The Dietary History

last authored: Nov 2014, Becca Green-LaPierre
last reviewed:

 

 

Introduction

The dietary history collects retrospective information on patterns of food use during a longer, less precisely defined time period.  It records a patient’s usual dietary intake (vs. actual food intake).

A full dietary history is composed of three components:

• 24hour recall
• Cross check
• Three day food record

However, depending on time and opportunity for followup, the three day record is often skipped.

 

 

The 24 Hour Recall

During the 24 hour recall, guide the patient to recall, in detail, all food and drink consumed the previous day, as well as any pertinent nutritional/herbal supplements.

 

Potential probes to use include:

• When did you wake up?  What was the first thing you ate and/or drank? (collect breakfast information)
• Did you have a morning snack/morning coffee?
• What did you have for lunch?  Anything to drink with that?
• Afternoon snack? Snack when you came home from school/work?
• What did you have for supper?  Anything to drink with that?
• Did you have dessert?
• Snack in the evening/before you went to bed?
• Do you take a multivitamin? Any herbal supplements?  At what time of day do you take it?
• Do you drink water throughout the day?  How many glasses?

These questions provide you with a general account of what the patient consumed the previous day. 

 

Next, inquire about portion sizes.

Having visual aids such as food models, a measuring cup, and measuring spoons, can be very helpful. 

Helpful cues include:

• medium sized fruit is the size of a tennis ball
• one serving of meat is about the size of a deck of cards

Show them a typical dinner plate and ask them what portion of their plate if filled with vegetables/meat/potato etc. 

 

It is not necessary to inquire about the brand name of all foods, but it is important to note if your patient eats mostly processed, store bought foods to give you insight to the amount of sodum they consume and their personal food skills (e.g. cooking ability).

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Cross Check

After gaining a sense of what the patient ate yesterday, record what day of the week it was.  Ask them if that was a typical day for them in turns of eating? Do weekends differ from weekdays?  The cross check is a mini questionnaire on the frequency of consumption of specific food items used to verify and clarify the information gathered from the 24h recall. 

Potential probes include:

• Any food allergies/major food dislikes/food groups you avoid (e.g. vegetarian)?
• Any health-related diet implications (e.g. gluten free, low sodium)?
• Based on the number of meals and snacks they ate in the 24h recall, ask them if they normally eat three meals/day? Two-three snacks/day?
• Would you call yourself a “snacker”  (i.e. like to graze throughout the day) or do you prefer structured meal times?
• Do you find yourself skipping a certain meal more than others (e.g. breakfast, work through lunch)?
• Do you tend to have the same breakfast everyday? 
• Do you drink fluid milk (or milk alternative)?
• Do you normally bring a lunch from home or do you more often eat at the (cafeteria/local café/fast food restaurant)?
• How often do you eat red meat? Fish?
• Are their any vegetables you dislike/avoid?
• How often do you have dessert?
• What’s the most common method of food preparation in your house (e.g. frying, baking, steaming vegetables vs. boiling, etc.)?
• How often do you fill your water bottle?
• Do you remember to take your (vitamin/supplement) every day?

Being careful not to jump to conclusions, as you ask questions you might also gain a sense of their socio-economic status (Is everything no-name brand? Is there limited fresh fruits and vegetables? Does it seem like “healthy foods” are being rationed such as only 1 glass of milk at breakfast?).  You could also ask questions around how often they go grocery shopping and where.  How often they dine out and where.  This information can be helpful to provide income-appropriate nutrition recommendations.

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Three Day Food Record

Have your patient record what they actually ate for three non-consecutive days. The patient should be as detailed as possible, including the timing of their meals, portion sizes and specifying whether meals are home made or store bought. It is best to write down what they ate soon after actually eating the meal so as to not rely on memory, as memory is less reliable.

 

Resources and References

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