METHODS IN NUTRITION

SURVEY
PRACTICE OF NUTRITION
NUT 312 – Class 1
Mrs I.O Bodunde
 INTRODUCTION
A Reminder
Nutrition is the science that deals with the ingestion and digestion of
food, absorption and metabolism of nutrients, and the excretion of
waste product.
It is the science that deals with the interaction of nutrients and other
food substances with respect to growth, reproduction, maintenance of
the body, health and disease.
Nutritional status is the condition of the body due to intake,
absorption, and use of nutrients as well as the influence of disease-
related factors.
 INTRODUCTION
• A nutritional survey is a method that involves collecting information on
the nutritional status of a group of people
• This is important to monitor ongoing nutrition transition and justify the
need for and initiate appropriate interventions
• It is essential to identify populations at risk of malnutrition
• It helps to identify individuals of population groups who are malnourished.
• It facilitates the development of programmes and interventions to meet
the nutritional needs of a community
• It also helps to measure the effectiveness of nutritional interventions and
programmes.
• It is used to collect data for scientific research
 INTRODUCTION
• Just like in surveys generally, in nutrition surveys, it is not necessary to
examine the whole population.
• A randomly selected representative of the whole population across all age
group, sex, and socio-economic groups is sufficient to draw conclusions.
• The basic assessments are carried out in nutrition surveys are referred to
as nutritional assessment.
• Nutritional assessment is an in-depth evaluation of both objective
(physical examination, anthropometry, and laboratory measurements)
and subjective data (dietary intake) in relation to an individual’s food and
nutrient intake, lifestyle and medical history.
 METHODS OF NUTRITIONAL
ASSESSMENT
No single method can comprehensively assess nutritional status. The
assessment of nutritional status is complicated; reliable assessment always
depends on the characterization of various parameters where none is
isolated.
There are therefore 2 methods
1. Direct method: this method deals with individuals and is used for
objective nutritional assessment measures.
2. Indirect method: this method mostly uses subjective data.
Community health indices that reflect nutritional influences are often
used. They include ecological variables like crop production; economic
factors such as per capita income; and vital health statistics especially
infant and under 5 mortality.
 DIRECT METHODS OF
NUTRITIONAL ASSESSMENT
• These are the ABCD of nutrition assessment
A – Anthropometric methods
B – Biochemical/laboratory methods
C – Clinical methods
D – Dietary evaluation methods
 ASSESSMENT OF NUTRITIONAL
STATUS
Appropriate assessment techniques

• can detect a nutritional deficiency or nutrition related chromic disease in the early stages of
development

• enables intervention through appropriate nutritional support and counseling before a more severe
condition develops.

• Activity 2: Measuring waist circumference, hip circumference and calculating waist-hip ratio
• Click on the link below to learn how to measure your waist circumference and hip circumference.
• https://www.youtube.com/watch?v=lNllQPC0WsM
• Measure your waist circumference in centimeters
• Enter your result in the online spreadsheet provided using the link below:
• https://docs.google.com/forms/d/18ou4tOJX7Q6voUTWKUwS92KIUpntLsv7SfX0qSFEkmU/edit
•
 ANTHROPOMETRIC METHOD
Anthro – man ; metro – measurement
The measurement of body sites of Human beings
Defines physical measures of a person’s size, form, and functional capacities.
• Anthropometry is the non-invasive quantitative measurements and
proportions of the human body. It provides valuable assessment of nutritional
status in both children and adults, as well as pregnant women.
• Typically, they are used to evaluate the general health status, nutritional
adequacy, and growth and development of children.
• In adults, they can help assess health and nutritional status, and future
disease risk.
• The core elements of anthropometry are height, weight, head circumference,
body mass index (BMI), arm span, knee height, sitting height, body
circumferences to measure adiposity (waist, hip, and limbs), and skinfold
thickness. The most common are height and weight.
The most frequently used method to assess the nutritional
status of individuals or population groups.
Measurements of anthropometry are based on growth in
children and body weight changes in adults.
Weight
Height
Mid upper arm circumference
Waist circumference
Head circumference
Waist-hip ratio
Skinfold thickness
 ANTHROPOMETRIC INDICES
• Accurate serial anthropometric measurements can help identify
underlying medical, nutrition, or social problems.
• The measured values reflect the current nutritional status but do not help
to differentiate between acute & chronic changes
• Anthropometric measurements are combined to calculate anthropometric
indices.
 ANTHROPOMETRIC INDICES
• MUAC cut‐offs and use
• The advantages of MUAC are thought to be its simplicity, particularly for
screening children in emergency situations, as only a single measurement
is required which need not be related to a reference population.
• The standard MUAC cut‐off is
• <11.5 cm for severe malnutrition which is similar to the prevalence when
using <‐3 WHZ.
• 11.5 cm – 12.5cm for moderate acute malnutrition
• >12.5 for normal
MEASURING HEIGHT
 ANTHROPOMETRIC INDICES
Body mass index
• This is the measure of fat based on the height and weight of an adult
(20yrs and older). The weight is measured in kg and height in metres.
• For children and teenagers, the same formula is used but are age and
sex-specific because the amount of body fat changes with age and differs
between boys and girls.
• BMI-for-age growth charts are used and BMI is shown as percentile
ranking.
ANTHROPOMETRIC INDICES
Indicator Prevalence cut-off values
for public health
significance
Stunting <2.5%: very low
2.5 to <10%: low
10 to <20%: medium
20 to <30%: high
≥30%: very high
Wasting <2.5%: very low
2.5 to <5%: low
5 to <10%: medium
10 to <15%: high
≥15%: very high
Overweigh <2.5%: very low
t 2.5 to <5%: low
5 to <10%: medium
10 to <15%: high
≥15%: very high
 ANTHROPOMETRIC INDICES
Other measurements include
• Waist/hip ratio
High risk WHR= >0.80 for
females & >0.95 for males.
Waist measurement >80% of
hip measurement for women
and >95% for men indicates
central (upper body) obesity
and is considered high risk
for diabetes & CVS disorders.

• Skinfold thickness
 BIOCHEMICAL/LABORATORY
ASSESSMENT
• This includes laboratory tests to assess biochemical parameters
• They are usually time consuming and expensive which affects their use
on a large scale.
• They majorly reveal only current nutritional status. They are useful in
quantifying mild deficiencies.
• Measurements such as serum protein, serum micronutrient levels, serum
lipids, immunological parameters are used.
• These measurements are usually carried out on body fluids and excretion
such as urine, feces, blood or body tissues.
 BIOCHEMICAL/LABORATORY
ASSESSMENT
• In the blood sample, examples of tests include heamoglobin level, blood
sugar level
• In stools, tests for intestinal parasites can be done
• In urine, there can be an examination for albumin and sugar
BIOCHEMICAL PARAMETERS SUITABLE
FOR NUTRITION ASSESSMENT
 CLINICAL ASSESSMENT
• Clinical signs and symptoms can indicate specific nutrient deficiency.
• It involves looking out for signs and symptoms of deficiency
• Clinical assessment focuses on organs such as skin, eyes, tongue, ears,
mouth, hair, nails, and gums
Common clinical indicators and nutrient of importance
Clinical indicator Nutrient of importance
Pallor of palms or inside of eyelids or Iron deficiency
mouth; Brittle spoon shape nails
Night blindness, bitot’s spots Vitamin A deficiency
Goitre Iodine deficiency
Redness and swelling of mouth or lips Vitamin B2 deficiency
(cheilosis); especially at corners of
mouth (angular fissures and scars)
CLINICAL SIGNS OF
MALNUTRITION
 DIETARY ASSESSMENT
• This method examines adequacy of the diet for micronutrient and
macronutrient composition.
• Dietary assessment can provide both qualitative and quantitative
information of dietary intake.
• There are two major ways to document dietary intake: questioning and
observation to know the actual intake.
• The method used is dependent on the level at which the assessment is
being carried out.
 WEIGHED FOOD RECORD
• This is a prospective tool in which the respondent weighs & records every item of
food & drink consumed for a specific period. It involves correct detailed
description of foods & amounts consumed, including the name of the food (variety
or brand name), preparation methods, recipes for food mixtures and portion sizes.
Left-over is also recorded where it occurs. Food records are labor intensive and
time consuming. The records are analyzed and compared to the dietary reference
intakes (DRIs). There are different types of weighed food records
• One day record
• 3 day food record
• 4 day food record
• 5 day food record
• 7-day food record
 ESTIMATED FOOD RECORDS
• This involves the estimation of the foods & drink rather than weighed.
• The estimation is done using household measures such as cups or
tablespoons, food photographs, estimated food models or pictures, Price.
• The investigator converts these estimates into weights that can then be
used to calculate food and nutrient intake.
 24-HOUR DIETARY RECALL
• This is a quick retrospective (looking back) tool used to ask respondents
about food and drink intake during the previous 24 hours.
• The respondent is prompted to remember & report all the foods and
drinks consumed in the preceding 24 hours.
• It can be conducted by interview in person or by telephone and can be
either computer assisted or using a paper-and-pencil form.
• Well-trained interviewers are required.
• Interviewers must have the knowledge of foods available in the
marketplace, preparation practices including prevalent regional or ethnic
foods and portion sizes.
FOOD FREQUENCY QUESTIONNAIRE (FFQ)
• FFQ is a retrospective assessment tool that asks respondents to
complete a survey about food intake over a specific time period.
• It gathers information on the usual frequency of consumption of specific
foods (times per day, daily, weekly, monthly) from a list of foods for a
specified time frame (past 2-3 months, 1 year or longer).
• To estimate relative or absolute nutrient intakes, semiquantitative FFQ
incorporates portion size questions or specify portion sizes as part of each
question but little detail is collected on other characteristics of the foods
as eaten.
• It identifies habitual intake and recent changes in diet (e.g. changes
resulting from disease).
 FOOD BALANCE SHEET (FBS)
• This measures the food supply in the population. It shows
quantities and types of food available for human consumption,
sources of supply and utilization.
• It shows trends in the food supply overtime and pattern of the diet,
nutritional requirements and food dependency.
FBS Components
• FBS made up of 3 sets of data
• Supply: Production, imports and change in stocks
• Utilization: Exports, feed, seed, food and other use
• Per capita food supply: Population and nutrient content –
calories, protein and fat
• Food balance sheets provide data on food supplies.
• The accuracy of food balance sheets, which are in essence derived
statistics, is of course dependent on the reliability of the underlying
statistics of supply and utilization of food and of population.
• Production statistics may not be available for all commodities needed.
• Import and export data may be reasonably accurate in the majority of
countries, but in some countries significant amounts of trade across
national boundaries go unrecorded.
• FBS is an instrument for policy analysis and decision-making.
FBS are useful for:
• Appraisal of food and agricultural situation in a country.
• Estimating overall shortages and surpluses based on normative food
needs expressed in terms of energy as well as proteins, carbohydrates
and fats.
• Data on per caput food supplies are an important element for projecting
food demand, together other elements: elasticity coefficients, population,
etc.
• Establishing relationships between national food supplies & malnutrition.
• Evaluating food and nutrition policies.
• Basis for the policy analysis to ensure food security.
 FOOD COMPOSITION DATABASES
(FCDB)
Food composition has a central role in nutrition, dietetics and food-related
sciences because of its important applications:
• calculating nutrient intake estimations
• determining nutrient requirements
• in epidemiological research to establish relationships between nutrient
intake and disease
• calculating nutrient content for food labels
• assembling institutional and therapeutic diets
• Inclusion of nutritionally-important plants and animals in breeding programs
(Biodiversity)
• informing consumers of good food choices.
 LIMITATION OF FCDB
• variability in the composition of foods;
• Natural variation (species differences, soil and climate)
• Additional variation (storage, processing, mixing of foods)
• partial or limited coverage of foods;
• Impossible to cover all foods especially as consumed
• Taste/desire for brand name by users
• partial or limited coverage of nutrients;
• Missing nutrients and/or nutrient values
• New requirements due to new standards or research questions
• inappropriate data base;
• Changes in food over time which should be reflected in FCDB
• errors arising in data base use
• Failure to record sufficient details regarding the food (cooking or processing method)
• Use of nutrient data for raw instead of cooked foods
• The use of incorrect conversion factor
 FOR FURTHER READING
• https://www.fao.org/3/cb7496en/online/src/html/annex-02.html#:~:text=altitude%2
0and%20smoking.-,Prevalence%20cut%2Doff%20values%20for%20public%20healt
h%20significance%20are%20as,percent%3B%20severe%20%E2%89%A540%20per
cent.
• https://apps.who.int/nutrition/landscape/help.aspx?menu=0&helpid=391&lang=EN
• https://www.measurement-toolkit.org/anthropometry/objective-methods/simple-me
asures-skinfolds#:~:text=The%20calculation%20of%20body%20fat,the%20particip
ant's%20age%20and%20sex
.