Use of the multiple-day weighed record for Senegalese children during the weaning period: a case of the "instrument effect"

Comparison of an interactive 24-h recall and weighed food record for measuring energy and nutrient intakes from complementary foods among 9-10-month-old Malawian infants consuming lipid-based nutrient supplements

Fortifying complementary foods with lipid-based nutrient supplements (LNS) may improve energy and nutrient intakes of infants at risk for undernutrition. We aimed to determine the relative validity of an interactive 24-h recall (i-24-HR) for assessing the impact of an LNS intervention on dietary intakes of energy and nutrients among rural Malawian 9-10-month-old infants (n 132) participating in the International Lipid-Based Nutrient Supplements Dose (iLiNS-DOSE) trial. Dietary data were collected for the same day via i-24-HR and weighed food records. Inter-method agreements were estimated overall and by intervention group, using Bland-Altman plots and paired t tests; measurement error models (differential error); and percentage of food omissions and intrusions were estimated. Overall, inter-method differences in mean intakes of energy and most nutrients were not significant. When stratified by group, recalled energy intakes were under-estimated (-368 kJ; P=0·01) in the control but not in the intervention group (-42 kJ; P=0·6). This differential reporting error was related to an over-estimation of recalled LNS (8·1 v. 4·5 g; P30 % eating occasions) omissions were milk/fish/eggs, starchy roots/vegetables and sweetened snacks. Common intrusions were milk/yogurt. Starchy staples and LNS were recalled when consumed (>85 %) (i.e. matched). These results emphasise the importance of considering differential error when interpreting dietary results in LNS trials.

Validation of the second version of a quantitative food-frequency questionnaire for use in Western Mali

OBJECTIVE

To assess the relative validity of the second version of a quantitative food-frequency questionnaire (QFFQ), designed to measure the habitual food and nutrient intake in one season in rural populations in Western Mali, West Africa.

DESIGN

The dietary intake during the previous week was assessed with the 164-item QFFQ administered by interview. This was compared with the intake from a 2-day weighed record (WR) with weighed recipes.

SETTING

The village of Ouassala in the Kayes region, Western Mali.

SUBJECTS

Thirty-four women and 36 men aged 15-45 years, from 29 households.

RESULTS

The QFFQ gave a lower intake of lunch and dinner and a higher intake of snacks than the WR. The discrepancies were larger for women than for men. The median proportion of subjects classified in the same quartile of intake was 29% for food groups and 36% for energy and nutrients. For classification into extreme opposite quartiles, the median proportion was 6% for food groups and 7% for energy and nutrients. Spearman's rank correlation for energy and nutrients ranged from 0.16 (% energy from protein) to 0.62 (retinol equivalents).

CONCLUSIONS

The second version of the QFFQ tends to underestimate total food weight. The methods used for estimating food portion size should therefore be applied with caution. The changes made from the first version had little effect. The ability to rank subjects according to dietary intake is similar with both versions. The improved layout of the new QFFQ makes it a more user-friendly tool for comparing dietary intake between population groups and for measuring changes over time.

Validation of a quantitative food-frequency questionnaire for use in Western Mali

OBJECTIVE

The purpose of this study was to validate a quantitative food-frequency questionnaire (QFFQ) created for assessing the usual intake of foods and nutrients in the prevailing season in Western Mali.

DESIGN

Intake of foods and nutrients over the week preceding the interview was measured with a 69-item QFFQ. Intakes were compared with intakes as measured with 2-day combined weighed and recalled diet records.

SETTING

A rural village in Western Mali, West Africa.

SUBJECTS

Twenty-seven men and 48 women (15-59 years of age) representing 18 households.

RESULTS

Spearman rank correlations between intake of food groups from the QFFQ and the diet record ranged from 0.09 (meat/fish) to 0.58 (tea/coffee). Median coefficient was 0.37. Median Spearman correlation coefficient for nutrient intake was 0.40. Men had higher median correlation coefficients than did women. The proportion of subjects being classified into the same quartile of food intake was on median 33%, while a median of 7% was misclassified into extreme quartiles. Correct classification into the same quartile for intake of nutrients was on median 34% while a median of 4% was grossly misclassified. Intakes of most food groups and nutrients as measured by the QFFQ were higher than those measured by the diet records. However, while men had higher estimated intakes for foods eaten in-between meals, women in general had higher intake of foods eaten in the main meals.

CONCLUSION

This QFFQ can be used for comparing the intake of foods and nutrients between groups within this study population. It therefore represents a useful tool in the surveillance of food intake in the population, both in identifying vulnerable groups and for tracking food intake over time. The differences between men and women in overestimating food intake need to be taken into account when using the method.

Maternal and non-maternal time-allocation to infant care, and care during infant illness in rural Java, Indonesia

An estimated 60% of women in Central Java are engaged in income-generating work. This study addresses the manner in which mothers allocate time to infant care as well as to household maintenance and employment. The study investigates the time-allocation to infant care by non-maternal carers, both among infants whose mother is involved in income-generating work and among infants whose mother is not employed. The longitudinal study followed 60 households, one infant per household, of the age range 3-25 months (mean infant age over the course of the study was 13.8 months). Each household was visited every 7 to 10 days from February 1991 through June 1991. One observation day and two separate recall-days were recorded per month. Daily time allocation (6 a.m. to 6 p.m.) to infant care by the mother and other individuals, frequency and minutes of breastfeeding, and infants' non-breastmilk kilocalorie intake were recorded. In addition, mothers recorded any infant symptom(s) on a daily calendar provided to them, and this symptom-data and information on any treatments and/or help-seeking for the infant was collected every 7-10 days. One or more non-maternal caretaker participated in infant care on 90% of the total sample days, for a median of 3 hr 15 min (mean 3 hr 50 min per day), and participated in infant feeding on one-third of all sample days. Grandmothers, sisters, and fathers of the infants were the most important in terms of time allocated to infant care. One or more sister cared for the infant on 30% of total sample days (mean 180 min, median 150 min, 5-645 min), the father on 55% of sample days (mean 90 min, median 65 min, 5-600 min), and grandmother(s) on 32% of sample days (mean 160 min, median 130 min, 5-670 min). Non-maternal care was also substantial during days of symptom-reporting; other carers participated in infant-care on 84% of days, and fed the infant on 28% of days. The study findings suggest that health education messages related to infant care and feeding could be usefully targeted to other persons in addition to mothers. Infant care on symptom-free days were compared to symptom-days using Wilcoxon matched-pair test within each data-collection month (round). While no significant differences were found for the time-allocation to infant care by the mother or others on symptom-days compared to symptom-free days, there was a mean 25% lower non-breastmilk kilocalorie intake on symptom-days (P = 0.00) in four of five data-collection rounds. Mothers reported that lack of appetite accompanied other symptom(s) on 46% of the days of help-seeking in the modern sector. This reflects the mothers' concern for infant appetite in association with illness.