The Dietary History
The dietary history collects retrospective information on the patterns of food use during a longer, less precisely defined time period. It records a patient’s usual dietary intake (vs. actual food intake)
The original Dietary History data collection method was initially made up of 3 components - , 24h recall, Cross check, and the three day food record.
However, over time and depending on place, numerous modifications of the Diet Hx have been made and most often the third component eliminated. For purpose of this case practice we will focus on the first two components because this information can be collected during initial contact with patient.
1. The 24hour Recall
The Health Professional (aka the Interviewer) guides the Patient to recall in detail all food and drink consumed the previous day as well as any pertinent nutritional/herbal supplements.
Potential Probes:
- 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? Did you have dessert?
- Snack in the evening/before you went to bed?
- Do you take a multivitamin? Any herbal supplements? Iron pills? etc. at what time of day?
- Do you drink water throughout the day? How many glasses?
These questions provide you with a general account of what the patient consumed yesterday. Now you’re interested in portion sizes.
Having visual aids such as food models are helpful here, or having a measuring cup and measuring spoons. Other visual cues could be remembering that a medium sized fruit is the size of a tennis ball, one serving of meat is about the size of a deck of cards. Ask them if half of their plate if filled with vegetables/meat/potato etc.
Note: Generally the 24hour recall within a Diet Hx is not extremely detailed so it is not necessary to inquire about the brand name of all foods but it would be wise to note if your patient eats mostly processed foods, fresh foods, dines out a lot etc.
2. The Cross Check
Now that you have a sense of what the patient ate yesterday, record what day of the week it was. Was this 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
- Any food allergies/major food dislikes/food groups you avoid (e.g. vegetarian)?
- Any health-related diet implications (e.g. gluten free, low sodium)?
- Do you 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?
- What’s your favourite breakfast cereal?
- 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?
- Pick two of your most favourite foods from each of the four food groups (Vegetables & Fruit; Grain Products; Milk & Alternatives; Meat & Alternatives)
Being careful not to jump to conclusions, you might also gain a sense of their socio-economic status (is everything no-name brand? Are 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 recommendations.