Effectiveness of the US Department of Agriculture 5-step multiple-pass method in assessing food intake in obese and nonobese women1–3

Background: National surveys of food intake rely on the 24-h dietary recall method for assessing the nutrient intakes of Americans. Objectives: This observational validation study was conducted under controlled conditions to test the effectiveness of the US Department of Agriculture (USDA) 5-step multiple-pass method for dietary recall; to test the ability of normal weight, overweight, and obese women to recall food intake; and to test the accuracy of macronutrient recall. Design: Women (n = 49) aged 21–65 y with a body mass index (in kg/m2) of 20–45 selected all meals and snacks for 1 d from a wide variety of foods. A 24-h dietary recall with the use of the USDA 5-step multiple-pass method was administered by telephone the following day. Analysis of variance and covariance tested the overall accuracy of recall and the effect of BMI on dietary recall. Results: As a population, the women overestimated their energy and carbohydrate intakes by 8–10%. No significant differences between mean actual and recalled intakes of energy and the macronutrients were observed in the obese women. Normalweight and overweight women significantly (P < 0.01) overestimated their energy, protein, and carbohydrate intakes. Recalled fat intake was not significantly different from actual intake in women across the BMI range studied. Conclusions: The USDA 5-step multiple-pass method effectively assessed mean energy intake within 10% of mean actual intake on the previous day. Obese women more accurately recalled food intake than did overweight and normal-weight women despite undereating on the day of the study. Am J Clin Nutr 2003;77:1171–8.