Browsing by Subject "Nutrition assessment"

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    Dietary assessment: developing, validating, and improving a 24-hour Web food report questionnaire
    (2013-08) Desai, Jay Robert
    Developing, Validating, and Improving a 24-hour Web Food Report Questionnaire Jay Robert Desai Precise and accurate assessment of usual energy and nutrient intake among free living populations remains a major challenge for the study of diet and disease. The food frequency questionnaire (FFQ) carries a relatively low cost and participant burden, but it is much less accurate than multiple 24-hour telephone recalls (24TR). However, 24TRs are usually prohibitively expensive for large studies, and carry a high participant burden. Consequently, there remains a great need for alternative self-report approaches. Emerging web technology and internet penetration provide an opportunity to reduce dietary measurement error while increasing participant and investigator convenience. We developed the 284-item 24-hour Web Food Report Questionnaire (WFRQ) and conducted a pilot comparative validation study (n=51) examining energy and nutrient intake estimates from three WFRQs and the NCI Dietary History Questionnaire (NCI-DHQ) compared to three interviewer-administered 24TRs. Mean intake estimates were similar between the 24TR and the WFRQ but significantly lower with the NCI-DHQ for many nutrients. Correlations with the 24TR ranged from 0.24 to 0.73 and were typically lower with the NCI-DHQ than the WFRQ. Compared to estimated energy requirements the 24TR, WFRQ, and NCI-DHQ under-reported energy intake by 15%, 19%, and 25%, respectively. On average the WFRQ took 10 minutes to complete. A more in depth examination of reported foods and food amounts consumed, comparing 24TRs and WFRQs collected for the same day (n=46), revealed that the 24TR better captures foods used as additions, food-types, and for some foods, portion amounts. Incorporating more food detail and more effective portion size aids may improve the validity of the WFRQ. At the same time, refining the mapping of the WFRQ food items and portion categories to our food and nutrient database may also reduce measurement error. The WFRQ `beta' version is promising for research use in large studies involving free living populations.
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    Nutritional Status, Body Composition, and Psychosocial Outcomes Among Individuals with Advanced Head and Neck Cancers: A Prospective Investigation in An Outpatient Setting
    (2015-08) Mulasi, Urvashi
    Malnutrition among individuals with head and neck cancer (HNC) is of particular concern, with up to 40% - 57% with a compromised nutritional status even before beginning their treatment. Within the US, the prevalence of malnutrition has not been well-documented due to a lack of consensus on its definition and diagnosing markers. Therefore, the primary aim of this prospective natural history pilot study was to estimate the prevalence of malnutrition among individuals with HNC (n = 19) during and up to 3 months after treatment using the new Consensus malnutrition definition. The scored Patient-Generated Subjective Global Assessment (PG-SGA) was used as the reference standard to evaluate the sensitivity and specificity of the Consensus framework in defining malnutrition. Another aim of this research was to investigate the utility of raw bioimpedance parameters such as 50 kHz phase angle (PA) and 200 kHz/5 kHz impedance ratio (IR) to identify individuals with malnutrition, and to evaluate how bioimpedance markers relate to functional status outcomes. Finally, this research also assessed how malnutrition relates to quality of life (QoL) and self-efficacy perceptions among individuals with HNC. Results indicate that individuals with HNC are malnourished even before treatment initiation. Using the Consensus framework, 67% of our participants were malnourished before treatment; and the prevalence of malnutrition consistently increased during treatment and the post-treatment period. When compared to our reference standard PG-SGA, the Consensus criteria identified malnutrition with overall good sensitivity (95%) and specificity (43%). Bioimpedance markers PA and IR were useful in identifying individuals who were at increased risk for malnutrition and/or impaired functional status. From a psychosocial perspective, compared with well-nourished participants, malnourished individuals scored significantly lower in the global QoL and cognitive function scales and significantly higher in the disease- and treatment-related symptom scales and items. In the future, if clinicians are trained to assess malnutrition diagnostic markers before individuals with cancer undergo aggressive treatments, nutritional interventions could be initiated at an earlier time and loss in weight and/or lean tissue can be prevented. Early detection of malnutrition could also help with patient-specific intervention strategies aimed to improve overall health-related QoL outcomes.