Choice of methods to assess dietary intakes
Dunedin, NZ
Choice of methods to assess dietary
intakes of individuals or populations
Rosalind S Gibson,
Emeritus Professor,
Department of Human Nutrition,
University of Otago, Dunedin, New Zealand
RSG
Factors influencing choice of methods to assess
dietary intakes of individuals or populations
• Level of study objectives
• Sources of uncertainty in true usual intakes
• Characteristics of study group: age, degree
of literacy
• Respondent burden
• Available resources
• Validity and reproducibility of the methods
RSG
How to achieve Level 1 Objective
Level 1: Average intake of a population group
Single 24-hr recall/record per person
Ensure all days of the week proportionately
represented
Size of study group: depends on the precision
required and the between-subject variation
RSG
1
Rosalind S Gibson, University of Otago,
What will you learn from this session?
• Factors influencing choice of dietary methods
• How to achieve four levels of study objectives
• What objectives can be met at each level of
objectives?
• Sources of uncertainty in true usual intakes
o measurement errors
o true variation in usual intakes
• Other factors to consider
RSG
Four levels of objectives
Level 1: Average intake of a population group
Level 2: Proportion of population ‘at risk’ to
inadequate intakes
Level 3: Usual’ intakes of individuals for ranking*
Level 4: ‘Usual’ intakes of individuals for
correlation* or diet counseling
* Requires repeated assessment. The number of
repeats depends on within-subject variation. The greater
the within-subject relative to between-subject variation
the more repeats needed
RSG
How to achieve Level 2 Objective
Level 2: Proportion of the population ‘at risk’
Measure 24-hr recalls/records on two non-
consecutive days or three consecutive days
Measure 24-hr recalls/records for two days on at
least a subsample (40-50 per stratum) of the
participants
RSG
Choice of methods to assess dietary intakes Rosalind S Gibson, University of Otago,
Dunedin, NZ

How to achieve Level 3 Objective How to achieve Level 4 Objective

Level 4: Usual intakes of individuals for

Level 3: Rank “usual” intakes of individuals
correlation or regression and for counselling

Multiple-replicates of 24-hr recalls/records

Number of replicates depends on within-subject
variation
Alternatively, a semi-quantitative FFQ
Multiple-replicates of 24-hr recalls/records
Alternatively, a semi-quantitative FFQ or diet history
Note: Number of repeats depends on within-subject variation.
Greater the within-subject relative to between-subject variation,
the more replicates will be needed

RSG RSG

What objectives can be met with Level 1 data? Median (IQR) nutrient intakes of Ethiopian
children from complementary foods
Describe usual mean or median nutrient intake for a
group with a certain precision Nutrient Age 9-11 months Age 12–23 months
Demonstrate a significant difference in mean or median Energy (kcal) 169 (80, 291) 292 (193, 402)
intakes between two groups Protein (g) 3.6 (1.6, 7.3) 7.3 (4.8, 9.7)
Demonstrate a significant change in group mean Calcium (mg) 7.6 (3.6,14.2) 22.4 (10.7,112.6)
intakes based on paired measurements (eg: before
Iron (mg) 2.1 (0.9, 3.9) 4.5 (3.0,6.6)
and after intervention)
Zinc (mg) 0.9 (0.3, 1.9) 1.8 (1.4, 2.3)
Demonstrate a significant change in group mean
Niacin (mg) 0.64 (0.26, 1.35) 1.37 (0.90, 2.15)
intakes based on unpaired measurements
RSG RSG
From Abebe et al. (2008)

Median (IQR) nutrient intakes of two groups of Change in mean intakes (95th CI) over time in NZ
Malawian children: post-intervention toddlers based on paired measurements

Dietary quality Intervention Control

indicator (n=200) (n=81) Nutrient Baseline Post-intervention

Utilizable protein (g) 26 (20, 32) 204, 28)** Energy (kJ) 4126 (3917, 4334) 4093 (3864, 4322)
Animal protein (g) 8.9 (5.1, 12.7) 5.1 (14. 28)**
Protein (g) 41.1 (38.4, 44.1) 40.5 (37.9, 43.3)
Animal source (% energy) 5 3**
Fat (% energy) 11 (8. 15) 9 (2.9, 9.0)** Calcium (mg) 898 (821, 975) 782 (703, 861)
Heme iron (mg) 0.51 ( 0.33** Vitamin C (mg) 33.7 (27.9, 40.7) 39.0 (32.8, 46.5)
[Phy]:[Zn]* molar ratio 16 (12, 20) 20 (15, 23)**
Iron (mg) 4.7 (4.1, 5.3) 5.4 (4.7, 6.1)
[Phy]: [Zn]* < 15 (%) 23 12**
Meat / fish /
Analysis via Mann-Whitney-U-test; ** p<0.05 4.1 ( 3.1, 5.3) 10.0 (8.1, 12.4)
poultry (g)
From Yeudall et al. (2005) RSG From Szymlek Gay et al.(2009) RSG

2
Choice of methods to assess dietary intakes Rosalind S Gibson, University of Otago,
Dunedin, NZ

What objectives can be met with Level 2 data? Assessing prevalence of inadequate intakes after
adjusting distribution of observed to usual intakes
Determine distribution of intakes within the group to
assess proportion at risk of inadequate intakes Adjust 1-d intakes to usual intakes
to remove effects of within-
Determine a significant change in proportion at risk of
subject day-to-day variation
inadequate intakes before and after an intervention
Select appropriate EAR
Determine a significant difference in proportion at risk Use cutpoint method for Zn to
to inadequate intakes between two groups asses percent with inadequate
intakes
Assess risk of inadequate intakes of a nutrient in
Results in a reduction in likelihood
specific sub-groups defined by variables such as
of over- or under-estimating
age, sex, geographic region (urban vs. rural), prevalence of inadequate intakes
household composition, SES, etc
RSG RSG
See IZiNCG Brief No. 3

Risk of inadequate intakes of iron

Proportion at risk to inadequate intakes (as %) in for urban vs. rural subjects
two groups of Malawian children
Number of Number of
Risk of inadequate
urban rural
Nutrient Intervention** Control intake of dietary Fe
subjects subjects
Low risk of inadequate
intake of iron; intakes 58 (35.8%)a 35 (23.6%)
Protein 1 7* >RNI
Vitamin A 15 17 Moderate risk of in-
adequate intakes of iron; 11 (6.8%) 25 (15.4%)
Vitamin B-12 23 41* intakes >EAR but < RNI

Calcium 34 54* High risk of inadequate

intakes of iron: intakes 10 (6.2%) 23 (14.2 %)
Available iron 19 20 <EAR
Total 79 (48.8%) 83 (51.2%)
Available zinc 26 44*
a=percentageof the total number of subjects in each category
Sig. *p<0.01 From Yeudall et al. (2005) RSG Chi-square p<0.0=0.0003 RSG

What objectives can be met with Level 3 data? Median daily intake of dairy products by decile
versus mean (SEM) PDA in adipose tissue
Assess relationship between frequency of daily
• Pentadecanoic acid (PDA) level
intake of food groups (e.g. deciles (times/d) of in adipose tissue correlates with
dairy products) versus mean level of a intake of dairy products via decile
biomarker (eg. adipose pentadecanoic acid (r= 0.31; p<0.01) based on a FFQ
(PDA)) in adults (n=503) in Costa Rica
where intake of dairy products is
rather low
Divide individuals into terciles of nutrient intake
(eg. cholesterol) and calculate the • Age, sex, BMI, smoking status
corresponding average biomarker level (eg. taken into account in analysis
plasma cholesterol) for each tercile
RSG From Baylin et al. (2002) RSG

3
Choice of methods to assess dietary intakes Rosalind S Gibson, University of Otago,
Dunedin, NZ

What objectives can be met with Level 4 data? IYCF & sentinel food indicators at 9 mos in relation to
LAZ scores of Sumedang, W Java infants at 12 mos
Assess inter-relationships between nutrient intakes of
individuals to other indices of nutritional status in same persons IYCF indicators
ᵝ 95%Confidence I p-value

Minimum dietary diversity 0.01 -0.18, 0.20 0.91

Minimum acceptable diet 0.01 -0.18, 0.20 0.91
Iron-rich/iron fortified foods 0.22 0.01, 0.44 0.04*
Sentinel food indicators
Flesh foods 0.07 -0.12,0.26 0.45
Eggs 0.02 -0.18, 0.21 0.88
Animal-source foods 0.10 -0.10, 0.30 0.32
Correlations between fatty acid composition of adipose tissue Fortified infant foods 0.29 0.09, 0.48 0.04*
and fatty acid content of dietary intakes for 86 subjects
RSG RSG
From TjØnneland et al. (1993) * Also significant for WAZ at 12 mos Diana et al. (2017)

Measurement errors during collection of

Other factors to consider when selecting food and nutrient intake data
a method for measuring dietary intakes
• Non-response bias
• Interviewer and/or respondent biases
Sources of uncertainty in true usual intakes • Respondent memory lapses: for recalls, FFQ, DH only
• measurement errors • Incorrect estimation of portion sizes: for recalls, FQ, DH
• Omission of supplements: all methods
• true variation in usual intakes
• Errors in converting portion sizes to weight equivalents:
Characteristics of the study group for recalls, FFQ, DH
Respondent burden • Errors in handling of mixed dishes: all methods
• Coding and computation errors: all methods
Available resources • Errors in food composition databases: all methods
Validity and reproducibility of method in study setting
NB Errors may be random or systematic
RSG RSG

Sources of true variation in usual intakes
Between-subject variation: Depends on study group & nutrient.
Reduce by increasing number of subjects
Within-subject variation: Reduce with multiple days of intake per
subject
Day-of-the-week effects: weekends: market days. Avoid by
proportionately including these days in study design
Seasonal effects: Greater for intakes of foods than nutrients
(except Vit A). Accounted for by using random days
representative of all seasons
Training effect: May be severe if recalls/records on consecutive
days. Avoid by completing on randomly selected non-
consecutive days
RSG
Other factors to consider when selecting a
method for measuring dietary intakes
Characteristics of the study group and setting: Level of
literacy and numeracy; Age group:(elderly problems with
memory)
Respondent burden: Weighed intakes in home: high respondent
burden
Available resources: Experience of research assistants?
Availability of dietary scales; Availability of local food
composition data
Validity and reproducibility of the proposed method: Must be
confirmed for population group and study setting before
adopting any method
RSG

4
Choice of methods to assess dietary intakes Rosalind S Gibson, University of Otago,
Dunedin, NZ

Validity and reproducibility of dietary method Conclusions

Validity: degree to which the dietary method measures
what it is intended to measure:
Selection of a dietary method depends on :
• actual, usual, or past intake
Study objectives: 4 levels of objectives
• intake of foods and/or nutrients
Sources of uncertainty in true usual intakes
• intakes at group or individual level Characteristics of the study group
Reproducibility: degree to which a dietary method Respondent burden
yields very similar results when used repeatedly in Available resources
the same situation
Validity and reproducibility of method in study setting
NOTE: Dietary method can have good reproducibility but poor
validity. e.g: consistently over- or under-estimates of portion sizes
BUT a method with good validity cannot have poor reproducibility
RSG RSG

Key References

Gibson RS. Ferguson EL. An interactive 24-hour recall for

assessing the adequacy of iron and zinc intakes in developing
countries. Chapter 3. HarvestPlus Technical Monograph
Series 8. Washington. DC and Cali: International Food Policy
Research Institute (IFPRI) and International Center for
Tropical Agriculture (CIAT), 2008.
Gibson RS. Principles of Nutritional Assessment. Chapters 2
and 5. Oxford University Press, 2nd Edition, New York, 2005.
National Institute of Health NCI (2015). Dietary assessment
primer. http://dietassessmentprimer.cancer.gov/
Subar AF, Freedman LS, et al. (2015) Addressing current
criticism regarding the value of self-report dietary data. J Nutr
doi:10.3945/jn.115.219634.
RSG