Feasibility of an estimated method using graduated utensils to estimate food portion size in infants aged 4 to 18 months.

The Diet and Nutrition Survey of Infants and Young Children (DNSIYC) was carried out in 2011 to assess the nutrient intakes of 4 to 18 month old infants in the UK. Prior to the main stage of DNSIYC, pilot work was undertaken to determine the impact of using graduated utensils to estimate portion sizes. The aims were to assess whether the provision of graduated utensils altered either the foods given to infants or the amount consumed by comparing estimated intakes to weighed intakes. Parents completed two 4-day food diaries over a two week period; an estimated diary using graduated utensils and a weighed diary. Two estimated diary formats were tested; half the participants completed estimated diaries in which they recorded the amount of food/drink served and the amount left over, and the other half recorded the amount of food/drink consumed only. Median daily food intake for the estimated and the weighed method were similar; 980g and 928g respectively. There was a small (6.6%) but statistically significant difference in energy intake reported by the estimated and the weighed method; 3189kJ and 2978kJ respectively. There were no statistically significant differences between estimated intakes from the served and left over diaries and weighed intakes (p>0.05). Estimated intakes from the amount consumed diaries were significantly different to weighed intakes (food weight (g) p = 0.02; energy (kJ) p = 0.01). There were no differences in intakes of amorphous (foods which take the shape of the container, e.g. pureed foods, porridge) and discrete food items (individual pieces of food e.g. biscuits, rice cakes) between the two methods. The results suggest that the household measures approach to reporting portion size, with the combined use of the graduated utensils, and recording the amount served and the amount left over in the food diaries, may provide a feasible alternative to weighed intakes.

Innovations in national nutrition surveys.

The aim of this paper is to describe innovations taking place in national nutrition surveys in the UK and the challenges of undertaking innovations in such settings. National nutrition surveys must be representative of the overall population in characteristics such as socio-economic circumstances, age, sex and region. High response rates are critical. Dietary assessment innovations must therefore be suitable for all types of individuals, from the very young to the very old, for variable literacy and/or technical skills, different ethnic backgrounds and life circumstances, such as multiple carers and frequent travel. At the same time, national surveys need details on foods consumed. Current advances in dietary assessment use either technological innovations or simplified methods; neither lend themselves to national surveys. The National Diet and Nutrition Survey (NDNS) rolling programme, and the Diet and Nutrition Survey of Infants and Young Children (DNSIYC), currently use the 4-d estimated diary, a compromise for detail and respondent burden. Collection of food packaging enables identification of specific products. Providing space for location of eating, others eating, the television being on and eating at a table, adds to eating context information. Disaggregation of mixed dishes enables determination of true intakes of meat and fruit and vegetables. Measurement of nutritional status requires blood sampling and processing in DNSIYC clinics throughout the country and mobile units were used to optimise response. Hence, innovations in national surveys can and are being made but must take into account the paramount concerns of detail and response rate.