Validation of a Checklist for Estimating Fat Intake
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UNIVERSITY OF NEW SOUTH WALES Thesis/Project Report Sheet Surname or Family name: DEAKIN First name: Vicki Other name/s: Abbreviation for degree as given in the University calendar: M.Sc in Food Sc Tech School: Food Science and Technology Faculty: Applied Science Title: Validation of a Checklist for Estimating Fat Intake Abstract 350 words maximum: The objective of this study was to develop a short-term fat checklist (FC) and to examine whether it could replace a three-day food record (FR). The intended use of the FC was to measure and monitor current fat intake over three consecutive days in patients attending a local clinic in Canberra during a four-month lifestyle intervention program, and to provide an education message. A self-administered FC, in the form of a semi-quantitative FFQ, comprising 43 food items derived from food consumption data of two Australian population studies of adults was developed. The FC was compared with a three-day estimated food record (FR) in 19 volunteer clinic patients (9 men, 10 women) and also, to broaden its application, in 42 tertiary nutrition students (12 men, 30 women) against a three day weighed FR. Correlations for fat intake between the FC and FR were 0.86 for clinic patients and 0.68 for nutrition students. Mean differences in fat intake estimated by the two methods did not differ significantly from zero although Bland-Aitman plots showed large difference in fat intake between individuals. When classified by the FR, 92% of all subjects fell into the same or adjacent quartile when classified by the FC. Fifty-four percent of subjects were classified in the same qua1tiles for fat intake although overall ranking of quartiles suggested a 'poor' but significant agreement (kappa statistic, 0.33). The FC classified subjects consuming "?.70 g fat/d with 74% sensitivity. A Pearson's correlation of0.65 was calculated by a test-retest reproducibility procedure at three weeks in 49 tertiary physiology students. The FC reflected the food choices of all subjects tested with few exceptions. It was concluded that the FC cannot replace a three-day FR to measure absolute fat intake of individuals but was acceptable for measuring fat intake at the group level and to rank individuals into broad categories of fat intake. Its sensitivity of 74% to fat intakes "?.70g fat/d suggested that, the FC detected around three out of four subjects identified as consuming a high fat level by the FC have, in fact got a high fat consumption. It was also useful for screening between 'high' and 'low' fat intakes in groups. 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FOR OFFICE USE ONLY Date of completion of requirements tor Aw< rd ~aistrar anti Deo\itv Princioal THIS SHEET IS TO BE GLUED TO THE INSIDE FRONT COVER OF THE THESIS MBT 613.284 2 Validation of a Checklist for Estimating Fat Intake Vicki Deakin A thesis submitted for the degree of Master of Science The University of New South Wales September 2000 UN S V\1 1 4 JAN ZOOZ LIBRARY Contents and abstract Certificate of originality I hereby declare that this submission is my own work and that, to the best of my knowledge and belief, it contains no material previously published or written by another person nor material which to a substantial extent has been accepted for the award of any other degree or diploma of a university or other institute of higher learning, except where due acknowledgment is made in the text. I also declare that the intellectual content of this thesis is the product of my own work, even though I may have received assistance from others on style, presentation and language expression. Vicki Deakin September 2000 Department of Food Science and Technology The University ofNew South Wales ii Contents and abstract ACKNOWLEDGMENTS This thesis was undertaken while the author was working in a full-time capacity at the University of Canberra. The University of Canberra provided a three-month study leave to undertake data collection and I would like to thank Mrs Janice Plain, in the first instance, for acting in my position while on this leave. Associate-Professor Peter Greenham kindly granted access to his class of undergraduate student during lecture periods. The work was jointly supervised by Associate Professor Heather Greenfield (UNSW) who willingly and enthusiastically accepted the role of primary supervisor of an ex-campus student, an undoubtedly daunting task and Dr Karen Cashel from the University of Canberra. I am grateful and appreciative to Dr Greenfield for her dedication to this task, her thoroughness and attention to detail. Her numerous visits to Canberra and the feedback she provided, considering the circumstances, went beyond the role of any supervisor. Dr Greenfield is indeed an outstanding mentor. Dr Cashel has been invaluable in providing scholarly input, personal support, motivation and encouragement. Her contribution and assistance to me both personally and professionally is worth more than a simple acknowledgment. Mrs Deidre Briscombe and Mrs Helen Cooke, both nurses of extensive experience in patient counselling and management, voluntarily acted as data collectors at The Cardiovascular Health Risk Management Clinic and assisted in processing of data. I would like to thank Miss Maria Roberts, an undergraduate student at The University of Canberra for voluntarily cross checking, double-coding and assisting in the analysis of the food records. Dr Katrine Baghurst from CSIRO Division of Human Nutrition in Adelaide made available unpublished information about food sources of fat intake in her surveys of the population groups in SA and Victoria. Both Dr Baghurst and Professor Tony Worsley from NCEPH provided direction and encouragement to pursue this difficult topic. Dr George Cho and Ms Cathy Hales from the University of Canberra were invaluable in their assistance in data analysis and statistical procedures and I appreciate the resources and advice they provided in setting up a database and solving problems with reading the data. Finally Wayne Robertson, a statistician at the University of Canberra resolved a statistical problem that delayed the progress of this thesis for many months. Thank you Wayne. Finally I dedicate this thesis to my son, Lachlan Deakin, who has, at the young age of six, tolerated and endured my long absences involved with completing this thesis, especially in the last few months. iii Contents and abstract TABLE OF CONTENTS Page Certificate of originality .................................................................................................................. ii Acknowledgments ................................................................................................................. iii Contents ................................................................................................................. iv Appendices ................................................................................................................. xi List of tables ................................................................................................................ xii List of figures ............................................................................................................... xiv Glossary ............................................................................................................... xvi Acronyms ............................................................................................................... xix Abstract ................................................................................................................ xx CHAPTER 1: Introduction and aims 1.1 Introduction .................................................................................................................. 1 1.2 Background .................................................................................................................. 1 1.1.2 Fat intake in the Australian population .................................................................. 1 1.2.2 High fat intake and disease .................................................................................... 1 1.2.3 The need for a simple method to assess fat intake in local programs ................... 2 1.3 Methods for measuring dietary intake ........................................................................... 2 1.3 .1 Traditional methods ..............................................................................................