Contents - Previous - Next


This is the old United Nations University website. Visit the new site at http://unu.edu


6. Measuring impact by assessing dietary intake and food consumption


Miriam Chavez and Ruth Huenemann

This chapter, intended for the professional health worker, presents a brief summary of household dietary assessment methods, from the more complex to the simpler. its purpose is to encourage wider use of such assessments, employing appropriate methodology, in nutrition programme evaluation.


Reasons for assessing household food practices


Food is the major vehicle for effecting improved nutrition of people. Therefore, assessment of food intake practices, knowledge, and beliefs should constitute part of every nutrition programme evaluation. Such assessment should in fact, form the basis for initial and subsequent programme planning.

In Third World countries and in rural areas of all parts of the world, food is usually procured, prepared and consumed at the household level. In many instances food production is also a household function. For these reasons, nutrition programmes must concern themselves with household food consumption and its accompanying social ramifications.

Long-term change in food pratices requires change in knowledge, attitudes, and beliefs about food, as well as change in food practices. Evaluation of nutrition programmes should therefore assess all of these factors.

The type of evaluation of household food consumption, knowledge, and beliefs depends upon the objectives of the programme. Programmes may be designed to introduce new food, to bring about one or more changes in existing production or consumption patterns, or to do both. This being the case, evaluation usually requires the gathering of baseline information as the first step in initiating a programme, regathering of data during and upon completion of the programme, and continuous comparisons.

In addition to serving as a basis for comparisons, assessments may serve the following purposes:

  1. Provide a basis for establishing food policies.
  2. Determine needs and priorities for feeding programmes, food production, food storage and transportation, food industrialization, food enrichment, and nutrition education relevant to socio-cultural practices of the people.
  3. Serve as a basis for planning community development programmes.
  4. Create a nutrition consciousness among government, health, medical, and paraprofessional personnel, and lay groups.
  5. Help people become aware of their own nutritional needs, so as to increase their involvement in solving nutritional problems.
  6. Stimulate industries to produce and process nutritious foods at low cost, provide nutritionally adequate foods to increase the efficiency of their workers, provide facilities such as day care centers for feeding of preschool children, and allow time for female workers to breast-feed infants.
  7. Help determine a possible need for enrichment and fortification programmes.
  8. Help support or explain morbidity, mortality, anthropometric, or biochemical findings. Care must be exercised, however, not to assume equal food consumption among household members. If correlations are to be attempted with individual findings, individual food intake data will need to be obtained in addition to household consumption. Likewise, household data are not adequate for identification of vulnerable age groups, such as preschoolers, workers, etc.

Deciding on a method


Careful consideration should be given to the type of data and degree of precision of food measurement and nutrient calculation actually required for effective programme purposes. One must avoid gathering data that are never used and that absorb time and money that should be used for other aspects of programming. While simplification of dietary assessment inevitably results in some limitation of scope and applicability of the data, it may actually enhance the usefulness of the data. Simple methods that permit immediate summarizing of data make it possible to report findings promptly to clients and other programme participants, whereas, computer calculations performed in some distant city may be long delayed. (See Annex A, "Score Card" method). Often, delay in reporting findings has resulted in loss of interest on the part of all concerned, not to mention needless suffering caused by programme delays.


Models for household dietary assessment


Models commonly used include qualitative and quantitative intakes, written records and oral histories, complete household intakes, and intakes of certain foods only. These cover periods of time ranging from one day to an entire season or longer. Table 6.1 summarizes some of the models. A discussion of these methods follows.

 

Initial Informal Assessment

Before attempting a formal dietary survey, some experienced team member or members should live in the community for at least a few days to observe the total food situation. They should visit food markets and stores; converse with people; observe gardening and other food production practices; note methods of food preparation; and eat local dishes-if feasible, in people's homes. Observers can gain an impression of the degree of interhousehold and day-to-day intrahousehold variation. They can gather information about such concerns as buying practices, market days, pay days, and animal slaughtering days. They can determine standard portion size for certain foods, e.g., loaves of bread. Much information can be obtained that can subsequently be used for evaluation purposes, and so may even eliminate the need for more formal surveys. Even when formal surveys are indicated, anecdotal records can greatly enhance the value of statistical data. Often the community itself and also outside authorities can be persuaded of the need for change on the basis of appropriate anecdotes.

 

Determining Household Intake of Calories and Many or all Major Nutrients

While data in food terms only may be useful for food production and other programmes, some nutrition programmes require conversion of quantitative food intake into the common denominators of calories and nutrients. If time, money, personnel, and circumstances permit, one may want to do as complete an assessment as possible of the total dietary structure in order to help uncover unsuspected deficiencies or irregularities in the diet. Four methods that have been used are:

  1. Weighing and measuring of all food for as extended a period of time as feasible or necessary (usually a week) to obtain a fair measure of the "usual" intake. This method, designated here as the "detailed method," has been described in an early FAO publication (1).
  2. The detailed dietary history (2).
  3. A more rapid modified dietary history method (see Annex B).
  4. The food inventory method, used by the United States Department of Agriculture in its early household food consumption studies (3).

The detailed method of weighing or measuring food for a week involves a daily visit to each home in the sample to weigh or measure all food to be consumed on that day. Corrections for later additions and for left-overs must then be made in a subsequent visit. This method obviously requires much interviewer time and has the further disadvantage that subjects may modify their diets during the recordkeeping period. It has the obvious advantage of greater validity. In a functionally literate population, the homemaker may keep a record of food consumed. Frequent checking of such records by a trained investigator is essential.

The detailed quantitative dietary history, covering periods of time ranging from a week to a lifetime, requires skill and patience on the part of both interviewer and client. It is commonly used for research purposes only.

TABLE 6.1 Methods of Household Dietary Assessment and Some of Their Advantages and Shortcomings

Method Techniques Advantages / Use Shortcomings
1. Initial informal assessment. Survey personnel live in community to observe food pratices and gather preliminary data. Sets stage for later survey facilitates planning. Subjective impressions may be inaccurate or incomplete.
2. Detailed dietary history (long term). Inteviewer inquires in detail about food consumed over specified time period. Quantitative assessments made. More commonly used for individual than household intakes. Accurate data: Only quantitative method available to cover long time periods Usually used for research purposes. Requires trained. extremely skillful interviewers and intelligent. cooperative subjects. Time consuming and costly.
3. Weighed or measured food intake ("detailed method"). All household food for specified period (usually a week) weighed or measured and recorded by interviewer or householder. Accurate data. if well gathered can help explain biochemical and clinical date. Readily converted into nutrients. Intake may be influenced by the record-keeping process. Time consuming and expensive.
4. Modified dietary history method. Inteviewer assesses quantitatively the household food intake for past week or days. Reasonably accurate data. Quicker and less expensive than weighed intake and detailed history. Can be converted into nutrients. Method of choice if complete data are needed. Period covered may not be typical of long-term diet. Fairly time-consuming and costly. Requires fair degree of knowledge and skill on part of interviewer.
5. Food inventory method. All food in household weighed at beginning and end of time period. All food entering or leaving household recorded. Accurate data. Method not much used any longer because of time and effort involved. Costly and time-consuming. Method not relevant in areas where there are no food stores.
6. "Score card" method. Interviewer assesses quantitative intake of those foods high in specified nutrients Calculation of nutrient intake is only. "Points" assigned for specified quantities. Shorter interview time because not all foods are assessed based on a previous survey or quick and easy. Data can be processed in the field. Relatively inexpensive. Useful if 4 is not possible. Information contained is limited to certain nutrients. Method is considerable knowledge of community food practices.
7. 24-hour diet history. Same as 2, but covers only 24-hr. period. Much faster than 2. Requires less skill on part of interviewer and client. Best used for assessing community dietary status rather than individual household because of interhousehold variation. Intake may not be "typical" of "usual" intake, especially in regard to quantities.
8. Food frequency lists. Householders report frequency of consumption of foods on a list. Quick and easy. Gives picture of food patterns. Non-quantitative. Cannot be used to assess nutrient intakes.
9. "Scalograin" method. Householders report frequency of consumption of foods that have "scale" value. Quick and easy. Permits classifying population into consumption strata. Non-quantitative. Does not assess nutrient intakes.
10. Single food intakes. Householders report intake (usually quantitative) of one food only. Quick and easy. May indicate use of recently introduced food. or of a particularly desirable or undesirable food. Limited to the food in question. Does not assess nutrient intake.
11. "Indicator" foods. Householders report use of foods indicative of total food pattern. Quick and easy. For designating food patterns. Useful only to indicate possible problems.

 

The more rapid modified dietary history method is based on a single interview during which the interrogator tries to obtain the "usual" daily food intake of the family, and specific intakes for as many days of the time period under consideration as the homemaker can recall. Quantities are then corroborated by inquiries about food purchases and omissions are corrected through use of a "reminder list," listing all foods common to the area. From these interrogations the interviewer then constructs an average daily intake for the time period under consideration. Such an interview may require several hours, depending on the complexity of the diet, the interviewer's skill, ability of the homemaker to recall, etc. It is, of course, subject to the inaccuracies of recall. Skillful interviewing can mitigate this problem. Compared to record-keeping, it has the advantage of not enabling subjects to modify their diet. Validity of information obtained is influenced greatly by the degree of rapport established, clients' understanding of the purpose of the survey, and so forth. It has been successfully used to obtain reasonably complete information when it was not practical to carry out either a detailed assessment of dietary intake or a detailed dietary history.

The food inventory method involves taking an inventory of all food in the household at the beginning and end of the survey period as well as records of food entering the household during the period and of food wasted or fed to animals. While dependable, (especially when literate clients may assist in record-keeping), this method, like the FAO method, requires much interviewing and processing time. Furthermore, record keeping, whether done by clients themselves or interviewers, has the disadvantage of permitting clients to change their food intake during the record-keeping period. It has the advantage of relative validity.

 

Determining Intake of Calories or a Limited Number of Nutrients Only

Sometimes, as in situations of obvious food scarcity, only calories need to be assessed. For this purpose, measurement of just the staple food is usually adequate. In other situations one may want to assess only a few specified nutrients. Not all programmes need to assess all nutrients. If, for example, it is obvious that all households are consuming rich sources of vitamin C, and biochemical and clinical data bear out this observation, one may not want to assess fruit and vegetable intake. If, on the other hand, there is evidence of protein-calorie malnutrition, one may focus on main calorie and protein sources only. In such instances the "Score Card Method" (see Annex A) may be practical. (In our terms, "score card" implies a shortened nutrient calculation method.) The method does require preliminary study to determine the chief sources of calories and protein in the "usual" dietary. Such a study may be a small one carried out by a nutritionist in advance of the proposed major survey. When this method is used, only foods that are major sources of the nutrients in question need to be assessed, although amounts must be determined because the food data are to be converted into quantative nutrient terms.

Compared to the three more detailed methods previously outlined, the score card method saves considerable interview time and also nutrient calculation time. When tested in Guatemala, it showed approximately 70 per cent agreement with the modified dietary history method (Annex B) for calories and protein, 60 per cent for iron, and 82 per cent for vitamin A.

 

24-hour History

By this method, the interviewer determines the previous 24-hour food intake of the household, usually in quantative terms. In a literate community, homemakers may keep a record of such an intake.

Because of the short time period covered, this method is more economical than the "detailed method" and the modified dietary history method. One day may or may not represent a "typical" intake for the individual household. Twenty-four-hour intakes of a large sample of households may, however, represent a typical daily intake for the community as a whole.

 

Food Frequency Lists

By this method, a client is asked simply how frequently the household consumes specified foods from a list of those available in the community. For some purposes, such as determining the popularity of specified foods, this information is sufficient. Usually no attempt is made at quantification.

The food frequency method has the obvious advantage of ease, rapidity, and consequent low cost. A main disadvantage is that non-quantitative data cannot be converted into nutrient terms. A few assumptions about data showing only frequency of food consumption seem warranted, however:

  1. A monotonous diet consisting of one or two foods only is at risk of being deficient in calories and nutrients.
  2. A diet extremely low in fat is at risk of being calorically deficient.
  3. If consumption of fruits and vegetables is seasonal, intakes of vitamins A and C are likely to be low at certain times of the year.

 

Scalogram Method

The scalogram method is a variation of the food frequency list method, but only those foods known to have "scale" value are included (4). "Scale" foods are those whose consumption is closely linked to socio-cultural factors and therefore define a consumption stratum. By means of a formula designed by Guttman, foods can be defined as having scale value. The method is relatively rapid and easy. It permits determining the proportion of a population falling into specified consumption strata and therefore their relative risk of malnutrition. Population consumption pyramids of communities can be compared with each other to identify those at greatest risk.

 

Assessment of Household Consumption of a Single Food Product

One may wish to gain insight into the consumption of (a) a food recently introduced into the culture, e.g., a corn-soya product (b) a specific food or food group already in the dietary or (c) an "indicator food".

Concerning the case of consumption of new food, amounts used may be obtained from dealers or distributors. Furthermore, if the number of households consuming the product and the range of consumption is to be assessed, a sample of households can be interviewed directly. The interview should include a few tactful questions regarding the product to ascertain whether or not it is indeed being used for human consumption and by whom. Caution: one dare not assume from such consumption data alone that the product constituted an addition to the diet; it may well have served as a substitute for other items previously consumed. Careful interviewing may elicit this information, as may comparison with baseline survey data if available.

As for the case of specific food or food group already in the dietary, one may want to determine the general acceptance of certain foods or food groups for nutritional evaluation or programme reasons. If, for example, certain vegetables are found to be popular, even though underused, they might be incorporated into a gardening programme; or similarly, small animal production may be indicated if meat is popular. Total absence of fruits and vegetables may help to explain clinical and biochemical findings indicative of the lack of ascorbic acid. A short interview could obtain such data, either qualitatively alone. or quantitatively if needed.

The third category mentioned above, indicator foods, are those single foods or food groups which may be indicative of a total food pattern. For example, in Mexico the use of bread or rolls rather than tortillas is likely to indicate adoption of non-indigenous eating practices. Consumption of indicator foods may be a useful way of assessing change, although it is not an assured way of determining nutritional adequacy.


Additional data


Food Practices

In addition to information about food consumption, information about numbers of meals consumed, mealtimes, food-buying, and food production and preparation practices may be extremely useful in assessing change. The nutritionist could structure appropriate questions on the basis of the initial informal survey.

 

Knowledge, Beliefs and Attitudes

To assure more nearly permanent changes, knowledge, beliefs, and attitudes must change as well as practices. With many people, such changes require time. A competent nutritionist and social scientist together can devise survey tools, appropriate to the culture of the population, to assess these factors initially and as the programme progresses. If time is extremely limited, even one insightful question, e.g.. "If you had more money to spend, what would you buy?", may reveal useful information.

 

Anecdotal Records

Anecdotal material should be gathered not only during the initial informal survey but throughout the programme. The alert programme evaluator will hear and see numerous indications of change in household food practices throughout the duration of an intervention. Such anecdotal material, as previously indicated, can be extremely useful to augment more formal data and to help explain changes.


Steps and procedures in surveying


Sampling

Depending on the objectives of the programme, sampling may be done on the basis of income, ethnicity, or other variables. It is not always necessary to sample entire populations. If the entire community is to be sampled, stratification may be desirable. It may be appropriate, if funds permit, to choose a control population so as to permit a more valid assessment of impact.

 

Testing Forms and Procedures

All forms and methods should be tested with a small population group outside of the sample before the survey begins.

 

Responsibility of the Dietary Coordinator

A well-qualified dietician-nutritionist, with experience in field work and preferably indigenous to the country being served, should be a member of the evaluation team and serve as diet coordinator. This person would participate in team functions prior to the actual programme evaluation.

Specific duties of the diet coordinator may include the following:

  1. Gather and interpret existing food information for the country as a whole and for different regions of the country from the literature, reports, and food-balance sheets; conduct interviews with national and local personnel: visit markets, farms, gardens, and so forth,
  2. Conduct or participate in the initial informal dietary assessment.
  3. Obtain and evaluate local food composition tables and local food analysis facilities, and structure an adequate shortened food table or food score sheet for hand-calculation where indicated.
  4. Train diet personnel.
  5. Structure dietary forms and questionnaires and supervise field-testing of these instruments.
  6. Prepare dietary portion of field manual.
  7. Supervise diet personnel in the field.
  8. Check dietary data from the field. This should be done before leaving the field.
  9. Be responsible for interpretation and presentation of data.
  10. Devise a plan for future dietary surveys, if required. Future surveys might be indicated to show seasonal trends, or programme progress.
  11. Assume responsibility for the collection of anecdotal data.

 

Selecting and Training Interviewers

Interviewers must be able to read and write, to communicate well with the people and the professional staff, and to speak the language of the people. If health, welfare, or educational agencies have professional or semiprofessional staff in the community, they could participate in the survey. These might be teachers, health or nutrition aides, nursing aides, or agricultural extension aides. If none of these is available, intelligent, literate local people must be chosen and trained.

Either of two systems of selecting and training interviewers may be used. In one system, the nutritionist and other members of the health team select local interviewers from each sample site. If only a few places are to be selected, this system may be more economical. A second system is to select a team of interviewers to be moved from one site to another until the entire country or area has been surveyed. With this method there is economy of interviewer-training time. There also will be less probability of error in all procedures, and the overall survey time will be shortened. This method does not, however, permit as much community involvement as the first method does.

The nutritionist is responsible for training the interviewers or aides. Such training should include not only the techniques of gathering dietary data, but also at least a modicum of nutrition education in general. so that workers may appreciate the meaning and importance of the data they are gathering. They must be trained to understand the importance of the work they are to do, to introduce themselves into the house and establish rapport with the occupants, to use the interview forms, to accept and write down statements made without interpretation, to assess food portion size by weight and volume, to code or calculate the dietary intakes, and to check and verify calculations. This training is achieved through interviewers' practicing on each other and on populations not included in the sample. During the training period. the nutritionist should demonstrate an interview and observe each interviewer perform. Two or three days should be allowed for training.

If at all possible, representatives of all influential community groups should be involved in this as well as subsequent aspects of the programme. Key informants from the community can be of great help in planning the training and the survey procedures.

Training for both field supervisors and dietary interviewers should include practice in the field. Residents in one area may not know the culture and eating practices of all parts of the country, or be able to speak the language. In the developed countries, professionals may be quite unfamiliar with minority groups. Even professional nutritionists may need field training.

 

Data Gathering

Data are to be gathered in the field, usually in the home. Home visits will permit observations of cooking techniques, availability of fuel and water, size of serving dishes, health conditions, eating practices, and food attitudes, knowledge and beliefs. Obviouslyy, visits must be made when people are at home. Often this means late day or evening visits.

 

Methods of Estimating Quantities of Food

If quantitative food assessment is decided upon as the appropriate method, foods may be quantitated according to weight, volume, or in the case of some foods, by common standards, e.g.. eggs, commercial breads, soft drinks, etc. Weight is usually preferred. Frequently, the respondent replies directly in terms of kilograms or, if not, in local measures that can readily be converted into weights by trained interviewers. If nonstandard measures such as gourds are used, interviewers must make conversions to standard measurements or weights, usually through replication. A kilogram scale demarcated in units of 10 grams is a helpful tool for the interviewer.

Mixed dishes present problems, particularly if only a part of the dish is consumed. The interviewer may need to estimate quantities of some ingredients. Since the composition of any mixed dish depends upon availability of ingredients, a mixed dish is seldom standard and so calculations based on standard recipes are not likely to be valid.

 

Time Period

The number of days to assess in order to obtain a fair estimate of the usual quantitative intake will depend on the inter-day and inter-household variation. Traditionally, the FAO method covered a week. Where the diet is extremely simple, a shorter time period may give equally valid results. A study in Mexico showed that three days gave the same results as seven. As a rule, unless the sample size is large, a minimum of three days is needed. These should be different days of the week, because Sundays, market days, pay days and so on, may differ appreciably from others. Initial informal assessment can help determine the degree of variation, and, if indicated, three-day periods can be staggered so as to help offset variation.

Seasonal variations are difficult to assess without repeated surveys. It is usually possible to ascertain what foods are consumed in various seasons, but not how much. Such qualitative information may suffice for programme purposes. If not, resurvey is necessary.

 

Checking data

After each day's interviews, the nutritionist should meet with the interviewers to check records for completeness. readability, and possible missing information. Revisits to some homes may be needed to obtain missing information. Samples of food of unknown composition may need to be collected for later analysis. Coding or summarizing may begin during the interviewing period, even though this work will probably need to be completed on the ensuing days. Omissions in data are often recognized during the coding or calculation process.

 

Evaluating Dietary Intakes

Once data are collected they need to be evaluated. Quantitative food intake data are generally converted into nutrient terms and compared with a suitable standard, usually a recommended dietary allowance or, depending on the situation, with minimal dietary requirements.

For converting food into nutrient data, the nutritionist should review available food composition data. If the country has prepared its own food composition tables, based on sufficient and reliable analyses, these should be used. A second choice would be the use of international tables for particular geographic areas. If neither is available, the nutritionist should select the most appropriate, reliable data for comparable foods. For selected items, laboratory analyses may be conducted. In all cases, the data should represent edible portions minus refuse or waste.

Data for computer calculation should be coded promptly. For hand calculations in the field, the nutritionist should compile a table of the foods consumed with the caloric, protein, and possibly other nutrient values by weight and volumetric units. A shortened food table giving whole number values for food groupings is sufficiently precise and saves time and energy.

Analysis of score card data involves only simple additions of point values.

Occasionally, instead of calculating nutrient intake from food composition tables, it may be expedient to structure a composite of a day's intake as determined by the survey and to analyse an aliquot of this composite. This is sometimes done to evaluate the consumption of those nutrients whose concentration in foods is highly variable, or whose composition is not found in food composition tables. It is also used when high precision is required, or when it is necessary to validate the results of a survey in which many local foods were consumed. The method has the obvious advantage of high validity. It does require laboratory facilities and suitably trained laboratory personnel.

Calculations or food analyses may be compared with the standard international dietary recommendation tables, or preferably, with those of the country, if the country has such. Each household's food intake should be compared with its own dietary recommendation obtained by summing up the recommendations for household members.

Such comparison with the recommended intake for the household should perhaps be made on a probability basis rather than on the more traditional approach of judging whether intake is above or below a single fixed point in the range of requirements or recommended intakes* The probability approach recognizes the fact that individuals and therefore households, vary in their nutritional requirements.

Non-quantitative data cannot be translated into nutrient terms. Neither can they be assessed in terms of nutrient requirements or recommended allowances. Comparisons can be made with a food guide, but caution in interpretation is essential. Because there are many possible ways of obtaining an adequate diet, failure to eat sufficient foods from any one food group on the guide need not necessarily mean nutrient insufficiency. Non-quantitative food data should therefore never be reported or interpreted in nutrient terms.

 

Presentation of Dietary Data

If data are to be useful in effecting change, they must be presented to decision makers. Too often they are reported only to nutrition groups at international meetings.

To be meaningful to lay people and others, food data may be compared with a food guide to show consumers what they are eating, what they need to eat more (or less) of, and what they need to add to their diets. Obviously, the guide must incorporate only available foods.

Assessing dietary change


The effectiveness of nutrition programmes is usually measured by the changes they have brought about. It must be remembered, however, that not all change is voluntary and that influences other than the programme being evaluated might well have been responsible for observed change. Change may be assessed by either of two methods:

 

Assessing Change Directly

Throughout the course of a programme, clients may be interviewed regarding changes that have occurred in household food practices during a specified time period. As with all interviews, the validity of the data obtained will depend largely on the interviewing skill of the interrogator and the degree of rapport established with the client. Changes may be assessed in terms of food, of if food amounts can be quantified with sufficient accuracy, in nutrient terms.

 

Comparing Initial with Subsequent Data

Comparisons may be made in terms of types and variety of foods, quantities of specific food groups; money value of food purchases; and actual nutrient consumption, if amounts of food have been carefully estimated or measured. Whenever evaluation is based primarily on changes over time, the interval between initial and succeeding assessments may be crucial. Frequently, reassessment is done immediately after educational or other dietary-improvement methods have been completed. Lasting changes in eating practices are seldom made so quickly. People need time to readjust their practices and to change their attitudes and beliefs.

When controls are not feasible, one must depend upon the judgement of the evaluators. Validity of clients' answers may be enhanced by using interviewers not otherwise associated with the nutrition programme.


Summary


Because food is a major vehicle for improving the nutrition of people. assessment of food intake, attitudes, knowledge, and beliefs should constitute part of all nutrition programme evaluation. Methods employed for assessing food intake range from detailed, quantitative record-keeping to simple interviews regarding the use of even a single food. What method to use depends entirely on the goal of the programme. Frequently, simple, short, and relatively inexpensive assessments are adequate to meet programme needs.

Nutritionists and paraprofessionals and non-professional personnel must be trained for effective field evaluation work. Data should be promptly summarized and reported in a meaningful way to decision-makers and all people rightfully concerned with the programme.


Annex A. Development of a score card for the rapid assessment of calorie and nutrient intakes


The following method for assessing calorie and nutrient intakes was developed in Guatemala in 1976. Reviewing the dietary records of 44 women who had been interviewed in 1972 under the auspices of the Institute of Nutrition of Central America and Panama (INCAP), we found that dietary "adequacy" according to INCAP dietary recommendations varied from nutrient to nutrient. We decided to develop a scoring method for critical nutrients rather than for diets as a whole.

For this pilot study, we selected calories, protein, iron, and vitamin A (retinol) as the factors to be evaluated, as these are commonly considered critical in the dietaries of developing countries, and used the following procedure for each of the four:

  1. Of the 44 women's diets for which records were available, we identified those that met the INCAP standards and found 29 that met the calorie standard, 18 met the protein standard, and 23 the iron standard. In the case of retinol, only two met the standard of 750 g; in order to have a sufficient number of cases, therefore, we used the 19 diets that contained 300 g or more of retinol.
  2. We identified the food items that provided the major portion of calories and of each of the nutrients in these "adequate" diets.
  3. We determined the mean weight of amounts eaten of these foods and the calorie or nutrient value of these mean amounts, and rounded these average values to convenient portion sizes.
  4. We then assigned point values for each of the four factors to a given portion size of each food. These point values are additive for each factor. We also expressed the recommended standards in points so that they could easily be compared with the total point values of the foods consumed.

Obviously, only those foods that were found actually to have contributed a major portion of calories or of one of the nutrients in the diets surveyed appear on the score card. Thus, eggs, for example, commonly known as a protein-rich food, do not appear, because the average intake of eggs by the seven women who ate them was only 15 grams. The score card developed in this Guatemalan study (FIG. 6 A.1. Food Score Sheet) lists the eight foods that contributed sufficient calories, protein, iron, and vitamin A to meet the INCAP standards.

NAME___________________________________
IDENTIFICATION__________________________
DATE___________________________________
INTERVIEWER____________________________

 

Food Groups Units of Meas. Units
Consumed/
Week
Av. Units/ Day Calories Protein Iron Retinol
        Pts/Unit Total Pts Pts/Unit Total Pts Pts/Unit Total Pts Pts/ Unit Total Pts
Tortillas (50 g each) No./day -   1   1 per 3 tortilla   1      
Coffee/w/sugar (record as grams sugar-1 TBSP = 12 g) 2 TBSP, 25 g or 1 oz/day -   1   - - -   -  
Beans, dry 25 g or 1 oz.     1   1   2   -  
Rice, dry 25 g or 1 oz.     1   1 per 3 oz   - - -  
Bread 25 g or 1 oz.     1   1 per 3 oz   - - -  
Meat, poultry,

fish, cheese

25 g or 1 oz.     1/2   1   1/2   -  
Milk 2 TEASP     - - 1 per 8 oz          
  25 g or 1 oz.         or 200 g          
Green leaves, 10-15 g                    
yellow vegetables or 1/2 oz.     - -         1  
Totals Consumed - - - - - - - - - - -
Recommended Pts. per person (adult) modify for total household         20 (1 Pt = 200 Cal.)   9 (1 Pt = 7 g Pro.)   13 (1 Pt = 1 mg Iron)   2 (1 Pt = 400mcg Retinol)

FIG. 6.A.1. Food Score Sheet


Annex B. Household quantitative intake record


A useful approach is to get a quantitative record of the "usual" daily food intake (or the previous 24-hour intake) of the household for the current season from the person most responsible for the household's food. (See FIG. 6.A.2. Quantitative Intake Record) Often the 24-hour and usual intakes are virtually the same. The interviewee often finds it easy to recall the previous 24-hour intake in quantitative detail. The "usual" intake is essential only if the previous 24-hour food intake was not typical. After obtaining this, the interviewer should use a "reminder list" of foods available in the community to determine frequency and amount of items that may not have appeared in the daily intake. Often amounts of food purchases are helpful in determining quantities. It is important to develop a form that will permit coding or nutrient calculation without recopying the data, if at all possible.

FIG. 6.A.1. Food Score Sheet

Usual Daily intake Use of Foods on "Reminder List"*
Not Already
Corrected "Usual" Daily Intake Food** Code Cal. *** Pro. ***
Food Amount Food Frequency of Use Amount Food Amount (Wt.)      
Measure Wt. Measure Wt.

FOODS CONSUMED AT OTHER SEASONS - LIST

* The interviewer should use a "reminder" list of foods available in the community to obtain frequency of use and, when indicated, quantities of foods not already included in the "usual" or 24 intake
** Number corresponding to entry in Food Composition Table
*** For hand calculations

FIG. 6 A 2. Quantitative Intake Record


References


  1. FAO, "Manual on Household Food Consumption Surveys," FAO Nutritional Study No. 18 (Food and Agriculture Organization, Rome, 1962).
  2. B.S. Burke, "The Dietary History as a Tool in Research," J. AM. Dietet. A, 51 426 (1967).
  3. H.K. Stiebeling. D. Monroe, E.F. Phipard et al, "Family Food Consumption and Dietary Levels (1935-1936 Data, "USDA Publication No. 452 (US Department of Agriculture, Washington DC, 1941).
  4. S.A. Stouffer, E.A. Guttman, P.F. Schuman, S.A. Lafeld, Starr and J.A. Clausen, Measure and Prediction Studies in Social Psychology in World War 11, Vol. 4. (Princeton University Press, Princeton, NJ, 1950),


Contents - Previous - Next