Diet Assessment in Children and Adolescents

Although increases in obesity prevalence over the last few decades have been dramatic in all age groups, trends among youths have been particularly alarming. The prevalence of childhood overweight has almost doubled in the past two decades in the United States (CDC, National Center for Health Statistics [NCHS, 2004]). The emergence of childhood obesity as a serious public health problem underscores the need for dietary assessment tools that are not only reliable and valid but also feasible to administer across multiple settings and age ranges and with diverse populations. Accurate dietary assessment is critical for monitoring the nutritional status of children, examining associations between diet and health, and identifying dietary intake patterns and eating behaviors that are associated with unhealthy weight and weight gain over time. Such information is critical for developing intervention messages and behavioral targets for obesity prevention and treatment programs and for evaluating their effectiveness.

As others have documented, there is no “one-size-fits-all” dietary assessment tool appropriate for all research and clinical applications, and there is always a trade-off with the choice of any diet assessment methodology (Goran, 1998; Rockett, Wolf, & Colditz, 1995). Moreover, the measurement of energy and nutrient intake in children and adolescents is further complicated by a variety of factors, including reliance on a third person (e.g., adult caregiver, teacher) to report a child's intake during the preschool years, cognitive abilities, motivation, and reporting biases (e.g., underreporting and overreporting) influenced by developmental stage and other factors (e.g., weight status). The goal of this chapter is to review the variety of dietary assessment methods available, evidence regarding their reliability and validity for different age groups (preschool-aged children, school-aged children, and adolescents), and the advantages and disadvantages of each approach. Dietary assessment methods reviewed include food records, dietary recalls, food frequencies, brief approaches, and observation largely focused on specific aspects of the diet (e.g., fruit and vegetable intake). This chapter builds on several recent, comprehensive reviews of the dietary assessment literature (Livingstone, Robson, & Wallace, 2004; McPherson, Hoelscher, Alexander, Scanlon, & Serdula, 2000; Rockett et al.; Serdula, Alexander, Scanlon, & Bowman, 2001) and incorporates data from more recently published validation studies. PubMed searches using relevant keywords (e.g., “diet,” “nutrition,” “children,” “adolescents,” “validation studies”) and reference lists from key articles were used to obtain relevant literature. The chapter concludes with a brief discussion of factors to consider when choosing the best measure for a particular purpose and study population.