Case Studies

The Eleventh NASA Expedition to the International Space Station

Nutrition is critical during long space flight missions. Loss of body weight is frequently observed, often accompanied by loss of muscle mass and bone. Other concerns include consumption of too little water, and of too much sodium and iron.

During space flight, it is critical that astronauts obtain enough calories to maintain body weight, enough protein to preserve muscle mass, enough calcium for bone health, and enough water. In earlier space flights before the International Space Station, astronauts lost weight during the mission, but there was no real-time way to counsel them about their nutrient intake during the mission. Consequently, NASA set about to test whether a simple, brief method could be developed that could provide real-time information about what crew members were eating.

Nutritionquest was approached to develop such a method. It was rigorously tested in a "chamber test", designed by Dr. Scott M. Smith of NASA's Human Adaptation and Countermeasures Office. In the chamber test, volunteers remained in a closed environment resembling the Space Station for 60 and then 90 days. All food consumption was known, and closely resembled the food that would be provided on the Space Station. Multiple weighed five-day food records were obtained. This research is described at

Following those successful tests, a Space Flight Food Frequency Questionnaire designed by Nutritionquest has flown with each successive International Space Station Expedition. A new questionnaire is developed for each Expedition, to take into account the specific foods that will be flown with that Expedition. Missions always include Russian as well as US foods, and these are incorporated into each Expedition questionnaire. The space food system is described at

Astronauts complete the questionnaire once a week, electronically, to report what foods they have eaten during the previous week. The results are sent electronically to the ground, and mission specialists examine the data immediately so that they can recommend ways that the astronauts can improve their dietary intake. An example of the value of this approach is described in a journal article by Scott M. Smith in The Journal of Nutrition, 135:437-443, 2005. The article reports that for one astronaut, "Dietary counseling was provided for this subject after wk 5 because energy intake had been consistently low. At landing, this subject's weight was not substantially less than it was before the flight." We are proud and gratified that our questionnaires and services have had such a direct, tangible benefit to real people!

Nutrition prior to space flight is also carefully assessed by NASA. Extensive dietary and nutritional status tests are performed by NASA on astronauts embarking on space flight. One of these measures is the Block98 Food Frequency Questionnaire.

Case Study: The Sister Study – NIH/NIEHS

The Sister Study is a landmark NIEHS project providing a large-scale evaluation of women ages 35 to 74 who have never had breast cancer themselves but whose biological sister was diagnosed with the disease. Investigators are examining how environment (including dietary intake) and genes affect the chances of getting breast cancer. Over 50,000 women have participated.

NutritionQuest collaborated with Sister Study investigators to develop a tailored paper-and-pencil FFQ appropriate for the study population. Then, in order to produce nutrient estimates from FFQ data most accurately reflecting dietary intake for this population, we also developed a tailored analysis, with a modified nutrient database and suitably modified computational algorithms. The nutrient database was modified to incorporate the latest available data from USDA. We also worked with investigators to produce a tailored format for the summary nutrition reports provided to participants. Collection and analysis of nutrient intake data for this large-scale study is nearing completion.

For the Sister Two Study, a follow-up project, NutritionQuest is continuing to work with this team of investigators. This study is focusing on 1,600 women with young-onset breast cancer. NutritionQuest will again provide a tailored FFQ with an appropriately modified analysis protocol for dietary assessment of study participants.

Case Study: Guide to Health Project – Virginia Tech

Investigators at Virginia Tech are researching how an Internet program for inactive adults can improve their nutrition habits, increase their physical activity through walking and prevent them from gaining weight. They are asking participants to take a series of three assessments, of which one component is completion of a food questionnaire. NutritionQuest collaborated with these investigators to modify the full-length Block 2005 FFQ and tailor the feedback provided to study participants.

The project is using NutritionQuest's Data-on-Demand System to collect, analyze and manage data for this large-scale, multiphase research project. Two ways in which this study makes effective use of the online system: Respondents self-administer the electronic FFQ online in their own homes, using their own computers. Then data collected each day is passed at night to the Virginia Tech study's server and imported automatically into the investigators' database for statistical analysis.

Case Study: Preventive Cardiology Care – Stanford University

The Preventive Cardiology Clinic at Stanford's School of Medicine, Prevention Research Center, is using the full-length Block 2005 FFQ in electronic format to produce dietary assessment data for their patients. Because data analysis is completed online by the Data-on-Demand System, the staff clinical dietitian can immediately access results and print out a summary nutrition report comparing patient intake estimates with national standards for energy (kcal) and a variety of nutrients.


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