Lab Exercise 7. Dietary Assessment Methods (144 points)

Transcription

1 Student name: April R. Dela Fuente Kasey Harding Lab Exercise 7 Dietary Assessment Methods (144 points) Introduction Assessment of dietary intake requires: 1) measurement of food intake, 2) conversion of food intake to nutrient intake, and 3) comparison of nutrient intakes with estimated requirements. During this lab, your food intake will be measured on three different days. During two of these days, you will complete a food record at home. These records need to be completed during the week prior to the lab. On the day of the lab, you will interview your lab partner using a 24-hour dietary recall. You will then convert the food intakes to nutrient intakes for each of the two days of study of your own intake and the 1 day of your lab partner s recall, using the ESHA Food Processor nutrient analysis software. Finally, you will need to answer a set of questions related to this information. For this lab exercise you will: Complete a two-day dietary record at home (prior to lab) Conduct a 24-hour dietary recall interview (during lab) Convert food intake to nutrient intake using a computerized database (start during lab and finish at home) and interpret the results Compare nutrient intake data obtained from two nutrient analysis programs [Note: This is a complicated lab. Please read through all of the assignments before starting. Before submitting your lab exercise, be sure to review the summary checklist at the end of this document, which lists all of the forms that must be submitted.] Bring to Lab: 1. Your completed 2-day food record (Part I of this handout) 2. You are encouraged to bring a laptop computer to remotely login to access the diet analysis software. This is compatible with both Macs and PCs, but not with tablets. 1

2 Student name: April R. Dela Fuente Kasey Harding Part I: Pre-Lab Assignment 2-Day Food Record (out-of-lab) See supplemental instructions and food record sheets posted in the Lab 7: Diet Assessment folder on SmartSite. Part II: 24-Hour Dietary Recall (in-lab) On the day of the lab, carry out a 24-hour dietary recall to measure your lab partner s dietary intake on the previous day. Be polite, friendly, reassuring and non-judgmental in your interactions with your lab partner! Use the Form 2 in the Appendix to record the information. You will submit this form with your lab exercise. You will need this information for Part V. The recall history is completed in four steps, as follows (4-passes): Pass 1 (Quick List) Ask about all foods consumed during the previous day, beginning with the first foods eaten in the morning and proceeding chronologically through the rest of the day (and night) for a complete 24-hour period. Pass 2 (Detailed Description): After obtaining the foregoing information for the entire day, then go back over the list of foods and ask for detailed descriptions of each of the foods and their preparation techniques. Pass 3 (Amounts and Models): Estimate the amounts consumed of each of the reported foods. Use the food models available in the lab or other measuring implements to assist with these estimates. (Later you will convert these amounts to metric units). Pass 4 (Review): Review the list with the respondent to check for accuracy. Remember to probe for any items that might have been forgotten (snacks, cups of coffee, alcoholic beverages, vitamin supplements, diet drinks, etc.). If any item seems incomplete, politely request more information (e.g., toppings on bread, sweeteners in drinks). Remind the respondent to mention all foods, no matter how small the portion (e.g. 1 spoonful of peanut butter, 1 oz. alcohol). Include all condiments, sauces, gravies, sweeteners, supplements, etc. Specify the method of preparation (i.e. fried, boiled, broiled, etc.) Prompt for omissions, but avoid suggesting answers (e.g., it is acceptable to ask "Did you add anything to your coffee?", but not, "Didn't you put any milk in your coffee?"). Finally, ask if the recorded intake is typical of the respondent s usual diet; and, if not, what is unusual. 2

3 Student name: Part III: Introduction to ESHA Food Processor (in lab) Note: Comprehensive instructions for accessing FoodPro, entering data, and printing reports can be found on SmartSite. There are a variety of different software programs available to convert food intake data to nutrient intake data. It is important to do this so that we may examine an individual s nutrient take and garner a greater understanding of their overall nutritional status. This is routinely done in clinical and research settings. In lab, your TA will demonstrate how to use the Food Processor program and you will enter the food intake data provided in this section of the lab report. Food Processor is available for remote access from any internet enabled computer. You can use your own computer or any campus computer lab computer. You will need to login using your Kerberos ID and password. Instructions are provided on SmartSite. Use the following info to answer the questions below: Mr. Robins is a 57 y/o male who is 5 9, weighs 198 lb, and rarely exercises. In the past he has received out-patient advice from his primary care physician to cut down on what he eats and to use less salt. He stated that he has found this difficult to do, is not entirely sure what that means, and has been trying to follow his doctor s advice. To help understand his diet, you conducted a 24-hour dietary recall and have started processing the information. It has been typed-up and you are ready to enter the information into Food Processor to start analyzing. NOTE: In order to save your results and not risk them being overwritten by other students, you need to give your record a unique name. When you input Mr. Robins name, add the last 4 digits of your student ID to his last name. For example, if your student ID ends in 1234, enter the patient s first name as Mr. and last name as Robins1234. Quantity Measurement Breakfast Cereal, Raisin Bran Crunch Milk, nonfat/skim w/add vit A & D Cheese, mozzarella, string, sticks Cup Cup Each Lunch Sandwich, chicken, bbq flavor, charbroiled Added mayonnaise Added lettuce, iceberg, fresh Added tomatoes, red, fresh Water Serving Packet Lettuce leaves Medium sized slices Bottle (16 oz approx.) Afternoon snack Potato chips, hickory bbq Banana, fresh, med, 7 to 7 7/8 long Diet Pepsi Bag (7 oz) Whole banana Ounces-fluid Dinner Frozen Digiorno Pizza, cheese, thin crust (baked) Beer, pale ale 2 2 Slices Bottles (~12 oz per bottle) 3

4 Student name: 1. Print out your 1 day report for Mr. Robins and use the information to complete the following questions. Print the following reports: 1) Personal 2) Diet 3) Single Nutrient (Select only sodium, open all meals and snacks for viewing) 4) Bar Graph (select all options) 5) Calories and Fats Pie Chart Attach Mr. Robin s report to the end of this lab. (10 points for complete set of Mr. Robins reports) 2. (i) What is Mr. Robins BMI? (ii) What is his BMI classification? (iii) Is he at increased risk for disease, based on his BMI classification? (3 points) BMI : BMI Classification : Overweight; pre-obese He has an increased risk of comorbidities associated with obesity. 3. According to the Food Processor Reports, fill in the estimated requirement for Mr. Robins and his actual reported intake yesterday for the selected nutrients below. (15 points) Estimated requirement Reported intake Percent of recommendation Energy (kcal) kcal kcal % Vitamin A (RAE) RAE RAE 51.41% Vitamin B12 (mcg) 2.40 mcg 4.10 mcg % Vitamin D (mcg) mcg 2.50 mcg 16.65% Sodium (mg) 1300 mg mg % 4. (i) What are the two most significant sources of sodium in Mr. Robins diet? (ii) How much sodium is in each of these foods? (iii) What proportion of his daily sodium intake comes from each of these two foods? (6 points) Food item pizza, thin crispy crust, cheese, bkd, f/frzn chips, potato, hickory bbq, wavy Sodium content (mg) Percent of daily total (%) mg 31.48% mg 28.40% 4

5 Student name: April R. Dela Fuente Kasey Harding 5. What percent of calories came from protein, fat, carbohydrates and alcohol in Mr. Robins diet? (4 points) Protein 15.2% Fat 33.5% Carbohydrate 45.0% Alcohol 6.3% 6. Based on these results, what recommendations might you make to Mr. Robins to control his sodium intake and lose weight? (5 points) Mr. Robins was % over his daily recommendation of sodium. To begin controlling his sodium intake and weight lost, Mr. Robins should decrease his sodium intake. I would recommend less prepackaged and frozen foods since most frozen and prepackaged foods are prepared with added sodium. When possible, he should prepare and cook meals at home so he can control the amount of sodium that is going into his food and meals. When eating out, he can request for low sodium meals or ask that no salt be added to his meal. In addition, it wouldn't hurt to continue to keep a record of what he eats throughout the day so he is aware of what he is eating and when he is eating in order to manage his weight loss regime. 7. (i) If you wanted to get a more representative picture of Mr. Robins usual diet, what might you do? (ii) Why? (2 points) Repeated food records and 24 hour recalls are often used as indicators of long-term "usual intake". Replicate days are usually required to estimate usual patterns. We would want multiple days of repeated 24-hr recalls. In addition to 24 hour recalls, we could possibly as Mr. Robins to do a food frequency questionnaire in hope that it is more representative of his usual diet. 5

6 Student name: Part IV: Calculate the Nutrients Consumed for 2 day Food Record & 24-hr Recall 1. Enter your two day food record into ESHA Food Processor. Print out the reports for each of the 2 days, (as in Part III, Question 1). Staple them together with your hand-written food records (Form 1). (20 points) 2. Enter the data from the 24-hour recall you performed on your lab partner into ESHA Food Processor and print out the reports, as above (you may wish to print out two copies and give them the 2nd copy) Staple them together with your hand-written 24-hour recall (Form 2). (10 points) 3. Use the results from your 2 day food record to complete the table on the following page. 6

7 Kasey Harding Student name: April R. Dela Fuente Nutrient values from 2 day food record (10 pts) Day1 Day of Week: Nutrient % DRI (% Rcmnd) 5/11/14 Energy (kcal) Protein (g) Fiber (g) Day 2 Day of Week: % DRI (% Rcmnd) 5/12/ kcal 74.73% kcal g % g 7.00 g 19.65% 5.50 g 15.44% 28.62% 49.32% Sodium (mg) mg % mg 25.39% Calcium (mg) mg % mg 17.42% Iron (mg) 60.76% 2.13 mg 11.84% mg 13.74% 67.56% 21.79% 0.23 mg 12.97% 0.17 mg 9.28% mg % mg 41.77% 2.49 mg 31.16% 0.92 mg 11.46% Vitamin A (RAE) RAE 62.36% RAE 15.37% Vitamin C (mg) mg 14.65% 4.92 mg 6.57% 2.14 mcg 14.27% 0.00 mcg 0.00% mg % 0.35 mg 2.34% 1.52 mcg 1.69% 1.52 mcg 1.69% 0.18 mg 16.28% 0.23 mg 20.57% Riboflavin (mg) % Niacin (mg) 1.53 mg 10.96% 6.76 mg 4.60 mg 91.95% 1.68 mg 37.17% 17.30% mcg 8.36% Magnesium (mg) Manganese (mg) Phosphorus (mg) Zinc (mg) Vitamin D (mcg) Vitamin E (mg) Vitamin K (mcg) Thiamin (mg) Pantothenic Acid (mg) mg 0.64 mg 58.49% 48.25% Folate (mcg) mcg Vitamin B6 (mg) 0.17 mg 13.09% 0.01 mg 1.07% Vitamin B12 (mcg) 1.48 mcg 61.64% 0.14 mcg 5.82% 7

8 Student name: April R. Dela Fuente Kasey Harding 4. Indicate whether you consumed any nutrients in amounts that were less than the DRI; and, if so, note the day(s) on which this occurred. This can be done by using a highlighter or by circling the information in the table above. List the nutrients below. (5 points) 5/11/14 : energy, fiber, iron, magnesium, manganese, zinc, vitamin A, vitamin D, vitamin C, vitamin E, vitamin K, vitamin B1, vitamin B3, pantothenic acid, folate, vitamin B6, vitamin B12 5/12/14 : energy, protein, fiber, sodium, calcium, iron, magnesium, manganese, phosphorus, zinc, vitamin A, vitamin C, vitamin D, vitamin E, vitamin K, thiamin, riboflavin, niacin, pantothenic acid, folate, vitamin B6, vitamin B (i) Were the same nutrients problematic on both days? (ii) Were there any other nutrients that might raise concern (i.e. were consumed in very high quantities)? (iii) Which ones? (3 points) There were some nutrients that were problematic on both days. This include everything except protein, sodium, calcium, phosphorus, and riboflavin. On the first day, sodium was consumed at % and calcium at %. Phosphorus and riboflavin were also consumed over 100%. Although they were consumed over 100%, they were not consumed at drastically high quantities. No nutrients were consumed at high amounts on 5/12/ Discuss two or three reasons why nutrients might not be consumed in similar amounts every day. (2 points) 1. On the weekend, there is more time to prepare food or go out for food. On the weekdays there is less time to prepare food when one has a busy schedule. Varied eating patterns on different days of week or on holidays. 2. difference in food availability from one day to the next 3. different choice in foods from day to day (not eating the same foods each day) 7. Reflect on your experience in collecting a 2 day food record. (i) What was challenging? (ii) Was there anything that you did to help you remember to record the foods? (iii) Did you eat anything differently because you knew you had to write it down? (Be honest!) (iv) Did you have any more or less enthusiasm on the 2nd day compared to the 1st day? (5 points) Something I found challenging was trying to determine the portions of what I was eating. Before this assignment, I just poured coffee into my mug and added creamer until it was the way I liked it. Before this assignment, I didn't know how many cups my coffee mug was. I kept my food record in my school planner so I would always have it with me. I ended up eating differently because I did not want to write it down. Such as ice cream. I didn't have ice cream for dessert because I did not want to see all the calories that would come from it. I neither had more or less enthusiasm on the 2nd day compared to the 1st just because I got busy with classes and work and had little time to care and compare. 8. (i) How did you quantify portion size at home and when out? (ii) What was that experience like? (iii) How accurate do you think you were? (3 points) For the 2 day food record, I did not eat out. When at home, I used measuring cups and slices to quantify my portion sizes. To be honest, it was irritating to have to quantify my portion sizes. For example in the mornings, I did not want to take the time to measure my coffee and my creamer. I just wanted my coffee to start the day. And counting calories that early in the morning did not put me in a good mood. When it came to measuring portion sizes at home, I was only as accurate as the measuring cups I was using. But I'd like to say I was pretty accurate when measuring my foodsa nd beverages. I even used tablespoons for my peanut butter and jelly. 8

9 Student name: April R. Dela Fuente Kasey Harding Part V: Experiences with food records, recall and use of nutrient analysis software (Total points: 19) 1. What are some reasons that respondents (patients, community members, research subjects) might take greater care in maintaining a food record or to maintain a food record for longer? List at least 2 reasons. 1. looking at risks of deficiencies 2. to look at calorie intake for weight management or weight control or if trying to gain or lose weight 2. What are some reasons that respondents (patients, community members, research subjects) might not maintain a food record carefully or would not be willing to maintain a food record over many days? List at least 2 reasons 1. it may be a tedious task to respondents 2. poor awareness of foods and portion size leading them to no longer be willing to maintain a food record 3. remembering it all can be challenging 3. Reflect on the experience of conducting the 24-hour recall. (i) Was it easy to avoid asking leading questions? (ii) Do you think that there was anything you could do to make it easier to help your lab partner provide more accurate information? Think outside of the box compared to what we did in lab. (i.) After seeing a sample 24-hour recall, it made me super aware of leading questions and after that I was afraid to accidentally ask leading questions in fear that the other person would feel judged. So I chose my words carefully. If I have been doing this for years, I think I would get used to it and better. (ii.) It was helpful to ask about the activities my partner did throughout the day and what they may have eaten before or after that activity or during. Like my partner realized he was having a snack on his way home from work. I suggested what I liked eating with certain foods and my partner remembered he had soda with his meal. So that at least helped my partner remember other foods and drinks he may have had. 4. Reflect on entering food intake data into the ESHA Food Processor. (i) How easy was it to find the appropriate foods? (ii) Did you think that the data from your own 2 day record was accurate? To be honest, it was quite difficult. I wanted to be as accurate as possible but even a program can only have so much of a selection. What was nerve racking was when I actually knew the brands of certain food products that I had and yet they weren't on Food Processor. I thought things would be easier if I knew the brand, and yet I couldn't be accurate since Food Processor didn't have my food products. For the most part, I just ended up choosing the food product with the brand of "USDA". (ii.) The data I wrote into my 2 day food record was as accurate as I could have made it. I actually tried for this food record. But once I have to put it into Food Processor, I believe there was a decrease in accuracy. 9

10 Student name: April R. Dela Fuente Kasey Harding 5. Compare your experiences collecting your own data by the 2-day food record and collecting your partner s data by the 24-hour recall interview. (i) Which method do you think was more accurate? (ii) Explain. (i.) Although I feel the 2-day food record is easier to do, the 24-hour recall interview may have been a little more accurate. (ii.) The interviewer can as questions that can probe and possibly get their partner to remember foods and beverages they may have forgotten. In addition, doing an interview can get a lot more detail about portion sizes and how a food was prepared if the interviewer asks the proper questions. But cons of both the 2-day food record and the 24-hour recall interview is that a person can still forget or not mention certain foods or mention certain foods that didn't actually eat. 6. Based on your experience with using Food Processor, is there anything you would have done differently during the 24 hour recall interview to make it easier to use the software? I think I would have had the Food Processor open and would have been entering data as I was doing the 24 hour recall just in case I needed to ask more specific questions about the meal or food portions in hope to get more accurate data into Food Processor. Part VI. ChooseMyPlate.gov SuperTracker vs. Food Processor Many people do not have access to nutrient analysis software like the ESHA Food Processor, but there are a number of programs available for free or at minimal cost that allow an individual to estimate their nutrient intake. One program that is available free online is through the Choose My Plate website, maintained by the USDA. The SuperTracker program allows anyone to input foods and evaluate their nutrients consumed. Go to Look back at the meal that Mr. Robins consumed for lunch (on page 3). Use both The USDA SuperTracker program and the EHSA Food Processor program to compare the nutrient intakes estimates for this meal. 1. Record the full description of the foods you selected including portion size: (4 points) SuperTracker Sandwich, chicken, bbq flavor, charbroiled with added mayonnaise, lettuce and tomatoes. Water Food Processor chicken BBQ sandwich (Carl's Junior) sandwich, chicken, bbq, charbroiled Carl's 2 sandwich ; mayonnaise, regular, 1 Junior 1 each; dressing, mayonnaise 1 pack; lettuce, iceberg, raw 2 leaf(s); individual packet ; lettuce, iceberg, fresh, tomato, red, from fresh 2 slice(s); leaf 2 medium; tomatoes, red, fresh, year water round avg, sliced, 2 thick slice bottled, unsweetened 2 (8 fl.oz) water, bottled, 1 bottle 10

11 Student name: 2. Within the Food Tracker program, click on Nutrient Intake Report (Found on the right side of the screen in small font, under the Daily Food Group Bar Chart). This will show you the nutrient intake for the lunch meal under the Average Eaten category. Compare this to the results you obtain from the ESHA Food Processor. Fill out the table below for the selected nutrients. (12 points) Estimated nutrient intake values, as obtained from the SuperTracker or the ESHA Food Processor program SuperTracker ESHA Food Processor Calories (kcal) 470 kcal kcal Protein (g) 22 g g Dietary fiber (g) 2g 4.83 g Iron (mg) 3 mg 0.23 mg Vitamin C (mg) 7 mg 7.85 mg Calcium (mg) 180 mg mg 3. Are the results provided by each database the same? (1 pt) The results are close, but no, the results provided by each database is not the same. 4. If not, state why these results may be different. Give at least 2 reasons. (2 pts) 1. Food Processor is for professionals and costs $699 while SuperTracker is for the public and is free of charge. 2. Food processor has more foods (>35,000) and SuperTracker has less (~7,000) 3. Food Processor's company is a research company (ESHA Research) and SuperTracker's company is USDA Center for Nutrition Policy 5. Which database provides more complete information on nutrient intake? (1 point) Food Processor. 11

12 Student name: Checklist before turning in lab The following forms should be submitted for this lab. Be sure to write your name at the top of each packet and clip everything together with a large paper clip or metal clip. Please place each item in the order listed below. (2 pts for turning in all parts, in this order) 1) Completed lab handout 2) Computer printout of Mr. Robins 24-hour recall 3) Hand-written dietary record data form for each of the 2 days of your self-administered dietary record. Computer analysis (Total) for each of the 2 days of your self-administered dietary record that you analyzed. Staple the computer printouts to the back of the hand-written record form. 4) Hand-written 24-hour dietary recall data form of your partner s intake and computer analysis (Total) of the recall data 12

13 Student name: FORM 2: 24-HOUR DIETARY RECALL Name of respondent: Date of interview: Day of week: Respondent s age: Gender: M / F Time Meal (Breakfast, lunch, dinner, snack) Height: Weight: Physical activity level: Place eaten Description of food or beverage Brand name Amount Consumed 13

14 Student name: FORM 2: 24-HOUR DIETARY RECALL 1. How does the amount of food you consumed yesterday compare with what you usually consume for that day of the week? more than usual usual 2. Do you take nutrient supplements? less than usual Yes don t know No If yes, then how long have you taken them: months, years Type (ex. Multivitamin or single nutrient such as iron, selenium, etc.) How many per day or wk Brand Strength (mg, IU, etc) 14