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Effective and consistent dietary intervention during lipid-altering clinical drug trials requires reliable techniques for food-intake monitoring. Food-record rating has been used as a diet-monitoring tool in numerous studies since its development for the Multiple Risk Factor Intervention Trial (MRFIT). Food-record rating uses a modified version of the Keys equation to score foods according to their ability to alter blood lipid levels (1).
During the past several years, the food-record rating system has been criticized for several reasons. Complexities in scoring rules often lead to inconsistent scores, and food-record rating does not reflect current research on the effect of dietary fat on blood cholesterol. Specifically, scores are lowered if large amounts of polyunsaturated fats are consumed, mono-unsaturated fats are omitted from the scoring equation, and saturated fat and total dietary fat intakes are not evaluated. As a result, it is difficult to assess dietary adherence to the National Cholesterol Education Program (NCEP) step 1 or step 2 guidelines of [less than or equal to]30% energy from fat (2).
Another problem is that the score remains constant regardless of energy or fat requirements. Perhaps most importantly, teaching subjects to monitor their own dietary intake is often difficult because of the complexities of scoring. As a result, subjects are hindered in their efforts to increase their knowledge about food intake and diet adherence.
Monitoring dietary adherence using fat-gram counting may be a simpler and more effective technique than food-record rating. Fat-gram counting has been used successfully in cancer prevention trials in which participants follow a diet of 20% of energy from fat (3,4). It uses information that is readily available and is easily taught to subjects for use between clinic visits. It is an excellent self-monitoring technique, and can be readily standardized for use among dietitians. When scored manually, fat-gram counting can be used with subjects during a clinic visit without the need for a computer.
Table 1 Abbreviated list of calculated fat-gram values for fat-gram scoring procedure Food item Serving size Fat (g) Meat Medium fat fish (eg, catfish, bass) 1 oz 1 Poultry, light meat (skinless) 1 oz 1 Poultry, dark meat (skinless) 1 oz 3 Extra lean ground beef 1 oz 4 Regular ground beef (30% fat) 1 oz 9 Mixed dishes Spanish rice 1/2 cup 5 Carrot salad 1/2 cup 8 Stuffing 1/2 cup 10 Chili with meat and beans, canned 1/2 cup 12 Dairy foods Milk, 1% fat 1 cup 3 …