Are food record charts useful components of nutritional assessment?

Background:  Food record charts (FRCs) are routinely used to monitor and assess the oral intake of patients deemed to be at nutritional ‘risk’. These charts are normally completed by nursing staff and are subsequently used to inform and direct dietetic treatment plans. However, there is no evidence on the validity of the qualitative and quantitative information recorded on FRCs. A pilot study in two stages was undertaken; first, to examine the qualitative information recorded and, second, to qualitatively evaluate information recorded on the FRC using weighed food intake methodology in a comparative analysis. Methods:  Stage 1 focused on appraising the quality of information recorded on FRCs. Twenty FRC that were completed by nursing staff were arbitrarily scored out of 10, with two points assigned for detailed recording at each meal time (breakfast, lunch and evening meal) and one point for snacks (mid morning, mid afternoon and supper). A further discretionary point was awarded if the chart clearly identified the types of food and fluids consumed at two or more meal times. Stage 2 examined patients’ estimated energy intakes derived from FRCs for one meal (lunch) in 20 randomly selected patients and compared this with the energy intakes derived from weighed intake for the same meal (WISP Tinuviel software, Anglesey, UK). To eliminate bias, one dietitian was responsible for the analysis of FRCs and another undertook the weighed intake component. Results are expressed as median (IQR), and a Wilcoxon rank test was used in pairwise comparisons and a Spearman's rank correlation to examine the association between variables. Results:  None of the 20 FRC were completed to the extent that they provided sufficient information for full interpretation [median 5 (IQR = 5)]. There was no significant difference between energy intake estimated from FRC or weighed intake for the one meal studied [estimated intake 961 kJ (230 kcal) (IQR = 794 kJ); measured intake 1421 kJ (340 kcal) (IQR = 949 kJ)]. However, no relationship between estimated and measured energy intake ( r  = 0.42) was observed. Discussion:  The lack of consistency in statistical results may in part be derived from the relatively small patient numbers studied at only one meal episode. The rationale for the study design was partly dictated by the available resources for undertaking this study. Although no differences in energy intake derived by either method were observed, this is at odds with the poor completion rate of FRC and the lack of an association between FRC and weighed intake. This study suggests that FRCs may be of little value in nutritional assessment, which is of some concern because their completion puts increased demands on staff to provide information that is potentially of little value. Furthermore, FRCs are used in informing clinical decision‐making for patient intervention strategies. Conclusions:  This small study has acted to direct future work in this area where undertaking a more robust study (including power calculation) would add value to the process. The incompleteness of FRC completed by staff is an area of immediate concern but, with the imminent implementation of Food, Fluid and Nutritional Care Standards, this may be timely in terms of re‐evaluation.