Nutritional Disorders Telehealth Network Project

Tracking of dietary intake can offer additional nutrition details to the providers in their treatment of nutrition disorders.

 

Typically, families that are asked to complete food records are asked for three to seven days of data. Generally, families are provided with tracking forms which they are asked to complete after each meal or snack their child eats. Studies have demonstrated that verbal recall of range of foods and volumes consumed beyond 24 hours is unreliable. Thus, the quickest and least intensive assessment of dietary intake is a guided 24 hour food recall. However, families of children who are underweight may over-report intake and report dietary practices that are consistent with the overall dietary recommendations for good health. Diet journals (daily written food records) have been shown to be more reliable but unfortunately are also subject to the halo effect (families biasing their report in a direction they believe the provider wants). Therefore, providers are advised to interpret all such materials cautiously. Families that complete tracking each day are the most likely to provide accurate data, and research has shown that daily tracking of food intake, and dietary practices are beneficial to help achieve goals and may be considered an intervention in and of itself. 

 

Food records can be used for the purpose of obtaining additional detail of typical intake or assist the patient and family in making nutritional modifications to current intake. Families should be given a copy of the food record and provided with an example of how the form should be completed. It is advisable to read the instructions aloud as this will likely cue the family to ask any questions that they might have and to overcome any confusion that the family may have related to the tracking task. Families are strongly encouraged to complete the form immediately after each meal and with as much detail as possible to enhance the reliability of the report. After a family has been asked to complete diet records, they should return shortly after completing the prescribed duration of tracking. At this return visit, it is best to review the diet records with the patient as this will help to reduce any errors due to poor documentation and enhance the provider’s ability to extract accurate information from the family by way of oral interview.

 

In underweight children, clinicians completing an analysis of food records commonly find: snacking/grazing throughout the day, lack of structured meal and snack times, excess juice intake (>8 ounces/day), excess intake of refined carbohydrate snacks (e.g. crackers, chips, sweets), small volumes with meals, limited food variety or disproportionate balance across food groups.