*All of the details on this page are available as a Word document or PDF file.

Food Frequency Questionnaires
Description
A Food Frequency Questionnaire (FFQ) is a limited checklist of foods and beverages
with a frequency response section for subjects to report how often each items was
consumed over a specified periods of time.  Semi-quantitative FFQ collect portion size
information as standardized portions or as a choice of portion sizes.  Portion size

Food Records
Description
A food record is a detailed description of the types and amounts of food, beverage and/or
supplements documented over a prescribed period, usually 3 to 7 days.  Food records are
also known as “Food Diaries” because of the specially designed booklets that subjects
use to enter the details of the food and beverages that they consume.  Information on food
preparation, recipes, brand names and amounts consumed included specific portion sizes
is included.  In addition, the name of the meal, the time of day and exact location may be
required depending upon the nature of the study.
Subjects may be asked to weigh and measure foods and should be trained to record intake
to the level of detail needed to describe the diet and nutrients in question.  At the end of the
recording period, a trained interviewer meets with the respondent to clarify food details and
to review the foods and portions documented.
Pros (Strengths)
Open ended design
Easy to quantify amounts
Does not rely upon the subjects memory if used correctly
Practical method to obtain information about the use of specific foods and frequency
Optimal method for validating food frequency questionnaires and diet histories
The act of recording dietary intake may alter eating behavior which is useful in
dietary intervention programs and as a teaching tool  (however, this is considerably
a disadvantage in measuring “usual intake”)
Cons (Weaknesses)
Substantial burden upon the subject
Very expensive to code and analyze due to the cost of skilled personnel,
computer hardware and software
Requires literate and motivated individuals so has limited use in many populations
Less effective in measuring “usual intake” due to heightened awareness,
may alter behavior
Significant decrease in the subjects recording intake as the number of
reporting days increase
Validation studies indicate usual intake may be seriously underestimated,
e.g., underreporting thought to be common in women and obese individuals.
Examples of Food Records
Weighted Food Record:  The subject weighs all food and beverages on a small
household scale then records the amount eaten.  (Leftover food is subtracted from
the original food weight to document the exact amount consumed.)
Estimated Food Record:  This is the most common example of food records used in
research.  Study participants estimates the amount consumed by using commond
household measures (e.g., spoons, cups, glasses, plates) or by using portion size
estimation aides (e.g., three dimensional food models)
Food Record Citations
Craig MR, Kristal AR, Cheney CL, Shattuck AL: The prevalence and impact
of 'atypical' days in 4-day food records. J Am Diet Assoc 100: 421-427, 2000.
Freudenheim JL, Johnson NE, Wardrop RL: Misclassification of nutrient intake of
individuals and groups using one-, two-, three-, and seven-day food records.
Am J Epidemiol 126: 703-713, 1987.
Kristal AR, Feng Z, Coates RJ, Oberman A, George V: Associations of race/ethnicity,
education, and dietary intervention with the validity and reliability of a food frequency
questionnaire: The Women's Health Trial Feasibility Study in Minority Populations.
Am J Epidemiol 146: 856-869, 1997. Erratum in: Am J Epidemiol 148: 820, 1998.
Millen BE, Quatromoni PA, Franz MM, Epstein BE, Cupples LA, Copenhafer DL:
Population nutrient intake approaches dietary recommendations: 1991 to 1995
Framingham Nutrition Studies. J Am Diet Assoc 97: 742-749, 1997.
Reeves RS, McPherson RS, Nichaman MZ, Harrist RB, Foreyt JP, Goodrick GK:
Nutrient intake of obese female binge eaters. J Am Diet Assoc 101:209-215, 2001.
Wilson AM, Lewis RD: Disagreement of energy and macronutrient intakes estimated
from a food frequency questionnaire and 3-day diet record in girls 4 to 9 years of age.
J Am Diet Assoc 104:373-378, 2004.
Food Record Websites
Lafene Health Center of Kansas State University includes a sample food record with
instructions.  To view, go to: http://www.k-state.edu/lafene/foodrecordsample.htm
Dennis Gage, M.D., F.A.C.P. discusses the importance of recording food intake in
his book “The Thinderella Syndrome:  A Practical Guide to Individualized Permanent
Weight Loss.”  His website includes a sample food record:
http://www.thethinderellasyndrome.com/food_record_the_thinderella_syndrome.html
The University of Texas at Austin Health Promotion and Education Services provides
their students with services to keep them healthy.  Included on their web site is
information on Computerized Dietary Analysis which includes a food record
form and instructions.  To view the PDF file, visit:
http://www.utexas.edu/student/health/pdfs/dailyfoodrecordform.pdf

Dietary Recalls
Description
The twenty-four hour dietary recall is the most widely used diet assessment method.  As
the name implies, the subject is asked to report all of the food, beverages and/or supplements
that he has consumed for the past 24 hours or the previous day.  Usually, the recall is conducted
by personal interview and can be completed by using a computer or by recording the intake on
paper.  The interview may be face-to-face or occur via telephone.
The interviewer must be very well-trained as they are crucial in collecting accurate information
through the use of probing questions.  The ideal interviewer is a registered dietitian; although,
non-nutritionists who have been trained in the use of a standardized instrument can be very
effective.  Interviewers should be very knowledgeable about foods available in the marketplace,
how foods are prepared and know about regional or ethnic food habits.
The interview is very structured with specific probes to help the respondent remember all of the
foods eaten.  Probing is useful in collecting details on how foods were prepared.  It is also useful
in recovering foods that are forgotten (e.g., butter on toast) or in retrieving eating occasions not
originally reported by the subject such as snacks or coffee breaks.
Pros (Strengths)
Least amount of burden to the participant
No literacy requirements of the participants
Does not alter the food intake behavior
Relatively rapid method of data collection; usually 30 minutes for
a trained interviewer to complete a 24-hour recall
Provides estimates of the average intake of large samples sizes that are
comparable to other methods such as food records
Cons (Weaknesses)
Very expensive because it requires trained and skilled interviewers
Estimation of portion sizes may be very difficult; precision may be improved
through the use of food models and photographs
There may be a “reporting effect” because individuals may wish to “please” the
interviewer by overestimating perceived “healthy” foods and underreporting alcohol,
high calorie and high fat foods.
Detail about intake relies upon the respondent’s memory
Examples of Dietary Recalls
Three-pass recall method:   The interviewer employs three distinct probing sessions
(or “passes”) during the interview.  The first pass obtains a list of foods, the second
pass adds detailed descriptions, and the third pass was reviews for missing items.
Automated Multiple-Pass Method (AMPM):  The AMPM is a computerized dietary
intake instrument that offers a guided interview of five distinct research-based steps.
It is designed to elicit accurate food recall descriptions and the amount consumed by
respondents.  The method includes standardized questions and possible response
options for foods in the U.S.; each response option is programmed to proceed to
subsequent appropriate questions.  The AMPM is used for collecting dietary recalls
of 5,000 Americans yearly in a national federal nutrition survey, What We Eat in America,
NHANES.  Data from the survey is used to assess the nutritional health of Americans
and is the basis of Federal nutrition policy and regulatory decisions.
Five-step Multiple Pass Approach:  The Obesity Nutrition Research Center (ONRC) of
the University of Pittsburgh routinely uses this type of food recall.  The interviewer is
thoroughly trained to use an interactive, computerized software program, the “Nutrition
Data System for Research” (NDSR), developed by the University of Minnesota Nutrition
Coordinating Center.  Steps for this example of recall include:  1) Use of a “Quick List”
where individuals are asked to briefly outline foods consumed. 2)  Review of the quick list,
where an interviewer uses memory prompts to help individuals recall forgotten foods.
3) Recall of time and occasion of food consumption. 4) Food details: individuals are
asked to describe foods and beverages by brand name, ingredients and preparation,
portion size, and quantity eaten. 5) Final review of the list to make sure that nothing
was omitted.
Dietary Recall Citations
Bialostosky K, Wright JD, Kennedy-Stephenson J, McDowell M, Johnson CL:
Dietary intake of macronutrients, micronutrients, and other dietary constituents:
United States 1988-94.  Vital Health Stat 11(245): 1-158, Jul. 2002.
Block G, Wakimoto P, Metz D, Fujii ML, Feldman N, Mandel R, Sutherland B:
A randomized trial of the Little by Little CD-ROM: demonstrated effectiveness in
increasing fruit and vegetable intake in a low-income population.
Prev Chronic Dis 1: A08, 2004. Epub 2004 Jun 15.
Conway JM, Ingwersen LA, Moshfegh AJ:  Accuracy of dietary recall using the
USDA five-step multiple-pass method in men: an observational validation study.
J Am Diet Assoc 104: 595-603, 2004.
Schatzkin A, Kipnis V, Carroll RJ, Midthune D, Subar AF, Bingham S,
Schoeller DA, Troiano RP, Freedman LS:  A comparison of a food frequency
questionnaire with a 24-hour recall for use in an epidemiological cohort study:
results from the biomarker-based Observing Protein and Energy Nutrition (OPEN) study.
Int J Epidemiol 32: 1054-1062, 2003.
Shai I, Rosner BA, Shahar DR, Vardi H, Azrad AB, Kanfi A, Schwarzfuchs D, Fraser D:
DEARR study. Dietary evaluation and attenuation of relative risk: multiple comparisons
between blood and urinary biomarkers, food frequency, and 24-hour recall questionnaires:
the DEARR study.  J Nutr 135: 573-579, 2005.
Dietary Recall Websites
The University of Tennessee Family and Consumer Sciences Expanded Food and
Nutrition Education Program has instructions posted to their website for completing the
Homemaker’s 24-Hour Food Recall Form. http://fcs.tennessee.edu/efnep/recallinstruc.htm
A videotape on the 24-Hour Recall is available from the Oklahoma Cooperative Extension
Service, Oklahoma State University for $35.  For more information, go to:
http://www.fcs.okstate.edu/cnep/tools/food-recall.htm
The Virginia Polytechnic Institute and State University digital library and archives allows
unrestricted access to a theses which includes detailed descriptions on the procedure.
http://scholar.lib.vt.edu/theses/available/etd-101097-6128/unrestricted/AppendixH.pdf
An excellent source for detailed twenty-four hour recall information is
the United States Department of Agriculture (USDA).
http://www.csrees.usda.gov/nea/food/efnep/ers/documentation/24hour-recall.pdf
 
 

Core-C MainLinksOnline ReviewsWorkshopsConsultation