Week 6: Lecture 28: Food Records, Diet Diaries and the Duplicate‑portion method

Hello and welcome dear learners to the NPTEL course on nutritional epidemiology or wait towards a healthy life. For the module three, dietary assessment, nutritional status and measure measurement error for the chapter 28, we'll be taking discussion on food records, diet diaries and duplicate proportion method. So, we will understand the way versus estimated food records, advantages of food records, disadvantages of food records, duplicate portion method, digital tools and mobile apps. We'll also have discussion on different case studies with respect to this topic. So, in introduction to the food records and diet diaries, a prospective dietary assessment, we will understand what are food records in detail. So, what are food records and diet diaries? So, actually it is an accurately recording of dishes with a mixed date. It is about fresh veggies, fruits at time of eating. It is accurately a record of a real time and of more difference prospectively, which is a mixed data and at the time of eating. The characteristics are prospective method, no memory reliance, no guessing. Records actual consumption where real time recording is important over here for the diet diaries. And a quantitative assessment, which is giving an estimate with respect to numerical labels and duration from 3 to 7 days. The food records are widely used and make a sort of an benefits or utility to the nutrition epidemiology, clinical nutrition and public health. It gives more reasons for the population surveillance data, health lean interventions and diverse research element. The types of food records that we take is with respect to the weighing estimation that is done with the common household measures and digital food diaries which are nowadays very much popular. Duplicate portion records where you may have a duplicate portion records with respect to the analysis actually, we can take it. The principles of the food record is like the type of food with respect to the ingredients, preparation methods, time and location. Where uh precisely you can say one bowl or spices, veggies, or you can say steaming method with frying, with oil, without oil, timing with respect to the home in context to the different diverse modern homes which are being stated. Quantity, you can state about 200 estimated spices, veggies listed, or complex chewing and specific for non-home settings. So, food records and diet diaries find a major place in nutrition epidemiology. Weighing versus estimated food records. So, estimation is something like you assume and weighing is where you get an actual. So, weighing food records is like the participants weighs every food and beverage food before consumption using a calibrated scale. Which is being stated over here. So, you may find that the weighing raw ingredient, recording the cooked ingredient, and recording the leftover. So, whatever is before the food preparation, whatever we eat is to be eaten, and whatever which is not or leftover. So, what is the calculation? Like cooked weight is like 350 g, leftover is 50 g, so consumption is 350 minus 50, that is 300 g. So, what is the actual intake? It is the 300 g. This is for example for the rice. So, rice you may see the actual consumed over here, for example over here is coming 200 g. Dal, it is coming 130 g. So, the procedure is like weighing the raw ingredients, record cooked weighing, be it is like steaming uh with a pressure cooker and all that, recording the leftovers, and calculating the actual intake. So, the whole procedure is coming with four parameters. What is the advantages of food record? Like gold standard among self-reported methods where the individual as in subjectively is recording everything. Highly accurate in terms of portion sizes, better nutrient estimation, and reduced measurement errors, which is a golden standard way. The limitation is like time-consuming, very expensive in terms of taking all the resources. Participants get fatigue to do all this exercise, and not suitable for large survey because of number of participants getting increased. Weighing versus estimated food records where you can take the participant estimate the portion size without weighing foods. So, household measures may be used to take in terms of understanding the weighing of cup, bowl, spoon, tumbler, or to estimate the proportion. Standardized serving foods where you can divide and you can compare the comparing the food with the standard serving size references. Which is usually done in hotels. The food photographs which is used to show the different portion sizes. Portion in terms of the size in booklets where you can refer with thumb as one or even all five fingers of the palm as five refers to the portion size booklets for visual guidance. Measuring cups and spoons using measuring cups and spoons for liquid and small portion. So, you can see examples of estimated food record like rice it is one bowl or one katori or sambar it is for one ladle. Or milk it is one cup or one glass. Similar and more practical than the weighing records. Relies on participants ability to estimate accurately where estimation is something which is on the memory. Less accurate than the weighing record because it is suitable for larger studies. Provides useful information on dietary intake in real life settings which is important for Indian studies. You can have the comparison weighing food record versus estimate. The measurement over here is weighed on a precise kitchen scale before eating. Leftovers are also weighed and subtracted which give you exact measurement. In estimate food records portions are estimated using household measures and visual aids. So, you can understand the comparison of getting what are the challenges and the constraints to come ahead with this. Equipments [snorts] on the weighing food record is requires a digital kitchen scale and here it requires top spoons and visual estimation. Accuracy in weighing food record is highly considered the gold standard. Here it is moderate because it relies on the subject's spatial awareness and estimation accuracy. Participant's burden very high. High requires significant time, motivation, equipment. It is moderate to high because uh easier to sustain over multiple days but still requires constant attention. Here the setting for weighing food record is like best for highly motivated cohorts or clinical metabolic studies. Difficult to use in large surveys which is impossible. On estimated food records, better suited for free-living population and general clinical practice suitable to use in large surveys. What is the correlation with the gold standard? For the weighing food record, it is reference method for validation. Whereas for the estimated food record, the nutrient values closely associated with the weighing records. What are the advantages of food records? Food records are often considered among the most accurate self-report dietary assessment method. The reason is it reduces the recall biases because recording happens concurrently with the consumption. Participant do not need to remember what they ate yesterday or over the past month. The result is less memory dependence. Fewer forgotten food and better reporting of snacks. Accurate portion size estimation, especially in the weight records where it gets a direct measurement. Reduces the portion of the size errors and better nutrient calculation which is done with the weighing. The detailed dietary information as you can see, the food records provides information on meal timing. To remember about what it is being done previously. Eating frequencies, food combinations, cooking methods, and contextual eating behaviors. Emotional eating triggers. Also, it captures day-to-day variation. Usually, you may have something as a variation in summers, monsoon, winter, festival, or also on days. Like on Mondays, you may eat differently. On Thursdays, you may have a different and Sunday, all together it is different. So, a temporal distribution of macronutrients. Useful for validation studies. Food records are frequently used to validate FFQs, 24-hour recall, dietary screeners, and mobile dietary assessment tools. What are the advantages of food record? Disadvantages of food records comes with despite their strength, food records have important limitations. High respondent burden. So, it is like that the participant must be highly motivated, willing to carry a record materials everywhere. Participant must record each and every item consumed and major proportions, record recipes, record snacks, beverages, and all those things. It's a very high posing burden. It may also sometimes lead to incomplete record, missing meals, and dropouts. Reactivity with respect to the behavior modification comes as a second advant- disadvantage. Where the participants may alter their eating habit because they know they are being observed. Observation is something which gives lot of constraints. This is called as reactivity effect. The reactivity effect examples eating healthier foods, avoiding snacks, reducing sugar intake, and reducing alcohol consumption. So, you may say a behavioral modification is also being taken as a major disadvantage of food records. Literacy requirement for adults, children, rural communities, it becomes a great challenge. Food records requires reading and writing ability of numerical skills. Then comes cost and logistic. As it is a personal cost and the study duration is high, the researcher must train the participant, check records, enter data, and analyze the recipes. So, all this is more like a very logistic and cost-driven activity. Then comes underreporting, which is very common because frequently what happens people do underreporting of sweeteners, food fried food, alcohol, age, snacks. So, a lot of underreporting of energy intake consistent across the self-report, and energy intake was underestimated by 11 to 41% of the all total food records. Commonly seen among individuals who are adolescents, obese, and women in uh some cultural contexts. The social desirability is also being seen as a major disadvantage, where the participants may consciously omit reporting of bad foods, alcohol, sweets. These are all bad foods. And exaggerate to state that they are taking more good foods, like veggies, fruits. They avoid the judgment from the researchers or the clinician, which is also being seen as a major disadvantage. Now, we'll talk about duplicate portion methods. Original portion and a duplicate portion. So, in original portion and duplicate portion, what is the difference? The duplicate portion methods involve collecting an identical duplicate of every food and beverage consumed by a participant during a specific period. The duplicate portion is then chemically analyzed in a laboratory. What is the process? Step one, the participant eats a normal meal, like two chapatis, one bowl of dal, one bowl of vegetable curry for an Indian in a specific study design for one day. Duplicate portion collected an identical second serving is stored separately. Record details, food items, time, place, and portion size. So, there is a sort of a duplication record going on. Step three, the sample preservation. The identical second portion undergoes refrigeration, freezing, and it is being transported to the laboratory. It is maintained in a cold chain of 0 to 4° per Celsius for frozen. Laboratory analysis, analysis of nutrients and contamination. What is the method giving us? Unlike the recalls and food records, here there is no reliance on nutrient databases. Direct chemical measurement and objective assessment done. So, these are the very three important thing which are coming as an objective assessment to be seen in duplicate portion methods. Duplicate portion methods are giving a detailed laboratory analysis, sample preparation, analytical sample techniques, and it is it is coming like something you are weighing the edible proportion, a measuring the volumes, measuring the linear dimensions, and record of all those, which is an exact accurate measurement being done. It takes a larger symmetrical items to cut and quadrants and take in terms of the proportion. Homogenized and mechanically for inorganic analysis to take a larger analytical portion for ashing and wet digestion. So, a lot of analytical sampling techniques are being stated where laboratory energy proportion of fats in terms of proteins, fats, carbohydrates, sodium, iron, zinc, vitamin, selenium and the contaminants are measured before with respect to energy and whole lot of things. Application is more in nutrient intake studies. Particularly for sodium association with cardiovascular disease, trace minerals for some addictive studies, micronutrients. And also environmental exposure studies for pesticides, heavy metals, food contaminants. Validation studies like FFQs, food records, and biomarkers is an advantage in terms of comparison. Advantages is more being seen like high accuracy, direct chemical analysis, objective assessment, and useful for contaminant research. Limitation is extremely extremely expensive, sample collection, transport, laboratory analysis, lot of logistics, high participant burden where the participant must duplicate every meal and so a lot of measurement is being done. Difficulty in large population mostly limited to very small studies. Digital tool and mobile apps. Digital tool and mobile apps are being used and the technology is transforming dietary assessment. The digital food diaries, image-based dietary assessment, artificial intelligence and wearable technologies. These are being seen as something which are giving a boom for making a dietary digital tool as something as very advantageous. The participant record food using smartphones, tablets, and web-based platform. Image-based dietary assessment where the participants photograph meals before and after are taken. >> [snorts] >> Artificial intelligence is scanning, recognizing food from images, estimate portion sizes, calculate nutrient intakes, reduce the coding workload. Wearable technologies are being stated like many people are using smartwatches. Eating detection sensors and continuous glucose monitoring systems are being used. Advantages are more in terms of real-time recording, automated reminders, cloud storage is there for a lot of healthcare analytics, and reduced transcription error which comes to state that there is a lot of digital entry which minimize the manual data entry mistakes. So, on the advantage side it is good. Challenges, no doubt, digital literacy is important. Internet access is something which is to be stated and limited to unstable internet which can hinder the load and synchronizing. Data privacy concerns where sensitive dietary data requires strong privacy and security measures. And algorithmic inaccuracies which can come from AI detections. Now, we'll start to study and understand the different case studies. The case study on the use of food record for dietary assessment in India. In this case study, the assessment of dietary intake among college students in an urban region was done using a food record. The study population was taken of participants of 200 undergraduate students age between 18 to 24 and both males and females were included. They all were hostelites and day scholars. The method which was used for this group of population was a 3-day food record was taken which was including 2 weeks day and 1 weekend day. So, in a day from Monday to Saturday 2 weeks a day was taken and a weekend of Sunday was included. So, total 3 days studies was done. What was being taken as the food diary for all these 3 days where the participants were instructed to give information on the type of food, what you ate, quantity that is being consumed and the time of consumption. Only three things were being taken. And additionally, the place of consumption whether they have carried it to their rooms, whether they have ate at the hostel dining or at a serving place or whether they have taken it and ate later actually at other place also. What are the findings? The positive findings were like most students consume breakfast regularly. The rice and chapati were the major staples that that were consumed. And the third and very important positive finding that home cooked foods predominated among the day scholars. Which is being seen into this case study. The other findings with that were very concerning actually which was like high consumption of packed snacks was there. Frequent sugar sweetened beverages were consumed in that day. Low food intake was being seen and late night eating among the hostel students were very common. Even after 12:00 or even after 1:00 at night. Problems encountered during the data collection. Missing records. Several students forgot to record tea and coffee, snacks, soft drinks that was consumed for the day. Student often consider snacks insignificant. They forgot between the between meal food and record food retrospectively rather than immediately. The second problem was portion size error. Students reported one plate of rice or one bowl curry without specifying the actual quantities. So, it was stating that inaccurate portion estimates can result in incorrect energy calculation. Misclassification of nutrient intake can reduce study validity. The question of validity over here is very important. Problems of reactivity. Several participant reported changing their eating habits during recording. Such as avoiding fast food, reducing soft drink consumption, and increased food intake. So, participant usually alter their behavior because they know they are being observed. Problem four, weekend variation. Researchers found major differences between food which was consumed in the weekdays and the food which was consumed on the weekend. Student often consume hostel meals at regular meeting times on the weekdays. Whereas on the weekend, they preferred restaurants, hotels, food like pizza, burgers, and higher snacks consumptions. Practical recommendations from the study coming as that for future studies in India, you should use digital food diaries, which will give an ease with respect to the literacy. Regional [snorts] food atlases actually, which will give more food items to be included. Especially 150 to 200. The portion size photographs which will be given to understand the estimates of the portion that is being taken with respect to the measures that Indians are using. Local language instructions with Hindi, Marathi, and English. Weekend and weekdays recording from days mentioning Monday, Tuesday, Wednesday, Thursday, Friday, and so on. And at least 3 days of record should be there. Especially day one, day two in the weekdays, and day three as weekends like Saturdays or Sundays. Now we will take the case study two. The case study two is a food diary method in India. The study is about evaluating our dietary habits of working women in Mumbai using a 7-day food diary. A very important study about women's health. The study objectives were to assess our daily food and beverages intake that these women were consuming, the meal timing and frequency. Also, consumption of fruits, veggies, and intake of ultra-processed food, snacks, behavior, and dietary diversities being taken. The objectives were major in terms of understanding and evaluating the dietary habits of working women. The participants were 150 working women. The age was 25 to 45. Who were employed in a corporate offices, banks, schools, and hospitals, and residents of Mumbai city. The methodology was being taken for 7-day food diary. Each of the participant women were asked to maintain a food diary for 7 consecutive days, and participants recorded the food and beverages consumed, portion sizes, place of consumption, methods of preparation, and any skipped meals that they have taken. The participants were instructed to record food immediately after consumption rather than replying or memory later. So, it is very important, very interesting to understand like what did they have taken as example. Like the example was for the one day we can say that at 7:30 they said that we have taken tea with milk, one cup as a quantity, the place was home, method was boiled. At 8:00 a.m. they took poha as a Maharashtrian Mumbai specific food in terms of breakfast. The quantity was one plate, the place was home, and method of preparation was lightly cooked. So, on the entire routine you can understand they have taken four to five meals, maximum six meals. Our positive findings was being coming like major participant women consumed breakfast. Home-cooked food and dinners were very common. And tea consumption was nearly universal to every participant. Now, the areas of concern. The areas of concern were giving the frequent consumption of fried snacks. Very identical to the previous case study. High intake of sugar sweetened beverages same like low fruit intake and late dinners among women especially as they return home after their work. After completing the work, they used to take their meals. Now, what are the challenges encountered which are very important to be understood from this case study is like incomplete recording. Several of the women participant forgot to record tea, coffee, biscuits, chocolates, and small snacks as they often consider them as a too small or insignificant to the record. Which was coming as a major deterrent. Under reporting, several participants reported that fewer snacks and lower sweet consumption that was observed during the follow-up interviews and it may be due to social desirability or a bias that when they are participants, many omit because they find it is very unhealthy and you should not report it. Modification. Where the behavior was something which is being modified when you are being observed. And you always record something which is like increasing the food intake and showing that you are avoiding sweets and all that, but in exact that you are taking more fatty food. Portion size estimation was also being seen as wrong that major of the participant used descriptive such as one bowl, one plate, one spoon, and there was no standard way of defining actually the portion. Weekend and weekday variation was very common. Weekdays, they were taking quick breakfast, office cafeterias lunches, and late dinners at homes. In weekends, they were going for restaurant meals, family gatherings, higher calorie intake, and more sweets. So, you can find the weekdays and weekends in this particular study of the participants was completely different. Socioeconomic differences was being most majorly seen. Higher income group women more preferred to go for restaurant food, more packed products, and more salads and fruits. Low-income group women were more to be seen more home-cooked food, lower dietary diversity, and less fruits. So, in this case study, the Mumbai working women food diary, the study demonstrates that food diaries are valuable tools for capturing detailed dietary behaviors in Indian context. They provide insights into meal timing, snacking patterns, workplace, and habits. Also, dietary diversity, however, the challenges such as participants burden reactivity, underreporting, portion size estimation must be carefully addressed to ensure the accurate dietary assessment, which was coming as a major conclusion from the study. The futuristic recommendations were stating that there should be a digital food diaries. Regional estimates to be captured to be stated that there should be more added databases. The portion size photographs needs to be included, and again, local language instruction should be there. Weekly and weekend records should be separated. At least 3 days estimation can be done to be taken as a major states. This is also one of a very interesting study to be taken where assessing dietary sodium and pesticide among rural and urban household, which was a comparison using a duplicate portion method was being used. Where the study objective is to measure actual sodium intake, assessment of micronutrient intake, determine the dietary exposure to pesticide, and compare the urban and rural dietary exposure, and the final objective was validate the estimate obtained from the food records and a 24-hour recall. The study population were 100 adult between the age of 25 to 60 years. 50 urban and 50 rural participants. The urban household were consuming more rice, chapati, dal, and restaurant foods, and packed snacks, and soft drinks. Where the rural households were consuming rice, ragi, sambar, green leafy vegetables, and locally grown vegetables. The methods of duplication was same to be seen where you have to prepare the meals, normal meals and you have to take more to identical proportion. The sample was preserved, it was sent and logistically as being stated, it has to be transported. Initial findings show that there is a sodium intake was higher than the expected. Urban population average sodium intake was substantially higher than the recommended level. Major sources include pickles, papad and the packed snacks and restaurant food. Rural population, it was stated to state that the sodium intake was lower, but still exceeds the recommendation level because major sources includes the salt added cooking, pickles and salted chutneys. The finding is like hidden salt was underestimated. When it is being stated that consumption on 24-hour recall, researchers found that participant often failed to accurately report the added salt. So, duplication method is considered a very superior in terms of scenarios which is taken for one set of a ingredient as a micro or a macro. The pesticide residue detected, so among rural household, researchers detected low levels of pesticide and residuals like leafy vegetables, tomatoes and chilies. But the challenge is still contains over here even in the study as participant's burden. Participant has to do a lot of duplicate breakfast and lot of constraints comes in terms of the logistics. Challenges of sample transport, uh festive foods particularly in terms of proportion that they have to take and the challenges for mixed dishes which is something that Indians prefer often of combining lot of foods in terms of biryani, kitchari and the sambar. Vegetable curries as you see. And the key findings like the advantage comes like direct chemical measurement, high accuracy, objective assessment, and useful for contaminant studies. Excellent for validation studies, which is something which can we can say that the duplicate portion method is very useful. The limitations comes with economical constraints, logistical, high participant burden, and requires lot of laboratory interface. So, what is the conclusion from the study? The duplicate portion study demonstrate that duplicate portion method is the most objective way, has lot of technical things to be considered. While it provides a highly accurate estimates of sodium micronutrients, and the pesticides residuals, it's high cost and laboratory requirements. Participants burden limits to its use to primary validate and environmental exposures, and you may say that the assessment and smaller scale nutrition research projects in India. So, practical application is it is little in terms of constraints and environmental exposure. It has been found to be useful. So, in summary, you can say food record diet diaries and duplicate portion methods are important dietary assessment technique, and they are used in nutritional epidemiology to measure food and nutrient intake. Food records and diet diaries require participants to prospectively record all foods and beverages that are consumed. It provides a detailed information on meal patterns, portion sizes, B behavior. These two methods reduces the recall biases and often relatively the accurate estimate of the nutrient intake. Although they may impose a high respondent burden and influence eating behaviors. So, in the duplicate portion method, which involves collecting an identical duplicates of all foods and beverages consumed and analysis them chemically in a laboratory. It is considered the most objective dietary assessment method because it is directly measuring the nutrients. It is measuring the contaminants which you have seen in the case study three without relying on the food composition databases. While the accuracy is very good, the duplication portion method is expensive, labor intensive, and generally limited to validation studies and small-scale research which is applicable according to the constraints that is being observed. So, with this we have come an end to this chapter. You can use this references which are being stated over here and very useful for producing such sort of research and case studies that if you are interested for this. So, thank you and thank you for this. >> [music] [bell] [music]