Question 2
The DHQ, which was developed 8 years ago, showed the greatest underestimation of calcium intake compared to the Calcium Questionnaire and Short Calcium Questionnaire. What factors could have contributed to this underestimation?
posted by lynn2552 @ 11:49 AM
14 comments
14 Comments:
The factors that contributed to the underestimation by the DHQ include the fact that more calcium fortified foods have been added to our food options, diets of Americans have changed and may not be accurately reflected by the old DHQ, and the DHQ is very board as it looks at the entire diet thus it may not be as accurate for estimating intake of a single nutrient.
There is thought that maybe the food portions are not accurate enough for how individuals currently eat. The study states that pts are probably actually consuming larger amounts of high Ca foods than are accounted for in the survey. The absence of Ca-fortified items from the database also makes a large impact as many consumers are choosing items such as Ca-fortified OJ and Ca-fortified Soy Milk which are not included in this survey. Most likely it is a combination of these things, in conjunction with the fact that eating habits have probably changed a little since eight years ago and the tool simply needs to be updated for accuracy.
The fact that the DHQ is such a long questionnaire could impact the thoughtfulness of the individual filling out the survey. When the amount of time spent on one item grows longer and longer many times people start to rush through and "skim" the material rather than really sit and think over what the question is saying. I also think it may have to do with the fact that it was developed 8 years ago while in this time the food supply is continuously changing.
The Calcium Questionnaire and Short Calcium Questionnaire are stictly looking at the amount of calcium in the diet, whereas the DHQ is looking over the diet as a whole and not just the calcium component. This could be why the calcium is underestimated. Also, like Steph and Karlie already stated, the DHQ was developed 8 years ago so the database for Ca fortified foods or new food inventions that contain calcium may not be accurately measured with the DHQ!
There are several factors that could contribute to the underestimation of calcium intake. Since the DHQ was created 8 years ago, there have been several changes to the American diet. Many foods are now being fortified with calcium, including Orange Juice among other products. This would indicate that the survey would not be accurate due to the changes in today's diet. Also, the patients that fill out the survey may not have accurately determined their portion sizes or included very truthful answers.
Along with what others have said, diets have not only changed drastically over the past several years(interest in health has increased) but changes in food products that are enriched or fortified has a huge impact on the actual amount of calcium a person consumes. Since the DHQ has not been updated to account for these changes then it would likely miss a great deal. Also, since it is more of a general survey and doesn't focus specifically on calcium intake it is more likely to have error on a specific nutrient. This survey could be useful if you were just looking for a conservative intake of calcium and used it as a general screening tool, or the updated foods could be added to make it more useful for today.
Karlie,
I really agree with you that portion sizes of food and lack of Ca fortified foods in the database are major factors that account for the DHQ underestimating calcium intake. A simple update to this survey would likely see great improvements in the adequate estimation of calcium intake.
The DHQ most likely had the greatest underestimation in calcium intake due to the fact that it is outdated, which will affect things like portion size estimation (since portion sizes have grown considerably even within the past 10 years)and lack of inclusion of current products such as fortified foods or meal replacement drinks (or a space to write in items not listed) which will greatly impact calcium intake estimation since there are many products fortified with calcium today. Another issue might be that the questionnaire is simply too long--when a survey is extremely lengthy, people tend to lose interest or focus and aren't as accurate with their responses.
Lauren-
I completely agree with you that a major weakness of the DHQ is that it is too long and that would cause people to just "skim" the material. I know I find it hard to stay focused and seriously read through each question when it gets very long so I could see how it would be quite the same for the general public who may have no initial interest in answering the questionnaire as it is.
Lauren,
I also agree with you that the DHQ is too long. After that many questions people are more than likely not really reading the question and answering truthfully, rather skimming the question and picking an answer.
Vanessa,
You bring up an excellent point stating that the DHQ is probably not up to par with the Ca supplements and those foods fortified with Ca! The last 10 years have been the biggest boom for food manufacturers in that they have made many with extra sources of nutrients, one of them being Calcium. I think that like you said, this could greatly effect the DHQ results because it would underestimate the amount of Ca intake in the diet!
The fact that it was developed 8 years ago and has not been updated would cause the results to not be as accurate. It is not surprising that the Ca intake is underestimated because it does not have all the fortified foods that have been developed in the last 8 years. The questionnaire is not able to consider the Ca fortified foods and will not be able to calculate that in the final analysis. Also, people are not really aware of what a standard portion should be. For the most part, Americans are not aware of how much we are consuming over the standard portion sizes. Again, this is outdated and Americans diet has changed over the years and it will not reflect accurately on the questionnaire. Also, the unnecessary length of the questionnaire will deter people away from filling it out completely and to the clinician’s satisfaction.
Shanell~
I agree with you that surveyers might not be truthful in their answers especially if the DHQ is so lengthy that they might just rush to finish and fill in any answer that they think they should put down (rather than the truth)
Vanessa,
I agree that products would definitely not be updated in the DHQ and that they would be missing several fortified items in the database. Good point!
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