"...all doctors should be able to diagnose and treat nutritional deficiencies."

Royal College of Physicians. Nutrition and Patients: A Doctor's Responsibility. London 2002

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This page has been printed from the www.stewartnutrition.co.uk web site.


Simple Dietary Assessment for Adults

The following six point questionnaire has been devised by Dr Alan Stewart and is based upon four elements:

  • Identification of important and nutritious foods from The Food Standards Agency guides The Eatwell Plate and 8 Tips to Eat Well 
  • Adopting targets for these foods that result in intakes observed to be in the top half of those achieved by adults in the National Diet and Nutrition Survey of British Adults (2003/4)
  • The likely provision of essential nutrients that would be achieved if these targets are achieved
  • The experience of the author derived from twenty five years of clinical practice.

The questions have been kept as simple as possible and relate to key nutritious foods.  The targets for sugar, salt, and animal fats are not included in this questionnaire as they are hard to quickly assess and a nutritious diet might still be achieved by those who consume a significant amount of them.

If all of the following targets are met and the intakes of sugar, salt, animal fats and alcohol are moderate or low then the person’s diet is likely to be very healthy indeed.

It should be noted that those who are underweight, are unwell, drink alcohol excessively, have other risk factors for nutritional deficiency or symptoms of deficiency might still have nutritional deficiencies despite a seemingly adequate intake.

This questionnaire, as with the other parts of this website, is not a substitute for a medical consultation or nutritional assessment by a trained professional.

Questionnaire

1.  Fruit and Vegetables

Do you consume five or more portions of a variety of fruit and vegetables daily?

A portion of fruit or vegetable is equal to 80g, or any of these:

  • 1 apple, banana, pear, orange or other similar size fruit
  • 2 plums or similar size fruit
  • ½ a grapefruit or avocado
  • 1 slice of large fruit, such as melon or pineapple
  • 3 heaped tablespoons of vegetables (raw, cooked, frozen or tinned)
  • 3 heaped tablespoons of fruit salad (fresh or tinned in fruit juice) or stewed fruit
  • 1 heaped tablespoon of dried fruit (such as raisins and apricots)
  • A dessert bowl of salad
  • A glass (150ml) of fruit juice (counts as a maximum of one portion a day)
  • 1 handful of grapes, cherries or berries

If not your diet may be lacking in vitamins C, A, folate, potassium, magnesium and fibre.

2. Main Meal Protein

Does your daily main meal always contain a good-sized serving of protein-rich food?
The serving should be at least 4 ounces, 112 g in size.
This protein source could be either animal e.g. meat, fish or eggs or vegetarian e.g. pulses (beans, peas or lentils), nuts, seeds, tofu and mycoprotein marketed as Quorn™.

If not, your diet may be lacking in protein, iron, zinc and vitamin B. Additionally those on a long-term vegan diet may develop vitamin B12 deficiency.

3. Dairy Foods

On average do you have two or more servings of dairy foods or fortified soya replacement per day?
(A serving is 200 ml of milk, yoghurt, fromage frais or 50 g of non low-fat cheese.)

If not your diet may be lacking in protein, calcium, vitamin A, vitamin B2 – riboflavin, vitamin B12 and iodine.

4. Fish

Do you eat two or more portions of fish per week including at least one that is oily?

(Oily fish are mackerel, herring, sardines, salmon, trout, pilchards, eels and sprats as well as fresh  tuna.)

If not you may be lacking in omega-3 essential fatty acids, selenium and vitamin B12.

5. Nutritious Carbohydrates

Do you eat some nutrient-rich complex carbohydrates every day?

This includes:

  • potatoes with their skins - jacket potatoes or boiled new potatoes
  • wholemeal and wholegrain bread including granary or heavy rye bread
  • wholemeal and wholegrain pitta or chapatti
  • brown rice but not white rice
  • wholewheat pasta but not white pasta
  • wholegrain breakfast cereals e.g. muesli, porridge or wholewheat cereal

If not you may be lacking in potassium, magnesium, trace elements, folate, vitamins B1, B6, vitamin C (fresh potatoes) and fibre.
Vegetarians may also be lacking in protein.

6. Breakfast

    Do you eat breakfast every day?

If not then you are more likely to make poor food choices during the day and are more likely to be overweight.

 

Scoring the Questionnaire

Score
Interpretation
6 Excellent.  Your intake of protein and essential nutrients is likely to be very good.  There is no need to change anything provided that your weight is satisfactory and your intakes of salt, sugar and fats are low.
5 A pretty good score but you could still have some deficiencies depending upon which target you did not make.  Look at the risk factors for deficiency and the symptoms of deficiency and if you have any cause for concern see your GP or seek the advice of a nutrition practitioner. 
4 Some cause for concern and it is time to make some real effort to improve your diet.  You may want to seek the advice of a nutrition practitioner or your GP, particularly if you also have risk factors for deficiency or symptoms of deficiency.
3-0 This is a very low score and means that your diet is likely to be deficient in several nutrients.   You may need to get professional advice from your doctor especially if you have one or more risk factors for deficiency.

What Does this Questionnaire Assess?

The following table is derived from the National Diet and Nutrition Survey of British Adults 2003/4 which analysed the dietary intake of a representative sample of nearly 2,000 adults aged 19 to 64 years from the British Isles.

Average Consumption of Wholesome Staple Foods by British Adults aged 19 to 64 years

Fruit and vegetables 3 approximate 80g servings per day
Meat and meat products 165g (6 ounces) per day = one large portion per day
Fish 217g (8 ounces) per week = one and a half portions per week - less than half of this is likely to be of an oily variety
Dairy foods 7 portions of milk, 2.25 portions of cheese per week and 1 portion of yoghurt/ice cream per week
Fresh potatoes 475g of fresh potato = 4 x 120g servings per week (also 250g of chips per week = 2 portions if fresh)
Bread 760g per week = two and a half slices per day (20% of which is wholemeal bread)

Nutrients Provided by the current Average Consumption of Wholesome Staple Foods in the Adult British Diet Percentage of Average Daily Intake

 

Fruit and Vegetables
Meat
Fish
Dairy Foods
Potatoes Fresh
Bread All types
Total Provision
Protein
7%
36%
7%
16%
2%
12%
80%
Calcium
6%
6%
2%
43%
1%
19%
77%
Magnesium
15%
12%
3%
11%
7%
13%
61%
Potassium
17%
15%
3%
13%
9%
5%
62%
Iron
13%
17%
3%
1%
4%
15%
53%
Zinc
8%
34%
3%
17%
3%
11%
76%
Copper
15%
15%
3%
5%
4%
14%
56%
Iodine
4%
7%
11%
38%
3%
3%
66%
Vitamin A
28%
28%*
1%
14%
1%
0%
72%
Vitamin C
41%
4%
0%
5%
8%
2%
60%
Vitamin B1
18%
21%
1%
6%
8%
14%
68%
Vitamin B2
6%
15%
2%
33%
2%
6%
64%
Folate
18%
7%
2%
8%
6%
11%
52%
Vitamin B12
1%
30%
18%
36%
0%
1%
86%
n-3 EFAs**
14%
17%
14%
5%
2%
4%
56%

**Essential Fatty Acids

^ some figures for fresh potatoes have been estimated from presented data
* of the 28%, only 7% was derived from non-liver products and 21% from liver and liver products

Thus it is likely that achieving the targets set in the 6-point questionnaire of the Simple Dietary Assessment for Adults would result in a higher than average intake of fruit and vegetables, dairy foods, fish including oily fish and nutritious sources of carbohydrate.  Only intake of meat protein might be lower but the nutritional shortfall that might result is likely to be provided from some foods in the other groups.

A good or even excellent diet is still no guarantee of nutritional adequacy as a variety of other factors can increase an individual’s risk of deficiency.



Copyright Dr. Alan Stewart M.B.B.S.M.R.C.P. (UK)M.F. Hom.
47 Priory Street, Lewes, East Sussex. BN7 1HJ
Tel 01273 487003 Fax: 01273 487576