SEANUTS study design and methodology
Child health and nutrition in four countries
In order to collect up-to-date health and nutritional data, well-designed nationwide surveys are necessary. In 2009, the multinational food company Royal FrieslandCampina commissioned SEANUTS to gain better insight into dietary imbalances that result in over- or undernutrition of children. In each of the four participating countries (see table 1 for countries, institutes and principal investigators), children aged 0.5-12 years were recruited using a randomized multistage cluster or stratified random sampling methodology. Trained field teams were responsible for recruitment and data collection.
Table 1: Institutes and principal investigators per country
|Indonesia||PERSAGI (Indonesian Nutrition Association)||Dr. Sandjaja|
|Malaysia||Universiti Kebangsaan Malaysia||Dr. Poh Bee Koon|
|Thailand||Mahidol University Thailand||Associate Prof. Nipa Rojroongwasinkul|
|Vietnam||Vien Dinh Duong (National Institute of Nutrition)||Dr Le Nguyen Bao Khanh|
Nutrition and health status of children was assessed using data on growth and body composition, physical activity, bone quality, development and cognition, food intake and food habits, and biochemical status of iron, vitamins A and D. In Thailand, the researchers also studied the lipid profile in blood, whereas in Indonesia, iodine excretion in urine was analyzed. All assessments were carried out using standardized and validated methods. Biochemical data were analyzed in certified laboratories. The study protocols and methodology were aligned where practically possible. Reference standards used for the various health and nutrition parameters are shown in table 2.
Table 2: Standards used for data reporting
|Type of data||Standards used|
|Biochemical parameters||WHO standards (where available) or internationally accepted standards|
|Dietary intakes||Local RDA and FAO/WHO RDIs|
|Physical activity levels||European standards*|
|Development and cognition||International standards established per test|
*local or Asian standards are not available
In total, 16,744 children participated in this study. An overview of age groups per country is presented in table 3. The number of participants to be included was based on the potential occurrence of anemia (18-25%), and/or vitamin A deficiency (19-22%), and/or being underweight (9-18.4%), depending on likely nutritional problems per country.
Table 3: Overview of sample size per country, per age group
|Age (years)||n||Age (years)||n||Age (years)||n||Age (years)||n|
Age categories between the countries differ because the usual local age categorisations were used
The data produced as a result of SEANUTS depict the current nutrition and health status of children in South East Asia. Leading SEANUTS scientist, Dr. Panam Parikh says: “It is the scale and magnitude of SEANUTS which makes it unique. The assessments in this survey included dietary intakes, food habits, nutritional status, growth, body composition, physical activity, and cognitive development and performance – all in a country-representative sample of infants and children between the ages of six months and twelve years. This information serves as an evaluation of the ongoing efforts to counter malnutrition in the region, and as a tool to identify areas and age groups most at need of intervention.”
Schaafsma A et al. Design of the South East Asian Nutrition Survey (SEANUTS): a four-country multistage cluster design study. British Journal of Nutrition (2013), 110, S2–S10.