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Article Excerpt
Abstract
Aim: Our primary objective was to determine the effect of follow-up phone calls on estimated nutrient intakes obtained by three-day food diaries from 13-year-old adolescents.
Methods: Food diaries were recorded using household measures and entered into a dietary analysis software program, before and after follow up by telephone. A sample of 340 participants aged 13 years born into the Western Australian Pregnancy Cohort (Raine) Study, a population-based longitudinal cohort followed from 16 to 20 weeks' gestation to 13 years of age (current follow up). After face-to-face instruction, participants completed three-day food diaries at home and returned them by post. Follow-up telephone calls were made to each participant to improve data collection response and to verify missing details in the food diaries. Nutrient intakes before and after telephone follow up were compared using Student's t-tests in SPSS. Results were also compared with those of the Child and Adolescent Physical Activity and Nutrition survey.
Results: Follow-up phone calls significantly increased the estimated intake of total kilojoules, water, total carbohydrates, sugars and magnesium (P < 0.05).
Conclusion: These results indicate the importance of follow-up phone calls to obtain missing details in three-day food diaries completed by adolescents.
Key words: adolescent nutrition, diet record, food diary, nutrition assessment.
INTRODUCTION
There is growing interest in lifestyle habits of children and adolescents because of the association of these habits with adult health outcomes, such as obesity, cardiovascular disease, some cancers (1) and psychosocial health outcomes. (2,3) Accurate assessment of dietary intake in childhood and adolescence (4,5) is required to monitor the observance of dietary recommendations and to better understand dietary factors that may be predictive of adult health outcomes. (6) Food frequency questionnaires (FFQs), food diaries (FDs), weighed food records (WFRs) and 24-hour recalls are commonly used for dietary assessment in adults, although in children and adolescents, measurement of dietary intake is especially difficult and prone to error. (6,7) FFQs ask usual frequency of consumption of a list of foods within a defined period. Portion size may be quantified or not. FDs involve participants using household measurements to record food intake over a defined period, whereas WFRs require participants to weigh and record food served and any waste. Twenty-four-hour recalls require a trained interviewer to elicit detailed information regarding the participant's food intake over the previous 24 hours. (8)
For younger children, time may be difficult to conceptualise, and children and adolescents are often unsure of how their foods are prepared, and they have a limited capacity to appraise portion sizes. (5,6) Dietary assessment in children may be confounded by reliance on parents/primary caregivers to report their child's intake. (9) Parents may not be able to accurately report dietary intake of their children due to increasing independence with age and the number of meals consumed away from home. (6) In addition, child and parental recollection may be influenced by memory failure, motivation to accurately report food intake, and level of nutrition knowledge. (10)
Measurement of dietary intake is difficult, and no single method has proved wholly successful. WFRs are considered by some to be the gold standard of dietary intake assessment. (11) However, WFRs still have limitations; they are associated with a high participant burden and financial cost, limitations of the database used for analysis, operator interpretation of food descriptions, and operator error in data entry. In the present study, operator interpretation was of limited variability as a single operator was utilised. Studies have shown a lack of agreement between FD and FFQ methods of assessing usual dietary intake. (12) In children, FFQs may overestimate total energy intake by as much as 50%, compared with the doubly labelled water (DLW) method. (13) On the other hand, FDs may underestimate total energy intake by 19% in non-obese adolescents and 41% in obese adolescents compared with total energy expenditure estimated by DLW. (6,14)
When FDs are administered, the ideal scenario is for the participant to complete the instrument and for a trained interviewer to probe and clarify details face-to-face. (15) However, this is not always practical in large, multidimensional studies with many assessments and high respondent burden. The purpose of the present study was to test the hypothesis that follow-up phone calls would increase completeness of data collection and, hence, contribute a better estimation of the nutrient intake of 13-year-olds.
METHODS
Participants
The Western Australian Pregnancy Cohort...
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