College of Applied and Natural Science

Department of Food Science and Applied Nutrition

Nutrition Assessment (FSAN3122)
2Cr.Hr

Mrs. Sinke Mengesha

March /2024
 Past Intake Assessment Methods

1. 24 hour recall method

• The 24-hour dietary recall (24HR) method provides quantitative

information on individual diets.
• The international standard approach uses the multiple pass 24HR
technique, in which the respondent recalls foods and beverages
consumed and their quantities in the past 24 hours.
• A single 24HR provides an estimate of mean intake of foods and
nutrients, while collecting a second 24HR on a sub-sample of the
population allows for an estimate of 'usual intake.‘
• A single 24-hour recall is not enough to describe an individual’s
usual intake of food and nutrients.
 24 hour recall method

• To estimate the usual intake , multiple nonconsecutive 24-hour

recalls on the same individual are required in order to capture
daily variability
• A standard multiple pass 24HR includes having the respondent
iteratively provide increasingly granular data about each food or
drink and its preparation method and other attributes, as well as
an estimation of the portion size consumed
 24 hour recall method

• The 24-hour Dietary Recall (24HR) method provides comprehensive,

quantitative information on individual diets by querying respondents
about the type and quantity of all food and beverages consumed
during the previous 24-hour period.
• Estimation of portion size is facilitated by the use of measurement
aids such as standard household measures, photo atlases, food
models, etc.
• To calculate energy and nutrient intakes, the estimated portion size or
the amount of food intake is multiplied by the values of nutrient
content in foods as found in the food composition tables or databases
 Cont’d…….
• When doing so, it can be advantageous to first review with the
individual the past day’s events, which then can be used to help
recall specifics about dietary consumption.
• The 24-hour dietary recall can be performed by two different
methods.
• The first is when the investigator asks the individual to start from
the beginning of the previous day and provide in detail all of the
food and beverages consumed from the beginning of the day
before.
 Cont’d…….
• The second method starts with the current day and works
backward.
For example, the individual would be questioned on what he or
she ate prior to this visit and then work back over the past 24
hours.
• Both methods allow the dietitian to use the individual’s activities
as a way to assist in recalling his or her dietary intake.
 Cont’d…….
• A 24-hour dietary recall can take approximately 15 to 30 minutes
to perform; however, it can take considerably longer if the
individual has had mixed dishes or different foods.
• Both quantity and food preparation play a major role when
performing a 24-hour dietary recall.
• A main concern with a 24-hour dietary recall is its
misrepresentation of the usual diet.
 Cont’d…….
• It is important to ask the individual if the diet consumed within
the last 24 hours is a normal diet or if it was a variation from the
norm.
• As one might expect, the 24-hour recall is also very dependent on
the individual’s short-term memory.
• A further complication in recalling food relates to its preparation,
and accuracy is likely to be less if the diet was not prepared by the
individual.
• Currently- Multiple pass 24 hours is used to improve the quality
 Multiple-pass-24 hour recall

• First Pass: Quick List

• Second Pass: Detailed Description
• Third Pass: Review
 1. A quick list of foods eaten or drunk

• Respondents are asked to report everything that they had to eat

or drink on the previous day between midnight and midnight.
• This recall session is not interrupted.
• At the end of the recall, respondents are invited to add any
additional items not initially recalled.
 2. Collection of detailed information

• Concerning the items in the quick list. For each item of food or drink,
respondents are asked to provide additional detail.
 The time at which the food or drink was consumed.
 A full description of the food or drink, including brand name where available.
 Any foods likely to be eaten in combination e.g. milk in coffee
 Recipes and other combinations of foods e.g. sandwiches
 The quantity consumed, based on household measures, photographs of different
portion sizes of foods or weights.
 Any leftovers or second helpings
 3. A Recall Review

• Respondents are given an opportunity to provide additional

information and for the interviewer to prompt for information
about foods or drink not mentioned.
• The interviewer reviews all the food eaten and drunk in
chronological order, prompts for any additional eating or
drinking occasions or foods/drink possibly consumed and
clarifies any ambiguities regarding type of food eaten or portion
size.
 Cont’d….
• Finally the interviewer asks the respondent to name the place
where each food or drink item was consumed.
• All of the information gathered is recorded by the interviewer on
the record sheet in the booklet called Food Consumption Record:
Individual 24-hour recall.
 24 hours dietary recall method
Advantages
• Relatively cheap
• Quick
• Less respondent burden
• No chance for the respondents to change their dietary habit
• The usual intake of a group can be determined from a single 24
hours recall
 Cont’d…
Disadvantages
• A single day 24 hours recall does not indicate the usual intake of
individuals
• Respondent memory laps
• Social desirability bias
• Has less precision
• Accuracy depends on the respondent’s ability to estimate portion
sizes
 Common question in 24hr recall
 What time did you get up yesterday?
 What did you eat for the first time yesterday? How much?
 When was the next time you ate? What did you eat ? How much?
 What did you eat next? What did you eat? How much?
 Did you eat or drink anything else between meal times?
 Did you add condiments, butter, salad dressing, sugar or other?
 Was the intake different from usual intake?
 Was this a weekday or a weekend day?
 Preparation for interview

• Make the environment comfortable

• Keep desk neat
• Choose private quiet location, away from
distractions
• Set up the food models to help client recall
amounts/portions
 Conducting the interview

1st step- Quick List

• Get a list of all foods eaten or drunken
• The respondent should tell you everything eaten or drunk, which
including
Snacks
Coffee breaks
Alcoholic beverages, and
Carbonated water either eaten at home or away from home.
 Cont’d…..
2nd Step - Detailed Description
• Get more complete information on foods already reported
• Do you remember anything else you ate or drank with this food?
• What else did you have at this meal?
• Was this (bread, vegetable) eaten plain or did you put something
on it?
 Cont’d…
3rd step - Review (final step)
• Review the 24 hour list, ask if there's anything else that he/she
may have forgotten before or that you missed?
• Determine if this intake is typical of most days.
• Begin by asking open ended questions
• Save close ended questions for later
• Avoid leading questions
• Avoid labeling meals, breakfast/lunch/dinner
 Probing technique
• To get more information and using probing question is important.
The most common Probing Techniques are:
• Probing related to:
 Time
 Activities
 Food Probe
 At what time was this? Did you eat or drink anything before or
after that?
 What did you do this morning?
 Type of food what type of milk
 Form purchased fresh/frozen/canned/dry
 Probing technique cont’d…
 Method of preparation
 Boiled
 Baked
 Fried
 Breaded
 Brand name commercial/ready to eat/brand
 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 table? Was dressing added? Cream or sugar?
Appropriate Applications for 24hr Recalls

• Assessing the average intake of groups

• Because open-ended, useful in assessing mean nutrient
intakes among culturally different groups
• Useful in evaluating the effectiveness of dietary intervention
methods (intervention and control group comparisons)
• Multiple short-term recalls improve the accuracy of
individual intake estimates
• Useful in validating other dietary assessment methods
among populations with limited motivation or literacy
 Reporting 24 hour recall
• Please enter todays date _ _ _ _ _ _
• Which days of the week does this record please tick one
 Sunday __ Monday __ Tuesday__ Wednesday__ Thursday__ Friday __
Saturday__
 Is this a typical day
 Yes ___
 No___
 Reporting 24 hour recall

24 hour record
Time Quantity eaten Detail of food and drink

8:00 am 100g White bread

1 Fried egg

1cup Tea

2 teaspoon White sugar

10:00am 1glass Mango juice

1 Lemon

3 teaspoon White sugar

 2. Dietary history

• Dietary history method is used to assess the nutrient

intake of an individual or a group from food over a
longer period of time, usually to see the association
between diet and disease
• Dietary history is a detailed assessment to describe usual
food intake and its variation over a long period of time
(six months to a year).
Advantages and disadvantages of Dietary history

Advantages
• It gives the dietary habits of an individual or a group of people
over a longer periods of time
• It is possible to target the dietary questions to specific dietary
habits or intake of specific nutrients of interest
• Less respondent burden
 Cont’d…
Disadvantages
• It over emphasizes the regularity of the dietary pattern
• It is very difficult to validate
• It needs a very highly trained interviewer
• It gives just a relative if not an absolute information
 3. Food Frequency Questionnaire
• Assesses energy or nutrient intake by determining the frequency
of consumption of a limited number of foods.
• Consists of a list of approximately 100 or fewer individual foods
or food groups (important contributors to energy or nutrients)
and a frequency response section.
• Subjects indicate how many times a day, week, month, or year
that they usually consume the foods
 Principle of FFQ
• Average long-term diet (over weeks, months, or years) is the
conceptually important exposure rather than intake on a few
specific days.
• It may be advantageous to sacrifice precise intake measurements
obtainable on 1 or more days in exchange for more crude
information relating to an extended period of time.
• It is easier to describe one’s usual frequency of consuming a food
than to describe what foods were eaten at any specific meal.
 Cont’d….
• FFQ method is based on the preparation of a food frequency
questionnaire, which is based on the local staple diet to
determine the frequency of consumption of a particular
nutrient.
• This could be achieved through self or interviewer
administration of the questionnaire.
• Sometimes the quantities consumed could be included, in
such circumstances, the FFQ is called semi-quantitative FFQ.
• If the quantities consumed are weighed and recorded as
Quantitative FFQ
 Cont’d…..
• Portion size can be either proposed or not
• Subjects can be allowed to indicate whether their usual portion
sizes are small, medium, or large with respect to a stated medium
or standard portion for certain age/sex groups
• If portion size indicated- semi-quantitative FFQ
 Cont’d…….
• Some FFQ are designed to assess intake of individual nutrients or
food components (vitamin A, fat, calcium……)
• Some are designed to assess a wide spectrum of macro and
micronutrients
• Is the goal to rank individuals in terms of intake or to provide a
measure of absolute intake?
 Cont’d….
• Important to select carefully the most informative items for the
food list to avoid fatigue and boredom that can impair
concentration and accuracy.
• Individuals are generally willing to complete relatively long
dietary questionnaires, probably because of strong general
interest in food
 Cont’d……
• Examine published food composition tables and identify the foods that
contain substantial amounts of the nutrient(s) of interest.
• Start with a long list of foods that are potentially important nutrient sources
and systematically reduce the list
• Conduct a focus group interview in the community to identify foods with the
nutrient(s) of interest.
• Use open-ended data (dietary records or 24-hour recalls) to identify the foods
that contribute most importantly to the total absolute intake of a nutrient by
the group
 Cont’d……
• The organization and structure of a food list is important because
one item can change the interpretation of another.
• Related items should be clustered together, such as by traditional
food groups.
• For closely related foods, more specific items should precede
general items (low calorie dressings before other dressings).
• Ask about single items rather than several at the same time
(peaches vs. peaches, apricots or plums).
 FFQ-Time Frame

• For most epidemiologic purposes, dietary intake over a number of

years is the exposure of conceptual interest.
• Because diets tend to be reasonably correlated from year to year,
FFQ are usually done in reference to the preceding year.
• Time frame depends on the health outcome.
 Congenital malformations (1st2 months of pregnancy)
 Colon cancer (last 5 years)
 Plasma HDL-cholesterol (preceding month)
 FFQ- Response Format

• Usually a multiple-choice response format with options ranging

from 5 to 10.
• Asking about portion sizes might not increase accuracy (over
estimation from standard portion sizes) and might increase the
burden on the respondent.
 Example of semi quantitative FFQ for Vitamin C
friendly foods
Food list Frequency of consumption

Daily Every other day Once per week Once per month Portion size

Thyme

Orange

Lemon

Strawberries

papaya

Broccoli

Kiwi
 Advantages and Disadvantages of FFQ

Advantages
• It is usually used for areas where there is a geographically widely
scattered study population
• It is less costly especially if self administered
• Less respondent burden
 Cont’d…….
Disadvantages
• It is very difficult to develop especially in multi-cultural society
where different staple foods are consumed
• It needs literate and numerate subjects