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Title:   Author  item
                                            Blanton, Cynthiaitem
                                            Moshfegh, Alannaitem
                                            Baer, Daviditem
                                            Kretsch, Mary
  Submitted to: Journal of Nutrition
                                    Publication Type: Peer Reviewed Journal
                                    Publication Acceptance Date: 7/27/2006
                                    Publication  Date: 10/9/2006
                                    Citation: Blanton, C.A., Moshfegh, A.J., Baer, D.J., Kretsch, M.J. The USDA Automated Multiple-Pass Method Accurately Estimates Group Total Energy and Nutrition Intake. Journal of Nutrition. 136:2594-2599, 2006.Interpretive Summary: Dietary assessment methodology has seen important advancement in the context of increasingly sophisticated computer technology.    A recent development in this area is the USDA Automated Multiple-Pass Method (AMPM), a 5-step computerized dietary recall instrument used in the “What We Eat in America” survey, the dietary intake interview component of the U.S. National Health and Nutrition Examination Survey (NHANES). The AMPM was designed to improve the accuracy of dietary survey data used for developing national nutrition and health-related policies and programs but to date has been assessed only under laboratory conditions. The need also exists to understand the performance of the AMPM method in contrast to other assessment methods designed for large-scale studies. Thus, the present study compared the performance of the AMPM method and two other widely used methods designed for epidemiological studies, the Block food-frequency questionnaire (FFQ), and the National Cancer Institute’s Diet History Questionnaire (DHQ), in three functions: 1) validity of total energy intake (TEI) against the reference measure of total energy expenditure (TEE), DLW; 2) validity of total nutrient intake against the comparative reference method, the 14-day food record (FR); and 3) repeatability of intake estimates. Our hypothesis proposed that the validity and repeatability of the AMPM in measuring total energy and nutrient intake would meet or exceed that of the comparative methods. An important design feature of this study is that highly motivated subjects were selected to represent a best-case scenario for implementing these dietary assessment tools in a real-life context. Twenty, normal-weight-stable, premenopausal women participated in this free-living study that included two unannounced AMPM recalls, fourteen days of FR and two administrations of the Block and DHQ. Results show that AMPM & FR TEI did not differ significantly from DLW TEE (AMPM: 2145 ± 627 kcal; FR: 2010 ± 529; DLW: 2127 ± 449). Conversely, the questionnaires underestimated TEI by ~28% (Block: 1520 ± 523; DHQ: 1484 ± 472; p<0.0001 vs. DLW). Most nutrient intakes were significantly higher for the AMPM and FR vs. the Block and DHQ.  For all methods, TEI did not differ significantly between repeated measures. Nutrient intakes were repeatable between measures for the AMPM and DHQ, but differences were seen for a number of nutrients measured by FR and the Block.  In highly motivated women, the AMPM provides valid, repeatable measures of total energy and nutrient intake.  In contrast, the Block and DHQ significantly underestimate total energy and nutrient intake in this population.
                                Technical Abstract: The imperative to address the national obesity epidemic has stimulated efforts to develop accurate dietary assessment methods suitable for large-scale applications. This study evaluated the validity and repeatability of the USDA Automated Multiple-Pass Method (AMPM), the computerized dietary recall designed for the national dietary survey, and two widely used epidemiological methods [the Block food-frequency questionnaire and NCI’s Diet History Questionnaire (DHQ)] in measuring energy and nutrient intake using highly motivated subjects. Twenty, normal-weight-stable, premenopausal women participated in a free-living study that included two unannounced AMPM recalls and two administrations of the Block and DHQ. Methods were analyzed for: 1) validity in estimating total energy intake (TEI) and nutrient intake against the reference measures of doubly-labeled water (DLW) and 14-d food records (FR), respectively; and 2) repeatability of total energy and nutrient intake estimates. AMPM & FR TEI did not differ significantly from DLW TEE (AMPM: 2145 ± 627 kcal; FR: 2010 ± 529; DLW: 2127 ± 449). Conversely, the questionnaires underestimated TEI by ~28% (Block: 1520 ± 523; DHQ: 1484 ± 472; p<0.0001 vs. DLW). Most nutrient intakes were significantly higher for the AMPM and FR vs. the Block and DHQ. For all methods, TEI did not differ significantly between repeated measures. Nutrient intakes were repeatable between measures for the AMPM and DHQ, but differences were seen for a number of nutrients measured by FR and the Block.  In highly motivated premenopausal women, the AMPM provides valid, repeatable measures of total energy and nutrient intake.  In contrast, the Block and DHQ significantly underestimate total energy and nutrient intake in this population.


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