1. INTRODUCTION TO NUTRITION ANALYSIS : POLICY PARAMETERSLalita BhattacharjeeNutritionist Training Workshop on Analysis of Data for MeasuringAvailability, Access and Nutritional Status Assessmentof Nutritional Status 14 -26 January 2012

2. DIETARY ASSESSMENT ANDNUTRITIONALASSESSMENT : KEY TERMS A DIETARY ASSESMENT : comprehensive evaluation of a personsfood intake. It is one of the established methods of nutritionalassessment. Dietary assessment techniques range from food recordsto questionnaires and biological markers. NUTRITIONAL ASSESSMENT : more comprehensive and includesdetermining nutritional status by analyzing the individuals brief socioeconomic background, medical history, dietary, anthropometric,biochemical, clinical data and drug nutrient interactions NUTRITIONAL STATUS : measurement of the extent to which anindividuals physiologic need for nutrients is being met NUTRIENT INTAKE : depends on actual food consumption which isinfluenced by factors such as economic situation, eating behaviour,emotional climate, cultural influences, effects of disease states onappetite 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 3. OPTIMAL NUTRITIONALSTATUSSource: Mahan and Stump, 2000 4. DIETARY ASSESSMENTPRINCIPLESAdequacy : a diet that provides enough energy and nutrients tomeet the needs according to the recommended dietaryintakes/allowances (for healthy and active life)Balance : a diet that provides enough, but not too much of eachtype of food ( adequacy of basic food groups)Variety : a diet that includes a wide selection of foods within eachfood group (dietary diversity/ includes biodiversity species, varieties, cultivars)Nutrient Density : a diet that includes foods that provide themost nutrients for the least number of calories(nutrient dense foods)Moderation : A diet that limits intake of foods high in sugarand fat (nutrient intake goals/guidelines) 5. WHAT IS DIETARY DIVERSITY Dietary diversity isa qualitativemeasure of foodconsumption thatreflects householdaccess to a varietyof foods and isalso a proxy fornutrient adequacyof the diet ofindividuals 6. HHDDS and IDDSMeasures no. of different food groups consumed over a given reference period i.e. 24 hours/1 dayHDD is also a proxy for HH socio economic status, whereas IDD is purely a proxy measure of an individuals quality of diet. 7. WHEN TO MEASURE DIETARYDIVERSITYObjectiveTimingAssessment of the typical diet ofWhen food supplies are stillHHs/individualsadequate (may be 4-5 mo after the main harvest)Assessment of the FS situation inDuring periods of greatest foodrural, agriculture based communities shortage, such as immediately prior to the harvest/immediately after emergencies or natural disastersAssessment of FS situation in non- At the moment of concern to identifyagricultural communities a possible food security problemMonitoring of FS/N programmes or Repeated measures to assessagricultural interventions such as impact of the intervention on thecrop/livelihood diversificationquality of the diet, conducted at the same time of the year as te baseline (avoid interference due to seasonal factors) 8. Foods/food groups HDDSWDDS 9-group WDDS 13-groupIYCF DDQFood Group Q Food GroupQ Food Group Q Food Group1. Cereals1,2 Starchy staples 1,2 Starchy staples1,2 Starchy staples2. White tubers & roots 4 Dark green leafy4 Dark green leafyvegetablesvegetables3,4, Vegetables 3,6 Vitamin A rich fruits 3 Vitamin A rich 3,4,6 Vitamin A rich fruits &5 & vegetablesvegetables vegetables5,7 Other fruits &6 Vitamin A rich 5,7 Other fruits &vegetablesfruits vegetables5 Other vegetables6,7Fruits 7 Other fruits8,9Meat 8 Organ meat8 Organ meat11 Fish and other sea 9,11Meat and fish 9,11Meat and fish8,9,1 Flesh foods food110 Egg10Egg 10Egg10Egg12 Legumes, nuts &12Legumes, nuts & 12Legumes, nuts &12Legumes, nuts & seedsseeds seedsseeds13 Dairy13Dairy 13Dairy13Dairy14 Oils & fats15 SweetsPracticalCondiments &16 Exercise 3: Use of dietary diversity in food security and nutrition surveillance Jillian L. Waid beverages 9. 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 10. HDDS CalculationStep 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%) 11. Different Types of Childhood Malnutrition Normal height for ageChildren WastedStuntedUnderweightNormal Low weight for height Low height for age Low weight for age 12. Why is nutrition not improving? Knowledge: do people know what foods they shouldconsume by age, sex, occupation, physiologicalstatus? Do families have the resources/motivation to convertknowledge to practice If food intakes (energy and nutrients) are adequate,could there be intervening factors e.g. illness Pre-disposing factors: maternal undernutritionseasonal food/income shortages, migration, illnessoutbreaks, hygiene/sanitation, emergencies Importance of under 2s 13. Illustration of associationbetween dietary adequacy andanthropometryPrevalence of % with % with Total underunder inadequate adequate ornutrition diet diet adequate% -2SDs0 70 70Total sample20 80100Note: 10% have adequate diets but are still undernourished due to other causesSource : Mason, 2002 in Measurement and Assessment of Food Deprivation and Undernutrition, FAO