Dorine T. Lam


Poor adherence to dietary instructions is a critical problem in nutritional care. This study points out the level of adherence that can be achieved over a relatively long period of time among chronically ill outpatients and the usefulness of the 24-hour recall and a food frequency questionnaire in assessing compliance.

Twenty two rheumatoid arthritis patients volunteered to enroll in this pilot diet study, fifteen remained with the study for the stipulated period of 18 months. The study consisted of three parts: an initial six month baseline period (Period I), a six-month experimental period (Period II) in which the patients' diet was altered, and a final six-month baseline period (Period III). The patients were scheduled for return visits every two months.

The dietary plans were individualized to conform as closely as possible to the subject's lifestyle and were designed to provide 13% of the kilocalories as protein, 30% of the kilocalories as fat and be restricted in added sugar to 24 grams (six teaspoons) per week. Both 24- hour recalls and food frequency questionnaires were used here as assessment tools.

Repeated measures analysis of variance test showed significant differences in mean daily intakes of protein, fat and sugar between the three periods. Similar results were obtained from both the 24-hour recalls and the food frequency questionnaires. The modified least significant difference method of pairwise multiple comparison, showed that Period II is different from Period I in all the nutrients analysized.

The correlation analysis to compare dietary intake data obtained by 24-hour recalls and the food frequency questionnaires at the initial month 8 and month 14 showed few statistically significant correlations primarily because of small sample size.

The patients were instructed to return to their original diet during Period III to minimize bias and the placebo effect and to maximize the accuracy of the statistics. Although 80 percent of the patients failed to reach complete dietary adherence but significant reduction in intake of protein, fat and sugar were achieved during the experimental period.




Graduate School

First Advisor

Irma B. Vyhmeister

Second Advisor

Edwin H. Krick

Third Advisor

David E. Abbey

Fourth Advisor

Ella Hasso-Haddad

Degree Name

Master of Science (MS)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Diet; Arthritis, Rheumatoid



Page Count

iii; 65

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website


Loma Linda University. Del E. Webb Memorial Library. University Archives