Validity of food consumption indicators in the Lao
context: Moving toward cross-cultural standardization
Soo Mee Baumann, Patrick Webb, and Manfred Zeller
Abstract
Background. Cross-cultural validity of food security
indicators is commonly presumed without questioning
the suitability of generic indicators in different geographic
settings. However, ethnic differences in the perception of,
and reporting on, food insecurity, as well as variations
in consumption patterns, may limit the comparability
of results. Although research on correction factors for
standardization of food security indicators is in process,
so far no universal indicator has been identified.
Objective. The current paper considers the ability of
the Food Consumption Score (FCS) developed by the
World Food Programme in southern Africa in 1996 to
meet the requirement of local cultural validity in a Lao-
tian context. The analysis is based on research that seeks
to identify options for correcting possible biases linked to
cultural disparities.
Methods. Based on the results of a household survey
conducted in different agroecological zones of Laos
in 2009, the FCS was validated against a benchmark
of calorie consumption. Changing the thresholds and
excluding small amounts of food items consumed were
tested as options to correct for biases caused by cultural
disparities.
Results. The FCS in its original form underestimates
the food insecurity level in the surveyed villages. How-
ever, the closeness of fit of the FCS to the benchmark
classification improves when small amounts of food items
are excluded from the assessment.
Conclusions. Further research in different cultural
Soo Mee Baumann and Manfred Zeller are affiliated with the
University of Hohenheim, Stuttgart, Germany; Patrick Webb is
affiliated with Tufts University, Boston, Massachusetts, USA.
Please direct queries to the corresponding author: Man-
fred Zeller, Chair of Rural Development Theory and Policy,
Department of Agricultural Economics and Social Sciences
in the Tropics and Subtropics, University of Hohenheim,
Wollgrasweg 43, 70599 Stuttgart, Germany; e-mail: manfred.
zeller@uni-hohenheim.de.
Food and Nutrition Bulletin, vol. 34, no. 1 © 2013, The United Nations University.
settings is required to generate more insight into the
extent to which universal thresholds can be applied to
dietary diversity indicators with or without locally deter-
mined correction factors such as the exclusion of small
amounts of food items.
Key words: Cross-cultural validity, dietary diversity,
food consumption indicators, Food Consumption Score
Introduction
Indicators for measuring food security are commonly
used across regions following the implicit assumption
that a tool valid for one region may be applied in a dif-
ferent cultural setting as well. However, food security
indicators often fail to meet the requirement of cross-
cultural validity. A measurement tool valid across dif-
ferent cultural environments should be appropriate in
multiple geographic settings with results comparable
across multiple settings; i.e., anthropometric indica-
tors for children under five can be compared across
different regions of the world given the global reference
standards established by the World Health Organiza-
tion (WHO) in 2006. However, ethnic differences in
the perception of, and reporting on, food insecurity,
as well as variations in consumption patterns, may
limit the comparability of results [1]. This is potentially
problematic, since having standardized measures of
food insecurity indicators would constitute an impor-
tant tool for practitioners in development programs.
Although research on correction factors for stand-
ardization of food security indicators is in process, so
far no universal indicator has been identified [2, 3],
in contrast to measurement instruments for poverty,
which are corrected according to the effective purchas-
ing power of local currencies. If correction factors for
different settings can be clearly identified, such factors
may contribute to the development of standardized
tools for food security.
105
106
The current paper considers whether the Food
Consumption Score (FCS) developed by the World
Food Programme (WFP) in southern Africa in 1996
meets the requirement of cultural validity in the
Laotian context. The analysis is based on research
that seeks to identify options for correcting possible
biases linked to cultural disparities. In order to test the
suitability of the FCS to measure food consumption
in Laos, the indicator was validated against a bench-
mark of calorie consumption and the association of
FCS, and the benchmark was tested through bivariate
descriptive analysis of food groups, individual food
items, and Calorie Consumption Groups (CCGs). By
doing so, the contribution of individual food items
and groups to the ability of the FCS to differentiate by
CCG was examined in detail. Changing the thresholds
and excluding small amounts of food items have been
tested as options to correct for biases that might be
caused by cultural disparities. To test the suitability of
the original FCS thresholds in the Laotian context, a
sensitivity–specificity analysis was conducted.
The FCS is a proxy indicator for food consump-
tion: it measures food intake and diet quality. It is a
frequency-weighted diet diversity score multiplied by
the relative nutritional importance of different food
groups. The FCS has been developed by WFP as a
harmonized measurement tool for rapid assessment
of the current food security situation in a given area.
Correction factors for the FCS may contribute to the
overall process toward a standardization of food secu-
rity indicators. The FCS is based on dietary diversity
and food frequency data that have proven to be strong
proxies for food security and are promising indicators
with a reasonable data collection and time frame. The
Food and Agriculture Organization (FAO) and WFP
both apply proxies based on dietary diversity or food
frequency information. Identifying correction factors
for the FCS will provide valuable information for the
further development of a standardized tool based on
diet diversity and food frequency information.
TABLE 1. Food groups and weights
No. Food items
1 Rice, maize, cassava, other roots and tubers
2 Fish, other aquatic animals, poultry, pork, red meat (goat,
sheep, beef, buffalo), wild meat (large- and small-bodied
wildlife), eggs
3 Pulses, lentils, tofu, bean curd
4 Vegetables, leafy vegetables, bamboo shoots, mushrooms
5 Oils, fats, and butter
6 Fruits
7 Sugar
8 Milk, milk products
Source: Adapted from World Food Programme [4].
S. Baumann et al.
The Food Consumption Score
The FCS was developed by WFP in order to improve
the assessment of food security levels in a way that is
tailored to WFP information needs and as a stand-
ard tool to further harmonize WFP’s data analysis
[4]. Among several tools to assess food security, the
measurement of food consumption in kilocalories is
considered one of the best indicators available. How-
ever, determining food security levels by means of food
consumption in kilocalories is highly complicated and
time consuming. In order to achieve a flexible data
collection instrument that can be applied in different
contexts and provide reliable and comparable results,
WFP uses proxies for actual caloric intake and diet
quality. For this reason, the FCS has been developed as
a standard methodology. As a proxy indicator, the FCS
“represents the dietary diversity, energy, and macro and
micro (content) value of the food that people eat” [5].
The FCS is a composite score based on dietary diversity,
food frequency, and relative nutritional importance of
different food groups. Dietary diversity refers to the
number of food groups a household consumes over a
certain reference period (usually 7 days for the FCS),
without regard to the frequency of consumption; food
frequency, in contrast, is defined as the number of days
on which a particular food group is consumed over a
reference period. The weights for the FCS were deter-
mined based on an interpretation by a team of analysts
of “nutrient density.” “Nutrient density is a term used
to subjectively describe a food group’s quality in terms
of caloric density, macro and micro content, and actual
quantities typically eaten” [4]. Pulses, for example,
are given a weight of 3, reflecting their high protein
content, whereas sugar is given a weight of only 0.5,
reflecting its lack of micronutrients [4]. Tables 1 and 2
show how the FCS is calculated with the food diversity
and frequency information and the respective weights
for each food group.
The information required for calculating the FCS is
Food group Weight
Main staples 2
Animal protein 4
Pulses 3
Vegetables 1
Oil 0.5
Fruit 1
Sugar 0.5
Milk 4
Cross-cultural validity of food consumption indicators
collected by asking households to recall on how many
days certain food items have been consumed within the
past 7 days. The FCS measures the frequency of con-
sumption in days instead of calculating single meals.
No matter whether an item is eaten once or several
times during one day, each day is counted as a fre-
quency of one (one day). In the next step, the frequency
of consumption of each food item is summed up into
eight standard food groups and truncated at 7 days. If
the sum of frequencies of all food groups amounts to
more than 7, this value is recoded as 7, constituting the
maximum number of days a food group can have been
consumed within the past 7 days. The consumption
frequency of each food group is then multiplied by an
assigned weight that is based on its nutrient content.
Finally, the weighted frequency of consumption of each
food group is summed up into the FCS. The maximum
value for a household score is 112; this score can only
be reached if a household consumes food from each
food group on every day within the reference period.
Consequently, the FCS can be described with the
following function:
FCS = astaple xstaple+ apulse xpulse+ aveg xveg+ afruit xfruit
+ aanimal xanimal+ asugar xsugar+ adairy xdairy+ aoil xoil
where
FCS = Food Consumption Score;
xi = frequency of food consumption = number
of days on which a food group was con-
sumed during the past 7 days; and
ai = weight of each food group.
The Food Consumption Group (FCG) is determined
by comparing each calculated household score with
pre-established thresholds to determine which FCG
the household should be assigned to and whether
the household is food secure or insecure. The typical
TABLE 2. Completed Food Consumption Score (FCS) template
Food items
Glutinous rice, white rice, maize, cassava, other roots and
tubers
Fish, other aquatic animals, poultry, pork, red meat, wild
meat, eggs
Pulses, nuts, bean curd
Green leafy vegetables, bamboo, other vegetables
Oil and fats
Fresh fruits
Sugar
Milk and milk products
Composite score
Source: Adapted from World Food Programme [4].
107
thresholds used are: poor food consumption (0–21),
borderline food consumption (21.5–35), and acceptable
food consumption (> 35). If the consumption of oil and
sugar is frequent in a population, while the consump-
tion of other food groups is rare, WFP recommends
raising the thresholds from 21 and 35 to 28 and 42
by adding 7 to each threshold. A daily consumption
of oil and sugar adds 7 points to the FCS: poor food
consumption (0–28), borderline food consumption
(28.5–42), and acceptable food consumption (> 42).
Households in the poor group and the borderline group
are usually considered food insecure, while households
in the acceptable group are categorized as food secure.
The major advantage of the FCS is its convenience.
Data collection is easy and fast, and the respondent
burden is comparably low. Respondents are generally
able to answer the questions without difficulty, and
enumerators can be trained within a short period of
time. Moreover, data analysis follows a recurring pat-
tern and thus does not require more than basic data
analysis skills. The FCS not only shows the current
status of food insecurity, but may be used for food
security monitoring. If surveyed regularly, the FCS
may display seasonal variations in food consump-
tion and changes over several years. The FCS can be
useful for depicting changes, as it not only estimates
which households are food insecure or secure, but also
distinguishes between the degrees of food insecurity.
Thus, the FCS also provides information on whether a
food-insecure household is close to being food secure,
and likewise if a food-secure household is on the brink
of food insecurity.
The major limitation of the FCS is that it does not
record quantities. Thus, the food security level of
households consuming very small amounts of various
food items is easily overestimated. Furthermore, the
FCS does not provide information on intrahousehold
food consumption. Within a household displaying
Days eaten in
past 7 days,
truncated at Weight Score
Food group 7 (A) (B) (A × B)
Staples 7 2 14
Animal protein 2 4 8
Pulses 0 3 0
Vegetables 5 1 5
Oil and fats 2 0.5 1
Fruit 2 1 2
Sugar 0 0.5 0
Dairy products 0 4 0
30
108
food-secure consumption according to the FCS, single
members might nevertheless be food insecure. Another
difficulty associated with the FCS is the necessity for
respondents to remember all food items consumed
during the reference period. Food-poor households
usually display a much more repetitive consumption
pattern and can easily recall which foods were bought
at the market. Nevertheless, at times respondents may
forget to report single food items. Moreover, the FCS
displays limitations by design: due to truncation, the
FCS is less precise for households with a higher score,
and weights given are based on the appraisal of a nutri-
tion expert group only. In the overall validation study
of the FCS, conducted by the International Food Policy
Research Institute (IFPRI) [6], the correlation of the
FCS with the benchmark increased when truncation
and weighting were omitted.*
The number of food items asked about during the
FCS data collection is not predetermined and may
vary between countries. Yet, the number of food items
asked about influences the resulting score of a house-
hold. Increasing the number of food items increases
the probability that households will report all foods
eaten but may inflate the FCS because different food
items from the same food group eaten on the same
day are double counted. For example, if a household
consumes both cabbage and mushrooms in one day,
because mushrooms are recorded separately from other
vegetables, together their frequency will be recorded as
2, even though the vegetable food group was consumed
on only one day.
Lastly, the FCS only captures a snapshot of the cur-
rent food consumption and cannot distinguish whether
the food consumption reported for the recall period
reflects average food consumption or might have
resulted from exceptional consumption due to special
events or a certain period of the year. More information
is needed if consumption practices and trends are to be
fully understood. FCS data collection should be com-
plemented by questions on usual food consumption
and context questions if a more in-depth understand-
ing of the reported consumption is required.
Methods
Kilocalorie benchmark
The quantity information required for calculating the
benchmark variable calorie consumption was collected
using a comprehensive 7-day recall module covering all
* IFPRI has conducted an overall validation study of the
FCS based on data from Burundi, Haiti, and Sri Lanka in
which alternative dietary diversity and food frequency indica-
tors were constructed and compared with the performance
of the FCS. The study recommends further validation of the
FCS at the country or (sub)region level.
S. Baumann et al.
food items commonly consumed in Lao PDR. All tra-
ditional measurement units were converted into metric
units either through direct on-the-spot weighing or by
measuring amounts reported on the market.** In rural
areas of Laos, food items are often sold at fixed prices
in varying amounts.*** If respondents could not recall
the quantity of a food item they bought at the market,
they usually remembered the amount of money they
spent on it. With that information, the interviewing
team went to the respective markets and weighed the
quantity of the food item sold at this price. As men-
tioned before, quantities vary, especially over seasons
and years. This increases the chance of the assessments
to be imprecise. Yet, it is unlikely that quantities sold
at a certain price changed drastically over a few days.
Moreover, rural households in Laos usually have few
options to store fresh food items. Thus, foodstuffs are
usually purchased shortly before consumption.
After translating all food items consumed by all
households interviewed into metric measurement
units, the quantity of each food item was converted
into kilocalories with the help of the ASEAN Food
Composition Table from 2000 [7] and the Food Com-
position Table for Use in East Asia from 1972 [8].
Before converting into kilocalories, the so-called refuse
was subtracted from the food quantities. Refuse refers
to the nonedible parts of a food item such as peels,
bones, or kernels and is usually given as a percentage.
Unfortunately, there is no food composition table for
Laos in particular. However, a compendium from the
Lao Ministry of Health with certain Lao food items that
are commonly consumed in Laos and their respective
nutrients was consulted [9].
In order to take varying individual food needs into
account, adult equivalents were calculated by using
the method applied in the IFPRI validation study [6].
The requirements for a household with newborns and
young children will be less than those for a household
of the same size with adults only. Applying adult
equivalents allows for comparison between house-
holds of different age and sex structures. Households
with calorie consumption/adult equivalent/day above
5,000 kcal or below 500 kcal were considered outliers
and excluded from the analysis in line with the iden-
tification of outliers in the IFPRI validation study [6].
The newly created variable of food consumption in
kilocalories per adult equivalent (Calorie Consumption
** All food quantities refer to uncooked and raw food items,
with the exception of processed foods such as the commonly
consumed fermented fish paste. Usually refuse was included
when measuring food items. If only edible parts were report-
ed, this was noted and considered later during the calculation
of the calorie consumption indicator.
*** For example, people buying mustard leaves on the mar-
ket would not ask to buy a certain amount but would state
how much money they were willing to spend. The number
of mustard leaves they would receive would then depend on
the price.
Cross-cultural validity of food consumption indicators
TABLE 3. Cutoff points for creating Calorie Consumption
Groups (CCGs)
Calorie consumption
(kcal/adult equivalent/ day) Shortfall (%) Profile
< 1,470 > 30 Poor
1,470 to < 2,100 30 to > 0 Borderline
≥ 2,100 0 Acceptable
Source: Adapted from World Food Programme [10]
per Adult Equivalent) was then transformed from
a continuous to a discrete variable by using existing
cutoff points for poor, borderline, and acceptable food
consumption. The food consumption module of the
Emergency Food Security Assessment Handbook sug-
gests two cutoff points derived from a basic minimum
dietary energy requirement of approximately 2,100
kcal/capita/day, corresponding with shortfalls of 0%
and 30% relative to requirements (see table 3).
Sampling and questionnaires
In order to capture the prevailing diversity within the
country, households in different agroecological zones
in the north and south of Laos were selected. According
to the Comprehensive Food Security and Vulnerabil-
ity Analysis (CFSVA) by WFP [11], several variables,
such as wealth, access to safe water, livelihoods, access
to forest resources, and prevalence of nutritional
status, vary tremendously between agroecological
zones. The classification used in the CFSVA is based
on a World Bank study [12]. Districts are assigned to
zones according to indicators related to agricultural
potential and ecological similarity or difference, which
provide a more useful frame than a distinction along
administrative units. The classification distinguishes
between six major agroecological zones: Vientiane
Plain, Central and Southern Highlands, Bolaven Pla-
teau, Mekong Corridor, Northern Lowlands, and
Northern Highlands.
Data from three different agroecological zones were
collected. Muang Sing belongs to the Northern High-
lands, Laongam is part of the Central and Southern
Highlands, and Toumlan is in the Mekong corridor.
The Vientiane Plain, the Bolaven Plateau, and the
Northern Lowlands were not covered. These three
agroecological zones are relatively wealthy. Working
in the better-off zones might have increased the pos-
sibility of no single household displaying food-poor
consumption, which would have been less favorable
for the validation.
Out of the three districts, eight villages were select-
ed.* The village selection was oriented toward the
* The villages selected were Ban Nammai, Ban Xo, Ban
Tapao-Donpoi, Ban Sandong, Ban Mouamterb, Ban Donm-
ouang, and Ban Hongloaong.
109
purpose of gaining information on whether the FCS is
suitable as an outcome indicator for WFP operations.
Therefore, villages receiving WFP food assistance and
villages that had never participated in WFP operations
were chosen. Furthermore, villages that were included
in the CFSVA based on a countrywide two-stage cluster
sample were chosen in order to be able to compare FCS
results from 2006 with those from 2009.** From each
village, 12 households were randomly selected using a
list of all households provided by the village heads.*** In
total, 96 households were interviewed.
Questionnaire
The questionnaire for the validation study included a
section on the FCS taken from the Lao CFSVA in 2006
and extended by a column that allows separate collec-
tion of data on the number of days in which a food
item was consumed in small amounts only. Those days
were later subtracted from the total number of days a
food item was consumed to test the effect of excluding
small amounts on the predictive power of the FCS.
Small amounts were defined as 1 level tablespoon per
person per day or less. The tablespoon was shown to
the respondents during the interview. For the section
on calorie consumption, the general questionnaire
design was taken from the IFPRI validation study;
however, food items were adapted to include only
those commonly consumed in Lao PDR. During the
Lao Expenditure and Consumption Survey III (LECS
III) [13], all households were asked to fill out a trans-
action diary, which, among other things, included all
the food items acquired by the household during an
entire month. The LECS III was conducted over a
whole year, which reduced the chance that food items
would be excluded due to seasonality. Taking from all
the transaction diaries of the LECS III resulted in a list
of more than 150 food items reported to be consumed
by households all over Laos. Furthermore, the Depart-
ment of Statistics set up a list of all measurement units
used by the households to report food quantities. Both
lists were made available to be incorporated into the
questionnaire for the FCS validation study in Laos.****
** The sampling frame for the CFSVA included all rural
households but excluded Vientiane Capital and Vientiane
Province.
*** From each village 12 households were chosen, and
another 5 households were selected to replace the chosen
households if necessary.
**** During the interview, all nonmetric measurement units
reported were asked to be shown and if possible directly
measured, and both the nonmetric and the metric equivalents
were noted. For measurement units that were not available
in the village, corresponding amounts were measured in
the market and cross-checked with prices reported by the
households.
110
TABLE 4. Accuracy table
“True” food insecure
(benchmark)
Predicted food insecure (FCS) pʹ True positives (TP)
Predicted food secure (FCS) nʹ False negatives (FN)
Total
Source: Adapted from International Food Policy Research Institute [6].
Data analysis methods
In order to assess how well the FCS predicts the food
security level for the Lao context, the FCS is vali-
dated against the benchmark of calorie consumption.
Validation is understood as the process of determining
whether a method provides a useful analytical meas-
urement for a given purpose and context [14]. Follow-
ing the validation study conducted by IFPRI [6], the
predictive power of the FCS was tested with a range of
analytical techniques, in particular, descriptive analysis,
scatter plots, correlation analysis, bivariate analysis,
cross tabulation, and sensitivity–specificity analysis.
The bivariate descriptive analysis was undertaken
for a more in-depth understanding of the association
between the FCS and the benchmark variable. With the
help of this analysis, the contribution of individual food
items and groups to the ability of the FCS to differenti-
ate by CCG may be examined. The bivariate analysis
is carried out for the original FCS (without quantity
restrictions) as well as after exclusion of small amounts.
In order to compare classifications based on the FCS
with those of the benchmark, the two indicators were
cross tabulated. Because of its design, cross tabulation
may, however, produce a relatively high proportion
of “close matches,” even though the observations are
equally distributed across cells and no association of
the two variables exists.
For testing the ability and extent to which the FCS
may predict the calorie consumption benchmark,
different options to improve the predictive power
of the FCS were examined. First of all, the impact of
excluding small amounts from the analysis was tested.
In order to show the goodness of the FCS when small
amounts were excluded, the analysis, which included
descriptive analysis, scatter plots, correlation analysis,
and cross tabulation, was repeated with an FCS for
which small amounts had been excluded. Moreover, we
assessed whether thresholds can be found for which the
FCS mimics the food security level of the benchmark
better, and if so, which thresholds are most suitable.
Therefore, the FCS was calibrated against the bench-
mark. Considering, though, that calibration does not
provide information on errors of inclusion or exclusion,
a sensitivity–specificity analysis was conducted.* This
* When using an indicator for targeting, errors of inclusion
S. Baumann et al.
“True” food secure
(benchmark)
P N Total
False positives (FP) Pʹ
True negatives (TN) Nʹ
P N
analysis is a more sophisticated way of assessing the
goodness of the FCS classification, and is at the same
time applicable for the optimization of the thresholds
because it systematically examines errors of exclusion
and inclusion with reference to the benchmark.
In order to assess the general suitability of a proxy
indicator, the Area Under the Curve (AUC) from
Receiver Operating Curve (ROC) analysis is an impor-
tant test statistic. The ROC plots sensitivity against 1
– specificity for all thresholds of the test variable (e.g.,
the number of food groups) based on the results of
cross-classifications with the dichotomous benchmark
variable. Sensitivity refers to the proportion of food-
insecure households also classified by the proxy indica-
tor as food insecure; specificity, in contrast, describes
the proportion of food-secure households also classi-
fied by the proxy indicator as food secure. Sensitivity
increases with higher thresholds (errors of exclusion
decline), while specificity falls (errors of inclusion rise).
Thus, there is always a tradeoff between sensitivity and
specificity. If the FCS shows good properties for the
classification, it will produce an ROC well above the
diagonal of the graph, indicating combinations of high
sensitivity and specificity for a range of thresholds. If
the ROC coincides with the diagonal, the association
between the variables is purely random. The AUC will
be 0.5, and no acceptable combinations of sensitivity
and specificity will be found. A perfect classification
by the proxy indicator would result in an AUC of 1.00.
As a general rule of thumb, an AUC below 0.6 is con-
sidered not acceptable, above 0.7 is good, higher than
0.8 is very good, and greater than 0.9 is excellent [6].
The components relevant for testing the suitability
of FCS thresholds in order to optimize the FCS pre-
diction of the benchmark classification are shown in
table 4 [15]. A suitable cutoff point for classifying the
food security status can be found by seeking to balance
sensitivity and specificity and to minimize the propor-
tion of households misclassified [16].** As a rule of
thumb, sensitivity and specificity should amount to at
are also referred to as leakage (households receive food
assistance even though they are not in need) and errors of
exclusion as undercoverage (households in need of food as-
sistance are not targeted).
** Minimizing the proportion of households misclassified
will at the same time maximize total accuracy. The proportion
of misclassified equals 1– total accuracy.
Cross-cultural validity of food consumption indicators 111

50

40

Cumulative consumption frequency

30

20

10

0
21
23
24
25
26
27
28
29
30
31
32
33
34
35
37
38
40
41
42
43
44
45
47
48
49
50
52
53
54
55
56
58
59
60
61
62
63
64
66
72
76
Borderline Acceptable

Food consumption score

Staples Vegetables Pulses Fruit Animal protein Dairy Sugar Oil and fat

FIG. 1. Stacked food frequency of food groups. FCS, Food Consumption Score

least 60%, and the percentage misclassified should not
exceed 30%. However, sensitivity–specificity analysis
does not guarantee that chosen cutoff points will yield
realistic estimates of the prevalence of food security
[6]. Sensitivity–specificity analysis requires dichoto-
mous variables for the benchmark as well as the proxy
indicator, dividing the households into either food
insecure or food secure. In order to test for thresholds
between all three FCGs, the analysis was done for the
lower threshold (between poor and borderline) and
upper threshold (between borderline and acceptable)
separately.
Results
The data collected were entirely usable, with one
exception.* A single household was excluded from
the analysis as an outlier, with its members reporting
a consumption of only 231 kcal/adult equivalent/day.
Even though this low calorie consumption accurately
reflects a small food consumption obtained by begging,
it was determined beforehand that all households with
calorie consumption above 5,000 or below 500 kcal/
* It is important to stress that the results shown are not rep-
resentative of the entire country, nor is the study necessarily
reflective of average household food consumption throughout
the year. Data were only collected in 96 households, which
does not allow for generalization of the findings across all
regions and ethnic groups of Laos. Moreover, the data were
collected at the end of the rainy season, which is the lean
season in Laos and the beginning of the rice harvest. Informa-
tion on consumption patterns is therefore only valid for the
end of the rainy season and may not reflect average annual
household consumption. Data for the validation study were
collected between August and October 2009.
adult equivalent/day would be considered outliers and
would be excluded from the analysis.
Figure 1 presents the stacked food frequency of the
food groups as it evolves with an increasing FCS.** The
figure shows that during the reference period, almost
all households interviewed reported consumption of
staples on a daily basis and a high consumption of
vegetables. The food groups that were barely consumed
by food-poor households and were more frequently
consumed with an increasing FCS are animal protein
and oil. Fruit and sugar were very rarely consumed by
households with poor or borderline food consump-
tion, and only those in the high end of the acceptable
FCG seem to consume fruit and sugar on several days
per week. Pulses were barely consumed, and no single
household reported having consumed dairy products.***
Figure 2 shows that the FCS calculated as recom-
mended by WFP gave much lower estimates of food
insecurity than did the calorie consumption indicator.
According to the FCS, only 1% of households were food
poor, in contrast to the benchmark that indicated 21%
to have poor food consumption.**** In the borderline
consumption group, the FCS came up with 27%, which
is a higher share of households than the 21% estimated
by the benchmark. WFP considers all households in the
poor and borderline groups to be food insecure. Thus,
** For each FCS value, a running average of the surrounding
values for that food group and the value in question was used
to smooth the graph.
*** Condensed milk, which is common in Laos, was not
considered in this survey. Whether it should be included
and weighted equally to fresh dairy products requires a more
detailed nutritional examination.
**** Households in the food-poor CCG consume fewer than
1,470 kcal/adult equivalent/day.
112
Poor Borderline Acceptable
80
70
60
50
Percent
40
30
20
10
0 In order to assess which food items or food groups
CCGs FCGs
FIG. 2. Calorie Consumption Groups (CCGs) compared with
Food Consumption Groups (FCGs)
according to the benchmark, 42% of all households
were classified as food insecure, whereas the FCS only
ranked 28% of households as food insecure.* The share
of households considered food secure is correspond-
ingly 72% according to the FCS and 58% according to
the calorie consumption indicator.
The scatter plot exploring the relationship between
the FCS and the calorie consumption per adult bench-
mark (fig. 3) showed a positive relationship between
the two indicators, with most cases lying fairly close
to the line of best fit and an R-squared of 0.258, mean-
ing that the FCS explained 25.8% of the variance of
the calorie consumption variable. One household
displayed remarkably high calorie consumption, close
to 5,000 kcal per adult equivalent/day. As it was still
within the acceptable 500 to 5,000 kcal range, this case
was not excluded. But the quantities consumed in that
household were reassessed. The high number of calo-
ries resulted from a very high rice consumption, which
could be reproduced through reassessment. Pearson’s
correlation coefficient (0.508) and Spearman’s nonpara-
metric correlation coefficient (0.504), both significant
at the .01 level (2-tailed), confirmed the positive rela-
tionship between the FCS and the benchmark variable.
In the course of the bivariate descriptive analysis,
the food frequency of each food item, the frequency
of all food groups, and the FCS were examined across
the three CCGs. This analysis was done for the origi-
nal FCS and for the FCS excluding small amounts
(1 tablespoon/person/day or less). For more than half
of all food items for which consumption was reported
during the reference period,** the average frequency of
* Households considered as food insecure (poor and
borderline CCG) consume fewer than 2,100 kcal/adult
equivalent/day.
** None of the households reported consumption of goat or
sheep meat, large-bodied wildlife, or milk products during
the reference period.
S. Baumann et al.
consumption increased from poor to acceptable calorie
consumption, regardless of whether small amounts
were excluded.*** The consumption of sticky rice or
white rice was not included in the analysis, because
the frequency of consumption depends mainly on
preference of the different ethnic groups. When food
items were summed up as food groups, five out of seven
groups for which consumption was reported**** showed
an increasing frequency along CCGs. After exclusion
of small amounts, the frequency of consumption for all
reported food groups increased from poor to accept-
able calorie consumption.
contributed to the ability of the FCS to differentiate
by CCG, it was tested which food items or groups
with consumption frequency increasing along CCGs
displayed a significant difference across CCGs. The
food items were maize, poultry, pork, eggs, vegetables
(excluding green leafy vegetables, bamboo shoots, and
mushrooms), oil and butter, and sugar; after exclu-
sion of small amounts, the food items were poultry,
pork, and eggs. The food groups were oil and fats,
and sugar; after exclusion of small amounts, the food
groups were animal protein and fruit. WFP recom-
mends not changing the weights in order to maintain
comparability. However, raising the weights of the food
groups that were able to differentiate well between
CCGs relative to other food groups may improve the
predictive power of the FCS. Animal protein is already
weighted very high (weight = 4), but an increase in the
weights for oil and fats, sugar (weight = 0.5), and fruit
(weight = 1), for which the weights as of now are very
low, would possibly improve the ability of the FCS to
predict calorie consumption. Excluding small amounts
did not improve the ability of food items or groups to
differentiate across CCGs.
Cross-tabulating the FCGs based on the FCS with
CCGs shows large errors of exclusion. A total of 8
households that the FCS ranked as borderline and 11
households considered to have acceptable food con-
sumption were categorized as food poor according to
the benchmark. There are also some errors of inclusion;
for instance, eight households that were considered to
be in the borderline consumption group were ranked
as acceptable by the benchmark. The only household
that the FCS ranked as being food poor also seems to
be calorie deficient, but the households considered to
be borderline (8 households) and acceptable (11 house-
holds) instead of food poor were likewise severely calo-
rie deficient (fewer than 1,470 kcal/adult equivalent/
day). Table 5 shows in more detail how only 1% of the
extremely calorie-deficient households were captured
*** Note that no data on small amounts were collected for
staples. Therefore, a comparison with and without small
amounts is not available for staples.
**** The only food group not reported at all was dairy.
Cross-cultural validity of food consumption indicators 113

5,000

4,000

Kilocalories per adult equivalent

3,000

2,000

1,000

0
20 30 40 50 60 70 80
FCS
FIG. 3. Calorie consumption per adult equivalent plotted against Food Con-
sumption Score (FCS)

TABLE 5. Cross tabulation of Food Consumption Groups (FCGs) against Calorie Consumption Groups
(CCGs)
CCG
Poor, Borderline, and Acceptable Poor Borderline Acceptable Total
FCG Poor ( ≤ 21) Count 1 0 0 1
% of total 1.1% 0.0% 0.0% 1.1%
Borderline ( > 21–35) Count 8 10 8 26
% of total 8.4% 10.5% 8.4% 27.4%
Acceptable ( > 35) Count 11 10 47 68
% of total 11.6% 10.5% 49.5% 71.6%
Total Count Total 20 20 55 95
% of total 21.1% 21.1% 57.9% 100.0%

Good match 61.1%

Close match 27.3%
Poor match 11.6%

by the FCS classification. This means that the FCS did
not recognize 19% of households that were severely
calorie deficient and thus, as expected, underestimated
the food insecurity level. Furthermore, 10 out of the
20 households with borderline consumption were
estimated as being food secure by the FCS. The 8%
ranked as borderline by the FCS despite acceptable
consumption were less alarming, but indicate a prob-
lem of the FCS at the threshold between borderline and
acceptable consumption. It did not simply rank house-
holds as having a better food security status than they
actually have, but it was less precise. Some households
were considered acceptable while they should have
been ranked as borderline, whereas at the same time
other households were considered borderline instead
of acceptable.*
* However, because of limitations of the method in an ex-
treme case, if all households might be considered food secure
by the FCS, the cross-tabulation would nonetheless result in
57.9% good matches and 21.1% close and poor matches each.
Therefore, aiming at a high percentage of good matches is
not sufficient to improve the predictive power of the proxy
indicator and was thus complemented by other data analysis
methods.
114
Effect of excluding small amounts on association of
FCS and benchmark
Even though the FCS is fairly well correlated with the
benchmark, the classification into FCGs differs tremen-
dously from the CCGs of the benchmark. Therefore,
different options to improve the predictive power of
the FCS and to identify correction factors were tested.
The effect of excluding small amounts from the analy-
sis on the relationship of the two continuous variables
FCS and Calorie Consumption per Adult Equivalent,
in addition to the ability of the FCS to mimic with its
FCGs the food security level estimated by the food con-
sumption benchmark, was tested. After consultation
with different nutrition experts, small amounts were
only excluded for some of the food groups. For animal
protein, pulses, vegetables, fruit, and dairy products,
small amounts were excluded. Small amounts were
not excluded for sugar and oil and fats, because from
a nutritional point of view, 1 tablespoon/person/day
or less of these food groups is not considered a small
enough amount to be excluded from the analysis. Fur-
thermore, small amounts were not excluded for staples,
considering that they are usually not consumed in
amounts of 1 tablespoon/person/day or less.
The following equation shows how the FCS, after
exclusion of small amounts for animal protein, pulses,
vegetables, fruit, and dairy, was calculated:
FCSsmall amounts = astaple (xstaple) + aanimal (xanimal – sani-
mal) + apulse (xpulse – spulse) + aveg (xveg
– sveg) + afruit (xfruit – sfruit) + adairy
(xdairy – sdairy) + asugar xsugar + aoil xoil
5,000
4,000
Kilocalories per adult equivalent
3,000
2,000
1,000
0
10
FIG. 4. Calorie consumption per adult equivalent plotted against Food Con-
sumption Score (FCS) after exclusion of small amounts
S. Baumann et al.
where
FCSsmall amounts = Food Consumption Score after
exclusion of small amounts;
xi = frequency of food consumption
= number of days on which each
food group was consumed during
the past 7 days;
ai = weight of each food group; and
si = number of days a food group was
consumed in small amounts only
during the past 7 days.
The scatter plot in figure 4 shows a clear positive
relationship between the FCS and the household
calorie consumption indicator after exclusion of small
amounts. Inserting a line of best fit shows that the
R-squared at 0.285 is slightly higher than without
exclusion of small amounts. This slightly increased
magnitude of the relationship between proxy indicator
and benchmark is confirmed by Pearson’s correlation
coefficient at 0.534 compared with 0.508 without exclu-
sion of small amounts and Spearman’s rho, generating a
correlation of 0.542 compared with 0.504 before.
A more significant change can be found when look-
ing at the FCGs after exclusion of small amounts from
the analysis. Table 6 shows the tremendous increase in
the number of households now ranked as food poor.
Almost 14% more households are considered food poor
than when small amounts were not excluded. A similar
share of households (11.6%) moved from the accept-
able group to the borderline consumption group. Thus,
we understand that excluding small amounts had an
20 30 40 50 60 70 80
FCS — excluding small amounts
Cross-cultural validity of food consumption indicators
TABLE 6. Effect of excluding small amounts on predictive
power of FCS
FCGs—
exclud-
Predictive ing small
power CCGs FCGs amounts
Poor 21.1% 1.1% 14.7%
Borderline 21.1% 27.4% 25.3%
Acceptable 57.9% 71.6% 60.0%
CCG, Calorie Consumption Group; FCG, Food Consumption Group;
FCS, Food Consumption Score
impact on all consumption groups. Households from
all FCGs, not only the very food-poor households, ate
foodstuffs in small amounts.
Small amounts were mainly consumed of certain
animal proteins and vegetables. Almost 19% of house-
holds reported eating wild fish in small amounts
(mostly on 1 or 2 days, but also up to 7 days out of the
last 7 days), and more than 10% of households speci-
fied that on some days they ate vegetables (other than
green leafy vegetables and bamboo or mushrooms) in
small amounts only. Furthermore, households reported
eating small amounts for most other food items in the
animal protein group and for all vegetables and fruits.
When comparing the prevalence of households in
each FCG after exclusion of small amounts with the
ranking of CCGs, we see an improvement in the pre-
dictive power of the FCS. Table 6 shows the changes in
the FCG classification for the original FCGs and after
exclusion of small amounts in comparison with the
CCGs. The ranking reflects the classification according
to the benchmark indicator much better when small
amounts are excluded. It is remarkable that the size of
all three FCGs comes closer to the benchmark predic-
tion after exclusion of small amounts from the analysis.
When cross-tabulating the FCS after the exclusion
of small amounts with the calorie consumption bench-
mark, no major difference from the cross-tabulation
with the FCS in its original form can be found. The
share of good matches is slightly lower and the poor
matches are consequently marginally higher; however,
the difference is negligible considering the size of the
sample and the impact of each single household, as well
as the discussed shortcomings of the method. The dif-
ference derives from one fewer household in the group
of good matches and one more in the poor matches.
TABLE 7. Effect of excluding small amounts on mean values of CCGs
Total
FCS 44.43
FCS—excluding small amounts 40.65
CCG, Calorie Consumption Group; FCS, Food Consumption Score
***Significant at the 1% level.
115
Excluding small amounts, moreover, shifts the mean
of the FCS. Without exclusion of small amounts, the
mean values in the poor and borderline consumption
classes are barely distinguishable. After exclusion of
small amounts, however, the FCS shows mean scores
that reflect the increasing calorie consumption from
poor to acceptable much better (table 7).
Changing the thresholds
Apart from exploring the impact of excluding small
amounts, we also looked at whether changing the
thresholds improves the predictive power of the FCS.
A plausible method to match the FCGs to the CCGs
is simply to calibrate the FCS against the benchmark.
To do this, the cumulative percentage of households
at each possible threshold is looked at, and the thresh-
old for which the share of households below matches
the percentage predicted by the calorie consumption
benchmark, the best is chosen. Given that excluding
small amounts seems reasonable for Laos, new pos-
sible thresholds for the original FCS as well as for an
FCS after exclusion of small amounts were examined.
Due to the fact that excluding small amounts mark-
edly improves the ability of the FCS to mimic the food
consumption classes estimated by the benchmark, the
magnitude of adaptation of the thresholds is much
smaller if small amounts are actually excluded.
If no small amounts were excluded, the thresholds
producing FCGs closest to the food consumption
classes proposed by the benchmark would be as high
as 32 and 43 (compared with the original thresholds
of 21 and 35). If small amounts were excluded first,
the thresholds resulting from calibration would be
24.5 and 36.5 for FCGs most similar to the size of the
benchmark classes.
The major advantage of the calibration is that it helps
to select thresholds that produce as close as possible
an estimate of food insecurity that matches the “true”
prevalence of food insecurity. The main problem of
conducting a simple calibration is that we do not know
whether the households in each group are the same as
those assigned to the respective CCGs. In our case,
for example, all households ranked as food poor by
the benchmark could possibly be considered to have
borderline food consumption by the FCS. Similarly,
all households ranked as borderline by the benchmark
CCG Significance of
group difference
Poor Borderline Acceptable F-statistic
37.85 38.43 49.00 10.50***
30.75 36.43 45.78 9.81***
116
could possibly be ranked as food poor by the FCS. Nev-
ertheless, we would end up having the same, or almost
the same, number of households in each group accord-
ing to benchmark and proxy indicator. In this case, we
could not consider the FCS to be a good or valid proxy
indicator. Yet, knowing the correlations and scatter
plots shown before, it is unlikely that the calibration in
the case of the FCS for Laos produces such poor results.
Nonetheless, a sensitivity–specificity analysis was also
performed in order to compare the results with those
from the calibration. A sensitivity–specificity analysis
systematically examines errors of exclusion and inclu-
sion with reference to the benchmark.
When looking at different possible thresholds and
their sensitivity, specificity, and percentage of mis-
classified for the lower threshold (between poor and
borderline), no single threshold could be found that
would meet all requirements (balanced sensitivity
and specificity, both above 60%, and a proportion of
misclassified below 30%). At the thresholds 43.35 and
43.75, sensitivity and specificity are balanced and are
both above 60%, but the percentage of misclassified
amounts to 38% and 39%, respectively. A proportion of
misclassified households below 30% could be found for
thresholds between 20 and 34.75, but sensitivity is only
between 0% and 45%. If small amounts were excluded
before conducting a sensitivity–specificity analysis, six
thresholds could be found between 28 and 32.5 that
meet the balanced sensitivity and specificity, either at
or above 60%, and a proportion of misclassified of 30%
or below. Figure 5 shows the results for the ROC of the
lower threshold.
The sensitivity–specificity analysis for the upper
threshold (between borderline and acceptable) yielded
Original FCS
1.0
0.8
Sensitivity
0.6
0.4
0.2
0 0
0 0.2 0.4 0.6 0.8
1 – Specificity
AUC = 0.692
FIG. 5. Receiver Operating Curve (ROC) for lower threshold (between poor and borderline). FCS, Food
Consumption Score; AUC, Area Under the Curve
S. Baumann et al.
a different picture. The AUC of the ROC using the
original FCS amounted to 0.76, and after exclusion of
small amounts the ROC showed an AUC of 0.78, both
being higher than that for the lower threshold (fig. 6).
Without exclusion of small amounts, eight thresholds
were identified between 42.5 and 47.25 with balanced
sensitivity and specificity above 60%, and a proportion
of misclassified between 30% and 32%. In total, only
three possible thresholds (between 36.75 and 38.75)
displayed a proportion of misclassified below 30%. Yet,
when small amounts were excluded before conducting
the sensitivity–specificity analysis, around half of the
values showed a proportion of misclassified close to
30%, but none below. This reflects the earlier finding
that for the surveyed sample, the prediction of the FCS
for the distinction between borderline and acceptable
is less precise than that between poor and borderline.
A balanced sensitivity and specificity with values at or
above 60% can be found for 10 thresholds within a wide
range between 35.25 and 46.25. At these thresholds, the
proportion of misclassified varies between 30% and 33%.
Considering that thresholds selected based on sen-
sitivity–specificity analysis results will not necessar-
ily yield realistic estimates of the prevalence of food
security, it was tested whether the thresholds from
calibration also show acceptable sensitivity, specificity,
and proportion of misclassified. For the lower thresh-
olds suggested by calibration (24.5), sensitivity is fairly
low. If we shift the lower threshold to 25.5, sensitivity
increases to 55% and is thus extremely close to an
acceptable level of sensitivity. The prevalence of food-
poor households is shifted to 23.2% instead of 22.1%
(threshold of 24.5). Yet, for the purpose of assessing
food insecurity, errors of inclusion are preferable to
Excluding small amounts
1.0
0.8
Sensitivity
0.6
0.4
0.2
1.0 0 0.2 0.4 0.6 0.8 1.0
1 – Specificity
AUC = 0.746
Cross-cultural validity of food consumption indicators
errors of exclusion. At the threshold of 25.5, sensitivity
and specificity are not yet balanced, as expected since
the “true” prevalence of food poor is much lower than
50%, but the proportion of misclassified remains very
low. Achieving acceptable sensitivity and specificity
would require a threshold above 28, which in turn
would produce a prevalence of food-poor households
of 28.4%, which is much higher than the prevalence
predicted by the benchmark. The upper threshold of
36.5 according to the calibration against the benchmark
shows acceptable sensitivity and specificity, with fairly
balanced errors of inclusion and exclusion. However,
the proportion of misclassified is slightly above the 30%
considered as acceptable. Yet, for the upper threshold
there is no single option that would display a propor-
tion of misclassified below 30%.
For assessing the general food security level in Lao
PDR, it will be important to decide on thresholds that
guarantee that the FCS matches the “true” prevalence of
calorie-deficient households and that it displays a high
total accuracy in predicting the benchmark. Sensitivity
and specificity should be balanced and display accept-
able values. The proportion of misclassified should
remain below 30%. Considering, though, that the pro-
portion of misclassified equals 1 minus total accuracy,
accounting for a high total accuracy will automatically
produce a low proportion of misclassified.
For the lower threshold, 25.5 matches most of the
mentioned criteria, displaying a prevalence of food
poor similar to the benchmark, high total accuracy,
unbalanced but nevertheless fairly acceptable sensitivity
and specificity, and a very low proportion of misclassi-
fied. The most suitable upper threshold seems to be the
one resulting from calibration. For a threshold of 36.5,
the prevalence of food-insecure households (poor +
Original FCS
1.0
0.8
Sensitivity
0.6
0.4
0.2
0 0
0 0.2 0.4 0.6 0.8
1 – Specificity
AUC = 0.763
FIG. 6. Receiver Operating Curve (ROC) for upper threshold (between borderline and acceptable). FCS,
Food Consumption Score; AUC, Area Under the Curve
117
borderline) is identical to the benchmark prediction,
total accuracy is still acceptable, sensitivity and speci-
ficity are fairly balanced and both above 60%, and the
proportion of misclassified is slightly above the accept-
able 30%. The suggested thresholds improve the ability
of the FCS to predict the calorie consumption bench-
mark. Yet, it should be remembered that the sample for
the FCS validation study in Laos was very small and not
representative of the entire country. In order to decide
on definitive thresholds, a replication of the present
study with a representative sample would be required.
Conclusions and discussion
The validation of the FCS has disclosed the following
main results:
The FCS in its original form does underestimate the
food insecurity level for the surveyed villages. It dis-
plays a comparably strong, positive, highly significant
correlation with the calorie consumption benchmark,
but the classification of households into FCGs does not
mimic the food security status predicted by the CCGs
of the benchmark.
Excluding small amounts has no major impact on
the relationship of the two continuous variables, Calo-
rie Consumption per Adult Equivalent and FCS, but
certainly improves the ability of the FCS to mimic the
number of food-insecure and/or -secure households
predicted by the benchmark. According to the find-
ings of this study, excluding small amounts for the Lao
context seems advisable.
After exclusion of small amounts, the original
thresholds produce acceptable results for the sensi-
tivity–specificity analysis, but the prevalence of food
Excluding small amounts
1.0
0.8
Sensitivity
0.6
0.4
0.2
1.0 0 0.2 0.4 0.6 0.8 1.0
1 – Specificity
AUC = 0.781
118
security predicted with regard to the benchmark still
has room for improvement. As a compromise between
the thresholds suggested by calibration and the results
of sensitivity–specificity analysis, the lower thresh-
old of 25.5 matches most of the mentioned criteria,
displaying a prevalence of food poor similar to the
benchmark, high total accuracy, unbalanced but nev-
ertheless fairly acceptable sensitivity and specificity,
and a very low proportion of misclassified. The most
suitable upper threshold seems to be the one resulting
from calibration. For a threshold of 36.5, the prevalence
of food-insecure households (poor + borderline) is
identical to the benchmark prediction, total accuracy
is still acceptable, sensitivity and specificity are fairly
balanced, both are above 60%, and the proportion
of misclassified is slightly above the acceptable 30%.
Whether these proposed thresholds are suitable for all
parts of Laos can only be assessed through a nationally
representative sample.
For a final decision on whether small amounts
should be excluded from the analysis and which thresh-
olds to choose for the FCS in Laos, the findings should
be reassessed with a nationwide representative sample.
In the present study, the FCS has not been validated
against diet quality due to the fact that individual die-
tary assessments were beyond the scope of the research.
It should be considered that excluding small amounts
might impact the evaluation of diet quality, despite the
low contribution of small amounts to overall energy
intake. Apart from validating the FCS against diet
quantity with a countrywide representative sample, a
validation against a benchmark of diet quality is highly
recommended. A full measure of dietary quality should
go beyond measures of energy consumption and diver-
sity of foods consumed to a fuller understanding of
amounts, content and nutrient density. Such metrics
have still to be developed for field settings.
Moreover, various studies have pointed out that wild
foods, which are consumed frequently in Lao PDR,
are considered inferior foods and their consumption
increases as preferences are curtailed [17]. If this is the
case, an increased diversity of food from the consump-
tion of wild foods cannot be considered as improved
food security. In a countrywide representative sample,
it would be worthwhile to assess whether excluding
small amounts may reduce the effect of ranking a
household as more food insecure due to greater dietary
diversity resulting from increased consumption of wild
foods. It is possible that households increase the con-
sumption of wild foods if other acquirable food items
are insufficient, but due to the limited availability, the
consumption might not exceed what are considered as
small amounts in this study.
Further shortcomings of the study are seasonal-
ity issues that might have impacted the association
between the proxy indicator and the benchmark. If,
for example, people consume more wild foods during
S. Baumann et al.
the lean season, this might increase their diversity
while calorie consumption could be reduced. How-
ever, research has shown that at least dietary diversity
indicators are able to predict calorie consumption
fairly accurately over different seasons [18]. Assess-
ing whether the relationship between the FCS and the
calorie consumption benchmark varies over different
seasons requires further research.
The calculation of the benchmark was based on
kilocalorie information from regional food composi-
tion tables because no food composition table specifi-
cally for Laos is available. This might have impacted
the precision of the benchmark. Yet, most food items
consumed on a regular basis are very similar to those
consumed in remote areas of the region.
With regard to the question of cross-cultural validity,
the FCS in its original form does not seem to be valid
in Lao PDR without adaptation. The fact that excluding
small amounts from the analysis improves the ability
of the FCS to predict the calorie consumption bench-
mark supports the assumption that due to differing
consumption patterns (higher diversity in Laos but in
small amounts only), the FCS might overestimate the
food security level in Laos. Excluding small amounts
for regions in which people are frequently consuming
wild foods and consumption is typically based on one
staple product supplemented by various condiments in
very small amounts, might constitute a suitable correc-
tion factor for the FCS.
After exclusion of small amounts in the Lao context,
the thresholds proposed by WFP were very close to the
thresholds resulting from calibration and sensitivity–
specificity analysis. A harmonized shift of FCS thresh-
olds based on dietary patterns (regular consumption
of fat and sugar) is being tested in various countries.
Nevertheless, the question remains whether universal
thresholds can be applied to indicators based on dietary
diversity with or without locally determined correc-
tion factors such as the exclusion of small amounts.
This question might be better understood if excluding
small amounts as a correction factor for the FCS was
tested in different countries and the thresholds were
subsequently calibrated against a benchmark. Compar-
ing the results of these studies would then allow for a
more general statement on the suitability of excluding
small amounts as a correction factor and the possibility
of applying universal thresholds when small amounts
are excluded.
Acknowledgements
The authors acknowledge the support of the WFP
Laos team and the WFP Regional Bureau for Asia; in
particular, the valuable inputs from Laura de Franchis,
Ruangdech Poungprom, Michael Sheinkman, and Rita
Bhatia.
Cross-cultural validity of food consumption indicators
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