NUTRITION AND DIET

THERAPY
Dietary Guidelines and Food
Guides
Food guides are graphic
representations of all or some of
the messages of the dietary
guidelines. They typically
represent the recommended food
groups in the suggested
proportions for a good diet.
adapted their food guide for
Messages about lifestyle, such as
recommendations of regular
physical activity and warnings
related to alcohol consumption
may also be displayed. The most
common example of food guides is
in the shape of a food pyramid
and food plate. However, many
countries choose a food guide that
is culturally specific for the
population of each country and
may become an important symbol
in a nation's nutrition
communication and education
strategy. Some countries have

different population groups, such

as indigenous peoples.
 Science and Technology (DOST) to
guide on how much 1) fats and
oils, 2) sugar, 3) meat and poultry,
4) milk and milk products, 5)
vegetables, 6) fruits, 7) rice and
rice products and 8) water or

Daily Nutritional Guide Pyramid

beverages should a Filipino eat in
Nutritional Guide Pyramid by the
one day. Aside from that, this guide
Food and Nutrition Research
encourages Filipinos to exercise
Institute (FNRI) of Department of
and practice personal and
environmental hygiene for a
healthy living. Note that pyramids
differ in seven population groups --
toddlers, kids, teens, adults, elderly,
pregnant women and lactating
women.
 population groups namely, kids,
teens, adults, elderly, pregnant and
Pinggang Pinoy lactating women vary from each
other.
Pinggang Pinoy developed by the
Food and Nutrition Research
Institute (FNRI) of Department of

Science and Technology (DOST) is

a new, easy to understand food
guide that uses a familiar food
plate model to convey the right
food group proportions on a per
meal basis to meet the body’s
energy and nutrient needs of an
adult. This is a visual tool to guide
Filipinos in consuming the right
amount of food in every meal.
Also, Pinggang Pinoy of five

Food Labels
Understanding the Nutrition Facts
label on food items can help you
make healthier choices. The label
breaks down the amount of calories,
carbs, fat, fiber, protein, and
vitamins per serving of the food,
making it easier to compare the
nutrition of similar products. Be sure
to look at different brands of the
same foods—nutrition information
can differ a lot. For example, one
brand of tomato sauce may have
more calories and sugar than another
brand for the same serving size. weight, and whether you’re trying to
lose or maintain your weight.
In general, eat more foods that are
higher in vitamins, minerals (such as
calcium and iron), and fiber. Eat
fewer foods that are higher in added
sugars, saturated fat, and sodium
(salt), and avoid trans fat. Keep in
mind that the % Daily Value of each
nutrient, such as total fat of 10%, is
based on eating 2,000 calories a day.
You may eat fewer or more calories
a day depending on your age,
gender, activity level, current

What should you look for on a
food label to determine how
healthy or unhealthy it is?
No added sugar – products must
not contain added sugar, but may
contain natural sugars.
Reduced fat or salt – should be at
least a 25% reduction from the
original product.
Low fat – must contain less than
3% fat for solid foods (1.5% for
liquid foods).
Fat free – must be less than 0.15%
fat.
The Nutritional Guidelines for
Filipinos (NGF) is a set of dietary
guidelines based on the eating
pattern, lifestyle, and health status
of Filipinos.
The NGF contains all the nutrition
messages to healthy living for all
age groups from infants to adults,
pregnant and lactating women, and
the elderly.
The first NGF released in 1990
was composed of five messages
called “Dietary Guidelines for
Filipinos.”
In 2000, a revised nutritional
guideline composed of ten
messages was released and it was
called the Nutritional Guidelines
for Filipinos.
In 2012, the Technical Working
Group (TWG) for the revision of
the NGF, led by the Food and
Nutrition Research Institute of the
Department of Science and
Technology (FNRI-DOST)
developed a new set of the NGF,
based on the 2000 edition.
The 2012 NGF now includes the
basis and justification for each of
the ten nutritional and health
messages.
Below are the new messages of
the 2012 NGF:
1. Eat a variety of foods every day
to get the nutrients needed by the
body.
2. Breastfeed infants exclusively
from birth up to six months and
then give appropriate
complementary foods while
continuing breastfeeding for two
years and beyond for optimum
growth and development.
3. Eat more vegetables and fruits
to get the essential vitamins,
minerals, and fiber for regulation
of body processes.
4. Consume fish, lean meat,
poultry, egg, dried beans or nuts
daily for growth and repair of body
tissues.
5. Consume milk, milk products,
and other calcium-rich food such
as small fish and shellfish, every
day for healthy bones and teeth.
6. Consume safe foods and water
to prevent diarrhea and other food-
and water-borne diseases.
7. Use iodized salt to prevent
Iodine Deficiency Disorders.
8. Limit intake of salty, fried, fatty,
and sugar-rich foods to prevent
cardiovascular diseases.
9. Attain normal body weight
through proper diet and moderate
physical activity to maintain good
health and help prevent obesity.
10. Be physically active, make
healthy food choices, manage
stress, avoid alcoholic beverage,
and do not smoke to help prevent
lifestyle-related non-
communicable disease.
The revisions were made based on
the results of the 2008 National
Nutrition Survey (NNS) conducted
by FNRI-DOST.
Based on the said survey, the
Filipino household diet fell below
the recommended levels except for
niacin, which is above the
recommended.
Furthermore, all nutrients and
energy were below the 100 percent
adequacy levels. This was the
basis of NGF messages no. 1, 3,
and 4.
There is no single food that
contains all the nutrients that our
body needs so eating a variety of
food ensures that daily nutritional
needs are met.
There was also a decrease in
consumption of fruits from 77
grams in 2005 to 54 grams in 2008
and also a decrease in milk
consumption from 44 grams to 42
grams. These results were the
basis of message no. 3 and 5,
respectively.
Vegetables and fruits are the main
sources of vitamins, minerals, and
fiber, while milk is a good source
of calcium.
Low urinary iodine excretion is
still a prevalent problem among
pregnant and lactating mothers,
indicating to low iodine intake.
Iodine is important during
pregnancy because it is needed for
the brain development of the infant
while lactating mothers must have
adequate supply of iodine in their
breastmilk. This is the message of
NGF no. 7.
The total cholesterol level among
Filipino adults increased from 8.5
(mg/dL) in 2003 to 10.2 (mg/dL)
in 2008.
High cholesterol level may be
attributed to the high consumption
of sodium rich foods by Filipinos.
Salt and soy sauce were among the
top 10 widely used miscellaneous
food items used by Filipinos.
In addition, heart diseases ranked
first among the causes of death
based on the 2005 Department of
Health survey. This is the reason
behind no. 8 of NGF.
Excessive intake of salt and soy
sauce can result to high blood
pressure especially to salt-sensitive
individuals. Persistent high blood
pressure can result to
cardiovascular diseases.
There is also a decreasing trend of
physical inactivity among Filipinos
and also a large percentage of
Filipino smokers at 31.0% and
drinkers at 26.9%. These
situations were the basis of
messages no. 9 and 10 of the
NGF.
People are always encouraged to
exercise at least thirty minutes a
day, three to five times a week.
Limit alcohol drinking to one drink
per day for women and two drinks
for men is also advised. One
alcoholic drink is equivalent to one
and half ounce distilled beverage
such as gin or 12 ounces or a bottle
of beer or four ounces wine or half
glass wine or an ounce of 100
proof whiskey.
10 Kumainments
The “10 Kumainments” — a
campaign to promote the
Nutritional Guidelines for
Filipinos — was launched by the
NNC at the “3rd National
Conference of Nutrition Action
Officers” held at the SMX
Convention Center in Pasay City
on October 23, 2014.
The 10 Kumainments are the
popularized versions of the
Nutritional Guidelines for
Filipinos (NGF) approved by the
NNC Governing Board to promote
a healthy lifestyle among Pinoys.
The Kumainments are simple and
easy to remember guidelines that
can be easily followed by ordinary
citizens to improve their nutritional

status.
Nutrition Tools, Standards and
Guidelines Nutrient
Recommendations (Philippine
Dietary Reference Intake 2015)
Good Health starts with Good
Nutrition
Good Nutrition starts with a diet
that provides the necessary levels
of energy and essential nutrients
Diets based on the reference
values for energy and nutrient
levels of intake
The Food and Nutrition
Research Institute of the
Department of Science and
Technology (FNRI-DOST)
launches the PDRI 2015 during the
opening ceremony of the 41st
FNRI Seminar Series on July 1,
2015 at the FNRI Auditorium. The
2015 PDRI adopts the multi-level
approach for setting nutrient
reference values to meet the needs
of various stakeholders for
appropriate nutrient reference
values.
PDRI is the collective term
comprising reference value for
energy and nutrient levels of
intakes.
Philippine Dietary Reference
Intake 2015
From a single reference standard,
Recommended Energy and
Nutrient intake (RENI) to a new
set of multi-level standards
- meet the need of various
stakeholders for appropriate
nutrient reference values for
planning and assessing diets for
healthy groups and individuals
- endpoints of the DRI are to
ensure nutrient adequacy,
prevent nutrient deficiency and
avoid excess
- based on reference weight (0-18
yrs.) reflecting WHO-Child
Growth Standard (WHO-CGS),
and for adult BMI of 22 kg/m2
using 2013 NNS median height at
19y/o
Components of PDRI
1. Estimated Average Requirement
(EAR)
2. Recommended Energy/Nutrient
(REI/RNI)
3. Adequate Intake (AI)
4. Tolerable Upper Intake Level or
Upper Limit (UL)
The components of PDRI are:
Estimated Average Requirement
(EAR): daily nutrient intake level
that meets the median or average
requirement of healthy individuals
in particular life stage and sex
group, corrected for incomplete
utilization or dietary nutrient
bioavailability.
Note: EAR is not useful as an
estimate of nutrient adequacy in
individuals, because it is a mean
requirement for a group, and the
variation around this number is
considerable.
Recommended Energy/Nutrient
Intake (REI/RNI): level of intake
of energy or nutrient which is
considered adequate for the
maintenance of health and well-
being of healthy persons in the
population.
RNI = EAR for nutrients,
translated into dietary
recommendation to cover the
needs of almost all individuals in
the population (EAR+2SD).
REI = the computed average
requirement of the individuals in
that group.
Adequate Intake (AI): daily
nutrient intake level that is based
on observed or experimentally-
determined approximation of the
average nutrient intake by a group
(groups) of apparently healthy
people that are assumed to sustain
a defined nutritional state. It is
used when there is insufficient data
to establish the EAR.
Tolerable Upper Intake Level or
Upper Limit (UL): highest
average daily nutrient intake level
likely to pose no adverse health
effects to almost all individuals in
the general population.
Lack of suitable data could not
establish ULs for other nutrients,
but this does not mean that there is
no potential adverse effects
resulting from high intake.
When data about adverse effects
are extremely limited, extra
caution may be warranted.
Uses and Applications of PDRI
For assessing and planning dietary
intakes for an individual /
group/population
Appropriate DRI to use is hinged
on the concept that requirements
represent a distribution
Assessment – determining
adequacy and inadequacy of
individuals and prevalence of
adequate or inadequate intakes of
the group or population. (National
Nutrition Survey result compared
with DRI)
Planning – setting intake targets
for individuals and determining
desirable intake distributions for
groups or population. (Meal
planning for individuals and
groups, like in hospitals, prisons) Criterion – prevention of nutrient
and development of dietary deficiency or prevention of chronic
guidelines, feeding programs diseases for certain life stage (e.g.,
dental caries for fluoride)
Individual consumers - as
reference as to what foods to eat Recommendation for infants 0-5
and how much months was based on AIs
Food and beverage industry – for - Estimated from nutritional
fortification and marketing of composition and average volume
foods of breastmilk (BM) of 780 ml
consumed daily by exclusively
Government, NGO, private
breastfeed babies
institutions– to design, implement
and evaluate food and nutrition - For protein, Vitamin D,
assistance programs Vitamin K, selenium, iodine and
electrolytes –estimation done by
Scientific and regulatory bodies
using factorial mode
– to formulate standards and
regulations Recommendation for older
infants
Nutrition and health
professionals – to educate and - BM (650ml) and
counsel public health complementary foods (CF).
Estimating Recommended - In the absence of CF data,
Intakes requirements for most nutrients
were extrapolated from either
Review process –assessment of
younger infants or adults.
published foreign and local studies
and unpublished important local
studies
Review/adoption of
recommendations by expert
scientific bodies
Requirement is defined – lowest
nutrient that maintain level of
nutriture among apparently healthy
individuals.
 - For protein, requirements for docosahexaenoic acids) – play key
infants were estimated using a roles in CNS
linear regression model

Infants and Early Childhood

Adolescence and Adulthood
Requirements for macronutrients
Adolescent – higher intake of
and micronutrients are higher on a
protein and energy for growth
per-kilogram basis during infancy
and childhood compared to later Most micronutrients, same as for
life cycle. adults except for calcium and
phosphorus for bone growth.
Energy – breastmilk sole source
until 6 months when Iron requirements higher in
complementary foods will be given menstruating females
for optimal growth and
development
Protein – Provides amino acids for
the synthesis of membranes,
hormones, antibodies, other
proteins, and peptides.
Requirements per kilogram
decrease rapidly after the first year.
Essential Fatty Acids - through
desaturation and elongation,
linoleic and alpha-linolenic acids
are converted to long-chain fatty
acids (arachidonic and

A.O. No. 2019 - 0033
Guidelines for the
Implementation of Nutrition
Care Process in Hospitals
I. RATIONALE
The Republic Act No. 10862 or
the Nutrition and Dietetics Law of
2016 was enacted to regulate and
standardize the practice of
Nutrition and Dietetics in the
Philippines, with a provision on
Medical Nutrition Therapy (MNT)
through the application of
Nutrition Care Process (NCP) for
purposes of disease prevention,
treatment, and management.
There is a need to call for action
for interdisciplinary approach
for a coordinated service delivery
to recognize the performance
accountability of Registered
Nutritionist-Dietitians (RNDs) in
administering prompt Medical
Nutrition Therapy.
II. OBJECTIVE
This order shall provide guidelines
in the implementation of Nutrition
Care Process (NCP) in public and
private hospitals.
III. SCOPE AND COVERAGE
This Order shall provide the
mandate and direction for public
and private hospitals to
operationalize and institutionalize
the NCP in their respective
facilities.
Definition of Terms
Malnutrition - refers to
deficiencies, excesses, or
imbalances in the intake of energy
and/or nutrients of a person.
Registered Nutritionist-Dietitian
(RND)- holds a valid certificate of
registration and a valid
professional identification card,
which is renewed every three years
and issued by Board of Nutrition
and Dietetics of Professional
Regulation Commission, pursuant
to Republic Act No. 10862 or the
Nutrition and Dietetics Law of
2016.
Nutrition Care - is an organized
group of activities allowing the
identification of nutritional needs
and provision of care to meet the
needs.
Nutrition Care Process - is the
systematic problem-solving
method that dietetics professionals Medical Nutrition Therapy
utilized to critically think and (MNT) - is the application of NCP
make decisions to address for purposes of disease,
nutrition-related problems and prevention, treatment, and
provide safe and effective quality management.
nutrition care.
V. IMPLEMENTING
Nutritionally-at-risk patients are MECHANISM
considered at-risk, if they have
A. General Guidelines
any of the ff:
The following guidelines shall be
a. Actual or potential for
implemented to operationalize and
developing malnutrition
institutionalize NCP at all levels of
(involuntary loss or gain ≥ 10% of
public and private hospitals:
usual body weight within 6
1. Nutrition Screening is the
months, or ≥ 5% of usual body
prerequisite to the implementation
weight in 1 month, a weight of
of NCP in identifying nutritionally-
20% over or under ideal body
at-risk patients, including those
weight); process of chronic disease
who are critically-ill.
or increased metabolic
requirements. All patients admitted to the
hospitals shall be screened by
b. Altered diets or diet schedules
nurses to identify those who are
(receiving total parenteral or
nutritionally-at-risk using a
enteral nutrition, recent surgery,
nutrition screening tool (for Adult
illness or trauma)
and for Pedia).
c. Inadequate nutrition intake
Based on standards of patient care,
including those not receiving food
patients who are “nutritionally-at-
or nutrition products (impaired
risk” shall be identified
ability to ingest or absorb food
immediately.
adequately) for greater than 7 days.
2. Upon nutrition screening
Critically-ill patients - are usually
accomplished by the nurse, referral
those patients at the Intensive Care
for Medical Nutrition Therapy
Unit (ICU), geriatric, stroke and
(MNT) to the RND shall be
cancer patients, and those with pre-
accomplished by the physician on
and post-operative conditions.
duty.
A bi-annual accomplishment report
of nutritionally-at-risk patients
done in accordance with the
different steps in the NCP shall be
prepared by the RND and be
submitted to the Medical Records
Section under the Health
Information and Management
Department (HIMD) for
verification. A duplicate copy shall
be kept for reference.
Specific Guidelines
1. Nutrition Care Algorithm
a. Nutrition Screening, as the
prerequisite to the implementation
of NCP in identifying
nutritionally-at-risk patients
through certain parameters (i.e.,
anthropometric measures, dietary
intake, and clinical condition) shall
be
accomplished by the staff nurse
(RN) upon admission of patient in
the hospital using validated
nutrition screening tools.
All patients shall be screened
either at-risk or not-at-risk.
Hospitals using electronic health
record (EHR) system shall create
an automatic referral system to the
RND.
Identified not-at-risk patients shall
undergo periodic re-screening to
determine as totally not-at-risk or
at-risk.
b. Upon nutrition screening, the
physician on duty shall refer
patients needing MNT to the RND
using the Nutrition Screening and
Referral Tool, for adult and for
pedia, respectively
c. All nutrition referrals shall be
accommodated by the RND within
24-48 hours after admission. MNT
shall be implemented using MNT
Form (Nutrition Care Plan)
ROLES AND
RESPONSIBILITIES
a. The Health Facility and
Development Bureau (HFDB) of
DOH shall be the national
oversight in the implementation of
this Order based on its mandate in
providing technical assistance to
hospitals.
It shall coordinate and provide
technical inputs for the
operationalization of this Order
and other relevant initiatives.
HFDB shall convene series of
consultations with relevant offices
in DOH on how to include the
implementation of this Order as
part of minimum licensing
requirements of a hospital.
It shall provide reports on the
implementation of this Order to
relevant clusters in DOH.
b. The Centers for Health
Development (CHDs), thorough
the Regional RNDs, shall:
▪ Ensure the implementation of this
Order in all hospitals within its
catchment area;
▪ Conduct monitoring and
evaluation of this Order within its
catchment area; and
▪ Consolidate and submit reports
from LGU Hospitals within its
catchment area to HFDB
c. All public and private
hospitals shall provide necessary
logistics and management support
and shall strictly comply with the
implementation of this Order.
The roles and responsibilities of
he ff hospital staffs are as
follows:
The attending physician shall;
1. Refer all cases needing MNT to
RNDs;
2. Conform and duly sign the NCP
recommendations developed by
the RND;
3. Lead in the administration of
care plan provided by the RNDs,
RNs, RPhs, and other allied health
professionals;
4. Conduct nutrition support
access;
5. Actively convene
interdisciplinary conferences to
present results of managed cases
The registered nutritionist-
dietitian shall;
1. Develop nutrition care plan for
nutritionally-at- risk and critically-
ill patients;
2. Implement the nutrition care
plan;
3. Monitor, evaluate, and
document the nutrition care plan to
determine progress and nutrition
outcome of the interventions;
4. Prepare bi-annual
accomplishment report and submit
such report to the hospital
information management
department and to HFDB; and
5. Actively participate in case
conferences, e.g. ward rounds and
interdisciplinary health care
planning
The registered nurse shall; host a regular meeting with
stakeholders to address issues and
1. Complete nutrition screening
concerns in the implementation of
upon admission
this Order.
2. carry-out the prescribed
STEPS IN NUTRITION CARE
medications, diet and fluid
ALGORITHM
requirements, and diagnostic tests
related to nutrition care
3. Prepare and update
diet list for submission to
the Nutrition and
Dietetics
Service/Department;
4. Document changes in
eating/drinking patterns in the SUBSEQUENT STEPS IN
patients’ chart and NUTRITION CARE
tolerance/intolerance to certain ALGORITHM
foods, and discuss such matters
with the RND
---
The Professional Regulation
Commission (PRC) shall actively
participate in the monitoring,
evaluation, and proper practice of
RNDs in compliance with
Republic Act No. 10862 or the
Nutrition and Dietetics Law of
2016.
The Field Implementation and
Coordination Team (FICT) shall
be the over-all in-charge with
respect to monitoring for the
effective and efficient
implementation of this Order in all
government hospitals and shall
 d. All consolidated reports at all
levels shall
be a basis for
research and
development
activities and
program

enhancements in all hospitals or

health care facilities
MONITORING AND
EVALUATION
EFFECTIVITY
a. The HFDB Nutrition and
Dietetics Adviser shall lead in the This Order shall take effect
monitoring and evaluation in immediately.
coordination with the Health and
Signed over printed name by the
Information Service Adviser of
Secretary of Health, Francisco T.
HFDB
Duque III, MD, Msc
b. DOH hospital shall submit bi-
annual reports to HFDB
Nutrition Care Process
c. HFDB shall consolidate all
Assessment of Nutritional Status
reports and analyze its
implications on the
implementation of this Order. It
shall also provide bi-annual
technical advice to DOH hospitals,
to CHDs, and to relevant offices in Nutrition Assessment is the first
DOH for the compliance of step in the nutrition care process.
hospitals to this
To implement a successful
nutrition plan, the assessment must
include key elements of the
patient’s:
 Clinical or medical history
 Current situation
 Anthropometric
measurements
 Biochemical and
laboratory values
 Information on medication
and herbal supplement use
for potential food-drug
interactions
 Food and nutrition intake
history
Nutrition assessment often begins
with collection of dietary intake
data, the information on the food,
drink,
and supplements consumed.
This personal dietary intake is
influenced by factors such as;
- Economic situation
- Availability of food
- Eating behavior
- Emotional climate
- Cultural background
- Effects of disease
- Ability to acquire and absorb
nutrients
Once the dietary intake data are
collected, they are analyzed for
nutrient and phytonutrient
content. This is compared with
dietary recommendations and
requirements particular to that
individual.
These requirements depend on;
1. Age
2. Gender
3. Periods of growth such as
pregnancy or adolescence
4. Presence of chronic disease or
inflammation
5. Coexistence of stressors such
as injury or psychologic trauma
6. Medical treatments or
medications
A diet history is perhaps the best
means of obtaining dietary intake
information and refers to a
review of an individual’s usual
patterns of food intake and the
food selection variables that
dictate the food intake.
Dietary intake data may be
assessed either by collecting
retrospective intake data (e.g.,
a 24-hour recall or food
frequency questionnaire) or by
summarizing prospective intake
data (e.g., a food record kept for
a number of days
by an individual or the
caretaker).
Each method has specific
purposes, strengths, and
weaknesses. Any self-reported
method of obtaining data
can be challenging because it is
difficult for people to remember
what they ate, the content, and
the amounts (Thompson et al,
2010). The choice of data
collection depends on the
purpose and setting, but the goal
is to determine the food and
nutrient intake that is typical
for that individual.
Screening and assessment are
integral parts of the
nutrition care process (NCP),
which has four steps:
(1) assessment of nutrition
status;
(2) identification of nutritional
diagnoses;
(3) interventions such as food
and nutrient delivery, education,
counseling, coordination of care;
and
(4) monitoring and evaluation
of the effectiveness of the
interventions
Nutrition Screening
Nutrition risk is determined
through a nutrition screening
process.
Factors to consider in
determining whether an
individual is at nutritional risk
are:
- Food
- Nutrient
- Botanicals intake patterns
- Psychosocial and economic
factors
- Physical conditions
- Abnormal laboratory findings
- Medication
- Treatment regimens
The purpose of a nutrition
screen is to quickly identify
individuals who are
malnourished or at nutritional
risk and determine whether a
more
detailed assessment is warranted.
Nutrition screening is defined as
“the process of identifying
patients, clients, or groups who
may have a nutrition diagnosis
and benefit from
nutrition assessment and
intervention by a Registered
Nurse (RN)/Registered
Nutritionist- Dietitian (RND).
Key considerations for
nutrition screening include:
1. Tools should be quick, easy to
use, and able to be conducted in
any practice setting.
2. Tools should be valid and
reliable for the patient population
or setting.
3. Tools and parameters are
established by RNDs, but the
screening process may be
performed by dietetic
technicians, registered (DTRs),
registered nurses (RNs) or
other trained personnel.
4. Screening and rescreening
should occur within an
appropriate time frame for the
setting.
Nutrient Intake Analysis
A nutrient intake analysis
(NIA) also may be referred to as
a nutrient intake record analysis
or calorie count, depending on
the information collected and the
analysis done.
The NIA is a tool used in various
inpatient settings to identify
nutritional inadequacies by
monitoring intakes before
deficiencies develop.
Information about actual intake is
collected through direct
observation or an inventory of
foods eaten based on observation
of what remains on the
individual’s tray or
plate after a meal.
In many cases, photographs taken
by smartphones are useful in
documenting amount of food
consumed (LaGesse, 2011).
Intake from enteral and
parenteral tube feedings is also
recorded.
A daily food record, or food
diary, involves documenting
dietary intake as it occurs and is
often used in outpatient clinic
settings. The food diary is usually
completed by the
individual client.
A food diary or record is usually
most accurate if the food
and amounts eaten are recorded
at the time of consumption,
minimizing error from
incomplete memory
or attention.
The individual’s nutrient intake is
then calculated and averaged at
the end of the desired period,
usually 3 to 7 days, and
compared with dietary reference
intakes (DRIs),
government dietary guidelines as
in the MyPlate guide, or
personalized dietary
recommendations for disease
management or prevention.
The food frequency
questionnaire is a retrospective
review of intake based on
frequency (i.e., food consumed
per day, per week, or per month).
For ease of evaluation, the food
frequency chart organizes foods
into groups that have common
nutrients. Because the focus of
the food frequency questionnaire
is
the frequency of consumption of
food groups without portion
sizes, the information obtained is
general, not specific, and cannot
be applied to certain nutrients.
During illness, food consumption
patterns can change, depending
on the stage of illness. Therefore,
it is helpful to complete food
frequency questionnaires for the
period
immediately before
hospitalization or before illness
to obtain a complete and accurate
history.
The 24-hour recall method of
data collection requires
individuals to remember the
specific foods and amounts of
foods they consumed in the past
24 hours.
The nutrition professional asks
the person to recall his or her
intake using a specific set of
questions to
gain as much detailed
information as possible.
For example, when told that the
person had cereal for breakfast,
the nutritionist-dietitian may ask,
“What kind of cereal?” The next
question may be, “How much
did you have?” at the same time
that the person is being shown a
bowl or measuring cup to jog the
memory on portion size.
Problems commonly associated
with this method of data
collection include;
(1) an inability to recall
accurately the kinds and amounts
of food eaten,
 are confused, and those whose
(2) difficulty in determining intake is unpredictable.
whether the day being recalled
represents an individual’s typical
intake or was exceptional, and

(3) the tendency for persons to

exaggerate low intakes and
underreport high intakes of
foods.

Concurrent use of food frequency

questionnaires with 24 hour
recalls or food diaries (i.e., doing
a cross-check) improves the
accuracy of dietary intake data.
Reliability and validity of
dietary recall methods are
important issues. When attention
is directed toward
the diet, people may consciously
or unconsciously alter their
intake either to simplify
recording or
impress the interviewer, thus
decreasing the information’s
validity.

The validity of dietary recall

information from obese
individuals is often questionable,
because they tend to underreport
their intakes.

The same can be true for patients

with eating disorders, those who
are critically ill, those who abuse
drugs or alcohol, individuals who