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1. DIETARY ASSESSMENT By Lalita Bhattacharjee Nutritionist
Training on Assessment of Nutritional Status 18-22 December 2011
Date : 21 December 2011 Venue: FPMU Meeting Room The Training is
organized by the National National Food Policy Capacity
Strengthening Programme (NFPCSP) . The NFPCSP is jointly
implemented by the Food Planning and Monitoring Unit (FPMU),
Ministry of Food and DisasterManagement and Food and Agriculture
Organization of the United Nations (FAO) with the financial support
of the EU and USAID.
2. Whoever was the father of adisease, an ill diet was the
mother!
3. OUTLINE Introduction Determinants of food intake and
nutritional status National and household food consumption surveys
Assessment of individual food and nutrient intakes and nutrient
adequacy Food frequency questionnaires, Rapid methods of dietary
assessment Validation and Reliability Recommended dietary intake
and evaluating nutrient intakes Conclusion
4. OPTIMAL NUTRITIONALSTATUS Source: Mahan and Stump, 2000
5. DIETARY ASSESSMENT ANDNUTRITIONAL ASSESSMENT : KEY TERMS A
DIETARY ASSESMENT : comprehensive evaluation of a persons food
intake. It is one of the established methods of nutritional
assessment. Dietary assessment techniques range from food records
to questionnaires and biological markers. NUTRITIONAL ASSESSMENT :
more comprehensive and includes determining nutritional status by
analyzing the individuals brief socio economic background, medical
history, dietary, anthropometric, biochemical, clinical data and
drug nutrient interactions NUTRITIONAL STATUS : measurement of the
extent to which an individuals physiologic need for nutrients is
being met NUTRIENT INTAKE : depends on actual food consumption
which is influenced by factors such as economic situation, eating
behaviour, emotional climate, cultural influences, effects of
disease states on appetite and the ability to absorb nutrients
NUTRIENT REQUIREMENTS : are determined and influenced by age, sex,
BMR, physiological status, activity patterns, physiologic
6. Dimensions and methods forassessing food security and
undernutrition Methods Availability Access to Consumption
Utilization of food food of food of nutrients FAO Method Household
income& expenditure surveysIndividual food consumption/intake
surveysAnthropometry Qualitative measures of food security
7. Development of clinical deficiency withcorresponding
dietary, biochemical and clinical evaluation
8. Methods of assessing dietaryintake National food supply data
Household data Individual data (Food records, 24 hr dietary recall,
FFQs, diet histories, food habit questionnaires, combined methods
RAP - rapid assessment procedure ( focus groups to gather
information on food behaviours, beliefs and intakes)
9. National and household food consumption Food consumption
data collected at national, HH or individual levels Individual
intake data required for assessing nutrient adequacy Food supply
and HH data can provide useful information Food consumption
assessment at national level based on FBS ( per capita
availability, no individual variation in food intake) Food supply
data useful
12. (En%) of cereals and rice to Bangladesh dietSource/Year
Energy Cereal (g) Rice (g) intake (kcal) En % En % 452 440HIES 2005
2238 70% 68% 442 416HIES 2010 2318 66% 64%
13. DIETARY ASSESSMENT PRINCIPLESAdequacy : a diet that
provides enough energy and nutrients to meet the needs according to
the recommended dietary intakes/allowances (for healthy and active
life)Balance : a diet that provides enough, but not too much of
eachtype of food ( adequacy of basic food groups)Variety : a diet
that includes a wide selection of foods within eachfood group
(dietary diversity/ includes biodiversity species, varieties,
cultivars)Nutrient Density : a diet that includes foods that
provide the most nutrients for the least number of calories
(nutrient dense foods)Moderation : A diet that limits intake of
foods high in sugar and fat (nutrient intake goals/guidelines)
14. Methods of obtaining dietaryintake dataMethod Advantages
DisadvantagesNutrient intake analysis Allows actual observation May
yield inconsistent and of food intake subjective estimates of food
consumption; possible variation in portion sizeDaily food record or
diary Provides daily record of Variable literacy skills of food
consumption; can participants; requires provide information on
ability to measure or judge quantity of food; how food portion
sizes; actual food is prepared; and timing of intake possibly
influenced meals and snacks by the recording process; questionable
reliability of recordsFood frequency Easily standardized; can
Requires literacy skills; be beneficial when does not provide meal
considered in combination pattern data; requires with usual intake;
provides knowledge of portion sizes overall picture of intake24
Hour Recall Quick, easy Relies on memory
15. Assessment of individual intakes Dietary records Record all
foods and beverages consumed over a specific time period (3-4 d)
Amount consumed determined by weighing with a scale or measuring
volume using standard cups and spoons Specific/special foods may be
recorded (fat, vitamin A, iron rich) Total energy intake will
require all foods to be recorded.
16. Food Diary : DAYMeal Foods ( list Amount How Where eaten )
eaten prepared (home, work, etc)BreakfastSnackLunchTeaDinnerFood
supplements : Name (cans/d)Vitamins/minerals supplement :.
17. Assessment of individual intakesDiet history Collection of
information on frequency of intake of various foods and usual meal
pattern Entails detailed listing of foods and beverages consumed at
each eating session 3 d - diet record as an independent check on
food intake Methods of preparation
18. Assessment of individual intakes : 24 dieta Get an accurate
and complete listing of all food/drink individual consumed within
last 24 hrs Specifically: What food/drink was consumed? How much
was consumed? Time it was consumed? How was it prepared? How was it
served? Details of food (e.g low fat, 1%, whole, milk powder,
preparation, )
19. Assessment of individual intakes24 hour recall : Recall all
the foods and beverages consumed the previous day or 24 hours prior
to the interview Interviewers should be knowledgeable about foods
available in the market Regional and ethnic preparations and
methods Interview conducted face to-face, structured w/o probing
questions Estimates of portion size are made using standardized
cups and spoons Record of food amounts converted into nutrient
intakes using food composition tables
20. Assessment of individualintakesFood frequency questionnaire
(FFQ) Report usual frequency of consumption of each food item from
a list of food items in reference to a specified period (past
wk/mo/yr) Face to face interview, telephone or by self
administration Describes dietary patterns or food habits not
nutrient intake Semi quantified tools can obtain information on
portion size using household measures
21. FFQ - Examples : For each item indicate with a check mark
the category that best describes the frequency with which you
usually eat that particular food; complete questionnaire might
contain more than 100 items Food item > 1/d 1/d 3-6 1-2/wk 2/mth
or Never times/wk lessBeefFishLiverPoultryEggsDried beansGreen
leafyvegetablesEnter other foods not listed thatare eaten
regularly1.-------------2. -------------3. -----------
22. Example of semi quantitative FFQFood Medium Serving How
often ? serving S M L D W M Y NApples, apple 1 or sauce cupBanana 1
mediumPapaya mediumWater melon 1 sliceOrange 1 mediumBel juice 6 oz
glassCoconut water 4 oz glass
23. Relative risk of lung cancer according to categories of
baseline carotenoid and fruit + vegetable intake Quintile of
nutrient or Median Relative risk intake/d (n)Carotenoids (mcg)1 (
< 2770) ( 397) 2170 1.002 ( 2770-3786) (364) 3281 0.943 (3787
4988) (320) 4344 0.804 (4989 6792) (276) 5777 0.705 ( > 6792)
(287) 8577 0.72 P for trend < 0.0001Fruits + vegetables (g)1 (
< 116 ) 407 80 1.002 ( 116-176) 362 147 0.883 ( 177 241 ) 326
207 0.794 ( 242 332) 293 280 0.715 ( > 332) ( 256) 415 0.64 Amer
J Epidemiol (2002) 156: 536 -547
24. Estimating average intake of nutrients Specification of
portion size standardized portions (Willet ) Description of portion
size small, medium, large (Block) Information on frequency and
serving size allows for estimating nutrient intakes Food list
should contain foods that contribute to majority of the
nutrients/specific in the diet (represent 75% of the nutrient
intake selected nutrients) % adequacy of food groups % adequacy of
RDA for energy and nutrients including micronutrients Used in
epidemiological research to study diet disease relationships
25. Rapid methods for community dietary assessment Dietary
assessment of development of culture - HHs with children under 5s
specific relevant food usage list Rapid assessment survey (focus
group interviews, Linking food intake data with weighing /measuring
of selected target group children & mother interviews IYCF
practices, Derive mothers BMI from Social customs and food standard
tables beliefs, behaviours & intakes Key informants community
leaders, local shop owners or health personnel Small clusters of
women 5-6 women sufficient for FGD
26. Strengths and limitations of dietary
assessmentmethodsMethod Strengths LimitationsFood record Does not
rely on memory; open ended High participation burden; requires
literacy; may alter intake behaviour ( ?? community use )24 hr
recall Immediate recall period, easy to obtain Relies on memory;
requires skilled information; since interviewers interviewer; does
not reflect the usual dietary intake ; tendency to over report
administer tool & records the low intakes and under report high
responses, literacy is not a intakes ( need for food list, std menu
problem, respondent burden minimal; types; need for community based
does not alter intake behavior; wide training ) memory; requires
complexFFQs Inexpensive ; preferred for nutrients range of use
Relies on with high day-to-day variability; does calculations to
estimate frequencies; not alter intake behavior; lower requires
literacy, doe not quantify respondent burden; epidemiological
intake ( need for exhaustive food research to study diet-disease
list; need for manual tally type relationships calculations)Food
habit Rapid &low cost; does not alter intake may rely on
memory; may requirequestionnaire behaviour trained interviewer (
need for food list; std menu types; community based training)
Relies on memory; may requireDiet history No literacy needed;
trained interviewer ( need for food list & community based
training
27. Validation and Reliability of dietarymethods Validity - how
well it measures what it purports to measure (accuracy) Reliability
how well it agrees on retesting under the same conditions
(consistency) Assessment of reliability is feasible , validity
poses a problem Gold standard established dietary record/direct
observation of subjects consumption Reference for validation
28. SOURCES OF ERROR IN DIETARY ASSESSMENT METHODS (INDIVIDUAL
INTAKES)Source of Weighed food Estimated 24 hr recall Dietary
historyerror records food weight and FFQs recordsFCT /recipe + + +
+booksFood coding + + + +Wrong weight _ + + +of foodsReporting
error _ _ + +Variation of + + + _diet with timeWrong _ _ _
+frequencyModified _ _eating patternResponse bias Sampling bias + +
+ Ferro Luzzi in FAO, 2002 Source: Anna +
29. Ranges of nutrient intake goals (WHO/FAO, 2003) Dietary
factor Goal (% of total energy ) Total fat 15-30% Saturated fat
< 10% PUFA 6-10% Trans fatty acids < 1% Total CHO 55 -75%
Free sugars 10% Protein 10-15% Cholesterol