1.
Overcoming
the
challenges:
analyzing
Cambodian
24-­‐hour
dietary
recalls
Presented
by
Vash.
Verbowski
(MSc
student
at
UBC)
Presented
at
the
Interna.onal
Food
Security
Dialogue
2014:
“Enhancing
Food
Produc.on,
Gender
Equity
and
Nutri.onal
Security
in
a
Changing
World”
Sponsored
By:
Hosted
By:

2.
• The
Fish
on
Farms
project
is
being
jointly
conducted
by
the
University
of
Bri?sh
Columbia
(UBC)
and
Helen
Keller
Interna?onal
(HKI),
with
technical
assistance
from
World
Fish,
in
Prey
Veng
Province,
Cambodia.
• This
randomized
control
trial
inves.gates
an
integrated
Homestead
Food
Produc.on
models
in
rela.on
to
poverty,
gender
empowerment,
and
food
and
nutri.on
security,
par.cularly
among
women
and
children.
• This
is
the
first
project
known
to
rigorously
measure
the
effec.veness
of
different
models
of
Homestead
Food
Produc.on
at
reducing
undernutri.on
using
biochemical
and
anthropometric
measurements.

3.
• University
of
Bri?sh
Columbia
Ministry
of
Health,
Cambodia
• Dr.
Tim
Green,
Associate
Professor,
Human
Nutri.on
Ministry
of
Planning,
Cambodia
• Dr.
Judy
McLean,
Assistant
Professor,
Human
Nutri.on
• Dr.
Susan
Barr,
Professor,
Human
Nutri.on
• Dr.
Larry
Lynd,
Professor
&
Director,
Collabora.on
for
Outcomes
Research
&
Evalua.on
• Dr.
Tony
Farrell,
Professor,
Centre
for
Aquaculture
and
Environmental
Research
• Dr.
David
Ki_s,
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
Interna?onal
-­‐
Cambodia
Graduate
Students
• Dr.
Zaman
Talukder
Kyly
Whiaield
(PhD,
Nutri.on)
• Mr.
Hou
Kroeun
Crystal
Karakochuk
(PhD,
Nutri.on)
• Ms.
Ly
Sokhoing
Vash.
Verbowski
(MSc,
Nutri.on)
• Field
Research
Team
Pardis
Lakzadeh
(MSc,
Public
Health)
Jeff
Tang
(BSc,
Science)

4.
Outline
• 24-­‐hour
dietary
recall
review
• Interna.onal
nutri.on
research
• Research
project
overview
Ø Background
Ø Data
collec.on
• Challenges
encountered
Ø Possible
solu.ons
Ø Helpful
tools
• Summary
© Fish on Farms
© Fish on Farms

5.
24-­‐hour
dietary
recalls
(Lee
&
Nieman,
2012)
• Strengths
Ø Quick
&
inexpensive
Ø More
objec.ve
Ø Less
par.cipant
burden
Ø Can
es.mate
popula.on
intake
• Limita.ons
Ø Omi_ed/forgo_en
foods
Ø Under/over-­‐repor.ng
Ø Poor
descriptor
of
individual
usual
intake
Ø Data
entry
is
labor
intensive
à
mul.ple-­‐pass
method
à
unknown
in
Cambodia
à
students
à
repeat
recalls
© Fish on Farms

6.
Interna?onal
nutri?on
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?
We
need
24-­‐hour
recall
data!
Evidence
for
food-­‐based
strategies

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

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

9.
Research
project
overview:
Fish
on
Farms
• 90
villages
x
10
households
each
(n=900)
• Each
village
randomly
assigned
to:
① Plant-­‐based
HFP
② HFP
+
aquaculture
(fish
pond)
③ Control
• Outcomes
Ø Food
security
&
gender
equality
Ø Income
genera.on
Ø Dietary
intake,
blood,
urine,
&
anthropometrics
© Fish on Farms
© Fish on Farms

10.
Data
collec?on:
completed
by
HKI*
staff
• 24HR
data
(woman
&
child)
Ø Trained
interviewers
Ø Structured
dietary
recalls
Ø Baseline
&
endline
data
• Nutrient
analysis:
6
fish
species
Species
(per
100g)
Protein
(g)
Lipid
(g)
Iron
(mg)
Zinc
(mg)
Labeo
rohita
14.0
4.5
0.49
1.14
Vitamin A?*HKI:
Helen
Keller
Interna.onal
© Fish on Farms

11.
Spoon #1 Spoon #2 Spoon #3
Data
collec?on:
completed
by
HKI
staff
• Household
measures
(props)
• Weighed
por.ons
• Transla.ons
Ingredient
Spoon
#1
Spoon
#2
Spoon
#3
Piece
Trey
Phtok
12g
5g
3g
20g
Trey
Chhpin
11g
5g
4g
14g
Khmer:
La?n
name:
Common
name:
Method
of
cooking:
Trey
Phtuok
Channastriata
Common
snakehead
Made
into
fish
paste
(pra
hok)

12.
Meal
Food
item
Household
measure
Breakfast
Rice
0.5
plate
#1
Frog
meat
2
pieces
Kangkong
2
spoon
#1
Snack
Fruit
(rambutan)
10
small
Biscuit
(Sakira
brand)
3
small
package
Lunch
Rice
1
plate
#2
Frog
meat
1
piece
Kangkong
1
spoon
#2
Dinner
Rice
1
plate
#2
Amaranth
1
spoon
#1
Channastriata
(Trey
Phtok)
12
pieces
Data
analysis:
24-­‐hour
dietary
recall
(#325)
?

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

14.
1. Bảng
thành
phần
dinh
dưỡng
thực
phẩm
Việt
Nam
năm
2000
1.
Sheet
nutrient
composi.on
of
food
Vietnam
in
2000
3.
Cơ
sở
dữ
liệu
thành
phần
thực
phẩm
Mỹ
-­‐
USDA
Food
Composi.on
3.
Databases
U.S.
Food
ingredients
–
USDA
Food
Composi.on
Database,
Version
18,
2006…
Challenge
#1:
finding
nutri?onal
informa?on
www.translate.google.com…

15.
Challenge
#2:
dealing
with
unknowns
Es.mate
unknown
nutrients:
www.fishbase.org
Ø Step
1:
Classify
Labeo
rohita
(carp
or
minnow)
Ø Step
2:
Search
database
for
similar
fish
Species
(per
100g)
Protein
(g)
Lipid
(g)
Iron
(mg)
Zinc
(mg)
Vit.
A
(RAE)
Carp
[USDA
database]
17.83
5.6
1.24
1.48
9.0
(30
IU)
Carp
[Vietnamese
database]
16g
3.6
0.90
1.48
181
(603
IU)
Species
(per
100g)
Protein
(g)
Lipid
(g)
Iron
(mg)
Zinc
(mg)
Labeo
rohita
14.0
4.5
0.49
1.14
Vitamin A?

16.
Ques?ons
Response
from
HKI
staff
What
is
the
recipe
for
‘pra
hok’?
1kg
of
fish
(Trey
Phtuok)
&
300g
of
salt.
Put
fish
in
water
un.l
they
swell
&
smell
bad.
Dry
under
sun
&
mix
with
salt.
Challenge
#2:
dealing
with
unknowns
Liaise
with
experts
Khmer:
La?n
name:
Common
name:
Method
of
cooking:
Trey
Phtuok
Channastriata
Common
snakehead
Made
into
fish
paste
(pra
hok)
© Fish on Farms

17.
Challenge
#3:
ques?onable
reliability
Reliability:
“we
are
producing
the
same
es.mates
every
.me”
• Develop
set
of
assump.ons
Ø Replace
“water
lily”
with
“lotus
root”
(no
nutri.on
info)
• Use
the
5-­‐step
mul.ple-­‐pass
24-­‐hour
dietary
recall
for
endline
Ø 1st
pass:
quick
list
Ø 2nd
pass:
forgo_en
foods
Ø 3rd
pass:
.me
&
place
Ø 4th
pass:
detailed
descrip.on
Ø 5th
pass:
final
review
à
idea:
take
pictures
of
labels
à
por.on
size
&
addi.ons
à
snacks
&
beverages
à
food
from
previous
day
à
sort
chronologically

18.
Challenge
#4:
assessing
validity
Validity:
“we
are
measuring
what
we
intended
to
measure”
• Energy
&
fat
intake:
monitor
height
&
weight
• Compare
nutrient
intakes
against
biomarkers
Ø Iron:
hemoglobin,
ferri.n
Ø Vitamin
A:
re.nol,
carotenoids
Ø Zinc:
serum
zinc
© Fish on Farms

19.
Summary
of
the
challenges
&
solu?ons
• Finding
nutri.onal
informa.on
Ø Use
local
resources
when
possible
• Dealing
with
unknowns
Ø Develop
rela.onships
with
“experts”
Ø Consider
“road-­‐blocks”
beforehand
• Improving
reliability
Ø Develop
a
set
of
assump.ons
Ø Use
validated
techniques
• Improving
validity
• Compare
dietary
intake
data
against
biomarkers
© Fish on Farms
© Fish on Farms

20.
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/

21.
Acknowledgements
Thank
you
to
my
commidee
members
&
HKI:
Dr.
Tim
Green,
Associate
Professor,
UBC
LFS
Human
Nutri.on
Dr.
Judy
McLean,
Senior
Instructor,
UBC
LFS
Human
Nutri.on
Dr.
Susan
Barr,
Professor,
UBC
LFS
Human
Nutri.on
Dr.
Larry
Lynd,
Associate
Professor,
UBC
Pharmaceu.cal
Sciences
Helen
Keller
Interna.onal
in
Cambodia
(Zaman
Talukder
et
al.)
Sponsored
By:
Hosted
By: