Healthcare Study: Nutrient Intake and Physical Activity Assessment

This study focuses on the assessment of nutrient intake and physical activity in healthcare. It analyzes the dietary intake of calcium, iron, folate, vitamin C, and zinc through food records and questionnaires. The study also examines the relationship between energy intake and expenditure. The results show the percentage of the population at risk of nutrient deficiencies and the distribution of macronutrient intake. The study provides valuable insights into the importance of nutrition and physical activity in healthcare.

Running head: HEALTHCARE
Healthcare
Name of the Student:
Name of the University:
Author Note:

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Contents
Introduction......................................................................................................................................2
Methodology....................................................................................................................................3
Result...............................................................................................................................................5
Discussion......................................................................................................................................14
Conclusion and Recommendation.................................................................................................17
Reference.......................................................................................................................................18

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Introduction
The rationale or the background of the study states that physical activity has several
benefits for a person’s health. Physical activity helps a person stay healthy and have a health
body with reduced risk of fractures of bone occurring from the osteoporosis. Unhealthy body
also have increase amount of risks from heart diseases, and other serious illness like cancer. For
majority of the people, it is necessary to participate in the physical activity (1). Whereas,
nutrition also plays a major role in the physical activity because proper nutrition provides the
adequate amount of energy for maintaining a healthy body. A balanced diet means eating
according to the number of servings and it includes each and every food group for majority of
the days. The scientific rationale for nutrition and physical activity assessment will help in
gaining a stronger understanding of physical activity, nutrition through the anthropometric
techniques of assessment (2). The information is presented is a short communication format so
that that it will be easily understandable and will also help in interpretation of the results. The
overall objective of the study is to estimate the dietary intake (calcium) at the individual level
through the short food frequency questionnaire; to compare group dietary intake and individual
dietary intake data with that of the Australian population norms and dietary recommendations; to
compare the relationship between the intake of energy and expenditure results; determination of
the relationship of the energy expenditure with the mean energy intake and the BMI distribution;
to estimate the composition of the body weight with that of circumference, skinfolds, height and
weight and provide a comparison with that of percentage of body fat. Thus, the overall objective
of the study is mainly focused on the nutrient intake and the physical activity through the
different methodologies and procedures.

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Methodology
A total of 212 participants were initially selected and each and every one of the
participants entered data into the online databases. Among the 212 students, 35 male students
supplied data but were excluded from the analysis. Whereas, 3 females provided an incomplete
food works data and they were excluded from the study. Finally, valid data were collected from a
total of 173 female students that have an average age of 23.7 years with a standard deviation of
5.3. The age of the participants ranged from 19 to 56 years. For making comparison between the
recommendations, norms and the data, the age category of 18 years or above, and 18-30 year
categories are also used.
In the first assessment Food Frequency Questionnaire (FFQ) includes a finite list of the
beverages and food and it indicates the frequency of the food consumption over a period of time.
FFQ are used to analyse the examine the association between the health and diet and other
variables. In addition to the beverages and food items, FFQ also asks about the dosages and the
frequency of the intake of the dosages. Especially when the literacy is low, FFQ are administered
occasionally, and is usually self-administered. The completion of the questionnaire takes a time
period of about 30 to 60 minutes. FFQs can be used for the studies that are large prospective
studies. If the FFQ encounters systematic errors, then a less biased form of the instrument can
also be used (3). 3-day food record is another techniques of recording accurate description of the
food related data based on a typical form of diet. It is also recommended that during the record
keeping procedure it is important not to make any kind of changes in the diet plan. Furthermore,
it is recommended that the record keeping must be as accurate as possible and it must include the
beverages and food that a person is drinking or eating. The record keeping also demands
description of the food preparation (4). Active Australia Survey (AAS) is a survey which is

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designed to measure the participation of the people during the leisure activity. Furthermore, it
assesses the current health measures and its associated knowledge, also the health benefits
associated with the physical activity. The survey presents a set of questions that can be easily
implemented through a face to face interview, interviewing technique called the computer
assisted telephone interview. A manual is also provided with the survey which provides an
overview of how to conduct the survey. AAS takes into account of the one week of interview
before the survey is conducted. Furthermore, it consists of walking by transport. The survey
consists of 8 questions and assesses the participation into the various types of activity (5). 3-day
Physical activity diary is a novel of keeping the record of the daily physical activity over a 3-day
period of time (6). Anthropometry can be described as a correlation of measurements or
collection of a human body. One of the principle technique is the physical anthropometry and it
includes the measurements of the mid-upper arm circumference, waist circumference, height and
body weight. The anthropometric methodology is followed and is a practical indicator of the
body composition so that undernutrition can be identified within the community that is obese (7).
The statistical methods used in the study includes a paired t-test and along with it Pearson
correlation is used to assess the relationship between the percentage of the body fat measured
and other parameters like the EE, BIA and skinfolds. It is measured through the Active Australia
survey and physical activity diary.
The statistical software used for the study is the STATA SE 14 software which is made
by the StatCorp LP, USA (8). The statistical significance was indicated and it has been found to
be p<0.05. The differences between the means of various assessment is found through the paired
t-test. Correlation is measured using the Pearson correlation coefficient and the micronutrient

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intake inadequacy is measured by an EAR-cut point method (for the zinc, vitamin c, folate and
calcium) and full probability approach is followed (for iron).

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Result
Table 1: Descriptive statistics for the nutrient intake.
Statistic
Energy
intake
(kJ/d) -
3 day
food
record
Daily %
energy
from
fat - 3
day
food
record
Daily %
energy from
carbohydrat
e - 3 day
food record
Daily %
energy
from
protein
- 3 day
food
record
Daily
%
energy
from
alcoho
l - 3
day
food
record
Calciu
m
intake
(mg/d)
- 3 day
food
record
Iron
intake
(mg/d
) - 3
day
food
record
Folate
intake
(ug/d)
- 3 day
food
record
Vitami
n C
intake
(mg/d)
- 3 day
food
record
Zinc
intake
(mg/d
) - 3
day
food
record
FFQ
Calciu
m
(mg/d)
FFQ Dairy
(serves/d
)
Number (N) 173 173 173 173 173 173 173 173 173 173 173 173
mean 7525.5 33.5 40.1 21.2 1.0 726.9 11.7 391.2 105.1 10.9 630.7 2.1
standard
deviation
(SD) 2421.1 9.0 11.3 8.2 2.7 344.3 5.8 180.1 72.1 7.7 447.6 1.5
standard
error (SE) 184.1 0.7 0.9 0.6 0.2 26.2 0.4 13.7 5.5 0.6 34.0 0.1
p25 5990.0 29.0 34.0 17.0 0.0 535.0 8.0 257.0 57.0 7.0 318.0 1.1
p50
(median) 7257.0 33.0 40.0 20.0 0.0 708.0 11.0 374.0 91.0 9.0 511.0 1.7
p75 8669.0 39.0 46.0 23.0 0.0 881.0 14.0 487.0 132.0 12.0 935.0 3.1
Interquartil
e range
(IQR) 2679.0 10.0 12.0 6.0 0.0 346.0 6.0 230.0 75.0 5.0 617.0 2.1
min 2010.0 8.0 11.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
max 16674.0 69.0 97.0 87.0 15.0 2373.0 46.0
1000.
0 406.0 50.0 2131.0 7.1

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The estimated average requirement (EAR) is the mean of the population and the mean of
the population needs for a nutrient. The recommendations for the nutrient references value for
the age group of 19 to 30 years. Calcium is 840 mg/day, Vitamin C is 30 mg/day, Folate is 320
micrograms/day, Zinc for women participants is 6.5 mg/day, and Iron is 8 mg/day.
Table 2: percentage of the class population that have the risk of deficiency from the various
nutrients
Using 3 day food record
Number below EAR % below EAR Method
Calcium 118 68.21% Cut-point method
Folate 61 35.26% Cut-point method
Vitamin C 17 9.83% Cut-point method
Zinc women 34 19.65% Cut-point method
Iron Women 87 50.33%
Using Probability approach for iron(see
below)
Total 173 87.07
Divide by N=173
(87.07/173) x 100
50.33
From, the above data it has been seen that the 50.33 percent of the female population
have a risk of iron deficiency.
Table 3: Difference between the calcium uptake analysed by the 3-day food record and FFQ:
paired t test
Variable Number Mean Std. Err. Std. [95% Interval]

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(N) Dev. Conf.
FFQ Calcium intake
(mg/d)
173 630.7 34.0 447.6 563.5 697.9
3-day food record
Calcium intake
(mg/d)
173 726.9 26.2 344.3 675.3 778.6
Difference 173 -96.2 35.0 460.3 -165.3 -27.1
T= -2.74, degrees of freedom=172, P-value=0.001
The p-value has been found to be 0.001 and the differences between the means that are
obtained from the 2 methods implies that the 3-day food record has a high mean value in
comparison to the FFQ calcium intake. The major difference of 96 has been found between the
3-day food record and FFQ calcium intake. This means that the calcium intake is much higher in
the 3-day food record and the participants have consumed food that had high percentage of
calcium.
Figure 1: correlation between the 3-day food calcium intake and FFQ calcium intake

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Table 4: percentage of the class population presents the percentage of people that are meeting or
are above the recommended daily intake.
Macronutrient (Recommended
Percentage of Daily Energy Intake)
Percentage Below
Recommended
Percentage
Above
Recommended
Percentage
Meeting
Recommended
Fat (20-35%) 5 39 56
Carbohydrate (45-65%) 68 2 30
Protein (15-25%) 9 20 71
Two remarkable part of the above data states that the carbohydrate consumption is well
below for the majority of the population. While the percentage of the people that are meeting the
daily recommended for protein consumption is 70 percentages. This percentage is well above
than the other macronutrient intake levels.
Figure 2: Nutrient uptake charts for the Iron and calcium

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Figure 3: Nutrient uptake charts for the Folate and Vitamin C
Figure 4: Nutrient uptake charts for Zinc
From the figure 3, 4 and 5 it can be said that the calcium, iron and folate intake in
properly distributed among the participants. While the Vitamin c and zinc intake shows a

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positive skew data. This means that majority of the people takes low amount of zinc and vitamin
c on an everyday basis.
Table 5: Descriptive statistics for the energy intake (KJ/day) collected from the energy
expenditure (KJ/d) and (3-day food diary and AAS) and energy balance (KJ/day)
Statistic
Energy intake
(kJ/d) - 3 day
diary
Energy
expenditure
(kJ/d) - 3 day
diary
Energy
balance (kJ/d)
Energy
expenditure (kJ/d)
- AAS
Number (N) 173 165 165 163
mean 7525 8290 -736 1098
standard deviation (SD) 2421 4242 4689 1054
standard error (SE) 184 330 365 83
p25 5990 6188 -3420 497
p50 (median) 7257 8774 -789 500
p75 8669 10270 1996 1326
Interquartile range (IQR) 2679 4082 5416 829
min 2010 275 -15592 104
max 16674 21950 11514 7236
Table 6: difference between the expenditure of energy assessed through the 3-day food diary and
AASQ: Paired t-test
Variable Number
(N)
Mean Std. Err. Std. Dev. [95%
Conf.
Interv
al]
AAS Energy
Expenditure kJ/d
156 1109.99 85.9 1073 940 1280
3-day diary Energy
Expenditure kJ/d
156 8287.67 336.7 4205 7623 8953
Difference 156 -7177.69 344.3 4301 -7858 -6497
T= -20.8445, degrees of freedom=155, P-value <0.001

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The p-values is found to be less than 0.001. The differences between the AAS energy
expenditure and 3-day food diary expenditure is that the 3-day food diary energy expenditure is
higher than the AAS energy expenditure. There is even a considerable difference of 7177.69.
Figure 5: correlation between the AAS energy expenditure and 3-day diary energy expenditure
Table 7: people that are currently meeting the physical activity recommendation using the AASQ
Number (total) 163
Number (≥ 480 kJ/d) 123
% ≥ 480 kJ/d 75.40%
From the above table it can be seen that the total number of people that are able to meet
the daily target of the physical activity is 480 KJ/day. Therefore, the number of the people that

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are able to meet the physical activity recommendation is 75.4 percent. While it is important to
mention that the physical activity recommendation for the adults is 150 to 300 minutes; moderate
form of the physical activity is 75 to 150 minutes across a single week. This overall adds to the
480 KJ/day.
Table 8: Description of statistics for anthropometric measurements
Statistic Height
(cm)
Weight
(kg)
BMI
(kg/m
2)
Waist
Circumferen
ce (cm)
%
body
fat
from
skinfol
ds
%
body
fat
from
BIA
Number (N) 173 173 173 170 170 164
mean 164.9 61.8 22.6 74.2 26.4 23.8
standard deviation (SD) 7.2 11.9 3.6 11.6 8.7 6.8
standard error (SE) 0.5 0.9 0.3 0.9 0.7 0.5
p25 160.0 54.0 20.2 69.0 23.0 19.0
p50 (median) 165.0 60.0 21.9 74.0 26.5 23.0
p75 170.0 66.0 24.1 80.0 30.0 28.0
Interquartile range
(IQR)
10.0 12.0 3.9 11.0 7.0 9.0
min 148.0 41.0 15.4 32.0 2.0 6.0
max 187.0 106.0 38.5 118.0 73.0 41.0
Table 9: Proportion of the adults by the BMI category according to the WHO BMI classification
BMI Category
Number
(N)
Percent (%)
Underweight <18.5 kg/m2 13 7.51
Healthy weight 18.5-24.99
kg/m2
128 73.99
Overweight =>25.00-25.99
kg/m2
24 13.87
Obese =>30.0 kg/m2 8 4.62

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Total 173 100
Table 10: Difference between the percentage of body fat assessed by the BIA vs. Skinfolds:
paired t-test
Variable Number
(N)
Mean Std.
Err.
Std. Dev. [95%
Conf.
Interva
l]
% body fat from
skinfolds
164 26.3 0.7 8.8 24.9 27.6
% body fat from BIA 164 23.8 0.5 6.8 22.7 24.8
Difference 164 2.5 0.7 8.7 1.2 3.8
T=3.67, degrees of freedom= 163, p-value= 0.003
The p-value is found to be 0.003. The difference between the percentage of body fat
assess from the skin folds and percentage of body fat assessed from BIA is 2.5. The mean value
of percentage of fat from body weight is more in comparison to the percentage of body from
BIA.
Table 11: proportion of the adults that have exceeded the WC (waist circumference) cut-points
WC Category Number
(N)
Percent (%)
WC <80 cm 127 74.7
WC=>80 cm 30 17.7
WC =>88 cm 13 7.7
Total 170 100.0
It is important to highlight that the people that are having a waist circumference of less
than 80 cm is 74.7 percent.

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Figure 6: correlation between the percentage of body fat from BIA and percentage of fat from
skinfolds
Discussion
The major findings of the study direct towards the fact that 87 women participants were
having iron deficiency. This means that 50.33 percent of the women were at risk from the iron
deficiency. Furthermore, the percentage of the participants that were below the recommended
percentage of the daily energy intake. The 3-day food record data shows that calcium, iron and
folate were taken in proper proportions. While the zinc and vitamin c showed a positive
skewness. the total number of people that are able to meet the daily target of the physical activity
is 480 KJ/day. Therefore, the number of the people that are able to meet the physical activity
recommendation is 75.4 percent. The anthropometric data showed that the 128 participants were
healthy and their percentage is 73.99. While the 127 people were having a waist circumference

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of less than 80 cm. The importance of the findings is that the intake of vitamin c and zin is below
the recommended levels and this can affect the healthy build-up of the body (9). This means that
a healthy nutrition or a healthy diet along with physical activity is helpful in attaining a healthy
body. Whereas, women majorly suffer from the deficiency of iron due to low intake of iron.
Physical activity and nutrition are the major determinants of health and the occurrence of disease
is positively related with the risk of weight gain, osteoporosis, type 2 diabetes, colon cancer,
hypertension, coronary heart disease, and premature mortality (10). Therefore, promotion of
health diet and physical activity significantly reduces the burden on life and at the same time
reduces the quality of life. While it is important to mention that the about 45 percentage of the
adults were less likely to achieve the health benefits and also the older adults are less likely to
participate in the physical activity (11).
The major limitations of the study are the small number of the sample size considered for
the study. increasing the number of the participants can increase the chances of generalizing the
results. It is important to mention that a bigger sample size can provide a bigger picture of the
scenario. The participants are selected randomly instead of any selection criteria and this limits
the production of effective data (12).
According to the Nutrient Reference Values and 2013 Australian Dietary Guidelines, the
recommended values of the dietary nutrient intake are as follows: vitamin C- men (220
microgram) and women (190 microgram); folate (300 to 600 microgram); protein intake (lower
intake is 15 percent of the energy, 25 percent of the energy for the upper end of energy intake);
fat (lower intake is 20 percent of the energy, 35 percent of the energy for the upper end of energy
intake); carbohydrate (lower intake is 45 percent of the energy, 65 percent of the energy for the
upper end of energy intake) (13).

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The Australian Health Survey report revealed that the 97 percent of the people consumed
food from the cereal or from cereal products. Eight out of 10 people consumed dished and food
products made from milk. 7 out of 10 people consume poultry, and meat products. 75 percent of
Australian population consumes the vegetable products and dishes. 60 percent of the people
consume fruit products. Carbohydrate formed the major part of the energy source, and it came
from fat, protein, alcohol, dietary fibre (14).
The energy intake and expenditure results reveal negative energy balance. The negative
energy balance on the long term will lead to muscle loss, weight loss, malnutrition, reduction in
bone mass, reduction in physical performance, inability to concentrate, reduction in the levels of
hormones (testosterone and thyroid) (15).
Total number of people that are able to meet the daily target of the physical activity is
480 KJ/day. Therefore, the number of the people that are able to meet the physical activity
recommendation is 75.4 percent. While it is important to mention that the physical activity
recommendation for the adults is 150 to 300 minutes; moderate form of the physical activity is
75 to 150 minutes across a single week. This overall adds to the 480 KJ/day. The proper
intervention of usage of pedometer and physical activity worked here (16). The two methods of
3-day food record and FFQ imply that the 3-day food record has a high mean value in
comparison to the FFQ calcium intake. The major difference of 96 has been found between the
3-day food record and FFQ calcium intake. This means that the calcium intake is much higher in
the 3-day food record and the participants have consumed food that had high percentage of
calcium and it occurred due to intake of calcium rich diet (17). The difference between the
percentage of body fat assess from the skin folds and percentage of body fat assessed from BIA
is 2.5. The mean value of percentage of fat from body weight is more in comparison to the

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percentage of body from BIA. The fat deposition is higher and is the primary place where fat is
stored (18).
Conclusion and Recommendation
From the above discussion it can be concluded that, 87 women participants were having
iron deficiency. This means that 50.33 percent of the women were at risk from the iron
deficiency. Furthermore, the percentage of the participants that were below the recommended
percentage of the daily energy intake. The 3-day food record data shows that calcium, iron and
folate were taken in proper proportions. While the zinc and vitamin c showed a positive
skewness. the total number of people that are able to meet the daily target of the physical activity
is 480 KJ/day. Therefore, the number of the people that are able to meet the physical activity
recommendation is 75.4 percent. The anthropometric data showed that the 128 participants were
healthy and their percentage is 73.99. While the 127 people were having a waist circumference
of less than 80 cm. Thus, it is suggested women must maintain a stable intake of 18 mg of iron so
that they do not suffer from anaemia, and low bone density. While the negative energy balance
suggests that the majority of the people on the long term will face health issues of loss of weight,
loss of muscle mass and major health implication. Therefore, the diet must have adequate
sources of food item that have sufficient energy content.

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