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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 Vashti Verbowski (MSc student at UBC) Presented at the International Food Security Dialogue 2014: “Enhancing Food Production, Gender Equity and Nutritional Security in a Changing World” Sponsored By: Hosted By:
  2. 2. • The Fish on Farms project is being jointly conducted by the University of British Columbia (UBC) and Helen Keller International (HKI), with technical assistance from World Fish, in Prey Veng Province, Cambodia. • This randomized control trial investigates an integrated Homestead Food Production models in relation to poverty, gender empowerment, and food and nutrition security, particularly among women and children. • This is the first project known to rigorously measure the effectiveness of different models of Homestead Food Production at reducing undernutrition using biochemical and anthropometric measurements.
  3. 3. • University of British Columbia Ministry of Health, Cambodia • Dr. Tim Green, Associate Professor, Human Nutrition Ministry of Planning, Cambodia • Dr. Judy McLean, Assistant Professor, Human Nutrition • Dr. Susan Barr, Professor, Human Nutrition • Dr. Larry Lynd, Professor & Director, Collaboration for Outcomes Research & Evaluation • Dr. Tony Farrell, Professor, Centre for Aquaculture and Environmental Research • Dr. David Kitts, 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 International - Cambodia Graduate Students • Dr. Zaman Talukder Kyly Whitfield (PhD, Nutrition) • Mr. Hou Kroeun Crystal Karakochuk (PhD, Nutrition) • Ms. Ly Sokhoing Vashti Verbowski (MSc, Nutrition) • Field Research Team Pardis Lakzadeh (MSc, Public Health) Jeff Tang (BSc, Science)
  4. 4. Outline • 24-hour dietary recall review • International nutrition research • Research project overview Background Data collection • Challenges encountered Possible solutions Helpful tools • Summary
  5. 5. 24-hour dietary recalls (Lee & Nieman, 2012) • Strengths Quick & inexpensive More objective Less participant burden Can estimate population intake • Limitations Omitted/forgotten foods Under/over-reporting Poor descriptor of individual usual intake Data entry is labor intensive  multiple-pass method  unknown in Cambodia  volunteers?  repeat recalls
  6. 6. International nutrition 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? What do Cambodians eat? We need 24-hour recall data! We need 24-hour recall data! Evidence for food- based strategies Evidence for food- based strategies
  7. 7. Research project overview: background • Malnutrition among rural Cambodians (CDHS, 2010) Women • 20% underweight (BMI <18.5) • 47% anemic Children • 30% underweight (low weight-for-age) • 11% wasted (low weight-for-height) • 42% stunted (low height-for-age) • 57% anemic
  8. 8. Research project overview: background • Diet low in fat (FAO, 2009; Health Canada, 2006; Barba, 2008) 2382 kcal/capita/d 62.4g protein/capita/d (10.5% kcal) vs. 10-35% RDA 36.9g fat/capita/d (13.9% kcal) vs. 20-35% RDA vs. 40-57g/d SEA-RDA Potential to improve nutrition status Potential to improve nutrition status Aquaculture (small fish ponds) Aquaculture (small fish ponds) Homestead Food Production (HFP) Homestead Food Production (HFP) 24-hour dietary recalls 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: a. Plant-based HFP b. HFP + aquaculture (fish pond) c. Control • Outcomes  Food security & gender equality  Income generation  Dietary intake, blood, urine, & anthropometrics
  10. 10. Data collection: completed by HKI* staff • 24HR data (woman & child)  Trained interviewers  Structured dietary recalls  Baseline & endline data • Nutrient analysis: 6 fish species Vitamin A?*HKI: Helen Keller International
  11. 11. Spoon #1 Spoon #2 Spoon #3 Data collection: completed by HKI staff • Household measures (props) • Weighed portions • Translations
  12. 12. Data analysis: 24-hour dietary recall (#325) Kangkong: Rambutan: Amaranth: ?
  13. 13. Challenge #1: finding nutritional information • Purchased ESHA Uses latest USDA data Includes Canadian Nutrient File Errors minimized with quality control reviews Contains ~55,000 foods • Use local food composition data  Vietnamese East Asia
  14. 14. 1. B ng thành ph n dinh d ngả ầ ưỡ th c ph m Vi t Nam năm 2000ự ẩ ệ 1. Sheet nutrient composition of food Vietnam in 2000 3. C s d li u thành ph n th cơ ở ữ ệ ầ ự ph m M - USDA Food Compositionẩ ỹ 3. Databases U.S. Food ingredients – USDA Food Composition Database, Version 18, 2006… Challenge #1: finding nutritional information…
  15. 15. Challenge #2: dealing with unknowns Estimate unknown nutrients: Step 1: Classify Labeo rohita (carp or minnow) Step 2: Search database for similar fish Vitamin A?
  16. 16. Challenge #2: dealing with unknowns Liaise with experts
  17. 17. Challenge #2: dealing with unknowns Red ant egg Rabutan leaves Sakura (crab) Red ants Frogs
  18. 18. Challenge #3: questionable reliability Reliability: “we are producing the same estimates every time” •Develop set of assumptions  Replace “water lily” with “kangkong” (no nutrition info) •Use the 5-step multiple-pass 24-hour dietary recall for endline  1st pass: quick list  2nd pass: forgotten foods  3rd pass: time & place  4th pass: detailed description  5th pass: final review  idea: take pictures of labels  portion size & additions  snacks & beverages  food from previous day  sort chronologically
  19. 19. Challenge #4: assessing validity Validity: “we are measuring what we intended to measure” •Energy & fat intake: monitor height & weight •Compare nutrient intakes against biomarkers  Iron: hemoglobin, ferritin  Vitamin A: retinol, carotenoids  Zinc: serum zinc
  20. 20. Summary of the challenges & solutions • Finding nutritional information  Use local resources when possible • Dealing with unknowns  Develop relationships with “experts”  Consider “road-blocks” beforehand • Improving reliability  Develop a set of assumptions  Use validated techniques • Improving validity • Compare dietary intake data against biomarkers
  21. 21. 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 •FAO (1972). Food Composition Table for use in East Asia 1972. Retrieved from •FAO (2014). International Network of Food Data Systems (INFOODS). Retrieved from •FishBase (2014). Retrieved from •Google Translate. Retrieved from •Health Canada (2006). Dietary Reference Intakes. Retrived from •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 •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 * Photos from the Fish on Farms blog:
  22. 22. Acknowledgements Thank you to my committee members & HKI: Dr. Tim Green, Associate Professor, UBC LFS Human Nutrition Dr. Judy McLean, Senior Instructor, UBC LFS Human Nutrition Dr. Susan Barr, Professor, UBC LFS Human Nutrition Dr. Larry Lynd, Associate Professor, UBC Pharmaceutical Sciences Helen Keller International in Cambodia (Zaman Talukder et al.) Sponsored By: Hosted By: