Evaluating the relationship between the 24-hour recall and food habits questionnaire methods for measuring dietary compliance

This study was conducted within a larger investigation conducted by Dr. Geoffrey Williams at the Genesse Hospital in Rochester New York. The purpose of Dr. Williams\u27s investigation was to evaluate the long-term effects and cost effectiveness of a brief intervention to facilitate self-management among a sample of adults with diabetes mellitus coming in for regular outpatient visits. As part of the investigation, Type I patients were called three times within a two week period to obtain a 24-hour dietary recall. This information was used to determine adherence. The Type II patients within the study were required to fill out a Healthy Survey of which, a Food Habits Questionnaire was included. The Healthy Survey was used in replacement of the 24-hour recall series in the Type JJ patients. Dr. Williams questioned whether or not his decision to choose the Food Habits Questionnaire over the 24-hour recall method was correct. This thesis study answered this question. Obtaining valid information from a large group of people has been a challenge for years. The 24-hour recall method of collecting dietary information is costly. The food habits questionnaire (FHQ) method of obtaining dietary information is less costly. However, it is unclear if the FHQ can replace the 24-hour recall method of collecting dietary information. The FHQ is a relatively inexpensive way to obtain dietary information. The question tested here was whether the information obtained on a FHQ was as accurate as a series of 24-hour recalls in measuring dietary adherence. A strong correlation was hypothesized to be found for dietary adherence for total caloric intake and percentage of calories from both fat and carbohydrates as measured by two methods, the 24-hour recall and the food habits questionnaire. The purpose of this study was to evaluate the validly of the food habits questionnaire in relation to the 24-hour dietary recall method of obtaining dietary information for adherence among the diabetic population in a large investigation being conducted by Dr. Geoffrey Williams. The standard methods of dietary assessment include the 24-hour recall, the food frequency questionnaire (FFQ), the food record and the food habits questionnaire (FHQ). The 24-hour recall method is a method of dietary assessment in which the individual is asked to remember everything eaten during the past 24-hours. The food frequency questionnaire is a method in which written questions related to how often foods are consumed is given to the participant. A food record is a written report of all foods and liquids consumed during a time period, usually three to seven days, and often includes information on time, place and situation of eating. The food habits questionnaire is similar to the FFQ only it questions how often one participates in positive steps toward a healthy diet. The population studied were Type II diabetic patients from Dr. Williams\u27 investigation. Sixty-five patients were asked to participate in the study, 50 agreed to participate. The patients were called three times within a two-week period for a 24-hour dietary recall. The phone calls were made between the months February and May of 1998. Each patient filled out a Healthy Survey of which the FHQ was included at one of his or her doctor visits. The FHQ information was gathered and analyzed. The recommendations made for each patient by a registered dietitian at the Diabetic Clinic were obtained from each patient\u27s medical records. The 24-hour recall for each patient was analyzed using ESHA Food Processor 7.01 Nutrition Software. The average of the three days was calculated for calories, percentage of calories from both fat and carbohydrate. The responses for the FHQ for each patient were obtained at the Diabetic Clinic. The average was calculated and adherence was determined based on a calculated range. The dietitian recommendations for each patient were obtained at the Diabetic Clinic through medical records. Adherence was calculated for each patient. For fat and carbohydrate consumption, a significant relationship was found between what the patient reported on the FHQ and what the patient was actually practicing. If the patient showed a strong adherence on the FHQ, then that same person also showed a strong adherence to what the dietitian recommended for fat and carbohydrate consumption and vice versa. The same was not true for caloric intake. Caloric intake could have been off due to patients under reporting portion size. This could have been because they were embarrassed to admit to the amount of food they consumed or they did not have a true understanding of portion size. The FHQ is a quicker, more economic and easier method for measuring dietary adherence than the 24-hour recall method and therefore would be preferred when evaluating fat and carbohydrate dietary adherence