Association between dietary diversity with overweight and obesity: A cross-sectional study conducted among pastoralists in Monduli District in Tanzania

The association between dietary diversity score and food insecurity and novel cardiovascular risk factors in type 2 diabetes mellitus patients: a cross-sectional study

Objectives

An efficient approach to monitor the risks associated with chronic diseases is to use a dietary diversity score (DDS). To our knowledge, there has been no study conducted on the correlation between DDS and cardiovascular risk factors in individuals with diabetes. Hence, the objective of this study is to ascertain the correlation between these traits.

Methods

In this cross-sectional investigation, 490 individuals with type 2 diabetes were included. The patients' food consumption was assessed using a 168-item food frequency questionnaire (FFQ), and a dietary diversity score (DDS) was computed. Traditional CVD risk variables were used to evaluate cardiovascular risk factors, including Castelli risk index 1 and 2 (CRI-I and II), atherogenic index of plasma (AIP), lipid accumulation product (LAP), and cholesterol index (CI). We evaluated the anthropometric indicators that predict CVD, including the abdominal volume index (AVI), body roundness index (BRI), and body shape index (ABSI).

Results

In the final model adjusted for all the considered confounders, there was a significant association between DDS and LAP (OR: 1.33; 95% CI: 0.61, 0.82; p-trend = 0.03). Moreover, there was a significant association between DDS and AVI (OR: 1.99; 95% CI: 1.17,3.35; p-trend = 0.04). We could not find any association between food security and DDS among the participants of the current study.

Conclusions

In the present study, it was found that DDS may result in higher LAP and AVI which are markers of abdominal obesity and cardiovascular diseases. Therefore, despite the probable positive effect of having a diverse diet on cardiovascular health and wide recommendations for that, using healthier food groups should be considered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01557-0.

Understanding the dynamics of malnutrition dichotomy in India: Trends and insights from the National Family Health Surveys

Purpose

India is confronted with a multifaceted malnutrition landscape, characterized by the coexistence of stunting, underweight, and escalating overweight and obesity rates. Current programs predominantly target undernutrition, overlooking the surging prevalence of overweight and obesity. These trends carry substantial economic ramifications, with obesity-related costs expected to rise significantly. Addressing these challenges requires enhanced policy execution and strategic collaboration. This article seeks to help overcome policy inertia in addressing the other end of the malnutrition spectrum-overnutrition.

Methods

The National Family Health Survey (NFHS), a large-scale survey conducted by the Ministry of Health and Family Welfare, Government of India, provides high-quality data on population dynamics and health indicators. Data for relevant health indicators were extracted from NFHS-3 to NFHS-5 to identify trends and shifting paradigms in malnutrition profiles. Data from the latest NFHS (NFHS-5) were briefly analyzed to highlight the malnutrition dichotomy and perform linear regression analysis.

Results

The data revealed a declining trend in stunting and underweight prevalence alongside a rise in overweight prevalence. Linear regression analyses on NFHS-5 data showed a positive association between literacy and obesity in both men and women. The findings also indicated that children fed with minimum dietary diversity were more likely to be overweight, and revealed a significant association between elevated random blood glucose levels and obesity in women.

Conclusions

By implementing the necessary interventions and strategies, India can establish a holistic approach to addressing both undernutrition and overnutrition effectively, thus contributing to Sustainable Development Goal-2 and paving the way for a healthier and more productive future for India's population.

The association between food production, food security, household consumer behaviour and waist-hip ratio amongst women in smallholder farming households in Kilifi County, Kenya

Food insecurity disproportionately affects smallholder farming households and within them women, who bear primary caregiving responsibilities and contend with time and resource constraints that heighten their vulnerability to adverse nutrition-related health outcomes. This study cross-sectionally investigates the association between food production practices, household consumer behaviour, and the experience of food insecurity with women's waist-hip ratio (WHR), a key indicator of abdominal obesity, in a coastal community in Kenya. In total, 394 households were randomly selected from a list of farming households in Kaloleni and Rabai sub-counties of Kilifi. Trained enumerators administered questionnaires to adult female family members who play a pivotal role in household management. Household dietary diversity scores (HDDS) were computed from 16 food groups consumed in the 7 days preceding the survey. Waist-hip measurements focused on these females, representing vulnerable populations. Pathway-based regression models were constructed using STATA version 13 (p < 0.05). Most households practised mixed farming (59.9%) and monocropping (73.2%) and most female respondents were widowed (75.1%) with limited education (73.1% had no formal education) and over 20 years of farming experience. Food insecurity was prevalent, affecting 80.7% of households. Limited dietary diversity was noted with an average HDDS of 9. The most commonly consumed foods were cereals, spices, condiments and beverages, while meat, eggs and fruits were infrequently eaten. An inverse association was observed between HDDS and WHR (standardised regression coefficient = -0.1328; p = 0.026) but while food insecurity was inversely associated with both HDD and WHR, these associations did not reach statistical significance (HDDS-standardised regression coefficient -0.0294; p = 0.592: WHR-standardised regression coefficient -0.0155; p = 0.791). Existing research has primarily addressed the undernutrition and hunger-related impacts of food insecurity. The findings underscore the need to better understand the complex interplay between food insecurity and nutritional health, including markers of adiposity, to effectively promote health.

Associations between nutritional literacy and dietary diversity in elderly Chinese individuals with chronic diseases: A cross-sectional study

BACKGROUND

Dietary diversity is influenced by nutritional literacy. This study sought to investigate associations between nutritional literacy and dietary diversity among elderly Chinese individuals with chronic diseases and clarify how nutritional literacy affects dietary diversity.

METHODS

Three communities in Hangzhou, Zhejiang Province were chosen at random to assess nutritional literacy and diet status, which included 301 individuals over the age of 60 with chronic diseases.

RESULTS

The elderly had a middle and lower level of nutritional literacy (n = 301,20.16±5.45). Dietary diversity scores (DDSs) and nutrition literacy showed a positive correlation (r = 0.366, P < 0.001). Higher DDSs were seen in those with greater education levels (OR = 2.15,95 %CI = 1.57∼2.94) and those with better awareness of diet and health (OR = 1.29,95 % CI = 1.02∼1.55).

CONCLUSIONS

The elderly face significant challenges in maintaining a reasonable nutritional intake over time and their nutritional literacy warrants attention.

Dietary diversity and its association with changes in anthropometric indices of community-dwelling older adults in Tehran, Iran: a longitudinal study (2017-2021)

BACKGROUND

Dietary diversity refers to the consumption of a variety of foods or food groups over a given reference period, which is crucial for improving nutrition and overall health. This longitudinal study aimed to investigate the association between dietary diversity and anthropometric indices in community-dwelling older adults living in Tehran in 2017 and 2021.

METHODS

The current study was conducted on 368 older adults [204 (55.4%) women and 164 (44.6%) men] over 60 years of age living in Tehran, who were selected by a systematic cluster sampling method at two-time points, 2017 and 2021. Anthropometric measures (weight, height, hip circumference, and waist circumference) were assessed with standard methods. The participants' dietary intake was assessed by completing two non-consecutive 24-hour recalls, and dietary diversity score (DDS) was calculated based on Kant's method. Statistical analysis was performed using R software by the mixed effect model method.

RESULTS

The mean DDS of the participants in 2017 (5.07 ± 1.20) was higher than that in 2021 (4.94 ± 1.09) (p < 0.05). DDS and dairy diversity score decreased significantly over time. After adjusting for confounders, there was an inverse relationship between the DDS and Body Mass Index (BMI) (B = -0.22; SE = 0.09), but the interaction effect of year × DDS (B = 0.19; SE = 0.10) was not significant (p = 0.06). However, there was a positive relationship between the DDS and A Body Shape Index (ABSI) (B = 0.00; p = 0.022), after adjusting for confounders, this relationship was no longer significant. Additionally, the interaction effect of year and DDS on the ABSI was not significant.

CONCLUSION

The dietary intake and dietary diversity of older adult residents of Tehran declined dramatically with age, and a higher DDS was associated with improved anthropometric indices. DDS had an inverse relationship with general obesity in the studied participants, and the passage of time did not affect this relationship. The DDS can be used as a predictive index and is a powerful tool for investigating changes in nutritional status in longitudinal studies of old age. However, longer-duration studies are needed to obtain more conclusive results.

Impacts of the COVID-19 pandemic on HIV care and treatment services among adolescents attending a tertiary hospital in Dar es Salaam, Tanzania: a qualitative study

Background

The COVID-19 pandemic has caused substantial disruption on HIV care and treatment programmes, especially for adolescents living with HIV (ALHIV) who are known to have poorer health outcomes compared with adults. Efforts made to overcome the pre-existing challenges were hampered by the emergence of the pandemic which interrupted adolescent-friendly healthcare services. Therefore, the aim of this study was to assess the impacts of the pandemic on HIV care and treatment services from healthcare providers and adolescents' experiences at a tertiary hospital in Dar es Salaam, Tanzania.

Methods

A descriptive qualitative study using in-depth interviews was conducted with 17 study participants. Purposive and convenient sampling techniques were used to recruit healthcare providers and adolescents, respectively. Swahili semistructured interview guide was used to conduct interviews. Thematic analysis was conducted to generate themes and subthemes describing the experiences on effects brought by COVID-19 on HIV care and treatment among adolescents.

Results

The study revealed that alteration of approach in delivery of healthcare and limited human and non-human resources in healthcare facilities during the COVID-19 pandemic decreased effectiveness and quality of care which resulted in adolescent's poor adherence to medication and loss to follow-up. Loss of family income, food insecurity and limited socialisation posed threat to adolescent's mental health and overall quality of life.

Conclusion

Our findings underscore the impacts of COVID-19 and its immediate responses that significantly affected adolescent HIV care and treatment services. Reinforcement of sustainable ALHIV programmes and funding supports to these programmes are essential to promote retention and engagement to care during pandemics.

Prevalence, knowledge and practices on prevention and management of overweight and obesity among adults in Dodoma City, Tanzania

BACKGROUND

Overweight/obesity is increasing leading to high rates of non-communicable diseases. The study aimed to assess the prevalence, knowledge and practices on prevention and management of overweight/obesity among adults in Dodoma region.

METHODOLOGY

A cross- sectional research was conducted among 313 randomly selected adults aged 25-65 years. Face to face interviews were conducted to obtain demographic information, knowledge on preventing and managing overweight/obesity using a pre-tested questionnaire. Weight and height were measured following standard procedures and nutrition status was categorized using WHO criteria. Dietary intake was assessed using qualitative 24 hours recall to obtain dietary diversity score. Data was analyzed using the SPSS™ Version 20 to obtain descriptive and inferential statistics.

RESULTS

About 62.6% (n = 196) of the participants were females. The overall prevalence of overweight/obesity was 59.7% (n = 186) of which 28% (n = 88) were overweight and 31.3% (n = 98) obese. Obesity was three times higher among females (41.8% vs 13.7%) than males. Overweight/obesity was positively associated with female sex (Adjusted OR 2.34; 95%CI: 1.235-4.68; p = 0.001), low knowledge (Adjusted OR 2.15; 95%CI: 1.22-3.81; p = 0.008) and negatively associated with dietary diversity score (Adjusted OR 0. 452; 95%CI: 0.199-1.87; p = 0.03). About 76% of respondents reported that overweight/obesity is a result of consuming high energy (38.8%; n = 92) and high fat foods (27%; n = 63). More than half of the respondents reported to be insensitive with kind of foods they consume and for those who were sensitive, 64% do so to avoid diseases. Furthermore, 60% control their weight by doing physical exercises while 18% by both physical exercises and diet management. However, about 43% did not know foods exposing individuals to health problems.

CONCLUSION AND RECOMMENDATIONS

High prevalence of overweight/obesity was observed and significantly associated with female sex, low dietary diversity and knowledge on overweight/obesity prevention. This creates a need to improve knowledge on prevention of overweight/obesity.

Type 2 Diabetes Mellitus in Tanzania. A Narrative Review of Epidemiology and Disease Trend

INTRODUCTION

The prevalence of type 2 diabetes is on a rapid rise in Tanzania, driven by lifestyle modifications, nutritional changes, and increased obesity rates. This article reviews the epidemiology, and disease trends of type 2 diabetes in Tanzania and explores the economic implications and challenges in care, including policy, education, and healthcare systems.

METHODOLOGY

The study employs a narrative literature review from research articles, local healthcare reports, surveys, and public health records. It evaluates the economic impacts, healthcare capabilities, and patient behaviors in managing type 2 diabetes in Tanzania.

RESULTS

The economic burden of diabetes in Tanzania is increasing due to direct healthcare costs, lost productivity, and reduced quality of life, placing significant pressure on the already resourcelimited healthcare system. Treatment dropout rates are alarmingly high, and healthcare providers' knowledge of diabetes is insufficient. Insulin and metformin availability are critically low. Cultural norms and dietary habits pose substantial barriers to effective disease management.

CONCLUSION

The growing prevalence of type 2 diabetes in Tanzania presents a significant public health crisis, necessitating comprehensive strategies for prevention, early detection, and effective disease management. Priorities should include enhancing healthcare infrastructure, increasing public investment, improving healthcare education, and tackling socio-cultural barriers to disease management.

Dietary diversity, nutritional status, and agricultural commercialization: evidence from adult men of rural farm households

Access to healthy and affordable diet hinged on the realization of Sustainable Development Goal 2, higher productivity and, economic prosperity while it is difficult for a poorly nourished people to achieve optimum production of goods and services. This study assessed whether dietary diversity (DD) and nutritional status of adult men are associated with crop commercialization index (CCI) levels of agricultural households in two states of Southwestern Nigeria. This research utilized 352 farm households, comprising 277 adult male members. The individual version of dietary diversity score (DDS) of 9 food groups was used to calculate adult men’s DDS over a 24-h recall. Anthropometric data was obtained using body mass index (BMI) while CCI levels was estimated for each agricultural household. Logistic regression and ordered logit models were used to examine the determinants of adult men’s dietary diversity and nutritional status respectively. Hundred percent of adult men consumed starchy staples, with 11.2% consuming egg, 5.8% milk and milk products and 0.4% consuming organ meat over 24-h recall. Adult men of CCI 2 and CCI 4 agricultural households recorded overweight prevalence of >20% in Ogun state while the association between DDS and CCI was statistically insignificant suggesting that being a member of any of the CCI households may not guarantee the consumption of healthy diets among adult men. From Logit regression analysis, it is more likely for adult men with higher farm size to attain the minimum DDS of 4 food groups than those with smaller size of farmland (OR = 4.78; 95% CI: 1.94, 11.76; p = 0.001). The age, farm experience, and cassava marketing experience were positively related to the likelihood of obtaining the minimum DDS. For adult men to achieve a healthy diet, their diet pattern must incorporate a more diversified intake of food from different food groups capable of improving their nutritional status. This study emphasized the need for relevant stakeholders to provide adequate nutrition knowledge intervention programmes capable of improving the diets and nutrition of adult men and other members of farm households.

Dietary diversity and association with non-communicable diseases (NCDs) among adult men (15-54 years): A cross-sectional study using National Family and Health Survey, India

A healthy and diversified diet is essential for preventing several non-communicable diseases (NCDs). Given the increasing evidence of diet-related health burdens and the rising prevalence of NCDs among Indian adults, the present study aims to explore dietary diversity patterns among adult men in India and their association with non-communicable diseases (NCDs). For this purpose, the study used the fourth round of the National Family and Health Survey (NFHS-4) to analyze adult male samples (n = 1,12,122). Dietary Diversity Scores (DDS) were computed by the weighted sum of the number of different food groups consumed by an individual. The prevalence of diabetes, heart disease, and cancer among adult men is considered a non-communicable disease. Bivariate and logistic regression was carried out to examine the association between DDS and NCDs by estimating chi-squared tests (χ2-test), odds ratio (OR), and 95% confidence interval (CI). The prevalence of diabetes, heart disease, and cancer among adult men in India is 2.1 percent, 1.2 percent, and 0.3 percent, respectively. Results show a positive association between dietary diversity score and the prevalence of the non-communicable disease. High-level dietary diversity scores increase to two times the likelihood of diabetes (OR 2.15 with p<0.05) among adult men than to better-off counterparts while controlling all the covariates. However, a moderate dietary diversity score significantly decreases the likelihood of heart disease (OR 0.88 with p<0.10) and Cancer (OR 0.71 with p<0.05) for adult men compared to a lower score of dietary diversity. In addition, age, marital status, drinking and smoking habits, occupation, and wealth index are also significantly associated with the odds of non-communicable diseases among adult men.

Metabolic syndrome distributions in dietary diversity score groups and its associated factors among adults in the urban community of Jimma, Southwest Ethiopia: a community based cross- sectional study

BACKGROUND

Dietary diversity score has long been recognized as a key component of diets quality balances for healthy life status. However, diets with more variety of food items might increase calorie intake and body weight, which, in turn leads to central obesity (waist circumference).Therefore, this study aims to determine the prevalence of metabolic syndrome among dietary diversity score groups, and its associated factors among adults in the urban community of Jimma, Southwest Ethiopia.

METHODS

A total of 915 adults aged ≥ 18 years were randomly recruited in this cross-sectional study.The study was undertaken from June 17, 2019, up to July 27, 2019. To this end, the collected data were entered to Epi Data 3.1 and analysed using and SPSS 25 version. What's more, a multivariable logistic regression was used to assess associated factors of the unrecognized metabolic syndrome; adjusted odds ratio (AOR) with its corresponding 95% CI, at P-value ≤ 0.05.

RESULTS

The occurrence of metabolic syndrome was 14.4%, and it is more prevalent in females, 11.15% than males, and 3.25%. The most prevalent components of the metabolic syndrome were low level of high-density lipoprotein, elevated level of triacylglycerol, and waist circumferences. Even though metabolic syndrome is not significantly associated with any of the dietary diversity score groups, its prevalence distribution varies among the groups (6.6% in middle, 5.8% in high and 1.9% in low dietary diversity groups). With potential confounders adjusted, by 75% female was significantly associated with the occurrence of metabolic syndrome than male (102 vs. 29, AOR = 0.25 at 95%CI: 0.15-0.40, P = 0.001). Whereas, age ≥ 35 years old (104 vs. 27, AOR = 2.91 at 95%CI:1.78-4.86,P = 0.001), large family size > 5 (65 vs. 10,AOR = 2.43 95% CI: 1.10-5.36, P = 0.03), overweight and obesity (121 vs. 10, AOR = 6.97, 95% CI: 4.50 -10.83, P = 0.005), elevated total cholesterol (103 vs. 28,AOR = 2.46, 95% CI: 1.47-4.11, P = 0.001), and consuming ( spices, condemns and beverages) ≥ 4 days per week (79 vs. 52, AOR = 0.52, 95% CI:0.33 -0.82, P = 0.005) were positively associated with the prevalence of metabolic syndrome as compared to their counterparts.

CONCLUSION

Unrecognized metabolic syndrome was relatively high in the study community. The prevalence of metabolic syndrome varied among dietary diversity groups. But any of the dietary diversity scoring categories was not significantly associated with the occurrence of metabolic syndrome. Thus, awareness needs to be made to practice healthy diet and regular physical activity to maintaining normal body weight. Moreover, early screening of metabolic syndrome should be promoted.

Dietary diversity in primary schoolchildren of south-central Côte d'Ivoire and risk factors for non-communicable diseases

BACKGROUND

A balanced nutrition is important for children's physical and cognitive development; yet, remains a challenge in many parts of low- and middle-income countries (LMICs). Early detection of nutritional deficiency and metabolic syndrome in school-aged children is necessary to prevent non-communicable diseases (NCDs) in later life. This study aimed at obtaining baseline data on health, nutritional status, and metabolic markers of NCDs among primary schoolchildren in Côte d'Ivoire.

METHODS

A cross-sectional survey was conducted among 620 children from 8 public primary schools located in the south-central part of Côte d'Ivoire. Underweight and overweight were defined as a body mass index (BMI; kg/m2) < 5th and 85th up to 95th percentile for sex and age, respectively. Dietary diversity of children was calculated based on a 24-hour recall conducted with the primary caretaker according to the guideline of Food and Agriculture Organization. Anaemia, malaria, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and blood glucose levels (HbA1c) were assessed, using capillary blood samples. Logistic models were performed to identify risk factors associated with overweight, HDL-C, LDL-C, and HbA1c.

RESULTS

Among the 620 children (330 girls, 290 boys; Mage 8.0 (± 1.7) years), 530 children attended school in a semi-urban and 90 in a rural area. Around 60% of children had a medium dietary diversity score (DDS). Children in peri-urban areas consumed more cereals (80.2% vs. 63.3%, p < 0.05). Most children were normal weight (n = 496), whereas 3.9% of children classified as prediabetic, 5% were underweight, and 15% overweight. LDL-C and HDL-C levels of children were associated with age, high DDS, and moderate anaemia. A significant association was found between prediabetes and malaria infection, as well as medium and high DDS. Overweight was associated with malaria infection and moderate anaemia.

CONCLUSION

Overweight, prediabetes, low HDL-C, malaria, and anaemia are the main concerns of children's health in Taabo. Our findings highlight interactions between infectious diseases, particularly malaria, and NCD risk factors. Monitoring NCD risk and infectious disease comorbidity in LMIC paediatric populations simultaneously is essential to better understand the dual diseases burden and apply early prevention measures.