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DIETARY ASSESSMENT

:
INDIVIDUAL LEVEL

NIA N WIRAWAN
NUTRITIONAL ASSESSMENT COURSE
Nutrition Study Program
Faculty of Medicine Brawijaya University

The Importance for Conducting
Dietary Intakes
Dietary Assessment: assess the first sign of any
nutritional deficiency
 Can be used to predict possible nutrient
deficiency
 Assessing and monitoring food and nutrient
intake
 Formulating and evaluating government health
and agricultural policy
 Conducting epidemiologic research
 Uses for commercial purposes

Level National and Household level Individual level .

Individual Dietary Assessment Method Types of Data Quantitative Daily consumption  weight or volume of food eaten on one day or over a period of days  average daily intake: • Recall •Records Qualitative food habitually eaten Retrospective on food pattern: •Dietary historty •FFQ .

Quantitative and qualitative methods Quantitative methods Qualitative methods:  measure or estimate the  do not assess portion sizes weight or volume of food eaten by an individual or group on one day or over a period of days  Could estimates quantitative usual intake if the number of measuring days is increased so that data on nutrient intakes not available  record the kinds of food habitually eaten by an individual over a period of time in the past  results provide information on the usual food consumption patterns of an individual or group .

FOOD CONSUMPTION AT INDIVIDUAL LEVEL 24-hr recall (single and repeated)  Food records (estimated and weighed)  Food Frequency Questionnaire  Dietary history  .

Study Objective Characteristic of respondents Dieting Motivation Validity and reproducibility of method Available Resources Respondent Burden .

3 repeat are needed Level 3 : Rank intakes of subjects within distribution multiple observations of 24-h recalls/records.Level 1: Mean intake of a group single 24-h recall/food record all days of the week are proportionately represented in final sample Level 2: Population percentage “at risk” to inadequate intakes Repeat 24-h recalls/records at least 2 days on sub sample (30-40) Non-consecutive days (if 2 repeats) If non consecutive. alternative semi-FFQ Level 4: Usual intakes for correlation or counseling •Larger number of replicates required •Alternatively semi FFQ or FFQ or dietary history .

sex. etc 3 •Relationship between frequency of food group (deciles of green leafy vegetables) vs mean level of biomarker •Divide subject into tertiles of nutrient and calculate the corresponding average biomarker level for each tertile 4 •Relationship between nutrient intake of individuals to other indices of nutritional status measured in the same .Level Study Objective 1 •Describe: usual mean nutrient intake for a group •Significant difference in mean/median intake of a group •Change in group mean intake (before – after intervention/paired or unpaired) 2 •Distribution of intake within group  proportion at risk of inadequacy •Change in proportion at risk of inadequacy before and after intervention •Change in proportion at risk between group •Risk of inadequacy in specific sub group defined by SES.

p. 55) LEVEL 2 LEVEL 3 Proportion (%) of population at risk of inadequate intake At least 2 replicates in sub sample (3040 individuals represent age range) if nonconsecutive. or 3 replicates for consecutive Usual intake of individuals for ranking within a group for linking with risk of chronic disease Replicates in all Number of days in Gibson 05 p.LEVEL 1 Mean intake of a group All days of the week equally represented in final sample Number of sample Gibson 05. 57 Usual intake of nutrients in individuals for counseling/ correlation or regression analysis Replicates in all DIETARY HISTORY REPEATED 24 H RECALL/food records SINGLE 24 H RECALL/food record LEVEL 4 SEMI Quantitative FFQ .

Conversion of foods to nutrients 3. Adequacy of nutrient intakes relative to requirements .Particularly applied for quantitative methods 1. Measuring food intakes 2. Estimate of “absorbed” intakes of nutrients 4.

24-HOUR RECALLS .

Principle and use     To assess actual food intake of an individual during previous 24-h period Non consecutive day Can be repeated during seasons of the year to estimate average food intake of individuals over a longer time period Can be conducted for children >=8 years and most adults except person with poor memories .

all days of the week are represented) .Single 24-h recall   Not sufficient to describe an individual’s intake of food and nutrients Single 24-hr recalls used for large scale field studies to characterize average intakes of population groups (subjects are representative.

Repeated 24-h recalls     Can be used to assess usual nutrient intakes for an individual Repeated 24-hr recalls on a sub-group of the population can be used to assess prevalence of inadequate nutrient intakes within each sub-group Nutrient intake data can form the basis of subsequent nutrition education programs If it is not possible to carried repeated measures of all respondents  sub-sample .

Methods  Respondents:     recall all foods and beverages eaten in the past 24-h Describe in detail each food item consumed Estimates portion sizes in common HH measures Interviewer:   check the recall with respondent Converts portion sizes into gram equivalent .

MULTIPLE PASS 24-HR RECALL     A complete list of all foods and beverages consumed during the preceding day is obtained Detailed description of each food and beverages consumed (cooking method. brand names) Amounts of each food and beverages item consumed in HH measurements The recall is reviewed to ensure all items. including use of vitamin and minerals supplements .

Strengths of 24-hr recalls         Simple. easy and quick to administer Provides a qualitative description of the dietary pattern as well as nutrient intakes Can be used for both illiterate and literate Relatively inexpensive Non-threatening Element of surprise so less chance of altering diet Wide sampling coverage possible Respondent burden low so response rate is usually high .

Weaknesses of 24-hr recalls     Relies on memory and hence may not be reliable Prone to errors in estimating portion sizes consumed May not reflect the usual intake of the group if recalls do not represent all days of the week May be difficult to find appropriate time for recall interview .

Weaknesses of 24-hr recalls    Continuous questioning and answering is tiring for both the respondent and the interviewer and may result in errors Prone to errors when portion size estimates are converted to gram equivalents Prone to errors in coding food items if limited number of food items in database .

selection and spacing of days depends on:     Food intake Nutrient of interest Day to day variation Level of precision required  Weighed food record is the most precise method  Preferred method to make correlation between usual intake with biological parameters .24-h-Recalls and Food Records  Number.

FOOD RECORDS Estimated food records Weighed food records .

PRINCIPLE AND USE   Based on recording portion sizes of actual foods consumed by an individual (Estimated  HH measures or Weighed using dietary scales) Uses for research    Multi-center epidemiological studies For controlled metabolic studies If a weighed food record method is used. respondents must be motivated. numerate and literate .

and spices  method of food preparation and cooking .METHODS   Record a complete description of all foods and drinks as they are consumed in Detail description:  name (local and general if known)  method of cooking  state of food (e. refined)  brand names where applicable  all condiments. peeled. cooked.. raw. herbs.g.

METHODS   Weigh the amounts consumed (portion served minus left over) or estimate using household measures and calibrated household utensils Foods eaten away from home  records descriptions of the amount of food eaten. Nutritionist  buy and weigh duplicate portion of each recorded food eaten. if possible assess the probable weight consumed .

RECORDING OF MIXED DISHES     describe method of preparation and cooking weigh edible portion of each raw ingredient or estimate using household measures record final weight (or volume) of cooked food record weight of portion size consumed or estimate using household measures and/or calibrated household utensils .

especially when weighed Can be used with illiterate participants provided interviewer does the measurements Said to be reasonably valid for up to 5 days Can assess food patterns as well as the sociodemographic environment of respondent Can enhance interpretation of laboratory. anthropometric and clinical data Multiple day data more representative of usual intake .STRENGTHS OF FOOD RECORDS        Do not rely on memory Provide accurate data on portion size consumed.

WEAKNESSES of food records        Require high degree of cooperation Act of recording may alter habitual diet High respondent burden may result in low response rate Subjects must be literate to complete the records Time-consuming Labor-intensive and expensive Significant under-reporting may still occur .

New York Jelliffe DB. Community Nutritional Assessment. America. Oxford University Press. New York. (2005). Oxford University Press. Manual on Methodology for Food Consumption Studies. The McGraw-Hill Companies. Jelliffe EFP. Nieman DC.References     Cameron ME and WAV Staveren (1988). Principles of Nutritional Assessment. Lee RD. (1996). Nutritional Assessment (2nd edition). (1989). Oxford University Press. . New York Gibson RS.