A comparison of three dietary intake assessment tools among patients after sleeve gastrectomy who experience recurrent weight gain

Background Assessing nutritional intake among patients undergoing metabolic bariatric surgery is essential for optimizing outcomes. As estimates vary by assessment method, this study compared agreement between 24-Hour Dietary Recall (24HR), Food Record (FR), and Food Frequency Questionnaire (FFQ) in patients at least two years post-primary sleeve gastrectomy (SG) who experience recurrent weight gain. Methods A cross-sectional analysis was conducted, with data collection encompassing demographics, medical history, anthropometrics, and dietary intake, which was assessed using a 24HR via face-to-face interview with a registered dietitian, a FR completed over three consecutive weekdays, and a FFQ reflecting intake over the previous month. Results A total of 100 participants (76% women) at 7.8±2.8 years post-SG with a mean age of 49.9 ± 11.6 years were included. Their mean BMI and recurrent weight gain from nadir were 33.1±5.4 kg/m² and 25.7±13.4%, respectively. Significant positive correlations were found between intake estimates from all tools for most nutrients. The highest level of agreement was found between 24HR and FR, with Intraclass Correlation Coefficient values ranging from 0.712 (95% CI: 0.571–0.807) for iron intake to 0.867 (95% CI: 0.802–0.911) for protein intake. Bland-Altman plots supported these findings, showing the narrowest limits of agreement for 24HR and FR, and substantially wider limits for FFQ with either tool. Conclusions Agreement between dietary assessment tools varied by nutrient among patients who underwent SG and experienced recurrent weight gain. The strongest and most consistent agreement was observed between 24HR and FR, while FFQ demonstrated lower agreement with both tools.