Food record charts (2024)

Food record charts can provide the essential information that forms the basis of a nutritional assessment and help to determine subsequent treatment plans. They are therefore a valuable resource for dietitians, nurses and ultimately the patient.

It is very difficult to assess a person’s nutritional intake precisely. Our diet is hugely variable and affected by many different things. However, when someone is in hospital their intake usually becomes more restricted due to factors such as their medical condition, symptoms, medications and their access to foods and cooking facilities. The existence of such constraints would suggest that it is easy to establish exactly what a person is managing to eat and drink during the day. However, establishing accurate information on nutritional intake is a challenge.

Why we use food record charts

A food record chart aims to record quantitatively all food and drinks consumed as accurately as possible. Of course, there are fundamental problems with this type of assessment. This includes the interpretation of portion sizes - for example, ‘ate a big bowl of cornflakes’ does not really provide sufficient information to go on and estimate nutritional intake. A more accurate measurement is required.

Reliability of the information is another potential problem, owing to the inclusion of foods not actually consumed or omission of foods that were. In some situations patients may not be either willing or able to provide accurate information.

However, even when considering some of these potential difficulties, evidence suggests that food record charts can play a useful role in the nutritional assessment of a patient. Such contemporary record-keeping has been shown to provide more accurate information than methods involving recall. This is probably because memory is involved in the latter (Kroke et al, 1999). Food record charts compare favourably to other methods of questioning, such as food frequency questionnaires (Cann et al, 1999).

How food record charts fit in with other assessment tools

Screening should be linked to a plan of care, and this may include the use of food record charts.

There are numerous screening tools used in a variety of different settings. One of the most recognised is that produced by the British Association for Parenteral and Enteral Nutrition (Sizer, 1996), which has produced a screening tool to help detect patients at risk of malnutrition. The BAPEN tool is straightforward and easy to complete, comprising of four basic measurements:

- Normal weight;

- Body mass index (BMI);

- Any unintentional weight loss in the past six months;

- Any reduction in intake in the past six months.

The resulting score indicates the most appropriate intervention. This could range from:

- No intervention at present;

- Keeping weekly weight charts;

- Starting food record charts;

- Helping the patient choose appropriate menu choices, such as high protein or energy-dense or soft foods;

- Offering additional foods, such as milky drinks, toast, cereals, cakes, dependent on ward facilities;

- Offering supplements;

- Referring to dietitian or nutrition team.

Yet it has been reported that less than 50% of patients are weighed or have any form of nutritional assessment undertaken on admission (McWhirter and Pennington, 1994). The screening tool needs to be reproducible as well as quick and easy to complete. It should also include appropriate action plans that should be instigated, depending on scores (that is, the degree of risk of malnutrition). The information it provides is essential in the nutritional assessment of a patient. Such screening and monitoring of food intake are suggested as best practice in Essence of Care (Department of Health, 2001). Therefore, well maintained food record charts could be used as evidence for an A score in the food and nutrition benchmark.

When should a food record chart be started?

The result of the patient’s initial nutritional screening will determine if a food record chart should be started. This highlights the importance of having (and completing) a screening tool to enable an objective opinion to be formed of a patient’s nutritional status and to ensure that consistent and appropriate intervention is instigated. It must be remembered that surveys suggest that between 20-50% of hospital patients are malnourished (McWhirter and Pennington, 1994).

Food record charts should be started in all situations where there is any concern that a person’s intake may be inadequate. They need to be completed as evidence to prompt a more formalised assessment of intake.

Food record charts are helpful in patients who, for example, have a BMI below the normal range (20-25), a history of recent unintentional weight loss, poor/no appetite or physical problems, such as swallowing difficulties.

Questions need to be asked before determining whether keeping a food record chart would be of any value at all. However, if a patient is referred to the dietitian because of poor appetite, such information will be required. An accurate picture of exactly what a patient is currently eating is often useful, if not essential.

How long should food record charts be kept?

The menu choices available as well as a patient’s symptoms combine to determine the length of time information needs to be recorded to provide a meaningful and accurate assessment of intake. Some research suggests that information should be collected over at least seven days in order to estimate protein and energy intake to within +/-10% (Bingham, 1987).

A preferred approach is to ask that food intake is recorded for two to three days and then repeating this at a later time. It is considered acceptable (or even preferred in some situations), where patients are willing and able, for them to complete food record charts themselves, rather than staff. However, the nurse is clearly accountable for allowing the delegation of this work. The nurse, patient and dietitian need to negotiate this activity and the patient will need to be taught and supervised.

If the information contained in the food record chart is in sufficient detail, it can be used to:

- Determine nutritional intake;

- Assess adequacy of intake;

- Quantify nutritional deficits (if any);

- Determine dietetic intervention plan and goals.

Conclusion

While it must be acknowledged that there are potential problems with food record charts (including accuracy and subjectivity), their simplicity makes them a useful tool when used in conjunction with other nutritional assessment tools. When completed accurately food record charts provide information essential to nutritional intervention. They should only be started on appropriate patients, be easy to complete and be kept for a predetermined length of time. Those asked to keep food record charts should be aware of their aim. Only then can they be seen as a useful tool for gathering objective, evidence-based information and as an essential component of a nutritional assessment.