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Methodological issues in the estimation of the prevalence of undernourishment based on dietary energy consumption data: A review and clarification












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    The Probability Distribution Framework for estimating the Prevalence of Undernourishment
    Exploding the Myth of the Bivariate Distribution
    2007
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    In his pioneering study carried in the early 1960’s, Sukhatme had formulated the estimate of the prevalence of undernourishment in a population within a bivariate distribution framework where dietary energy consumption (DEC) and dietary energy requirement (DER) are considered as random variables. The evaluation of the formula required the specification of the joint distribution of DEC and DER. In the absence of data on the joint distribution Sukhatme had, as an approximation, formulate d the estimate within a univariate distribution framework involving the distribution of DEC and a cut-off point reflecting the lower limit of the distribution of DER. FAO’s methodology for estimating the prevalence of undernourishment has been traditionally based on this univariate distribution framework. However, since this approach appeared to ignore the risk of undernourishment at DEC levels overlapping the range of variation of requirement, it has been criticised as yielding an und erestimate of the magnitude of the problem of undernourishment. In view of this some analysts have attempted to apply the bivariate distribution framework by modeling the joint distribution of intake and requirement. Others have applied the univariate distribution framework but used the average DER requirement rather than the lower limit of the distribution of DER as the cut-off point. All these attempts have led to very high estimates of the prevalence of undernourishment. In further studies undertaken in the 1970’s Sukhatme has attempted to justify the univariate distribution framework that he proposed earlier by postulating the theory of intra-individual variation in energy requirement which implies that an individual cannot be considered to be undernourished or overnourished as long as his or her DEC is within the range of variation of DER.
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    Refinements to the FAO methodology for estimating the prevalence of undernourishment indicator 2014
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    The FAO prevalence of undernourishment (PoU) indicator monitors progress towards Millennium Development Goal target 1C of halving, between 1990 and 2015, the proportion of people suffering from hunger. Estimates of the number of undernourished (NoU) - calculated by multiplying the PoU by the size of the reference population - are used to monitor progress towards the World Food Summit goal of reducing by half the number of people suffering from undernourishment. The PoU indicator is defined a s the probability that a randomly selected individual from the reference population is found to consume less than his/her calorie requirement for an active and healthy life. This paper reports on refinements to the methodology for estimating the Prevalence of Undernourishment that were adopted during the preparation of the State of Food Insecurity in the World Report 2014. The paper reviews the method adopted for selecting the functional form of the probability density function for the calculati on of the PoU, which uses a data-driven criterion. It proposes revised methods for estimating the variability (CV) and asymmetry (SK) parameters from available household survey, based on a leave-out-one cross validation approach. This approach is shown to be more conservative and stable across different country datasets than alternative methods. Following, the paper describes a regression approach for controlling for excess variability due to differences between food acquisition and consumptio n in surveys, which allows for a seasonality adjustment. Finally, the paper introduces an updated regression for computing variability measures in the absence of reliable household surveys, which incorporates the effect of food prices along with those of per capita income levels and inequality.
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    Undernourishment and critical food poverty: Indicators at national and sub-national levels 2009
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    Indicators to measure food poverty and undernourishment are useful for understanding food insecurity at national level and within countries. This paper discusses two indicators: proportion of undernourishment, and proportion of critical food poverty. Both indicators are based on nutritional underlying criteria and derived from food consumption and income data collected in national household surveys. Proportion of undernourishment is the Millennium Development Goals (MDG) indicator number 1.9, which is based on the distribution of dietary energy consumption (DEC); the proportion of critical food poverty is an indicator that links undernourishment to food poverty, based on the distribution of income (INC). The link is the concept of minimum dietary energy requirement (MDER) used in the FAO methodology as the cutoff value in the distribution of dietary energy consumption for estimating undernourishment. The critical food poverty line for estimating the proporti on of critical food poverty is the critical income corresponding to the cost of the MDER, based on a balanced diet on energy-yielding nutrients accessible to low-income population groups. The macronutrient-balanced diet uses the recommendations of a Joint WHO/ FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases (2002, Geneva) as its point of reference. Examples illustrate the results of both indicators for a sample of countries in different continents.

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