Submitted to: American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/22/2008
Publication Date: 8/1/2008
Citation: Fisher, J.O., Butte, N.F., Mendoza, P.M., Wilson, T.A., Hodges, E.A., Reidy, K.C., Deming, D. 2008. Overestimation of infant and toddler energy intake by 24-h recall compared with weighed food records. American Journal of Clinical Nutrition. 88(2):407-415. Interpretive Summary: An accurate assessment of food intake during the first two years of life is important in understanding the changing dietary patterns of infants and toddlers as they progress from a single food to the family meal. Given its ease of use, low respondent burden, and cost effectiveness, the 24-hour dietary recall is the method of choice for assessing dietary intake; however, its accuracy has not been evaluated in this age group. Therefore, we compared the accuracy of a telephone-administered 24-hour dietary recall method against 3-day weighed food record, which is considered the "gold standard". In 157 infants and toddlers, the 24-hr recall overestimated energy intake by 13% among infants and 29% among toddlers compared to the 3-day weighed records. Use of a single, phone-administered multiple-pass 24-hr dietary recall method may significantly overestimate infant/toddler energy intakes due to portion size estimation error.
Technical Abstract: Twenty-four-hour dietary recalls have been used in large surveys of infant and toddler energy intake, but the accuracy of the method for young children is not well documented. We aimed to determine the accuracy of infant and toddler energy intakes by a single, telephone-administered, multiple-pass 24-h recall as compared with 3-d weighed food records. A within-subjects design was used in which a 24-h recall and 3-d weighed food records were completed within 2 wk by 157 mothers (56 non-Hispanic white, 51 non-Hispanic black, and 50 Hispanic) of 7 to 11-mo-old infants or 12 to 24-mo-old toddlers. Child and caregiver anthropometrics, child eating patterns, and caregiver demographics and social desirability were evaluated as correlates of reporting bias. Intakes based on 3-d weighed food records were within 5% of estimated energy requirements. Compared with the 3-d weighed food records, the 24-h recall overestimated energy intake by 13% among infants (740 +/- 154 and 833 +/- 255 kcal, respectively) and by 29% among toddlers (885 +/- 197 and 1140 +/- 299 kcal, respectively). Eating patterns (i.e., frequency and location) did not differ appreciably between methods. Macronutrient and micronutrient intakes were higher by 24-h recall than by 3-d weighed food record. Dairy and grains contributed the most energy to the diet and accounted for 74% and 54% of the overestimation seen in infants and toddlers, respectively. Greater overestimation was associated with a greater number of food items reported by the caregiver and lower child weight-for-length z scores. The use of a single, telephone-administered, multiple-pass 24-h recall may significantly overestimate infant or toddler energy and nutrient intakes because of portion size estimation errors.