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 January 2012

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 individual’s brief socio economic background, medical history, dietary, anthropometric, biochemical, clinical data and drug –nutrient interactions NUTRITIONAL STATUS : measurement of the extent to which an individual’s 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

OPTIMAL NUTRITIONAL STATUS Source: Mahan and Stump, 2000

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)

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

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 individual’s quality of diet.

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)

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

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

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  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%)

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

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 2’s

Illustration of association between dietary adequacy and anthropometry Total sample 70 0% > -2SDs % <-2SDs Total under or adequate nutrition % with adequate diet % with inadequate diet Prevalence of under nutrition Source : Mason, 2002 in “Measurement and Assessment of Food Deprivation and Undernutrition”, FAO Note: 10% have adequate diets but are still undernourished due to other causes