The week 4 signature Diet Analysis assignment has been designed for you to analyze and assess your own diet using the US Dietary Guidelines for Americans.
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Nnakwe_PPTS_CH02.pptxChapter 2 Nutrition Screening and Assessment
Nutrition Screening and Assessment
Community assessment is the process of critically thinking about the community that involves getting to know and understand the community as a client.
Community assessment helps identify community needs, clarify problems, and identify strengths and resources.
Nutrition Screening and Assessment Continued
Community nutrition assessment is an attempt to evaluate the nutritional status of individuals or populations through measurements of food and nutrient intake and evaluation of nutrition-related health indicators.
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The U.S. Department of Health and Human Services defines nutritional assessment as “the measurement of indicators of dietary status and nutrition-related health status to identify the possible occurrence, nature, and extent of impaired nutritional status,” which can range from deficiency to toxicity.
The Purpose of Community Nutrition Assessment
The purpose of a broad community nutrition assessment is to reveal the important nutrition-related needs in the community and finding opportunities for intervention.
A nutritional assessment of the community uses nutritional status measures acquired from anthropometric, biochemical, clinical, and dietary intake data as well as epidemiological information.
The Purpose of Community Nutrition Assessment Continued
Community nutrition assessment also needs to include the following:
The health of individuals within the community
The health of the community itself
Identifying the characteristics, resources, and needs of the community
Working with community members on those issues that arise
Addressing not only individuals’ behaviors, but also applicable environmental variables
Historical Development of Nutritional Assessment
In 1932, the Health Organization of the League of Nations (HOLN) held the first conference to discuss the physical, clinical, and physiological aspects of nutrition assessment in Berlin.
This conference motivated the publication of the procedures for conducting nutrition surveys.
In the United States, before the 1960s, the incidence of malnutrition was not noticed because little or no attention was given to nutritional health.
Historical Development of Nutritional Assessment Continued
Between 1968 and 1970 the National Center for Health Statistics (NCHS) conducted:
The Ten-State Nutrition Survey (TSNS)
The First National Health and Nutrition Examination Survey (NHANES) in 1971–1974
These surveys discovered evidence of clinical and subclinical malnutrition in individuals in different areas of the country.
Historical Development of Nutritional Assessment Continued
Results showed that population groups that were at nutritional risk were also socially, economically, educationally, or medically deprived.
Malnutrition was associated with poor growth, developmental disability, poor pregnancy outcomes, susceptibility to infectious diseases, delayed recovery from illness, and reduced life expectancy.
Historical Development of Nutritional Assessment Continued
1976–1980: NHANES II was conducted and it targeted non-institutionalized persons from 6 months to 74 years old.
It used a similar data collection method as the NHANES I.
1982–1984: The Hispanic Health and Nutrition Examination Survey (HHANES) was conducted.
1988–1994: The third NHANES survey was conducted used nationwide samples of about 40,000 non-institutionalized persons, ages 2 months and older.
Growth Charts
In 1977, the National Center for Health Statistics (NCHS) developed growth charts as a clinical tool for health professionals to determine if the growth of a child was adequate.
In 1977, the World Health Organization (WHO) also adopted the growth charts to be used internationally.
The 1977 growth charts were revised and updated to make them a more valuable clinical tool for health professionals.
The 2000 Centers for Disease Control and Prevention (CDC) growth charts represent the revised version of the 1977 NCHS growth charts.
Growth Charts Continued
The new BMI growth charts can be used clinically beginning at 2 years of age when an accurate stature can be obtained.
To establish the BMI of a client(s), measure height without shoes and weight with minimal clothing. Then use these numbers in the equation to calculate the BMI.
Community Needs Assessment
A needs assessment measures the current situation of a particular group or community.
In addition, a community needs assessment survey can be conducted when community groups want to take action, influence policy, or make changes.
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Needs assessment studies allow community groups or sponsoring agencies to:
Collect information about community attitudes and opinions regarding specific nutrition, health, and other issues
Determine how the communities would prioritize the issues
Provide the community the opportunity to determine policy, goals, methods, and procedures for solving the problem
Evaluate current programs and policies and available resources
Methods of Performing a Community Needs Assessment
The five frequently used approaches for collecting information of community needs are:
Existing Data Approach
Survey Approach
Key Informant Approach
Community Forum
Focus Group Interview
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Existing Data Approach: The nutritionist can use existing statistical data such as national vital statistics to obtain information about the well-being of people.
This approach uses descriptive statistics such as census data, labor surveys, income data, NHANES data for food consumption pattern, USDA data of Food Stamp Program, and school.
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Advantage
The data is available and is less expensive to use.
Disadvantage
The nutritionist must relate the data to nutrition issues for that particular community.
Methods of Performing a Community Needs Assessment Continued
Survey Approach: This approach requires some training or experience on how to create and administer survey questionnaires (e.g., writing clear and precise questions).
The nutritionist should consider the following before deciding to use this approach:
Cost of implementation
Time needed for completion
Rate of refusal of individuals to participate
Magnitude and type of training the supporting staff need
Methods of Performing a Community Needs Assessment Continued
Advantages
Entire population may be surveyed.
It provides an opportunity for many people to feel involved in the decision-making process.
It can be used in combination with other assessment techniques.
Disadvantages
It may be expensive.
It requires a great deal of time and expertise to develop the survey, train interviewers or staff, conduct interviews, and analyze and interpret the results.
Methods of Performing a Community Needs Assessment Continued
Key Informant Approach: This approach requires the nutritionist to first identify the key leaders, decision makers, and professionals in the community who can identify priority needs and concerns of the community accurately.
Methods of Performing a Community Needs Assessment Continued
Advantages
This technique can be combined effectively with other techniques.
It is inexpensive, and allows continuous clarification of ideas and information.
Disadvantages
Additional approach is required because it does not represent the total community perspective.
The information obtained from this technique may represent a biased perspective.
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Community Forum: A public meeting(s) is held and the participants discuss the needs of the community.
Methods of Performing a Community Needs Assessment Continued
Advantages
It allows input from many individuals with different perspectives on community needs.
It provides opportunity for all the community members to participate.
In-depth information can be collected.
It can be combined with other techniques.
Disadvantages
The information collected may be limited to those who agreed to participate.
Only those who are more vocal will be heard if the forum is not well conducted.
It may generate more questions than answers.
Methods of Performing a Community Needs Assessment Continued
Focus Group Interview: This approach involves selecting and interviewing people for their particular skills, experiences, or positions.
Methods of Performing a Community Needs Assessment Continued
Advantages
It can be used to expand the data obtained from surveys or existing data.
The data can be used to create specific survey for future use.
It provides opportunity to clarify ideas, and stimulates critical thinking.
Disadvantages
It does not give everybody in the community the opportunity to provide ideas.
It requires combining with other technique since data from this approach may not be enough.
A Framework for Performing an Assessment
The WHO and other authors suggested the following nine-step framework that provides a useful guide for planning and conducting a needs assessment:
Decide when to conduct the needs assessment and set up a committee. Then develop a plan of action.
List important issues or needs of the community.
Decide what information needs to be collected after reviewing available information.
Determine the target population to be surveyed and how the data will be collected.
A Framework for Performing an Assessment Continued
Determine the availability of existing data, and what information need to be gathered using a survey. Determine the cost estimates and the time frame.
Identify and train the assessment team. Pretest the questionnaire, and then select a sample of the individuals to survey.
Collect the data.
Analyze the data.
Interpret the results to identify priority needs, possible intervention strategies, and resources.
Present the results of the needs assessment to all the stakeholders and the community members.
Nutritional Needs Assessment
Dietary assessment is the first step in identifying nutritional deficiency.
These methods are based on the dietary, laboratory, anthropometric, and clinical measures presented in Table 2-4.
It is typically required to consider other factors, such as socioeconomic status, cultural practices, and health and vital statistics in order to make a correct interpretation of the results of nutritional assessments.
Together, these factors are sometimes called “ecological factors.”
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The main methods of assessing the food consumption of individuals include the following:
24-hour recall
Food diary
Food record
Dietary history
Food frequency questionnaire
Different Methods and Tools for Assessing Nutrition Status
Anthropometric Measurements and Body Composition are physical measurements of the body, such as height and weight, head circumference, girth measurement, or skinfold measurement.
National Center for Health Statistics Percentiles for Physical Growth (NCHSPG) charts are standard for evaluating the physical growth of males and females from birth to age 20 years.
Different Methods and Tools for Assessing Nutrition Status Continued
Biochemical Tests/Data measure body fluids such as blood, urine, or feces.
It is used mainly to detect subclinical deficiencies such as iron deficiency anemia.
Clinical Observations/Physical Examinations are methods used to determine physical signs of nutrient deficiency or excess that developed over a long period of time (advanced stage of nutrient deficiency).
Different Methods and Tools for Assessing Nutrition Status Continued
A clinical nutrition examination would observe the hair, nails, skin, eyes, lips, mouth, muscles, and joints.
Specific findings, such as changes in hair color, would suggest a protein deficiency.
Table 2-6 presents examples of generally used physical examination tests using appearance as an indicator of nutrition status.
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Dietary Assessment Methods dietary information may confirm a lack or excess of a dietary constituent detected by anthropometric, biochemical, or clinical evaluations.
Diet History is any dietary assessment that asks clients to report about their past diet.
It refers to the collection of the detailed (preparation methods and foods eaten in combination) make-up of meals.
The intake frequency of various foods plus other risk factors such as the economic status of the client.
Different Methods and Tools for Assessing Nutrition Status Continued
The Food Frequency Questionnaire (FFQ) asks how often the respondent consumed specific foods or groups of foods for a specific period.
Food Records or Diaries—the respondent provides detailed information about daily eating habits.
The respondent is usually asked to record all foods and beverages consumed during a defined period, typically over three to seven consecutive days.
Different Methods and Tools for Assessing Nutrition Status Continued
Twenty-Four-Hour Recall: This dietary assessment is termed a 24-hour recall because it is typically administered for a 24-hour period.
The respondents are asked to remember all foods and beverages they consumed in the past 24-hour period (usually midnight to midnight).
How to Analyze Dietary Intake Data
Comparison to Dietary Standards: The respondents’ nutrient intake can be compared to dietary standards using the Recommended Dietary Allowances (RDA) or Adequate Intake (AI) values.
Comparison to MyPyramid: The respondents’ food intake can be compared to MyPyramid, which is another type of dietary standard.
Comparison to Dietary Guidelines for Americans: The nutritionist can also compare the respondents’ diet to the Dietary Guidelines for Americans.
Screening for Community Health
Screening is an attempt to detect unrecognized or subclinical health conditions among individuals.
The purpose is to identify individuals who have a high risk of having or developing a specific health condition so they can be referred for definitive diagnosis and treatment.
Reliability and Validity of Screening for Community Health
Reliability is the consistency or repeatability and reproducibility of test results or if a testing instrument will measure nutrient intake the same way twice on the same client.
Validity is the ability of the test instrument to measure what it is supposed to measure accurately.
The Purpose of Assessment
Assessment of dietary intake is very important to the work of improving the health of individuals, communities, and populations.
Berdanier et al. stated that dietary intake data are used for three major purposes:
Dietary assessment at the individual level can be used to determine the individual’s dietary adequacy and dietary patterns, and for educating and counseling the individual.
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Dietary assessment is an essential component of research studies that determine the health of individuals and populations.
For example, etiologic studies assess dietary intake as an exposure for association with disease outcomes.
Behavioral research assesses dietary intake in order to develop and test strategies that encourage adoption of healthful eating patterns.
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Dietary assessment also is important in identifying national health priorities, population subgroups at risk or in need of special assistance, and developing public health dietary recommendations at the population/ national level.
Reliability and Validity
Test results may yield invalid or unreliable results due to inconsistent administration of the instrument.
The validity and reliability of the test instruments also depend on the responses of the participants.
It is important to modify the instrument for a specific population.
Many other factors affect the reliability and validity of dietary assessment questionnaires, including:
Degree of variability permitted by the instrument (convenience of recording food intake, external environment, etc.)
Reliability and Validity Continued
Quality control of coding and keying
Real dietary change in the time between the two administrations of the questionnaire
Respondent characteristics (level of education, cultural background, age, etc.)
Questionnaire design
The qualifications of the interviewer
Adequacy of the reference data
Sensitivity and Specificity
A screening method with high sensitivity means there are few false negatives.
A sensitivity test is able to correctly identify and classify individuals within the population who are truly malnourished as confirmed by the test (a true positive).
A screening method with high specificity has few false positives.
A specificity test is able to correctly identify individuals who are not malnourished within a population (true negative).
Successful Community Strategies
The Delta NIRI conducted a comprehensive rural community assessment through five surveys:
Key informant survey
Food Of Our Delta survey (FOODS 2000)
Food store survey
Focus groups
Community resources assessment
Successful Community Strategies Continued
In one of the surveys (FOODS 2000), more than 1,500 people were followed by an in-store survey conducted in 174 stores, supermarkets, small to medium grocery stores, and convenience stores.
It identified the problems of access to and quality of foods in this high health risk, low-income region.
Topics for Discussion
What is the importance of nutrition screening and assessment?
What are the different methods a nutritionist can use to assess the community and why?
What is the importance of the national nutrition surveys, such as the NHANES surveys?
How can a nutritionist use different demographic and health statistics sources to assess the community needs?
