Universiada De Tae Kwon Do

Effectiveness of the US Department of Agriculture 5-step multiple-pass
method in assessing food intake in obese and nonobese women1–3
Joan M Conway, Linda A Ingwersen, Bryan T Vinyard, and Alanna J Moshfegh

KEY WORDS
Food intake, energy intake, obesity, dietary
assessment, 24-h dietary recall, 5-step multiple-pass method, US
Department of Agriculture, women
INTRODUCTION
Scientistsstrive to assess the outcome of eating (ie, nutrient
intake) with assessment tools that are easy to administer and are
affordable in terms of time and money. One reason for conducting
nutrient assessments is the importance of diet as a determinant of
risk of disease or malnutrition. Other reasons include the need to
assess the nutrient adequacy of the diet in groups and populations,
to quantifythe exposure of a population to food contaminants, and
to provide baseline information for educators and policy makers
who develop educational materials, provide guidance, and design
nutrition interventions.

Methods typically used to assess dietary intake include diet histories, dietary recalls, food-frequency questionnaires, and diet
records with or without duplicate collection of food(1–4). Misreporting of food intake by participants in dietary surveys has been
well documented (5, 6). Data from published studies conducted
in metabolic ward (7) or outpatient (8) settings suggest a significant underreporting of energy intake from dietary recalls, particularly by overweight and obese women. In contrast, other studies
in outpatients (9–11) found overreporting of energy intake on 24-hdietary recalls. About 50% of the women whose eating was
observed by Myers et al (11) overreported their energy intake on
24-h dietary recalls.
The US Department of Agriculture (USDA) has surveyed the
food intake of the American population since 1935 using various
dietary recall methods (12). Recently, the current dietary recall
method was enhanced to aid recall and to reduce respondentburden and is referred to here as the USDA Automated Multiple Pass
Method, a 5-step multiple-pass 24-h dietary recall method. This
dietary assessment method has been used jointly by the US
Department of Health and Human Services, National Center for
Health Statistics, and the USDA Food Surveys Research Group
for dietary data collection entitled “What We Eat in America” in
the National Healthand Nutrition Examination Survey since 2002.
The present study was conducted as an observational validation
of this dietary recall method in obese, overweight, and normalweight women. We asked 3 primary questions. Under controlled
conditions, 1) can the USDA 5-step multiple-pass method be used
by women to accurately assess energy, protein, carbohydrate, and
fat intakes; 2) do obese [body massindex (BMI; in kg/m2) ≥ 30.0],
overweight (BMI ≥ 25.0 < 30.0), and normal weight (BMI < 25.0)
women differ in their recall of food intake; 3) are macronutrients
selectively under- or overreported? Our hypothesis was that

1
From the Diet and Human Performance Laboratory (JMC), the Food Surveys Research Group (LAI and AJM), and the Biometrical Consulting Service
(BTV), US Department ofAgriculture, Agricultural Research Service,
Beltsville Agricultural Research Center, Beltsville Human Nutrition Research
Center, Beltsville, MD.
2
Supported by the USDA Agricultural Research Service, National Program
in Human Nutrition.
3
Address reprint requests to JM Conway, USDA/ARS, Beltsville Human
Nutrition Research Center, Diet and Human Performance Laboratory, Building
308, Room 122,Beltsville, MD 20705. E-mail: conway@bhnrc.arsusda.gov.
Received December 27, 2001.
Accepted for publication October 9, 2002.

Am J Clin Nutr 2003;77:1171–8. Printed in USA. © 2003 American Society for Clinical Nutrition

1171

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ABSTRACT
Background: National surveys of food intake rely on the 24-h
dietary recall method...