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Dietary Assessment a Resource Guide to Method Selection and Application in Low Resource Settings

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DIETARY ASSESSMENT A RESOURCE GUIDE TO METHOD SELECTION AND APPLICATION IN LOW RESOURCE SETTINGS DIETARY ASSESSMENT A RESOURCE GUIDE TO METHOD SELECTION AND APPLICATION IN LOW RESOURCE SETTINGS Food and Agriculture Organization of the United Nations Rome, 2018 i Recommended citation FAO. 2018. Dietary Assessment: A resource guide to method selection and application in low resource settings. Rome. The designations employed and the presentation of material in this information product do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the United Nations (FAO) concerning the legal or development status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or products of manufacturers, whether or not these have been patented, does not imply that these have been endorsed or recommended by FAO in preference to others of a similar nature that are not mentioned. The views expressed in this information product are those of the author(s) and do not necessarily reflect the views or policies of FAO. ISBN 978-92-5-130635-2 © FAO, 2018 FAO encourages the use, reproduction and dissemination of material in this information product. Except where otherwise indicated, material may be copied, downloaded and printed for private study, research and teaching purposes, or for use in non-commercial products or services, provided that appropriate acknowledgement of FAO as the source and copyright holder is given and that FAO’s endorsement of users’ views, products or services is not implied in any way. All requests for translation and adaptation rights, and for resale and other commercial use rights should be made via www.fao.org/contact-us/licencerequest or addressed to [email protected]. FAO information products are available on the FAO website (www.fao.org/publications) and can be purchased through [email protected]. Cover photo credits: Background photo: ©FAO/Ado Youssouf Front cover photos: ©FAO/Ruth Charrondiere ©FAO/Alessandra Benedetti ©FAO/Warren Lee ©FAO/Giulio Napolitano Back cover photos: ©FAO/Oliver Bunic ©FAO/Warren Lee ©FAO/Ami Vitale ©FAO/Ruth Charrondiere CONTENTS 1. INTRODUCTION 1 2. DIETARY ASSESSMENT METHODS 3 2.1 Indirect methods 3 2.1.1 Food Balance Sheets – national food availability 4 2.1.2 Household Consumption and Expenditure Surveys – household food consumption 7 2.2 Direct methods 10 2.2.1 Retrospective direct methods 10 2.2.1.1 Food frequency questionnaire 10 2.2.1.2 24-hour recall 18 2.2.1.3 Dietary history 24 2.2.2 Prospective direct methods 28 2.2.2.1 Estimated food records 28 2.2.2.2 Weighed food records 33 2.2.2.3 Duplicate meal method 37 2.3 Integration of innovative technologies to improve dietary assessment 39 2.3.1 Personal Digital Assistant (PDA) 40 2.3.2 Image-assisted dietary assessment methods 40 2.3.3 Mobile-based technologies 41 2.3.4 Interactive computer and web-based technologies 43 2.3.5 Scan- and sensor-based technologies 43 2.3.6 Applications and uses of innovative technologies to improve dietary assessment 44 2.3.7 Validation of innovative technologies to improve dietary assessment 45 2.3.8 Strengths and limitations of innovative technologies to improve dietary assessment methods 46 2.4 Qualitative retrospective proxy tools for assessing dietary diversity 51 2.4.1 Minimum Dietary Diversity –Women (MDD-W) 52 2.4.2 Infant and Young Child Dietary Diversity Score (IYCDDS) 53 2.4.3 Applications and uses of individual level dietary diversity score 54 2.4.4 Validity of individual level dietary diversity score 55 2.4.5 Strengths and limitations of individual level dietary diversity scores 56 3. METHODOLOGICAL CONSIDERATIONS 59 3.1 Sources of dietary variation 59 3.2 Individual, community and culturally–specific issues in low resource settings 61 3.3 Intra-household food distribution, shared eating occasions and street food 63 3.4 Estimation of portion size 63 3.5 Availability of food composition data 64 iii 3.6 Measurement errors in dietary assessment 65 3.6.1 Misreporting energy intakes 68 3.7 Reproducibility in dietary assessment 69 3.8 Validity in dietary assessment 70 3.9 Quality control and data analysis on dietary assessment 76 4. SELECTING A DIRECT DIETARY ASSESSMENT METHOD 79 4.1 Study objectives in dietary assessment 79 4.2 Design of the study 81 4.3 Technical and financial aspects to take into account 82 4.4 Supporting information for the selection of a direct dietary assessment method 82 4.4.1 A step-by-step guide for method selection 82 4.4.2 Summary of the major features of the different direct dietary assessment methods 84 4.4.3 Case studies on selection of a dietary assessment method 90 5. KEY MESSAGES AND THE WAY FORWARD IN DIETARY ASSESSMENT 93 5.1 Key messages 93 5.2 The way forward 95 6. FURTHER READING 97 7. REFERENCES 99 8. APPENDICES 115 APPENDIX 1: EXAMPLES OF FOOD FREQUENCY QUESTIONNAIRE (FFQ) 115 8.1 Example 1A: Filled-out qualitative FFQ 115 8.2 Example 1B: Filled-out semi-quantitative FFQ 121 APPENDIX 2: AN EXAMPLE OF BRIEF DIETARY QUESTIONNAIRE 128 8.3 Example 2: Filled-out brief dietary questionnaire 128 APPENDIX 3: AN EXAMPLE OF 24-HOUR RECALL 130 8.4 Example 3: Filled-out 24-hour recall* 130 APPENDIX 4: AN EXAMPLE OF DIETARY HISTORY 133 8.5 Example 4: Filled-out dietary history* 133 iv APPENDIX 5: AN EXAMPLE OF FOOD RECORD 145 8.6 Example 5: Filled-out three day food record 145 APPENDIX 6: AN EXAMPLE OF MINIMUM DIETARY DIVERSITy – WOMEN (MDD-W) QUESTIONNAIRE 148 8.7 Example 6: Filled-out MDD-W questionnaire 148 v TABLES TABLE 1 - STRENGTHS AND LIMITATIONS OF USING FBS DATA FOR ASSESSING DIETS 6 TABLE 2 - STRENGTHS AND LIMITATIONS OF USING HCES DATA FOR ASSESSING DIETS 9 TABLE 3 - STRENGTHS AND LIMITATIONS OF FFQ 14 TABLE 4 - STRENGTHS AND LIMITATIONS OF 24-HOUR RECALL 21 TABLE 5 - STRENGTHS AND LIMITATIONS OF DIETARY HISTORY METHOD 26 TABLE 6 - STRENGTHS AND LIMITATIONS OF ESTIMATED FOOD RECORDS 30 TABLE 7 - STRENGTHS AND LIMITATIONS OF WEIGHED FOOD RECORDS 35 TABLE 8 - STRENGTHS AND LIMITATIONS OF DUPLICATE MEAL METHOD 38 TABLE 9 - STRENGTHS AND LIMITATIONS OF INNOVATIVE TECHNOLOGIES TO IMPROVE DIETARY AssEssMENT METHODS 47 TABLE 10 - STRENGTHS AND LIMITATIONS OF INNOVATIVE TECHNOLOGIES INTEGRATED INTO CONVENTIONAL DIETARY ASSESSMENT METHODS 49 TABLE 11 - STRENGTHS AND LIMITATIONS OF INDIVIDUAL LEVEL DIETARY DIVERSITY SCORE 56 TABLE 12 - SOURCES OF ERRORS IN DIRECT DIETARY ASSESSMENT METHODS FOR ASSESSING FOOD AND NUTRIENT INTAKES 66 TABLE 13 - EXAMPLES OF PAIRING TEST DIETARY ASSESSMENT METHODS AND REFERENCE METHODS 71 TABLE 14 - SELECTION OF A METHOD TO MEASURE NUTRIENT INTAKES TO MEET FOUR POssIBLE LEVELS OF OBJECTIVES 80 TABLE 15 - DIETARY ASSESSMENT METHODS COMMONLY USED IN THE DESIGN OF DIFFERENT STUDIES 81 TABLE 16 - COMPARISON OF THE MAJOR FEATURES OF METHODS FOR ASSESSING DIET 85 TABLE A - DESCRIPTIVE QUALITATIVE FFQ 116 TABLE B - SEMI-QUANTITATIVE FFQ 121 TABLE C - A BRIEF DIETARY QUESTIONNAIRE 128 TABLE D - A 24-HOUR RECALL 130 TABLE E - A DIETARY HISTORY RECORD 133 TABLE F - A THREE DAY FOOD RECORD 145 TABLE G - A 24-HOUR RECALL 149 TABLE H - TABLE OF FOOD GROUPS 150 TABLE I - THE 10 FOOD GROUPS 152 vi FIGURES FIGURE 1 - OVERVIEW OF DIETARY ASSESSMENT METHODS TO ESTIMATE FOOD AND NUTRIENT CONSUMPTION AT NATIONAL, HOUSEHOLD AND INDIVIDUAL LEVEL 4 FIGURE 2 - DIAGRAM OF THE TECHNOLOGY ASSISTED DIETARY ASSESSMENT (TADA) SYSTEM THAT STARTS WITH CAPTURING AN IMAGE WITH THE MOBILE FOOD RECORD (MFR) 42 FIGURE 3 - DIFFERENCE IN MEAN IRON INTAKE ESTIMATED BY A 24-HOUR RECALL AND A WEIGHED FOOD RECORD 75 vii BOXES BOX 1. QUICK GUIDE TO USING AN FFQ 15 BOX 2. BRIEF DIETARY ASSESSMENT 17 BOX 3. QUICK GUIDE TO USING A 24-HOUR RECALL 21 BOX 4. QUICK GUIDE TO USING A DIETARY HISTORY METHOD 27 BOX 5. QUICK GUIDE TO USING AN ESTIMATE FOOD RECORD 31 BOX 6. QUICK GUIDE TO USING A WEIGHED FOOD RECORD 35 BOX 7. QUICK GUIDE TO USING A DUPLICATE MEAL METHOD 39 BOX 8. QUICK GUIDE TO USING INNOVATIVE TECHNOLOGIES FOR DIETARY ASSESSMENT 50 BOX 9. QUICK GUIDE TO USING INDIVIDUAL LEVEL DIETARY DIVERSITY SCORES 57 BOX 10. STEPS AND TIPS ON CHOOSING A DIETARY ASSESSMENT METHOD 83 viii FOREWORD Across the world today, there is increasing interest in incorporating robust nutrition information into national information systems. The aim is to inform the implementation and evaluation of nutrition- sensitive agricultural projects, policies and programmes, and to tackle all forms of malnutrition. The need for such robust information was reaffirmed at the Second International Conference on Nutrition (ICN2) in November 2014. It is therefore important that as an organization, FAO works to meet global knowledge demands and gaps in decision-making, by supporting the collection of nutrition information for surveillance, setting targets, measuring impacts, and tracking progress. Up-to-date and valid assessment of what people eat and drink will help to generate better information and evidence that will contribute to the formulation of effective agricultural and nutrition policies and programmes. It will also benefit consumer education, which in turn will contribute to raising levels of nutrition and help to prevent undernutrition, obesity and non-communicable diseases. This increasingly rigorous approach will lead to a culture of robust dietary data collection, resulting in evidence-based decisions that are crucial to achieving the strategic objectives of the organization. This resource guide provides an updated overview of the dietary assessment methods that can be used to collect dietary data at national, household and individual levels.
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