1. DIETARY ASSESSMENT
By
Lalita Bhattacharjee
Nutritionist
Training on Assessment of Nutritional Status 18-22 December 2011
Date : 21 December 2011
Venue: FPMU Meeting Room
The Training is organized by the National National Food Policy Capacity Strengthening Programme (NFPCSP) . The
NFPCSP is jointly implemented by the Food Planning and Monitoring Unit (FPMU), Ministry of Food and Disaster
Management and Food and Agriculture Organization of the United Nations (FAO) with the financial support of the EU and
USAID.

2. Whoever was the father of a
disease, an ill diet was the mother!

3. OUTLINE
 Introduction
 Determinants of food intake and nutritional status
 National and household food consumption surveys
 Assessment of individual food and nutrient intakes
and nutrient adequacy
 Food frequency questionnaires, Rapid methods of
dietary assessment
 Validation and Reliability
 Recommended dietary intake and evaluating nutrient
intakes
 Conclusion

4. OPTIMAL NUTRITIONAL
STATUS
Source: Mahan and Stump, 2000

5. DIETARY ASSESSMENT AND
NUTRITIONAL
ASSESSMENT : KEY TERMS
 A DIETARY ASSESMENT : comprehensive evaluation of a person's
food intake. It is one of the established methods of nutritional
assessment. Dietary assessment techniques range from food records
to questionnaires and biological markers.
 NUTRITIONAL ASSESSMENT : more comprehensive and includes
determining nutritional status by analyzing the individual’s brief socio
economic background, medical
history, dietary, anthropometric, biochemical, clinical data and drug –
nutrient interactions
 NUTRITIONAL STATUS : measurement of the extent to which an
individual’s physiologic need for nutrients is being met
 NUTRIENT INTAKE : depends on actual food consumption which is
influenced by factors such as economic situation, eating
behaviour, emotional climate, cultural influences, effects of disease
states on appetite and the ability to absorb nutrients
 NUTRIENT REQUIREMENTS : are determined and influenced by
age, sex, BMR, physiological status, activity patterns, physiologic

6. Dimensions and methods for
assessing food security and under
nutrition
Methods Availability Access to Consumption Utilization
of food food of food of
nutrients
FAO Method
Household
income
& expenditure
surveys
Individual food
consumption/
intake surveys
Anthropometry
Qualitative
measures of
food security

7. Development of clinical deficiency with
corresponding
dietary, biochemical and clinical evaluation

8. Methods of assessing dietary
intake
 National food supply data
 Household data
 Individual data (Food records, 24 hr dietary
recall, FFQs, diet histories, food habit
questionnaires, combined methods
 RAP - rapid assessment procedure ( focus
groups to gather information on food
behaviours, beliefs and intakes)

9. National and household food
consumption
 Food consumption data collected at national, HH
or individual levels
 Individual intake data required for assessing
nutrient adequacy
 Food supply and HH data can provide useful
information
 Food consumption assessment at national level
based on FBS ( per capita availability, no
individual variation in food intake)
 Food supply data useful

10. SHARE OF FOOD GROUPS AS % OF DIETARY ENERGY
SUPPLIES
2007 78 3.5 6.6 2.5 2 2 3.1 2.3
2006 78.1 3.5 7.2 2.71.4 3 2.4
1.7
2005 78.2 4.1 6.6 2.51.7 3 2.2
1.7
2004 80.4 3.1 6.3 2 21.22.8 2.3
2003 82.2 2.4 6 1.9 1.12.81.8
1.8
Year
2002 82.6 2.7 5.4 1.72.11 2.81.7
2001 80.8 3.2 6.8 1.9 2 1 2.61.7
2000 81.6 2.7 6.7 1.8 1 2.71.9
1.6
1999 83.1 2.8 5.2 1.8 1 2.61.7
1.8
1998 79.6 3.2 8.7 1.2 1 2.61.8
1.9
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Cereal Sugar Oil Roots & Tubers Pulses Fruits & Vegetables Meat, Milk, Egg & Fish Other
Source: Adapted from FBS, FAO, 2010

11. Per capita/d intake of major food items
(g)

12. (En%) of
cereals and rice to Bangladesh
diet
Source/Year Energy Cereal (g) Rice (g)
intake (kcal) En % En %
452 440
HIES 2005 2238
70% 68%
442 416
HIES 2010 2318
66% 64%

13. DIETARY ASSESSMENT
PRINCIPLES
Adequacy : a diet that provides enough energy and nutrients to
meet the needs according to the recommended dietary
intakes/allowances (for healthy and active life)
Balance : a diet that provides enough, but not too much of each
type of food ( adequacy of basic food groups)
Variety : a diet that includes a wide selection of foods within each
food group (dietary diversity/ includes biodiversity – species, varieties, cultivars)
Nutrient Density : a diet that includes foods that provide the
most nutrients for the least number of calories
(nutrient dense foods)
Moderation : A diet that limits intake of foods high in sugar
and fat (nutrient intake goals/guidelines)

14. Methods of obtaining dietary
intake
data
Method Advantages Disadvantages
Nutrient intake analysis Allows actual observation May yield inconsistent and
of food intake subjective estimates of
food consumption;
possible variation in
portion size
Daily food record or diary Provides daily record of Variable literacy skills of
food consumption; can participants; requires
provide information on ability to measure or judge
quantity of food; how food portion sizes; actual food
is prepared; and timing of intake possibly influenced
meals and snacks by the recording process;
questionable reliability of
records
Food frequency Easily standardized; can Requires literacy skills;
be beneficial when does not provide meal
considered in combination pattern data; requires
with usual intake; provides knowledge of portion sizes
overall picture of intake
24 Hour Recall Quick, easy Relies on memory

15. Assessment of individual intakes
Dietary records
 Record all foods and beverages consumed over a
specific time period (3-4 d)
 Amount consumed determined by weighing with a scale
or measuring volume using standard cups and spoons
 Specific/special foods may be recorded (fat, vitamin A,
iron rich)
 Total energy intake will require all foods to be recorded.

16. Food Diary : DAY
Meal Foods ( list Amount How Where eaten
) eaten prepared (home, work,
etc)
Breakfast
Snack
Lunch
Tea
Dinner
Food supplements : Name…… (cans/d)
Vitamins/minerals supplement :….

17. Assessment of individual
intakes
Diet history
• Collection of information on frequency of intake of
various
foods and usual meal pattern
• Entails detailed listing of foods and beverages
consumed at each eating session
• 3 d - diet record as an independent check on food
intake
• Methods of preparation

18. Assessment of individual intakes : 24 dieta
 Get an accurate and complete listing of all
food/drink individual consumed within last
24 hrs
 Specifically:
 What food/drink was consumed?
 How much was consumed?
 Time it was consumed?
 How was it prepared?
 How was it served?
 Details of food (e.g low
fat, 1%, whole, milk
powder, preparation, )

19. Assessment of individual
intakes
24 hour recall :
 Recall all the foods and beverages consumed the
previous day or 24 hours prior to the interview
 Interviewers should be knowledgeable about foods
available in the market
 Regional and ethnic preparations and methods
 Interview conducted face –to-face, structured w/o probing
questions
 Estimates of portion size are made using standardized
cups and spoons
 Record of food amounts converted into nutrient intakes
using food composition tables

20. Assessment of individual
intakes
Food frequency questionnaire (FFQ)
 Report usual frequency of consumption of each
food item from a list of food items in reference
to a specified period (past wk/mo/yr)
 Face to face interview, telephone or by self
administration
 Describes dietary patterns or food habits not
nutrient intake
 Semi quantified tools can obtain information on
portion size using household measures

21. FFQ - Examples : For each item indicate with a check mark the category that
best describes the frequency with which you usually eat that particular food;
complete questionnaire might contain more than 100 items
Food item > 1/d 1/d 3-6 1-2/wk 2/mth or Never
times/wk less
Beef
Fish
Liver
Poultry
Eggs
Dried beans
Green leafy
vegetables
Enter other foods not listed that
are eaten regularly
1.-------------
2. -------------
3. -----------

22. Example of semi quantitative FFQ
Food Medium Serving How often ?
serving S M L D W M Y N
Apples, apple 1 or ½
sauce cup
Banana 1
medium
Papaya ¼
medium
Water melon 1 slice
Orange 1
medium
Bel juice 6 oz
glass
Coconut water 4 oz
glass

23. Relative risk of lung cancer according to categories
of baseline carotenoid and fruit + vegetable intake
Quintile of nutrient or Median Relative risk
intake/d (n)
Carotenoids (mcg)
1 ( < 2770) ( 397) 2170 1.00
2 ( 2770-3786) (364) 3281 0.94
3 (3787 – 4988) (320) 4344 0.80
4 (4989 – 6792) (276) 5777 0.70
5 ( > 6792) (287) 8577 0.72
P for trend < 0.0001
Fruits + vegetables (g)
1 ( < 116 ) 407 80 1.00
2 ( 116-176) 362 147 0.88
3 ( 177 – 241 ) 326 207 0.79
4 ( 242 – 332) 293 280 0.71
5 ( > 332) ( 256) 415 0.64
Amer J Epidemiol (2002) 156: 536 -547

24. Estimating average intake of
nutrients
 Specification of portion size – standardized portions
(Willet )
 Description of portion size – small, medium, large
(Block)
 Information on frequency and serving size allows for
estimating nutrient intakes
 Food list should contain foods that contribute to
majority of the nutrients/specific in the diet (represent
75% of the nutrient intake –selected nutrients)
 % adequacy of food groups
 % adequacy of RDA for energy and nutrients
including micronutrients
 Used in epidemiological research to study diet
disease relationships

25. Rapid methods for community
dietary
assessment
 Dietary assessment of  development of culture -
HHs with children under 5s specific relevant food usage
list
 Rapid assessment survey
(focus group interviews,  Linking food intake data with
weighing /measuring of
selected target group
children & mother
interviews IYCF practices,
 Derive mother’s BMI from
 Social customs and food standard tables
beliefs, behaviours &
intakes
 Key informants –
community leaders, local
shop owners or health
personnel
 Small clusters of women
5-6 women sufficient for
FGD

26. Strengths and limitations of dietary assessment
methods
Method Strengths Limitations
Food record Does not rely on memory; open ended High participation burden; requires
literacy; may alter intake behaviour (
?? community use )
24 hr recall Immediate recall period, easy to obtain Relies on memory; requires skilled
information; since interviewers interviewer; does not reflect the usual
dietary intake ; tendency to over report
administer tool & records the
low intakes and under report high
responses, literacy is not a intakes ( need for food list, std menu
problem, respondent burden minimal; types; need for community based
does not alter intake behavior; wide training ) memory; requires complex
FFQs Inexpensive ; preferred for nutrients
range of use Relies on
with high day-to-day variability; does calculations to estimate frequencies;
not alter intake behavior; lower requires literacy, doe not quantify
respondent burden; epidemiological intake ( need for exhaustive food
research to study diet-disease list; need for manual tally type
relationships calculations)
Food habit Rapid &low cost; does not alter intake may rely on memory; may require
questionnaire behaviour trained interviewer ( need for food
list; std menu types; community
based training)
Relies on memory; may require
Diet history No literacy needed; trained interviewer ( need for food
list & community based training

27. Validation and Reliability of dietary
methods
 Validity - how well it measures what it purports to
measure (accuracy)
 Reliability – how well it agrees on retesting under
the same conditions (consistency)
 Assessment of reliability is feasible , validity
poses a problem
 Gold standard established – dietary record/direct
observation of subject’s consumption
 Reference for validation

28. SOURCES OF ERROR IN DIETARY
ASSESSMENT
METHODS (INDIVIDUAL INTAKES)
Source of Weighed food Estimated 24 hr recall Dietary history
error records food weight and FFQs
records
FCT /recipe + + + +
books
Food coding + + + +
Wrong weight _ + + +
of foods
Reporting error _ _ + +
Variation of + + + _
diet with time
Wrong _ _ _ +
frequency
Modified ± ± _ _
eating pattern
Response bias ± ± ± ±
Sampling bias + + + Ferro –Luzzi in FAO, 2002
Source: Anna +

29. Ranges of nutrient intake goals
(WHO/FAO, 2003)
Dietary factor Goal (% of total energy )
Total fat 15-30%
Saturated fat < 10%
PUFA 6-10%
Trans fatty acids < 1%
Total CHO 55 -75%
Free sugars 10%
Protein 10-15%
Cholesterol <300mg/d
Na Cl <5g/d
Fruits and vegetables at least 400 g/d
Total dietary fibre From foods (40g/d)
Non starch polysaccharides (NSP) From foods (whole grains, F&V)

30. Dietary guidelines :Healthy food pyramid

32. Easy way to count your calories
(Measures providing 100 kcal
 Cereals : 30 g ( 1/5 cup)  Egg : 60 g ( 1 medium size)
 Bread : 40 g ( 2 slices)  Chicken : 90 g ( 3 small
 Pulses : 30 (2 Tbsp) pieces)
 Leafy vegetables (sak): 250 g  Mutton: 85 g
( 2 small bunches)  Fish (lean) 100 g
 Other vegetables : 400 g (4  Fish (fatty) 60 g
cups)  Shrimp : 30 g
 Potato : 100 ( 1 cup)  Prawn : 100 g
 Nuts/oilseeds : 20 g (handful)  Sugar : 25 g ( 5 tsp)
 Fruit : 150 g/ 1-2 fruits  Spices : 40 g ( 6 tsp)
 Milk/Curd :150 ml ( 1 cup)  Oil/ghee : 10 g (2 tsp)
 Butter milk (ghol) : 670 ml ( 4  Butter : 15 g (1 Tbsp)
cups)
 Channa/paneer/cheese : 30 g
(1 pkt)

33. Conclusions
 Need to use core indicators linked to food security &
nutrition outcomes;
 Identify food and nutrition vulnerability through information
on food consumption patterns
 Need to obtain information on intra household distribution
of food for accurate assessment of individual intakes;
 Differential nutritional status associated with differences in
morbidity or illness or other factors within HHs provides
valuable information on food distribution
 Knowledge of HH food allocation patterns and underlying
reasons for food / diet related behaviour, so that
effectiveness of nutrition interventions can be improved.

34. Conclusions
 Choice of method : Information needed, resources
available
 Food/nutrients of primary interest, group/vs individual data,
absolute /vs relative intake , population characteristics
 Include statistical expertise while designing survey and
questions
 Can provide qualitative data on dietary intake of HH
 Can be combined with other methods to obtain individual
quantitative data
 When absolute vs relative estimates are required, food
record, 24 dietary recall are methods of choice
 For day –to-day variability – FFQ useful
 DD – dietary patterns/habits/semi qualitative can be
quantified
 Dietary assessment is essential to identify populations at
risk
 Useful for informing and developing appropriate policies

35. THANK YOU FOR YOUR KIND
ATTENTION !