A Program Needs-Driven Approach to Selecting Dietary Assessment Methods for Decision-Making in Food Fortification Programs

摘要

Background. Dietary assessment data are essential fordesigning, monitoring, and evaluating food fortificationand other food-based nutrition programs. Planners andmanagers must understand the validity, usefulness, andcost tradeoffs of employing alternative dietary assessmentmethods, but little guidance exists.Objective. To identify and apply criteria to assess thetradeoffs of using alternative dietary methods for meetingfortification programming needs.Methods. Twenty-five semistructured expert interviewswere conducted and literature was reviewed forinformation on the validity, usefulness, and cost ofusing 24-hour recalls, Food Frequency Questionnaires/Fortification Rapid Assessment Tool (FFQ/FRAT), FoodBalance Sheets (FBS), and Household Consumption andExpenditures Surveys (HCES) for program stage-specificinformation needs. Criteria were developed and appliedto construct relative rankings of the four methods.Results. Needs assessment: HCES offers the greatestsuitability at the lowest cost for estimating the risk ofinadequate intakes, but relative to 24-hour recall compromisesvalidity. Design: HCES should be used to identifyvehicles and to estimate coverage and likely impactdue to its low cost and moderate-to-high validity. Baselineassessment: 24-hour recall should be applied usinga representative sample. Monitoring: A simple, low-costFFQ can be used to monitor coverage. Impact evaluation:24-hour recall should be used to assess changes innutrient intakes. FBS have low validity relative to othermethods for all programmatic purposes.Conclusions. Each dietary assessment method hasstrengths and weaknesses that vary by context and purpose.Method selection must be driven by the program’sdata needs, the suitability of the methods for the purpose,and a clear understanding of the tradeoffs involved.