This document summarizes the challenges of analyzing 24-hour dietary recall data collected in Cambodia as part of a randomized control trial investigating the impact of homestead food production models on nutrition. Some key challenges discussed include finding nutritional information for local Cambodian foods, dealing with unknown nutrient values, improving the reliability of recall methods, and assessing the validity of dietary intake data through biomarkers. Potential solutions explored involve using regional food composition databases, consulting nutrition experts, standardizing assumptions, and applying validated multi-pass 24-hour recall techniques.

1. Overcoming the challenges:
analyzing Cambodian 24-hour dietary recalls
Presented by Vashti Verbowski (MSc student at UBC)
Presented at the International Food Security Dialogue 2014:
“Enhancing Food Production, Gender Equity and Nutritional
Security in a Changing World”
Sponsored By: Hosted By:

2. • The Fish on Farms project is being jointly conducted by the University of
British Columbia (UBC) and Helen Keller International (HKI), with
technical assistance from World Fish, in Prey Veng Province, Cambodia.
• This randomized control trial investigates an integrated Homestead Food
Production models in relation to poverty, gender empowerment, and food
and nutrition security, particularly among women and children.
• This is the first project known to rigorously measure the effectiveness of
different models of Homestead Food Production at reducing
undernutrition using biochemical and anthropometric measurements.

3. • University of British Columbia Ministry of Health, Cambodia
• Dr. Tim Green, Associate Professor, Human Nutrition Ministry of Planning, Cambodia
• Dr. Judy McLean, Assistant Professor, Human Nutrition
• Dr. Susan Barr, Professor, Human Nutrition
• Dr. Larry Lynd, Professor & Director, Collaboration for Outcomes Research & Evaluation
• Dr. Tony Farrell, Professor, Centre for Aquaculture and Environmental Research
• Dr. David Kitts, 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 International - Cambodia Graduate Students
• Dr. Zaman Talukder Kyly Whitfield (PhD, Nutrition)
• Mr. Hou Kroeun Crystal Karakochuk (PhD, Nutrition)
• Ms. Ly Sokhoing Vashti Verbowski (MSc, Nutrition)
• Field Research Team Pardis Lakzadeh (MSc, Public Health)
Jeff Tang (BSc, Science)

4. Outline
• 24-hour dietary recall review
• International nutrition research
• Research project overview
Background
Data collection
• Challenges encountered
Possible solutions
Helpful tools
• Summary

5. 24-hour dietary recalls (Lee & Nieman, 2012)
• Strengths
Quick & inexpensive
More objective
Less participant burden
Can estimate population intake
• Limitations
Omitted/forgotten foods
Under/over-reporting
Poor descriptor of individual usual intake
Data entry is labor intensive
 multiple-pass method
 unknown in Cambodia
 volunteers?
 repeat recalls

6. International nutrition 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?
What do Cambodians
eat?
We need
24-hour recall data!
We need
24-hour recall data!
Evidence for food-
based strategies
Evidence for food-
based strategies

7. Research project overview: background
• Malnutrition among rural Cambodians (CDHS, 2010)
Women
• 20% underweight (BMI <18.5)
• 47% anemic
Children
• 30% underweight (low weight-for-age)
• 11% wasted (low weight-for-height)
• 42% stunted (low height-for-age)
• 57% anemic

8. Research project overview: background
• Diet low in fat (FAO, 2009; Health Canada, 2006; Barba, 2008)
2382 kcal/capita/d
62.4g protein/capita/d (10.5% kcal) vs. 10-35% RDA
36.9g fat/capita/d (13.9% kcal) vs. 20-35% RDA
vs. 40-57g/d SEA-RDA
Potential to
improve nutrition
status
Potential to
improve nutrition
status
Aquaculture
(small fish ponds)
Aquaculture
(small fish ponds)
Homestead Food
Production (HFP)
Homestead Food
Production (HFP)
24-hour
dietary
recalls
24-hour
dietary
recalls

9. Research project overview: Fish on Farms
• 90 villages x 10 households each (n=900)
• Each village randomly assigned to:
a. Plant-based HFP
b. HFP + aquaculture (fish pond)
c. Control
• Outcomes
 Food security & gender equality
 Income generation
 Dietary intake, blood, urine, & anthropometrics

10. Data collection: completed by HKI* staff
• 24HR data (woman & child)
 Trained interviewers
 Structured dietary recalls
 Baseline & endline data
• Nutrient analysis: 6 fish species
Vitamin A?*HKI: Helen Keller International

11. Spoon #1 Spoon #2 Spoon #3
Data collection: completed by HKI staff
• Household measures (props)
• Weighed portions
• Translations

12. Data analysis: 24-hour dietary recall (#325)
Kangkong:
Rambutan:
Amaranth:
?

13. Challenge #1: finding nutritional information
• Purchased ESHA
Uses latest USDA data
Includes Canadian Nutrient File
Errors minimized with quality control reviews
Contains ~55,000 foods
• Use local food composition data
www.FAO.org
Vietnamese
East Asia

14. 1. B ng thành ph n dinh d ngả ầ ưỡ
th c ph m Vi t Nam năm 2000ự ẩ ệ
1. Sheet nutrient composition
of food Vietnam in 2000
3. C s d li u thành ph n th cơ ở ữ ệ ầ ự
ph m M - USDA Food Compositionẩ ỹ
3. Databases U.S. Food ingredients –
USDA Food Composition Database,
Version 18, 2006…
Challenge #1: finding nutritional information
www.translate.google.com…

15. Challenge #2: dealing with unknowns
Estimate unknown nutrients: www.fishbase.org
Step 1: Classify Labeo rohita (carp or minnow)
Step 2: Search database for similar fish
Vitamin A?

16. Challenge #2: dealing with unknowns
Liaise with experts

17. Challenge #2: dealing with unknowns
Red ant egg
Rabutan leaves Sakura (crab)
Red ants
Frogs

18. Challenge #3: questionable reliability
Reliability: “we are producing the same estimates every time”
•Develop set of assumptions
 Replace “water lily” with “kangkong” (no nutrition info)
•Use the 5-step multiple-pass 24-hour dietary recall for endline
 1st
pass: quick list
 2nd
pass: forgotten foods
 3rd
pass: time & place
 4th
pass: detailed description
 5th
pass: final review  idea: take pictures of labels
 portion size & additions
 snacks & beverages
 food from previous day
 sort chronologically

19. Challenge #4: assessing validity
Validity: “we are measuring what we intended to measure”
•Energy & fat intake: monitor height & weight
•Compare nutrient intakes against biomarkers
 Iron: hemoglobin, ferritin
 Vitamin A: retinol, carotenoids
 Zinc: serum zinc

20. Summary of the challenges & solutions
• Finding nutritional information
 Use local resources when possible
• Dealing with unknowns
 Develop relationships with “experts”
 Consider “road-blocks” beforehand
• Improving reliability
 Develop a set of assumptions
 Use validated techniques
• Improving validity
• Compare dietary intake data against biomarkers

21. 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/

22. Acknowledgements
Thank you to my committee members & HKI:
Dr. Tim Green, Associate Professor, UBC LFS Human Nutrition
Dr. Judy McLean, Senior Instructor, UBC LFS Human Nutrition
Dr. Susan Barr, Professor, UBC LFS Human Nutrition
Dr. Larry Lynd, Associate Professor, UBC Pharmaceutical Sciences
Helen Keller International in Cambodia (Zaman Talukder et al.)
Sponsored By: Hosted By: