Dietary assessment at the end of life's spectrum

Dietary assessment at any life stage presents challenges. It is fundamental that the method of assessment used is appropriate both to the question to be answered and to the population group to be assessed. The choice of method must also be within the confines of finite resources available.

Assessing food choice and/or nutrient intake at either end of the life's spectrum, that is, the youngest young or the oldest old, presents particular challenges that share some common themes. The respondent may have no knowledge of or involvement in food acquisition or preparation; cognition and/or memory may prohibit or restrict the ability to recall intake; ability to record intake may also be limited; reporting may need to rely on a proxy (parent or carer), and a number of individuals or carers may be involved in the care of the respondent on any one day.

Infants and young children, at least up to the age of 8–9 years, are unlikely to be able to provide a reliable report of dietary intake. Literacy skills prohibit recording, cognition and ability to recall. Lack of familiarity with food and cooking methods renders traditional, subject-reported, prospective and retrospective methods useless. Dietary assessments of children, either prospective or retrospective, often rely on parents and this too presents a major challenge for all but the minority of children who are cared for exclusively by one parent. For children in day care and/or cared for by family members and/or attending pre-school or primary school, parents are unlikely to be able to provide a complete record of intake either of foods or of amounts consumed. Childcare workers and school staff in a busy work environment may be able to report on intake for an individual child, but if several children are subjects, alternative methods of observation are required.

At the other end of life's spectrum, dietary assessment of the oldest old presents some similar challenges. For those living independently, physical limitations may hinder prospective recording. Reliance on memory, ability to recall intake and/or a long interview process during which subjects might be exhausted, can all hinder the use of retrospective methods. Many of the oldest old may be in full or part-time care or cared for by a spouse or any other relative. A lack of involvement in food acquisition and preparation may present a barrier to subject reporting. Proxy reporting, as in the case of young children, may require input from several carers. To date, dietary assessment methods generally used for adult populations, such as: weighed inventory, food diaries and food-frequency questionnaires, have all been applied to older populations, but as the number of oldest old, that is, those aged 85 years, increases, dietary assessment methods developed specifically to meet these challenges are needed for accurate characterization of the dietary intake of this group. Such methods are required both to investigate the role of nutrition in maintaining health and preventing age-related decline, and to monitor nutrient intake in this population group at high risk of nutritional inadequacy.

Papers presented in this edition present and discuss some potential solutions to these challenges.

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The author has declared no financial interests.

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Adamson, A. Dietary assessment at the end of life's spectrum. Eur J Clin Nutr 63, S5 (2009). https://doi.org/10.1038/ejcn.2008.59

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