Nutritional Science: The Limitations of Dietary Assessments - Case Study Example

DIETARY AND PHYSICAL ACTIVITY ASSESSMENT: ASSESSMENT OF THREE DAYS NUTRIENT INTAKE AND PHYSICAL ACTIVITY BY USING WEIGHT INVENTORY Department University Address Word Count: 2 Date Abstract This study focuses on the assessment of three days nutrient intake and physical activity by using weight inventory. This study assessed the difference between dietary intake and energy expenditure compared to the National Reference values for 47 years old, weighing 114.5KG and height 176cm, the body mass index (BMI) 36.9. Foods consumed within three days were recorded and the mean for the three day taken to lab for analysis. The same applied to physical activity records. During the study 0.1kg different in weight was recorded within the three day period which is not significant thus we consider no gain or loss during the study. However, protein intake was 7% compare to the National Reference Value (NRV) of (15-25%) means less protein could cause serious health risks. The energy intake compared to expenditure reveals that intake was less than the population benchmark. This was attributed to by the medical condition the participant had known as lap band laparoscopy had only selective type of food. Generally the study concludes that most dietary assessment methods are limited by both bioavailability and natural variations in nutrients. Introduction Dietary assessment is the processes of evaluating nutrient intake by employing appropriate methods in order to identify the type of nutrients that are either under taken or overtaken by individual or a population. The appropriate method for dietary assessment is determined by the purpose and the target individuals. However, an appropriate dietary assessment must report all foods consumed by individuals including quantification, frequency and the nutrient content of each one (1). It is also important to note that quantification is very critical in assessment of nutrient intake and physical activity levels because of the need to compare individuals’ intakes of energy, macro and micronutrients with the recommended targets such as national reference values (NRV), Recommended Daily Intake (RDI), Estimated Average Requirement (EAR) and Acceptable Daily Intake (ADI). One of the best methods for assessing nutrient intake and physical activity is the Weighed Food Records. Weighed food record is a dietary assessment method that involves an individual taking actual weights of foods and drinks prior to their consumption (2). The records also contain details of eaten foods including full description and the time of consumption. The precise weight of food eaten is gotten by subtracting the left over from the original weights before consumption to improve on accuracy. High calorie foods have been associated with high risk factors of obesity, diabetes, atherosclerosis and cardiovascular diseases especially when not accompanied with appropriate physical activity. In this respect, interventions to mitigate these risk factors are often effective if they are approached in a multicomponent which addresses both physical activity and diet together (3). The objective of this study is to assess the difference between dietary intake and energy expenditure compared to the National Reference values (NRV). Materials and Methods This study utilized the weighed food record to assess the nutrient intake. The study was carried over a three day period, Thursday, Friday and Saturday. A hired home weighing scale with a maximum weight of one kg was used to weigh foods and drinks taken within 24hours of each day for the three days that were selected. Actual weights of foods taken were then recorded in form A with all the other details of food that was taken. This included the brand name, cooking methods, additives, additional ingredients and the portion size. This was then followed by taking and recording physical activity levels from the first day. On the first day before commencing the physical activity, body weight was taken and recorded in the morning after voiding urine. Physical activity, starting from 6:00 am for the three days of the study; 28/02, 01/03, 02/3/2014 was then recorded in five minutes blocks in form B. This was achieved by giving codes to activities such as RE= reading, RU, running and S= sleeping. At the end of the third day of food and physical activity records, body weight was recorded again. The data and information from the 3-day dietary, physical activity and anthropometry records were then taken to the lab for analysis and presentation of results. Results The study show the statistics for a male person , 47 years old , weighing 114.5KG and height 176cm, the body mass index (BMI) 36.9. During the study 0.1kg different in weight was recorded within the three day period which is not significant thus we consider no gain or loss during the study. The protein intake was 7% compare to the slandered (15-25%) means less protein could cause serious health risks. Protein is not stored in the body yet it is used by all body cells for everyday function such as providing structure for organs, formation of immune system, enzymes, hormones, blood cells and synthesizing other proteins. Lack of adequate protein is therefore a health risk and may lead to deterioration of health (4). The fat intake was 29% compare to slandered ( 20-35%) which is normal , carbohydrate intake was 63% ( 45-65% ) , 0% alcohol intake. The P:M:S ratio was 4:1:3 however this, EAR/AI for 19-30 years group only , the person is outside this age group due to no EAR OR DRI has been set because of (insufficient evidence ) FAO:WHO:UNU 2004. The following five tables show the details of the results for the three day period as well as the mean. Table 1 Energy and Nutrient Intake Day 1 Day 2 Day 3 The Mean Energy (KJ) 13250 10841 10454 7540 Protein (g) 63.47 34.27 33.42 43.72 Total Fat (g) 110.07 80.08 82.21 90.76 Polyunsaturated Fat (g) 12.47 9.37 9.50 10.45 Monounsaturated Fat (g) 43.21 40.50 41.02 41.57 Saturated Fat (g) 47.16 26.26 27.26 33.56 Carbohydrate (g) 488.10 446.86 418.28 451.08 Alcohol Fiber (g) 19.31 7.50 8.30 11.70 Iron (mg) 11.96 8.20 8.16 9.59 Calcium (mg) 279.62 275 166.35 240.32 Table 2 Mean daily intake of selected nutrients including a comparison with NRVs Nutrient Mean daily Amount Energy Value (Kj/d) Total Energy (Kj/d) EAR AI RDI UL Protein (g) 43.72 743 7% 56% 4.5% NP Total Fat (g) 90.8 3358 29% NP NP NP NP Carbohydrate (g) 451 7216 63% NP NP NP NP Fibre (g) 11.70 0 Iron (mg) 9.59 0 1.69% 120% 21% Calcium (mg) 406.99 0 48 16% Alcohol Table 3 Mean AMDR including a comparison with population benchmarks Relative energy Contribution to Total Energy Participants Values AMDR % Energy From Protein 7% 15 - 25% %Energy From Fat 29% 20 - 35% % Energy from Carbohydrate 63% 45 - 65% % Energy from Alcohol 0% N/A Table 4 Physical activity data for each day Activity Minutes Spend on the Activity PAL/Expressed as a ratio to BEE Day 1 Bed Rest 360 Seated 530 Some act 500 Home task 50 0.0000 0.0005 0.0019 0.0024 0.000 0.245 0.950 0.12 Subtotal 1440 1.335 Day (2) Bed rest 420 Seated 420 Activity 540 Task 060 0.0000 0.0005 0.0019 0.0024 0.000 0.12 1.026 0.144 Subtotal 1440 1.38 Day (3) Bed rest 480 Seated 420 Activity 450 Task 90 0.0000 0.0005 0.0019 0.0024 0.000 0.210 0.855 0.216 1440 1.281 1.332 Table 5 Energy Balance Gender Male Age Height (m) 1.76 BMI: 36.1 Weight on day 1 (kg) 114.6 Weight on day 3 (kg) 114.5 Weight gain or loss (kg) EER from NVR table (kg/d) 12809 KJ DAY (1) DAY (2) DAY (3) MEAN Energy intake (KJ/d) 1325 10840 10454 7540 PAL 1.325 1.380 1.281 1.322 EEE from activity records 12214 12626 11720 12187 Energy balance intake minus expenditure (KJ/d) 1036 1786 1266 672 From table (1) BEE = (0.048 X WT) + 3.653. = 0.048 X 114.5 + 3.653 = 9149 KJ/d Discussions The above results shows that the intake of energy and macronutrients was inadequate compared with population table 5. The energy intake compared to expenditure reveals that intake was less than the population benchmark. This was due to the medical condition I had known as lap band laparoscopy. In this respect, had only selective type of food I could eat must be very soft or very hard to go through. This was due to my high Body Mass Index (BMI) of 36.9Kgs/M2 as can be seen from the anthropometric data. Lap band laparoscopy reduces the size of the stomach thus limits the amount of food that can be taken at a given time (5). Moreover, it slows down the passage of food to the small intestine thus results into even very little absorption. This is also similar to the acceptable macronutrient distribution range (AMDR) as shown in table 3 with percent energy from protein at 7% instead of 15 - 25%. Lack of enough intake of protein in the diet is not good for health. The low percentage of protein as is evident in table 5 and table 3 can be attributed to the consumption of low quality protein foods. In this respect, the greater percentage of protein that was consumed lacked the essential amino acids. I have mentioned about my medical condition that only allows for soft foods, thus foods must be cooked for long time. The dietary intake and physical activity is data are not representative of my usual patterns due to on study period which is 3 months and there is no much of activity as work full time. Living away from home is also factor since I would not be able to engage in other activities such as gardening, dancing, walking my dog and so on. This dietary intake data is not representative also because a person living away from home will often rely more on fast food or canned food thus avoid cooking for convenience. The lap band laparoscopy has also contributed to a large extent the inability to meet energy balance since it is not a normal condition. This extremely important as you may see the problems with nutrients intake caused by lap band and problem with activity energy expenditure due to the above reason as well. In this study, there could have been under-reporting or over-reporting. Under reporting could have been due to components of food such as fat and sugar. This is because I live away from home thus most of the time am not able to account for the quantities of sugar, salt, fat and other food additives or ingredients in accurate amounts especially when am not involved in the preparation. Foods such as snacks and candies are difficult to estimate energy content due to the varying preparation methods and the fact they are often prepared by other people rather than ourselves (6). The above reasons can also contribute to over-reporting of dietary intakes. Research has also shown that foods that are often perceived to be ‘good’ are sometimes over-reported while those that are perceived to be ‘bad’ are under-reported either through unconscious or conscious and is common with those who are overweight or obese (1). Weighed food record is often kept for a period of between 3-15 days. It is however important to note that the wider the period the weights are taken say 15 days, the greater the representation of an individuals or a populations diet. While three day record is not a reasonable representation of the dietary intake, more accurate representations can be gotten by widening the period upon which the food intakes are recorded. This is because it increases the diversity of foods taken for a period of time (7). This is important since different foods differ in their nutritive value and energy content. Again, due to absence of most activity such as full time work, sport, walking the dogs, and living away from home. This apply also to the physical activity records, for instance, some people have scheduled exercises every two days and again the intensity of the exercises differ. However, keeping food intake records for a period of about 15 is recommended though can be limited by resources availability. The limitations associated with the using dietary reference standards in this context is that the study was done on 3 days, Friday, Saturday and Sunday which consists of two weekend days . The intake or energy expenditure is different from normal week days to weekend due to relaxation and limited activity during the weekends. The limitation for using equation for estimating energy expenditure and body mass index is that they are based on the expert opinions and are only recommended at a starting point for establishing intervention strategy. It is also important to note that the original equations are not designed for use with injury factors thus requires certain adjustments for instance, basal metabolic rates BMRs. BMRs variances among individuals may be as high as 10% and the use of injury factors may even worsen the variance (9). BMI equations is also limited due to the fact that it depends on weight and height and not necessarily fat distribution within the body and further do not tell about the body fat. Generally, most methods that are used to measure dietary intakes are limited by the fact that they are not biological though few have been developed scientifically for use in public health. For example, the food summary tables’ main purpose was to identify individuals at risk poor micro-nutritive status. The first limitation of food composition tables is that it only represents bioavailability which is the approximate food constituent and not the actual amount that is absorbed by the body (10). It is therefore important to consider the bioavailability of the nutrients in the diet taken. The second limitation is the variation of nutrients occurring naturally within food type such as lean to fat tissue, brix to acid ratio as well as variations in processed foods due to different levels of temperature treatments. References 1. Heimburger D. Malnutrition and Nutritional Assessment: Introduction. New York: McGraw-Hill; 2012 2. Rutishauser I. Principles of Nutritional Assessment, 2d ed. Nutrition & Dietetics: The Journal of the Dietitians Association of Australia. 2006, (3): 188 3. Gibson R. Principles of nutritional assessment. New York: Oxford University Press, 2005. 4. Dietary Reference Intakes: Guiding Principles for Nutrition Labeling and Fortification. Washington, D.C.: National Academies Press; 2003 5. 5. Warwick PM 1991, Factorial estimation of daily energy expenditure in university students, Comparison with recorded energy intake. Australian Journal of Nutrition and Dietetics. 1991; 48: 95-9 6. National Health and Medical Research Council, Department of Health and Ageing, Ministry of Health. Nutrient Reference Values for Australia and New Zealand: including recommended dietary intakes, National Health and Medical Research Council, Canberra. 2006: 15-24 7. Carlsen M, Lillegaard I, Karlsen A, Blomhoff R, Drevon C, Andersen L. Evaluation of energy and dietary intake estimates from a food frequency questionnaire using independent energy expenditure measurement and weighed food records. Nutrition Journal. 2010, 937-45. 8. Hamer M, McNaughton S, Bates C, Mishra G. Dietary patterns, assessed from a weighed food record, and survival among elderly participants from the United Kingdom. European Journal of Clinical Nutrition. 2010, 64 (8): 853-861 9. Nydahl M, Gustafsson I, Mohsen R, Becker W. Comparison between optical readable and open-ended weighed food records. Food & Nutrition Research. (2009). 531-8 10. Greenfield H, Southgate D. Food composition data: production, management, and use. Rome: FAO, 2003. Read More