Nutritional Assessment PDF

Nutritional Assessment  Brain storming 1. What is assessment? 2. Are Measurement and Assessment different or the same? 3. What nutrient deficiency do the following clinical signs/symptoms indicate? a.Pallor b.Goitre c.Bitot’s spots d.Bilateral pitting oedema e.Severe visi...

Nutritional Assessment  Brain storming 1. What is assessment? 2. Are Measurement and Assessment different or the same? 3. What nutrient deficiency do the following clinical signs/symptoms indicate? a.Pallor b.Goitre c.Bitot’s spots d.Bilateral pitting oedema e.Severe visible wasting  Nutritional Assessment Is the first step in the Nutrition Care Process Data collected depends on the setting For individuals, data can come directly from pt/client through interview, observations, and measurement For populations, data from surveys, epidemiological and research studies are used  Nutritional Assessment….used in – Schools: to identify those who need supplementary feeding – Military: to identify those ‘fit’ from the ‘unfit’ – Now a days used in community and clinical settings  Nutritional assessment Is the process of gathering, analyzing and interpretation of anthropometric, biochemical (laboratory), clinical and dietary data to tell whether a person/ group of people is well nourished or malnourished (Over nourished or under nourished).  There are direct and indirect methods of assessing Nutritional status 10/03/2024 Nutrition and Health 6  DIRECT METHODS The direct measurement of body dimensions and proportions, determination of tissue or body fluid concentrations of nutrients, dietary intake, appearance of the clinical symptoms and signs related to a specific nutrient dependent functional impairment abbreviated as the ABCDs  A=Anthropometry  B= biochemical/Biophysical,  C= Clinical,  D= Dietary 10/03/2024 Nutrition and Health 7  The indirect methods(Ecological) Indirect methods include assessment of indicators of the food and nutrition situations in the area/ region of interest by looking at certain data that are closely related to malnutrition or which are aggravated by malnutrition. These include: q Cause specific mortality rates q Age specific mortality rates q Health service statistics q Rate of nutritionally relevant infections 10/03/2024 Nutrition and Health 8  The indirect methods  Meteorological data (rainfall data )  Production pattern and distribution pattern  Income levels  Market price of foods  Predominance of cash crops 10/03/2024 Nutrition and Health 9  A. Anthropometric Assessments  Anthropometry comes from two words: Anthropo = Human, and Metry = measurement.  Definition: - Anthropometry refers to measurement of variations of physical dimension and gross composition of human body at different levels and degrees of nutrition (Jelliff, 1966). 10/03/2024 Nutrition and Health 10  ANTHROPOMETRIC ASSESSMENTS Anthropometric measurements could be used both in the clinical and field set- ups. In the clinical set-ups they are used to assess the nutritional status of:  post-operative patient, chronically sick medical patient, severely malnourished patient to assess the impact of nutritional intervention. 10/03/2024 Nutrition and Health 11  Purposes of Anthropometric measurements Anthropometric measurements are performed with two major purposes in mind: IN CHILDREN: to assess physical growth IN ADULTS: to assess changes in body composition or weight 10/03/2024 Nutrition and Health 12 ANTHROPOMETRIC MEASUREMENTS OF GROWTH 10/03/2024 Nutrition and Health 13  ANTHROPOMETRIC MEASUREMENTS OF GROWTH Growth performance of children is an excellent reflection of their underlying nutritional status. Children adapt to the chronic nutritional insult by either reducing their rate of growth or by totally failing to grow. 10/03/2024 Nutrition and Health 14  Child Growth Growing child is healthy child. Optimal growth occurs only with adequate food, absence of illness, caring and nurturing, social environment Most rapid in first year of life. How can we measure growth ?  How can we measure growth ? Common anthropometric measurements are weight, height/length, head circumference Most accurate and sensitive method of measuring growth is weight gain Weight gain can be measured by regularly weighing  HEAD CIRCUMFERENCE (HC): Measured using around 0.6cm wide flexible measuring tape to the nearest 1mm.  It is the circumference of the head along the supra orbital ridge anteriorly and occipital prominence posteriorly.  HC is useful in assessing chronic nutritional problems in under two children.  But after 2 years as the growth of the brain is sluggish it is not useful. 10/03/2024 Nutrition and Health 18  LENGTH  A wooden measuring board (also called sliding board) is used for measuring length.  It is measured in recumbent position in children height by 1-2cm.  An assistance of two people is needed in taking the measurement  Measurement is read to the nearest mm 10/03/2024 Nutrition and Health 19  HEIGHT  Is measured in children > 2 yrs and a adults in standing position to the nearest 0.1 cm.  The head should be in the Frankfurt plane during measurement, knees should be straight  The heels,thecalf,the buttocks, and the shoulders blades, should touch the vertical surface of the stadiometer ( anthropometer) or wall.  Stadiometer or portable anthropometer can be used for measuring.  There is also a plastic instrument called acustat Stadiometer that is cheaper than the conventional Stadiometer. 10/03/2024 Nutrition and Health 21  WEIGHT  Weighing sling (spring balance) also called salter scale is used for measurement of weight in children < 2 years.  In children the measurement is performed to the nearest 10g.  In adults and children >2 years, beam balance is used and the measurement is performed to the nearest 0.1 kg. 10/03/2024 Nutrition and Health 23  WEIGHT For both digital (electronic) scales can be used and are very accurate. UNICEF Mother- Infant scale can also be used Index and indicator What is the difference between Index and indicator?  INDEX What is an index? It is a combination of two measurements or a measurement plus age. The following are few of them: -  Head circumference-for age Weight -for-age Height-for age Weight for height 10/03/2024 Nutrition and Health 27  MEANINGS OF THE INDICES DERIVED FROM GROWTH MEASUREMENTS Weight for Age = Weight of the child x 100 Weight the normal child of the same age Weigh for height = Weight of the child x 100 Weight of the normal child of the same height Height for age = Height of the child. X 100 Height of the normal child of the same age 10/03/2024 Nutrition and Health 28 both weigh for age and weight for height are indices sensitive to acute changes to nutritional status Height for age of children in a given population indicates their nutritional status in the long run(chronic changes) 10/03/2024 Nutrition and Health 29 Indicator An indicator is an index + a cut-off point. Stunting = Height for age Z score of less than -2 Underweight=weight for age Z score of less than -2 Wasting=weight for height Z score of less than -2 10/03/2024 Nutrition and Health 30  EXPRESSING ANTHROPOMETRIC MEASUREMENTS EXPRESSING ANTHROPOMETRIC MEASUREMENTS EXPRESSING ANTHROPOMETRIC MEASUREMENTS  conventional cut-off points for diagnosing moderate malnutrition Type of Height for Weight for Weight for standard age height age Z-score -2 -2 -2 Standard -2 -2 -2 deviation Centile 3rd 3rd 3rd Percent of the 90% 80% 80% median  Using appropriate methods for different setups Percentiles are not recommended for evaluating anthropometric measurements from less developed countries when reference data from industrialized countries such as NCHS are used Because many of the study population in developing country may have indices below the extreme percentiles of the reference population making it difficult for accurately classifying large number of individuals  The WHO,2006 Growth reference is recommended for developing countries b/c – Growth data were gathered from widely diverse ethnic backgrounds and cultural settings (Brazil, Ghana, India, Norway, Oman, and USA) – unlike the NCHS growth reference in which data were gathered from white middle class family Children in USA Classification of Nutritional Status Based Anthropometric Indices  Disadvantages of Gomez classification  The cut off point 90% may be too high as many well-nourished children are below this value,  edema is ignored and yet it contributes to weight and  It does not indicate the duration of malnutrition  age is difficult to know in developing countries (agrarian society).  It does not also differentiate between kwashiorkor and marasmus  Disadvantages  This method does not differentiate :  Acute malnutrition (for emergency planning  Chronic malnutrition( for food security planning) Depends on knowledge of the child’s age Does not take height differences in to account ASSESSMENT BODY COMPOSITION  ASSESSMENT BODY COMPOSITION Linear growth ceases at around the age of 25-30 years. Therefore, the main purpose of nutritional assessment of adults using Anthropometry is determination of the changes of body weight and body composition. 10/03/2024 Nutrition and Health 48  Five levels of body composition Assessment Atomic level(C, H, N, P, Ca, O) Molecular level(fat, Water, protein) Cellular level(body cell mass, intra/extra cellular water, intracellular solids) Tissue level(adipose tissue, muscle, bone) Whole body level(Weight, height, skin folds, impedance) 10/03/2024 Nutrition and Health 49  ASSESSMENT BODY COMPOSITION Using Anthropometry  Whole body level assessment is used  In assessing body composition we consider the body to made up of two compartments:  The fat mass and the fat free mass.  Total body mass= Fat mass + fat free Mass.  Therefore different methods of measurements are used to assess these two compartments: 10/03/2024 Nutrition and Health 50  Measurements used for assessing fat free mass: Mid upper arm circumference*** Mid upper arm Muscle area Mid thigh circumference Mid thigh muscle area Mid calf circumference Mid calf muscle area 10/03/2024 Nutrition and Health 51 Mid upper arm circumference  Mid upper arm circumference (MUAC)  Is used for screening purposes especially in emergency situations where there is shortage of human resource, time and other resources.  less sensitive as compared to the other indices.  It is measured half way between the olecranon process and acromion process using non stretchable tape. 10/03/2024 Nutrition and Health 53  Which arm do we measure? The left or the right? why? Does looking for the mid point of the Upper arm matter? MUAC vs RUAC  MUAC…  It is a sensitive indicator of risk of mortality  Useful for screening of children for community based nutrition interventions  Useful for the assessment of nutritional status of pregnant women  In children the cut-off points are:  Normal > 13.5 cm  Mild to moderate malnutrition 12.5-13.5 cm  Severe malnutrition < 12.5 cm  ***These cut-offs could be arbitrarily modified based on available resource 10/03/2024 Nutrition and Health 55  Measurements used to assess fat mass Body mass index  Waist to Hip circumference ratio Skin fold thickness 10/03/2024 Nutrition and Health 57  Indices derived from the measurements Different indices could be derived by measuring the weight and height.  Wt/(Height in meters)2 (Quetelet’s index) (BMI)  Weight/height ratio (Benn’s index)P  Ponderal index = Wt/ (ht) 3 for new born  BMI isthe best method for assessing adult nutritional status  Therefore, it is most frequently used for assessing adult nutritional status 10/03/2024 Nutrition and Health 58  Cut-off points for BMI  > 40 kg/m2 = very obese  30-40 kg/m2 = obese  25-30 kg/m2 = overweight  18.5-24.9kg/m2 = Normal  17-17.9 kg/m2 = mild chronic energy deficiency  16-16.9kg/m2 = Moderate chronic energy deficiency  < 16 kg/m2 = severe chronic energy deficiency 10/03/2024 Nutrition and Health 59  BMI cut‐offs for children and adolescents  WHO suggest a set of thresholds based on single standard deviation of BMI for age :  Thinness: +1SD and +2SD  Obese: >+2SD  A new cutoff for Ethiopian for obesity BMI > 22.2 kg/m2 for males and > 24.5 kg/m2 for females 10/03/2024 Nutrition and Health 61  Limitations of BMI loss of height through aging- – BMI will increase without any corresponding increase in weight. pregnancy and muscle builders No indication of distribution of body fat May overestimate adiposity on those with more lean body mass (e.g. athletes). Does not distinguish b/n wt associated w/muscle vs. body fat High BMI can be due to  excessive adiposity;  muscularity; or edema Arm span and Demi-span and Knee height When it is not possible to measure height as in the case of : Elderly people Kiphosis / Scoliosis People unable to assume erect position Height can be estimated from arm span or demi-span or knee height 10/03/2024 Nutrition and Health 65 Arm span and Demi-span and Knee height Arm span is the distance between the tips of the tallest fingers while arms are starched on straight line(180 degrees). Demi span(Half arm span)- the distance from sternal notch to the tallest finger on the left side with the arm stretches on straight. Knee height- is the distance measured from 10/03/2024 the Nutrition heel to the top of and Health 66  Estimating height from knee height Height(men)= 64.19-(0.4Xage) + (2.02 X knee height) Height(women)=84.88- (0.24Xage) +(1.83 x knee height) 10/03/2024 Nutrition and Health 67 SKIN FOLD THICKNESSES  Measurement of double fold of skin and fat  Skin fold should be read to the nearest 0.5 mm after 2-3 seconds of caliper application  Measurements are made in triplicate until readings agree within ± 1.0 mm  All the measurements should be made on the left side 10/03/2024 Nutrition and Health 68  Assumptions of Skinfold Thickness Sites selected represent average thickness of all subcutaneous fat predicts non-subcutaneous fat as well because >50% of fat is subcutaneous compressibility of fat similar between subjects Thickness of skin negligible  Skinfold thickness measurements Single skinfolds  no agreement on best site as index of total body fat  triceps most frequent site used  Can be done in 5 places (biceps, triceps, sub- scapular, supra-iliac & mid-axiliary) Multiple skinfolds  For total body fat: one limb skinfold (eg., triceps) plus one body skinfold (subscapular) recommended Skin fold measurement calipers Biceps skin fold measurement Subscapular skin fold Supra iliac skin fold measurement Mid axillary skin fold measurement  MaleBody Density = 1.1043 - (0.001327 x triceps skinfold in mm) - (0.00131 x subscapular skinfold in mm), Females Body Density = 1.0764 - (0.0008 x subscapular skinfold in mm) - (0.00088 x tricep skinfold in mm) % Body Fat = (495 / Body Density) - 450 % of total body fat  Limitations of Skinfold Thickness Technician error Skinfold thickness affected by factors other than amount of fat – exercise increases skin thickness – dehydration reduces skin thickness – edema increases skin thickness – dermatitis increases skin thickness Poorly predicts visceral fat  WAIST TO HIP CIRCUMFERENCE RATIO  It is the circumference of the waist measured mid-way between the lowest rib cage and anterior superior iliac spine divided by the circumference of the hip measured at the level of the greater trochantor of the fumer( both are measured to the nearest 0.5 cm)  If the ratio is > 1 in male, and > 0.85 in female there is high risk of coronary heart disease and other CND 10/03/2024 Nutrition and Health 83 10/03/2024 Nutrition and Health 85 10/03/2024 Nutrition and Health 86  Visceral Fat Central obesity is linked with Visceral Fat Visceral body fat poses greater health risks because this fat is more labile and has greater access to the circulation. The accumulation of visceral body fat is typical of the android (male) fat pattern – males: visceral fat accounts for 10-35% of total fat – females: visceral fat accounts for 8 -13%of total fat  Abdominal Body Fat Relationships with CHD Risks Abdominal obesity predicts CHD risk independent of BMI, smoking, cholesterol and hypertension (Kannel et al., J. Clin Epid., 44, 183-190, 1991). Abdominal obesity predicts CHD risk independent of total body fatness.(Larsson et al. ,Appetite, 13, 37-44, 1989). Abdominal obesity statistically accounts for difference in CHD death rates between men and women (Larsson et al., Am. J. Epi., 135: 266-273, 1992).  Abdominal Body Fat Relationships with other risk factors Abdominal obesity is strongly influenced by genetics - similar gain among twins (Bouchard, NEJM, 322, 1477-1482, 1990). Abdominal obesity is greater in smokers than non-smokers due to the presence of androgens (Barrett-Conner, Ann. Int. Med. 111, 783-787, 1989). Abdominal body fat is preferentially lost during a physical activity program (Kohrt, J. Gerontology, 47: M99-M105, 19  QUALITY CONTROL MEASURES IN ANTHROPOMETRIC SURVEYS The following issues need to be considered in carrying out anthropometric surveys to ensure the quality of data:  Calibration of the instrument after each measurement and after moving the instrument from one room to another  Standardization of procedures  Making subjects wear a uniform gown before measuring weight or measuring their weight nude if they are children 10/03/2024 Nutrition and Health 95  QUALITY CONTROL MEASURES IN ANTHROPOMETRIC SURVEYS Verification of at least 10 % of the data by the main investigator Training of the data collectors and limiting the coefficient of variation to be less than 3% Train observers by skilled professionals 10/03/2024 Nutrition and Health 96  QUALITY CONTROL MEASURES IN ANTHROPOMETRIC SURVEYS Mark anatomic sites of measurement with permanent ink when repeatedly measuring the same subject over a short time span Periodically assess inter observer differences of the staff 10/03/2024 Nutrition and Health 97  taking more than one height or weight measurement on the same person, the two measurements can be averaged. If they are vastly different from each other, the measurements should be disregarded and the measuring should start again. 10/03/2024 Nutrition and Health 98 Measurement Accuracy  Advantages and disadvantages of Anthropometric measurements Advantages Disadvantages q Quick q Cheap Have Limited Diagnostic Relevance (Only For Diagnosing PEM) q Objective Need Reasonably Precise Age In Children q Gives Gradable Less sensitive to recent Results changes q More Accepted By The Community q Non Invasive 10/03/2024 Nutrition and Health 100 2.BIOCHEMICAL /LABORATORY AND PHYSIOLOGICAL METHODS  When there is deficiencies, – the tissue stores become gradually depleted. This may result in reductions in the levels of nutrients or their metabolic products – in certain body fluids and tissues Biochemical tests could detect these states  This involves measurement of either – total amount of the nutrient in the body, or its concentration in a particular storage site (organ) in the body or in the body fluids. – Metabolic end products Two types of assays Static biochemical tests Functional biochemical tests 1) Static biochemical tests:- This involves measurement a nutrient or its metabolites in pre-Selected biological material (blood, body fluids, urine, hair, fingernails etc.) Example, E.g. Biochemical Tests (laboratory) 1. Serum ferritin level 2. Serum HDL 3. Erythrocyte Folate 4. Tissue stores of Vit. A, Vit D,  Factors affecting the validity of static biochemical tests Physiological factors(pregnancy, diurnal variation, homeostatic regulation, physical exercise, age, sex, recent dietary intake) Pathological(inflammatory stress, infection, weight loss) Analytical(sample collection, sensitivity & specificity of the test, hemolysis, sample contamination, acuracy and precision of the method ) 2. Functional biochemical tests (Biophysical tests): - Based on measurement of nutrient depended functional impairment. These functional biochemical tests are also useful for:- – Sub-clinical deficiency states  Functional biochemical tests have greater biological value and significance than static tests, because they measure the – extent of functional consequence of a specific nutrient deficiency.  Types of Functional Tests 1. Abnormal metabolic products in urine/blood: - vitamins and minerals act as co-enzymes for groups enzyme systems E.g. Vitamin B6 is a co-enzyme for Kynureninase in the tryptophan-niacin pathway. B6 def. decreased Kynureninase activity Increased formation and excretion of xanthuremic and kynuremic acids  2. Changes in enzyme in the blood This involves measuring a change in the enzyme that is dependent on a given nutrient. E.g. Lysl oxidase for copper Glutathion reductase for riboflavin Transketolase for thiamin  3. Load and Tolerance Tests Load Test #1 Load Test: This test is usually performed for water-soluble vitamins.  The principle is that after loading a person with a dose of the nutrient (vitamin) orally, IM or IV. Then a timed sample of urine is collected and excretion/retention level assessed.  In carrying out this test it is assumed that there will be increased retention of the nutrient if the person is deficient of it and vice versa.  3. Load and Tolerance Tests Tolerance Tests#2 Tolerance Test: This is also called plasma appearance test and is performed based on the assumption that there will be increased absorption of the nutrient if the person is deficient of it. E.g.: absorption of nutrients (Zn, Fe, and Manganese) is increased in the deficiency states.  4. Invitro tests of in vivo function E.g. Immunocompetence (cell mediated immunity 5. Spontaneous invivo responses This includes impairment of some body functions resulting from deficiency of a particular nutrient, E.g. Capillary fragility in Vitamin C deficiency Dark adaptation in Vitamin A deficiency Taste acuity in zinc deficiency Muscle function in PEM  6. Growth or developmental responses Both physical growth and mental development are adversely affected by the deficiency of many nutrients. This is manifested by either failing to thrive or poor school performances, lagging milestones of development etc. E.g. Cognitive function = IRON  Others (Biophysical methods) include: - Bone X-ray = calcium deficiency Corneal impression cytology= Vit. A Buccal smear cytology = Vit.A Hair root morphology =Zinc  ADVANTAGES AND DISADVANTAGES OF BIOCHEMICAL TESTS Advantages Disadvantages Detect sub-clinical No ideal specimen or storage site Malnutrition Many quality control problems Give gradable during sample taking, carrying out the test, analysis. Etc nutritional Some times low values may not Information have any health Implication Are more objective No ideal biomarker for each nutrient Need sophisticated instruments Need highly trained staff Involve invasive procedures  C. CLINICAL METHODS This are detection of deviations from the normal state of nutrition just by observing and interpreting clinical signs and symptoms of deficiency or excess. 10/03/2024 Nutrition and Health 117  Table 1: Summary of clinical methods Sign/symptoms Nutritional abnormality Night blindness, Bitot’s spots Vitamin Adeficiency Easy bruising of skin, Spongy Scurvy bleeding gums Edema , short stature Protein deficiency Pallor, easy fatigability , Deficiency of Iron, anorexia, shortness of breath Vitamin B12,Folic acid, Fluoride deficiency or Dental carries , dental cavities increased consumption of sugar containing sweet foods Dental staining, fragility of Fluoride excess bone, teeth – Diagnosis of a nutritional deficiency should not exclusively on clinical methods Because the signs and symptoms are often nonspecific and only develop during the advanced stages of nutritional depletion Can we do nutrition surveys using Clinical signs and symptoms?  Palmar pallor Bitot’s Spots Night Blindness goiter among School age children  Goiter Endemic goiter is defined as thyroid enlargement that occurs in more than 10% of a population Epidemiologic criteria for assessing the severity of Iodine Deficiency Disorders (IDD) based on the prevalence of goiter in school-age children (WHO): < 5.0% : no public health problem 5.0 - 19.9% : mild public health problem 20.0 - 29.9% : moderate public health problem ≥30% severe public health problem  Vitamin A deficiency WHO Indicators for recognizing Vitamin A deficiency as a public health problem Sign Prevalence Night Blindness > 1% Bitot spot >0.5% Corneal xerosis / ulceration >0.01% Corneal scarring >0.05% 4. DIETARY METHODS Development of Deficiency  DIETARY METHODS These methods include assessment of past or current intakes of nutrients from food by individuals or a group in order to know their nutritional status. At national level:- Food balance Sheet – also called National food disappearance data or food going in to consumption Market data bases( for fortified foods by FDA) 10/03/2024 Nutrition and Health 142 At a household level Household food inventory method Food account method List recall method Household food record method 10/03/2024 Nutrition and Health 143 Methods used to assess current intake  Methods used to assess current intake 1. Weighed record method by study subjects: In this method the subject will be asked to weigh whatever he/she consumes including drinks I. before cooking II. after cooking III. the portion sizes consumed and IV. the left over 10/03/2024 Nutrition and Health 145  Advantages and Disadvantages of Weighed food record method Advantages It is more accurate There is no respondent memory loss Disadvantages High respondent burden Change of the dietary habit during the survey due fear of burden Needs literate and numerate respondents Costly  2. Observed weighed method  In this method the investigator him/herself records the amount and type of food consumed by the study subjects over specified period of time.  This method is usually applied for disabled people, infants and small children, mentally ill people or institutionalized elderly people or patients admitted to a hospital. Advantage VS disadvantages  The same as the observed weighed 10/03/2024 Nutrition and Health 147  3.Food Diary method In this method the subject/s are asked to record what ever they eat including beverages for specified period of time with estimation of the portion sizes consumed. Advantage – May give relatively accurate estimate o the nutrient intake if done properly Disadvantage – High respondent burden – Literacy and numeracy of subjects needed – High coding burden 10/03/2024 Nutrition and Health 148 II. Methods Used to assess past intake  1. 24 hours dietary recall In this method, the subjects are requested to remember whatever they consumed within the last 24 hours. This involves all beverages, snacks deserts etc. That have been ingested from x time yesterday to x time today. The portion sizes consumed during this time should also be determined by the respondents by assessing them to use either photographs or the common food being consumed at different sizes etc. 10/03/2024 Nutrition and Health 150  Advantages and disadvantages of 24 hrs dietary recall method Advantages Disadvantag   Relatively cheap Quick es A single day 24 hrs  Less respondent burden  recall does not No chance for the respondents to change their dietary habit indicate the usual  The usual intake of a group can intake of be determined from repeated 24 individuals hrs recall Respondent memory laps Social desirability bias (the flat slop syndrome) Has less precision 10/03/2024 Nutrition and Health Accuracy depends 151  Reasons why a single day assessment does not give the true mean intake Day of the week effect Seasonal effects Consecutive /nonconsecutive days Holiday effects(feasts and fasts) 10/03/2024 Nutrition and Health 152  2.Dietary history This method is used to assess the nutrient intake of an individual or a group from food over a longer period of time, usually to see the association between diet and disease. 10/03/2024 Nutrition and Health 153  Advantages and disadvantages of Dietary history Advantages  It gives the dietary habits of Disadvantages  It over emphasizes the an individual or a group of regularity of the dietary people over a longer periods pattern of time  It is very difficult to  It is possible to target the validate  It needs a very highly dietary questions to specific trained interviewer dietary habits or intake of  It gives just a relative if not specific nutrients of interest an absolute information  Less respondent burden 10/03/2024 Nutrition and Health 155  3.Food frequency questionnaire This method is based on the preparation of a food frequency questionnaire, which is based on the local staple diet to determine the frequency of consumption of a particular nutrient. This could be achieved through self or interviewer administration of the questionnaire. Sometimes the quantities consumed could be included, in such circumstances, the FFQ is called semi quantitative FFQ. The following table indicates the frame of a food frequency questionnaire. 10/03/2024 Nutrition and Health 156  Example of semi quantitative FFQ for Vitamin A friendly foods Frequency of consumption Every Once Once Portion size Food list Daily other per per consumed day week month Carrot Cabbage Papaya Mango Cod liver oil Liver 10/03/2024 Nutrition and Health 157  Advantages and Disadvantages of FFQ Advantages It is usually used for areas where there is a Disadvanta geographically widely ges scattered study  It is very difficult population to develop especially in multi- It is less costly cultural society especially if self where different staple foods are administered consumed Less respondent  It needs literate burden and numerate subjects 10/03/2024 Nutrition and Health 158  Errors in dietary surveys result from Interviewer bias Coding and computation errors Reporting errors Wrong weight of foods Wrong frequency of consumption Response bias( the flat slop syndrome or memory laps) Change in dietary habit 10/03/2024 Nutrition and Health 159 Analysis of Dietary Data  Quantitative Dietary Data Analysis Required inputs Dietary data Portion size (quantity consumed) Nutrient database software / Food composition Tables  Quantitative Dietary Data Analysis Foods can be converted into nutrients using food composition tables or nutrient data banks Then the nutrient intake will be compared to the RDAs(RNI) to determine the adequacy of intake 10/03/2024 Nutrition and Health 162  Quantitative Dietary Data Analysis Calculating Nutrient adequacy ratio(NAR) and Mean adequacy ratio(MAR) NAR = Subjects daily intake of a nutrient RDA of that nutrient MAR = Sum of the NARs for nutrients consumed number of nutrients consumed NAR- represents 10/03/2024 an index of adequacy Nutrition for a nutrient and Health 164  Qualitative Dietary Data Analysis Dietary Diversity Scores (DDS) Food Variety Scores (FVS) Animal Source Food (ASF) Food consumption Score (FCS) Food consumption scores(FCS)  WFP uses this for checking the dietary diversity and nutrient intake for Calculating Food consumption scores Interpretation of FCS Calculation of food consumption score (FCS)  Minimum Meal Frequency(WHO Recommendation) For breastfed and non-breastfed children 6-23.9 months of age who receive solid, semi-solid, or soft foods or milk the minimum meal frequency is defined as: – 2 times for breastfeeding infants 6–8 months – 3 times for breastfeeding children 9–23 months – 4 times for non-breastfeeding children 6–23 months  Minimum Acceptable Diet = Minimum meal frequency +Minimum DDS No of children fulfilling minimum meal frequency and at the same time fulfilling minimum dietary diversity sore  Quiz 1. What is nutritional assessment? 2. What is nutritional assessment used for? 3. Name the different ways in which it can be carried out. 4. What is the difference between an a index and an indicator? 5 what are the limitations of 24 hrs dietary recall