Assessment of nutritional status Direct and indirect methods

Anthropometry
 Anthropometry is the measurement of the physical dimensions, i.e. body size,
weight and proportions
 Measurement of growth has always been an important tool for assessing the
nutritional status of community
Anthropometric measurement are collected
 To provide objective health data which enable one to assess physical growth and
development.
 To identify health problems (overweight and underweight)
 To evaluate nutritional status and
 To identify individuals in need of treatment and follow up care
Use of anthropometric measurements depends on two factors
 Accurate age assessment.
 Appropriate normal values for comparison

Nutritional anthropometry is the measurement of human body at various ages and
levels of nutritional status.
It is based on the concept that an appropriate measurement should reflect any
morphological variation occurring due to significant functional physiological change
Measurement
 The measurements that are selected should be the simplest and quickest to measure,
and the easiest to reproduce, providing simultaneously maximum information
concerning a number of nutritional problems.
The most commonly used measurements in routine surveys are:
(1) Body weight,
(2) crown-heel length or standing height,
(3) mid-upper arm circumference, and
(4) fat fold at triceps.
Circumference of head and chest are also included in some surveys covering children
under five years of age.

Body weight
 Body weight is the most widely used and the simplest reproducible
anthropometric measurement for the evaluation of nutritional status of young
children.
 It indicates the body mass and is a composite of all body constituents like water,
minerals, fat, protein, bone etc.
 Serial measurements of weight as in growth monitoring are more sensitive
indicators of changes in nutritional status than a single measurements at a point
of time.
 It is sensitive even to small changes in nutritional status due to childhood
morbidities, like diarrhoea etc.
 Rapid loss of body weight in children should be considered an indicator of
potential malnutrition.
 Weight is an important variable in equations predicting calorie
expenditure and in indices of body composition.

Stature
 The height of an individual influenced both by genetic
 The maximum growth potential of an individual is decided by hereditary factors, while
the environmental factors, the most important being nutrition and morbidity;
 Inadequate dietary intake and/or infections reduce nutrient availability at cellular level
resulting in growth retardation.
 During periods of severe deprivation, linear growth rate slows down and leads to stunting
(short stature) in an individual.
 Thus, stunting in poor communities is less than 10% in infants and increases with age to
20-70% in children between 2-3 years.
 Since height is affected only by long-term nutritional deprivation, it is considered an
index of chronic
 Length and stature are measured with the head in frankfert horizontal plane
or long duration malnutrition.

Measurement of height
 While in the older children and adults, height is measured with a vertical measuring rod
(anthropometer), in children below the age of two years who can not stand properly,
recumbent length (crown-heel length) should be measured with infantometer
 Subject should inhale deeply, hold children below the a the breath and
maintain an erect posture during height measurement
Mid-upper arm circumference (MUAC)
 Poor musculature and wasting are cardinal features of protein energy malnutrition in early
childhood.
 Mid-upper arm circumference (MUAC) and calf circumference are recognized to indicate
the status of muscle development.
 The mid-calf and mid-upper arm are heavily muscled an approximately circular
 MUAC is not only useful in identifying malnutrition but also in determining
the mortality risk in children

Triceps skin fold thickness
 Measurement of the triceps skinfold thickness (TSF) provides an objective
estimate of subcutaneous fat reserves.
 Triceps skin fold can be measured with a Lange, Harpenden, Holtain, or
Ross Adipometer skin fold caliper.
 Skin fold measurements are inexpensive, require little space, are easily and
quickly obtained.
 It provides estimates of body composition that correlate well with results
of hydrostatic weighing.

Midarm-muscle circumference
This measurement is calculated from triceps skin fold and mid-arm circumference
measurements.
Mid arm muscle circumference (MAMC) is an indirect indicator of muscle mass
1. Triceps skin fold measurement in millimetres is converted to centimetres by
dividing the millimetre value by 10.2.
2. Triceps skin fold (TSF) and mid-arm circumference (MAC) measurements both in
centimetres are applied to the following formula:
3. MAMC (cm) = MAC (cm) - (3.14 xTSF (cm))

Head and chest circumference
 Head circumference help to detect abnormalities of head and brain growth
especially in first year.
 Head size relates mainly to the size of brain which increases quite rapidly
during infancy.
 The chest in a normally nourished child grows faster than heading during the second and
third year of life.
 As a result, the chest circumference overtakes head circumference by about one year
of age.
 In protein energy malnutrition (PEM) in poor children, due to poor growth of
chest, the head circumference may remain to be higher than the chest even at the age of
2 1/2 to 3 years.
 The head and chest circumference are measured with a flexible fibre glass tape used
for measuring arm circumference.
 The chest circumference is measured passing the tape round, the head is measured over
the supra-orbital ridges (just above the eyes) of the frontal bone in front, and the most
protruding point of the occipital on the back of the head

Standard Deviation Classification
TheWorld Health Organization recommends the use of SD
classification (WHO 1983) to categorize the children into different
grades of nutritional status.
Distribution of preschool children is carried out according to
underweight (weight for age), stunting (height for age) and
wasting (weight for height), computed usingWHO-MGRS
reference values, as provided below:

Measurement of waist circumference
Waist circumference is measured using fibre reinforced plastic tape.The
tape should pass mid way between the lower rib margin and iliac crest
of the pelvic bone.
Adult men with waist circumference ≥ 102 cms and adult women with ≥
88 cms considered as having abdominal obesity.
The Asian cut offs for the same are 90 cms and 80 cms respectively.
Measurement of hip circumference
Hip circumference is measured with tape passing over maximum
protuberance on buttocks.
Waist to hip ratio
The ratio of waist to hip is an indicator of central obesity.
Adult men with waist hip ratio of ≥ 0.95 and women with ≥ 0.8 are
considered as having central obesity.

USEFULNESS OF ANTHROPOMETRIC MEASUREMENTS
1. For assessment of extent of undernutrition of vulnerable groups of population, it is
recommended to assess the prevalence of undernutrition in children below 5 years of
age using less than Median -2SD ofWHO MGRS Growth standards as a criterion.
2. For monitoring the nutritional status of individual children at regular intervals (monthly or
quarterly) to find out whether there is any faltering in growth (deterioration/no change
of growth) during the intervals as being done in Integrated Child Development Services
(ICDS).This would help in early detection and in initiating prompt remedial measures.
3. For identification of children who are at risk of undernutrition, to target and prioritize
nutrition action programmes so as to control the extent of undernutrition.
4.These are useful for mid-term appraisal or terminal evaluation to assess the effect of
intervention programmes.

5. For assessing nutrition rehabilitation of malnourished children undergoing
treatment.
6. Anthropometry can be used for the purpose of nutrition surveillance along
with secondary data on indicators which directly or indirectly affect the
nutritional status.
7. Anthropometry can be used to assess the impact of seasonal food supplies on
nutritional status of the community. This would also provide time trends
when measured at two or more points of time.
Thus, nutritional anthropometry can be used to assess the type, extent and
duration of malnutrition in a community

Biochemical Estimation
 Biochemical assessment is one of the important methods to assess nutritional
status of population.
 Compared with the other methods of nutritional assessment (anthropometric,
clinical and dietary), biochemical tests provide the most objective and
quantitative data on nutritional status.
 The intake of various nutrients present in diet are reflected by changes in
concentration of corresponding nutrients or metabolites in the blood, tissues and
urine.
 Biochemical changes generally occur prior to clinical manifestation
 The biochemical tests often detect nutrient deficits much before anthropometric
measures are altered and clinical symptoms appear during the development of
any deficiency disease.
 The biochemical tests which can be conducted on easily accessible body fluids,
such as blood and urine can help to diagnose disease at subclinical stage and
confirm clinical diagnosis at the disease stage as clinical signs and symptoms are
often non-specific.

 An ideal biochemical test should be sensitive, specific, easy to carry out,
non-invasive, preferably inexpensive and should reveal information or the
extent of tissue unsaturation rather than short-term fluctuations in the diet.
 The choice of test depends on the purpose, i.e. whether it is for population
survey or individual diagnosis.
 While applying a test, one should be fully familiar with its limitations,
particularly the specificity and sensitivity of the test.
 Biochemical tests are a valuable adjunct in assessing and managing
nutritional status. However, their use is not without problems.

Assessment of nutritional status Direct and indirect methods

Types of tests
Laboratory tests for assessment of nutritional status involve : Measurement of
the nutrient, its metabolic or some other product in blood or urine.
Measurement of activity of a vitamin-dependent enzyme in erythrocytes and its in
vitro activation with corresponding coenzyme.
Measurement of an accumulated metabolite whose disposal depends on a vitamin-
or-mineral dependent enzyme, with or without preloading with a precursor.
Measurement of some end functions like erythrocyte fragility blood clotting,
tensile strength of skin, work capacity etc.
The important biochemical tests useful in the detection of nutritional deficiency
are presented in Table 9.1.
They have been broadly classified under two heads :
i)First category: This includes tests which are fairly simple to perform and have
been widely used for the detection of nutritional deficiency status.
ii) Second category methods: These are complicated for use as routine
procedures but can be used by institutions having adequate facilities.
The methods are used to gain more accurate and specific knowledge of particular
nutrient inadequacies suggested by first category tests.

Clinical Assessment
 The physical examination of the subject for the assessment of his nutritional
status is perhaps the oldest method known to mankind.
 This has also led the scientists to search for the nutrients responsible for the
appearance of specific deficiency signs.
 Clinical examination is a widely used practical method for assessing the
nutritional status of a community is widespread.
Definition
This method is based on examination for changes believed to be related to
inadequate nutrition that can be seen or felt in superficial epithelial tissues.
An exhaustive definition of clinical examination is given by Jelliffe (1966) who
defined it as "A method based on examination for changes believed to be related
to inadequate nutrition, that can be seen or felt in superficial epithelial tissues
especially the skin, eyes, hair and buccal mucosa or in organs near the surface of
body, such as thyroid gland.

General appearance and behaviour
 Underweight: Having at least 10% less weight than what one should have for
his height.
 Underheight: Having less than normal height for age.
 Easily fatigued : Feeling of tiredness or exhaution on doing even little work.
 Apathetic: Not interested in or enthusiastic about anything.
 Cachexic: State of general poor health especially the mental health.
 Depressed: Condition characterized by discouragement or a feeling of
inadequacy.
 Nervous: A feeling of worry and fear making a person tense and easily upset.
 Irritable: Easily annoyed, agitated and provoked to anger, impatient and fretful.
 Inability to concentrate: Inability to fix one's attention.
 Poor work capacity: Relatively less work output.
 Insomnia: Inability to sleep.
 Pallor: Unnatural paleness particularly of face

Face
 Diffuse depigmentation: A general lightening of colour of the pigment of skin of the
face.
 Nasolabial dyssebacea: The lesion consists of dry greasy filiform excrescences
greyish, yellowish or pale in colour, most commonly located in the naso-labial folds.
 Moon face: Peculiar rounded prominence of the cheeks which protrude over the
general level of the nasolabial folds.
Hair
 Thin and sparse: Hairs having small diameter and wider gaps between them covering
the scalp less abundantly.
 Dry and brittle: Stiff, hard, fragile, weak and lacking delicacy.
 Lustreless: Dull and lacking natural shine.
 Easily plucked out: Uprooting of hairs without pain by even moderate force.
 Dyspigmented: The hairs show distinct lightening of their normal colour (to be
compared with local hair colour guide).
 Flag sign: Characterized by bands of light and dark colour along the length of the hair.

Eyes
Pale conjunctiva: Pale mucous membrane or conjunctiva.
Conjunctival xerosis: Dry conjunctival membrane which does not get wet even by tears.
Corneal xerosis: Drying of film covering the cornea.
Bitot's spot : Well demarcated chalky white, foamy plaques, often triangular or
irregularly circular in shape, usually confined to lateral regions of the cornea.
Keratomalacia: Characteristic softening of the cornea leading to perforation and iris
prolapse.
Angular palpebritis : Inflammation and fissuring of the edges of the lid margin.
Lips
Angular stomatitis: Cracks or fissures at the angles of the mouth.
Cheilosis: Redness, swelling and vertical fissuring of lips particularly the centre of the
lower lip.

Tongue
 Pale:Generalized paleness of the tongue.
 Oedema:Swelling of tongue which can be detected by the indentations made
by pressure of teeth along the edges of the tongue.
 Scarlet and raw tongue (Glossitis): Inflammation of the tongue associated
with bright red appearance which is painful.
 Attrophic papillae:The extremely smooth look of the tongue due to
disappearance of the filiform papillae
Teeth
 Carries: Decay or cavities of teeth
 Mottled enamel: Appearance of white and brownish patches with or without
erosion or pitting of teeth (usually seen in upper incisors)

Gums
 Spongy and bleeding: Purplish or red, spongy swelling of the inter dental papillae
and/or the gum margins which usually bleed easily on slight pressure
Oral mucous membrane
Swollen, scarlet stomatitis: Generalized inflammation of the mucous membranes of oral
cavity
Skin
Xerosis: Generalized dryness of the whole body skin.
Follicular hyperkeratosis:The lesions consist of hyperkeratosis surrounding the mouths
of hair follicle and forming plaques that resemble spines.
Pellagrous dermatosis: Symmetrical hyperpigmented lesions on the areas of the skin
expossed to sunlight (usually seen at cheeks, forearms and neck).
Flaky paint dermatosis: Extensive, bilateral hyperpigmented patches of skin which
desquamate leading to ulceration.
 Petechiae: Small haemorrhagic spots on the skin or mucous membranes.
 Scrotal and vulval dermatosis: desquamating lesion of the skin of the scrotum or vulva,
often highly itchy.

Nails
 Brittle: Easily broken or shattered, fragile.
 Ridged: Appearance of raised lines on the surface.
 Pale nail bed: Paleness at the base of the nail.
 Koilonychia: A disorder of nails which are abnormally thin and concave with the
edges turned up (Spoon shaped).
Muscles
 Wasted: Loss of muscle mass causing weakness and debility
 Sore and painful: Physical pain due to weakness of muscles.
 Weak: Muscles lacking or deficient in physical strength.

Skeleton
 Bow legs: The space between the knees is abnormally large.
 Knock knee: The space between the knees is abnormally reduced and
between the ankles is increased.
 Beading of ribs: Ribs develop irregularly spaced areas of swelling that take
on the appearance of beeding (also described as Rachitic roasary).
 Chest deformities: There are number of chest deformities such as harrison's
sulcus and pigeon chest.
 Epiphyseal enlargement: Enlargement of the epihyseal ends of long bones,
particularly affecting the radius and ulna at the levels of wrist and the tibia and
fibula at the level of the ankle. Delayed closing of fontanelles
 Anterior fontanelle which remains open after the age of eighteen months.
 Frontal and parietal bossing: Localized thickening and heaping up of the
frontal and parietal bones of the skull.

Glands
 Thyroid enlargement: The gland is visibly and palpably enlarged. It has been
classified into three grades on the basis of extent of enlargement.
 Oedema: Swelling, which onsets over the ankles and feet and may extend to
other areas of extremities. It is confirmed by pressing the affected part and if a
pit is observed to persist even after removal of pressure.
 Subcutaneous fat: Is the amount of fat (excess or diminished) under the skin.

DIETARY ASSESSMENT
 Dietary assessment is mainly of two types - one, which concentrates on
qualitative aspects of the foods, i.e., frequency of use of different kinds of foods
that are eaten by the people and the other,
 which attempts to estimate the amounts of food consumed in quantitative terms,
i.e. how much of food is eaten by the people.
 Qualitative aspects of food consumption includes information on the types of
foods people eat, and frequency (habitual or occasional), their opinion and
attitudes towards food and the cultural significance they attach to special foods
or drinks if any.
 Data on food practices during health and disease and under special
physiological conditions like pregnancy, lactation and infancy also form part
of qualitative studies.
 In quantitative aspects of food , exact amounts of foods/soups/beverages
consumed in terms of grams or litres (ml) are assessed and their nutrient
contents estimated.
 Comparisons of nutrient intakes with the Recommended Dietary Allowances
(RDA) provide a measure of adequacy or inadequacy of food/nutrient
consumption.

METHODS OF DIET SURVEYS
 A number of diet survey methods are available.
 Depending on the purpose, level at which information is needed (individual, family, community or
country)
 and the availability of time and resources in terms of trained manpower, equipment, transport facility etc.,
survey method is chosen.
These methods include:
1)Food Balance Sheet Method
2) Inventory (food list) Method
3) Weighment (raw and cooked food) Method
4) Expenditure pattern method
5) Diet History Method [(a) qualitative, and (b) quantitative]
6) 24-hour Recall Method (Oral Questionnaire)
7) Duplicate sample (chemical analysis) Method
8) Dietary Score Method
9) Recording Method

1. Food Balance Sheet (FBS) Method
 This method is employed when information regarding the availability of food is needed at macro
level - country, region.
 Food balance sheets (FBS) for different countries at global level were first compiled by Food
and Agricultural Organization (FAO) in the year 1949.
 The FBS are computed on the basis of total food supplies available for human consumption at
retail level for a given country/ region, from different sources during a reference period of one
year.
 The computation takes into account the food used for animal feeds, exports, seeds (sowing
purposes) and wastages.
 Availability of food (per caput) per day is estimated as shown below:
Per caput Availability = Stocks at the beginning of the year + Total food produced + Imports per day
(g) - Stocks at the end of the year + exports + seeds + cattle/poultry feeds
+ Wastage
Mid year population X 365 days

2. Inventory (Food List) Method
 This method is often employed in Institutions like hostels, army barracks, orphanages,
homes for the aged etc., where homogenous groups of people take their meals from a
common kitchen.
 In this method the amounts of foodstuffs issued to kitchen as per the records maintained by the
warden, are taken into consideration for computation of consumption.
 No direct measurement or weighing is done.
 A reference period of one week is desirable.
 This method can also be used for assessing food consumption at household level provided
the respondent maintains a regular record of the foods used and he or she is willing to share the
recorded information with the investigator.
 In this method, the investigator makes two visits; one at the beginning of the survey when a
check list of food stocks is prepared and handed over to the housewife and the other, at
the end of the week to collect relevant data.
 Stocks of foods, if any, purchased or discarded during the week, are also taken into account.

 The average intake per person per day is calculated as follows:
Stocks at the beginning of the week - Stocks at the end of the week
Total No. of inmates partaking the meal X No. of days of survey
 This method like the FBS in fact, provides an estimate of the food available
rather than the food actually consumed.
 The estimates are as good as the food records (inventory) are.
 Lapses in recording of 'issues' and 'receipts' adversely affect the computations.
 Though a large sample can be covered in a relatively short time, active cooperation
of the respondent is very necessary.
 This method is possible only when the community is fairly educated and
subsists on cash economy where food is usually purchased from the market.

3. Weighment Method (Raw and Cooked Food)
 In this method, as the name implies, foods are actually weighed using an accurate
balance.
 Grocer's balance with standard weights and measures form the main equipment and
a structured diet survey schedule is the study instrument.
 The method can be used for weighing of raw as well as cooked foods.
 In community surveys, usually the raw foods rather than cooked foods, are weighed
since it is easy, and meets with lesser resistance from the households.
 Weighing of cooked food, however, is feasible in institutions like hostels, orphanages
etc., where cooking is often done at a central kitchen.
 It is ideal to conduct the survey for 7 consecutive days to capture the true picture of the
diet.
 However, depending on the purpose of the investigation the period of survey can either
be reduced or increased.

 In order to obtain the most representative picture of the diet the investigator should
keep in mind the following 'Dos' or 'Don'ts':
Do's
i)Everyday make at least two visits; one in the morning and the other in the evening
before actual cooking is begun by the housewife in the family or the cook in the
institution/hostel.
ii) Weigh only the edible portions of raw foods (before cooking).
iii) Make note of correct age, sex, physiological status (pregnancy, nursing etc.) and
activity of each member in the household/hostel, who is partaking meals on the
day of survey.
iv) Account for guests, visitors, pets and the absentees in the computations.
v) Collect additional information on socio-economic status of the household or
institution/hostel, Culinary practices, i.e. the way the food is cooked, preserved
and consumed.

Don'ts:
i)Avoid fasting and festival days.
ii) Results of the weighment method employed at household/institutional level, are expressed usually
as intake of foods in grams per consumption unit or per person per day.
Foods are converted to nutrients by referring to Food Composition Tables, which provide
information on quantities of different nutrients, such as, proteins, vitamins, minerals,
calories etc., per 100 g of edible portion of food. The Nutrient intakes thus, can be
expressed per consumption Unit (CU) or per person (per capita) per day.
Consumption Unit (CU): On the basis of energy requirement of the body for carrying out its
legitimate functions of growth, wear and tear, maintenance of body weight etc., arbitrary
calorie coefficient values have been assigned for persons of different age, sex and activity
groups.
The value assigned for adult male doing sedentary work is one (unit).
The calorie requirement (RDA) per CU is 2320 kilo calories.

Calculation procedures
 a) Intake per cu per day:
Raw amounts of each food (g)
 Intake per CU per day (g/ml) = Total CU X No. of days of survey
 If a household consists of an adult sedentary male, and female, a 13 year's old boy and
two children of ages 9 and 6 respectively, the total consumption units for the household
will be 1.0 + 0.8 + 1.2 + 0.7 + 0.6 =4.3.
 If the same household has cooked and consumed, say, 1500g (1.5 kg) of raw rice for the
day, the approximate intake of rice per CU per day will be 1500 divided by 4.3 = 349 g
 b ) Intake per person (capita) per day: This is calculated from the 0.5
 This is calculated from the following formula.
 b) Intake per person (capita) per day : This is calculated from the following formula.
 Raw amounts of each food (g)Intake per person per day (g/ml) =No. of persons X
No. of days of survey
 In the above household, the total number of persons irrespective of age and sex is 5.
 The total intake of raw rice (1500 g) if divided by total number of persons, the resulting
figure (1500 divided by 5 = 300 g) of 300 g rice will be the consumption per person (per
caput) per day.

 Though Weighment method is relatively more accurate as it involves direct
weighing of foods, it is time consuming and needs cooperation of the
housewives throughout the study period.
Two major limitations of this method are
 (i) calorie coefficient values used in computation of the intakes are considered
to hold good only for calories and hence, their applicability to other nutrients
like proteins, vitamins etc., is not valid.
 (ii) Precise consumption level of specific age and physiological groups,
(preschool child, pregnant or lactating woman), within the family cannot be
assessed through this method.

4. Expenditure Pattern Method
 In this method, money spent on food as well as non-food items by the family is
assessed by administering a specially designed questionnaire.
 The reference period could be either a previous month or week.
 This method, though apparently less cumbersome as it avoids actual weighing
of foods, needs more time as additional data on price of individual food items,
and qualitative aspects of diets (through frequency method) becomes necessary
for obtaining a realistic picture of the community.

5. Diet History Method
[(a) Qualitative and (b) Quantitative]
a) Qualitative
 This method is useful for obtaining qualitative details of diet and studying patterns of
food consumption at household or industrial level.
 The procedure includes assessment of the frequency of consumption of different
foods through a questionnaire - daily, or number of times in a week or fortnight
or occasionally.
This method has been used to study
 (i) meal patterns, (ii) dietary habits (iii) peoples' food 'preferences' and 'avoidances'
during physio-pathological conditions like pregnancy, lactation, sickness etc.
 Infant-weaning and breast-feeding practices, and the associated cultural constraints,
which are often prevalent in the community can also be studied by this method.
 At times, information on approximate quantities of foods consumed by the
households or individuals in terms of gross weights/volumes e.g. 30 kgs of rice per
month or half a litre of milk per day etc., is also collected.

b) Quantitative
Apart from frequency of use of foods, data on quantitative use of foods by
individuals/family
This can be done by incorporating questions concerning foods and amounts based
on known locally available foods, in known household measures and local
recipes.
A quantitative assessment of foods using frequency questionnaire helps to provide
a ranking classification of individuals into low, medium, and high intakes of
nutrients and is used to examine associations between nutrients and disease.
The questionnaire must contain locally available foods to provide data on nutrients.
In order to develop this questionnaire, the following steps are required:
➤ Construction of a food list of locally available foods
Definition of portion sizes, and Assignment of frequency of consumption ilies can
also be obtained through a questionnaire.

6. 24-hour Recall Method (Oral Questionnaire)
 In this recall method, dietary data is obtained from the respondent through an oral questionnaire
of diet survey, using a set of 'standardised cups', suited to local conditions.
The steps involved are:
1)The housewife or the member (respondent) of the household who invariably cooks and serves
food to the family members is asked about the types of food preparations made according to
meal pattern i.e., during breakfast, lunch, afternoon tea time and dinner, during the previous
24 hours.
2) An account of the raw ingredients used for each of the preparations is obtained.
3) Information on the total cooked amount of each preparation is noted in terms of standardised
cup(s) by weight/volume.
4) The intake of each food item (preparation) by the specific individual in the family such as the
preschool child, adolescent girl, or pregnant or lactating woman is also assessed by using the
cups. The cups are used mainly to aid the respondent recall the quantities prepared and fed to
the individual members.

7. Duplicate Samples (Chemical analysis)
 In this method, the individual is required to save (in a separate plate) a duplicate sample of
each type of food eaten by him during the day.
 These samples are then collected and sent to the laboratory for chemical analysis.
 It is the most accurate method but is costly and needs a good laboratory support and
individual or family cooperation.
8. Dietary Score
 This method involves assigning an arbitrary score to the foods (under consideration) on the
basis of its nutrient content.
 The consumption of this particular food by an individual is estimated through frequency
method.
 For example, grading nutrient. In case of vitamin A (carotene), the score for green leafy
vegetables is 3 that for egg is 2 and milk 1.
 The frequency of consumption of foods, the total score and percentages are then calculated.

9. Recording Method
 It involves maintenance of dietary records of weighed quantities of foods
consumed by an individual/family according to number of days of survey.
 If this method is followed well with proper instructions, a large sample can be
covered in a short time, sometimes through mailed questionnaires provided the
population is educated.
 However, the validity of this method is yet to be established as against
weighment and/or oral questionnaire (24 hour recall) methods in assessing the
dietary intake of populations

Assessment of nutritional status Direct and indirect methods

More Related Content

Similar to Assessment of nutritional status Direct and indirect methods (20)

Recently uploaded (20)

Assessment of nutritional status Direct and indirect methods