Introduction
The objective of dietary assessment is to recognize suitable and actionable changes in a person’s diet to advance their health and well-being. India is a socially and ethnically diverse country with diverse dietary practices linked to its exclusive religious and socioeconomic heterogeneity.1
Food is an important part of human health as Hippocrates rightly mentions ‘Let food be thy medicine and medicine be thy food and ‘All diseases begin in the gut’. It is necessary to assess nutrition at the primary care setting level. There are various methods of dietary assessment, but the 24-hr semi-quantitative dietary recall method can capture comprehensively the regional, ethnic, religious, and socio-economic heterogeneity of dietary habits within India.
Table 1
However, many textbooks have not yet adopted the changes recommended by the committee; with medical students still learning and using the old guidelines. Here we have attempted to simplify dietary assessment and recommendation at the bedside and community level for physiological conditions without special nutritional needs.
24 hr semi-quantitative dietary recall method: The 24-hr dietary recall is an open-ended method intended to report detailed information about all foods and beverages consumed by a respondent, in the preceding 24 h or over the previous day. The interview can be pen-paper based or computer-assisted making it suitable to administer at the bedside or in a community setting. The method relies on short memories and allows the quantification of all the foods and beverages consumed over the period concerned.4 This is a preferred method when the time to administer is brief, respondents are illiterate, or when there is no patience or motivation to answer food-related questions.5 We list the various food items consumed in the past 24 hours and note their portion on consumption in each meal (Figure 1). Looking at the chart containing their calorie value and protein content we add the total calories and proteins consumed by that person per day. (Table 1) Here is an attempt to compile and simplify all required information for dietary assessment from reliable sources in one place which empowers healthcare professionals to perform dietary assessment bedside and in community.
Dietary Assessment and Recommendation for an Individual
Note the age and gender of the person for whom we are performing the dietary assessment. We need to classify them as heavy workers, moderate workers, and sedentary workers based on their daily work schedules as seen in Table 2. Recommended Daily allowances requirement as per ICMR 2020 guidelines is given in Table 3. Considering the Calorie requirement of an adult sedentary reference male (19-39 yrs) of 2110 Kcal as one consumption unit, the corresponding consumption unit is calculated for other categories.
The calorie and protein difference in the person’s diet is measured by comparing it with the Recommended daily standards. Comparing the contents of food as a proportion with that of various food groups consumed in the balanced diet recommended will help us understand the diet qualitatively and give recommendations accordingly. (See annexure 1 for illustration)
Table 2
Classification based on the work and activity 6
Table 3
Recommended daily allowances requirement as per ICMR 2020 guidelines7
[i] * After the age of 40 years, requirements should be reduced by 5 percent per each decade until the age of 60 years, and 10 percent for each decade thereafter.8
Dietary Recommendation for a Family
List the total number of persons, their age, gender, and the type of work/ physical activity they are involved. Based on these criteria, looking at Table 3, calculate the total consumption units required for the family. Considering the Balanced diet chart for one consumption unit (Table 4), calculate the balanced diet required for the family by multiplying it with the total consumption units required for the family. (See annexure 2 for illustration)
Table 4
Balanced diet for 1 consumption unit =2110 Kcal sedentary worker male, ICMR 2020 guidelines7
Table 5
Additional allowance during pregnancy and lactation2
|
Food Item |
During Pregnancy (grams) |
During lactation (grams) |
|
Cereals |
35 |
60 |
|
Pulses |
15 |
30 |
|
Milk |
100 |
100 |
|
Nuts & Seeds |
10 |
10 |
|
Fats & Oils$ |
5 |
10 |
Discussion
Annexure 1
The 24-hr semiquantitative dietary recall of a 32-year-old Mr. Raju, working as a construction labourer, is as follows. Coffee 1 cup, 2 idlis, 2 Tbsp of chutney for breakfast, 1 medium-sized ragi ball, 1 cup rice, 1 and a half cup sambar, half cup of vegetable dry, half cup curd, 1 bajji for lunch, 4 biscuits and a cup of tea for the evening and 1 cup of rice, 1 cup of sambar for the night. Assess the diet of this person.
Tabulate the calorie and protein content of individual food items as per Table 1.
Table 6
Since Mr. Raju is a construction worker aged between 19-39, we consider values for adult male heavy workers. He must consume 3470 Kcal of energy and 42.9 grams of protein every day. However, on 24-hour semi-quantitative dietary recall, he is consuming 1468 Kcal and 35.3 grams per day. Mr. Raju’s diet is deficient by 56% in energy requirement and 18% in protein requirement.
When the diet is assessed qualitatively
The proportion of cereals are more it should be limited to 25-30% of the diet
The proportion of pulses is less addition of a pulse side dish/egg/ flesh can be added
Consumption of milk and milk products are inadequate
Proportion of vegetable, green leafy vegetables, roots, and tuber consumption is grossly inadequate
Fruit, nuts, and seeds need to be included in the daily diet
Annexure 2
Prescribe a balanced diet for a family consisting of a father, a 29-year-old software engineer, a mother aged 25 years (housewife), and children aged 4 and 1 year.
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