Comparing Food Intake Using the Dietary Risk Assessment with Multiple 24-Hour Dietary Recalls and the 7-Day Dietary Recall
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Article: Comparing Food Intake Using the Dietary Risk Assessment with Multiple 24-Hour Dietary Recalls and the 7-Day Dietary Recall
- SourceAvailable from: Patrick G O'Malley
[Show abstract] [Hide abstract] ABSTRACT: Dietary assessment tools are often too long, difficult to quantify, expensive to process, and largely used for research purposes. A rapid and accurate assessment of dietary fat intake is critically important in clinical decision-making regarding dietary advice for coronary risk reduction. We assessed the validity of the MEDFICTS (MF) questionnaire, a brief instrument developed to assess fat intake according to the American Heart Association (AHA) dietary "steps". We surveyed 164 active-duty US Army personnel without known coronary artery disease at their intake interview for a primary prevention cardiac intervention trial using the Block food frequency (FFQ) and MF questionnaires. Both surveys were completed on the same intake visit and independently scored. Correlations between each tools' assessment of fat intake, the agreement in AHA step categorization of dietary quality with each tool, and the test characteristics of the MF using the FFQ as the gold standard were assessed. Subjects consumed a mean of 36.0 +/- 13.0% of their total calories as fat, which included saturated fat consumption of 13.0 +/- 0.4%. The majority of subjects (125/164; 76.2%) had a high fat (worse than AHA Step 1) diet. There were significant correlations between the MF and the FFQ for the intake of total fat (r = 0.52, P < 0.0001) and saturated fat (r = 0.52, P < 0.0001). Despite these modest correlations, the currently recommended MF cutpoints correctly identified only 29 of 125 (23.3%) high fat (worse than AHA Step 1) diets. Overall agreement for the AHA diet step between the FFQ and MF (using the previously proposed MF score cutoffs of 0-39 [AHA Step 2], 40-70 [Step 1], and > 70 [high fat diet]) was negligible (kappa statistic = 0.036). The MF was accurate at the extremes of fat intake, but could not reliably identify the 3 AHA dietary classifications. Alternative MF cutpoints of < 30 (Step 2), 30-50 (Step 1), and > 50 (high fat diet) were highly sensitive (96%), but had low specificity (46%) for a high fat diet. ROC curve analysis identified that a MF score cutoff of 38 provided optimal sensitivity 75% and specificity 72%, and had modest agreement (kappa = 0.39, P < 0.001) with the FFQ for the identification of subjects with a high fat diet. The MEDFICTS questionnaire is most suitable as a tool to identify high fat diets, rather than discriminate AHA Step 1 and Step 2 diets. Currently recommended MEDFICTS cutpoints are too high, leading to overestimation of dietary quality. A cutpoint of 38 appears to be providing optimal identification of patients who do not meet AHA dietary guidelines for fat intake.
- "Commonly used dietary assessment tools include dietary history, 24-hour recall, seven-day recall, seven-day record, and food frequency questionnaire.1234567 Impediments to more widespread clinical use of these tools include their length, and the difficulty and expense of their analysis. "
- [Show abstract] [Hide abstract] ABSTRACT: To report 6 psychometric properties of food behavior checklist (FBC) items and then to use these properties to systematically reduce the number of items on this evaluation tool. Random assignment to the intervention and control groups. Setting: Low-income communities. Women (N = 132) from limited-resource families. Main Outcome Measures: Reliability, internal consistency, baseline differences by ethnicity, sensitivity to change, and criterion and convergent validity of subscales. The fruit and vegetable subscale showed a significant correlation with serum carotenoid values (r =.44, P <.001), indicating acceptable criterion validity. Milk, fat/cholesterol, diet quality, food security, and fruit/vegetable subscales showed significant correlations with dietary variables. Nineteen items have acceptable reliability. Twenty items showed no baseline differences by ethnic group. Eleven of the 15 items expected to show change following the intervention demonstrated sensitivity to change. This brief food behavior checklist (16 items) is easy to administer to a client group, has an elementary reading level (fourth grade), and has a low respondent burden in addition to meeting requirements for validity, reliability, and sensitivity to change. This study establishes a process that can be used by other researchers to develop and further refine instruments for use in community health promotion interventions.
- [Show abstract] [Hide abstract] ABSTRACT: The purposes of this study were to (a) examine the effectiveness of registered dietitian (RD) education and counseling on diet-related patient outcomes compared with general education provided by the cardiac rehabilitation (CR) staff, and (b) evaluate the effectiveness of the Meats, Eggs, Dairy, Fried foods, In baked goods, Convenience foods, Table fats, Snacks (MEDFICTS) score as an outcome measure in CR. Observational study data examined from 426 CR patients discharged between January 1996 and February 2004. Groups were formed based on education source: (a) RD and (b) general education from CR staff. Baseline characteristics were compared between groups; pre/post diet-related outcomes (lipids, waist circumference, body mass index, MEDFICTS score) were compared within groups. Controlling for baseline measures and lipid-lowering medication, associations were examined between (a) RD education and diet-related outcomes and (b) ending MEDFICTS score and diet-related outcomes. Mean age was 62+/-11 years, 30% of patients were female, and 28% were nonwhite. At baseline, the RD group (n=359) had more dyslipidemia (88% vs 76%), more obesity (47% vs 27%), a larger waist (40+/-6 vs 37+/-5 inches), a higher body mass index (calculated as kg/m(2); 30+/-6 vs 27+/-5), a higher diet score (32+/-28 vs 19+/-19), and lower self-reported physical activity (7+/-12 vs 13+/-18 metabolic equivalent hours) (all P<.05) than the general education group (n=67). RD education was associated with improved low-density lipoprotein (r=0.13; P=.04), triglycerides (r=0.48; P=.01), and MEDFICTS score (r=0.18; P=.01). Improvements in MEDFICTS scores were correlated with improved total cholesterol, triglycerides, and waist measurements (all r=0.19; P=.04). Dietary education by an RD is associated with improved diet-related outcomes. The MEDFICTS score is a suitable outcome measure in CR.