Assessment of nutritional status - methods
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Methods to assess nutritional status of a community
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Assessment of nutritional status - methods
- 1. Assessment of Nutritional Status Public Health Nutrition Module – MPH II Dr. Vignesh L, M.D. (AIIMS, New Delhi) Senior Resident Department of PSM JIPMER, Puducherry 06-04-2022 1
- 2. Basic terms/concepts • Food • Food groups • Nutrients – Macro and Micro • Diet • Nutritional problems – types 06-04-2022 2
- 3. Case The Child Division of a state health department wants to assess the nutritional status of districts in a state. You are a public health consultant and so you are asked to provide a concept note with plan for the activity. What approaches will you apply? 06-04-2022 3
- 4. Framework for nutrition assessment Intake of food & nutrients Changes in body composition Disease(s) Dietary intake assessment Anthropometry Clinical assessment & Bio-markers Indirect methods - Correlation studies ? 06-04-2022 4
- 5. Nutrition assessment • Collecting detailed information • to identify specific nutrition problems, and • their causes • Develop an appropriate action plan to prevent or treat malnutrition or other health conditions Nutrition surveillance Nutrition assessment Nutrition screening Individual level Population level 06-04-2022 5
- 6. Other purposes of nutrition assessment • Programme monitoring • Identify disparities within sub-populations e.g. sex, age groups, SES, caste, etc. • Track alignment with national or global nutrition goals/targets 06-04-2022 6
- 7. Outline • Framework for nutrition assessment • Dietary intake assessment • Recall and record based methods • Dietary record • 24-hr recall • Food frequency questionnaire • Anthropometry • Clinical assessment • Assignment 06-04-2022 7
- 8. Dietary intake assessment Long vs short term exposure Dietary pattern = Consistent pattern + Day-to-day variation Factors systematically affecting day to day variation: • Day of the week e.g. heavy meal on Sunday • Season e.g. vegetable availability • Cultural factors e.g. veg diet at ‘Puratasi’ • Ecological factors e.g. availability of foods in market 06-04-2022 8
- 9. Dietary intake assessment Day-to-day variation affects micronutrients more than macronutrients Types • Dietary record method • 24 hour recall • Food Frequency Questionnaire 𝐅𝐨𝐨𝐝 × 𝐀𝐦𝐨𝐮𝐧𝐭 × No. of days 𝐅𝐨𝐨𝐝 × 𝐍𝐨. 𝐨𝐟 𝐝𝐚𝐲𝐬 × Est. of amount 06-04-2022 9
- 10. Dietary record method • Detailed listing of all foods consumed in 1 or more day • Weighted and recorded whenever food is consumed, ideally 06-04-2022 10
- 11. Dietary record method Advantages • Accurate estimation • Measures absolute intake • Open ended Disadvantages • Difficult • Requires active involvement of participants • Can’t record past diet • Self-monitoring itself can change behaviour 06-04-2022 11
- 12. Dietary record method – E.g. 06-04-2022 12
- 13. 24 hour recall method • In-depth-interview • Participant • All food consumed in the past 24 hour or 12 am to 12 am • Probes for additional foods and preparation methods 06-04-2022 13
- 14. Portion sizes for quantification 06-04-2022 14
- 15. 24 hour recall method Advantages • Quick • Doesn’t require participant literacy • Measures absolute intake • Open ended Disadvantages • Recall / memory problem • Issues in identification & quantification • Interviewer requires training • Can’t record past diet 06-04-2022 15
- 16. 24 hour recall method – E.g. 06-04-2022 16
- 17. Recall and record based methods How many days? • One day is not sufficient • Representative of possible types of variations e.g. weekdays and weekends • Multiple days of intake – estimate of within person day-to-day variability • Can increase the number of individuals in the study rather than increase the no. of days of assessment 06-04-2022 17
- 18. Calculation of nutrients intake Recall and record based methods 06-04-2022 18
- 19. Food frequency questionnaire • Frequency of foods consumption (average long term intake) as an important exposure compared to amount of intake on particular setting(s) • Self-administered • Based on frequency of consumption of foods • Contains: • Food list • Frequency response section - Daily/weekly/monthly/yearly • Flexible to add more questions on composition and quantity 06-04-2022 19
- 20. 06-04-2022 20
- 21. Food frequency questionnaire Food list • Specific foods or comprehensive – depends on research question • Comprehensive list is generally preferred • Plan for analysis – ranking individuals or estimating intake • Other considerations: • Food groups must have reasonable responses • Foods must have sufficient content of nutrients • Can use published food composition tables 06-04-2022 21
- 22. Food frequency questionnaire Advantages • Assesses long term diet • Relatively inexpensive (self-administered) • Requires only little knowledge/ commitment Disadvantages • Inaccuracy of absolute intake • Fluctuation of nutrient values depending on instrument length and structure • Lack of detail regarding specific foods 06-04-2022 22
- 23. Framework for nutrition assessment Intake of food & nutrients Changes in body composition Disease(s) Dietary intake assessment Anthropometry Clinical assessment & Bio-markers Indirect methods - Correlation studies 06-04-2022 23
- 24. Anthropometry • Measurement of the human body • Can identify under or overnutrition, but not specific deficiencies • Some Examples? 06-04-2022 24
- 25. 06-04-2022 25
- 26. Anthropometry Advantages • Objective measurement • Less costly • Effective for large scale surveys Disadvantages • Non specific – w.r.t. planning intervention • Variability • within and between observers • Between instruments 06-04-2022 26
- 27. Framework for nutrition assessment Intake of food & nutrients Changes in body composition Disease(s) Dietary intake assessment Anthropometry Clinical assessment & Bio-markers Indirect methods - Correlation studies 06-04-2022 27
- 28. Clinical assessment • General – Bilateral pitting edema • Specific – Based on micronutrient deficient • Used under national programmes for surveillance • Iron – Pallor • Iodine – Neonatal goiter & Cretinism 06-04-2022 28
- 29. Clinical assessment • Vitamin A 06-04-2022 29
- 30. Clinical assessment • Fluorine • Others – Rickets 06-04-2022 30
- 31. Biomarkers • Diagnosis of a disease state – e.g. S. Vitamin D, FBS • Dietary intake of nutrients, non-nutritive food components or dietary patterns – e.g. urine nitrogen for protein intake • Reflect the effect of a single nutrient but the interactions of various nutrients – e.g. S. homocysteine 06-04-2022 31
- 32. 06-04-2022 32
- 33. Case The Child Division of a state health department wants to assess the nutritional status of districts in a state. You are a public health consultant and so you are asked to provide a concept note with plan for the activity. What approaches will you apply? 06-04-2022 33
- 34. Assignment • List out the national surveys in India that perform any type of nutrition assessment. • Tabulate which survey uses which nutritional approaches and methods. • What is dietary diversity? How is it measured? 06-04-2022 34
- 35. References • Willett, Walter. 2013. Nutritional epidemiology. Oxford: Oxford University Press. • Kristen Cashin and Lesley Oot. 2018. Guide to Anthropometry: A Practical Tool for Program Planners, Managers, and Implementers. Washington, DC: Food and Nutrition Technical Assistance III Project (FANTA)/ FHI 360. • FAO. 2018. Dietary Assessment: A resource guide to method selection and application in low resource settings. Rome. 06-04-2022 35