Picture Your Plate^TM is a brief (48-question) food frequency questionnaire developed to evaluate how well an individual’s diet aligns with current evidence-based recommendations for a dietary pattern that reduces cardiovascular disease risk and promotes overall health. Picture Your Plate provides a total score ranging from 0 to 96, and sub-scores for specific categories of food choices.

This tool was designed to meet cardiac rehabilitation programs’ needs for content and ease of use (including only 15-20 minutes to administer) and has been validated in a cardiac rehab population. It is one of the dietary assessment tools authorized for tracking cardiac rehab outcomes in the program registry of the American Association of Cardiovascular and Pulmonary Rehabilitation. However, this tool is also useful in a variety of other settings, since it fits with overall nutrition recommendations and is not aligned with any single dietary pattern.

Please scroll below to “References” for published research on the validation of this tool and the association of scores with recognized indexes of dietary pattern quality.

Scoring of this food frequency questionnaire awards points for food choices that support a plant-focused dietary pattern that:

• Emphasizes vegetables, fruits, whole grains, and other high-fiber foods;
• Limits foods high in saturated fat, added sugars (including sugar-sweetened beverages), and sodium;
• And allows for a range of unsaturated fat intake that is reflective of current dietary guidelines.

Picture Your Plate does not directly address overall caloric intake, but it does address several categories of calorie-dense foods that can promote excessive calorie consumption.

Total score is associated with recognized dietary pattern indexes that score diet quality. Guidance on scoring is included in the scoring worksheet provided below, which can also be used to evaluate change in scores over time. Interpretation of scores is addressed in the document “Interim Guidance for Interpreting PYP Scores.”

Category sub-scores: In the context of nutrition counseling, Picture Your Plate category sub-scores can be used to guide inform discussions about identifying food choices that may benefit from further attention. However, their precision in evaluating the quality of intake within each food category is limited compared to a longer and more detailed food frequency questionnaire (unpublished data from Aberegg et al., 2020 validation study below), so category sub-scores are not recommended as dietary assessment outcomes themselves.

Picture Your Plate is available at no cost.

It is a copyrighted document. However, the authors grant permission to use Picture Your Plate as long as the following conditions are met:

• Print format: Picture Your Plate may be printed for use only if the tool is used in its entirety and without changes. This is important to maintain a consistent tool for potential future research.

• Electronic format: Picture Your Plate may be used in an electronic patient care portal, electronic health record, or other private online platform only under the following conditions:
• Picture Your Plate must be used in its entirety without changes in content or structure, including the copyright permission statement and version number.
• Use of Picture Your Plate via your electronic patient portal does not make Picture Your Plate the property of your institution or of your electronic patient portal company.
• To support staff ability to interpret and use these scores appropriately, they will see some reminder of how to view or access the two support documents we have developed: the scoring worksheet for calculating a score and the interim guidance on interpreting scores.

Picture Your Plate was developed by Karen K. Collins, MS, RDN, CDN, FAND and Ellen S. Aberegg MA, LD, RDN, FAACVPR, in collaboration with two dietitians specializing in cardiac rehabilitation, Judith M. Hinderliter, MPH, RD and Sharon L. Smalling, MPH, RD, LD.

It is a revision of the Dietary Risk Assessment (DRA) tool developed by Alice S. Ammerman, DrPH, and Thomas C. Keyserling, MD, MPH. The DRA was originally published in 1991. This revision was undertaken with their permission, and they were actively involved in its validation study (see below). Picture Your Plate was developed as a revision of a previous DRA tool to better reflect current major nutrition recommendations for cardiovascular and overall health.

Picture Your Plate

Aberegg ES, Collins KK, Hinderliter JM, Smalling SL, Fung TT, Gizlice Z, Johnston LF, Ammerman AS, Keyserling TC. Validity and Reliability of a Brief Dietary Assessment Questionnaire in a Cardiac Rehabilitation Program. J Cardiopulm Rehabil Prev. 2020;40(4):280-283. doi:10.1097/HCR.0000000000000505

Dietary Risk Assessment (DRA) Earlier Versions

Ammerman AS, Haines PS, DeVellis RF, et al. A brief dietary assessment to guide cholesterol reduction in low-income individuals: design and validation. J Am Diet Assoc. 1991;91(11):1385-1390.

Jilcott SB, Keyserling TC, Samuel-Hodge CD, Johnston LF, Gross MD, Ammerman AS. Validation of a brief dietary assessment to guide counseling for cardiovascular disease risk reduction in an underserved population. J Am Diet Assoc. 2007;107(2):246-255.

Rosamond WD, Ammerman AS, Holliday JL, et al. Cardiovascular disease risk factor intervention in low-income women: the North Carolina WISEWOMAN project. Prev Med. 2000;31(4):370-379.