Photo-Assisted Recall Increases Estimates of Energy and Macronutrient Intake in Adults with Intellectual and Developmental Disabilities

Diet assessment of adults with intellectual and developmental disabilities is challenging because of their limited cognitive abilities. The objective of this study was to examine the feasibility and outcomes of combining photos with 24-hour dietary recalls for the assessment of energy and macronutrient intakes in adults with intellectual and developmental disabilities. Participants used an iPad 2 tablet computer (Apple) to take photos of all food and beverages consumed before a standard, multiple-pass, 24-hour dietary recall. After the standard 24-hour diet recall, the photos were reviewed with the participant for clarification details (eg, portion size) and differences were recorded. The standard 24-hour recall and photo-assisted recall were entered separately into the Nutrition Data System for Research for computerized dietary analysis. Sixty-four eating occasions were entered from 23 participants (48% female; mean age 26.4±9.7 years). Participants captured photos for 66.5%±30.4% of all recorded eating occasions. Greater energy intake per eating occasion was reported with the photo-assisted recalls than the standard recalls (625.6±85.7 kcal vs 497.2±86.6 kcal; P=0.002) and a greater intake of grams of fat (P=0.006), protein (P=0.029), and carbohydrates (P=0.003). Photo-assisted 24-hour recalls provided a significant increase in total calories and macronutrient content compared with a standard 24-hour recall and may be a feasible method to enhance dietary assessment in adults with intellectual and developmental disabilities.     

Diuretic medication therapy use and low thiamin intake in homebound older adults

Diuretic therapy (DT) plays a major role in disease management. However, one issue of concern in nutritionally vulnerable elders is that diuretic therapy also increases thiamin excretion, and little attention has been paid to the linkage between DT use and dietary intake of thiamin in this older population. The purpose of this study was to assess the relationship between DT use and dietary intake of thiamin in a randomly recruited sample of 342 homebound older adults. Baseline data, including three 24-hour recalls, were used to identify thiamin intake from food (15% < EAR and 33% < RDA), DT use (49%), and meal pattern (18% not regularly eating breakfast). Independent of sociodemographic and meal pattern variables, DT users (relative to non-users) were at increased odds for dietary thiamin intake < RDA (OR = 2.3) and < EAR (OR = 4.2). Considering the importance of home-delivered meals as a primary source of food assistance to homebound elders and that thiamin deficiency may exacerbate health problems, the results of this study suggest the need to include information on DT use as an integral component of program assessment for the targeting and monitoring of strategies to alleviate the risk for deficiency.     

Inadequate intakes of indispensable amino acids among homebound older adults

Adequate dietary intakes of all indispensable amino acids are vital to optimal health. Using three random 24-hour dietary recalls and the newly released Dietary Reference Intakes (DRIs), we examined the extent and correlates of inadequate dietary intakes of indispensable amino acids among 323 homebound older adults who received home-delivered meals. Despite regular receipt of home-delivered meals and controlling for other sample characteristics, three factors were independent ly associated with usual dietary intake below the Estimated Average Requirement (EAR) for at least one indispensable amino acid-not regularly eating a breakfast meal, having a diminished sense of taste, and consuming less than 65% of total protein from animal sources. With the greater vulnerability for poor nutritional health among homebound older individuals, policymakers and service providers should strengthen efforts to target the type and amount of protein and tailor programs that address a variety of influences on the adequacy of protein intake.     

The 7-day Beverage Intake Questionnaire for Latino Children: Validation of a Culturally Tailored Tool

ObjectiveTo validate a culturally tailored 7-day beverage intake questionnaire for Latino children (BIQ-L).DesignCross-sectional.SettingFederally qualified health center in San Francisco, CA.ParticipantsLatino parents and their children aged 1–5 years (n = 105).Variables MeasuredParents completed the BIQ-L for each child and three 24-hour dietary recalls. Participants’ height and weight were measured.AnalysisCorrelations between the mean intake of beverages in 4 categories as determined by the BIQ-L and three 24-hour dietary recalls were assessed. Multivariable linear regression examined the association between sugar-sweetened beverages (SSB) servings as determined by the BIQ-L and child body mass index z-score.ResultsMean daily intake of SSB (r = 0.52, P < 0.001), 100% fruit juice (r = 0.45, P < 0.001), flavored milk (r = 0.7, P < 0.001), and unflavored milk (r = 0.7, P < 0.001) from the BIQ-L were correlated with intake assessed via three 24-hour dietary recalls. In the multivariable model, weekly servings of SSBs were associated with child body mass index z-score (β = 0.15, P = 0.02). Culturally specific beverages comprised 38% of the SSB intake reported on the BIQ-L.Conclusions and ImplicationsThe BIQ-L is a valid tool for assessing beverage intake among Latino children aged 1–5 years. The inclusion of culturally specific beverages is critical for accurately assessing beverage intake among Latino children.     

Computerized portion-size estimation compared to multiple 24-hour dietary recalls for measurement of fat, fruit, and vegetable intake in overweight adults

Validated self-report methods of dietary assessment exist and might be improved in terms of both accuracy and cost-efficiency with computer technology. The objectives of this preliminary study were to develop an initial version of an interactive CD-ROM program to estimate fruit, vegetable, and fat intake, and to compare it to multiple 24-hour dietary recalls (averaged over 3 days). In 2009, overweight male and female adults (n=205) from Lane County, OR, completed computerized and paper versions of fruit, vegetable, and fat screening instruments, and multiple 24-hour dietary recalls. Summary scores from the 10-item National Cancer Institute Fruit and Vegetable Scan and the 18-item Block Fat Screener were compared to multiple 24-hour dietary recall−derived fruit/vegetable and fat intake estimates (criterion measures). Measurement models were used to derive deattenuated correlations with multiple 24-hour dietary recalls of paper and CD-ROM administrations of Fruit and Vegetable Scan fruit intake, vegetable intake, and fruit and vegetable intake, and Block Fat Screener fat intake. The computerized assessment and paper surveys were related to multiple 24-hour dietary recall−derived fruit/vegetable and fat intake. Deattenuated correlation coefficients ranged from 0.50 to 0.73 (all P≤0.0001). The CD-ROM−derived estimate of fruit intake was more closely associated with 24-hour dietary recall (r=0.73) than the paper-derived estimate (r=0.54; P<0.05), but the other comparisons did not differ significantly. Findings from this preliminary study with overweight adults indicate the need for additional enhancements to the CD-ROM assessment and more extensive validation studies.     

Twenty-four hour dietary recalls by fourth-grade children were not influenced by observations of school meals

ObjectiveTo investigate whether school-meal observations influenced children's 24-hour dietary recalls.Study Design and SettingOver three school years, 555 randomly selected fourth-grade children were interviewed to obtain a 24-hour dietary recall; before being interviewed, 374 children were observed eating two school meals (breakfast, lunch), and 181 children were not observed. Within observation-status groups (observed, unobserved), children were randomized within sex to one of six combinations from two target periods (prior 24 hours, previous day) crossed with three interview times (morning, afternoon, evening).ResultsFor each of the five variables (interview length, meals/snacks, meal components, items, kilocalories), naïve and adjusted equivalence tests rejected that observation-status groups were different, indicating that school-meal observations did not influence children's 24-hour dietary recalls. There was a target-period effect on length (P < 0.0001) (longer for prior-24-hour recalls), a school year effect on length (P = 0.0002) (longer for third year), and a target period–interview time interaction on items (P = 0.0110) and kilocalories (P = 0.0047) (both smaller for previous-day recalls in the afternoon than prior-24-hour recalls in the afternoon and previous-day recalls in the evening), indicating that variables were sufficiently sensitive and psychometrically reliable.ConclusionConclusions about 24-hour dietary recalls by fourth-grade children observed eating school meals in validation studies are generalizable to 24-hour dietary recalls by comparable but unobserved children in nonvalidation studies.     

A dietary behaviors measure for use with low-income, Spanish-speaking Caribbean Latinos with type 2 diabetes: the Latino Dietary Behaviors Questionnaire

This study examines the validity of a Spanish-language dietary behaviors self-report questionnaire (The Latino Dietary Behaviors Questionnaire [LDBQ]) for Latinos with diabetes. The sample (n=252) was Spanish-speaking, female (77%), middle-aged (mean age 55 years), low education (56% <8th grade education), and low income (50% <$10,000 annual household income). Baseline and 12-month measures were collected as part of a randomized clinical trial. LDBQ reliability, validity, and sensitivity to change over time were evaluated using exploratory factor analysis; internal consistency analysis; and correlation analysis using baseline and change scores for LDBQ, 3-day 24-hour dietary recall nutrient mean, and clinical measures. Cronbach's αs were moderate. Four factors were identified at both time points. Significant baseline correlations (r) were found for LDBQ total scores; factor scores; and energy intake (r=−0.29 to −0.34), total dietary fiber (r=0.19), sodium (r=−0.24 to −0.30), percent energy from total fat (r=−0.16), fat subtypes (r=−0.16 to 0.15), and percent energy from protein (r=0.17). Twelve-month data produced a similar pattern. T tests of LDBQ change scores showed significantly greater change in dietary behaviors for the intervention group than for the control group, t(135)=−4.17, P<0.01. LDBQ change scores correlated significantly with mean 24-hour nutrient intake and a subset of clinical measures, but were not associated with clinical change scores (except high-density lipoprotein cholesterol). The LDBQ is a useful tool to assess and target behaviors for change and assess intervention effects.     

Adoption of diet-related self-monitoring behaviors varies by race/ethnicity,education, and baseline binge eating score among overweight-to-obese postmenopausal women in a 12-month dietary weight loss intervention

Recent research has identified self-monitoring behaviors as important strategies for both initial weight loss and weight loss maintenance, but relatively little is known about adopters and nonadopters of these behaviors. To test our hypothesis that key characteristics distinguish adopters from nonadopters, we examined the demographic characteristics and eating behaviors (eg, restrained, uncontrolled, emotional, and binge eating) associated with more frequent compared with less frequent use of these behaviors. Baseline demographic characteristics and eating behaviors as well as 12-month self-monitoring behaviors (ie, self-weighing, food journaling, monitoring energy intake) were assessed in 123 postmenopausal women enrolled in a dietary weight loss intervention. Logistic regression models were used to test associations of self-monitoring use with demographic characteristics and eating behaviors. Nonwhites, compared with non-Hispanic whites, were less likely to monitor energy intake regularly (adjusted odds ratio [OR], 0.36; 95% confidence interval [CI], 0.13-0.97; P < .05), controlling for intervention arm and baseline body mass index. Participants with a college degree or higher education were less likely to self-weigh daily (adjusted OR, 0.30; 95% CI, 0.13-0.67; P < .01) compared with individuals who attended some college or less. Those with higher baseline binge eating scores were less likely to monitor energy intake (adjusted OR, 0.84; 95% CI, 0.73-0.97; P < .01) compared with participants with lower binge eating scores. In summary, use of diet-related self-monitoring behaviors varied by race/ethnicity, education, and binge eating score in postmenopausal women who completed a year-long dietary weight loss intervention. Improved recognition of groups less likely to self-monitor may be helpful in promoting these behaviors in future interventions.     

A Randomized Controlled Trial of a Theoretically-Based Behavioral Nutrition Intervention for Community Elders: Lessons Learned from the Behavioral Nutrition Intervention for Community Elders Study

Older adults with multiple comorbidities are often undernourished or at high risk for becoming so, especially after a recent hospitalization. Randomized controlled trials of effective, innovative interventions are needed to support evidence-based approaches for solving nutritional problems in this population. Self-management approaches where participants select their own behavioral goals can enhance success of interventions. The purpose of this study was to evaluate the feasibility and efficacy of a multilevel self-management intervention to improve nutritional status in a group of high-risk older adults. The Behavioral Nutrition Intervention for Community Elders (B-NICE) trial used a prospective randomized controlled design to determine whether the intervention, compared to standard care, maintained or increased caloric intake (depending on baseline body mass index) and, consequently, stabilized or increased body weight. Participants were 34 Medicare-eligible, age 65 years old or older, homebound adults who were consuming insufficient calories and/or had a history of weight loss ≥2.5% over 6 months. The intervention took place within participants' homes. Outcome measures, including energy intake (based on collection of three 24-hour dietary recalls) and body weights were assessed at baseline and at 60 days post randomization. The primary analyses included analyses of covariance and Pearson's χ². We hypothesized that the intervention would result in increased caloric intake and weight gain in underweight older adults and increased or stabilized caloric intake and weight for everyone else. The intervention was feasible; however, it did not result in differences between groups for desired outcomes of either caloric intake or body weight. Future interventions might either deliberately involve caregivers or reduce burden for both patients and caregivers.     

Dietary restraint and disinhibition do not affect accuracy of 24-hour recall in a multiethnic population

Some psychological predictors of eating behaviors have been shown to affect usefulness of methods for dietary assessment. Therefore, this study was conducted to determine the association of dietary restraint and disinhibition with dietary recall accuracy for total energy, fat, carbohydrate, and protein. In a cross-sectional study, data were obtained from 79 male and 71 female non-Hispanic whites and African-American volunteers. Participants selected and consumed all foods for a 1-day period under observation and actual intake was determined. The following day, each participant completed a telephone 24-hour recall using the US Department of Agriculture Multiple-Pass method to obtain recalled intake. The Eating Inventory, which measures dietary restraint and disinhibition, was administered prior to eating any food in the study. Repeated measures analyses of variance were used to determine if dietary restraint or disinhibition were independent predictors of recall accuracy. The mean (+/-standard deviation) age and body mass index of the participants was 43+/-12 years and 29+/-5.5 (calculated as kg/m2), respectively. On average, men overreported intake of energy by 265 kcal and women by 250 kcal; both groups also overreported intake of protein, carbohydrate, and fat. When controlling for body mass index, sex, and race, restraint was a significant independent predictor of energy intake (P=0.004) and negatively correlated with energy intake (r=-0.23, P<0.001). Unlike intake of carbohydrate or protein, fat intake was significantly and negatively associated with dietary restraint (P<0.001; r=-0.3). Dietary restraint did not affect accuracy of recall of intake of energy, fat, carbohydrate, or protein, but was significantly associated with intake of energy and fat. Disinhibition was not related to intake or accuracy. Dietetics professionals should consider dietary restraint a possible reason for a lower than expected estimate of energy intake when using 24-hour recalls.     

Parent–Child Associations in Selected Food Group and Nutrient Intakes among Overweight and Obese Adolescents

Few studies have compared parent–child dietary intake among adolescents who are overweight or obese. The purpose of our study was to determine the relationship between parent–teen intake of selected dietary components among this sample. Baseline data from 165 parent and adolescent (aged 11 to 16 years) pairs who presented for a lifestyle behavior modification intervention were collected between 2010 and 2012. Parent and adolescent dietary intake (servings of fruits and vegetables [F/V]; grams of sugar; and percent energy from total fat, saturated fat, dessert/treats, sugar-sweetened beverages, and snacks) was assessed using web-based 24-hour dietary recalls. Multivariable linear and negative binomial regression models identified associations between parent and child dietary intake adjusting for relevant covariates. A large proportion of adolescents and parents did not meet dietary recommendations for F/V, total fat, and saturated fat. Parent–adolescent intake of F/V, total fat, saturated fat, sugar, sugar-sweetened beverages, and snacks were positively associated (r=0.19 to 0.37). No relationship was observed for dessert/treats. In multivariate models, significant interaction effects suggest that the parent–child association in diet was weaker for fat intake among parents with higher educational attainment (b=–.31; P<0.05) and for snacking among adolescent boys (b=–.30; P<.05). Parent intake of several dietary components important for good health, and related to obesity, was associated with adolescent intake. Helping parents improve their diet may promote improvements in their adolescent's diet and is a potential target for interventions designed to increase healthy eating among adolescents.     

Validity and reliability of an omega-3 fatty acid food frequency questionnaire for first-generation Midwestern Latinas

This study tested the hypothesis that a culturally developed omega-3 (n-3) fatty acid food frequency questionnaire (FFQ) could be an accurate instrument to capture n-3 fatty acid food intakes of first-generation Midwestern Latinas. The goal of the study was to assess validity and test-retest reliability of an FFQ to estimate total n-3 fatty acid (total n-3), α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) intakes. An n-3 FFQ was developed and pilot tested. Two FFQs and 3 nonconsecutive 24-hour recalls were collected from 162 participants. Pearson correlation and paired t test were used to test the hypothesis. Correlation of the 2 FFQs was 0.71 for total n-3, 0.65 for ALA, 0.74 for EPA, and 0.54 for DHA (P < .01). The means of the 2 FFQs and of the 24-hour recalls were not significantly different for total n-3 and ALA (P > .05), but were significantly different for EPA and DHA. The n-3 FFQ had acceptable reliability, validated only total n-3 and ALA, and provided relevant findings about the n-3 eating habits of Midwestern Latinas.     

Association between eating patterns and obesity in a free-living US adult population

Some studies have suggested that eating patterns, which describe eating frequency, the temporal distribution of eating events across the day, breakfast skipping, and the frequency of eating meals away from home, may be related to obesity. Data from the Seasonal Variation of Blood Cholesterol Study (1994-1998) were used to evaluate the relation between eating patterns and obesity. Three 24-hour dietary recalls and a body weight measurement were collected at five equally spaced time points over a 1-year period from 499 participants. Data were averaged for five time periods, and a cross-sectional analysis was conducted. Odds ratios were adjusted for other obesity risk factors including age, sex, physical activity, and total energy intake. Results indicate that a greater number of eating episodes each day was associated with a lower risk of obesity (odds ratio for four or more eating episodes vs. three or fewer = 0.55, 95% confidence interval: 0.33, 0.91). In contrast, skipping breakfast was associated with increased prevalence of obesity (odds ratio = 4.5, 95% confidence interval: 1.57, 12.90), as was greater frequency of eating breakfast or dinner away from home. Further investigation of these associations in prospective studies is warranted.     

A Systematic Review of the Validity of Dietary Assessment Methods in Children when Compared with the Method of Doubly Labeled Water

Measuring dietary intake in children enables the assessment of nutritional adequacy of individuals and groups and can provide information about nutrients, including energy, food, and eating habits. The aim of this review was to determine which dietary assessment method(s) provide a valid and accurate estimate of energy intake by comparison with the gold standard measure, doubly labeled water (DLW). English-language articles published between 1973 and 2009 and available from common nutrition databases were retrieved. Studies were included if the subjects were children birth to age 18 years and used the DLW technique to validate reported energy intake by any other dietary assessment method. The review identified 15 cross-sectional studies, with a variety of comparative dietary assessment methods. These included a total of 664 children, with the majority having <30 participants. The majority of dietary assessment method validation studies indicated a degree of misreporting, with only eight studies identifying this to a significant level (P<0.05) compared to DLW estimated energy intake. Under-reporting by food records varied from 19% to 41% (n=5 studies) with over-reporting most often associated with 24-hour recalls (7% to 11%, n=4), diet history (9% to 14%, n=3), and food frequency questionnaires (2% to 59%, n=2). This review suggested that the 24-hour multiple pass recall conducted over at least a 3-day period that includes weekdays and weekend days and uses parents as proxy reporters is the most accurate method to estimate total energy intake in children aged 4 to 11 years, compared to total energy expenditure measured by DLW. Weighed food records provided the best estimate for younger children aged 0.5 to 4 years, whereas the diet history provided better estimates for adolescents aged ≥16 years. Further research is needed in this area to substantiate findings and improve estimates of total energy expenditure in children and adolescents.     

Dietary assessment instruments for preschool children: reliability of parental responses to the 24-hour recall and a food frequency questionnaire

Nutrient intakes of preschool-age children were assessed with a 24-hour dietary recall and a 3-month food frequency questionnaire (FFQ). Parents of 55 preschoolers (mean age = 4.25 +/- 0.59 years) completed the recall and FFQ on two occasions 1 week apart. The recalls and FFQs were analyzed for energy, cholesterol, protein, total carbohydrate, calcium, sodium, potassium, and saturated, polyunsaturated, and monounsaturated fats; each nutrient was expressed as raw value, value per kg body weight, and value per 1,000 kcal. Test-retest reliability estimates for the 24-hour recall indicated significant variability in reported total energy intake, but stable reports of intake were observed for one or all units of expression for polyunsaturated fats, cholesterol, protein, total carbohydrate, calcium, and potassium. The FFQ showed significant positive test-retest reliability estimates for all nutrients for all units of expression. Comparison of the recall and FFQ data showed similar percentages of intakes of energy from fat, carbohydrate, and protein and significant correlations for reported intakes of cholesterol, protein, calcium, and potassium. Comparison of the recall and FFQ data with recall data from a comparable cohort showed lower reported intakes for our sample, with the exception of protein, carbohydrate, calcium, and potassium. If validation studies are successful, the FFQ may be useful in epidemiological studies of preschoolers' intakes over extended periods. The recall may prove to be a useful tool in the assessment of day-to-day variations in macronutrient intakes.     

Thirst-Drinking, Hunger-Eating; Tight Coupling?

Although thirst and hunger have historically motivated drinking and feeding, respectively, the high and increasing consumption of energy-yielding beverages and energy-diluted foods may have degraded the predictive value of these sensations on ingestive behavior. Our within subject (ie, multiple responses from the same individuals), observational (ie, free-living, with no intervention) study explored the relationships between thirst, hunger, eating, and drinking patterns in 50 weight-stable adults (39 women and 11 men aged 30±11 years with body mass index 26.3±5.9). Twenty-four-hour dietary recalls were obtained for a consecutive 7-day period. Appetite ratings were recorded hourly, over the same time period, and correlated with hourly energy and fluid intake from food and beverages. Thirst ratings were not correlated with drinking (r=0.03) or energy intake (r=0.08) during the same hour over the 7-day period. Hunger ratings were significantly, albeit moderately, correlated with energy intake (r=0.30) (P<0.05), but not with drinking (r=0.04). On average, 75% of total fluid intake was consumed during periprandial events. Further, energy-yielding beverages were the main contributor to fluid intake during both periprandial and drink-only events. These data fail to reveal associations between either thirst or hunger and ingestion of energy-yielding beverages, or strong associations between hunger and eating or thirst and drinking. These data raise questions about the predictive power of appetitive sensations for ingestive behavior.     

Short- and long-term eating habit modification predicts weight change in overweight, postmenopausal women: results from the WOMAN study

BackgroundStandard behavioral obesity treatment produces poor long-term results. Focusing on healthy eating behaviors rather than energy intake may be an alternative strategy. In addition, important behaviors might differ for short- vs long-term weight control.ObjectiveOur aim was to describe and compare associations between changes in eating behaviors and weight after 6 and 48 months.DesignWe performed secondary analysis of data collected during a randomized weight-loss intervention trial with 48-month follow-up.ParticipantsWe studied 481 overweight and obese postmenopausal women enrolled in the Women on the Move through Activity and Nutrition (WOMAN) Study.Main outcome measuresWe measured changes in weight from baseline to 6 and 48 months.Statistical analyses performedLinear regression models were used to examine the associations between 6- and 48-month changes in eating habits assessed by the Conner Diet Habit Survey and changes in weight. Analyses were conducted in the combined study population and stratified by randomization group.ResultsAt 6 months in the combined population, weight loss was independently associated with decreased desserts (P<0.001), restaurant eating (P=0.042), sugar-sweetened beverages (P=0.009), and fried foods (P<0.001), and increased fish consumption (P=0.003). Results were similar in intervention participants; only reduced desserts and fried foods associated with weight loss in controls. At 48 months in the combined population, weight loss was again associated with decreased desserts (P=0.003) and sugar-sweetened beverages (P=0.011), but also decreased meats/cheeses (P=0.024) and increased fruits/vegetables (P<0.001). Decreased meats/cheeses predicted weight loss in intervention participants; desserts, sugar-sweetened beverages, and fruits/vegetables were independently associated in controls.ConclusionsChanges in eating behaviors were associated with weight change, although important behaviors differed for short- and long-term weight change and by randomization group. Future studies should determine whether interventions targeting these behaviors could improve long-term obesity treatment outcomes.     

Dietary behaviors associated with total fat and saturated fat intake

OBJECTIVE: To estimate percentages of US adults who have adopted behaviors promoted by dietary guidance about how to reduce fat intake, and to assess relationships between these behaviors and intake of energy from total and saturated fat. DESIGN: Relationships were examined between intake of total and saturated fat from two 24-hour recalls in the US Department of Agriculture's 1994-1996 Continuing Survey of Food Intakes by Individuals and responses to 19 fat-related behavior questions on the follow-up Diet and Health Knowledge Survey (DHKS). SUBJECTS: Data are from a national sample of 5,649 individuals 20 years of age and older. STATISTICAL ANALYSES PERFORMED: Multiple regression models are used to identify dietary behaviors, demographic factors, and personal characteristics that are determinants of fat intake. RESULTS: In this study, the percentage of US adults who consistently followed the low-fat behaviors ranged from 8% to 70%. The most highly adopted behaviors (45% or more of adults) included trimming fat from meat, removing skin from chicken, and eating chips infrequently. The least highly adopted behaviors (15% or less of adults) included eating baked or boiled potatoes without added fat, avoiding butter or margarine on breads, eating low-fat instead of regular cheeses, and having fruit for dessert when dessert is eaten. Together, the 19 fat-related behavior questions on the DHKS formed a statistically significant predictor for total fat and saturated fat intake, expressed as a percent of energy (P<.0001). Key behaviors in terms of their predicted effect on lowering both total and saturated fat intake were never adding fat to baked or boiled potatoes, not eating red meats, eating less than 3 eggs per week, and never eating chicken fried. Predicted effects of these key behaviors in terms of lowering fat intake as a percentage of energy were > or = 1.5 percentage points for total fat and > or = 0.5 percentage point for saturated fat. CONCLUSIONS: Results have applications for designing brief fat assessment instruments and for identifying key nutrition education messages that promote important fat-lowering behaviors.     

Validity and systematic error in measuring carotenoid consumption with dietary self-report instruments

Vegetables and fruits are rich in carotenoids, a group of compounds thought to protect against cancer. Studies of diet-disease associations need valid and reliable instruments for measuring dietary intake. The authors present a measurement error model to estimate the validity (defined as correlation between self-reported intake and "true" intake), systematic error, and reliability of two self-report dietary assessment methods. Carotenoid exposure is measured by repeated 24-hour recalls, a food frequency questionnaire (FFQ), and a plasma marker. The model is applied to 1,013 participants assigned between 1995 and 2000 to the nonintervention arm of the Women's Healthy Eating and Living Study, a randomized trial assessing the impact of a low-fat, high-vegetable/fruit/fiber diet on preventing new breast cancer events. Diagnostics including graphs are used to assess the goodness of fit. The validity of the instruments was 0.44 for the 24-hour recalls and 0.39 for the FFQ. Systematic error accounted for over 22% and 50% of measurement error variance for the 24-hour recalls and FFQ, respectively. The use of either self-report method alone in diet-disease studies could lead to substantial bias and error. Multiple methods of dietary assessment may provide more accurate estimates of true dietary intake.