Week 1/2: LEC 1&2&3

Question 1

What is Nutritional Assessment?
->
-> The info is used…

Nutritional Assessment Methods
1-4

Answer 1

-> The interpretation of info from dietary, laboratory, anthropometric and clinical studies
[gather FULL picture - not valid if just using one of these 4 components]

…used to determine the nutritional status of individuals or population groups as influenced by the intake and utilization of nutrients

1 Anthropometric 2 Biochemical 3 Clinical 4 Dietary

Question 2

Dietary Assessment is:
IS…
The goal -
This is ____

Anthropometric Assessment
IS…
EX;
Cannot be used to…

Answer 2

-IS…Measuring what people eat
-The goal - to estimate USUAL intake
-This is NOT EASY

IS… measurement of the dimensions and composition of the body
EX; height, weight, BMI, head/arm circumference, body fat, muscle, bone and water content
Cannot… be used to identify specific nutrient deficiency states
[very useful when chronic imbalances of protein and energy are likely to have occurred]

Question 3

Clinical Assessment
IS…

Biochemical Assessment
IS…

Static =
VS
Functional =

Answer 3

IS… medical history/ physical examination
Signs and symptoms of a malnutrition/disease

IS… Assessment of the nutrient content of blood, urine, hair, feces etc.

Static = measuring a marker somewhere EX - zinc in the blood
VS
Functional = checking the consequence of deficiency EX - Vit A - visual deficiency to check stage of Vit A deficiency
[Functional & clinical sign is close - visual is a sign but taste test is not] - some overlap

Question 4

Ecological factors or patient/client characteristics
EX:

Nutritional Assessment
Indices:
ie.
->
and
Indicator:
ie.

** Fill in the blank practice SLIDE 21 **

Answer 4

EX: education / socioeconomic status / family situation / literacy / religion / employment / access to health and agricultural services etc.

Indices: Raw measurements from each of the 4 nutritional assessment methods are often combined to form ‘indices’
ie. BMI (wt / ht2) / nutrient density / height-for-age percentile
-> Evaluated by comparison with predetermined reference limits or cut-off points

Indicator: The index and its associated reference limit or cut-off value
ie. for those aged 5 years and below, weight-for-age (INDEX) <3rd percentile (CUT-OFF) is an Indicator of underweight

Question 5

Who uses Nutritional Assessment?
->
Clinical Example…. (Slide 24/25)
->

Research/Public Health/International
-> Use Nutritional Assessment to answer…
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-
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International Nutrition Example… (Slide 27/28)

Answer 5

->
- What is the nutr status of a pop?
- How does dietary intake affect the nutritional status and health of a pop?
- What is the effect of an intervention on the nutritional status of a pop?

Question 6

A note on research and nutritional assessment
- all nutr professionals have to be able to read and interpret the scientific literature
- the quality of any nutrition study relies heavily on the quality of nutritional assessment techniques used

Nutr Assessment components are your TOOLS
You need to know:
- what they are / how they work / how well they work / when to use them or when not to use them / how to interpret the results / what the results mean

Question 7

LEC 2
Methods of Measuring Intake
1-8

[1] =
AKA
IS…
each entry should include:
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-
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[may also include:] - not practical in community setting
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-
-
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Answer 7

[1] = Food Record
AKA food diary
IS… records all foods and beverages at the time they are consumed,
each entry should include:
- Specific food description, including brand names
- How the food was prepared (ie. baked, broiled, etc.)
- Portion size (estimated or weighed)
Also:
- Which meal or snack and time
- Place (home, restaurant, other)
- Hunger or fullness level
- Feelings or activity at the meal intake time

Question 8

[1] CON’D
Two main types of food records:
1 =
2 =

Answer 8

1 = Estimated food records
- use standard kitchen measures (ie. cups, tbsp, tsp)
- use hands or household items to measure / measure dimensions of items (2” x 2” piece of cake)
- some items can be counted (eggs, slices of bread, pieces of fruit)

2 = Weighed food records
- portions are weighed, the most precise method available for estimating usual food and nutrient intakes of individuals
- May have greater respondent burden and impact on eating habits [b/c of higher burden on respondents than 24-hr recall, indiv may be less willing to co-op - significant underreporting highly possible
- more common in Europe

Question 9

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Answer 9

• Doesn’t depend on memory
• can provide detailed intake data
• can provide data about eating habits (time, place and feelings when eating)
• Multiple-day food records are more representative of usual intake than a 24-hour recall or 1 - day food record (usually, food records include 3,5,7 days - ideally include: non-consecutive/random days & weekends)
• Requires a high degree of coop - response burden can result in low response rates in lg surveys
• Respondent must be literate - time consuming
• Act of recording may alter diet
• Analysis is labor-intensive and expensive
• Errors may result from failing to quantify portion sizes correctly, or during the conversions between volumes and weights

Question 10

[2] =
Interviewer asks…
Interviewer assists…

Prompts:
and
Probing:
What SHOULDN’T you ask??
->

-
-

National Surveys have used 24-hour recalls…

Answer 10

= 24-hour recalls
asks… the respondent to recall everything consumed in the past day (usually 12pm-12pm)

assists… the respondent to describe intake in detail:
- specific food description, including brand names
- how the food was prepared
- portion size

-> Shouldn’t : unhealthy and healthy labeling / no leading or judgemental questions /
‘what was 1st meal… next” <- should ask

• Household measures
• Food models
• Food photographs

…
Canadian Community Health Survey (CCHS)
What We Eat in America (WWEIA)
- both countries used the automated multiple-pass method to improve accuracy

Question 11

Automated Multiple-Pass Method
-> 24 hour recall involves 5 steps:
1
2
3
4
5

Can be done…

Answer 11

1 Quick list - list all foods and bevs consumed the day before the survey (12pm-12pm)

2 Forgotten Foods - prompt recall of foods commonly forgotten (ie. snacks, bevs)

3 Time and Occasion - time and what the respondent would call the eating occasion (ie. breaky, lunch, dinner, snack)

4 Detail Cycle - specific description of food type, method of preparation, portion size and location

5 Final Review - probe for any foods or details missed (ie. vitamin and mineral supplements; water)

… in person / by phone / online (self-administered 24 hour (ASA24) recall done online)
by phone/online YOU can’t see body language / some don’t have access to

Question 12

24 hour recalls for children
-> Methods used in the CCHS:
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Answer 12

• For very young children (under 6), a caregiver completed the interview
• Children 6-11 were interviewed together with caregiver
• Children aged 12+ completed interview alone

-> If child was with a caregiver and the parent didn’t know what child ate then parent contacted caregiver

• Relatively quick, cheap, and easy to administer
• Can provide detailed info, low respondent burden
• Can be used to estimate the intake of groups
• Multiple recalls can be used to estimate usual intake of indiv
• Usual diet altered the least / can be used equally well with both literate and illiterate subjects
• Can be useful in clinical settings
• One recall is seldom representative of a person’s usual intake
• Data entry can be very labour intensive
• Relies on memory
• Tendency to over-report intake at low levels and underreport intake at high levels of consumption (“flat-slope syndrome”)

Question 13

Repeat 24-hour recalls
-> Can be done…

-> Can greatly reduce…

-> Not feasible to carry out….

Answer 13

-> done consecutively, randomly, over several seasons
- non-consecutive days should be selected, when possible

-> reduce the limitations of single 24 hour recall
- better estimate of the average food intake of individuals over a longer period of time

-> on all participants of a community survey; the recalls can be repeated on a sub-sample of the studied population

Question 14

[3] =
-> FFQs are designed…
-
-
-> Consist of…
3 main types:
1
2
3

-> Can be…

Answer 14

= Food Frequency Questionnaire (FFQ)
-> … to measure usual food intake
- assess the freq with which foods or food groups are consumed during a specified time period
- take on avg 15-30 min to complete

-> of a list of foods and freq-of-use categories

1: Simple or non quantitative - no choice of portion size
2: Semi-quantitative - gives an idea of the portion size consumed (relative to a standard portion size)
3: Quantitative - respondent describes the usual portion consumed

-> Can be self- or interviewer-administered (paper or web based formats)

Question 15

Multiple-choice response format
- # of response options range from:
- too few response options:
- too many response options:
- plan for…

EX - Slide 31: “What type is this FFQ?” & on Slide 32

Answer 15

• from 5-10
• may not give an accurate estimation of the frequency of intake
• can be overwhelming for the respondent
• plan for greater detail at the high-frequency end (ie. more options per week or per day)

Question 16

Whole Diet FFQs
->
-> Used widely in…
-> Many FFQs have been developed for use in specific populations
EX: development of a QFFQ -> assess dietary intake of Arctic Inuit in Nunavut, CAN

Short FFQs
-> may be used as…
-
Uses of short FFQs
-> Have been used in National Surveys
- National Pop Health Survey - longitudinal study in CAN, short FFQ on intake of fruits & vege, soft drinks and milk // CCHS fruit and vege FFQ since 2001

Answer 16

-> Long and comprehensive
-> in nutritional epidemiology research

-> as clinical screening tools or to assess a single nutrient or food pattern
- MEDFICTS identifies indiv with high fat intake, in need of further assessment and intervention
[focuses on foods that are primary contributors of total fat, SatFat and cholesterol in avg American diet // stands for Meats, Eggs, Dairy, Fried foods, fat In baked good, Convenience foods, fats added at the Table and Snacks
- Osteoporosis CAN - Calcium Calculator

Question 17

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Answer 17

• Can be quick way to assess key dietary components
• Can be self administered or interviewer administered - large research questionnaires are machine readable
• “Modest” demand on respondents
• Relatively inexpensive for lg sample sizes // Design can be based on lg population data
• May be more representative of usual intake than a few days of food records // may be considered preferred method fro research on diet-disease relationships
• Problematic if foods or portion sizes to be chosen by respondents are not reflected in the FFQ
• Intake data is compromised when foods are grouped in broad categories
• Relies on memory, can be cognitively difficult
• Literacy is needed if self-administered
• Not as accurate as 24-hour recalls or food records

Question 18

[4] =
-> Used to assess…

4 components (Burke Method)
1
2
3
4

A note on diet histories…
Central feature = step 1
24 hour recall = sometimes included as part of interview
Cross checks of the history = steps 3 & 4

Answer 18

= Diet History
-> Used to assess usual food intake and meal pattern over an extended period, such as a month or a year

1 detailed interview about usual patterns of eating and health
ie. # of meals per day, appetite, food dislikes, use of supplements

2 24 hour recall of actual intake

3 A food list asking for amount and frequency usually eaten
- details about characteristics of foods in addition to amount and frequency of food intake

4 3 - day food record

Question 19

Strengths of a diet history
->
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->
->

Limitations of a diet history
->
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->
->
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Answer 19

-> Assesses usual intake of indiv
- meal patterns identified
- better characterization of nutrient intake (ie. frying, broiling, baking etc)
-> Can detect seasonal changes
-> Can correlate well with biochemical measures

-> Time consuming and expensive
- can take up to 2 hrs per patient/participant
- often used in epidemiological studies
-> Need highly trained interviewers / tends to overestimate intake / requires a high degree of co-op / relies on memory (foods may be forgotten)
-> Lack of standardized techniques
- Difficult to make comparisons across studies

Question 20

[5] =
-> In long term care settings:
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-
-

-

-> ___ are considered the best practice for RDs in LTC…

Answer 20

= Observation

-> LTC - Food intake is typicall recorded as 1/4, 1/2, 3/4 or full portion
- Fluid intake is recorded as 1/2 or full cups
- Staff need ongoing training to do this accurately

-> - Portions consumed are documented by nurses in acute care setting if a calorie count is ordered
- Typically, nursing notes in the medical chart give a general idea of whether a patient or resident is eating well or poorly

-> MEAL ROUNDS are…
- observe patients eating, watch for low intake and for problems that may contribute to low intake

Question 21

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Answer 21

= Household food records or 24 hour recalls
- Record food eaten in household in a specified period of time (usually 7 days)
- Recored weight or volume of each food consumed at each meal separately
- Describe food indetail including brand names, methods of prep, recipes etc.
- Indicate # of family members and visitors at each meal
- Generally, do not account for kitchen and plate waste and food fed to pets (apply an arbitrary wastage factor of 10% of all edible portions of the foods consumed)
- Generally Exclude meals eaten away from home

Question 22

-
->

Answer 22

• Person responsible for food preparation is interviewed about food eaten in the household in the previous 24 hours
• Yields info on the # of eating occasions per day in the household; and the # of different foods/food groups consumed by the entire household

-> Household records/recalls may be especially helpful in cultures where there is communal eating

Question 23

[7] =
->
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-
EX:
-
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-

Answer 23

= Food accounts
-> Provides household estimates of food expenditures and quanities
- Log of food purchases
- Daily record of all food entering the household, either purchased, received as gifts or produced for household use during a specified period

EX: Food Expenditure Survey (FOODEX)
- Carried out in private households in urban and rural settings across CAN
- Used to update calculation of the Consumer Price Index

-> over 7 days
- may include the collection of receipts
- low respondent burden, and relatively inexpensive

Question 24

[8] =
-> Assesses…
AKA…
-> Data is helpful for…
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Answer 24

= Food Balance Sheets
-> food availability over a specified period at the national level (availability per person)
AKA - food disappearance data
-> …
- developing agricultural policies
- observing trends in food supplies over the years
- making inter-country comparisons of food supplies
- examining associations between nutrition and mortality rates

• Beginning and ending inventories
• Food production
• Imports and exports
• Non-human consumption (ie feed, seed)
• Waste (ie. industrial losses in processing, transport, storage)

Question 25

*** View and understand SLIDE 56 *** < the derivation of food balance sheets -> Use of food balance sheets in CAN - - *** view example balance sheet and answer her question on SLIDE 57 *** FAO complies food balance sheet data - data on 176 countries - Food supply is reported as: - kcal/capita/day - fat g/capita/day - protein g/capita/day

Answer 25

- Stats CAN calculates food availability (per person) annually