Overcoming	
  the	
  challenges:	
  	
  
analyzing	
  Cambodian	
  24-­‐hour	
  dietary	
  recalls...
 	
   	
  	
   	
  	
  
•  The	
  Fish	
  on	
  Farms	
  project	
  is	
  being	
  jointly	
  conducted	
  by	
  the	
  Un...
 	
   	
  	
   	
  	
  
•  University	
  of	
  Bri?sh	
  Columbia	
   	
   	
   	
   	
   	
  Ministry	
  of	
  Health,	
 ...
 	
   	
  	
   	
  	
  
Outline	
  
•  24-­‐hour	
  dietary	
  recall	
  review	
  
•  Interna.onal	
  nutri.on	
  researc...
 	
   	
  	
   	
  	
  
24-­‐hour	
  dietary	
  recalls	
  (Lee	
  &	
  Nieman,	
  2012)	
  
•  Strengths	
  
Ø Quick	
  ...
 	
   	
  	
   	
  	
  
Interna?onal	
  nutri?on	
  research	
  	
  
	
  •  Food	
  diversity:	
  dietary	
  diversity	
  ...
 	
   	
  	
   	
  	
  
Research	
  project	
  overview:	
  background	
  
•  Malnutri.on	
  among	
  rural	
  Cambodians	...
 	
   	
  	
   	
  	
  
Research	
  project	
  overview:	
  background	
  
•  Diet	
  low	
  in	
  fat	
  (FAO,	
  2009;	
...
 	
   	
  	
   	
  	
  
Research	
  project	
  overview:	
  Fish	
  on	
  Farms	
  
	
  
•  90	
  villages	
  x	
  10	
  h...
 	
   	
  	
   	
  	
  
Data	
  collec?on:	
  completed	
  by	
  HKI*	
  staff	
  
•  24HR	
  data	
  (woman	
  &	
  child)...
 	
   	
  	
   	
  	
  
Spoon #1 Spoon #2 Spoon #3
Data	
  collec?on:	
  completed	
  by	
  HKI	
  staff	
  
•  Household	
...
 	
   	
  	
   	
  	
  
Meal	
   Food	
  item	
   Household	
  measure	
  
Breakfast	
   Rice	
  	
   0.5	
  plate	
  #1	
...
 	
   	
  	
   	
  	
  
Challenge	
  #1:	
  finding	
  nutri?onal	
  informa?on	
  
•  Purchased	
  ESHA	
  
Ø Uses	
  lat...
 	
   	
  	
   	
  	
  
1.  Bảng	
  thành	
  phần	
  dinh	
  dưỡng	
  
thực	
  phẩm	
  Việt	
  Nam	
  năm	
  2000	
  	
  
...
 	
   	
  	
   	
  	
  
Challenge	
  #2:	
  dealing	
  with	
  unknowns	
  	
  
	
  
Es.mate	
  unknown	
  nutrients:	
  w...
 	
   	
  	
   	
  	
  
Ques?ons	
   Response	
  from	
  HKI	
  staff	
  
What	
  is	
  the	
  recipe	
  for	
  
‘pra	
  ho...
 	
   	
  	
   	
  	
  
Challenge	
  #3:	
  ques?onable	
  reliability	
  	
  
Reliability:	
  “we	
  are	
  producing	
  ...
 	
   	
  	
   	
  	
  
Challenge	
  #4:	
  assessing	
  validity	
  
Validity:	
  “we	
  are	
  measuring	
  what	
  we	
...
 	
   	
  	
   	
  	
  
Summary	
  of	
  the	
  challenges	
  &	
  solu?ons	
  
•  Finding	
  nutri.onal	
  informa.on	
  ...
 	
   	
  	
   	
  	
  
References:
•  Barba, C.V.C. & Cabrera, M.I.Z. (2008). Recommended Dietary Allowances harmonizatio...
 	
   	
  	
   	
  	
  
Acknowledgements
Thank	
  you	
  to	
  my	
  commidee	
  members	
  &	
  HKI:	
  	
  
Dr.	
  Tim	
...
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Nutrition and Health: Overcoming the challenges: analyzing Cambodian 24-hour dietary recalls

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Nutrition and Health: Overcoming the challenges: analyzing Cambodian 24-hour dietary recalls

  1. 1.             Overcoming  the  challenges:     analyzing  Cambodian  24-­‐hour  dietary  recalls    Presented  by  Vash.  Verbowski  (MSc  student  at  UBC)       Presented  at  the  Interna.onal  Food  Security  Dialogue  2014:   “Enhancing  Food  Produc.on,  Gender  Equity  and  Nutri.onal   Security  in  a  Changing  World”   Sponsored  By:     Hosted  By:    
  2. 2.             •  The  Fish  on  Farms  project  is  being  jointly  conducted  by  the  University  of   Bri?sh  Columbia  (UBC)  and  Helen  Keller  Interna?onal  (HKI),  with   technical  assistance  from  World  Fish,  in  Prey  Veng  Province,  Cambodia.     •  This  randomized  control  trial  inves.gates  an  integrated  Homestead  Food   Produc.on  models  in  rela.on  to  poverty,  gender  empowerment,  and  food   and  nutri.on  security,  par.cularly  among  women  and  children.     •  This  is  the  first  project  known  to  rigorously  measure  the  effec.veness  of   different  models  of  Homestead  Food  Produc.on  at  reducing   undernutri.on  using  biochemical  and  anthropometric  measurements.  
  3. 3.             •  University  of  Bri?sh  Columbia            Ministry  of  Health,  Cambodia         •  Dr.  Tim  Green,  Associate  Professor,  Human  Nutri.on    Ministry  of  Planning,  Cambodia     •  Dr.  Judy  McLean,  Assistant  Professor,  Human  Nutri.on         •  Dr.  Susan  Barr,  Professor,  Human  Nutri.on             •  Dr.  Larry  Lynd,  Professor  &  Director,  Collabora.on  for  Outcomes  Research  &  Evalua.on       •  Dr.  Tony  Farrell,  Professor,  Centre  for  Aquaculture  and  Environmental  Research   •  Dr.  David  Ki_s,  Professor,  Food  Science  &  Associate  Dean  of  Research   •  Dr.  Ian  Forster,  Centre  for  Aquaculture  and  Environmental  Research   •  Jen  Foley,  Fish  on  Farms  Program  Coordinator   •  Helen  Keller  Interna?onal  -­‐  Cambodia        Graduate  Students   •  Dr.  Zaman  Talukder                Kyly  Whiaield  (PhD,  Nutri.on)   •  Mr.  Hou  Kroeun                  Crystal  Karakochuk  (PhD,  Nutri.on)   •  Ms.  Ly  Sokhoing                  Vash.  Verbowski  (MSc,  Nutri.on)   •  Field  Research  Team                Pardis  Lakzadeh  (MSc,  Public  Health)                          Jeff  Tang  (BSc,  Science)  
  4. 4.             Outline   •  24-­‐hour  dietary  recall  review   •  Interna.onal  nutri.on  research   •  Research  project  overview   Ø Background   Ø Data  collec.on   •  Challenges  encountered   Ø Possible  solu.ons   Ø Helpful  tools   •  Summary   © Fish on Farms © Fish on Farms
  5. 5.             24-­‐hour  dietary  recalls  (Lee  &  Nieman,  2012)   •  Strengths   Ø Quick  &  inexpensive   Ø More  objec.ve   Ø Less  par.cipant  burden   Ø Can  es.mate  popula.on  intake   •  Limita.ons   Ø Omi_ed/forgo_en  foods   Ø Under/over-­‐repor.ng   Ø Poor  descriptor  of  individual  usual  intake     Ø Data  entry  is  labor  intensive   à  mul.ple-­‐pass  method   à  unknown  in  Cambodia   à  students   à  repeat  recalls   © Fish on Farms
  6. 6.             Interna?onal  nutri?on  research      •  Food  diversity:  dietary  diversity  indices  (Olney,  2009)   •  Food  availability:  food  balance  sheets  (Hop,  2003)   •  Adherence:  garden  maintenance  rates  (Bushamuka,  2005)     •  Current  research  lacking…     What  do   Cambodians   eat?   We  need     24-­‐hour  recall   data!   Evidence  for   food-­‐based   strategies  
  7. 7.             Research  project  overview:  background   •  Malnutri.on  among  rural  Cambodians  (CDHS,  2010)   Ø Women   •  20%  underweight  (BMI  <18.5)   •  47%  anemic   Ø Children   •  30%  underweight  (low  weight-­‐for-­‐age)   •  11%  wasted  (low  weight-­‐for-­‐height)   •  42%  stunted  (low  height-­‐for-­‐age)   •  57%  anemic     © Fish on Farms
  8. 8.             Research  project  overview:  background   •  Diet  low  in  fat  (FAO,  2009;  Health  Canada,  2006;  Barba,  2008)   Ø 2382  kcal/capita/d       Ø 62.4g  protein/capita/d  (10.5%  kcal)  vs.  10-­‐35%  RDA   Ø 36.9g  fat/capita/d  (13.9%  kcal)  vs.  20-­‐35%  RDA                            vs.  40-­‐57g/d  SEA-­‐RDA   Poten.al  to   improve  nutri.on   status   Aquaculture   (small  fish  ponds)   Homestead  Food   Produc.on  (HFP)   24-­‐hour   dietary   recalls  
  9. 9.             Research  project  overview:  Fish  on  Farms     •  90  villages  x  10  households  each  (n=900)   •  Each  village  randomly  assigned  to:     ① Plant-­‐based  HFP   ② HFP  +  aquaculture  (fish  pond)   ③ Control     •  Outcomes   Ø  Food  security  &  gender  equality   Ø  Income  genera.on   Ø  Dietary  intake,  blood,  urine,  &  anthropometrics     © Fish on Farms © Fish on Farms
  10. 10.             Data  collec?on:  completed  by  HKI*  staff   •  24HR  data  (woman  &  child)   Ø  Trained  interviewers   Ø  Structured  dietary  recalls     Ø  Baseline  &  endline  data     •  Nutrient  analysis:  6  fish  species   Species  (per  100g)   Protein  (g)   Lipid  (g)   Iron  (mg)   Zinc  (mg)   Labeo  rohita   14.0   4.5   0.49   1.14   Vitamin A?*HKI:  Helen  Keller  Interna.onal   © Fish on Farms
  11. 11.             Spoon #1 Spoon #2 Spoon #3 Data  collec?on:  completed  by  HKI  staff   •  Household  measures  (props)   •  Weighed  por.ons   •  Transla.ons     Ingredient   Spoon  #1   Spoon  #2   Spoon  #3   Piece   Trey  Phtok   12g   5g   3g     20g   Trey  Chhpin    11g   5g   4g   14g   Khmer:   La?n  name:   Common  name:   Method  of  cooking:   Trey  Phtuok   Channastriata   Common  snakehead   Made  into  fish  paste     (pra  hok)  
  12. 12.             Meal   Food  item   Household  measure   Breakfast   Rice     0.5  plate  #1   Frog  meat   2  pieces   Kangkong   2  spoon  #1   Snack   Fruit  (rambutan)   10  small   Biscuit  (Sakira  brand)   3  small  package   Lunch   Rice     1  plate  #2   Frog  meat   1  piece   Kangkong   1  spoon  #2   Dinner   Rice     1  plate  #2   Amaranth   1  spoon  #1   Channastriata  (Trey  Phtok)   12  pieces   Data  analysis:  24-­‐hour  dietary  recall  (#325)   ?
  13. 13.             Challenge  #1:  finding  nutri?onal  informa?on   •  Purchased  ESHA   Ø Uses  latest  USDA  data   Ø Includes  Canadian  Nutrient  File   Ø Errors  minimized  with  quality  control  reviews   Ø Contains  ~55,000  foods   •  Use  local  food  composi.on  data   Ø www.FAO.org       Ø Vietnamese     Ø East  Asia      
  14. 14.             1.  Bảng  thành  phần  dinh  dưỡng   thực  phẩm  Việt  Nam  năm  2000     1.    Sheet  nutrient  composi.on                  of  food  Vietnam  in  2000     3.  Cơ  sở  dữ  liệu  thành  phần  thực   phẩm  Mỹ  -­‐  USDA  Food  Composi.on     3.  Databases  U.S.  Food  ingredients  –            USDA  Food  Composi.on  Database,            Version  18,  2006…   Challenge  #1:  finding  nutri?onal  informa?on   www.translate.google.com…
  15. 15.             Challenge  #2:  dealing  with  unknowns       Es.mate  unknown  nutrients:  www.fishbase.org       Ø Step  1:  Classify  Labeo  rohita  (carp  or  minnow)   Ø Step  2:  Search  database  for  similar  fish     Species  (per  100g)   Protein  (g)   Lipid  (g)   Iron  (mg)   Zinc  (mg)   Vit.  A  (RAE)   Carp   [USDA  database]   17.83   5.6   1.24   1.48   9.0  (30  IU)   Carp     [Vietnamese  database]   16g   3.6   0.90   1.48   181  (603  IU)   Species  (per  100g)   Protein  (g)   Lipid  (g)   Iron  (mg)   Zinc  (mg)   Labeo  rohita   14.0   4.5   0.49   1.14   Vitamin A?
  16. 16.             Ques?ons   Response  from  HKI  staff   What  is  the  recipe  for   ‘pra  hok’?     1kg  of  fish  (Trey  Phtuok)  &  300g  of  salt.   Put  fish  in  water  un.l  they  swell  &  smell  bad.     Dry  under  sun  &  mix  with  salt.   Challenge  #2:  dealing  with  unknowns   Liaise  with  experts   Khmer:   La?n  name:   Common  name:   Method  of  cooking:   Trey  Phtuok   Channastriata   Common  snakehead   Made  into  fish  paste     (pra  hok)   © Fish on Farms
  17. 17.             Challenge  #3:  ques?onable  reliability     Reliability:  “we  are  producing  the  same  es.mates  every  .me”       •  Develop  set  of  assump.ons   Ø Replace  “water  lily”  with  “lotus  root”  (no  nutri.on  info)   •  Use  the  5-­‐step  mul.ple-­‐pass  24-­‐hour  dietary  recall  for  endline   Ø 1st  pass:  quick  list     Ø 2nd  pass:  forgo_en  foods   Ø 3rd  pass:  .me  &  place   Ø 4th  pass:  detailed  descrip.on   Ø 5th  pass:  final  review  à  idea:  take  pictures  of  labels     à  por.on  size  &  addi.ons   à  snacks  &  beverages   à  food  from  previous  day   à  sort  chronologically  
  18. 18.             Challenge  #4:  assessing  validity   Validity:  “we  are  measuring  what  we  intended  to  measure”     •  Energy  &  fat  intake:  monitor  height  &  weight   •  Compare  nutrient  intakes  against  biomarkers   Ø  Iron:  hemoglobin,  ferri.n   Ø  Vitamin  A:  re.nol,  carotenoids   Ø  Zinc:  serum  zinc     © Fish on Farms
  19. 19.             Summary  of  the  challenges  &  solu?ons   •  Finding  nutri.onal  informa.on     Ø Use  local  resources  when  possible   •  Dealing  with  unknowns   Ø Develop  rela.onships  with  “experts”     Ø Consider  “road-­‐blocks”  beforehand     •  Improving  reliability     Ø Develop  a  set  of  assump.ons   Ø Use  validated  techniques   •  Improving  validity   •  Compare  dietary  intake  data  against  biomarkers   © Fish on Farms © Fish on Farms
  20. 20.             References: •  Barba, C.V.C. & Cabrera, M.I.Z. (2008). Recommended Dietary Allowances harmonization in Southeast Asia. Asia Pacific Journal of Clinical Nutrition, 17(S2): 405-408. •  Bushamuka, V.N., de Pee, S., Talukder, A., Kiess, L., Panagides, D., Taher, A., & Bloem, M. (2005). Impact of a homestead gardening program on household food security and empowerment of women in Bangladesh. Food and Nutrition Bulletin, 26(1), 17-25. •  FAO (2009). FAOSTAT: Cambodia. Retrieved from http://faostat.fao.org/site/368/DesktopDefault.aspx?PageID=368#ancor •  FAO (1972). Food Composition Table for use in East Asia 1972. Retrieved from http://www.fao.org/docrep/003/X6878E/X6878E00.htm •  FAO (2014). International Network of Food Data Systems (INFOODS). Retrieved from http://www.fao.org/infoods/infoods/tables-and-databases/asia/en/ •  FishBase (2014). Retrieved from http://fishbase.org/search.php •  Google Translate. Retrieved from http://translate.google.com/ •  Health Canada (2006). Dietary Reference Intakes. Retrived from http://www.hc-sc.gc.ca/fn-an/nutrition/reference/table/ref_macronutr_tbl-eng.php •  Hop, L.T. (2003). Animal Source Foods to Improve Micronutrient Nutrition and Human Function in Developing Countries. Journal of Nutrition, 133(11:2), 4006S-4009S. •  Lee, R.D. & Nieman, D.C. (2012). Nutritional Assessment. Sixth edition. McGraw-Hill. •  National Institute of Statistics, Directorate General for Health, & Measure DHS. (2010). Cambodia Demographic and Health Survey (CDHS) 2010. Phnom Penh, Cambodia & Calverton, Maryland, USA. Retrieved from http://www.measuredhs.com/pubs/pdf/FR249/FR249.pdf •  Olney, D.K., Talukder, A., Iannotti, L.L., Ruel, M.T., & Quinn, V. (2009). Assessing impact and impact pathways of a homestead food production program on household and child nutrition in Cambodia. Food and Nutrition Bulletin, 30(4), 355-369. •  Vietnamese Food Composition Table (2007). Retrieved from http://www.fao.org/fileadmin/templates/food_composition/documents/pdf/VTN_FCT_2007.pdf * Photos from the Fish on Farms blog: http://fishonfarms.landfood.ubc.ca/topics/blog/
  21. 21.             Acknowledgements Thank  you  to  my  commidee  members  &  HKI:     Dr.  Tim  Green,  Associate  Professor,  UBC  LFS  Human  Nutri.on   Dr.  Judy  McLean,  Senior  Instructor,  UBC  LFS  Human  Nutri.on   Dr.  Susan  Barr,  Professor,  UBC  LFS  Human  Nutri.on   Dr.  Larry  Lynd,  Associate  Professor,  UBC  Pharmaceu.cal  Sciences   Helen  Keller  Interna.onal  in  Cambodia  (Zaman  Talukder  et  al.)     Sponsored  By:     Hosted  By:    

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