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Dietary macro-nutrient and micro-nutrient intake estimation in children

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Tibebu Moges

researcher

Normal user

10 Jun 2015, 12:59

Dear colleagues,
In Ethiopia, family members eat together in the same plate. In a household consisting a child and adult family members, estimating the dietary intake, especially the amount using 24 hr recall is difficult due to sharing. Could any body tell me the way to estimate the amount under such circumstance?
Thank you

Mark Myatt

Consultant Epideomiologist

Frequent user

10 Jun 2015, 15:19

One approach is to use adult male equivalents (AMEs). The AME is the age and gender specific energy requirement divided by the energy requirement for an adult male aged 18-30 years.

Data tables for calculating AMEs for different activity levels can be found in "Human energy requirements (Report of a Joint FAO/WHO/UNU Expert Consultation), Rome, 17–24 October 2001" which was, I think, published in 2004.

Here is a table of AMEs based on moderate activity:

    Age (low)  Age (high)  Males AME  Female AME
    ---------  ----------  ---------  ----------
     6 months         < 1        0.22       0.22
            1           2        0.31       0.28
            2           3        0.37       0.34
            3           4        0.41       0.38
            4           5        0.44       0.41
            5           6        0.48       0.43
            6           7        0.52       0.47
            7           8        0.56       0.51
            8           9        0.60       0.56
            9          10        0.65       0.61
           10          11        0.70       0.66
           11          12        0.77       0.70
           12          13        0.84       0.75
           13          14        0.91       0.78
           14          15        0.98       0.80
           15          16        1.04       0.82
           16          17        1.09       0.82
           17          18        1.11       0.82
           18          30        1.00       0.79
           30          60        0.97       0.77
           60        > 60        0.80       0.69
    ---------  ----------  ---------  ----------

Each person in the household is assigned an energy requirement based on a table of AMEs (as above). This individual AME is constructed by taking the ratio of their requirement to that of an adult male age 18-30 years. This is done for all members of the household. The individual AMEs are summed to give the total household AME.

Each person’s share is calculated as the ratio of their individual AME to the total household AME. For example, if you have 200g of wheat flour to divided over all HH members and your total HH AMEs sum (e.g.) to 6.5 then an adult male aged 18-30 years would get (1.0 / 6.5) * 200 or 30.8g while a boy aged four years would get (0.44 / 6.5) * 200 or 13.5g.

You can then use food tables to estimate individual energy intake from a given food. The idea can be extended to other nutrients / micronutrients.

I hope this is of some use.

Merry

Friedman School of Nutr Science & Policy, Tufts Un

Normal user

10 Jun 2015, 15:58

This is a common difficulty and there is no easy solution for actual intake as opposed to requirements. I'm also struggling with this same problem for a study in the DRCongo and I haven't found anything in the literature that helps very much.

Each household might be a bit different in how they divide out the food within the common plate. The mother may help the younger children, selecting bites for them and feeding them. So how each mother chooses those bites might vary by household. In some households the men and older boys may eat separately from the women and other children. Knowing how women divide the food and prioritize certain favored foods might be a start.

What I plan to do, though there may be more robust methods out there that I haven't found, is to start with some discussions with mothers, but more importantly, attempting to observe meal-times (and snacking), perhaps through female staff that might have a similar status to the women of the household so we can see what is normal. In this way, I can at least get an idea for how much difference there is between households and what the usual trends are. From that, I'll try to extrapolate from a 7-day household dietary measurement how much the child received, as well as an attempt at a 24-hour dietary recall based on the amounts that the mother thinks the child ate. This isn't optimal, but I'm not sure there is an optimal way that doesn't change the eating habits.

Anonymous 81

Public Health Nutritionist

Normal user

10 Jun 2015, 17:09

Dear Tigabu,
For various reasons, it is difficult to measure the amount of food intake by individual. that is why, as a variable, it is not included in the WHO 15 IYCF indicators. so, you better collect information to measure, dietary diversity, meal frequency and minimum acceptable diet as they are a proxy for positive outcomes. Research has shown that Dietary diversity is a proxy for adequate micronutrient-density of foods.

Tibebu Moges

researcher

Normal user

15 Jun 2015, 12:00

Thank You Mark.

Rosemary Atieno

Nutritionist- MOH

Normal user

15 Jun 2015, 14:12

Dear Tigabu
I would also agree that proxy indicators of nutritional status especially of the vulnerable that is women and children would be a good start up for you in the households where sharing is practiced to determine if sharing is positively or negatively affecting nutritional status and thereby have it as a talking point to the community

Mark Myatt

Consultant Epideomiologist

Frequent user

16 Jun 2015, 08:29

Just to say that I agree with all those posting here that urge you to collect IYCF indicators and to use meal frequency and dietary diversity.

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