Diet Matters:
Approaches and Indicators to Assess
Agriculture's Role in Nutrition
Diego Rose, Brian Luckett, and Adrienne Mundorf
School of Public Health & Tropical Medicine
Tulane University

• Outline plausible mechanisms in which agriculture and food-based interventions can improve nutrition through the diet pathway
• Identify approaches and indicators to measure progress in this area

• Augmented Causal Framework
• Indicators
– Individual
– Household
– National
• Data Collection Systems
• Recommendations

A Standard Framework Outlining Causes of Undernutrition
Short-term consequences
Long-term consequences
Outcomes
Basic causes
Maternal and child undernutrition
Immediate causes
Inadequate dietary intake
Underlying causes
Household
Food Insecurity
Inadequate care and feeding practices
Disease
Unhealthy household environment and inadequate health services
Household access to adequate resources: land, education, employment, income, technology
Inadequate financial, human, physical and social capital
Sociocultural, economic, and political context

Zoom-in on determinants of household food security
Household
Food Security
Own production
( food & cash crops, livestock, fish farm)
Gathering
Fishing
Hunting
Food receipts
Food purchases
Sales Cash income
Nonagricultural production
Trading
(Adapted from WFP, 2005)
Employment Cash receipts Debts

A Standard Framework Outlining Causes of Undernutrition
Short-term consequences
Long-term consequences
Outcomes
Basic causes
Maternal and child undernutrition
Immediate causes
Inadequate dietary intake
Underlying causes
Household
Food Insecurity
Inadequate care and feeding practices
Disease
Unhealthy household environment and inadequate health services
Household access to adequate resources: land, education, employment, income, technology
Inadequate financial, human, physical and social capital
Sociocultural, economic, and political context

• Dietary outcomes are challenging due to multidimensionality
– many nutrients, all essential
• So, aggregation of data into a single index
– e.g. Mean Probability of Adequacy
• Measurement is also challenging, costly
– diet is a complex set of behaviors
– 'Gold standard' methods are costly
• Proxies for diet quality
– simple indicators of diet diversity

Lack of universal approaches
• Different indicators
– Foods, food groups, fd grp systems ± min quantity
• Many different benchmarks
– MAR, MPA, MMDA
– Several different cutoff points – 50%, 75%, etc
• Different collection methods
– Weighed food record, 24-hour recall, food frequency
• Different criteria
– Correlations, sensitivity, specificity, area under ROC, prediction equations

Outcomes
• Modest predictive power
– good for population monitoring: project process, trends over time, or general planning
– not good for evaluating impact
• Best proxies tend to be country-specific
• Elimination of 'minimum quantities' improves estimates
– can it be implemented in a low-cost field method?

Food Expenditure Modules
• Energy availability, food poverty
– household food security interventions
• Food group availability
– biofortification studies
– other specific crop/livestock interventions

Diversity Proxy Indicators
• Household Diet Diversity Score
– 16 groups in data collection collapsed to 12
– 24 hr recall (not quantitative)
– 1 point for each group
• Food Consumption Score
– 8 groups
– 1 week food frequency
– weights used in calculation

Using Food Supply Data
• Prevalence of undernourishment
– energy per capita + distributional measure + threshold
• Micronutrient densities
– micronutrients per 1000 kilocalories
– compared to micronutrient density goals
• Healthy eating index
– score based on U.S. diet guidelines
– food groups, negative components (fats, sugars)

• Demographic and Health Surveys
– Measure USAID
• Multiple Indicator Cluster System
– UNICEF
• Living Standard Measurement Study
– World Bank
• Vulnerability Analysis and Mapping Surveys
– World Food Program
• FAOSTAT
– National food supply data, other info

Best Practices
• To evaluate agricultural programs & policies: assess outcomes proximal to interventions
• Continue to foster a diverse set of indicators for population monitoring
– Women's Diet Diversity Score on DHS, MICS
– Food Consumption Score on VAM, LSMS
– Pilot-test 24-Hr Recall on LSMS
– Food Balance Sheet indicators

Research & Development
• New proxy validation research should
– integrate several indicators
– include information on costs
• Focus on making 'gold standards' less costly, rather than on making more low-cost proxies
• New research is needed on developing indicators of energy expenditure

Nutritional Diplomacy
• Seek inter-agency collaboration in
– survey implementation
– instrument, indicator development
• Use representative expert panels to develop consensus on
– specific indicators, overall measurement approach
– thresholds to count the affected