វិទ្យាស្ថានបច្ចេកវិទ្យាកពង់ស្ ឺ ព

Kampong Speu Institute of Technology

មុខវជ្ជ
ិ ា ៖ ការវាយតម្មអា
ៃ ហារបតតម
ថម ភ

ច្េច្ ៀនទ្យី២៖ ប្បង័នធច្េកូឡ្

ូ នី នអាហា និ់អាហា ូប្ាេភ

Nutritional

តង្រៀនងោយ ងេក លីនី assessment

Ecology of Food and Nutrition
• Study of interaction/interrelationships between an
organism and their environment
• Importance of understanding the ecology of food and
nutrition
➢ Identification of root cause of malnutrition problem
➢ Identification of appropriate solutions
➢ Assessing the potential food consumption and
nutrition effects of policies/programs/projects
• Frameworks for understanding the ecology of food and
nutrition
• A. Epidemiological Approach
1.Host or man
Genetic
a. Age h.Nutritional state and
b. Sex constitution
c. Ethic or racial i. Birth order
d. Religion j. Intercurrent infection
e. Family size k. Human behavior
f. Marital status l. Resistance
g. Occupation
2. Environment
-sum total of all external conditions and influences
that affect the life and development of an organism
Components
a. Physical environment-inanimate surroundings and
its feature
b. Biologic environment-animate things
1. Flora
2. Fauna
3. Human populations
C. socio-economic environment
1. Occupation
2. Urban/rural area
3. Economic development
4. Social disruption
3. Agent
an element, a substance or force, either animate or
inanimate, the present or absence of which may
following effective contact with a susceptible host
under proper environment condition serve as a
stimulus to initiate or perpetuate a disease process.

Agents maybe:
a. Biological
b. Nutritive
c. Chemicals
d. Physical
e. Mechanical
Food and Nutrition System
The processes and conditions by which food produced
processed and stored, marketed and distributed, prepared
and consumed in order to attain food security, proper
nutrition and good health.
Components
1. Food Supply
• agricultural inputs and practices that
determine the kinds and amounts of food
grown
• Includes the complementary activities of
harvesting, storage, processing and
preservation to prevent food losses
2. Food Distribution
• The ways and means by which food is physically and
economically available to population groups and
individuals in communities through trade and
marketing, road infrastructure, transport facilities, and
policies on employment and income, equity and
improved welfare.

3. Food consumption
• The amount and variety of food consumed as influenced
by income levels, socio-cultural factors, family size,
preferences and eating patterns, religious restriction,
customs and traditions, and level of nutrition knowledge
4. Biological utilization of food
• The state of health, illnesses, and physiological
conditions that affect the digestion, metabolism and
utilization of food in the human body for growth,
development and maintenance of vital body
processes; sanitary/safe environments and basic
services to prevent occurrence of diseases.
5. Nutritional status
• The state of health, human growth, physical
and mental and development conditioned by
the kinds and amounts of essential nutrients
from food consumed to needs of individuals,
families and population groups
• Malnutrition reduces function performance
and productivity, lifespan and resistance to
disease.
 Nutrition factor Social and Ecological Program/Policies
Determinants
Extension/credit
Production resources Rural development
Labor inputs &institutional changes
FOOD& Distribution network Agricultural technical inputs
PRODUCTIVE (marketing system) package
AVAILABILITY IN Trade/aid Resource ownership
SOCIETY Processing/national Policies especially land
storage access/tenure
State monitoring and control of
markets
Trade/aid policies
Fortification/quality control
 Own production Income/employment
FOOD Food subsides, rations
Money income/income in kinds
PRODUCTION (intrahousehold distribution ) Direct feeding
&AVAILABILITY IN Processing, preservation Income transfer
THR COMMUNITY Market access, storage, prices Price: food / non-food
Food marketing
& THE Culture/ tradition/religion
/distribution
HOUSEHOLD Perceived household need Storage/processing

Intrahousehold distribution of Social services

food
Preparation and cooking Housing/fuel/water/waste
UTILIZATION OF Time constraints Promotion/advertising
FOOD BY THE FAMILY Different members
Access to fuel and water Distribution system
Culture/tradition/religion
 UTILIZATION OF Demographic structure Public health program
FOOD BY THE Environmental health
Health/disease status
INDIVDAUL Child care assistance
Nutrient status
Food preferences Creche, maternal leave

Child care /time Food quality control

constraints
Labor/pattern of work
NUTITIONAL/HEALTH Disease resistance Output/wages
STATUS OF Work capacity and demands Mechanization
Social functioning adaption Social organization
INDIVIDAUL
Work leisure
 Nutritional Assessment

A. Definition of terms

1. Nutritional assessment

a. The interpretation of information obtained from dietary,

biochemical, anthropometric, and clinical studies. The
information is used to determine the health status of
individuals or population groups as influenced by their intake
and utilization of nutrients.
b. The process through which the nutritional health of an
individual is evaluated, specific nutrient needs is estimated and
plans for nutrition intervention are determined.
2. Nutritional status

The condition of the body resulting from the intake, absorption

and utilization of food. These status refers to severe, moderate,
normal, mild, overweight, and obese for the weight measurement
and either normal, tall, or stunted for height.
3. Community assessment

Community assessment paints a picture of the health of the

community, its ecology, and the factors influencing the way its
people live. It is the most practical method of obtaining an
overview of the nutritional status of a given community.
4. Nutritionally at risk groups

Refers to certain segments of the population which by virtue of

age, physiological status, occupation, or geographic location,
become more susceptible to nutritional disorders.
B. Reasons for assessing the nutritional status

1. In the individual

To establish the nature and etiology of the problem in order to

provide the appropriate treatment and prevent re-occurrence of
the problem.
2. In the community

To establish the extent and distribution of the problem and to

determine the associated environmental factors in order to
provide appropriate health and nutrition services and facilitate the
implementation of preventive programs.
 C. Purposes of Nutritional Assessment

1. Define nutritional problems that need attention; as an integral part

of situational analysis, it is the first step in the nutrition program
planning and management cycle.
2. Provide baseline date for planning and evaluation of programs.
3. Help identify priorities and responsibilities of the public health
system at all administrative levels.
D. Types of Nutritional Assessment Systems

1. Nutritional survey (also known as cross-sectional survey)

a. Establishes baseline nutritional date and/or determine the

overall nutritional status of the population; identify and define
population sub-groups at risk of chronic malnutrition and less
likely to identify acute malnutrition.
b. Information obtained used to allocate resources to the
population groups identified in need and to formulate policies
to improve the overall nutritional of the population.
2. Nutritional surveillance

a) Continuous monitoring of the nutritional status of selected

population groups to assess change over time.
b) Data are collected, analyzed for an extended period of time.
Also can identify the possible causes of malnutrition and
hence, can be used to formulate and initiate intervention
measures at the population or subpopulation level.
c) Objectives include the promotion of decisions by governments
concerning priorities and the disposal of resources,
formulation of predictions on the basis of current trends, and
evaluation of the effectiveness of nutrition programs.
d) Can be done on selected individuals, but the term ‘ monitoring ’
is used.
 3. Nutrition screening

a) Identifies malnourished individuals needing interventions; can be

done at the individual or specific population groups at risk.
b) Compares an individual’s measurements with predetermined risk
levels or cut-off points.
E. Factors affecting the selection of the design of nutritional assessment system
1. Study objective
Study objectives should be the major basis for selecting the
design of the assessment system and the measurements or
indices.
2. Sampling protocol
Necessary to avoid systematic bias in the sample selecting, and to
ensure that the sample is random and representative of the target
population. Better to use probability sampling than non-
probability sampling methods.

3. Validity

Describes the adequacy with which any measurement or index

reflects the nutritional parameter of interest.
4. Precision

The degree to which repeated measurements of the same

variable give the same value. Also referred to as reproducibility or
reliability. Does not influence the mean or median CV = standard
deviation ×100%/mean
5. Random measurement errors
Caused by an insensitive or variations in the measuring and
recording technique. Reduces the reduces the precision of a
measurement by increasing the variability about the mean. May
occur when the same examiner repeats the measurements (
within or intra-examiner error) or when several different
examiners repeat the same measurements (between-or inter-
examiner error).
6. Accuracy

A term best used in a restricted statistical sense to describe the

extent to which the measurement is close to the true value. It is
possible that measurement can be precise but at the same time
inaccurate – a situation which occurs when there is a systematic
bias in the measurements.

7. Systematic measurement errors or bias

Arise in any nutritional assessment methods that reduces the

accuracy of a measurement by altering the mean or median value.
Bias cannot be removed by subsequent statistical errors in the
design of the nutrition assessment system.
8. Sensitivity

The sensitivity of an index refers to the extent to which it reflects

nutritional status or predicts changes in nutriture. Sensitive
indices show large changes as a result of only small changes in NS
as a result, have the ability to identify and classify those persons
within a population who are genuinely malnourished.

9. Specificity
The sensitivity of an index refers to the ability of the index to
identify and classify those persons who are genuinely well-
nourished.
10. Additional factors affecting the design of nutritional assessment systems

a) Respondent burden
b) Equipment and personnel requirements
c) Field survey and data processing costs
F. Steps in conducting a nutritional assessment

1. In conducting nutritional assessment, a set of questions are answered

a) Who are the malnourished?

b) What malnutrition problems exist?
c) Where are the malnourished?
d) How many are affected by the problem?
e) Why does the problem exist?
f) What are the available resource in the area?
2. The steps are listed in sequence but the process is iterative and circular than linear

1. Justification and definition of the objectives of the assessment

2. Preliminary appraisal and reconnaissance

3. Setting up a team

4. Analysis of the causes of malnutrition in the population

5. Consistency appraisal

6. Assembly of existing data

7. Data analysis and interpretation

8. Presentation of the result

G. Scheme for the development of nutritional deficiency

Table 1. Generalized scheme for the development of a nutritional deficiency

Stage Depletion stage Method(s) used

1 Dietary inadequacy Dietary

2 Decreased level in reserve tissue store Biochemical

3 Decreased level in body fluids Biochemical

4 Decreased functional levels in tissue Anthropometric/Bioch

emical
5 Decreased activity in nutrient-dependent Biochemical
enzyme
6 Functional change Behavioral/Physiologic
al
7 Clinical symptoms Clinical

8 Anatomical sign Clinical

H. Methods used in nutritional assessment (could be used either alone, or more
effectively, in combination)

1. Methods that provide direct information

a) Clinical examination
b) Biochemical examination
c) Anthropometry
2. Methods that provide indirect information

a) Dietary methods or food consumption studies

b) Studies that would provide information variables known to
affect the nutritional status of a population such as vital
statistics, food production, health data.
c) Studies that would provide information on non-nutrition
variables that are strongly related to malnutrition that can be
used to identify at-risk individuals in surveillance studies, i.e.
birth order, episodes of infectious disease in early life.