This document discusses methods for dietary evaluation in communities. There are direct methods like anthropometry, biochemical tests, and clinical exams, as well as indirect methods using health statistics. Dietary evaluation includes 24-hour recalls, food frequency questionnaires, dietary histories, food diaries, and observed consumption. These methods assess intake and compare it to requirements to identify deficiencies, excesses, and necessary diet corrections.

1. Dietary evaluation in theDietary evaluation in the
communitycommunity
Dr. Chamath FernandoDr. Chamath Fernando
LecturerLecturer
Department of Family MedicineDepartment of Family Medicine
Faculty of Medical SciencesFaculty of Medical Sciences
University of Sri JayewardenepuraUniversity of Sri Jayewardenepura
Sri LankaSri Lanka

2. ObjectivesObjectives
 To determine the populations who requireTo determine the populations who require
nutritional evaluation and adjustmentnutritional evaluation and adjustment
 To enumerate the tools for nutritional assessmentTo enumerate the tools for nutritional assessment
 To identify the direct and indirect methods ofTo identify the direct and indirect methods of
dietary evaluationdietary evaluation

3. Why assess diet?Why assess diet?
The purpose of nutritional assessment is to:The purpose of nutritional assessment is to:
Identify individuals or population groups
at risk of becoming malnourished
Identify individuals or population groups
who are malnourished
To develop health care programs that meet the
community needs which are defined by the
assessment
To measure the effectiveness of the nutritional
programs & interventions

4. MalnourishedMalnourished
 Under nourishedUnder nourished

5. Over nourished….
Malnourished

6. At community level…

7. Under nutrition in the
global level

8.  Therefore the dietary interventions implementedTherefore the dietary interventions implemented
can be generalized to the population depending oncan be generalized to the population depending on
its overall need in the individual, family,its overall need in the individual, family,
community and regional level.community and regional level.

9. Methods of NutritionalMethods of Nutritional
AssessmentAssessment
 Nutrition is assessed by methods
 Direct methods - deals with the individual and
measure objective criteria
 Indirect methods - uses community health indices that
reflects nutritional influences.

10. Direct methodsDirect methods
These are summarized as ABCDThese are summarized as ABCD
 Anthropometry (e.g. height/length, weight, mid-arm
circumference, triceps skinfold thickness, head circumference,
waist-hip ratio) Use of growth monitoring charts…..
 Biochemical parameters – (e.g. haemoglobin, albumin,
measurement of individual nutrient in body fluids like serum
retinol, serum iron, urinary iodine, vitamin D, urinary
creatinine)
 Clinical assessment – (e.g. general clinical examination, with
special attention to organs like hair, angles of the mouth,
gums, nails, skin, eyes, tongue, muscles, bones, & thyroid
gland.)
 Dietary evaluation

11. Indirect methodsIndirect methods
These include three categories:
Ecological variables including production of crops
per annum.
Economic factors e.g. per capita income,
population density & social habits
Vital health statistics particularly infant & under 5
mortality & fertility index

12. Dietary EvaluationDietary Evaluation
 Five distinct methodsFive distinct methods
11.. 24 hours dietary recall
2. Food frequency questionnaire
3. Dietary history since early life
4. Food dairy technique
5. Observed food consumption

13. 1. 24-hour dietary recall1. 24-hour dietary recall

14.  A trained interviewer asks the subject to recall all food & drinks
taken in the previous 24 hours.
 The exact food taken per each meal and snacks is documented
along with the quantity consumed.
 It is quick, easy, & depends on short-term memory
 But may not be truly representative of the person’s usual intake

15. 2. Food frequency2. Food frequency
questionnairequestionnaire
In this method the subject is given a list of around
100 food items to indicate his or her intake
(frequency & quantity) per day, per week & per
month.
inexpensive, more representative & easy to use.

17. Limitations:
 long Questionnaire
 Errors with estimating serving size.
 Needs updating with new commercial food
products to keep pace with changing dietary
habits.

18. 3. Dietary History3. Dietary History
It is an accepted method for assessing the
nutritional status.
Collected by a trained interviewer.
Details about usual intake, types, amount,
frequency & timing needs to be obtained in a
chronological order.
Cross-checking to verify data is important.

20. 4. Food diary4. Food diary
Individuals are supposed to maintain a food diary
Food intake (types & amounts) should be recorded
by the subject at the time of consumption.
Reliable but difficult to maintain.
The length of the collection period range between
1-7 days.

22. 5. Observed food5. Observed food
consumptionconsumption
 Not used for clinical practice, but it is recommended
for research purposes.
 The meal eaten by the individual is weighed and
contents are exactly calculated.
 The method is characterized by having a high degree of
accuracy but expensive & needs time & efforts.

23. How to evaluate the diet?How to evaluate the diet?
 Once the consumed amounts are assessed andOnce the consumed amounts are assessed and
calculated, it is evaluated whether they are deficientcalculated, it is evaluated whether they are deficient
or sufficient or are in excess.or sufficient or are in excess.

24. Calculate the calorie
count and amount of
nutrients in the
individual’s diet….
e.g. chart for
vegetables
1. Quantifying
the nutrients

25. Calculate the
nutrient
requirement for
age, sex, physical
activity level

26. Calorie Intake as
proportions of
nutrients….

27. 2. Qualitative assessment - Nutrient pyramid
….

28. Diet correctionDiet correction
 Correction of the dietary practices can then be doneCorrection of the dietary practices can then be done
depending on the discrepancy between the intake anddepending on the discrepancy between the intake and
actual requirement.actual requirement.
 Hygienic food preparation, food additives, methods ofHygienic food preparation, food additives, methods of
preparation (e.g. how the nutritional value differs on thepreparation (e.g. how the nutritional value differs on the
fact whether the fish is consumed raw, grilled or fried)fact whether the fish is consumed raw, grilled or fried)
should also be advised on.should also be advised on.
 Importance of timely food consumption, varying the dietImportance of timely food consumption, varying the diet
in quantity and quality according to the age, sex,in quantity and quality according to the age, sex,
physiological status, co-morbidities, level of activity etc.physiological status, co-morbidities, level of activity etc.
are stressed.are stressed.

29.  Reference: Assessment of nutritional status.Reference: Assessment of nutritional status.
 Abdelaziz Elamin, MD, PhD, FRCPCHAbdelaziz Elamin, MD, PhD, FRCPCH
 College of MedicineCollege of Medicine
 Sultan Qaboos University, OmanSultan Qaboos University, Oman

30.  Thank you!Thank you!