Development of a food checklist for fat, saturated fat, and sodium for middle school students - Research Articles - Statistical Data Included

Family Economics and Nutrition Review, Spring, 2001 by Johanna T. Dwyer, Anne O. Garceau, Deanna M. Hoelscher, Kevin Smith, Theresa A. Nicklas, Leslie A. Lytle, Michelle M. Zive, Ann L. Clesi

Although 24-hour recalls and food records are the most accurate of the dietary assessment methods available, they require a great deal of instruction and are too expensive and burdensome to use in large-scale community studies (28). Thus brief, inexpensive, valid, culturally appropriate dietary assessment instruments that can be used to categorize children's relative intakes of nutrients are needed. Food checklists are useful in large-scale studies for detecting changes in food choices and for quantifying and ranking individuals' intakes of specific nutrients. When used to assess the prior day's food consumption, food checklists can be calibrated by comparing results with 24-hour recalls.

The Child and Adolescent Trial for Cardiovascular Health (CATCH) was a large-scale, school- and family-based, multicenter intervention trial aimed at decreasing cardiovascular risk factors and making organizational-level changes. The cohort consisted of elementary schoolchildren and their schools. Details of the CATCH study are described elsewhere (21). Particular attention was directed at educating children on positive eating behaviors to improve and lower intakes of sodium, total fat, and saturated fat (19).

A food checklist was designed as a short, inexpensive diet assessment tool to detect differences between the target nutrients in the diets of the CATCH cohort as they were followed longitudinally. Use of a checklist appeared promising, but existing checklists were either inappropriate for children or the targeted nutrients differed from those of interest in CATCH. For example, Kristal and colleagues (14) used a 19-item checklist of foods high in fat and fiber--although neither saturated fat nor sodium was included--to study women's intakes. For 16 foods, Kappa values exceeded 0.6 when food items reported on the checklist and 24-hour recalls were compared.

In students followed from the sixth through the twelfth grades in the Class of '89 Study, an 18-item scale or paired food choice was used (13). This scale detected differences in high-fat food choices between students residing in intervention and control communities, and scores suggestive of a preference for high-fat foods correlated well with lack of exercise and smoking (12,13,17,20). Middle school students in the CATCH intervention group differed from controls on their usual choices between food pairs on the Health Behavior Questionnaire (16). However, items on the Class of '89 and the CATCH Health Behavior Questionnaire food-choice scale asked subjects to indicate which of two food pairs they usually choose rather than asking them to report their food consumption.

The purpose of this study was to develop a brief food checklist to report intakes of foods that were major contributors to middle school children's intake of fat, saturated fat, or sodium over the previous day. This checklist needed to be inexpensive, culturally sensitive, and suitable for administration in group settings to a multiethnic group of middle and junior high school students.

Methods

Sample

The data we used consisted of 224 24-hour recalls, 56 at each of the four CATCH sites: San Diego, CA; New Orleans, LA; Minneapolis, MN; and Austin, TX. These recalls were selected randomly from all 1,182 recalls collected in the CATCH study after stratifying by site when the cohort children were in the fifth grade, in the spring of 1994. The multiethnic sample reflected the composition of the CATCH population: 44 percent females and 56 percent males; 68 percent White, 13 percent Black, 15 percent Hispanic, and 4 percent Native American, Asian American, and others. The sample size was selected to permit us to detect reliably food-item effect sizes of 0.35 or greater (8), sizes we considered large enough to be of dietary importance. Effect size is the difference in mean nutrient intake levels between those who consumed a food versus those who did not, divided by the standard deviation of the measured nutrient.

Preliminary List of Foods Included on the Food Checklist

Developing the food checklist involved (1) compiling the preliminary list of foods to be included on the food checklist, (2) coding the food checklist by using previously obtained 24-hour recall information to simulate student response, (3) calibrating the food checklist to 24-hour recalls to produce a final version of it for administration, and (4) formalizing administration procedures after pretesting the food checklist administration with students.

The food checklist was a modification of a questionnaire used in the Youth Risk Behavior Survey (11), with some items from the Food Behavior Checklist (14). It included food choices, reported by third graders in the CATCH pilot study, that were high in fat, saturated fat, and sodium and similar foods identified in other studies (3-5,10, 26,30). Other questionnaires that focused on fat, saturated fat, and sodium were also reviewed even if they were not designed for children or adolescents (1,2,6,9,11,14,24,25,29). Foods that contributed substantially to intakes of target nutrients, because they were consumed frequently, were also included (5,26,30). In addition, special attention was paid to inclusion of relevant ethnic foods.