Validasi Survei Konsumsi

Makanan

Kamis, 19 Maret 2020

R. Dwi Budiningsari, M.Kes, Ph.D

m.k Epidemiologi Gizi

Program Studi S1 Gizi Kesehatan FK-KMK
 • Survei konsumsi makanan
(pengertian, manfaat)
• Metode pengukuran konsumsi
Subtopik

makanan berdasarkan:
– Waktu
– Jenis data yang diperoleh
– Sasaran pengamatan/pengguna
• Cara pengukuran & pemilihan
metode konsumsi makanan
• Kegunaan & keterbatasan metode
pengukuran konsumsi makanan
• Validasi metode konsumsi makanan
SURVEI KONSUMSI MAKANAN
Survei Konsumsi Makanan
Informasi yang diperoleh:

- apa yang dikonsumsi

- frekuensi yang dikonsumsi
- jumlah yang dikonsumsi

→ Tingkat individu, kelompok, rumah

tangga, nasional
 Aplikasi Survei Konsumsi
Makanan
• Kegiatan survei yang dilakukan untuk
mengumpulkan data pangan apa saja
yang dikonsumsi oleh suatu penduduk.
• Dimulai sejak pertengahan abad 18 untuk
mempelajari hubungan antara konsumsi
bahan pangan tertentu dengan kejadian
suatu penyakit.
• Pada negara-negara maju, pengumpulan
data konsumsi pangan telah sejak lama
dilakukan secara periodik.
 Aplikasi Survei Konsumsi Makanan
(cont’)
• Di Indonesia, survei ini sejak tahun 1992
telah dilakukan dan disebut Survei
Konsumsi Gizi (SKG)
– secara periodik (3 tahun sekali) oleh
Departemen Kesehatan.
 Manfaat Data Konsumsi
Makanan Penduduk
• Menaksir asupan gizi
• Menaksir tingkat kecukupan gizi
• Merencanakan program perbaikan gizi
• Merencanakan penyediaan pangan
METODE PENGUKURAN
KONSUMSI MAKANAN
Metode pengukuran konsumsi
makanan ~ waktu
Metode Survei Konsumsi Pangan
~ Jenis Data yang Diperoleh

Kualitatif Kuantitatif

Jenis pangan
• Jenis pangan
Frekuensi
• Frekuensi

KEBIASAAN KONSUMSI /
MAKAN SATUAN WAKTU
5
 Metode Survei Konsumsi Pangan .
~ Jenis Data yang Diperoleh

Kualitatif Kuantitatif

❑ Food Frequency ❑ Metode Recall 24-jam

❑ Estimated Food Records
Questionare
❑ Weighing Method
❑ Dietary History ❑ Food account
danHousehold Food
Record

5
 Metode Pengumpulan data (cont')
~ Sasaran Pengamatan/Pengguna
Tingkat Metode
Individu 24-hour recall (Mengingat kembali 24
jam y.l.)
Repeated 24-hour recalls (Penambahan jumlah
hari dalam menggunakan metode mengingat
kembali 24 jam y.l.)
Estimated food records (Pencatatan pangan)

Weighed food records (Penimbangan pangan)

Dietary history (Sejarah Konsumsi)

Food frequency questionnaire (Kuesioner
Frekuensi Pangan)
 Metode Pengumpulan data (cont')
~ Sasaran Pengamatan/Pengguna
Tingkat Metode
Nasional ▪ Food balance sheet (Neraca bahan
makanan/NBM)
▪ Market databases (Database
perdagangan)
Rumah ▪ Food account (Pencatatan keluar masuk
tangga pangan di rumah tangga)
▪ List-recall (Mengingat kembali

& mencocokkan dengan daftar pangan yang

sudah disusun)
▪ Inventory (Metode Inventaris)
▪ Household food record (Pencatatan
CARA PENGUKURAN DAN
PENILAIAN KONSUMSI
MAKANAN
No Cara Keterangan
Pengukuran
Konsumsi Pangan

1. Food Frequency • informasi pola konsumsi pangan

Questionnaire seseorang
• Kuesioner, terdiri 2 komponen :
(Metode Frekuensi
1) Daftar Jenis Pangan
Pangan )
2) Frekuensi Konsumsi Pangan

2. Dietary History • menemukan pola konsumsi pangan

(Metode Riwayat pada jangka waktu lama
Makanan) • kaitan konsumsi pangan dengan
kejadian penyakit tertentu.
No Cara Keterangan
Pengukuran
Konsumsi
Pangan
1. Dietary History • terdiri dari tiga komponen dasar:
(Metode Riwayat A. Wawancara mendalam pola konsumsi
Makanan) pangan sehari-hari
(termasuk recall 24 jam yang lalu)
B. Checklist frekuensi konsumsi pangan
C. Pencatatan konsumsi pangan 2-3 hr,
sbg pemeriksaan silang

2. Metode Recall • estimasi  makanan & minuman yang

24 jam yll dimakan oleh seseorang 24 jam yll
• besarnya porsi makanan diukur dengan
ukuran rumah tangga (URT), kemudian
dikonversi ke ukuran metrik (gr)
No Cara Keterangan
Pengukuran
Konsumsi
Pangan
4. Weighing •Pewawancara mengukur scr langsung
Method (Metode berat setiap jenis makanan yang
penimbangan) dikonsumsi oleh seseorang pada hari
wawancara
5. Food Records •Responden mencatat makanan &
minuman yang dikonsumsi selama
seminggu.
•Pencatatan dilakukan oleh responden
dengan ukuran rumah tangga
7
(URT/Estimated Food Records) dg cara
menimbang langsung berat makanan
yang dimakan (Weighed Food Records).
KEGUNAAN &
KETERBATASAN METODE
PENGUKURAN KONSUMSI
MAKANAN
 Metode dan Prosedur Pengumpulan Data
Konsumsi Makanan, Kegunaan dan Keterbatasan
Metode dan Prosedur Kegunaan dan Keterbatasan
Food Frequency Kegunaan : untuk memperoleh data kualitatif
Questionaire Responden dan deskriptif tentang kebiasaan konsumsi
dapat mengisi selama waktu tertentu.
sendiri atau diwawancarai oleh •Dapat untuk mengklasifikasikan frekuensi
petugas lapang tentang konsumsi responden (rendah, sedang, tinggi)
frekuensi konsumsi pangan dalam mengkonsumsi pangan tertentu, atau zat
tertentu selama periode gizi atau komponen pangan tertentu, atau untuk
tertentu (hari, minggu, bulan perbandingan dengan prevalensi atau statistik
atau tahun). kematian terkait kekurangan konsumsi zat gizi
Jika responden diminta untuk tertentu.
mengkuantifikasi jumlah •Dapat pula untuk identifikasi pola konsumsi
pangan yang dikonsumsi maka yang dapat menyebabkan kekurangan zat gizi
metode ini dikategorikan tertentu.
sebagai semikuantitatif.
•Pengumpulan data menggunakan metode ini
relatif cepat, tidak membebani responden dan
respon responden tinggi.
Keterbatasan : Akurasi metode ini rendah.
 Metode dan Prosedur Pengumpulan Data
Konsumsi Makanan, Kegunaan dan Keterbatasan
Metode dan Prosedur Kegunaan dan Keterbatasan

Dietary History Kegunaan : untuk mengetahui kebiasaan

Mewawancarai konsumsi selama ini dan dapat pula untuk
responden untuk memperkirakan prevalensi kekurangan pangan.
merecall makanan yang Informasi ini dapat digunakan untuk
dikonsumsi 24 jam yang pengembangan kebijakan pangan terutama
lalu, ditambah informasi dalam perencanaan fortifikasi atau untuk
kebiasaan konsumsi identifikasi pola konsumsi yang dapat
menggunakan food menyebabkan kekurangan zat gizi tertentu.
frequency Keterbatasan : memakan waktu & tenaga dan
quesstionaire. sangat tergantung pada ketrampilan tenaga
Jumlah pangan yang lapang
dikonsumsi ditaksir
menggunakan URT.
 Metode dan Prosedur Pengumpulan Data
Konsumsi Makanan, Kegunaan dan Keterbatasan
Metode dan Prosedur
• 24-hour Recall
• Melalui wawancara, peneliti
atau tenaga lapangan meminta
responden mengingat kembali
apa saja dan perkiraan jumlah
makanan dan minuman yang
dikonsumsi selama 24 jam yang
lalu.
• Dalam memperkirakan
jumlah makanan/minuman yang
dikonsumsi dapat dibantu
menggunakan Ukuran Rumah
Tangga (URT) atau food model.
Kegunaan dan Keterbatasan
• Kegunaan : untuk mengukur rata-
rata kebiasaan konsumsi pada
populasi yang besar, dengan syarat
jumlah sampel dan jumlah hari
pengawatan representatif.
• Metode ini murah, mudah dan
cepat sehingga respon responden
biasanya baik. Dapat mengcover
sampel dalam jumlah banyak dan
dapat digunakan pada masyarakat
yang buta huruf.
• Keterbatasan : sangat tergantung
pada kemampuan mengingat
responden sehingga tidak
direkomendasikan untuk kelompok
manula dan anak-anak
 Metode dan Prosedur Pengumpulan Data
Konsumsi Makanan, Kegunaan dan Keterbatasan

Metode dan Kegunaan dan Keterbatasan

Prosedur
Weighed Food Kegunaan : dapat untuk mengukur konsumsi
Record pangan saat ini (aktual) atau kebiasaan makan,
Semua makanan tergantung pada jumlah hari pengamatan.
dan minuman yang Sangat akurat untuk mengetahui jumlah pangan
dikonsumsi dalam yang dikonsumsi.
waktu tertentu di Keterbatasan : responden mungkin akan
catat oleh mengubah kebiasaan makannya untuk
responden, peneliti mempermudah penimbangan atau untuk
atau tenaga lapang. menyenangkan peneliti.
Membutuhkan responden yang bisa baca tulis,
bermotivasi dan mau berpartisipasi.
Metode ini membutuhkan waktu yang sangat
lama dan mahal
Metode dan Prosedur Pengumpulan Data Konsumsi
Makanan, Kegunaan dan Keterbatasan

Metode dan Prosedur Kegunaan dan Keterbatasan

Estimated Food Kegunaan : dapat untuk mengukur
Record konsumsi pangan saat ini (aktual) atau
Responden mencatat kebiasaan makan, tergantung pada jumlah
semua makanan dan hari pengamatan.
minuman yang dikonsumsi Konsumsi pangan aktual dapat digunakan
(termasuk snack) selama untuk konsultasi gizi dan analisis lebih
periode waktu tertentu, lanjut secara statistik.
dapat berkisar 1 – 7 hari. Ketepatan tergantung pada ‘kesadaran’
Jumlah yang dikonsumsi responden dan kemampuan memperkirakan
dapat diperkirakan jumlah yang dikonsumsi
menggunakan URT. Keterbatasan : responden harus dapat
baca tulis, membebani responden dan lama
pencatatan akan mempengaruhi kerjasama
responden.
Metode dan Prosedur Pengumpulan Data Konsumsi
Makanan, Kegunaan dan Keterbatasan
VALIDASI METODE KONSUMSI
MAKANAN
 Measurement:
Reliability and Validity
• For a measure to be useful, it must
be both reliable and valid
• Reliable = consistent in producing
the same results every time the
measure is used
• Valid = measuring what it is
supposed to measure
 What is validity?

• Refers to the degree to which a study accurately

reflects or assesses the specific concept that the
researcher is attempting to measure.

• While reliability is concerned with the accuracy of

the actual measuring instrument or procedure,
validity is concerned with the study's success at
measuring what.
 Construct Validity Types
Construct
Translation Validity Criterion-
Validity related Validity

Face Predictive
Validity Validity
Content Concurrent
Validity Validity
Convergent
Validity
Discriminant
Validity
Inter- or Intra-Observer
Reliability
 Reliability
• Is the extent to which two or more
individuals (observers or raters) agree.
• Inter-Rater reliability addresses the
consistency of the implementation of a
rating system.
 Observed Score
Observed Score = true score + systematic error +
random error
• Observed Scores are the data gathered by the
researcher.
• True Scores are the actual unknown values that
correspond to the construct of interest.
• Systematic Error/bias is variations that results from
constructs of disinterest (affects the average), can result
in incorrect estimates and conclusions.
• Random Error is nonsystematic variations in the
observed scores (doesn’t affect the average, only
variability around the average).
 Observed Score =

Systematic Error
True Score Random Error

More Reliable:

Less Reliable:
 Types of Errors
• Systematic Error
– Any variable causing a consistent shift in
the mean in a given direction
e.g. Retrospective diet records tend to omit the
snacks between meals

• Random Error
– The fluctuation of scores due to chance
e.g. Innaccurate descriptions of the food consumed
Akurasi & Presisi
 160
Direct Record This variability
140
between methods is
caused by both
120 Retrospective systematic and
Recall
Number of People

error factors
100

80

60

40

20 SD
0

1500 2500 3500 4500 5500

Energy Intake (calories per day)

 Assessment of Error
• Systematic
& Random
Error
Multiple Food Recall 24h FFQ
10.00 17.00
12.00 22.00
8.00 14.00
11.00 12.00
14.00 11.00
18.00 15.00
10.00 21.00
9.00 17.00
 Assessment of Error
• Systematic &
Random Error
MFR24H FFQ Difference Mean
10.00 17.00 7.00 13.50
12.00 22.00 10.00 17.00
8.00 14.00 6.00 11.00
11.00 12.00 1.00 11.50
14.00 11.00 -3.00 12.50
18.00 15.00 -3.00 16.50
10.00 21.00 11.00 15.50
9.00 17.00 8.00 13.00
 Assessment of Error
• Systematic & 

Random Error 10 .0 0 

The “Bland-Altman” Plot 



3 points of visual assessment:

differences
5.00

Mean = 4.63
-Systematic Error: are points evenly
distributed about the zero line? 

0.00

-Random Error: do points deviate

greatly from the mean line?  

12 .0 0 14 .0 0 16 .0 0

-Nature of error: is the error Me an

consistent left-right?
Examples of Bland-Altman Plots
10 .0 0

Very Little Systematic Error

differences

5.00

Very Little Random Error

0.00 Zero
Mean difference

12 .0 0 13 .0 0 14 .0 0 15 .0 0 16 .0 0

Me an
Examples of Bland-Altman Plots
10 .0 0

Some Systematic Error

Very Little Random Error
differences

5.00

Mean difference

0.00 Zero

12 .0 0 13 .0 0 14 .0 0 15 .0 0 16 .0 0

Me an
Examples of Bland-Altman Plots
10 .0 0

Very Little Systematic Error

Some Random Error
differences

5.00

0.00 Zero
Mean difference

12 .0 0 13 .0 0 14 .0 0 15 .0 0 16 .0 0

Me an
Examples of Bland-Altman Plots
10 .0 0
differences

5.00
Mean difference

0.00
Some Systematic Error Zero

Some Random Error

12 .0 0 13 .0 0 14 .0 0 15 .0 0 16 .0 0

Me an
Examples of Bland-Altman Plots
10 .0 0

Nature of Error:
Funnelling Effect?
differences

5.00

0.00 Zero

12 .0 0 13 .0 0 14 .0 0 15 .0 0 16 .0 0

Me an
 Minimize measurement error
• To pilot test your instruments, getting
feedback from respondents
– regarding how easy or hard the measure was
and information about how the testing
environment affected their performance.
• To train interviewers or observers them
thoroughly.
• To double-check the data thoroughly.
– All data entry for computer analysis should be
"double-punched" and verified.
 Minimize measurement error
• To use statistical procedures to adjust for
measurement error. These range from
rather simple formulas you can apply directly
to your data to very complex modeling
procedures for modeling the error and its
effects.
• To use multiple measures of the same
construct. Especially if the different
measures don't share the same systematic
errors, you will be able to triangulate across
the multiple measures and get a more
accurate sense of what's going on
Validity of Food Consumption
Survey
 The main limitation of food
consumption surveys is that they
depend on:
 accurate report or recall of food quantity
 type by the participants in the study.
 The quality of nutrient & energy
values depends on:
 the quality & accuracy of food
consumption tables.
 SOURCES OF ERROR IN THE METHODS FOR
ASSESSING INDIVIDUAL DIETARY INTAKES

Ferro-Luzzi, A. (2003). Individual food intake survey methods. FAO.

Daily Fluctuation of Food Intake
 Daily fluctuation (quantity, type of food) are
large
 Some survey protocols 24-hour intake
should be recorded only between Monday
till Friday
 On weekend→many people alter their food
consumption
 Variation on appetite, activity or work load,
time schedule (exercise, party,etc) and
many factors influence intake, so it can be
expresion an average day intake.
 Gold Standard
• There may also be challenges in determining a
“gold standard” for the assessment of dietary
intake.
• Since validation studies are defined as “a study
conducted to compare a dietary assessment
instrument to a reference”, it is not possible to
establish true validity (Gibson 2005).
• In the absence of such an accepted reference,
therefore, generally the researchers relied on
food weights to establish the accuracy of
dietary assessment tool.
 Gold Standard – Doubly Labeled Water
→isotop yang memiliki elemen hidrogen
dan oksigen.
→Hidrogen dan beberapa ion oksigen
dari DLW dieliminasi sebagai
bagian molekul di urin, sedangkan
jumlah O2 diekspirasi sebagai bagian
dari molekul CO2.
→Karena jumlah oksigen yang sama
dieliminasi sebagai air dan CO2,
pengukuran isotop hidrogen dan
oksigen pada cairan tubuh dapat
digunakan untuk menentukan
produksi CO2.
 Gold Standard – Doubly Labeled Water

= Pengukuran
pengeluaran energi yg
didasari oleh
pemberian 2 dosis
isotop air yang stabil
yaitu 2H2O & H218O.
• Kedua jenis isotop ini
digunakan sebagai
tracer (pelacak).
• Dapat diukur pada
berbagai cairan tubuh,
seperti urin.
 Gold Standard – Doubly Labeled Water
• Perbedaan laju pengeluaran
kedua tracer menunjukkan
laju produksi karbondioksida.
• Dengan diketahui oksidasi
bahan campuran ini maka
pengeluaran energi dapat
dihitung.
• Pengeluaran energi diukur
dari output CO2 setiap hari &
pergantian isotop dalam urin
untuk mengetahui total cairan
tubuh.
Gold Standard – Doubly Labeled Water
 FFQ Validation
• Methods used to validate FFQs
include:
– multiple 24-hour recalls
– food records (weighed & estimated)
– biomarkers
• Special attention is required to ensure
that measurement days captured by
the records or recalls reflect the time
frame covered by the FFQ,
– since some FFQ time frames can cover
up to one year (Willett et al., 2013).
 FFQ Validation (cont’)

• Though a weighed food record is the preferred

validation method, it is not error free.
• A weighed food record is more valid and precise
than 24-hour recall to validate FFQ.
• However, when the study participants are
illiterate, the use of multiple 24-hour recalls is
more appropriate than a weighed food record,
despite the weaker correlations
– because both FFQ and 24-hour recall rely on memory
and estimation of portion size.
•
 Validation Study of FFQ
• The reproducibility & validity of a self-
administered 130-item FFQ was assessed
against:
– biomarkers in urine (nitrogen, potassium, and
sodium) and blood (plasma ascorbic acid)
– compared to a 7-day food record.
• For validity, the correlation between urinary
potassium and dietary potassium from the FFQ
was 0.33 and from the food record was 0.53.
• The authors concluded that food record provides
a better estimates of nutrient intakes than the
FFQ (McKeown et al., 2001).
 Factors related to FFQ development
that could influence validity

• The number of food items in the list.

This is partly determined by:
– the population characteristics
– study objectives
• The order of the food list, e.g. items of
particular interest should be placed at
the beginning of the questionnaire.
 Factors related to FFQ development
that could influence validity (cont’)
• The frequency & portion size
responses. These should be close-
ended rather than open-ended, to
minimize errors in coding and
transcription.
• The time frame of the recall period.
• The mode of administration.
• Data entry & computation once the
survey is complete.
 A 24-Hour Recall Validation
• A single weighed food record may be
considered as a validation method against
a 24-hour recall (Gibson, 2005).
• A number of studies have reported good
agreement between the methods of:
– 24-hour recall VS one day weighed record
with trained observers
– 24-hour recall VS biomarkers (Thompson et
al., 2013).
 Validation Study of a 24-hour
Recall
• Estimates from a multiple-pass
interactive 24-hour recall in rural
Ethiopian women have been compared
with estimates from weighed food records
(Alemayehu et al., 2011).
• Their results showed that the median
daily intakes of energy and most
nutrients obtained were lower when
measured by 24-hour recall than by
weighed food record (P<0.05).
 Validation Study of a 24-hour
Recall (cont’)
• Furthermore, negative bias for energy
and nutrient intake were confirmed by
Bland–Altman plots.
• The two methods were not comparable
in this setting: a result which could be
attributed to the poor portion size
estimation.
Validation Study of a 24-hour Recall
(cont’)
• Scagliusi et al. (2006) conducted a study
measuring the level of underreporting of
energy intakes in a female Brazilian
population, using the doubly-labelled
water (DLW) method to validate a 3-day
multiple pass 24-hour recall.
• The energy intake measured by the multiple-
pass 24-hour recalls presented a significant
difference compared to energy
expenditure measured by doubly-labelled
water (p<0.0001).
Validation Study of a 24-hour
Recall (cont’)
• Therefore, 24-hour recall was
shown to underestimate energy
intake.
• The authors noted that the outcome
of the study could be related to
the methodological approach:
– number of recall days
– portion size estimation
– measurement aids
– food composition tables.
 Dietary History Validation
• Compared to other assessment methods,
there are a limited number of studies in
validating dietary history as it is often
used as a reference method to validate
other methods of dietary assessments,
e.g. 24-hour recall and FFQ
(Thompson et al., 2013).
 Validation Study of Dietary History

• A validation study by Mensink et al. (2001),

compared the results from the computerized
version of dietary history, DISHES 98, compared
against a 3-day weighed dietary record & 24-
hour recall.
• For most nutrients measured, the mean intakes
recorded by DISHES 98 were lower than
those measured by the 3-day weighed food
records with an average Pearson’s correlation
coefficient of 0.51.
Validation Study of Dietary History (cont’)
• DISHES 98 were compared with a 24-hour
recall, presenting an average Pearson’s
correlation coefficient of 0.46.
• The similarity observed could be due to the
tendency of 24 hour-recall & dietary history
to be influenced by similar error sources
→ since they both rely on the memory of the
respondent.
• The authors concluded that the validity of
DISHES 98 was deemed comparable to
those of other dietary histories
• → the method was valid for assessing dietary
intake (Mensink et al., 2001).
Validation Study of Dietary History (cont’)

• Hagfors et al. (2005) conducted a

validation study to compare the results of
a dietary history to estimate energy,
protein, sodium and potassium intakes
against bio-markers.
• Protein, sodium & potassium estimates
were compared with respective markers
from a 24-hour urine sample
→ good agreement was observed (r=0.58).
Validation Study of Dietary History (cont’)

• Overall, the authors noted that dietary

history methods are adequate in
assessing dietary intake.
• However, due to the small sample size of
the study, (n=32), results could not be
generalized.
Weighed Food Records Validity
• Weighed food records are considered the
gold standard against which other dietary
assessment methods are validated;
→therefore, their relative validity cannot be
assessed via other direct assessments
(Gibson, 2005).
Validation Study of Weighed
Food Records
• The validity of a 16-day weighed
record to measure habitual food
intake was compared against the 24-
hour urine nitrogen technique in
women aged 50–65 years in the UK.
• Correlation between dietary & urinary
nitrogen estimates was 0.69
(Bingham et al., 1995).
.
 The relationship between weighed records
and other potential biomarkers (i.e.
potassium and vitamin C)
• Showed relatively high correlation
between 24-hour urine potassium
excretion and dietary potassium intake
(r=0.73), and between plasma vitamin C
and dietary vitamin C (r=0.86), among
others.
• The authors concluded that weighed food
records provided an accurate estimate
of energy and nutrient intakes (Bingham
et al., 1995).
Innovative technologies to improve dietary
assessment
Diagram of the Technology Assisted Dietary Assessment (TADA)
system that starts with capturing an image with the mobile food record
(mFR)

(Khanna et al., 2010. An overview of the technology assisted dietary

assessment project at Purdue University, Multimedia (ISM), 2010 IEEE
International Symposium on IEEE. pp. 290—295)
Validation study of innovative technologies
to improve dietary assessment
• Lassen and colleagues (2010) have developed
an image-based food record.

• Example of images from the reference material (½ and 1 unit,

respectively, of five different vegetable items from twodifferent plate-
angles).
Validation study of innovative technologies
to improve dietary assessment (cont’)
• A total of 23 participants (11 women and 12
men) were instructed to:
– take images of evening meals for five consecutive
week-days
– provide recipes according to the digital method
procedure.
– weigh & record individual foods within the meals
separately using a Soehnle 8026 digital balance
(0 1,000g1 g, 1,000 2,0002 g).
• Beverages were not included in the analysis.
• The instruction took place at the participants’
homes or another location convenient to them.
 Training of Analysts
• Two image analysts working within the area of food
and nutrition were trained in portion size
estimation.
1. They were provided with reference charts
containing information about typical portion sizes of
different foods
– They were asked to estimate portion sizes in grams of
individual foods (spread, bread, filling, garnish,
vegetables, pasta, rice, potatoes, and meat dishes).
• As part of the training, the computer provided the
image analyst with the correct answer after each
weight estimation.
 Training of Analysts (cont’)
2. The image analysts were asked to
estimate the weights of individual
foods within various dishes, including
the 10 evening meals (data from two of
the participants) on the basis of the
reference database.
→ were estimated independently by the two
image analysts.
Validation study of innovative technologies
to improve dietary assessment (cont’)
• This method was validated against weighed food
records of evening meals, with a negative
difference of 11.3 percent for energy intake
(P<0.001).
• Intraclass correlation in the present study
showed good agreement between image
analysts (intraclass-correlation coefficient: 0.96).
→ High correlations between the image-assisted
methods & weighed food records.
Validation study of innovative technologies
to improve dietary assessment (cont’)
• In the Bland–Altman plots analysis, acceptable
limits of agreement between the methods were
found for both energy and nutrient intakes.
• This indicated that differences were random
without systematic bias (Lassen et al., 2010).
 Validation study of innovative technologies
to improve dietary assessment (cont’)
• It was suggested that by improving the
quality of the photos it might be possible
to reduce the differences.
• Image-assisted dietary assessment
methods are promising to enhance the
accuracy of some traditional self-reported
dietary assessment methods
– although there is still room for improvement in
accuracy.
Lassen et al (2010). Evaluation of a digital method to assess
evening meal intake in a free-living adult population. Food &
nutrition research, 54(1), 5311.
Validation study of innovative technologies
to improve dietary assessment (cont’)

• Nevertheless, the different technologies

and alternatives available in the literature
need to be adjusted according to:
– the characteristics of each study area
– validated before their actual application
 PENGGUNAAN METODE FOTO DIGITAL UNTUK
PEMANTAUAN ASUPAN MAKANAN PASIEN DI RUMAH SAKIT
Pemantauan Asupan Makanan
Pasien RS
METODE PENIMBANGAN
METODE ESTIMASI VISUAL
MAKANAN
(+) akurat (+) Cepat dan lebih mudah
(-) rumit, lama, harus dikerjakan
tersedia alat (timbangan)) (-) tidak fleksibel
• Mudah dan cepat
METODE FOTO • Tidak bergantung pada daya ingat pengamat
DIGITAL • Mengurangi gangguan pada tempat pelayanan
makanan,
• Estimasi dapat dilakukan oleh lebih dari satu
orang penilai
• Hasil foto dapat disimpan dan digunakan kembali

Tujuan Penelitian: Mengevaluasi metode foto digital dibandingkan dengan

observasi langsung dalam pemantauan asupan makanan pasien

Budiningsari dkk, 2020

Metode Penelitian
Metode Foto Digital

Peneliti mengambil foto

Peneliti mengambil
sisa makanan sampel
foto makanan pasien
dan mencatat data diri
untuk setiap jenis diet
pasien

Ahli Gizi di setiap

bangsal mengamati
sisa makanan pasien
menggunakan metode
Foto Digital post meal
dan pre-post meal

Hasil estimasi ahli gizi akan

masuk ke dalam software
yang dapat mengkonversi
secara otomatis asupan
energi dan protein
 Dua Metode Foto Digital
Pre-Post Meal Post Meal
Estimasi Asupan Makanan Pasien Menggunakan
Metode Foto Digital Pre-Post Meal Dibandingkan
dengan Penimbangan
Jumlah Pasien Distribusi Estimasi (%)
yang
Tingkat Estimas Agreemen
Mengkonsums
Asupan i yang t beyond
i di Setiap 10
Makanan 0 25 50 75 Benarb Chance
a Tingkat 0
(%) ()
Asupan
Makanana
Makanan Pokok Nasi (n=96)
0% 2 1b 1 0 0 0 50.00 .710*
13
25% 16 1 b 2 0 0 81.25
19
50% 25 0 4 b 2 0 76.00
16
75% 26 0 1 2 b 7 61.54
b
100% 27 0 0 0 1 26 96.29
Lauk Hewani (n= 96)
0% 1 1b 0 0 0 0 100.0 .683*
25% 11 1 6b 2 0 2 54.54
50% 7 0 2 3b 1 1 42.86
75% 13 0 0 2 8b 3 61.54
100% 64 0 0 1 0 63b 98.43
Lauk Nabati (n= 96)
19
0% 24 b 4 0 0 1 79.17
b
25% 12 5 3 3 1 0 25.00
.618*
50% 12 1 0 7b 1 3 58.33
75% 8 0 1 2 3b 2 37.50
100% 40 1 0 1 0 38b 95.00
Sayur (n= 96)
0% 23 8b 6 7 2 0 34.78 .344
25% 21 1 9b 5 5 1 42.86
50% 24 3 4 8b 5 4 33.33
75% 8 0 1 3 2b 2 25.00
100% 20 0 0 1 0 19b 95.00
a
Berdasarkan metode penimbangan
b
Jumlah perkiraan akurat pada levl asupan ini
* Signifikan (P<0.001)
Estimasi Asupan Makanan Pasien Menggunakan
Metode Foto Digital Post Meal Dibandingkan
dengan Penimbangan
Jumlah Pasien Distribusi Estimasi (%)
yang
Tingkat Estimas Agreemen
Mengkonsums
Asupan i yang t beyond
i di Setiap 10
Makanan 0 25 50 75 Benarb Chance
a Tingkat 0
(%) ()
Asupan
Makanan a
Makanan Pokok Nasi (n=96)
0% 2 1b 1 0 0 0 50.00 .693*
12
25% 15 0 b 2 1 0 80.00
19
50% 24 0 2 b 2 1 79.17
14
75% 27 0 0 5 b 8 51.85
b
100% 28 0 0 0 0 28 100.0
Lauk Hewani (n=96)
0% 1 1b 0 0 0 0 100.0 .659*
25% 9 3 3b 1 0 2 33.33
50% 9 0 1 6b 0 2 66.67
75% 14 0 0 7 7b 0 50.00
100% 63 0 0 1 0 62b 98.41
Lauk Nabati (n= 96)
20 .649*
0% 24 b 1 2 0 1 83.33
25% 12 7 3b 0 1 1 25.00
50% 12 1 2 9b 0 0 75.00
75% 8 0 0 3 3b 2 37.50
100% 40 2 0 1 0 37b 92.50
Sayur (n= 96)
13 .353*
0% 22 b 3 5 0 1 59.09
25% 22 4 6b 8 4 0 27.27
50% 23 2 3 7b 7 4 30.43
75% 8 0 0 4 1b 3 12.50
100% 21 1 0 0 0 20b 95.24
a
Berdasarkan metode penimbangan
b
Jumlah perkiraan akurat pada level asupan ini
*
Signifikan (P<0.001)
 Derajat Persetujuan antara Metode
Comstock, Pre-Post Meal dan Post Meal
dengan Metode Penimbangan
Agreement
Metode beyond Chance
()
Penimbangan vs. Comstock 0,727*
Penimbangan vs. Pre-Post Meal 0,684*
Penimbangan vs. Post Meal 0,809*
*Signifikan (P<0.001; analisis Cohen’s Kappa )

< 0 menunjukkan tidak ada persetujuan (none)

0.01 – 0.20 menunjukkan sedikit (slight)
0.21 – 0.40 menunjukkan cukup (fair)
0.41 – 0.60 menunjukkan sedang (moderate)
0.61 – 0.80 menunjukkan besar/kuat (substantial)
0.81 – 1.00 menunjukkan derajat persetujuan sempurna
 Bland Altman Plots
Pre-Post Meal VS FW Post Meal VS FW
 Kesimpulan
1. Metode foto digital dapat menggantikan
Metode Comstock dalam mengestimasi
sisa makanan pasien di rumah sakit.
2. Metode foto digital post meal memiliki
derajat persetujuan yang sedikit lebih
baik terhadap metode penimbangan
dibandingkan metode foto digital pre-post
meal.
 Saran
• 1. Metode foto digital pre-post meal atau post
meal disarankan untuk dapat diterapkan RS
– untuk meningkatkan ketersediaan data
pemantauan asupan makan pasien yang dapat
diakses kapan pun, di mana pun, dan oleh siapa
pun.
• 2. Foto plato disarankan untuk dapat diambil
oleh pramusaji yang sebelumnya sudah
diberi pelatihan mengenai SOP pengambilan
dan pengunggahan foto plato,
– yaitu dengan mempertimbangkan pencahayaan
yang optimal untuk meminimalkan gangguan
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 References (cont’)
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Terima Kasih