Research
The eating pattern assessment tool: A simple instrument for assessing dietary fat and cholesterol intake☆

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Abstract

Objective This study describes the development of the self-administered Eating Pattern Assessment Tool (EPAT), which is designed to assess dietary fat and cholesterol intake and acid patients and health professionals in achieving control of blood cholesterol levels.

Design Test-retest reliability of the instrument over five visits and concurrent validity testing compared with 4-day food records.

Setting and sample The instrument was tested at multiple sites of a large manufacturing corporation using 436 adult volunteers with approximately equal proportions of men and women from three socioeconomic levels.

Main outcome measure Development of the EPAT centered on creating an instrument that was simple and easy to use in a primary-care setting, that would provide a reliable assessment of intake of dietary fat and cholesterol among adults, and that would measure frequency of consumption of foods from high-fat and low-fat categories.

Analyses test-retest reliability for repeated use was estimated by between-visit Pearson product-moment correlations of EPAT section scores. Concurrent validity was assessed by using product-moment correlation between EPAT section scores and mean daily B-scores obtained from 4-day food records.

Results Test-retest reliability estimates were 0.91 between all adjacent pairs of visits and 0.83 between visits 1 and 5 (4 months). Validity was 0.56.

Applications/conclusions The EPAT is a simple, quick, self-administered tool using an easy scoring method for accurately assessing fat and cholesterol intake. It is a reliable and valid substitute for more time-consuming food records. EPAT also provides an efficient way to monitor eating patterns of patients over time and is arranged to provide an educational message that reinforces the consumption of recommended types and numbers of servings of low-fat foods.

Section snippets

DESIGN OF THE EPAT

The EPAT is a self-administered food frequency questionnaire divided into two sections. Section 1 contains 12 questions that assess intake of foods characterized by high fat and cholesterol content; section 2 has 11 questions and contains lower-fat food groupings as an alternative to those in section 1 (Figure 1). The EPAT is designed to achieve three primary goals: (a) assess the overall intake of dietary fat and cholesterol; (b) assess the frequency with which a person eats foods within each

DEVELOPMENT OF THE EPAT

EPAT was designed to be an instrument that was simple and easy to use in a primary-care setting. Therefore, it needed to be inexpensive, require only a few minutes to complete, allow for self-administration, and provide a reliable assessment of adult eating habits. An additional goal was to incorporate an implicit educational message into its design to encourage patients to decrease the frequency of consuming high-fat or high-cholesterol foods and increase the consumption of low-fat

METHODS

This study was designed to investigate the reliability, concurrent validity, and content validity of the EPAT as related to the first and third primary goals of the EPAT previously described. That is, we examined the ability (reliability and concurrent validity) of the EPAT to assess the overall intake of dietary fat and cholesterol. We also determined whether the implicitly recommended diet designed into the EPAT (ie, the educational message) is, in fact, both low-fat and nutritionally

STUDY DESIGN

Reliability and validity testing were done using a repeated measures design with individuals completing the EPAT at five visits (V1, V2, V3, V4, V5). Subjects (N=436) were blue-collar and white-collar employees randomly selected from volunteers in a large corporation during 1987 (16). Volunteers were stratified into 12 sampling cells on the basis of age, gender, and socioeconomic status. A monetary incentive was provided as an impetus to complete all five visits. Visits were scheduled at weeks

RESULTS

The number of subjects selected from each cell exceeded the sample size for conventionally precise reliability and validity estimates (α = 0.05 and 1 − β = 0.80; Table 1). Mean time intervals between week 0 and the last four visits were 1.1, 4.3, 12.7, and 17.1 weeks, respectively. The mean (±standard deviation) time required to complete the EPAT was 11±4 minutes. Scores for the criterion reference (B-scores based on 4-day food records collected between V4 and V5) ranged from 0.9 to 114.3

DISCUSSION

The current NCEP recommendations are such that the step 1 diet can be implemented by a wide range of health professionals who are not trained dietitians. If the patient does not achieve target goals or requires the step 2 diet, referral to a dietitian is recommended. The EPAT, which does not require a trained dietitian for accurate scoring, is designed for use in primary-care clinics, and most health professionals can be quickly trained in both administering and scoring this instrument. Its

APPLICATIONS

The EPAT is a simple, quick, self-administered tool for assessing fat and cholesterol intake. It is a reliable and valid substitute for more time-consuming food records. Because EPAT is easily scored, it gives the patient numbers to use as measures of progress. The tool also provides an efficient way to monitor eating patterns of patients over time. An adequately nutritious diet similar to, though not exactly like, the NCEP step 1 and step 2 diets is implicitly recommended in EPAT.

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    ☆

    The research was supported, in part, by NIH Grant No. 5R01-HL 36889.

    1

    Currently, she is a professor and the chair in the Department of Nutrition and Dietetics, College of Health Sciences, Georgia State University, Atlanta.

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    Copyright © 1994 The American Dietetic Association. Published by Elsevier Inc. All rights reserved.