Overcoming  the  challenges:    analyzing  Cambodian  24-­‐hour  dietary  recalls    Presented  by  Vash.  Verbowski  (MSc  student  at  UBC)  

   

Presented  at  the  Interna.onal  Food  Security  Dialogue  2014:  “Enhancing  Food  Produc.on,  Gender  Equity  and  Nutri.onal  

Security  in  a  Changing  World”  

Sponsored  By:     Hosted  By:    

           

•  The  Fish  on  Farms  project  is  being  jointly  conducted  by  the  University  of  Bri?sh  Columbia  (UBC)  and  Helen  Keller  Interna?onal  (HKI),  with  technical  assistance  from  World  Fish,  in  Prey  Veng  Province,  Cambodia.    

•  This  randomized  control  trial  inves.gates  an  integrated  Homestead  Food  Produc.on  models  in  rela.on  to  poverty,  gender  empowerment,  and  food  and  nutri.on  security,  par.cularly  among  women  and  children.    

•  This  is  the  first  project  known  to  rigorously  measure  the  effec.veness  of  different  models  of  Homestead  Food  Produc.on  at  reducing  undernutri.on  using  biochemical  and  anthropometric  measurements.  

           

•  University  of  Bri?sh  Columbia            Ministry  of  Health,  Cambodia        •  Dr.  Tim  Green,  Associate  Professor,  Human  Nutri.on    Ministry  of  Planning,  Cambodia    •  Dr.  Judy  McLean,  Assistant  Professor,  Human  Nutri.on        •  Dr.  Susan  Barr,  Professor,  Human  Nutri.on            •  Dr.  Larry  Lynd,  Professor  &  Director,  Collabora.on  for  Outcomes  Research  &  Evalua.on      •  Dr.  Tony  Farrell,  Professor,  Centre  for  Aquaculture  and  Environmental  Research  •  Dr.  David  Ki_s,  Professor,  Food  Science  &  Associate  Dean  of  Research  •  Dr.  Ian  Forster,  Centre  for  Aquaculture  and  Environmental  Research  •  Jen  Foley,  Fish  on  Farms  Program  Coordinator  

•  Helen  Keller  Interna?onal  -­‐  Cambodia        Graduate  Students  •  Dr.  Zaman  Talukder                Kyly  Whiaield  (PhD,  Nutri.on)  •  Mr.  Hou  Kroeun                  Crystal  Karakochuk  (PhD,  Nutri.on)  •  Ms.  Ly  Sokhoing                  Vash.  Verbowski  (MSc,  Nutri.on)  •  Field  Research  Team                Pardis  Lakzadeh  (MSc,  Public  Health)  

                       Jeff  Tang  (BSc,  Science)  

           

Outline  

•  24-­‐hour  dietary  recall  review  •  Interna.onal  nutri.on  research  •  Research  project  overview  

Ø Background  Ø Data  collec.on  

•  Challenges  encountered  Ø Possible  solu.ons  Ø Helpful  tools  

•  Summary  

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24-­‐hour  dietary  recalls  (Lee  &  Nieman,  2012)  

•  Strengths  Ø Quick  &  inexpensive  Ø More  objec.ve  Ø Less  par.cipant  burden  Ø Can  es.mate  popula.on  intake  

•  Limita.ons  Ø Omi_ed/forgo_en  foods  Ø Under/over-­‐repor.ng  Ø Poor  descriptor  of  individual  usual  intake    Ø Data  entry  is  labor  intensive  

à  mul.ple-­‐pass  method  à  unknown  in  Cambodia  

à  students  à  repeat  recalls  

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Interna?onal  nutri?on  research      •  Food  diversity:  dietary  diversity  indices  (Olney,  2009)  •  Food  availability:  food  balance  sheets  (Hop,  2003)  •  Adherence:  garden  maintenance  rates  (Bushamuka,  2005)    •  Current  research  lacking…    

What  do  Cambodians  

eat?   We  need    24-­‐hour  recall  

data!  

Evidence  for  food-­‐based  strategies  

           

Research  project  overview:  background  

•  Malnutri.on  among  rural  Cambodians  (CDHS,  2010)  Ø Women  

•  20%  underweight  (BMI  <18.5)  •  47%  anemic  

Ø Children  •  30%  underweight  (low  weight-­‐for-­‐age)  •  11%  wasted  (low  weight-­‐for-­‐height)  •  42%  stunted  (low  height-­‐for-­‐age)  •  57%  anemic    

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Research  project  overview:  background  •  Diet  low  in  fat  (FAO,  2009;  Health  Canada,  2006;  Barba,  2008)  

Ø 2382  kcal/capita/d      Ø 62.4g  protein/capita/d  (10.5%  kcal)  vs.  10-­‐35%  RDA  Ø 36.9g  fat/capita/d  (13.9%  kcal)  vs.  20-­‐35%  RDA  

                         vs.  40-­‐57g/d  SEA-­‐RDA  

Poten.al  to  improve  nutri.on  

status  Aquaculture  

(small  fish  ponds)  

Homestead  Food  Produc.on  (HFP)   24-­‐hour  

dietary  recalls  

           

Research  project  overview:  Fish  on  Farms    •  90  villages  x  10  households  each  (n=900)  •  Each  village  randomly  assigned  to:    

① Plant-­‐based  HFP  ② HFP  +  aquaculture  (fish  pond)  ③ Control    

•  Outcomes  Ø  Food  security  &  gender  equality  Ø  Income  genera.on  Ø  Dietary  intake,  blood,  urine,  &  anthropometrics  

 

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© Fish on Farms

           

Data  collec?on:  completed  by  HKI*  staff  

•  24HR  data  (woman  &  child)  Ø  Trained  interviewers  Ø  Structured  dietary  recalls    Ø  Baseline  &  endline  data    

•  Nutrient  analysis:  6  fish  species  Species  (per  100g)   Protein  (g)   Lipid  (g)   Iron  (mg)   Zinc  (mg)  Labeo  rohita   14.0   4.5   0.49   1.14  

Vitamin A? *HKI:  Helen  Keller  Interna.onal  

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Spoon #1 Spoon #2 Spoon #3

Data  collec?on:  completed  by  HKI  staff  

•  Household  measures  (props)  

•  Weighed  por.ons  

•  Transla.ons  

 

Ingredient   Spoon  #1   Spoon  #2   Spoon  #3   Piece  

Trey  Phtok   12g   5g   3g     20g  

Trey  Chhpin    11g   5g   4g   14g  

Khmer:   La?n  name:   Common  name:   Method  of  cooking:  Trey  Phtuok   Channastriata   Common  snakehead   Made  into  fish  paste    

(pra  hok)  

           

Meal   Food  item   Household  measure  

Breakfast   Rice     0.5  plate  #1  Frog  meat   2  pieces  Kangkong   2  spoon  #1  

Snack   Fruit  (rambutan)   10  small  Biscuit  (Sakira  brand)   3  small  package  

Lunch   Rice     1  plate  #2  Frog  meat   1  piece  Kangkong   1  spoon  #2  

Dinner   Rice     1  plate  #2  Amaranth   1  spoon  #1  Channastriata  (Trey  Phtok)   12  pieces  

Data  analysis:  24-­‐hour  dietary  recall  (#325)  

?

           

Challenge  #1:  finding  nutri?onal  informa?on  

•  Purchased  ESHA  Ø Uses  latest  USDA  data  Ø Includes  Canadian  Nutrient  File  Ø Errors  minimized  with  quality  control  reviews  Ø Contains  ~55,000  foods  

•  Use  local  food  composi.on  data  Ø www.FAO.org      Ø Vietnamese    Ø East  Asia    

 

           

1.  Bảng  thành  phần  dinh  dưỡng  thực  phẩm  Việt  Nam  năm  2000    

1.    Sheet  nutrient  composi.on                  of  food  Vietnam  in  2000    

3.  Cơ  sở  dữ  liệu  thành  phần  thực  phẩm  Mỹ  -­‐  USDA  Food  Composi.on    3.  Databases  U.S.  Food  ingredients  –            USDA  Food  Composi.on  Database,            Version  18,  2006…  

Challenge  #1:  finding  nutri?onal  informa?on  

www.translate.google.com…

           

Challenge  #2:  dealing  with  unknowns      

Es.mate  unknown  nutrients:  www.fishbase.org      Ø Step  1:  Classify  Labeo  rohita  (carp  or  minnow)  Ø Step  2:  Search  database  for  similar  fish    

Species  (per  100g)   Protein  (g)   Lipid  (g)   Iron  (mg)   Zinc  (mg)   Vit.  A  (RAE)  Carp  [USDA  database]  

17.83   5.6   1.24   1.48   9.0  (30  IU)  

Carp    [Vietnamese  database]  

16g   3.6   0.90   1.48   181  (603  IU)  

Species  (per  100g)   Protein  (g)   Lipid  (g)   Iron  (mg)   Zinc  (mg)  

Labeo  rohita   14.0   4.5   0.49   1.14  

Vitamin A?

           

Ques?ons   Response  from  HKI  staff  What  is  the  recipe  for  ‘pra  hok’?    

1kg  of  fish  (Trey  Phtuok)  &  300g  of  salt.  Put  fish  in  water  un.l  they  swell  &  smell  bad.    Dry  under  sun  &  mix  with  salt.  

Challenge  #2:  dealing  with  unknowns  

Liaise  with  experts  

Khmer:   La?n  name:   Common  name:   Method  of  cooking:  Trey  Phtuok   Channastriata   Common  snakehead   Made  into  fish  paste    

(pra  hok)  

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Challenge  #3:  ques?onable  reliability    Reliability:  “we  are  producing  the  same  es.mates  every  .me”      •  Develop  set  of  assump.ons  

Ø Replace  “water  lily”  with  “lotus  root”  (no  nutri.on  info)  

•  Use  the  5-­‐step  mul.ple-­‐pass  24-­‐hour  dietary  recall  for  endline  Ø 1st  pass:  quick  list    Ø 2nd  pass:  forgo_en  foods  Ø 3rd  pass:  .me  &  place  Ø 4th  pass:  detailed  descrip.on  Ø 5th  pass:  final  review  à  idea:  take  pictures  of  labels    

à  por.on  size  &  addi.ons  

à  snacks  &  beverages  à  food  from  previous  day  

à  sort  chronologically  

           

Challenge  #4:  assessing  validity  

Validity:  “we  are  measuring  what  we  intended  to  measure”    •  Energy  &  fat  intake:  monitor  height  &  weight  

•  Compare  nutrient  intakes  against  biomarkers  Ø  Iron:  hemoglobin,  ferri.n  Ø  Vitamin  A:  re.nol,  carotenoids  Ø  Zinc:  serum  zinc  

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Summary  of  the  challenges  &  solu?ons  

•  Finding  nutri.onal  informa.on    Ø Use  local  resources  when  possible  

•  Dealing  with  unknowns  Ø Develop  rela.onships  with  “experts”    Ø Consider  “road-­‐blocks”  beforehand    

•  Improving  reliability    Ø Develop  a  set  of  assump.ons  Ø Use  validated  techniques  

•  Improving  validity  •  Compare  dietary  intake  data  against  biomarkers  

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© Fish on Farms

           

References: •  Barba, C.V.C. & Cabrera, M.I.Z. (2008). Recommended Dietary Allowances harmonization in

Southeast Asia. Asia Pacific Journal of Clinical Nutrition, 17(S2): 405-408. •  Bushamuka, V.N., de Pee, S., Talukder, A., Kiess, L., Panagides, D., Taher, A., & Bloem, M. (2005).

Impact of a homestead gardening program on household food security and empowerment of women in Bangladesh. Food and Nutrition Bulletin, 26(1), 17-25.

•  FAO (2009). FAOSTAT: Cambodia. Retrieved from http://faostat.fao.org/site/368/DesktopDefault.aspx?PageID=368#ancor

•  FAO (1972). Food Composition Table for use in East Asia 1972. Retrieved from http://www.fao.org/docrep/003/X6878E/X6878E00.htm

•  FAO (2014). International Network of Food Data Systems (INFOODS). Retrieved from http://www.fao.org/infoods/infoods/tables-and-databases/asia/en/

•  FishBase (2014). Retrieved from http://fishbase.org/search.php •  Google Translate. Retrieved from http://translate.google.com/ •  Health Canada (2006). Dietary Reference Intakes. Retrived from

http://www.hc-sc.gc.ca/fn-an/nutrition/reference/table/ref_macronutr_tbl-eng.php •  Hop, L.T. (2003). Animal Source Foods to Improve Micronutrient Nutrition and Human Function in

Developing Countries. Journal of Nutrition, 133(11:2), 4006S-4009S. •  Lee, R.D. & Nieman, D.C. (2012). Nutritional Assessment. Sixth edition. McGraw-Hill. •  National Institute of Statistics, Directorate General for Health, & Measure DHS. (2010). Cambodia

Demographic and Health Survey (CDHS) 2010. Phnom Penh, Cambodia & Calverton, Maryland, USA. Retrieved from http://www.measuredhs.com/pubs/pdf/FR249/FR249.pdf

•  Olney, D.K., Talukder, A., Iannotti, L.L., Ruel, M.T., & Quinn, V. (2009). Assessing impact and impact pathways of a homestead food production program on household and child nutrition in Cambodia. Food and Nutrition Bulletin, 30(4), 355-369.

•  Vietnamese Food Composition Table (2007). Retrieved from http://www.fao.org/fileadmin/templates/food_composition/documents/pdf/VTN_FCT_2007.pdf

* Photos from the Fish on Farms blog: http://fishonfarms.landfood.ubc.ca/topics/blog/

           

Acknowledgements

Thank  you  to  my  commidee  members  &  HKI:    Dr.  Tim  Green,  Associate  Professor,  UBC  LFS  Human  Nutri.on  Dr.  Judy  McLean,  Senior  Instructor,  UBC  LFS  Human  Nutri.on  

Dr.  Susan  Barr,  Professor,  UBC  LFS  Human  Nutri.on  Dr.  Larry  Lynd,  Associate  Professor,  UBC  Pharmaceu.cal  Sciences  Helen  Keller  Interna.onal  in  Cambodia  (Zaman  Talukder  et  al.)    

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