INTRODUCTION TO NUTRITION ANALYSIS : POLICY PARAMETERS Lalita
Bhattacharjee Nutritionist Training Workshop on Analysis of Data
for Measuring Availability, Access and Nutritional Status
Assessment of Nutritional Status 14 -26 January 2012
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DIETARY ASSESSMENT AND NUTRITIONAL ASSESSMENT : KEY TERMS A
DIETARY ASSESMENT : comprehensive evaluation of a person's food
intake. It is one of the established methods of nutritional
assessment. Dietary assessment techniques range from food records
to questionnaires and biological markers. NUTRITIONAL ASSESSMENT :
more comprehensive and includes determining nutritional status by
analyzing the individuals brief socio economic background, medical
history, dietary, anthropometric, biochemical, clinical data and
drug nutrient interactions NUTRITIONAL STATUS : measurement of the
extent to which an individuals physiologic need for nutrients is
being met NUTRIENT INTAKE : depends on actual food consumption
which is influenced by factors such as economic situation, eating
behaviour, emotional climate, cultural influences, effects of
disease states on appetite and the ability to absorb nutrients
NUTRIENT REQUIREMENTS : are determined and influenced by age, sex,
BMR, physiological status, activity patterns, physiologic stressors
(infection, disease) and psychological stress
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OPTIMAL NUTRITIONAL STATUS Source: Mahan and Stump, 2000
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DIETARY ASSESSMENT PRINCIPLES Adequacy : a diet that provides
enough energy and nutrients to meet the needs according to the
recommended dietary meet the needs according to the recommended
dietary intakes/allowances (for healthy and active life)
intakes/allowances (for healthy and active life) Balance : a diet
that provides enough, but not too much of each type of food (
adequacy of basic food groups) Variety : a diet that includes a
wide selection of foods within each food group (dietary diversity/
includes biodiversity species, varieties, cultivars) food group
(dietary diversity/ includes biodiversity species, varieties,
cultivars) Nutrient Density : a diet that includes foods that
provide the Nutrient Density : a diet that includes foods that
provide the most nutrients for the least number of calories most
nutrients for the least number of calories (nutrient dense foods)
(nutrient dense foods) Moderation : A diet that limits intake of
foods high in sugar Moderation : A diet that limits intake of foods
high in sugar and fat (nutrient intake goals/guidelines) and fat
(nutrient intake goals/guidelines)
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WHAT IS DIETARY DIVERSITY Dietary diversity is a qualitative
measure of food consumption that reflects household access to a
variety of foods and is also a proxy for nutrient adequacy of the
diet of individuals
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HHDDS and IDDS Measures no. of different food groups consumed
over a given reference period i.e. 24 hours/1 day HDD is also a
proxy for HH socio economic status, whereas IDD is purely a proxy
measure of an individuals quality of diet.
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WHEN TO MEASURE DIETARY DIVERSITY ObjectiveTiming Assessment of
the typical diet of HHs/individuals When food supplies are still
adequate (may be 4-5 mo after the main harvest) Assessment of the
FS situation in rural, agriculture based communities During periods
of greatest food shortage, such as immediately prior to the
harvest/immediately after emergencies or natural disasters
Assessment of FS situation in non- agricultural communities At the
moment of concern to identify a possible food security problem
Monitoring of FS/N programmes or agricultural interventions such as
crop/livelihood diversification Repeated measures to assess impact
of the intervention on the quality of the diet, conducted at the
same time of the year as te baseline (avoid interference due to
seasonal factors)
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Foods/food groups Practical Exercise 3: Use of dietary
diversity in food security and nutrition surveillance Jillian L.
Waid HDDSWDDS 9-groupWDDS 13-groupIYCF DD QFood GroupQ Q Q
1.Cereals1,2Starchy staples1,2Starchy staples1,2Starchy staples
2.White tubers & roots4Dark green leafy vegetables 4
3,4,5Vegetables3,6Vitamin A rich fruits & vegetables 3Vitamin A
rich vegetables 3,4,6Vitamin A rich fruits & vegetables
5,7Other fruits & vegetables 6Vitamin A rich fruits5,7Other
fruits & vegetables 5Other vegetables 6,7Fruits7Other fruits
8,9Meat8Organ meat8 11Fish and other sea food9,11Meat and
fish9,11Meat and fish8,9,11Flesh foods 10Egg10Egg10Egg10Egg
12Legumes, nuts & seeds12Legumes, nuts & seeds12Legumes,
nuts & seeds 12Legumes, nuts & seeds
13Dairy13Dairy13Dairy13Dairy 14Oils & fats 15Sweets
16Condiments & beverages
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Methods for data analysis Cut offs :Not universally defined
FANTA 2: Less than 5 ( out of 9 or 13 food groups) is inadequate
Programmatically : Goal to raise the mean overall to the mean of
the top third of the respondents
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HDDS Calculation Step 1: Assign 1 if the food group/item
consumed; 0 not consumed. Sum all the scores for various food
groups. Sum will be between 0-12. Step 2: The average HDDS for the
sample population Sum HDDS Total no. of households Setting HDDS
Threshold: Option 1: From a baseline survey take the HDDS for the
richest income tercile (33%) Option 2: From a baseline survey take
HDDS of the upper tercile of diet diversity (33%)
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Different Types of Childhood Malnutrition Wasted Low weight for
height Stunted Low height for age Underweight Low weight for age
Normal Normal height for age Children
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Why is nutrition not improving? Knowledge: do people know what
foods they should consume by age, sex, occupation, physiological
status? Do families have the resources/motivation to convert
knowledge to practice If food intakes (energy and nutrients) are
adequate, could there be intervening factors e.g. illness
Pre-disposing factors: maternal undernutrition seasonal food/income
shortages, migration, illness outbreaks, hygiene/sanitation,
emergencies Importance of under 2s
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Illustration of association between dietary adequacy and
anthropometry 100 80 20Total sample 70 0% > -2SDs 30 10 20%