Question 1
Many of these studies’ assessment methods had limitations, so it is necessary to be careful when drawing conclusions. What do you think would be an accurate, yet achievable, method to assess the dietary intake of participants in future studies?
posted by Stephanie Hinkle @ 7:46 PM
27 comments
27 Comments:
I think an accurate and achievable method of assessing the participants’ dietary intake for future studies would be to have them keep a food diary or dietary food record. They would document their consumption of fruits and vegetables and include the portion sizes of what they consumed as well as all other food and beverage intake for the time frame of the intervention. It should not be to big of a burden if the participants are given information and tips on how to judge portion sizes as well as easy instructions for how to document their intake. Providing an electronic form that they could either print off or enter their food and beverage intake on a daily basis would not take up too much time in my opinion and would be relatively accurate.
Considering the population targeted,I think that it would certainly be difficult finding an accurate, yet achievable, method to assess the dietary intake of participants in future studies. Since very few studies used well-established measures such as 24-hour diet recalls and validated food frequency questionnaires, validated tools should be considered for future studies so that results can be compared across studies and reliable conclusions can be reported. For example, I think that 24-hour dietary recalls could work when administered by trained staff. In addition, an orally administered food frequency questionnaire could be completed during a client's appointment. Therefore, if the client has poor literacy skills, the trained professional would be there to answer questions and properly fill out the questionnaire.
Determining an accurate, yet achievable method for assessing dietary intake in future studies is obviously a difficult task, which is likely why it hasn't already been accomplished. Like Anna and Melanie stated, 24 hour recalls and food journals can be accurate and achievable the participants are guided to record correctly and efficiently
It is definitely challenging to try to evaluate the diet of people in a way that is both accurate and viable. I think an accurate way to assess the dietary intake of participants would be to have them keep a simple food journal for a period of time. The individuals in the study can also be given a food frequency questionnaire. In this type of study, specifically, something such as the Fruit and Vegetable Screener by the U.S. National Cancer Institute could be useful. I think using a combination of these things might be a little more accurate than using one on their own.
I believe that a 24 hour diet recall and a food frequency questionnaire are both great ways to assess the dietary intake of participants. Although, as Anna pointed out, it is difficult to find an assessment method that is both accurate and achievable.
Like Kara stated previously, it is challenging to evaluate people’s diet in a way that is accurate and achievable. Possibly including some type of food journal with each basket of fruit and vegetables could be an efficient way of assessing participants’ dietary intake. Ideally, if the journal was provided at the farmer’s market I think the participants would be more apt to use it. The journal would have to be explained to each participant beforehand.
I think that if resources were available the most accurate way to assess this would be to do pantry, cabinet, and refridgerator checks. This way you can see what is being purchased and then do an oral assessment with the individuals about what they are eating by doing a 24 hour recall or a food frequency questionnairre.
Having the participants keep a food journal is one feasible and accurate, yet achievable method of assessing dietary intake in future studies of this nature. However, the length of the study may have an impact on the appropriateness of food journals as an assessment measure. A study with greater longitude is desirable, but participants would have to be willing to journal for that length of time.
I agree with all the previous posts about the fact that accurate methods of assessing dietary intake of fruits and vegetables is difficult to achieve. Probably the best way to compile data is a 24-hour recall and/or FFQ, but I'm wondering if these strategies could be combined with analysis of a list of exactly what was bought at the farmer's market at each visit. Suppose each study subject completed a list (maybe with assistance from on-site staff) at the end of each visit to the market (it could be in the form a "receipt" that indicated every fruit and vegetable purchased plus the quantity). Subsequent visits to the WIC office (or other study "site") would compare the list of items bought with the 24-hour recalls and FFQ to examine what is really being consumed....this isn't perfect, but I'm trying to think through a way to achieve increased accuracy for future studies....
Determining an accurate, yet achievable method for assessing dietary intake in future studies could involve consideration of administering food frequency or 24 hours recalls. I agree with Anna, trained individuals present for administering these would be beneficial and help assure accuracy.
The challenge with obtaining dietary intake records is that all of the tools have limitations. Considering the demographic and the goal of the study, I would say that a realistic tool is the 24-hour typical recall. The participants will likely not want to take the time to keep a food diary, nor will they want to take the time to sit down and take a food frequency questionnaire.
Tough call on this one - as stated above there is no perfect way to measure fruit and vegetable consumption. At the WIC I previously worked at we utilized a 1-day food recognition form. On the FRF, foods were listed in columns according to meal and checked if consumed. Not a perfect science but easy and convenient. I would assume most consumers are more apt to use a tool that is quick and easy. I would agree that education would be crucial to assure accuracy.
Shelby and Alison---I like your style. Both of your ideas really involve the researchers' trained staff with the study subjects' actual use of the F/V. FFQ's and 24 hour recalls are teh most common tools because they are the most feasible, and I think that so often in research, more information of questionable quality is better than very little information of immpeccable quality. As with any method of data collection, there is potential for inaccuracy with both frdge checks and reciept comparison, but these are neat ways to assess farmers' market impacts because they focus on what actually happens to the food product between market and table-- not a personal report of behavior. Way to take the road less travelled.
And here is one for the definitely not feasible but probably most accurate history books: Private Investigators/Spies. Each person going through the Farmers' Market or Community Garden would--unbeknownst to them--be assigned a trained research assistant who would personally account for each fruit or vegetable that entered a study participant's home. They may use any means necessary--late night stakeouts, bugged telephones, high-resolution satellite imaging and heat seeking cameras (to see when the fridge was opened and what was taken out of it, silly)--to track the actual uses of the foods that were purchased from farmers' markets and community gardens. The participant would never be asked a single question, and all movements of the fruits and vegetables would be accounted for, from purchase to either consumption or disposal. There is literally zero chance of portion size misrepresentation or participant 'forgetfulness' of what actually happened to the locally grown, organic bunch of broccoli they bought last week. It's expensive and possibly unethical, but dang it, that information would be correct!
As everyone else has stated, it is difficult to find a tool that will accurately reflect the participant’s intakes completely. In this case, I would most likely suggest using a 24-hour recall or a food frequency questionnaire that would be administered by trained individuals. Although, not perfect, it would provide a good picture of the dietary patterns of the participants.
I agree with Sarah, the 24-hour recall would most likely be the best option for this population seeing as how they will most likely not be willing to keep a food diary and would not like to complete the food frequency questionnaire. I also agree with Alison that a list of foods purchased at the farmers’ market would also be very useful in addition to the 24-hour recall or food frequency questionnaire.
This is a difficult question to answer especially when going back to the January journal blog where many of us discussed the inaccuracy of using diet recalls, food journals, ect. I definitely agree with everyone that said using a 24-hour diet recall would be an appropriate way to assess the dietary intake of the participants but I do not think it would be any more accurate then what this study used to assess the fruit and vegetable intake. Just as the question states, using the diet recalls "should be examined carefully when drawing conclusions." Even with this being said, I can not think of a better way to assess the participants' intake then by using the 24 hour recall because a food journal comes off as tedious to many people and anything else seems too invasive which may discourge people in wanting to participate.
Clearly there are limitations that concerns for these populations. However, using the WIC population as an example, there are ways to at least start to evaluate the impact of the farmer's market coupons. WIC develops materials that their population can understand and the employees are trained well to work with those that have reading concerns. I think either a food frequency questionnaire in place of a self-study module or incorporating a 24-recall into a nutrition interview/education could be a good starting point.
I also think it would be wise to notate what patients they use for the study and conduct follow ups at their next visits to ensure the increase as continued. These would obviously just the starting point, but it would be one way to get data on this population.
It seems everyone is somewhat on the same page. I definitely agree that training needs to be done to ensure accuracy, something I think could be easily done with staff at WIC, but I don't know enough about the other areas to know how well that would work.
I agree with many on the previous comments that suggested a food journal or 24 hour recall would be the most accurate and achievable methods available currently. My first thought was to educate the participants on what a serving is and they collect a food journal over several days.
Sarah Udell
I agree with Liz that there isn't really a proven accurate method right now and it's really a challange to find something that is the most accurate. It seems to vary person to person as far as how accurate different methods are.
Sarah Udell
Many times it is very difficult to find an accurate and achievable way to assess dietary intake since most methods have a pretty high margin of error. Usually, if the participant is given the freedom to keep track of their own food intake without any assistance from a professional, there is a larger chance for error. Any method can be more appropriate if a professional is assisting.
Sarah U.,
I agree that it is a great idea to educate the participants prior to allowing them to complete 24 food journals or keep track of their own intake. It would be very easy to make food serving mistakes if the patient was not educated on serving sizes previously.
I think the food diary might actually be the most accurate tool for determining what kinds of foods are being eaten, although quantity would not necessarily be particularly accurate. I'm uncomfortable with the 24-hr recall, mostly due to how truthful subjects are as well as how typical the diet recalled would actually be. Perhaps it would be even more accurate to just weigh fruits and vegetable purchases at farmer markets, then have the family weigh any left overs from these products upon disposal of them. In this way, total f&v consumption could be recorded.
~Anna Taylor
Erin, I think you make an excellent point: In a perfect world, with no limitations, accurate recording of F&V intake may be possible. In our world, however, we are left to much less accurate tools for measuring F&V intake. Perhaps using a variety of methods may be the best solution given the circumstances. You definitely get an A+ for creativity though... :)
~Anna Taylor
Although in many cases pantry, cabinet and refrigerator checks would not be feasible due to cost limitations and patient privacy,it is definitely a more precise and all-encompassing method. I think it would be interesting to help facilitate a study utilizing this method in the future!
I think that using a method such as a food frequency questionnaire could be a reliable indicator.
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