or metabolism of foods and nutrients) do not. FFQs and biomarkers provide infor- mation about a person’s usual intake and nutrient utilization, respectively, which may be necessary in some cases. Other considerations when choosing a method of dietary assessment include the available resources, patient characteristics (24- hour recall is beneficial for those with low literacy levels), patient burden, and goals of dietary assessment. Notably, food diaries support self-monitoring efforts, which is important for achieving long-term dietary changes.35 In addition to the more comprehensive dietary screening tools already described, brief dietary screening tools are also available that can be valuable in clinical settings. More frequent dietary screening in clinical settings can increase referrals to RDNs for individuals who require more intensive dietary counseling for weight loss. Furthermore, it can enhance recommendations for evidence-based dietary strategies that promote cardiometabolic health, potentially reducing the influence of nutrition misinformation on people’s dietary habits. Though the screening tool selected may vary with practice setting, brief dietary screening in primary care settings by other clinicians and members of the health care team may enhance clinical practice for RDNs.16


In addition, some evidence suggests that


simple dietary guidance using results from a dietary screener in a mobile-health intervention can still promote positive dietary changes.36 Beyond food intake, many other factors related to diet and health behaviors should be assessed when evaluating a patient’s diet. These elements are summa- rized in Box 7.3 on page 106.37-40


Food Access, Food Security, and Dietary Intake


Food choice, dietary intake, and diet quality are shaped by many factors in our broader food environment, making it essential for RDNs to assess various social and environmental determinants of diet quality and health. Food security is defined by the United Nations Committee on World Food Security to mean that, “all people, at all times, have physical, social, and economic access to sufficient, safe, and nutri- tious food that meets their food preferences and dietary needs for an active and healthy life.”41


This holistic definition underscores the global and complex nature


of food security, which is influenced by climate change, agricultural practices, and global food trade and policy, as well as food prices, food availability and access, and food processing. Yet, at the personal level, this definition reminds clinicians that an individual’s ability to consume a healthy dietary pattern is markedly affected by income, food availability and cost, and varied cultural preferences. Although screening tools for food insecurity, such as the US Household Food Security Survey Module are available for clinical use,40,42


starting a conversation with patients


about the broader dimensions of food access and availability may be helpful before making dietary recommendations. Food access and availability are often overlooked dimensions of food security.


More recently, the importance of assessing nutrition security (“an individual or household condition of having equitable and stable availability access, affordability, and utilization of foods and beverages that promote well-being and prevent and treat disease”) rather than food security has gained recognition, given that diet is the leading contributor to cardiometabolic disease.43


Processed, energy-dense foods,


most of which are heavily marketed, shelf-stable, highly palatable, and inexpensive due to their subsidized production, are widely available in the broader food environ- ment (and, hence, promote excess consumption) and are implicated in obesity.44


In


comparison, foods that are less energy-dense and more nutrient-rich, such as fruits and vegetables, are more expensive, often unavailable, perishable, and require more preparation, all of which contribute to making them less frequently consumed.


CHAPTER 7: Nutrition Assessment 105


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