattern of intake (relies on honesty)
Patient frequently do not provide specific info

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16
Q

What is direct observation?

A

Directly looking at an individuals food/beverage selection intake and eating behaviour

  • prospective tool
  • qualitartive and quantitative
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17
Q

What are the advantages of direct observation?

A

Not burdensome for patient
Does not rely on memory
Not necessary for patient to read and write

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18
Q

What are the limitations to direct observation?

A

Burdensome for RD/nutritionist
Can be invasive
May be difficult to get all info
Does not reflect usual consumption (unless done in a home care environment)

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19
Q

What is a diet history?

A

Complete profile of dietary intake of an individual collected by skilled nutritionist during interview using a combo of data collection methods

  • 24hr recall
  • FFQ
  • FIR
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20
Q

What kind o questions are asked in a diet history?

A

Probing Q asked to get a good picture of overall dietary habits

  • allergies
  • changes
  • supplements
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21
Q

What are the advantages of diet history?

A

Fairly complete and detailed description of intake (qualitative and quantitative)
More accurate than 24hr, FFQ or FIR
Makes up for daily and seasonal variations

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22
Q

What are the limitations of the diet history?

A

Time consuming (only get 15-30 for everything)
RD/nutritionist should be competent and experiences
Interview should be standardized
Mostly relies on patient recalling info
More $ to administer and analyze

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23
Q

What are the items that are more commonly underreported?

A

Energy intake more frequent in females and overweight people
Snacks, sweets, desserts in obese
Alcohol in heavy drinkers
Among those not following their diet Rx

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24
Q

Who is likely to over report things??

A

people with Anorexia nervosa

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25
Q

In people doing a diet report, what are the things they write that a re not accurate?

A

Write what they think the interviewer wishes them to eat
Reporting desirable intake
Missing and Phantom foods

26
Q

What is the difference between missing and phantom foods?

A

Missing= food eaten but not reported (snacks, alcohol, coffee, bread)

Phantom= Food not eaten but reported (veggies and fruit)

27
Q

What is the best way to evaluate usual nutrient intake?

A

Diet should be measured for multiple days, including days and weekends

28
Q

What does the # of days depend on when evaluating nutrient intake?

A

Nutrient of interest
Individuals/groups studied
Degree of inter-individual variation in nutrient intake
Desired degree of measurement precision

29
Q

Which nutrient requries the most number of days to get an accurate estimate?

A

Vitamin A

-micro nutrients tak emoe days to analyze because there is a higher variance of micronutrients in food

30
Q

How can we help patients in estimating serving size?

A

Use of food models
Sales
Serving size aids
Photographs

31
Q

What are the 2 limitations in dietary assessments?

A

Interview should trained and follow a similar standard protocol

Limitation of nutrient comp takes and databases

  • data not available
  • errors
  • lack of analytical sensitivity of lab tests to measure small quantities of nutrients
32
Q

For sizing what does your palm, fist, thumb and thumb tip equal to?

A

Palm - 3oz
Fist - 1 cup
Thumb - 1-2 tablespoons
Thumb tip - 1 teaspoon

33
Q

When doing a 24hr recall what kind of questions should you use?

A

Using neutral questions

-then can prob for more specific info like where and when

34
Q

What is the standard protocolar 24hr recall?

A

Use aids for serving size estimation
Ask about food group missing and supplements
Ask if typical dat (if not why)
Ask if they eat differently on weekends (is yes, then why)

35
Q

What is an easting behaviour diary?

A

Food intake record also including info related to eating behaviour

  • degree of hunger/thirst
  • Reason for choices
  • number of helping
  • degree of satiation
  • feelings associated with eating/drinking
36
Q

What are some tools used to quantify energy and nutrient intake?

A

Exchange lists
Food Comp tables
Food analysis software

37
Q

What is the most popular food analysis software and some facts about it?

A

ESHA

  • origin in salem Oregon in 1984
  • over 72,000 foods
  • 172 nutrient components
  • 700 for 1 licence
38
Q

Are food analysis software available on the internet?

A

Yes but not as good because:

  • slower
  • harder to use
  • editing more dificult
  • Dont allow nutrient analysis for several days
  • Fewer foods and nutrients
  • no social features
  • lack adequate help function
39
Q

What is the %. daily value?

A

DV for vitamins and minerals based on 1983 recommended nutrient intakes for Canadians and representatives the highest recommended intake for each sex and age

40
Q

what re the limitations to the DV?

A

Alot has changed since 1983
Based on Sedentary lifestyle
Certain people need more or less than 2000 cals

41
Q

How do you evaluate diet adequacy?

A

By comparison to requirements set by Food guide or Dietary reference intakes (DRI)

42
Q

What reference do we use to measure energy?

A

Estimated energy requirement

43
Q

What reference do we use to measure macronutrients?

A

Acceptable Macronutrient Distribution Range (AMDR)

44
Q

What reference dow e use to measure other nutrients?

A

Adequate intake (AI)
Tolerable Upper Intake Level (UL)
Estimated Average Requirement (EAR)
Recommended Dietary Allowance (RDA)

45
Q

What are some factors that influence measurements?

A 
Bioavialability
Drugs
Alcohol
Smoking
Age
Gender
Ethnicity
Disease
46
Q

How to we interpret DRI for individuals?

A

Intake can be assessed qualitativly or quantitatively

Qualitative may suffice depending on purpose

Quantitative assessment need accurate dietary data, correct DRI and interpret results appropriately

47
Q

When applying DRIs what 2 distributions do they use?

A

Requirement distribution

  • EAR
  • RDA

Intake distribution
-Observed or reported nutrient intakes

48
Q

What is the difference between individual EAR and Group EAR?

A

Individual

  • probability of inadequacy: outcome of comparison between individual usual intake to corresponding life stage distribution of requirements. Probability that intake does not meet requirements
  • Probability of inadequacy

Group
-Prevalence of inadequacy- % of group with intakes below requirements

49
Q

What is better statistically for the graph, 1 day or lots of days of observations?

A

Lots because you will be more accurate and it will give you more of a bell shaped curve

50
Q

What is the interpretation if the z-score is positive or negative?

A

+ means you have a probability of an adequate diet

  • probability go an inadequate diet
51
Q

What happens when you use a z score for AI instead of EAR?

A

z score is less certain

52
Q

What can you conclude if you have a z score with AI and intake is higher than the AI?

A

Consumption is alsmost certainly going to be adequate

if intake is less than AI, no conclusion can be drawn

53
Q

When using UL to asses individuals, what does it apply to?

A

Only to intakes form supplements, fortificants or medications

-Similar to AI if intake is below= inconclusive

54
Q

What are other sources of information about nutrient intake and assessment?

A

Biochemical measurements

Healthy lifestyle factors

Anthropometric measurements

55
Q

What should you recommend/plan to do for patients so they meet the values they are supposed to be consuming?

A

Meet RDA or AI to minimize risk of inadequacy for gender/age/classification (pregnancy)

56
Q

How do you evaluate dietary needs for groups?

A

RDA not appropriate

Variabiity between and within gorups

EAR method:

  • probability
  • EAR cut-point method
57
Q

What is the probability approach for groups?

A

Determine the risk of inadequacy for each individual in the population then averaging individual probabilities across the group

58
Q

What are the validity conditions in group testing?

A

Intakes and requirements are independent of each other

Distribution of requirements is symmetrical around the EAR

Distribution of intakes has greater variability than the distribution of requirements

59
Q

In assessing groups, what do you do with nutrients with an EAR?

A

% with usual intake < EAR approximates prevalence of inadequatcy

60
Q

In assessing groups, what do you do with nutrients with an AI?

A

Group with mean intake> AI likely at low risk

-no conclusions if mean intake is

61
Q

In assessing groups, what do you do with nutrients with an UL?

A

% with usual intake > UL at potential risk

62
Q

In planning for groups what must you consider about the group?

A 
Homogenous or mix of people
Group stable or stressed
Vulnerable subgroups
If needs are similar, use EAR and adjust upward if need be
Consider. UL to about risk

FN 3344 (13 decks)

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