The dietary survey is an important part of the nutritional assessment method for assessing the nutritional status of the patients

1. Dietary Survey
Dr. Chirag R. Sonkusare
Junior Resident
Dept of Community Medicine
GGMC & JJH, Mumbai-08

2. Specific learning objectives
Describe and discuss
dietary surveys for
nutritional assessment of
communities.
Demonstrate the various
nutritional assessment
methods for individual,
family

3. Introduction
Dietary survey
• A nutritional survey is never complete without diet
survey.
• We may be able to find out that there is a nutritional
deficit through clinical, laboratory, or
anthropometrical methods, but to find out whether
this nutritional deficiency is because of diet and due
to which diet/nutrient, we must invariably resort to a
diet survey.

4. Introduction
• It is thus an integral part of nutritional survey.
• A diet survey objectively defines the importance of
diet in various health states and disease.
• Diet survey is the scientific assessment of food
consumption, and this data can be used for various
purposes, including assessment of the nutritional
status.

5. Methods to
undertake
diet survey
1. Food balance sheet
method
2. Inventory method 3. Weighment method
4. 24-hour recall
method (questionnaire
method)
5. Food frequency
questionnaire (FFQ)
method
6. Food diary

6. 1. Food Balance Sheet Method.
• This method is used when information regarding
availability and consumption of food is required at a
macro level such as the global, national, region, or
state level.
• The difference between receipt (of food of various
sources) and expenditure of food over a given
period gives an estimate of the food consumed by
population.
• These figures are used for various types of planning
and budgeting at national and state levels.

7. 2. Inventory Method
• This method is used at an institutional level for a
homogenous group (e.g., hostel, jail, mess, army barrack,
orphanage).
• Amounts of various food stuffs available as per records at
the beginning and end of a certain period (say a week)
are taken into consideration
• The balance of various food items is again checked.
• Individual consumption/day=
Stocks at beginning of week −
Stocks at end of week
Number of individuals
x Number of days

8. 3. Weighment Method.
• In this method, both raw and cooked foods
are weighed.
• The amount (weight or volume) eaten by
each individual is also assessed.
• One can thus calculate the nutrients
consumed by each person.
• This method is more accurate than the
inventory method. But it is a very
cumbersome, time-consuming, and tedious
process as it involves weighing of all
foods.

9. 4. 24-Hour Recall (or
Questionnaire) Method.
• This method is a relatively easy
method based on the recall
capabilities of individuals about the
food intake over a period of past 24
hours.
• Although it might be the most
widely used method, as it is a short-
term retrospective method, it is more
prone to errors.

10. 5. Food Frequency
Questionnaire
(FFQ) Method
• It is an epidemiological technique based on counting the
frequency of consumption of an item over a period of
time.
• It can be used to assess specific dietary intakes during
pregnancy, lactation, and so on.
• It can even be conducted through post.
• For example, a FFQ may read "In 1 week how often
do you consume the following items....”
• This filled-up questionnaire is analyzed using pre-decided
nutrient values for different foods.

11. 6. Food Diary.
• A food diary is a daily log of what one eats
and drinks each day.
• It is a useful method to understand the
eating habits of an individual.
• It is better than the 24-hour recall
questionnaire method as there is no recall
bias. These days, there are many mobile
phone apps available which can maintain e-
record/diary of an individual.

12. Nutritional assessment methods for
individual, family
Direct Indirect
Deals with individual and are
based on objective criteria.
Based on community health
indices.
Clinical Examination. Vital statistics
Anthropometric measurement. Assessment of ecological
factors.
Biochemical evaluation and
laboratory methods.
Dietary assessment/dietary
survey.
Functional indicators.

13. Clinical Examination:
• Simplest and most practical.
• Head to toe examination:-hair, angles of mouth, gums, nails, skin, eyes etc.
• Rapid, easy, inexpensive and noninvasive
• Disadvantage- not detect early cases, malnutrition can't be quantified, missed diseases.
• Clinical signs are classified into three categories:-
• Signs not related to nutrition- eg. Pterygium
• Signs that need further investigation- eg. Corneal vascularization
• Signs known to be of value- eg. Bitot’s spots

14. Anthropometric methods
• Anthropometry is the measurements of body height, weight and
• calculating related proportions.
• Used to evaluate both undernutrition and overnutrition.
• Body weight, height, crown-heel length, mid upper-arm circumference, HC, CC,
skinfold thickness, WHR and waist circumference.
• Height- stadiometer/ infantometer, long term illness, remains unaffected in acute
stages
• Weight-mc used, Salter scale

15. • Anthropometric indicators:-
• Weight for age(%)= (Weight of child/weight of normal child of same age) X 100
• Weight for height(%)= (Weight of child/weight of normal child of same height)
X 100 (age Independent indicator)
• Body mass index= weight (kg)/height(m2)
• Anthro is objective, easy, reproducible readings, inexpensive, minimal training,
• Disadvantage;- human, instrument errors, standard of measurement

16. Biochemical and lab assessment
• Hb
• Stool examination
• Urine examination
• Serum iron, Vit B12, Vit D etc
• Appear before Clinical signs
• Time Consuming, Expensive, Needs Training

17. Functional assessment
• Measure functionality of body cells or tissues
• Eg. Erythrocyte fragility, prothrombin time etc

18. Dietary Assessment
• Recognize problems related to eating patterns and constitute a valuable
tool to deliver nutritional education.
• Assessment of nutritional intake of an individual, family or a population
is important to have an idea about existing pattern of dietary habits and
deficiencies prevalent among the population esp. vulnerable groups.
• Individual level
• Household level
• State/national level

19. Individual level
• 24- hour dietary recall -suitable for large scale surveys and ease of
administration; limitations are that it is memory dependent and bias.
• Multiple 24 hour recalls, or multiple days of diet records- 7 days of dietary
record is considered as a dietary cycle, atleast 3 days of data is required; suitable
for large scale surveys.
• Food records- individuals are asked to record all foods eaten for usually 3-7 days;
quantification of food is estimated by measuring frequencies of standard portion
sizes; memory independent.
• Weighed food records -individual/investigator weighs each item of food and
drink prior to consumption by the individual for a period of 3-7 days; 2
investigators required –one for taking history and weighing and other to record
observations.
• Food frequency questionnaire- consists of list of food items and a corresponding
set of frequencies like daily/twice etc; not a valid method to quantify calorie
intake.
• Video and photographic method -not feasible for large scale surveys

20. Infants and young children
• Minimum diet diversity- 6 to 23.9 months of age
• Minimum meal frequency- 6 to 23.9 months of age of breast-fed r on breast fed
children
• Minimum adequate diet

21. Household level
• Food account method- individual of the house keeps a daily record of all food
items which are purchased during a given time period, usually 7 days; gives info
about mean food consumption; food eaten outside not taken into assessment
• List recall method- recall all food items utilized by whole household; quanity and
price of foods noted.
• Inventory method-record of stock of food items prepared at the beginning and end
of specified period, usually 1 week; avg intake of food per person per day ; used
for hostels, orphanages etc; large sample is covered in a short time
• Household food record method -Household methods are used for their national
food consumption surveys Info regarding socio-economic status, purchasing
practices, meals n snacks consumed outside home, eating patterns, dietary
supplements etc can be collected simultaneously
• Telephone survey

22. National level
• Food balance sheets- gross national food supply is calculated; useful for
administrators, planners
• Market databases- used to analyze trends in consumer
• preferences.
• Computerized dietary assessment
• Nutrient analysis system

23. Indirect methods
• Vital statistics:- -under5 mortality rate, prev of anemia, etc
• Ecological studies:- socio economic, cultural, health and educational services,
food production etc
• Nutritional surveillance/ nutritional Survey/ réhabilitation

24. Thank you