NUT 801 - ASSESSMENT OF NUTRITIONAL STATUS - PART II.pptx

Nutrition

1. BCH 801: NUTRITIONAL BIOCHEMISTRY - Course Distribution Prof R. Auta : Dietary essentiality of carbohydrate and lipid. Concept and biological value of proteins. Physiological function and biochemical mechanism of action of vitamins and inorganic nutrients. Metabolic interaction of nutrients. Proximate composition of foodstuff; Estimation of fibre , additives, vitamins, trace minerals and amino acids. Dr M. A. Dakare : Food sensitivity and toxicology. Biochemical assessment of nutritional status Adaptive response to undernutrition . Protein energy malnutrition Alcohol, sugar and fibre nutrition. Micronutrients deficiency diseases

2. MALNUTRITION Malnutrition is a condition caused by inadequate or excess intake of nutrients. It is either undernutrition or overnutrition

3. Undernutrition is the result of inadequate nutrition. Common causes include: Consuming inadequate amounts of energy. Consuming inadequate amounts of vitamins or minerals. Inefficient absorption of food consumed. Excessive diarrhea.

4. Overnutrition can also occur if a child is overweight (obese) as a result of the intake of too much energy. The main features of obesity are overweight and fatness. It is mostly caused by overeating and intake of abundance of calories

5. Conceptual Framework of Malnutrition

6. UNDERNUTRITION Malnutrition is a condition caused by inadequate or excess intake of nutrients. This session focuses on undernutrition caused by inadequate intake of nutrients. When the body does not receive enough food or receives food that does not provide the appropriate components for healthy living, it becomes weak or overburdened and cannot function properly. Undernutrition is manifested as stunting, underweight, and wasting and/or micronutrient disorders, mainly iron deficiency anemia , iodine deficiency disorders (IDD), and vitamin A deficiency (VAD).

7. Undernutrition is a serious global problem, causing an estimated 50 percent of all child deaths. Undernutrition has been widespread in Africa for many years, particularly among young children. Chronic undernutrition is prevalent in sub-Saharan Africa, where almost 33 percent of all children under 5 are underweight and 38 percent are stunted (low height for age). Undernutrition may be improved by improving household access to nutritious foods, improving cultural practices, and improving the individual physiological requirements of food and nutrients.

8. The underlying causes of undernutrition include - inadequate access to food and nutrients, - improper care of mothers and children, - limited access to health services, - and unhealthy environments. The UNCEF framework below divides the causes of undernutrition into immediate, underlying, and basic.

9. Strategies to prevent and control undernutrition The following actions can help prevent and control undernutrition : Improve household food security. Households must also promote equitable distribution of food, prioritizing vulnerable groups such as children and pregnant and lactating women. Improve maternal nutrition and health care. Improving maternal nutrition and health care is an important strategy to prevent undernutrition in women and LBW in their infants. Promote appropriate child feeding practices. Exclusive breastfeeding of infants for the first 6 months of life and adding the appropriate amount of nutritious complementary foods after 6 months can reduce the prevalence of undernutrition .

10. Provide nutrition rehabilitation. A well-functioning health facility or community based system should be in place to identify undernourished children and adults and adequately treat the condition. Effective programs require to provide nutrition assessment include the following: - A surveillance system to identify and refer people - Procedures and tools to categorize malnutrition (severity and complications) - Guidelines for treatment and recovery (particularly for severe acute malnutrition - A reliable inventory of appropriate supplies for clients especially those who are severely malnourished - Follow-up visits and interventions to prevent relapse

11. ASSESSMENT OF NUTRITIONAL STATUS Nutritional status is the physical health of a person as it results from consumption and utilization of food in the body. It was defined by Christakis 1973 as health condition of an individual as influenced by his intake and utilization of nutrients determined by physical (anthropometric), biological, clinical and dietary studies. The effect of diet on health is measured by an assessment of nutritional status. Nutritional assessment procedures were used as early as in 1932 in survey designs to describe the nutritional status of population on a national basis.

12. Nutritional assessment has become an essential component of nutritional care of hospitalized patient. Nutritional assessment can also be defined as the interpretation of information obtained from anthropometric, dietary, biochemical and chemical studies. The information obtained is needed to determine the health status or population groups as influenced by their intake and utilization of nutrients. Nutritional assessment is done for survey, surveillance screening and monitoring.

13. Nutritional Survey:- The nutritional status of a selected population may be assessed in cross sectional survey. The cross sectional data can be used for baseline nutritional data or can ascertain the overall nutritional status of a population. It can also identify the population at risk, so that there could be allocation of resource to the much needed population and also to form policies to improve the overall nutrition. Nutritional surveillance: Nutritional surveillance means continuous monitoring of nutritional status of a selected population group. Here the data is collected analysed and utilized for an extended period of time. Surveillance studies identify the possible causes of malnutrition and hence can be used to formulate and initiate intervention measures as population or sub population level.

14. Nutritional screening: The identification of malnourished individuals requiring intervention can be accomplished by nutritional screening. This involves a comparison of an individual’s measurement with predetermined risk levels or cut off points. Screening can be carried out at the individual level or at a specific sub population considered to be at risk. Nutritional Monitoring: This is required during the nutritional management of the patients. Base line parameters are compared during and after the nutritional intervention.

15. Nutritional Assessment, Why? The purpose of nutritional assessment is to: Identify individuals or population groups at risk of becoming malnourished Identify individuals or population groups who are malnourished

16. To develop health care programs that meet the community needs which are defined by the assessment To measure the effectiveness of the nutritional programs & intervention once initiated

17. Methods of Nutritional Assessment Nutrition is assessed by two types of methods; direct and indirect. The direct methods deal with the individual and measure objective criteria, while indirect methods use community health indices that reflects nutritional influences.

18. Indirect Methods of Nutritional Assessment These include three categories: Ecological variables including crop production Economic factors e.g. per capita income, population density & social habits Vital health statistics particularly infant & under 5 mortality & fertility index

19. Direct Methods of Nutritional Assessment Nutritional assessment systems utilize 4 types of methods which are used alone or in combination. They are; Anthropometric assessment Biochemical assessment Clinical assessment Dietary assessment methods For the assessment of nutritional status in a community basically Dietary and Anthropometric measurements are used. The methods are simple, less time consuming and do not require sophisticated instruments.

20. Anthropometric Methods Anthropometry is the measurement of body height, weight & proportions. It is an essential component of clinical examination of infants, children & pregnant women. It is used to evaluate both under & over nutrition. The measured values reflects the current nutritional status & don ’ t differentiate between acute & chronic changes .

21. a. ANTHROPOMETRIC ASSESSMENT: This involves physical measurements of body and dimensions. Body composition maybe estimated from anthropometric measurements. The measurements vary with age and degree of nutrition and as a result are useful in assessing imbalances of protein and energy. They can be used to defect moderate as well as severe degree of malnutrition. The technique also provides information on past nutritional history which cannot be obtained in other assessment techniques. Anthropometric measurements are of 2 types – growth and body composition measurement. Anthropometric indices are weight for age, height for age, head circumference for age, or from combination of raw measurement such as weight and height, skinfold thickness at various sites.

22. Advantage of Anthropology Assessment i The procedure is simple, safe and non-invasive and can be used for large population Equipment required is inexpensive The methods are precise and accurate An unskilled person can also perform the measurement procedure Mild to moderate malnutrition can be detected Information on past long term nutritional history can be retained Changes in nutritional status over time or over generation changes can be absorbed.

23. Other anthropometric Measurements Mid-upper arm circumference Skin fold thickness Head circumference Head/chest ratio Waist/Hip ratio

24. MID ARM CIRCUMFERENCE (MAC) One of the most widely used indices for the assessment of nutritional status especially during childhood because the tape used is inexpensive and portable. Advantage: measurement is easy and simple, takes less time to perform. It involves only a simple measurement, can be taught to lay people, equipment is inexpensive. MAC correlates well with weight and weight for height. It indicates state of muscle protein. MAC should be measured only when weighing scale, cannot be supplied. Cut off points: AC > 14cm normal nutritional state AC 14 – 12.5 mild/moderate undernutrition AC < 12.5 severe underrutrition

25. SKINFOLD THICKNESS The most direct measure of fatness in people is measurement of skinfold thickness using skinfold calliper . These springs loaded callipers exert a constant pressure on a fold of skin, the thickness of skin is indicated in a meter. The thickness depends in the amount of fat stored subcutaneously in the region of the skinfold. It is measured at several sites and it is still the representative of the total amount of body fat.

26. SKINFOLD THICKNESS Typically, it is determine at 4 sites over the triceps muscle over the biceps in the subscapular region in the supra-iliac region. The single triceps muscle is sometimes used in nutritional survey because it can be measured quickly.

27. Anthropometry for children Accurate measurement of height and weight is essential. The results can then be used to evaluate the physical growth of the child. For growth monitoring the data are plotted on growth charts over a period of time that is enough to calculate growth velocity, which can then be compared to international standards

28. Discussion Why are 6-59 month children the most targeted population in measurement (anthropometric) surveys? 28

29. Children 6 to 59 months old Nutritional Status: Indication of the severity of the situation in the whole population. Particularly vulnerable to disease and food shortage. Face a higher risk of mortality in cases of crises. Easier to measure and generally at home.

30. Children 6 to 59 months old (con’t) Anthropometric indicators and references are internationally recognized. Stakeholders are used to this type of data and to respond to it correspondingly. Lots of expertise in surveys for this age group.

31. Anthropometric Measurements To determine the nutritional status of an individual, the following 6 variables will be measured : Age. Sex. Weight. Height. Bilateral edema. MUAC*.

32. Using anthropometry to determine nutritional status The following anthropometric measurements are used to measure nutritional status: Height for age (chronic malnutrition) Weight for height (acute malnutrition) Weight for age (chronic and acute malnutrition) These indexes measure the following nutrition conditions: Stunting (height for age). An indicator of chronic malnutrition or past growth failure as a result of inadequate intake of nutrients over a long period or because of long-term illness Wasting (weight significantly below the weight expected for the child’s height). An acute condition resulting from inadequate dietary intake or infection. Underweight (weight for age). Children in this category experience body changes resulting from both acute and chronic malnutrition.

33. Stages of Acute Malnutrition Moderate acute malnutrition (MAM) = moderate wasting. Severe acute malnutrition (SAM) = severe wasting or bilateral edema (can also be both). Global acute malnutrition refers to both moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) .

34. Interpretation of Measurements

35. To assess the nutrition status of children in our survey, we compare them to normal children. The normal children we compare them to are a “reference population”. The reference population is called the WHO Child Growth Standards.

36. Breastfed infants and young children in good health, from non-smoking mothers. WHO standards are not only a reference , but a model of growth that are considered indicators of good health. The following Z-score tables are all based on the WHO Child Growth Standards 2006. 36 WHO Child Growth Standards 2006

37. After measuring each child but before leaving the home, surveyors have to identify child nutrition status by: Comparing their weight/height to WHO Z-score tables. Surveyors do not calculate an exact Z-score. Use the tables to classify children as normal or malnourished. If the child is malnourished, refer them to a local facility for treatment.

38. Z-score Table

39. Z-score Interpretation of Measurements Criteria Moderate Acute Malnutrition Severe Acute Malnutrition Normal Z-score ≥ -3 and < -2 < -3 > -2

40. Exercise: Weight for Height Z-scores All examples are based on Boys 2 -5 years WHO Reference Tables . Using the WHOs growth chart for boys provided below and any other nutritional indices, interpret your result(s) 40

41. A 2 year boy with a height of 65.8 cm and weighing 7.0 kg A 3 year boy with a height of 78 cm and weighing 8.3 kg . A 36 months boy child with a height of 71.7 cm and weighing 7.6 kg . A 30 months boy with a height of 66.8 cm and weighing 5.5 kg .

42.   Z-scores (weight in kg)       Height (cm) -3 SD -2 SD -1 SD Median   1 SD 2 SD 3 SD 65.0 5.9 6.3 6.9 7.4   8.1 8.8 9.6 65.5 6.0 6.4 7.0 7.6   8.2 8.9 9.8 66.0 6.1 6.5 7.1 7.7   8.3 9.1 9.9 66.5 6.1 6.6 7.2 7.8   8.5 9.2 10.1 67.0 6.2 6.7 7.3 7.9   8.6 9.4 10.2 67.5 6.3 6.8 7.4 8.0   8.7 9.5 10.4 68.0 6.4 6.9 7.5 8.1   8.8 9.6 10.5 68.5 6.5 7.0 7.6 8.2   9.0 9.8 10.7 69.0 6.6 7.1 7.7 8.4   9.1 9.9 10.8 69.5 6.7 7.2 7.8 8.5   9.2 10.0 11.0 70.0 6.8 7.3 7.9 8.6   9.3 10.2 11.1 70.5 6.9 7.4 8.0 8.7   9.5 10.3 11.3 71.0 6.9 7.5 8.1 8.8   9.6 10.4 11.4 71.5 7.0 7.6 8.2 8.9   9.7 10.6 11.6 72.0 7.1 7.7 8.3 9.0   9.8 10.7 11.7 72.5 7.2 7.8 8.4 9.1   9.9 10.8 11.8 73.0 7.3 7.9 8.5 9.2   10.0 11.0 12.0 73.5 7.4 7.9 8.6 9.3   10.2 11.1 12.1 74.0 7.4 8.0 8.7 9.4   10.3 11.2 12.2 74.5 7.5 8.1 8.8 9.5   10.4 11.3 12.4 75.0 7.6 8.2 8.9 9.6   10.5 11.4 12.5 75.5 7.7 8.3 9.0 9.7   10.6 11.6 12.6 76.0 7.7 8.4 9.1 9.8   10.7 11.7 12.8 76.5 7.8 8.5 9.2 9.9   10.8 11.8 12.9   WHO Child Growth Standards           Weight-for-height BOYS 2 to 5 years (z-scores)

43.   Z-scores (weight in kg)       Height (cm) -3 SD -2 SD -1 SD Median   1 SD 2 SD 3 SD 77.0 7.9 8.5 9.2 10.0   10.9 11.9 13.0 77.5 8.0 8.6 9.3 10.1   11.0 12.0 13.1 78.0 8.0 8.7 9.4 10.2   11.1 12.1 13.3 78.5 8.1 8.8 9.5 10.3   11.2 12.2 13.4 79.0 8.2 8.8 9.6 10.4   11.3 12.3 13.5 79.5 8.3 8.9 9.7 10.5   11.4 12.4 13.6 80.0 8.3 9.0 9.7 10.6   11.5 12.6 13.7 80.5 8.4 9.1 9.8 10.7   11.6 12.7 13.8 81.0 8.5 9.2 9.9 10.8   11.7 12.8 14.0 81.5 8.6 9.3 10.0 10.9   11.8 12.9 14.1 82.0 8.7 9.3 10.1 11.0   11.9 13.0 14.2 82.5 8.7 9.4 10.2 11.1   12.1 13.1 14.4 83.0 8.8 9.5 10.3 11.2   12.2 13.3 14.5 83.5 8.9 9.6 10.4 11.3   12.3 13.4 14.6 84.0 9.0 9.7 10.5 11.4   12.4 13.5 14.8 84.5 9.1 9.9 10.7 11.5   12.5 13.7 14.9 85.0 9.2 10.0 10.8 11.7   12.7 13.8 15.1 85.5 9.3 10.1 10.9 11.8   12.8 13.9 15.2 86.0 9.4 10.2 11.0 11.9   12.9 14.1 15.4 86.5 9.5 10.3 11.1 12.0   13.1 14.2 15.5 87.0 9.6 10.4 11.2 12.2   13.2 14.4 15.7 87.5 9.7 10.5 11.3 12.3   13.3 14.5 15.8 88.0 9.8 10.6 11.5 12.4   13.5 14.7 16.0 88.5 9.9 10.7 11.6 12.5   13.6 14.8 16.1   WHO Child Growth Standards          

44. Measurements for adults Height: The subject stands erect & bare footed on a stadiometer with a movable head piece. The head piece is leveled with skull vault & height is recorded to the nearest 0.5 cm.

45. WEIGHT MEASUREMENT Use a regularly calibrated electronic or balanced-beam scale. Spring scales are less reliable. Weigh in light clothes, no shoes Read to the nearest 100 gm (0.1kg).

46. Nutritional Indices in Adults The international standard for assessing body size in adults is the body mass index (BMI). BMI is computed using the following formula: BMI = Weight (kg)/ Height (m²) Evidence shows that high BMI (obesity level) is associated with type 2 diabetes & high risk of cardiovascular morbidity & mortality

47. BMI (WHO - Classification) BMI < 18.5 = Under Weight BMI 18.5-24.5 = Healthy weight range BMI 25-30 = Overweight (grade 1 obesity) BMI >30-40 = Obese (grade 2 obesity) BMI >40 =Very obese (morbid or grade 3 obesity)

48. Waist/Hip Ratio Waist circumference is measured at the level of the umbilicus to the nearest 0.5 cm. The subject stands erect with relaxed abdominal muscles, arms at the side, and feet together . The measurement should be taken at the end of a normal expiration .

49. Waist circumference Waist circumference predicts mortality better than any other anthropometric measurement. It has been proposed that waist measurement alone can be used to assess obesity, and two levels of risk have been identified MALES FEMALE LEVEL 1 > 94cm > 80cm LEVEL 2 > 102cm > 88cm

50. Level 1 is the maximum acceptable waist circumference irrespective of the adult age and there should be no further weight gain. Level 2 denotes obesity and requires weight management to reduce the risk of type 2 diabetes & CVS complications.

51. Hip Circumference Is measured at the point of greatest circumference around hips & buttocks to the nearest 0.5 cm. The subject should be standing and the measurer should squat beside him. Both measurement should taken with a flexible, non-stretchable tape in close contact with the skin, but without indenting the soft tissue.

52. Interpretation of WHR High risk WHR = >0.80 for females & >0.95 for males i.e. >80% for women and >95% for men indicates obesity and is considered high risk for diabetes & CVS disorders. A WHR below these cut-off levels is considered low risk.

53. ADVANTAGES OF ANTHROPOMETRY Objective with high specificity & sensitivity Measures many variables of nutritional significance ( Ht , Wt , MUAC, HC, skin fold thickness, waist & hip ratio & BMI). Readings are numerical & gradable on standard growth charts Readings are reproducible. Non-expensive & need minimal training

54. Limitations of Anthropometry Inter-observers errors in measurement Limited nutritional diagnosis Problems with reference standards, i.e. local versus international standards. Arbitrary statistical cut-off levels for what considered as abnormal values.

55. Biochemical Assessment The biochemical evaluation of nutritional status in when quantitative determination of nutrients or related metabolites in such tissues as blood and urine. Low blood levels of a nutrient may reflect a low dietary intake, defective absorption, or increased utilization, destruction in excretion. The data serves to confirm findings from clinical observations and dietary studies or to identify subclinical deficiencies before clinical symptoms are evident. They can be used for some nutrients to assess the range for frank deficiency levels through adequate optimal and excessive levels of nutrition intake.

56. Biochemical Laboratory Assessment Hemoglobin estimation is the most important test, & useful index of the overall state of nutrition. Beside anemia it also tells about protein & trace element nutrition. Stool examination for the presence of ova and/or intestinal parasites, Urine dipstick & microscopy for albumin, sugar and blood.

57. Specific Lab Tests Measurement of individual nutrient in body fluids (e.g. serum retinol, serum iron, urinary iodine, vitamin D) Detection of abnormal amount of metabolites in the urine (e.g. urinary reatinine / hydroxyproline ratio) Analysis of hair, nails & skin for micro-nutrients.

58. Advantages of Biochemical Method It is useful in detecting early changes in body metabolism & nutrition before the appearance of overt clinical signs. It is precise, accurate and reproducible. Useful to validate data obtained from dietary methods e.g. comparing salt intake with 24-hour urinary excretion.

59. Limitations of Biochemical Method Time consuming Expensive They cannot be applied on large scale Needs trained personnel & facilities

60. CLINICAL ASSESSMENT It is an essential features of all nutritional surveys It is the simplest & most practical method of ascertaining the nutritional status of a group of individuals It utilizes a number of physical signs, (specific & non specific), that are known to be associated with malnutrition and deficiency of vitamins & micronutrients.

61. Good nutritional history should be obtained General clinical examination, with special attention to organs like hair, angles of the mouth, gums, nails, skin, eyes, tongue, muscles, bones, & thyroid gland. Detection of relevant signs helps in establishing the nutritional diagnosis

62. ADVANTAGES OF CLINICAL ASSESSMENT Fast & Easy to perform Inexpensive Non-invasive LIMITATIONS OF CLINICAL ASSESSMENT Did not detect early cases

63. Clinical signs of nutritional deficiency 1. HAIR Protein, zinc, biotin deficiency Spare & thin Protein deficiency Easy to pull out Vit C & Vit A deficiency Corkscrew Coiled hair

64. 2. MOUTH Riboflavin, niacin, folic acid, B12 , pr. Glossitis Vit. C,A, K, folic acid & niacin Bleeding & spongy gums B 2,6,& niacin Angular stomatitis, cheilosis & fissured tongue Vit.A,B12, B-complex, folic acid & niacin leukoplakia Vit B12,6,c, niacin ,folic acid & iron Sore mouth & tongue

65. 3. EYES Vitamin A deficiency Night blindness, exophthalmia Vit B2 & vit A deficiencies Photophobia-blurring, conjunctival inflammation 4. NAILS Iron deficiency Spooning Protein deficiency Transverse lines

66. 5. SKIN Folic acid, iron, B12 Pallor Vitamin B & Vitamin C Follicular hyperkeratosis PEM, Vit B2, Vitamin A, Zinc & Niacin Flaking dermatitis Niacin & PEM Pigmentation, desquamation Vit K , Vit C & folic acid Bruising, purpura

67. 6. Thyroid gland in mountainous areas and far from sea places Goiter is a reliable sign of iodine deficiency.

68. 7. Joins & bones Help detect signs of vitamin D deficiency (Rickets) & vitamin C deficiency (Scurvy)

69. DIETARY ASSESSMENT Nutritional intake of humans is assessed by five different methods. These are: Dietary history since early life 1 – 7 day food record 24 hours dietary recall Food frequency questionnaire

70. 1. DIETARY (Nutritional) HISTORY It is an accurate method for assessing the nutritional status. The information should be collected by a trained interviewer. Details about usual intake, types, amount, frequency & timing needs to be obtained. Questions on nutritional history are typically collected during the medical history. Below are 5 generic questions that are most pertinent to every adult patient.

71. Nutritional History Questions: Have you gained or lost more than 5 pounds (2.3Kg) over the last year? (Intentional or unintentional?) How many meals do you eat a day? How many snacks? Have you in the past or are you currently following any “special” diet? (If yes, which ones and why?) Are there any foods or groups of foods that you dislike, avoid or are allergic to? Are you taking any vitamin/mineral supplements or dietary supplements (herbals/food replacement products)? (If yes, which ones and why?)

72. 2. 1–7 Day FOOD Record The food record of 7 days is considered the “gold standard” of dietary intake assessment. At least 3-4 days are required to get adequate information on an individual’s usual intake, but 7 days is considered optimal. A person is instructed to write down everything he or she eats prior to or just after finishing a meal including as much detail as possible.

73. Persons collecting such data are asked to weigh or measure the food consumed to improve the quantitation of their intake. Food intake (types & amounts) should be recorded by the subject at the time of consumption. The length of the collection period range between 1-7 days. Reliable but difficult to maintain.

74. 3. 24 Hours Dietary Recall A trained interviewer asks the subject to recall all food & drink taken in the previous 24 hours. It is quick, easy, & depends on short-term memory, but may not be truly representative of the person’s usual intake. The data is not considered as accurate as a 1-7 day food record since the subject did not measure or weigh food at time of consumption and memory of food eaten is required.

75. 5. Food Frequency Questionnaire (FFQ) In this method the subject is given a list of around 100 food items to indicate his or her intake (frequency & quantity) per day, per week & per month . inexpensive, more representative & easy to use. Foods included in the questionnaire represent the foods that contribute significantly to nutrient intake in our “standard” population. It is not as appropriate for ethnic populations.

76. FOOD CONSUMPTION PATTERN Food group Frequency Daily Once in a week 2-4 times per week 5-6 times per week Not consumed Cereals and grain Root and tubers Legumes, nuts, seeds and their products Milk and milk products Meat and poultry Fish or seafood Eggs Fruits Vegetables Fats and oils Soft drinks, sugars Coffee, tea, beverages

77. Food diversity score Is an indicator for nutrient adequacy It is defined as the number of food groups consumed in the previous day. It is calculated by summing the number of food groups during the 24 hour recall. Individuals who consumed 4-9 food groups in the last 24hrs were said to have met the dietary diversity requirement recommended WHO 2011. Those who consumed less than 4 food groups are considered undiversified.

78. Limitations Food Frequency Questionnaire long Questionnaire Errors with estimating serving size. Needs updating with new commercial food products to keep pace with changing dietary habits.

79. Interpretation of Dietary Data 1. Qualitative Method using the food pyramid & the basic food groups method. Different nutrients are classified into 5 groups (fat & oils, bread & cereals, milk products, meat-fish-poultry, vegetables & fruits) determine the number of serving from each group & compare it with minimum requirement.

80. 2. Quantitative Method The amount of energy & specific nutrients in each food consumed can be calculated using food composition tables & then compare it with the recommended daily intake. Evaluation by this method is expensive & time consuming, unless computing facilities are available.

81. Purpose of Collecting dietary Intake Data a. National Health Monitoring Provide data on the nutritional intake of a population over time and to compare sub-population groups. Used to determine national policy for nutritional interventions or programs and monitor progress of nutritional programs. b. Research Carry out epidemiological studies to investigate the relationship between dietary intake and development of disease. Track nutrition intervention programs in research populations to determine effectiveness of intervention protocols. c. Patient Care (Clinical Setting) Identify patients at risk for nutritional problems. Identify patients who would benefit from changes in dietary habits to prevent chronic disease. Track effectiveness of a therapeutic nutrition intervention.