Dietary assessment

1 Dietary assessmenta resource guiDe to methoD selection anD application in low resource settingsiDietary assessmenta resource guiDe to methoD selection anD application in low resource settings Food and Agriculture Organization of the United NationsRome, 2018 Recommended citationFAO. 2018. Dietary assessment : A resource guide to method selection and application in low resource settings. designations employed and the presentation of material in this information product do not imply the expression of anyopinion whatsoever on the part of the Food and Agriculture Organization of the United Nations (FAO) concerning the legalor development status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers orboundaries.

2 The mention of specific companies or products of manufacturers, whether or not these have been patented, doesnot imply that these have been endorsed or recommended by FAO in preference to others of a similar nature that are views expressed in this information product are those of the author(s) and do not necessarily reflect the views or policies of 978-92-5-130635-2 FAO, 2018 FAO encourages the use, reproduction and dissemination of material in this information product. Except where otherwiseindicated, material may be copied, downloaded and printed for private study, research and teaching purposes, or for use innon-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.

3 All requests for translation and adaptation rights, and for resale and other commercial use rights should be made via or addressed to information products are available on the FAO website ( ) and can be purchased photo credits: Background photo: FAO/Ado YoussoufFront cover photos: FAO/Ruth Charrondiere FAO/Alessandra Benedetti FAO/Warren Lee FAO/Giulio NapolitanoBack cover photos: FAO/Oliver Bunic FAO/Warren Lee FAO/Ami Vitale FAO/Ruth Charrondiereiiicontents1. introduction 12. Dietary assessment methods indirect methods Food Balance Sheets national food availability Household Consumption and Expenditure Surveys household food consumption direct methods Retrospective direct methods 10 Food frequency questionnaire 10 24-hour recall 18 Dietary history Prospective direct methods 28 Estimated food records 28 Weighed food records 33 Duplicate meal method integration of innovative technologies to improve Dietary assessment Personal Digital Assistant (PDA)

4 Image-assisted Dietary assessment methods Mobile-based technologies Interactive computer and web-based technologies Scan- and sensor-based technologies Applications and uses of innovative technologies to improve Dietary assessment Validation of innovative technologies to improve Dietary assessment Strengths and limitations of innovative technologies to improve Dietary assessment methods Qualitative retrospective proxy tools for assessing Dietary diversity Minimum Dietary Diversity Women (MDD-W) Infant and Young Child Dietary Diversity Score (IYCDDS) Applications and uses of individual level Dietary diversity score Validity of individual level Dietary diversity score Strengths and limitations of individual level Dietary diversity scores 563.

5 Methodological considerations sources of Dietary variation individual, community and culturally specific issues in low resource settings intra-household food distribution, shared eating occasions and street food estimation of portion size availability of food composition data measurement errors in Dietary assessment Misreporting energy intakes reproducibility in Dietary assessment Validity in Dietary assessment Quality control and data analysis on Dietary assessment 764. selecting a direct Dietary assessment method study objectives in Dietary assessment design of the study technical and financial aspects to take into account supporting information for the selection of a direct Dietary assessment method A step-by-step guide for method selection Summary of the major features of the different direct Dietary assessment methods Case studies on selection of a Dietary assessment method 905.

6 Key messages and the way forward in Dietary assessment Key messages the way forward 956. further reading 977. references 998. appendices 115appendix 1: examples of food freQuency Questionnaire (ffQ) example 1a: filled-out qualitative ffQ example 1B: filled-out semi-quantitative ffQ 121appendix 2: an example of Brief Dietary Questionnaire example 2: filled-out brief Dietary questionnaire 128appendix 3: an example of 24-hour recall example 3: filled-out 24-hour recall* 130appendix 4: an example of Dietary history example 4: filled-out Dietary history* 133vappendix 5: an example of food record example 5: filled-out three day food record 145appendix 6: an example of minimum Dietary diVersity women (mdd-w) Questionnaire example 6.

7 Filled-out mdd-w questionnaire 148vitablesTable 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.

8 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 152viiFiguresFIGure 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 75viiiboxesbox 1. Quick guide to uSing an ffQ 15box 2. Brief Dietary assessment 17box 3.

9 Quick guide to uSing a 24-hour recall 21box 4. Quick guide to uSing a Dietary hiStory method 27box 5. Quick guide to uSing an eStimate food record 31box 6. Quick guide to uSing a weighed food record 35box 7. Quick guide to uSing a duplicate meal method 39box 8. Quick guide to uSing innovative technologieS for Dietary assessment 50box 9. Quick guide to uSing individual level Dietary diverSity ScoreS 57box 10. StepS and tipS on chooSing a Dietary assessment method 83ixForeworDAcross 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.

10 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 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.