Could economic household surveys provide valid information to estimate nutrient adequacy of the diet? lessons from the Dominican Republic

Introduction: Household Consumption and Expenditure Surveys (HCES), periodical studies to assess economic situation of countries, have been used to measure availability of food supply, estimate dietary diversity, and identify foods for fortification. However, type and amount of micronutrients to add to fortified foods are usually unknown. This study offers a practical alternative to laborious food intake surveys for identifying micronutrient inadequacies. Methods: We estimated the nutrient density per each 1000 kcal of the household diet using the Dominican Republic HCES-2007. Food acquisitions were transformed into food weights and then nutrient availability was estimated using a country-adjusted Food Composition Table. Dietary nutrient density was then compared with the Estimated Average Requirements (EAR) of each nutrient adjusted for the average energy intake as estimated by INCAP for the Central American population. Percent of households whose diet had an insufficient nutrient density was estimated. Results: Nutrient density for calcium, zinc, and iron were highly inadequate for all strata; followed by vitamin A, folate, vitamin B-12, and riboflavin in inverse correlation with socio-economic status; vitamin C was inadequate only for the two poorest strata; and thiamin, niacin, and vitamin B-6 were sufficient. Discussion: Although this method assumes that individuals consume all family-available food and in proportion to their energy requirements, it provides a practical, periodical, and objective way to support decisions on micronutrient interventions for the whole population without the need of estimating food intakes. It may also become a useful screening method for communities where more direct nutritional assessments should be done.