Diet Matters: Approaches and Indicators to Assess
Description: Diet Matters: Approaches and Indicators to Assess Agricultures Role in Nutrition Diego Rose, Brian Luckett, and Adrienne Mundorf School of Public Health Tropical Medicine Tulane University Main objectives Outline plausible mechanisms in
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slide1. Diet Matters: Approaches and Indicators to Assess Agriculture's Role in Nutrition Diego Rose, Brian Luckett, and Adrienne Mundorf
School of Public Health & Tropical Medicine
Tulane University<br>
slide2. Main objectives Outline plausible mechanisms in which agriculture and food-based interventions can improve nutrition through the diet pathway
Identify approaches and indicators to measure progress in this area<br>
slide3. Outline Augmented Causal Framework
Indicators
Individual
Household
National
Data Collection Systems
Recommendations<br>
slide4. Disease Maternal and child undernutrition Inadequate dietary intake Unhealthy household
environment and inadequate
health services Household
Food Insecurity Inadequate care and
feeding practices Underlying
causes Immediate
causes Basic
causes Outcomes Short-term consequences Long-term consequences A Standard Framework Outlining Causes of Undernutrition<br>
slide5. (Adapted from WFP, 2005) Food purchases Food receipts Gathering Fishing Hunting Cash income Own production
(food & cash crops, livestock, fish farm) Sales Employment Non-agricultural production Cash receipts Trading Debts Zoom-in on determinants of household food security Household
Food Security<br>
slide6. Disease Maternal and child undernutrition Inadequate dietary intake Unhealthy household
environment and inadequate
health services Household
Food Insecurity Inadequate care and
feeding practices Underlying
causes Immediate
causes Basic
causes Outcomes Short-term consequences Long-term consequences A Standard Framework Outlining Causes of Undernutrition<br>
slide7. Individual-Level Measures Dietary outcomes are challenging due to multi-dimensionality
many nutrients, all essential
So, aggregation of data into a single index
e.g. Mean Probability of Adequacy
Measurement is also challenging, costly
diet is a complex set of behaviors
'Gold standard' methods are costly
Proxies for diet quality
simple indicators of diet diversity<br>
slide8. Dietary Proxy Validation Research Different indicators
Foods, food groups, fd grp systems ± min quantity
Many different benchmarks
MAR, MPA, MMDA
Several different cutoff points – 50%, 75%, etc
Different collection methods
Weighed food record, 24-hour recall, food frequency
Different criteria
Correlations, sensitivity, specificity, area under ROC, prediction equations Lack of universal approaches<br>
slide9. Diet Proxy Validation Research Outcomes Modest predictive power
good for population monitoring: project process, trends over time, or general planning
not good for evaluating impact
Best proxies tend to be country-specific
Elimination of 'minimum quantities' improves estimates
can it be implemented in a low-cost field method?<br>
slide10. Household Level Measures Food Expenditure Modules Energy availability, food poverty
household food security interventions
Food group availability
biofortification studies
other specific crop/livestock interventions<br>
slide11. Household Level Measures Diversity Proxy Indicators Household Diet Diversity Score
16 groups in data collection collapsed to 12
24 hr recall (not quantitative)
1 point for each group
Food Consumption Score
8 groups
1 week food frequency
weights used in calculation<br>
slide12. Country Level Measures Using Food Supply Data Prevalence of undernourishment
energy per capita + distributional measure + threshold
Micronutrient densities
micronutrients per 1000 kilocalories
compared to micronutrient density goals
Healthy eating index
score based on U.S. diet guidelines
food groups, negative components (fats, sugars)<br>
slide13. Data Collection Systems Demographic and Health Surveys
Measure USAID
Multiple Indicator Cluster System
UNICEF
Living Standard Measurement Study
World Bank
Vulnerability Analysis and Mapping Surveys
World Food Program
FAOSTAT
National food supply data, other info<br>
slide14. Recommendations Best Practices To evaluate agricultural programs & policies: assess outcomes proximal to interventions
Continue to foster a diverse set of indicators for population monitoring
Women's Diet Diversity Score on DHS, MICS
Food Consumption Score on VAM, LSMS
Pilot-test 24-Hr Recall on LSMS
Food Balance Sheet indicators<br>
slide15. Recommendations Research & Development New proxy validation research should
integrate several indicators
include information on costs
Focus on making 'gold standards' less costly, rather than on making more low-cost proxies
New research is needed on developing indicators of energy expenditure<br>
slide16. Recommendations Nutritional Diplomacy Seek inter-agency collaboration in
survey implementation
instrument, indicator development
Use representative expert panels to develop consensus on
specific indicators, overall measurement approach
thresholds to count the affected<br>
School of Public Health & Tropical Medicine
Tulane University<br>
slide2. Main objectives Outline plausible mechanisms in which agriculture and food-based interventions can improve nutrition through the diet pathway
Identify approaches and indicators to measure progress in this area<br>
slide3. Outline Augmented Causal Framework
Indicators
Individual
Household
National
Data Collection Systems
Recommendations<br>
slide4. Disease Maternal and child undernutrition Inadequate dietary intake Unhealthy household
environment and inadequate
health services Household
Food Insecurity Inadequate care and
feeding practices Underlying
causes Immediate
causes Basic
causes Outcomes Short-term consequences Long-term consequences A Standard Framework Outlining Causes of Undernutrition<br>
slide5. (Adapted from WFP, 2005) Food purchases Food receipts Gathering Fishing Hunting Cash income Own production
(food & cash crops, livestock, fish farm) Sales Employment Non-agricultural production Cash receipts Trading Debts Zoom-in on determinants of household food security Household
Food Security<br>
slide6. Disease Maternal and child undernutrition Inadequate dietary intake Unhealthy household
environment and inadequate
health services Household
Food Insecurity Inadequate care and
feeding practices Underlying
causes Immediate
causes Basic
causes Outcomes Short-term consequences Long-term consequences A Standard Framework Outlining Causes of Undernutrition<br>
slide7. Individual-Level Measures Dietary outcomes are challenging due to multi-dimensionality
many nutrients, all essential
So, aggregation of data into a single index
e.g. Mean Probability of Adequacy
Measurement is also challenging, costly
diet is a complex set of behaviors
'Gold standard' methods are costly
Proxies for diet quality
simple indicators of diet diversity<br>
slide8. Dietary Proxy Validation Research Different indicators
Foods, food groups, fd grp systems ± min quantity
Many different benchmarks
MAR, MPA, MMDA
Several different cutoff points – 50%, 75%, etc
Different collection methods
Weighed food record, 24-hour recall, food frequency
Different criteria
Correlations, sensitivity, specificity, area under ROC, prediction equations Lack of universal approaches<br>
slide9. Diet Proxy Validation Research Outcomes Modest predictive power
good for population monitoring: project process, trends over time, or general planning
not good for evaluating impact
Best proxies tend to be country-specific
Elimination of 'minimum quantities' improves estimates
can it be implemented in a low-cost field method?<br>
slide10. Household Level Measures Food Expenditure Modules Energy availability, food poverty
household food security interventions
Food group availability
biofortification studies
other specific crop/livestock interventions<br>
slide11. Household Level Measures Diversity Proxy Indicators Household Diet Diversity Score
16 groups in data collection collapsed to 12
24 hr recall (not quantitative)
1 point for each group
Food Consumption Score
8 groups
1 week food frequency
weights used in calculation<br>
slide12. Country Level Measures Using Food Supply Data Prevalence of undernourishment
energy per capita + distributional measure + threshold
Micronutrient densities
micronutrients per 1000 kilocalories
compared to micronutrient density goals
Healthy eating index
score based on U.S. diet guidelines
food groups, negative components (fats, sugars)<br>
slide13. Data Collection Systems Demographic and Health Surveys
Measure USAID
Multiple Indicator Cluster System
UNICEF
Living Standard Measurement Study
World Bank
Vulnerability Analysis and Mapping Surveys
World Food Program
FAOSTAT
National food supply data, other info<br>
slide14. Recommendations Best Practices To evaluate agricultural programs & policies: assess outcomes proximal to interventions
Continue to foster a diverse set of indicators for population monitoring
Women's Diet Diversity Score on DHS, MICS
Food Consumption Score on VAM, LSMS
Pilot-test 24-Hr Recall on LSMS
Food Balance Sheet indicators<br>
slide15. Recommendations Research & Development New proxy validation research should
integrate several indicators
include information on costs
Focus on making 'gold standards' less costly, rather than on making more low-cost proxies
New research is needed on developing indicators of energy expenditure<br>
slide16. Recommendations Nutritional Diplomacy Seek inter-agency collaboration in
survey implementation
instrument, indicator development
Use representative expert panels to develop consensus on
specific indicators, overall measurement approach
thresholds to count the affected<br>