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DIETARY ASSESSMENT:

INDIVIDUAL LEVEL

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

The Importance for Conducting


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

Level

National and
Household level

Individual level

Individual Dietary Assessment Method


Types of Data

Quantitative
Daily consumption
weight or volume of food
eaten on one day or over a
period of days average daily
intake:
Recall
Records

Qualitative
food habitually eaten
Retrospective on food
pattern:
Dietary historty
FFQ

Quantitative and qualitative methods


Quantitative methods

Qualitative methods:

measure or estimate the

do not assess portion sizes

weight or volume of
food eaten by an
individual or group on
one day or over a period
of days
Could estimates
quantitative usual
intake if the number of
measuring days is
increased

so that data on nutrient


intakes not available
record the kinds of food
habitually eaten by an
individual over a period of
time in the past
results provide
information on the usual
food consumption
patterns of an individual
or group

FOOD CONSUMPTION AT INDIVIDUAL LEVEL

24-hr recall (single and repeated)


Food records (estimated and weighed)
Food Frequency Questionnaire
Dietary history

Study
Objective

Characteristic of
respondents

Dieting
Motivation

Validity and reproducibility


of method

Available
Resources

Respondent
Burden

Level 1: Mean intake of a group


single 24-h recall/food record
all days of the week are proportionately represented in final
sample
Level 2: Population percentage at risk to inadequate intakes
Repeat 24-h recalls/records at least 2 days on sub sample (30-40)
Non-consecutive days (if 2 repeats)
If non consecutive, 3 repeat are needed

Level 3 : Rank intakes of subjects within distribution


multiple observations of 24-h recalls/records;
alternative semi-FFQ

Level 4: Usual intakes for correlation or counseling


Larger number of replicates required
Alternatively semi FFQ or FFQ or dietary history

Level

Study Objective

Describe: usual mean nutrient intake for a group


Significant difference in mean/median intake of a group
Change in group mean intake (before after
intervention/paired or unpaired)

Distribution of intake within group proportion at risk of


inadequacy
Change in proportion at risk of inadequacy before and
after intervention
Change in proportion at risk between group
Risk of inadequacy in specific sub group defined by SES,
sex, etc

Relationship between frequency of food group (deciles of


green leafy vegetables) vs mean level of biomarker
Divide subject into tertiles of nutrient and calculate the
corresponding average biomarker level for each tertile

Relationship between nutrient intake of individuals to


other indices of nutritional status measured in the same

LEVEL 1

Mean intake of
a group

All days of the


week equally
represented in
final sample
Number of
sample Gibson
05. p. 55)

LEVEL 2

LEVEL 3

Proportion (%) of
population at risk of
inadequate intake

At least 2 replicates
in sub sample (3040 individuals
represent age
range) if
nonconsecutive, or
3 replicates for
consecutive

Usual intake of
individuals for ranking
within a group for
linking with risk of
chronic disease
Replicates
in all

Number of
days in
Gibson 05
p. 57

Usual intake of
nutrients in individuals
for counseling/
correlation or
regression analysis

Replicates in
all

DIETARY
HISTORY

REPEATED 24 H
RECALL/food records
SINGLE 24 H
RECALL/food
record

LEVEL 4

SEMI Quantitative
FFQ

Particularly applied for


quantitative methods

1. Measuring food
intakes
2. Conversion of foods
to nutrients
3. Estimate of
absorbed intakes
of nutrients
4. Adequacy of
nutrient intakes
relative to
requirements

24-HOUR RECALLS

Principle and use

To assess actual food intake of an individual


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

Single 24-h recall

Not sufficient to describe an individuals


intake of food and nutrients
Single 24-hr recalls used for large scale
field studies to characterize average
intakes of population groups (subjects
are representative, all days of the week
are represented)

Repeated 24-h recalls

Can be used to assess usual nutrient intakes


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

Methods

Respondents:

recall all foods and beverages eaten in the


past 24-h
Describe in detail each food item
consumed
Estimates portion sizes in common HH
measures

Interviewer:

check the recall with respondent


Converts portion sizes into gram equivalent

MULTIPLE PASS 24-HR RECALL

A complete list of all foods and beverages


consumed during the preceding day is obtained
Detailed description of each food and beverages
consumed (cooking method, brand names)
Amounts of each food and beverages item
consumed in HH measurements
The recall is reviewed to ensure all items,
including use of vitamin and minerals
supplements

Strengths of 24-hr recalls

Simple, easy and quick to administer


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

Weaknesses of 24-hr recalls

Relies on memory and hence may not be


reliable
Prone to errors in estimating portion sizes
consumed
May not reflect the usual intake of the group if
recalls do not represent all days of the week
May be difficult to find appropriate time for
recall interview

Weaknesses of 24-hr recalls

Continuous questioning and answering is


tiring for both the respondent and the
interviewer and may result in errors
Prone to errors when portion size estimates
are converted to gram equivalents
Prone to errors in coding food items if limited
number of food items in database

24-h-Recalls and Food Records


Number, selection and spacing of

days depends on:

Food intake
Nutrient of interest
Day to day variation
Level of precision required

Weighed food record is the most

precise method
Preferred method to make
correlation between usual intake
with biological parameters

FOOD RECORDS
Estimated food records
Weighed food records

PRINCIPLE AND USE

Based on recording portion sizes of actual foods


consumed by an individual (Estimated HH
measures or Weighed using dietary scales)
Uses for research

Multi-center epidemiological studies


For controlled metabolic studies

If a weighed food record method is used,


respondents must be motivated, numerate and

literate

METHODS

Record a complete description of all foods


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

METHODS

Weigh the amounts consumed (portion


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

RECORDING OF MIXED DISHES

describe method of preparation and


cooking
weigh edible portion of each raw
ingredient or estimate using
household measures
record final weight (or volume) of
cooked food
record weight of portion size
consumed or estimate using
household measures and/or calibrated
household utensils

STRENGTHS OF FOOD RECORDS

Do not rely on memory


Provide accurate data on portion size consumed,
especially when weighed
Can be used with illiterate participants provided
interviewer does the measurements
Said to be reasonably valid for up to 5 days
Can assess food patterns as well as the sociodemographic environment of respondent
Can enhance interpretation of laboratory,
anthropometric and clinical data
Multiple day data more representative of usual
intake

WEAKNESSES of food records

Require high degree of cooperation


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

References

Cameron ME and WAV Staveren (1988). Manual on


Methodology for Food Consumption Studies. Oxford
University Press, New York
Gibson RS. (2005). Principles of Nutritional
Assessment. Oxford University Press, New York
Jelliffe DB, Jelliffe EFP. (1989). Community Nutritional
Assessment. Oxford University Press, New York.
Lee RD, Nieman DC. (1996). Nutritional Assessment
(2nd edition). The McGraw-Hill Companies, America.

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