FACULTY OF HEALTH SCIENCES

SEMESTER 1 SESSION 2019/2020

NDD 20103
NUTRITIONAL STATUS ASSESSMENT

NAME : NUR IZZAH ANIS BINTI ABU BAKAR (050128)

PRACTICAL : MEASURING DIET
NAME OF : DR. MOHD RAZIF BIN SHAHRIL
LECTURER
DATE OF : 1ST DECEMBER 2019
SUBMISSION

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TABLE OF CONTENTS

CONTENTS PAGE

1.0 INTRODUCTION 3

2.0 METHODS AND RESULTS 4 - 19

3.0 DISCUSSION 20 – 23

4.0 CONCLUSION 24

5.0 REFERENCES 25

6.0 APPENDICES 26

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Introduction
Dietary assessment is an evaluation of food and nutrient intake and dietary pattern of an
individual or individuals in the household or population group over time. Inaccurate dietary
assessment may be a serious obstacle of understanding the impact of dietary factors on disease.
The purpose of measuring dietary intake is to identify appropriate and actionable areas of
change in the patient's diet and lifestyle and to improve patient health and wellbeing. It provides
an estimation the amounts of energy and nutrients available for metabolism. The purpose of this
practical is to assess the diet of specific individuals and population. In this situation the
information on the usual pattern of food intake on nutrient intake is required. There are three
assessment methods applied in this practical which are 24-hr diet recall, weighed food record
and food frequency questionnaire.
A weighed record can be either a record of food as it is consumed or a much more
detailed record of the weights of ingredients, final cooked weights of prepared foods, the weights
of foods eaten and any plate waste. Weighed records have the potential to provide the most
accurate description of the types and amounts of the foods actually consumed over a specified
period of time. The 24-hour recall is the most widely used method for obtaining quantitative recall
data. The period of recall can be longer than 24 hours but is usually restricted to this length of
time because of the difficulties that individuals have in being able to recall what and how much
food was eaten over longer periods of time. A food-frequency questionnaire is basically a list of
foods with a selection of options for reporting how often each food is consumed. Respondents
indicate the most appropriate frequency option for each of the foods on the list by marking the
appropriate column in the questionnaire.

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Activity 1 Collecting a 24-Hour Diet Recall
Method
1. All foods and drinks consumed in the past 24 hours were recalled accurately for three
days.
2. The data recorded in the 24 hours Food Recall Form.
3. Each food is described in detail. Only the edible portion is recorded. All the ingredients
and amount consumed for a mixed dish is recorded.
4. The food measurement is described using household measurement in detail.
5. The household measurement is then converted into grams of intake by using the online
version of Malaysian Food Composition Table (MyFCD) and Atlas of Food Exchanges &
Portion Sizes (Third Edition) (Shahar et al. 2015). Estimation should be done as accurate
as possible.
6. The intake of calories, protein, fat and carbohydrate were manually estimated using the
online version of Malaysian Food Composition Table (MyFCD).
7. The average per day from the three days 24-hour diet recall is calculated by using the
following formula:
Average per day = [2 x weekend] + [5/2 x (weekday 1 + weekday 2)] / 7

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 Results
24 HOUR FOOD RECALL FORM
Day: 1 Date of recall: 14 November 2019 Day of week: Friday

Time Place Foods and Amount Quantity Calorie Protein Fat Carbohydrate
Beverages (gram) (kcal) (g) (g) (g)

12.00pm Library UniSZA Nasi 1 plate 300 650 35 25 50

Ayam
Penyet
5.00pm Night market Char Kuey 1 plate 329 744 23 38 76
Teow
6.00pm Home Corndog 1 piece 206 229 6 12 22
TOTAL 1623 64 75 148

Day: 2 Date of recall: 18 November 2019 Day of week: Monday

Time Place Foods and Amount Quantity Calorie Protein Fat Carbohydrate
Beverages (gram) (kcal) (g) (g) (g)

9.00am Cafe Iced 1 glass 250 134 0 0 0

Sunquick

9.00am Cafe Nasi 1 plate 180 350 9 13 58

lemak
telur mata
kerbau
12.00pm Home White rice 1 plate 178 194 2 0 38
Sambal 2 tbs 30 100 2 0 3
tumis
Fried egg 1 egg 54 86 5 6 0
8.00pm Home Mi segera 1 76 370 6.7 18.5 44.1
packet
TOTAL 1234 24.7 37.5 143.1

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 Day: 3 Date of recall: 19 November 2019 Day of week: Tuesday

Time Place Foods and Amount Quantity Calorie Protein Fat Carbohydrate
Beverages (gram) (kcal) (g) (g) (g)

12.00pm Home White rice 1 plate 178 194 2 0 38

Sambal 2 tbs 30 100 2 0 3
tumis
Telur 1 egg 109 90 6 4 1
masak
kicap
8.00pm Home White rice 1 plate 178 194 2 0 38
Tomyam 1 bowl 150 75
ayam
Telur 1 egg 54 86 5 6 0
dadar
9.00pm Home Doughnut 1 piece 80 290 3 15 37
TOTAL 1029 20 25 143.1

Calculations
[ 2 𝑥 𝑤𝑒𝑒𝑘𝑒𝑛𝑑 ] + [5/2 𝑥 (𝑤𝑒𝑒𝑘𝑑𝑎𝑦 1 + 𝑤𝑒𝑒𝑘𝑑𝑎𝑦 2) ]
Average per day =
7
[ 2 𝑥 1623 ] + [5/2 𝑥 (1234 + 1029) ]
Average calorie per day = = 1271.93 kcal
7
[ 2 𝑥 64 ] + [5/2 𝑥 (24.7 + 20) ]
Average protein per day = = 34.25 g
7
[ 2 𝑥 75 ] + [5/2 𝑥 (37.5 + 25) ]
Average fat per day = = 43.75 g
7
[ 2 𝑥 148 ] + [5/2 𝑥 ( 143.1 + 143.1) ]
Average carbohydrate per day = = 144.5 g
7

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Activity 2 Weighed Food Record
Method
1. All food and drinks consumed were weighed accurately for three (3) days using Tanita
Digital Scale KD-160 (Tanita Corporation, Japan).
2. Each weighed food (g) and drinks (ml) that have consumed day and night were recorded
in the Food Record Form.
3. Procedure in weighing food:

a) All foods packed separately (if bought them from cafeteria).

b) When ready to enjoy meal, plate placed on scale.
c) Make sure plate is clean and the scale is showing ‘0’. If not, press ‘TARE’.
d) The plate filled with the food that wanted to weigh and their weight is recorded. One
food item at a time.
e) Before adding another food item, press ‘TARE’ to zero the scale and repeat step (d).
f) Enjoy meal only after all food items have been weighed and recorded.
g) After finishing meal, non-edible portion or left-over of foods were weighed.

4. Each food is described in detail. Only the edible portion is recorded. All the ingredients
and amount consumed for a mixed dish is recorded.
5. The intake of calories, protein, fat and carbohydrate were manually estimated using the
online version of Malaysian Food Composition Table (MyFCD).
6. The average per day from the three days 24-hour diet recall is calculated by using the
following formula:
Average per day = [2 x weekend] + [5/2 x (weekday 1 + weekday 2)] / 7

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 Results
FOOD RECORD FORM
Day: 1 Date of recall: 31 October 2019 Day of week: Thursday

Time Place Foods and Amount Quantity Calorie Protein Fat Carbohydrate
Beverages (g) (kcal) (g) (g) (g)

8.00am Home Fried rice 1 plate 259 435.12 16.32 16.14 54.55
11.00am Home Chocolate 1 packet 10 50 0 0.6 6.6
snack
2.00pm Home White rice 1 plate 206 265.74 5.48 0.58 57.47
Sambal 2 tbs 84 224 6.3 6.8 0.4
telur
Asam 1 piece 68 136 6.19 3.24 2.03
pedas ayam
Plain water 1 glass 438 0 0 0 0
5.00pm Home Plain water 2 glass 883 0 0 0 0
7.00pm Home Apple 1 piece 110 57.2 0.5 0.3 24.7
TOTAL 1168.1 34.79 27.66 145.75

Day: 2 Date of recall: 1 November 2019 Day of week: Friday

Time Place Foods and Amount Quantity Calorie Protein Fat Carbohydrate
Beverages (gram) (kcal) (g) (g) (g)

8.00am Home Pisang 4 pieces 125 315 1.84 16.59 45.09

goreng
Plain water 1 glass 438 0 0 0 0

2.00pm Home White rice 1 plate 180 302.4 4.79 0.50 50.22
Fried 2 small 79 260 17.32 11.49 8.50
chicken pieces
Sambal 2 tbs 29 96.67 1.89 7.66 16.07
ikan bilis
Plain water 1 glass 438 0 0 0 0
7.00pm Home White rice 1 plate 132 221.76 3.51 0.37 36.83
Ayam 1 piece 100 170 21 12.1 21

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 sambal
Sambal 2 tbs 11 36.67 0.72 2.90 6.09
ikan bilis
TOTAL 1402.5 51.07 51.61 183.8

Day: 3 Date of recall: 4 November 2019 Day of week: Monday

Time Place Foods and Amount Quantity Calorie Protein Fat Carbohydrate
Beverages (gram) (kcal) (g) (g) (g)

11.00am Home White rice 1 plate 178 194 2 0 38

Chicken 2 tbs 85 93.5 5.1 2.55 13.6
curry
Cucumber 5 pieces 60 16 0.39 0.07 2.16
Plain water 1 glass 250 0 0 0 0
8.00pm Home White rice 1 plate 178 194 2 0 38
Ikan 1 piece 85 142 16.42 7.96 0
kembung
goreng
Curry 2 tbs 60 14 0 3.56 1.12
Plain water 1 glass 250 0 0 0 0
9.00pm Home Apple 1 piece 112 57.3 0.5 0.3 24.8
TOTAL 710.8 26.41 14.44 117.68

Calculations
[ 2 𝑥 𝑤𝑒𝑒𝑘𝑒𝑛𝑑 ] + [5/2 𝑥 (𝑤𝑒𝑒𝑘𝑑𝑎𝑦 1 + 𝑤𝑒𝑒𝑘𝑑𝑎𝑦 2) ]
Average per day =
7
[ 2 𝑥 1402.5 ] + [5/2 𝑥 (710.8 + 1168.1) ]
Average calorie per day = = 1071.75 kcal
7
[ 2 𝑥 51.07 ] + [5/2 𝑥 (26.41 + 34.79) ]
Average protein per day = = 36.45 g
7
[ 2 𝑥 51.61 ] + [5/2 𝑥 (14.44 + 27.66) ]
Average fat per day = = 29.78 g
7
[ 2 𝑥 183.8 ] + [5/2 𝑥 ( 117.68 + 145.75) ]
Average carbohydrate per day = = 146.60 g
7

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Activity 3 Food Frequency Questionnaire
Method
1. Food Frequency Questionnaire (FFQ) is filled as provided in Food Frequency
Questionnaire Form to estimate intakes for the past one (1) month.
2. Conversion factor is calculated to estimate food intake according to frequency of intake
for each food item, e.g.:

Frequency Frequency conversion factor

1 x per day 1
2 x per day 2
3 x per day 3
1 x per week 1/7 = 0.14
2 x per week 2/7 = 0.29
3 x per week 3/7 = 0.43
1 x per month 1/30 = 0.03
2 x per month 2/30 = 0.07
3 x per month 3/30 = 0.10

3. The household measurement is converted into grams of intake by using the online
version of Malaysian Food Composition Table (MyFCD) and Atlas of Food Exchanges &
Portion Sizes (Third Edition) (Shahar et al. 2015).
4. Food frequency is converted to daily food intake. Formula:

Weight food (g) per day

= frequency conversion factor x weight of food per serving (g) x serving size

5. The intake of calories, protein, fat and carbohydrate were manually estimated using the
online version of Malaysian Food Composition Table (MyFCD).
6. The intakes from all three dietary assessment methods is compared.

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 Results
Weight food per day= Frequency conversion factor x weight of food per serving (g) x serving
size

Rice = [2 x 76.3g x 2 ] 305.2

Instant noodle = [3/30 x 85g x 1 ] 8.5
Bihun/Kuew Teow = [3/30 x 85g x 2 ] 17
Bread = [5/30 x 30g x 2 ] 10
Roti canai = [1/30 x 100g x 2 ] 6.67
Corn = [1/30 x 250g x 1 ] 8.33
Chicken = [4/7 x 136.5g x 1 ] 78
Cow = [1/30 x 60g x 3 ] 6
Lamb = [1/30 x 60g x3 ] 6
Chicken meat burger = [2/30 x 85g x 1 ] 5.67
Hotdog = [5/30 x 51g x 3 ] 25.5
Nugget = [2/30 x 20g x 3 ] 4
Ocean fish = [2/30 x 53g x 1 ] 3.53
Fresh fish = [2/30 x 53g x 1 ] 3.53
Anchovies = [5/30 x 30g x 2 ] 10
Prawn = [2/30 x 56g x 4 ] 14.93
Squid = [2/30 x 90g x 2 ] 12
Salted fish = [3/30 x 20g x 2 ] 4
Fish ball = [3/30 x 33.3g x 3 ] 9.99
Keropok lekor = [2/30 x 30g x 4 ] 8
Chicken egg = [3/7 x 46g x 1 ] 19.71
Tauhu = [1/30 x 150g x 1 ] 5
Tempe = [3/30 x 70g x 2 ] 14
Ground nuts = [2/30 x 38.6g x 1 ] 2.57
Yogurt = [2/30 x 150g x 1 ] 10
Green leaves vegetables = [5/7 x 88g x 1 ] 62.86
Beans vegetables = [2/30 x 60g x 1 ] 4
Carrot = [2/30 x 40g x 1 ] 2.67
Cabbage = [2/30 x 88g x 1 ] 5.87
Cucumber = [3/7 x 96.7g x 1 ] 41.44
Bean sprouts = [2/30 x 86.7g x 1 ] 5.78
Banana = [2/30 x 50g x 1 ] 3.33
Watermelon = [2/30 x 13.4g x 2 ] 1.79
Apple = [2/30 x 130g x 1 ] 8.67
Orange = [2/30 x 130g x 1 ] 8.67
Plain water = [8 x 250g x 2 ] 4000
Tea = [2/30 x 200g x 1 ] 13.33
Coffee = [2/30 x 200g x 1 ] 13.33
Chocolate drink = [2/30 x 250g x 1 ] 16.67
Malt drink = [2/7 x 250g x 1 ] 71.43
Fruit juices = [1/30 x 250g x 1 ] 8.33
Kuih = [3/30 x 70g x 3 ] 21
Cake = [3/30 x 79.4g x 1 ] 7.94
Biscuits = [4/30 x 6.67g x 6 ] 5.34
Ice cream = [1/30x 35g x 2 ] 2.33
Snack/ rempeyek = [2/30 x 15g x 8 ] 8
Seri kaya = [5/30 x 5g x 2 ] 1.67
Sugar = [3 x 5g x 3 ] 45
Sambal belacan = [4/30 x 10g x 1 ] 1.33

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 Soy sauce = [4/30 x 10g x 2 ] 2.67
Chilli sauce = [4/30 x 10g x 2 ] 2.67

Table 1 shows calculation of conversion factor to estimate food intake according to frequency
of intake for each food item.

Food and Beverages Weight food per Calorie Protein Fat Carbohydrate
day (g) (kcal) (g) (g) (g)
Rice 305.2 396.8 7.02 0.3 91.56
Instant noodle 8.5 38 0.8 1.5 5.2
Bihun/Kuew Teow 17 29 1.92 0 13.01
Bread 10 42 1.6 0.2 8.5
Roti canai 6.67 21.14 0.47 0.72 3.19
Corn 8.33 7.84 0.77 1.2 5.77
Chicken 78 129 10.0 10.0 0
Cow 6 15.24 1.36 0.13 0
Lamb 6 16.5 1.2 0.32 0
Chicken meat burger 5.67 12.02 1.02 0.65 0.43
Hotdog 25.5 62 3.6 5.3 0
Nugget 4 11.56 2.7 3.7 2.8
Ocean fish 3.53 5 1.1 0.1 0
Fresh fish 3.53 2 0.3 0.1 0
Anchovies 10 32.14 19.0 0.23 0.05
Prawn 14.93 1.33 1.01 0.09 0.05
Squid 12 11.04 8.88 0.79 1.76
Salted fish 4 7.32 1.68 0.06 0.02
Fish ball 9.99 10.0 9.0 3.0 9.0
Keropok lekor 8 24 0.7 2.1 2.37
Chicken egg 19.71 31 2.6 2.2 0.2
Tauhu 5 8.75 0.36 0.17 0.1
Tempe 14 22 2.22 1.05 0.95
Ground nuts 2.57 7 0.3 0.5 0.2
Yogurt 10 6 0.31 2.0 1.86
Green leaves vegetables 62.86 13.21 7.4 0.8 9.6
Beans vegetables 4 3.2 0.88 0.05 2.52
Carrot 2.67 0.93 0.03 0 0.2
Cabbage 5.87 8 0.6 0.1 1.3
Cucumber 41.44 6.42 0 0 0.4
Bean sprouts 5.78 2.31 0.66 0.2 1.28
Banana 3.33 2.96 0.04 0.01 0.76
Watermelon 1.79 0.50 0.01 0 0.11
Apple 8.67 4.51 0.02 0.01 1.20
Orange 8.67 4.07 0.06 0.04 0.90
Plain water 4000 0 0 0 0
Tea 13.33 3.88 0 0 0.87
Coffee 13.33 4.0 1.57 0.01 9.76
Chocolate drink 16.67 91.52 1.23 5.47 9.33
Malt drink 71.43 292.14 5.95 7.44 48.81
Fruit juices 8.33 5.00 0.67 0.03 1.25
Kuih 21 45 0.88 1.66 6.74
Cake 7.94 25.49 0.54 1.48 3.55
Biscuits 5.34 18.85 0.45 0.90 3.47
Ice cream 2.33 4.82 0.08 0.25 0.55
Snack/ rempeyek 8 47.76 1.39 3.46 2.75
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Seri kaya 1.67 4.45 0.04 0.05 0.95
Sugar 45 180 0 0 44.73
Sambal belacan 1.33 0.67 0 0.1 0
Soy sauce 2.67 3.02 0.07 0.05 1.19
Chilli sauce 2.67 1.87 0 0 1.28
TOTAL 1723.26 122.89 58.52 300.52

Table 2 shows estimation weight food per day, calorie, protein, fat and carbohydrate based on
frequency conversion factor.
Calculations

Total calorie intake = 1723.26 kcal

Total protein intake = 122.89 g
Total fat intake = 58.52 g
Total carbohydrate intake = 300.52 g

Nutrients 24 Hour Diet Recall Weighed Food Food Frequency

Record Questionnaire
Calorie (kcal) 1271.93 1071.75 1723.26
Protein (g) 34.25 36.45 122.89
Fat (g) 43.75 29.78 58.52
Carbohydrate (g) 144.5 146.60 300.52

Table 3 shows the comparison of the calorie, protein, fat and carbohydrate values between all
three dietary assessment methods.

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Activity 4 Diet Analysis of 24-Hour Diet Recall, Weighed Food Record and Food Frequency
Questionnaire Using Computerized Tools

Method

1. 24-hour diet recall, weighed food record and food frequency questionnaire were collected

and the nutrient intake is analyzed using the Nutritionist Pro TM Diet Analysis software.
2. Result of analysis is printed out and compared with previous manual calculation.

Results

Nutrients Nutritionist Pro TM Diet Analysis Manual Calculation

24-hr DR WFR FFQ 24-hr DR WFR FFQ

Energy (kcal) 1403.189 1190.838 1122.328 1271.93 1071.75 1723.26
Protein (g) 52.138 52.016 67.041 34.25 36.45 122.89
Protein (%)* 14.86 17.47 23.89 10.77 13.60 28.53
Carbohydrate (g) 170.744 142.138 240.454 144.5 146.60 300.52
Carbohydrate (%)* 48.67 47.74 85.70 45.44 54.71 69.76
Fat (g) 56.562 46.341 45.863 43.75 29.78 58.52
Fat (%)* 36.28 35.02 36.78 30.96 25.00 30.56
Retinol (ug) 178.865 45.493 115.880 - - -
Vitamin A (RE) 519.723 853.653 820.731 - - -
Vitamin B1 (mg) 0.833 0.254 0.951 - - -
Vitamin B2 (mg) 1.434 0.461 1.664 - - -
Niacin Eq (mg) 9.950 6.944 15.625 - - -
Vitamin C (mg) 26.351 22.006 97.66 - - -
Calcium (mg) 210.851 205.583 448.824 - - -
Iron (mg) 11.725 12.685 13.464 - - -
Sodium (mg) 2068.160 1303.433 1959.6 - - -
24-hr DR = 24 hour diet recall, WFR = Weighed food record, FFQ = Food Frequency
Questionnaire
* Percentage of energy

Table 4 shows the comparison between diet analysis of 24-Hour Diet Recall, Weighed Food
Record and Food Frequency Questionnaire using computerized tools with the previous manual
calculation.
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Activity 5 Using Recommended Nutrient Intake (RNI) for Malaysian to evaluate nutrient
intake
Method

1. The nutrient intake assessed from 24-hour diet recall, weighed food record and food
frequency questionnaire is used to analyze and then the intakes are compared with RNI for
Malaysian (2017).

Formula:

𝐼𝑛𝑡𝑎𝑘𝑒 𝑜𝑓 𝑐𝑒𝑟𝑡𝑎𝑖𝑛 𝑛𝑢𝑡𝑟𝑖𝑒𝑛𝑡

% of RNI achieved = 𝑥 100%
𝑅𝑁𝐼 𝑓𝑜𝑟 𝑡ℎ𝑎𝑡 𝑛𝑢𝑡𝑟𝑖𝑒𝑛𝑡

2. The intakes is presented in Table 5 and Graph 1 by showing percentage achievement of

RNI for all available nutrient.

3. Step 1 and 2 are repeated using data from the classmate and compared. The comparison
is shown in Table 6.

4. For each nutrient, the number of classmate in percentage that achieved 66% of RNI is
calculated and presented in Table 7 and Graph 2.

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 Results

Nutrients 𝑰𝒏𝒕𝒂𝒌𝒆 𝒐𝒇 𝒄𝒆𝒓𝒕𝒂𝒊𝒏 𝒏𝒖𝒕𝒓𝒊𝒆𝒏𝒕

% of RNI achieved = 𝒙 𝟏𝟎𝟎%
𝑹𝑵𝑰 𝒇𝒐𝒓 𝒕𝒉𝒂𝒕 𝒏𝒖𝒕𝒓𝒊𝒆𝒏𝒕

24-hr DR WFR FFQ

Energy (kcal) 1403.189 1190.838 1122.328
𝑥 100% = 87.15 𝑥 100% =73.97 𝑥 100% = 69.71
1610 1610 1610

Protein (g) 52.138 52.016

𝑥 100% = 98.14 67.041
𝑥 100% = 98.37 53 𝑥 100% = 126.49
53 53
Carbohydrate (g) 170.744 142.138 240.454
𝑥 100% = 84.84 𝑥 100% = 70.63 𝑥 100% = 119.48
201.25 201.25 201.25
Fat (g) 56.562 46.341 45.863
𝑥 100% = 110.91 𝑥 100% =90.86 𝑥 100% = 89.93
51 51
51
Retinol (ug) 178.865 45.493 115.880
𝑥 100% = 29.81 𝑥 100% = 7.58 𝑥 100% = 19.31
600 600 600
Vitamin A (RE) 519.723 853.653
𝑥 100% = 142.28 820.731
𝑥 100% = 86.62 600 𝑥 100% = 136.79
600 600
Vitamin B1 (mg) 0.833 0.254 0.951
𝑥 100% = 75.73 𝑥 100% = 23.09 𝑥 100% = 86.45
1.1 1.1 1.1
Vitamin B2 (mg) 1.434 0.461 1.664
𝑥 100% = 130.36 𝑥 100% = 41.91 𝑥 100% = 151.27
1.1 1.1 1.1
Niacin Eq (mg) 9.950 6.944 15.625
𝑥 100% = 71.07 𝑥 100% = 49.6 𝑥 100% = 111.61
14 14 14

Vitamin C (mg) 26.351 22.006 97.66

𝑥 100% = 37.64 𝑥 100% = 31.44 𝑥 100% = 130.94
70 70 70
Calcium (mg) 210.851
𝑥 100% = 21.09 205.583 448.824
1000 𝑥 100% = 20.56 𝑥 100% = 44.88
1000 1000
Iron (mg) 11.725 12.685 13.464
𝑥 100% = 58.63 𝑥 100% = 63.43 𝑥 100% = 67.32
20 20 20
Sodium (mg) 2068.160 1303.433 1959.6
𝑥 100% = 137.88 𝑥 100% = 86.90 𝑥 100% = 130.64
1500 1500
1500
Table 5 showing the percentage achievement of RNI for all available nutrient based on data from
three dietary assessment methods.

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 P E RC E N TAG E O F R N I AC H I E V E D
24-hr DR WFR FFQ

160

140

120

100

80

60
40

20

Graph 1 shows percentage of RNI achieved for individual for all available nutrients.
Nutrients Mean Standard Deviation (SD)
24-hr DR WFR FFQ 24-hr DR WFR FFQ
Energy (kcal) 88.8 97.8 115.0 23.9 53.5 53.0
Protein (g) 114.4 123.4 143.2 45.4 83.6 66.0
Carbohydrate (g) 95.4 101.2 138.3 32.1 66.3 90.9
Fat (g) 97.5 105.0 111.3 27.5 52.0 57.5
Retinol (ug) 23.4 19.4 15.4 33.2 20.9 17.7
Vitamin A (RE) 150.1 149.0 204.4 141.5 196.8 186.4
Vitamin B1 (mg) 66.5 74.1 100.6 33.2 69.2 58.5
Vitamin B2 (mg) 85.9 122.8 165.5 47.4 233.0 110.9
Niacin Eq (mg) 96.6 99.8 125.6 54.0 68.5 69.8
Vitamin C (mg) 110.0 72.5 106.8 373.9 106.8 70.2
Calcium (mg) 42.1 51.9 80.8 23.9 100.6 84.9
Iron (mg) 55.3 48.9 107.3 32.2 28.6 370.4
Sodium (mg) 137.0 134.8 144.1 71.9 92.4 112.5
Table 6 showing the mean and standard deviation of the percentage achievements of RNI for all
available nutrient of this population.
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 Nutrients Number of people achieved Percentage of people achieved
66% of RNI 66% of RNI (%)

24-hr DR WFR FFQ 24-hr DR WFR FFQ

Energy (kcal) 47 45 45 88.7 84.9 84.9

Protein (g) 48 49 51 90.6 92.5 96.2

Carbohydrate (g) 46 45 47 86.8 84.9 88.7

Fat (g) 47 45 42 88.7 84.9 79.2

Retinol (ug) 4 4 2 0.1 7.6 3.8

Vitamin A (RE) 36 40 48 67.9 75.5 90.6

Vitamin B1 (mg) 24 20 36 45.3 37.7 67.9

Vitamin B2 (mg) 35 34 49 66.0 64.2 92.5

Niacin Eq (mg) 35 35 41 66.0 66.0 77.4

Vitamin C (mg) 16 20 35 30.2 37.7 66.0

Calcium (mg) 5 5 18 0.1 9.4 34.0

Iron (mg) 13 15 13 0.2 28.3 24.5

Sodium (mg) 48 49 43 90.6 92.5 17.0

Table 7 shows the number of people achieved 2/3 or 66% of RNI and the percentage of people
achieved 2/3 or 66% of RNI.

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 Percentage of people achieved 66% of RNI
120

100

80

60

40

20

24-hr DR WFR FFQ

Graph 2 shows percentage of people achieved 66% of RNI for all available nutrient.

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Discussion

Based on the practical, the measurement dietary intake of 2nd year UniSZA Dietetics students are
measured by using standardized examination procedure and calibrated equipment. This practical
applied two ways; manually estimation and computerized tools. There are three assessment
methods which are 24 hour Diet Recall, Weighed Food Record and Food Frequency Questionnaire.
In measuring diet, we estimated calorie, protein, fat and carbohydrate per daily intake by manual
estimation and computerized tools. With all the measurement data, we were able to compare intakes
from all three dietary assessment methods. With the two ways of estimation, we were able to
determine the differences between values from computerized and manually calculated nutrients.
The population mean values and standard deviation of all available nutrients that achieved 66% of
RNI is calculated to identify which nutrient that was lacking the most in diet.
Dietary intake can be assessed by subjective report and objective observation. Subjective
assessment is methods that assess an individual's intake include the 24-hour dietary recall (24-hr
DR), weighed food record (WFR) and FFQ. Each method has inherent strengths and limitations.
Firstly, the strengths of 24-hr DR is can assess the usual intakes of large population, captures
information on eating patterns followed with preparation method and place of consumption. The
mode of administration does not affect food choice and eating pattern. The limitation of this method
is totally relies on respondent’s memory and required well-trained interviewers with knowledge
cultural practices, eating habits, local recipes and preparation methods. The recall also may bias as
the respondents can be selective with the foods they to report during recall. This method is quite
expensive due to the fact extensive training is needed for the interviewers. Secondly, the
advantages of WFR is does not rely on memory, since information is recorded at the time of
consumption. It also provides the exact portion sizes which does not rely on estimation. This method
is more accurate that other dietary assessment methods. It has been considered the gold-standard
method for dietary assessment. However, WFR is limited as this method is high level of respondent
burden when compared to the other assessment methods. It requires motivated respondents with
numeracy skills to weigh out foods and record food intakes. Error also can be existed resulting due
to difficulties in weighing foods eaten away from home. Last but not least FFQ method advantages
are can assess the usual intake over a long period of time, low respondent burden and interview
based FFQ does not rely on the literacy and numeracy skills of the respondents. The limitation for
this method are the food list cannot cover all the foods consumed by the respondent which may
lead to underreporting and it does not give precise information on estimated portion size consumed.
This method relies heavily on memory therefore declined cognitive ability can result in errors when
reporting on frequency and portion size estimation (Food and Agriculture Organization of the United

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Nations Rome, 2018).

There is a growing need for more specific and accurate dietary assessment methods. New
information and communication technologies aim to obtain more accurate and reliable dietary
information. In addition, innovative technologies aim to reduce the cost of collecting and processing
dietary information. Based on recent reviews, innovative technologies to improve dietary
assessment have been classified into four key groups: personal digital assistant (PDA), image
assisted methods, interactive computer and web-based technologies, and scan and sensor based
technologies. PDA has a specially-designed dietary software program that can be used to register
and self-monitor dietary intake. It allows for the evaluation of short-term dietary intake, facilitating
real-time data collection. Mobile-based technologies allow short-term dietary assessment which the
participants are asked to take photographs, video or voice records of all the foods and drinks they
consume on eating occasions. The identification of foods in the images and portion size estimation
can be carried out by the respondents or dietitians. Interactive computer and web-based
technologies involve the use of interactive dietary assessment programs installed on a desktop or
portable computer refers to these devices being connected to the Internet. The aim of these
technologies is to collect dietary data during a specific period in the short or long term dietary
assessment. Scan-based technologies allow participants to scan the barcodes of purchased food
items (Food and Agriculture Organization of the United Nations Rome, 2018).

Based on the Table 3 shows the comparison of the calorie, protein, fat and carbohydrate values
between all three dietary assessment methods. For the calorie values, it shows that Food Frequency
Questionnaire (FFQ) method is the highest with 1723.26 kcal followed with 1271.93 kcal (24-hr DR)
and 1071.75 kcal (WFR). FFQ method also is the highest for protein and carbohydrate values with
122.89 g and 300.52 g respectively. Lastly, FFQ method for fat values recorded is the highest among
the rest with 58.52 g. Based on Journal Nutritional Science in 2017, it stated there are five studies
used 24-hr DR as their reference method to validate an FFQ. In all studies the FFQ overestimated
mean nutrient intake estimates but could provide reliable estimates of nutrient intakes in young
children with good agreement when compared with the 24-HR. Eleven studies used WFR as their
reference method to validate an FFQ. Ten studies that estimated nutrient intakes found that the
FFQ tended to overestimate intakes. From the research, this explains why the values for all calorie,
protein, fat and carbohydrate obtained from the FFQ method is significantly highest compared to
the value that derived from WFR and 24-hr DR methods.

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 Diet analysis in this practical were measured using two ways which are manually calculated
and computerized tools based on data obtained from 24-hr DR, WFR and FFQ. Based on Table 4,
it shows there are significantly differences between values from computerized and manually
calculated nutrients. Nutritionist Pro TM Diet Analysis is a computerized tools used to analysis dietary
intake and all available nutrients. For 24-hr DR and WFR energy intake are 1403.189 kcal
determined by computerized tools while energy intake are 1190.838 kcal determined by manual
calculated nutrients. Meanwhile for FFQ, the energy value derived from manually calculated is
1723.26 kcal which is higher than computerized tools. For protein, computerized tools estimated for
24-hr DR and WFR are expected to be higher than manually calculated. This is because based on
the energy value differences that stated before. FFQ using manually calculated for protein is higher
(122.89 g) than computerized tools which is 67.041 g. Carbohydrate analysis from WFR method
shows only small differences between values from computerized tools and manually calculated
nutrient which is 142.138 g and 146.60 g respectively. However, there is a big differences in fat
value from WFR method by using computerized tools which is 46.341 g while manually calculated
is 29.78 g.
First and foremost, there is the aspect of different interpretation of portion size in the two
methods. The computerized tools used standard portion sizes, while the manually calculated
nutrients used more detailed descriptions in grams of portion sizes. The different kind of food
portions could introduce food quantification errors. Researchers have suggested that computerized
tools method used in conjunction with manually calculated nutrients were more likely to have poorer
accuracy when estimating energy and protein intake. The database is an essential part of dietary
assessment software. Validity of assessments produced by the software depends on the quality of
the food component data. Potential users should evaluate food names and descriptions and
determine whether the food component data is representative of foods available to the population
being surveyed. Precise food names and descriptors help ensure that the associated data
correspond to the food for which information is accurate. Non-US databases introduce another level
of difficulty for US users even when the foods names are in English. Food names need to consider
common usage and regional variation as well as standard nomenclature. Users expect the food
database from computerized to be accurate for their purpose which might be to estimate food
component intake of clients in the eastern, mid-west or western states and at any time of the year.
It is unlikely that a single set of values for a food will match the data needs in all situations. Fruits
and vegetables have a variable composition due to differences in maturity, length and method of
storage, variety and method of analysis. Food Composition databases require frequent updates to
keep pace with new and reformulated items in the market place and to keep pace with advances in
food analysis methods. One criterion for selecting a database is to choose a data source that
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represents foods available to dietetic practice population because food names, varieties grown and
distributed, typical recipes, fortification rules and practices differ by geographic region and national
boundaries. For example, calculation of food energy differs between the U.S. and Canada, two
neighboring countries (Jessica Paciepnik, Judi Porter, 2017)
From the Graph 1, it shows the nutrient that I was lacking the most in my diet is retinol. The RNI
for retinol is 600 ug. With all three dietary assessment methods, the percentage of RNI achieved for
retinol in average is 18.1% meaning that the amount of retinol per daily intake is 113.41 ug. The
second nutrient that was lacking is calcium where the average amount per daily intake is 288.42 mg
with percentage of RNI achieved only 28.84%. Next is nutrient level of vitamin C in my dietary intake
is significantly low with average amount per daily intake is 48.67 mg with 66.67% of RNI achieved.
To increase the intake of retinol in my diet, it is recommended to consume more for green leafy
vegetables and other green, orange and yellow vegetables for example broccoli and carrot (National
Institute of Health, 2019). Next, it is suggested to eat more fish or eat tinned fish such as sardines
with the bones left in to increase the calcium intake in my diet. Other than that, calcium intake can
be increased by replacing the meat in some meals with tofu or tempeh. To enhance the absorption
of calcium in body, it is advised to reduce caffeine and soft drink intake (Better Health Channel,
2012). Last but not least, to enrich vitamin C level in daily dietary intake is by keeping a bowl of
vitamin-C rich fruit in the house for snaking. A grapefruit for breakfast is not a bad idea. It is also
suggested to eat more fermented vegetables. One serving of kimchee provides about half of
recommended daily value of vitamin C (Deborah Enos - CN, 2013).
Based on Graph 2, it shows the percentage of this population that achieved 66% of RNI for all
available nutrients. It reveals there are few nutrients that the population was lacking in their diet
which are retinol, calcium and iron. From the Table 7, range of people that achieved 66% of RNI in
average for retinol is only 2 to 4 people followed with 3.83% from population. The number of people
that achieved 66% of RNI for calcium is recorded with 9 people in average. For the iron values,
17.7% from population is achieved 66% of RNI meaning that only 14 people in average. In the
graph, it is observed that sodium is one of the nutrients that was highest daily intake in their diet.
For the three main nutrients which are protein, carbohydrate and fat are well achieved 66% of RNI.
The other nutrients which are vitamin A, vitamin B1, vitamin B2, niacin and vitamin C are also well
achieved in moderate daily recommended intake of 66% of RNI.

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Conclusion

To summarize dietary intake is difficult to measure and any single method cannot assess
dietary exposure perfectly. Nutritional biomarkers are valid for objective estimates of dietary
exposures in anthropometric and clinical assessment meanwhile the 24-hr diet recall, weighed
food recall and FFQ are subjective estimation.
Recently, it has been suggested that a combination of methods such as the FFQ with
WFR or the FFQ with biomarker levels be used to obtain more accurate estimates of dietary
intakes than that of individual methods. Considerable efforts to improve the accuracy and
feasibility of large epidemiological studies are still ongoing. Dietary assessment methods
should be selected with caution and while considering the research objective, hypothesis,
design and available resources. All self-report methods are challenging. People do not
commonly attend to the foods they have eaten, do not remember everything, do not know the
contents of the foods eaten and cannot estimate portion sizes accurately. Further, factors such
as gender and weight status can bias reports of diet. Three principle types of diet assessment
instruments are widely used which are the food frequency questionnaire (FFQ), weighed food
record (WFR) and 24 hour dietary recall (24-hr DR). Each has strengths and weaknesses.
Biological indicators of intake do not suffer from errors in self-reporting but have other
limitations, including that they often reflect status on short term intakes, are highly specific and
are generally expensive and invasive.

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Reference
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Appendices

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