Introduction
Nutritional assessments have been largely utilized as a guide during national surveys aimed at determining the nutritional status of the residents of a certain region or the whole population. More importantly, the data is overly utilized in the identification of problems of public health importance thus informing the application of appropriate interventions. In this regard, nutritional assessment has been defined as the interpretation of nutritional information that are mainly based on dietary, laboratory and to a larger extent the anthropometric and sometimes clinical studies (Gibson, 2005, p.2). The major foods offer varying amounts of micronutrients to the consumers. It is therefore imperative to ensure that enough micronutrients are availed to the body by strictly taking the appropriate amounts of the foods. In this regard, the percentages of energy intake and micronutrients levels particularly from each component of the foods must be computed.
This research paper will aim at looking at the various values pertaining to the energy intake and the percentage of energy a student receives from consuming fat. Moreover, the class values on the intake levels of protein, micronutrients and alcohol will be computed using the 3-day food record method. The data collected will also enhance the determination of the number of the students at risk of not receiving enough nutrients.
Aims
The aims of this research paper are:
- To determine the dietary intakes of energy, carbohydrates, alcohol, micronutrients, fats and the percentage of energy received from fats by utilization of a 3 day food record method.
- To identify and support with appropriate data the proportion of the class that is at the highest risk of consuming inadequate amounts of micronutrients.
- To determine the calcium intake levels in the combined population of men and women through the appropriate utilization of the food frequency questionnaire (FFQ) and 3 day food record.
- To determine the comparative data for the energy intake and expenditure for the group by utilization of the food record combined with the 3 day activity diary.
- To determine the comparative values for energy expenditure particularly for men and women by utilization of activity questionnaire amongst all members of the group.
Methodology
Various instruments and tools for each practical component were utilized during the nutritional assessment. Data collection was achieved through various tools while comparative analysis was carried out to enhance the determination of the relationship between the men and women in the group. In the determination of the average food intakes, a 3 day food record method was utilized. This method is usually preferred because of its accuracy when it comes to the determination of the food and micronutrients intake for the students. The method has less chances of reproducibility due to the fact that the portion sizes are usually weighed. More importantly, the weighted food record offers the best alternative especially when correlations of intakes that involve biological parameters are put in place (Gibson, 2005, p.45). The calcium intake level was achieved by the application of food frequency questionnaire. In this case, the frequency of consumption of food is enhanced by the integration of portion size estimates combined with compatibility with computers. It’s reliable due to its simplicity in data collection and analysis. However, the feasibility and validity of this method has not been clearly established with regard to the estimation of food intakes. On the other hand, the physical activity questionnaire was employed in measurement of energy expenditures in men and women. The questionnaire was feasible due to its propensity to have repeatability tests.
Literature review
Nutritional assessment has found wide application in many developing countries due to its overemphasis on the utilization of simple approaches that ensures the risks associated with deficits and excesses are detected (Graham, 1982, p. 122). In this regard, nutritional assessment plays a major role in linking health and nutritional status of the individuals. Graham noted that the determination of the energy intake by the living being is among the most difficult tasks to accomplish (1982, p. 343). This is due to some problems that usually arise. The lack of precise measurement of the customary intake, the translation of the intake into energy and nutrients units and the time duration needed to ascertain a habitual trend form the bulk of these problems.
The last several years has witnessed the change in American society with more cases of overweight reported since early 1991. Of particular importance is the anticipated change that has seen the Americans shift to taking foods with low levels of macronutrients. However, studies have indicated that the utilization of a wide variety of foods is responsible for the increase in obesity since this behavior encourages overfeeding (McCrory, Fuss & McCallum, 1999, p. 443). Due to the lack of a standardized methodology to determine the diet variety, it becomes difficult to ascertain the levels of nutrients intakes contributed by the diet. However, a combination of several methods has indicated that a positive relationship exists between body weight and intake of a wide variety of foods (Lissner, 1987, p.886-893, Rats, 2007, p. 480).
Dietary calcium has become one of the controversial areas that have elicited a lot of interest from researchers. This is because of its effect on influencing changes in the body composition. The relationship between calcium absorption and gain in weight has not been clearly brought forward. A study on the effects of different levels of calcium on the body composition was carried out forma period of 72days. Insignificant changes were observed due to effects related to the calcium uptake. That the study failed to concur to previous studies make this field a controversial and thus the need for future studies to clearly bring out the effects (Malekzadeh et al, 2007, p. 478, Day et al, 2001, p. 67). An assessment of the levels of intake of micronutrients carried out on 500women residing in South Africa has depicted mixed results. The levels of median calcium and vitamin D were found to fall short of the AI levels. Moreover, about half of the women were responsible for the consumption of more than 65 % of the recommended dietary intakes while a fairly large proportion of the sample cleared more than two thirds of the recommended daily allowance for vitamin B6. The study notes that there is great need to address the inadequacies in micronutrients where the median intakes were less than 67% (Hattingh et al, 2008).
Lovelace and Barr (2005, p. 51) conducted a study on the available methods of diagnosis and calcium intake particularly from food and supplements given to individuals who had cases of lactose intolerance. The researchers utilized a cross-sectional survey that involved. Out of the 188 sampled populations, 159 were able to return their questionnaires. A food frequency questionnaire was used to estimate the levels of calcium intakes from the various types of foods and supplements (Johansson et al, 2002). The average food calcium intake was found to be 591+or – 382 mg/d while no variations were reported depending on mode of diagnosis. More than 65 % of the population relied on calcium supplements thereby providing an average of 704 mg of calcium per day. The mean calcium intakes for this group were enough to offset the AI (Lovelace and Barr, 2005, p. 51).
In recent times, a significant number of research studies have indicated that the macronutrient composition of all consumed food stuffs is instrumental in influencing the composition of the body. Inn this regard, the greatest impact on the body fat is received from the amount of fats consumed when compared to the carbohydrates and proteins. The fat has a relatively higher effect of promoting the occurrence of obesity due to its high density (38 kJ/g) as compared to 17KJ/g in the rest of the macronutrients. This is better understood particularly when a higher fat diet is taken thereby resulting in a relatively higher energy intake which translates to a high positive energy balance especially when energy expenditure is not increased to compensate for the increased intake. This dent in previous study done by Westerterp et al who concluded that alteration in the fat content intake has a role in influencing the changes in the body fat mass. It is therefore worth noting that the amount of fat taken in has been implicated as a leading cause for the actual deposition of fat in the body (1996, p.1022). This means that the dietary fat intake has a direct impact in manipulation of the adipose tissue in the human being (Romieu et al, 1988, p. 409). This has been aggravated by the lack of involvement in energy demanding activities thereby resulting in the accumulation and eventual storage of energy in the body (Tucker, Seljaas & Hager, 1997, p.986; Maffeis, Pinelli & Schutz, 1996, p. 171). More importantly, the increased intake of high calorific foods which are served as fast foods by less active and dormant adolescents and youths have negatively impacted on their health thus exposes them to obesity related complications (Rockett et al, 1997, p.808).
Results
The food record method was useful in the determination of descriptive statistics of the various nutrients needs with regard to the sex of the individuals. Moreover, the minimum and maximum values together with the range were deduced. In a sample of 130 females, the minimum and maximum values of calcium in the food frequency questionnaire were found to be 96 and 2322.40 respectively compared to 441.20 and 2098.00 in males. The mean and standard deviation were 939.38 and 418.39 in males and 1144.43 and 522.96 in females respectively. The minimum and maximum values of energy were found to be 3059.70 and 13799.00 in females and 4004.00 and 15427.00 in males with standard deviations and mean of 1688.35 and 7316.92 in females and 3053.55 and 10956.34 in males were recorded. The minimum and maximum, mean and deviation of percentage of energy derived from fats, carbohydrates, proteins and alcohol in females were found to be (12.40, 71.10, 28.56 & 7.00), (28.00, 71.10, 50.46 & 8.14), (11.20, 46.00, 19.49 & 5.03) and (0.00, 20.70, 1.46 & 3.21) respectively. This was comparable to (18.70, 35.00, 24.86 & 5.85), (41.50, 63.30, 52.33 & 8.01), (17.00, 27.40, 20.33 & 3.05) and (0.00, 17.60, 2.60 & 4.93) respectively in a sample of 10 males. Calcium recorded the highest minimum and maximum values with 166.80 and 2017.80 compared to 0.00 and 31.50 in iron respectively. The mean and standard deviation for calcium and iron were (872.29 & 283.95) and (11.54 & 4.13) respectively.
Table 1: summaries of the descriptive statistics in females
Table 2: summaries of the descriptive statistics in males
The proportion of the class population that is at risk of taking inadequate amounts of micronutrients varies for the various nutrients. Using the 3 day record method, 67students (47 %) received less than the estimated average requirement for calcium while 94 students (65%) had less than average intakes of folate. About 8 students (6%) are at risk of consuming inadequate amounts of vitamin C. About 21 women (16%) and 4 men (29%) are at a higher risk of consuming less than the estimated average requirement. 63 women who account for 48% of their population have higher chances of consuming less than the estimated average requirement (EAR).
Table 3: proportion of the population at risk of consuming less than EAR of
Micronutrients
The calcium intake for the men and women were compared using the food frequency questionnaire and 3-day food record. The mean value for calcium was found to be 959.32 for FFQ and 903.72 for 3D record while the standard deviation was 431.85 and 324.54 for FFQ and 3D record respectively. The low and high mean of calcium in FFQ was recorded at 517.39 and 1438.44 while that for the 3D record were found to be 591.53 and 1254.43. A positive correlation exists between the FFQ and 3D record. The paired t-test is 0.080 thereby signifying a significant relationship exists between CaFFQ and CA 3 day (p<o.10) (Rummel, 1976).
The energy expenditure of 129 women in the three days ranges from 972 to 18469 KJ in women compared to values of 5546 to 17250 kJ in the 13 men. The women recorded a mean of 9034 and a standard deviation of 2440.70 against comparative values of 12312.90 and 2934.09 in men.
The 130 women had their heights range from a minimum of 1.5 m to a maximum of 1.8 m compared to a low of 1.67 to a high of 1.9 in the 14 men. Likewise, the weight of the women ranges from 42.2 to 85 kg compared to 61.9 and 95.7 kg in men. The waist circumference ranges from 27.4 to 92.4 and 74 to 96 in women and men respectively. The mean and standard deviation were 69.78 and 8.74 in women while the men had 81.74 and 6.23 respectively. The body mass index (BMI) recorded a minimum of 16.9 and a maximum of 29.2 kg/m2 in women and 21.1 and 28.3 in men. This represented means and standard deviation of 21.85 and 2.59 in women and 23.38 and 1.93 in men respectively. The mean body composition based on the percentage of fat skin ranges from 15.8 to 39.6 in women and 12.6 to 24.2 in men. The mean and standard deviation of the percentage fat skin is 27.43 and 4.63 in women while the values for men are 16.70 and 3.13. Moreover, the % fat BIA ranges from 11.1 to 37.5 in women and 10.2 to 31.8 in men. The means and standard deviations are 24.01 and 6.01 in women while the values in men are 18.18 and 7.67.
Discussion
The study has served to show the disparities between men and women in the population particularly in the level of energy and micronutrients intake and energy expenditure. The application of the various tools in the collection of data ensured that bias was minimized thereby boosting the reproducibility and offering reasonable validity to the results.
The dietary intake of food in the group varies with higher values recorded in the male category due to more demand for energy required in carrying out physical activities. In this regard, the values of energy requirements are comparable and fall within the normal range (Schouten, Goldbohm, & Van den Brandt, 2004, p. 1635). More importantly, the amounts of energy provided by the other macronutrients fall in the ranges indicated in the national nutrition survey of 1995. The values for the micronutrients are compatible in both documents. Despite the figures conforming to the national survey, a significant deviation has been recorded in the amounts of micronutrients intake when compared with the national reference values (NRV). This is depicted by the figures from the group that indicate that almost half of the women are at risk of suffering from iron deficiency. Women have more demand for micronutrient thereby requiring supplementation of normal foods (Shu et al, 2004, p. 58).
Saturated fats and alcohol do not provide substantial energy to the body. Taking large amounts of the fats and alcohol is believed to have deleterious effects to the human body. Deposition of the saturated fats in the blood vessels results in cardiovascular diseases. This led to the development of these guidelines as part of awareness campaign to the Australian people in order to prevent unnecessary deaths. Generally, the men take more energy foods than the females. However, the ladies have a high range of expenditure compared to men. The women are more susceptible fall into negative energy balance when compared to the men who have a positive energy balance. The women body needs a lot of energy to sustain all the functions hence the shortfall in the energy balance (Noakes et al, 2005; Australian National Health and Medical Research Council (NHMRC), 2003).
The class results indicate that the females and the males with the highest BMI took energy requirements that were higher than average. This shows that the trend followed by the class is contrary to the advice set by the Australian dietary guidelines. Overconsumption of energy and fatty foods results in the deposition of fats in the body thereby ushering in obesity (Atkin & Davies, 2000). There is need for the Australians to limit their food according to their needs in order to sustain their body shapes and remain healthy (Matthews, Xu & Zheng, 2005, p. 779; Romieu, Willett & Stampfer, 1988, p. 46).
The BMI results of the class shows very few cases of obesity with majority of the students having moderate or normal BMI values. On the other hand, the Australian population has the tendency of people with normal BMI to take larger amounts of nutrients and energy foods. This is also comparable to the data from the class that indicates the largest nutrients are consumed by people with BMI that is less than 25. A high level of BMI directly influences the level of energy balance in the body and vice versa (Lagerros, Hsieh, & Hsieh, 2004; Australian National Health and Medical Research Council (NHMRC) and the New Zealand Ministry of Health (MoH), 2006).
The %fat skin has a range of 15.8 and 39.6 in females compared to 12.6 and 24.2 in the males. The % FATBIA has a low of 11.1 and a high of 37.5 in females compared to lows of 10.2 and highs of 31.8 in males. Women have a bigger probability of deposition of fats due to the low level of physical activity that means that metabolic reactions are kept at minimal levels. This is contrary to the metabolic rates achieved by men that ensure all excess fats are broken down instead of being deposited under the skin (Schouten, Goldbohm, & Van den Brandt, 2004, p. 1635; Amin & Al-Sultan AI, 2008 ).
There are considerable variations between the various methods in term of reproducibility and validity. Their reliability is overly reliant on the accuracy of data collection by the household owner or the interviewer the weighted food records is advantageous since it provides the most accurate information although it is time consuming and relatively costly due to the high levels of supervision required. The food frequency questionnaire is useful in the determination of diet information over a short period and is easily analyzed and standardized. Its main shortcoming is the generation of semi quantitative data. Self report measures which rely on the capacity of the individual to recall the activities performed. The method is cost effective and is usually applicable in large population settings. Its efficacy is limited by the inability of the participants to recall events in a given period of time and also bias particularly towards the societal norms (Sallis & Saleana, 2000; Murphy & Poos, 2001, p.843).
Conclusion
Nutritional assessments have been largely utilized as a guide during national surveys aimed at determining the nutritional status of the residents of a certain region or the whole population. Nutritional assessment has found wide application in many developing countries due to its overemphasis on the utilization of simple approaches that ensures the risks associated with deficits and excesses are detected. The study has served to show the disparities between men and women in the population particularly in the level of energy and micronutrients intake and energy expenditure. The application of the various tools in the collection of data ensured that bias was minimized thereby boosting the reproducibility and offering reasonable validity to the results. There are considerable variations between the various methods in term of reproducibility and validity. Their reliability is overly reliant on the accuracy of data collection by the household owner or the interviewer the weighted food records is advantageous since it provides the most accurate information although it is time consuming and relatively costly due to the high levels of supervision required. The correct utilization of assessment methods is important in the determination of issues related to nutrition.
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