Diet History and Dietary Intake Assessment 17
1
nutrient def iciencies or excesses a nd of a ny ba rri-
ers to intake or to following the advice given. Ad-
vice should then be tailored accordingly. It is es-
sential to involve both the child and the parent(s)
(and any significant other carers) in understand-
ing any dietary advice prescribed. Nutrient anal-
ysis of the diet history or food records collected
can be used as a summary of the diet, but the fig-
ures obtained are not accurate at the level of the
individual and thus should only be used as a
rough indicator of dietary adequacy.
After the initial dietary history, if the child is
thought to have an inadequate diet, advice may be
given about incorporating dietary sources of the
relevant nutrients into the child’s diet or about the
addition of suitable supplements. Wherever pos-
sible, dietary solutions should be encouraged,
since, once established, they tend to be more sus-
tainable than supplement use. Furthermore,
foods tend to provide a mixture of nutrients, fibre
and different textures, and it is not always under-
stood which is providing the beneficial effect; in-
deed, it may be that it is the combination that is
important rather than one constituent alone.
If, during the monitoring phase of working
with the child, more than 7 days of reasonably
complete food records have been accumulated,
then nutrient analysis may be informative. This
requires a suitable dietary analysis programme
which can accommodate all the foods eaten and
provide up-to-date nutrient contents for all the
nutrients of interest [4]. Obtaining this type of
analysis package needs careful thought, since
foods change over time and off-the-shelf versions
of packages do not always cover culturally spe-
cific foods, new foods on the market or some spe-
cific nutrients. Again, it is best to involve an ex-
pert dietician in this process.Conclusions- Assessment of diet in a clinical setting with an
individual child requires a different set of con-
siderations than assessing diet in groups of chil-
dren. The aim should be to diagnose the par-
ticular dietary problem and provide suitable
treatment or advice to alleviate the problem
Ta b l e 2. Key aspects to consider in interpreting a dietary assessment
This will depend on the problem that the individual child presents with:
Slow weight gain/weight loss/eating behaviour problems
Barriers to intake or absorption are likely to be the main problem
Diet history is likely to show a limited food intake either in amount or range of foods consumed
Consider involving a child feeding behaviour specialist
Anaemia or low blood concentrations of other key nutrients
Barriers less likely to be the main problem
Diet history is likely to show a poor balance of foods consumed
e.g. for anaemia – check enhancers: meat, fruit, vegetables, vitamin C [5]
inhibitors: cow’s milk, tea, calcium [5]
Consider involving a dietician
Overweight, obesity and diabetes
Barriers less likely to be the main problem
Inactivity may be a factor
Diet history is likely to show a poor balance of foods consumed
e.g. for all three morbidities – check promotors: snack foods, sweet foods, soft drinks [6]
inhibitors: fruits, vegetables, wholegrain cereals [6]
Consider involving a dietician
Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 14–18
DOI: 10.1159/000367877