# 2.6 Dietary Assessment

Dietary Assessment
In a society that is constantly performing in a type A lifestyle, it is sometimes quite difficult for person to find time for their bodies. Now I’m not just talking about exercising, people actually forget to monitor something that is equal to if not more important; their diets. Fortunately, there is a test a person can use in order to monitor their diets, and it’s a Dietary assessment. According to Delores Truesdell from the American Heart association, a dietary assessment is a comprehensive evaluation of a person’s food consumption. In order words, it is the gathering of information of all the foods and beverages a person intakes. It is also a segmented section of a full nutritional assessment done in a clinical setting, sort of like a physical, but specifically for the diet. Moreover, a dietary assessment is accompanied by three other evaluations including, anthropometrics, which measures a person’s weight to height ratio and body mass index, a physical examination, and a biochemical exam. What is even more promising, is how vital a dietary assessment can be for a person’s future and current health. Especially since it may uncover possible risks like chronic diseases and assist with the prevention of theses diseases. Once the data is collected from the person, it is used to calculate the percentages of energy, nutrients, and what the category each food consumed falls in to. In a typical examination a few things need to happen before receiving important results. Starting off with a 24-hour recall, which according to UCLA’s School of medicine, a patient is asked to recall all of the foods and beverages they consumed in the last 24 hours. Then the patient is asked to recall a typical daily intake pattern, including the methods and frequency preparation in their foods. The Food Frequency questionnaire is then used to make a standardized checklist where the patient can check off the specific foods they consumed. Finally, a Dietary food log would be incorporated in order to ask the patient to record all the foods consumed for one week, and that is the information that will later be entered into a program that will calculate and analyze the data obtained. From that data usually consisting of consumed calories, fats, proteins and carbs, the Nutritionist would make decisions or suggestions on important changes that need to be made in order to help the patient live a healthier lifestyle. Think about a situation where a dietary assessment did not exist. What would happen to our society? It seems like we would all be walking health issues. The reality of it is even with these specific assessments out there, and all the progress we have made in order to become a healthier society, we still have many people that suffer from dietary health issues. Fortunately, we as a society are continuing to shed light on the harmful risks of unhealthy consumption and find solutions to this problem.
Resources
American Heart Association. “Healthy Lifestyle: Diet and Nutrition.” Available form <http:// www.americanheart.org>
David Geffen School of Medicine at UCLA." David Geffen School of Medicine at UCLA. N.p., 03 Mar. 2014. Web. 01 Dec. 2015. <http://dgsom.ucla.edu/>.
"Individual Dietary Assessment." Individual Dietary Assessment. N.p., 02 Dec. 2015. Web. 30 Nov. 2015. <https://fnic.nal.usda.gov/dietary-guidance/individual-dietary-assessment>.
"Short Dietary Assessment Instruments." Short Dietary Assessment Instruments. N.p., 04 Nov. 2014. Web. 28 Nov. 2015. <http://appliedresearch.cancer.gov/diet/screeners/>
David Geffen School of Medicine at UCLA." David Geffen School of Medicine at UCLA. N.p., 03 Mar. 2014. Web. 01 Dec. 2015. <http://dgsom.ucla.edu/>.

## 2.6.1 Individual Assessment
### Patient History

There are many factors to include in a patient’s history such as food preferences, health risk, and food intake. Food preferences as a result of cultural, religious, and ethnic reasons influence a patient’s history (Fine). Health risk is an additional component to a patient’s history. Family history, disease, and risk factors for diseases are all analyzed as part of a patient’s health risk. For example, a body mass index (BMI) over 30 is considered obese and is a risk factor for diabetes (Whitney & Rolfes, 2016). Health risk factors can usually be evaluated using physical and laboratory measurements. Food intake, including nutritional supplements, is another factor to include in a patient’s history. If a patient is taking vitamins or minerals as supplementation, is important to record the dosage, frequency, and dosage of the particular supplement (Thompson & Byers, 1994, p. 2259S) Environmental factors such as poverty and illiteracy can coincide with some nutritional deficiencies (“Clinical assessment,” 1973).
References (1973). Clinical assessment of nutritional status. Journal of American Journal of Public Health, 63. 18-27.
Fine, B. Nutrition assessment [PowerPoint slides]. Retrieved from Lecture Notes Online Website: https://www.uic.edu/depts/mcam/nutrition/pdf/nutrition_assessment.pdf
Thompson, F. E., & Byers, T. (1994). Dietary assessment resource manual. Journal of Nutrition, 124 (11). 2245s-2317s.
Whitney, E., & Rolfes, S. R. (2016). Health Risks. In Understanding Nutrition (9.3). Retrieved from http://ng.cengage.com/static/nb/ui/index.html?nbId=196342&nbNodeId=58604887&de oymentId=4842767387588213997397576#!&parentId=58605175

### Physical Measurements

Dental evaluations can be a crucial part for a nutritional assessment. Dental caries, edema, bleeding, calculus deposits, and soft materia alba are all considerations that should be included in in a dental report (“Clinical assessment,” 1973). Physical signs of malnutrition can be found all over the body. General appearance, hair, skin, skeletal, muscle, eyes, face, mouth, teeth, mouth, and organs should all be included in an evaluation for malnutrition (“Clinical assessment,” 1973). In a 1968 White House Conference on Food, Nutrition and Health, recommendations were made for clinical evaluation of nutrition. For infants, weight, recumbent length, head circumference, chest circumference, and triceps skinfold are recommended measurements. Pre-schooler age children should be measured for all of those previously listed, with recumbent height replaced with standing height and the addition of arm circumference. School age through adolescents should be measured the same, besides head and chest circumferences. Lastly, adults should be nutritionally evaluated with standing height, weight, triceps skinfold, subscapular skinfold, and arm circumference. Symptoms for a nutrient deficiency present differently on different populations depending on multiple factors. For example, deficiency of vitamin C, or scurvy, presents as swollen joints in children, but as black and blue marks on elderly people’s shinbones (“Clinical assessment,” 1973).
References (1973). Clinical assessment of nutritional status. Journal of American Journal of Public Health, 63. 18-27.

### Laboratory Measurements

When tending to an individual there are different methods that a professional could use to assess the person. These methods include:
* Dietary Records
* 24- Hour Diet Recall
* Food Frequency (Ferro-Luzzi)
Dietary Records
This method requires the individual, or other (as in the case for a parent reporting for their child), to report everything they eat. Ideally this is done as the person eats so that they are less likely to forget to report something. This method can last anywhere from one to seven days but the ideal number of days is four since subjects tend to report less and less.
(Coulston, 2001)
The individual being assessed is usually trained in how to report their diet including not only what they eat but also the amount (which can be measured with a scale or household measures), recipe, method they used to prepare their meals. If the assessment has a specific focus on a certain food group then an individual may only need to keep track of the food they consume that pertains to that group.(Chapter 3)
Pros:
* Open-ended
* Does not rely on memory
Cons:
* Individuals can and sometimes do alter their eating patterns and quantities consumed since they have to record everything
* Validity since a person might not record what they eat as they eat but hours later when they may forget to include some details
* Requires literacy, limiting who can be assessed (individuals with a lower income) (Chapter 3)
24- Hour Diet Recall
This method involves a 30 to 45 minute interview with the participant. During this time they are asked what they have consumed in the last 24 hours, or just the day before. These interviews are conducted by experienced, well-trained professionals, usually dieticians, since a lot of information is obtained from asking probing questions. Probing questions are extremely useful for getting a lot of forgotten information, such as food additives such as condiments. Also the interviewer should have extensive knowledge of food and how it is prepared.
When conducting the interview the Automated Multi-Pass Method (AMPM) is used. This involves the individual being assessed listing out a “quick list” of the foods they can remember having eaten to the interviewer. This is followed by a forgotten food list consisting of nine food categories usually left out. Next the individual must state the times that they ate the foods and are then asked probing questions. Lastly, a final review is conducted to ensure that nothing was left off. (Coulston, 2001)
Pros:
* Literacy not required
* Does not alter intake behavior
Cons:
* Skilled, trained interviewer needed
* Relies on memory
(Chapter 3)
Food frequency
This method is a questionnaire consisting of a list of food groups. Next to each category the individual is required to estimate the amount of times they consume that particular food in a given day, month, or year. Some questionnaires include questions about food preparation, supplements and brands of food that a person usually eats. (Coulston, 2001)
This method can also be used to determine whether a relationship exists between a food consumed and whether the population consuming this food contracts a certain disease. The main reason behind using this method, however, is to get an estimate of the total amount of different types of food consumed. The questionnaires can be self-administered or given by a trained professional in person or on the phone. (Ferro-Luzzi)
Pros:
* Inexpensive
Cons:
* Invalid; people may not remember how often they eat a certain food
* Complex calculations required
* Measurement error
(Chapter 3)
Chemical analysis of diets
Another method of analysis requires the individual to bring exact replicas of what they normally eat. They are then stored in a refrigerator before being tested. The foods can be tested in two ways: an exact replica of the foods eaten, or the raw foods that are made into the meal consumed. After being refrigerated the food is weighed and chemically analyzed. Even though it is accurate, this method is not readily used since it’s so inconvenient to use. (Ferro- Luzzi)
Pros:
* Accurate
* Provides a lot of information of nutrient content of consumed foods
Cons:
* Time consuming
* Costly
(Chapter 3)
Laboratory methods involving blood panels can also be used to determine deficiencies in serum protein, iron, folacin, vitamin B6, vitamin B12, thiamine, riboflavin, niacin, iron, iodine, cholesterol, triglycerides, glucose, and vitamins C, A D, E, and K. However, not all nutrient deficiencies can be measured via laboratory methods (“Laboratory assessment,” 1973).
References (1973). Laboratory assessment of nutritional status. Journal of American Journal of Public Health, 63. 28-33.
Ferro-Luzzi, A. (n.d.). Keynote Paper: Individual food intake survey methods. Retrieved December 2, 2015, from http://www.fao.org/docrep/005/y4249e/y4249e0a.htm
Chapter three - Methods of monitoring food and nutrient intake. (n.d.). Retrieved December 2, 2015, from http://www.fao.org/docrep/x0243e/x0243e05.htm
Coulston, A., Carol, B., & Mario, F. (Eds.). (2001). Nutrition in the prevention and treatment of disease (3rd ed.). San Diego, CA: Academic Press.

## 2.6.2 Population Assessment
### Population Data

Many nations and organizations around the world are working to improve human nutrition. On the national level, the Food and Agriculture Organization (FAO) of the United Nations (UN) publishes Nutrition Country Profiles in developing countries assessing the nutrition status of populations (FAO, 2010). On the national level, companies like the National Institutes of Health (NIH) and Center for Disease Control and Prevention (CDC) also monitor the nutrition status of populations (CDC, 2014). These organizations use several methods to collect data about populations studied. These include conducting national surveys, reviewing historical information, and conducting laboratory tests and physical examinations.
The National Health and Nutrition Examination Survey (NHANES) is the basis for the national standards for health assessment in the United States. It is conducted by the National Center for Health Statistics (NCHS) under the CDC. The NHANES consists of a series of surveys and examinations that obtain data from 5,000 individuals per year. This survey is used to determine the prevalence and risk factors for many conditions such as diabetes, metabolic diseases, obesity, diabetes, eye diseases, oral health, osteoporosis, and respiratory disease. It also measures physical fitness, physical functioning and nutrition in general to educate both health professionals and American citizens alike (CDC, 2014). It is important to note that the survey method requires that individuals self-report their health status, therefore the prevalence reported may not reflect the actual amount of people with the characteristics studied, but rather an estimate of these amounts.
The NIH also relies on the NHANES for population data. According to the survey, more than 2 in 3 adults are considered overweight or obese and 1/3 of children and adolescents ages 6 to 19 are considered obese (NIH, 2012). These and other diagnosis of kidney disease, digestive diseases and anemia promote dietary suggestions and determine the prevalence of disease. It is also important to observe the number of new diagnoses of disease and whether this number increases over time when planning future dietary suggestions.
The NHANES’s biochemical measures include level of water-soluble and fat-soluble vitamins, trace elements (iron indicators and iodine) and isoflavones and lignans collected from the population by urine excretions and blood samples. The survey’s physical measures include demographics, smoking habits, known conditions, allergies and activity level. By using statistical measures, they are able to determine mean levels of nutrient consumption and inspire ways to improve the population’s diet (CDC, 2014).
It is important to note that some population assessment measures, such as physical examinations, pinpoint disease and issues only after symptoms appear. Meanwhile, other measures, such as lab tests, may detect disease and issues early on (Whitney, 2013. p. 26). This should be considered when observing prevalence statistics and predicting changes in disease rates over time.
References
About the National Health and Nutrition Examination Survey. (2014, February 3). Retrieved November 30, 2015, from http://www.cdc.gov/nchs/nhanes/about_nhanes.htm
Nutrition Assessment. (2010). Retrieved November 30, 2015, from http://www.fao.org/food/nutrition-assessment/en/ Overweight and Obesity Statistics. (2012, October 1). Retrieved November 30, 2015, from http://www.niddk.nih.gov/health-information/health-statistics/Pages/overweight-obesity-statistics.aspx
Whitney, E., & Rolfes, S. (2013). An overview of Nutrition. In Understanding nutrition (Fourteenth ed., pp. 24–28). Stamford, Connecticut: Cengage Learning.

### Incidence Data

(MINIMAL CONTENT - STUDENTS ADD HERE)

### Prevalence Data

Prevalence data is the measurement of the likelihood of a person to have a disease. The prevalence number of cases for a disease is the total number of cases of the disease that exist within a given population. A prevalence rate is the total number of cases of a disease existing in the given population divided by the total population (Basic Statistics, 1999).
When prevalence data is obtained regarding dietary assessments, it is typically from nutritional epidemiological studies. The dietary assessments are comprehensive evaluations of the dietary intake of the patients. As a result, by careful review of the dietary data obtained, risk factors for chronic diseases can be discovered, so that steps can be taken to prevent the diseases (Johansson, 2006). When the data of the dietary intake is reviewed, it may suggest that the patient may be at risk of developing chronic disease. Then, steps may be taken to help prevent it. Further tests of the patient may reveal more problems before side effects are given the chance to emerge. Examples include malnutrition and anemia.
Several examples of previously conducted studies include a systematic analysis of population health data conducted in 2001. The aim of this analysis was to calculate the global burden of disease and risk factors, separated by regional trends over the span of 1990 to 2001. The analysis of the data collected would then allow the Disease Control Priorities Project to know what diseases to begin with. The disease most important for the DCPP to control would be the one with the highest prevalence rate (Lopez, Mathers, Ezzati, Jamison, & Murray, 2001).

### Morbidity and Mortality

Morbidity and mortality are quantitative data that can also be assessed from dietary assessments (Implementing Physical Activity, 2015). Morbidity refers to the illness within a given population. Mortality refers to the number of deaths. A mortality rate is the number of deaths due to a disease divided by the total population. Data collected regarding morbidity and mortality typically come from surveys with defined populations and accomplished through systematic methodology (Basic Statistics, 1999).
References
Basic Statistics: About Incidence, Prevalence, Morbidity, and Mortality - Statistics Teaching Tools. (1999, April 1). Retrieved November 30, 2015, from https://www.health.ny.gov/diseases/chronic/basicstat.htm Implementing Physical Activity Programming for SNAP-Ed Eligible Populations. (2015, September 1). Retrieved November 30, 2015, from http://www.cdph.ca.gov/programs/cpns/Documents/CDPH-PA-ResourceGuide-v1r14.pdf Johansson, G. (2006, June 16). Dietary assessments Use, design concepts, biological markers, pitfalls and validation. Retrieved November 30, 2015, from http://www.diva-portal.org/smash/get/diva2:464612/FULLTEXT02 Lopez, A., Mathers, C., Ezzati, M., Jamison, D., & Murray, C. (n.d.). Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. The Lancet, 367(9524), 1747-1757. doi:doi:10.1016/S0140-6736(06)68770-9