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Janmohamed A, Baker MM, Doledec D, Ndiaye F, Konan ACL, Leonce A, Kouadio KL, Beye M, Danboyi D, Jumbe TJ, Ndjebayi A, Ombati C, Njenga BK, Dissieka R. Dietary Quality and Associated Factors among Women of Reproductive Age in Six Sub-Saharan African Countries. Nutrients 2024; 16:1115. [PMID: 38674806 PMCID: PMC11054593 DOI: 10.3390/nu16081115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
The burden of micronutrient malnutrition is high among women of reproductive age (WRA) in sub-Saharan Africa. We examined the dietary quality and associated factors for WRA in Cameroon, Côte d'Ivoire, Kenya, Nigeria, Senegal, and Tanzania. Data were collected from women aged 15-49 years using representative Diet Quality Questionnaire surveys. The Minimum Dietary Diversity for Women (MDD-W), All-5 (key food group) consumption, noncommunicable disease risk (NCD-Risk), and Global Dietary Recommendation (GDR) indicators were assessed. Participants included N = 16,584 women [Cameroon: N = 2073; Côte d'Ivoire: N = 242; Kenya: N = 864; Adamawa State (Nigeria): N = 1283; Benue State (Nigeria): N = 1047; Nasarawa State (Nigeria): N = 1151; Senegal: N = 7232; Tanzania: N = 2692]. The MDD-W ranged from 43.0% in Tanzania to 81.4% in Côte d'Ivoire and was higher in urban, compared to rural, areas in Cameroon, Kenya, Nasarawa, Senegal, and Tanzania (p < 0.001). Increased education and wealth were positively associated with MDD-W in Kenya, Benue, Senegal, and Tanzania. Fewer than half of all women attained All-5 consumption. NCD-Risk scores ranged from 1.13 (95% CI: 1.08, 1.17) in Tanzania to 2.28 (95% CI: 2.16, 2.40) in Nasarawa, and women's GDR scores ranged from 10.47 (95% CI: 10.40, 10.54) in Cameroon to 11.45 (95% CI: 11.25, 11.64) in Côte d'Ivoire. Our findings highlight key aspects of women's diets in sub-Saharan African settings to enable greater awareness and more targeted responses to the specific areas needing the most improvement.
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Affiliation(s)
- Amynah Janmohamed
- Helen Keller International, Vitamin A Supplementation Africa Regional Office, Nairobi 00800, Kenya
| | - Melissa M. Baker
- Helen Keller International, Vitamin A Supplementation Africa Regional Office, Nairobi 00800, Kenya
| | - David Doledec
- Helen Keller International, Vitamin A Supplementation Africa Regional Office, Nairobi 00800, Kenya
| | - Fatou Ndiaye
- Helen Keller International, Vitamin A Supplementation Africa Regional Office, Nairobi 00800, Kenya
| | | | - Amoakon Leonce
- Helen Keller International, Abidjan BP 1334, Côte d’Ivoire
| | | | - Maguette Beye
- Helen Keller International, Yoff-Dakar BP 29898, Senegal
| | | | | | | | - Caleb Ombati
- Helen Keller International, Nairobi 00800, Kenya
| | | | - Romance Dissieka
- Helen Keller International, Vitamin A Supplementation Africa Regional Office, Nairobi 00800, Kenya
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Mahal S, Kucha C, Kwofie EM, Ngadi M. A systematic review of dietary data collection methodologies for diet diversity indicators. Front Nutr 2024; 11:1195799. [PMID: 38577154 PMCID: PMC10992480 DOI: 10.3389/fnut.2024.1195799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 02/16/2024] [Indexed: 04/06/2024] Open
Abstract
The purpose of the current study was to critically assess the gaps in the existing methodologies of dietary data collection for diet diversity indicators. The study proposed the importance of smartphone application to overcome the drawbacks. The review paper identified and assessed the conventional methodologies used in diet diversity indicators including Minimum Dietary Diversity for Women (MDD-W), Minimum Dietary Diversity of Infant and Young Child Feeding Practices (IYCF-MDD), and Household Dietary Diversity Score (HDDS). The 80 research studies from 38 countries were critically assessed on the basis of their research aim, study design, target audience, dietary data collection methodology, sample size, dietary data type, dietary data collection frequency, and location point of dietary data collection. Results indicated that most studies employed interviewer-administered 24-h recall assessing the dietary diversity. The review paper concluded that smartphone application had potential to overcome the identified limitations of conventional methodologies including recall bias, social-desirability bias, interviewer training, and cost-time constraints.
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Affiliation(s)
- Subeg Mahal
- Department of Bioresource Engineering, McGill University, Ste-Anne-de-Bellevue, QC, Canada
| | - Christopher Kucha
- Department of Food Science and Technology, University of Georgia, Athens, GA, United States
| | - Ebenezer M. Kwofie
- Department of Bioresource Engineering, McGill University, Ste-Anne-de-Bellevue, QC, Canada
| | - Michael Ngadi
- Department of Bioresource Engineering, McGill University, Ste-Anne-de-Bellevue, QC, Canada
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Hanley-Cook GT, Hoogerwerf S, Parraguez JP, Gie SM, Holmes BA. Minimum Dietary Diversity for Adolescents: Multicountry Analysis to Define Food Group Thresholds Predicting Micronutrient Adequacy among Girls and Boys Aged 10-19 Years. Curr Dev Nutr 2024; 8:102097. [PMID: 38419832 PMCID: PMC10899069 DOI: 10.1016/j.cdnut.2024.102097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Background Adolescents' diets have been overlooked in nutrition information systems, interventions, and policies. The minimum dietary diversity for women (MDD-W) indicator has been validated to signal greater micronutrient adequacy among nonpregnant women from low- and middle-income countries, but there is limited evidence for valid food group thresholds among boys or nonpregnant nonlactating girls. Objective To define a food group threshold that reflects minimum dietary diversity for adolescents. Methods This multicountry study evaluated the test characteristics of a 10-point food group diversity score (FGDS)-underlying MDD-W-and food group thresholds to predict the micronutrient adequacy of diets from single 24-h recalls or food diaries (24-HRs) among 83,935 adolescents aged 10-19 y and repeated 24-HRs among 75,480 adolescents from upper-middle and high-income countries. Results FGDS was lowest among adolescents in lower-middle countries (3.5 ± 1.1) and greatest in high-income countries (5.4 ± 1.3 points). Using single 24-HRs, 1-point increments in FGDS performed identically to predict a higher mean adequacy ratio among boys and girls (5.1 percentage points; 95% confidence interval: 5.0, 5.2; P < 0.001). MDD-W (i.e., ≥5 food groups) performed well in predicting a mean adequacy ratio of >0.60 among adolescents from upper-middle and high-income countries, whereas a ≥4 food group cutoff showed a superior balance between sensitivity, specificity, and percentage correctly classified in low (only girls) and lower-middle-income countries (boys and girls). In contrast, using repeated 24-HRs, the mean probability of adequacy levels among adolescents were too high and homogeneous (i.e., all mean probability of adequacies > 0.60) to define an optimal food group threshold. Conclusions MDD-W can be extended to boys and girls aged 10-19 y from upper-middle and high-income countries. Furthermore, an adapted indicator using a ≥4 food group threshold signals higher micronutrient adequacy in low and lower-middle-income countries. Food group cutoffs to predict the micronutrient adequacy of usual intakes should be validated using repeated 24-HRs in populations where a lower proportion of adolescents meet mean dietary requirements.
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Affiliation(s)
| | - Sara Hoogerwerf
- Food and Nutrition Division (ESN), FAO of the United Nations, Rome, Italy
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Verger EO, Eymard-Duvernay S, Bahya-Batinda D, Hanley-Cook GT, Argaw A, Becquey E, Diop L, Gelli A, Harris-Fry H, Kachwaha S, Kim SS, Nguyen PH, Saville NM, Tran LM, Zagré RR, Landais E, Savy M, Martin-Prevel Y, Lachat C. Defining a Dichotomous Indicator for Population-Level Assessment of Dietary Diversity Among Pregnant Adolescent Girls and Women: A Secondary Analysis of Quantitative 24-h Recalls from Rural Settings in Bangladesh, Burkina Faso, India, and Nepal. Curr Dev Nutr 2024; 8:102053. [PMID: 38187987 PMCID: PMC10767136 DOI: 10.1016/j.cdnut.2023.102053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024] Open
Abstract
Background The Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) indicator was validated as a proxy of micronutrient adequacy among nonpregnant women in low- and middle-income countries (LMICs). At that time, indeed, there was insufficient data to validate the indicator among pregnant women, who face higher micronutrient requirements. Objective This study aimed to validate a minimum food group consumption threshold, out of the 10 food groups used to construct MDD-W, to be used as a population-level indicator of higher micronutrient adequacy among pregnant women aged 15-49 y in LMICs. Methods We used secondary quantitative 24-h recall data from 6 surveys in 4 LMICs (Bangladesh, Burkina Faso, India, and Nepal, total n = 4909). We computed the 10-food group Women's Dietary Diversity Score (WDDS-10) and calculated the mean probability of adequacy (MPA) of 11 micronutrients. Linear regression models were fitted to assess the associations between WDDS-10 and MPA. Sensitivity, specificity, and proportion of individuals correctly classified were used to assess the performance of MDD-W in predicting an MPA of >0.60. Results In the pooled sample, median values (interquartile range) of WDDS-10 and MPA were 3 (1) and 0.20 (0.34), respectively, whereas the proportion of pregnant women with an MPA of >0.60 was 9.6%. The WDDS-10 was significantly positively associated with MPA in each survey. Although the acceptable food group consumption threshold varied between 4 and 6 food groups across surveys, the threshold of 5 showed the highest performance in the pooled sample with good sensitivity (62%), very good specificity (81%), and percentage of correctly classified individuals (79%). Conclusions The WDDS-10 is a good predictor of dietary micronutrient adequacy among pregnant women aged 15-49 y in LMICs. Moreover, the threshold of 5 or more food groups for the MDD-W indicator may be extended to all women of reproductive age, regardless of their physiologic status.
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Affiliation(s)
- Eric O Verger
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | | | - Dang Bahya-Batinda
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Giles T. Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elodie Becquey
- International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Loty Diop
- International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Aulo Gelli
- International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sunny S Kim
- International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | - Phuong Hong Nguyen
- International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | | | | | - Rock R Zagré
- International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Edwige Landais
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Mathilde Savy
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Yves Martin-Prevel
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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Pastori G, Brouwer ID, Feskens EJM, Huong LT, Samuel FO, Xuan LTT, Shittu OF, Eyinla TE, Talsma EF. A simple fruit and vegetable score is a valid tool to assess actual fruit and vegetable intake. Br J Nutr 2023; 130:1942-1949. [PMID: 37143365 PMCID: PMC10632721 DOI: 10.1017/s0007114523001125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023]
Abstract
With the recent growing interest in improving fruit and vegetable intake for better health and limited research resources in many settings, simple-to-administer and low-priced indicators are essential tools for monitoring fruit and vegetable intake at the population level. A potential candidate indicator is the fruit and vegetable component of the Global Dietary Recommendation score (FV-GDR) based on data collected using the Diet Quality Questionnaire (DQQ). We investigated the relative validity of FV-GDR collected with the DQQ to measure fruit and vegetable intake by comparison with a 24-h recall (24hR) as a reference collected from 620 Vietnamese and 630 Nigerian adults in 2021. We found proportional differences in the prevalence of intake of vitamin A-rich vegetables, other vegetables and other fruits in Vietnam and all vegetable food groups in Nigeria. In both countries, we found a small difference in the total FV-GDR from DQQ compared with the 24hR, and the percentage of agreement between the two methods was quite high for the majority of the food groups. The FV-GDR calculated from the DQQ correlated with the actual intake, although less strongly than the FV-GDR from 24hR. The DQQ is a promising low-burden, low-cost and simple tool to calculate FV-GDR and to monitor fruit and vegetable consumption at the population level. This provides the possibility of evaluating an important aspect of diet quality in low-resource settings.
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Affiliation(s)
- Giulia Pastori
- Department of Global Nutrition, Division of Human Nutrition and Health, Wageningen University and Research, 6700 AAWageningen, the Netherlands
| | - Inge D. Brouwer
- Department of Global Nutrition, Division of Human Nutrition and Health, Wageningen University and Research, 6700 AAWageningen, the Netherlands
- International Food Policy Research Institute, Washington, DC, USA
| | - Edith J. M. Feskens
- Department of Global Nutrition, Division of Human Nutrition and Health, Wageningen University and Research, 6700 AAWageningen, the Netherlands
| | - Le Thi Huong
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Folake O. Samuel
- Department of Human Nutrition and Dietetics, University of Ibadan, Ibadan, Nigeria
| | - Le Thi Thanh Xuan
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Oluyemisi F. Shittu
- Department of Human Nutrition and Dietetics, University of Ibadan, Ibadan, Nigeria
| | - Toluwalope E. Eyinla
- Department of Human Nutrition and Dietetics, University of Ibadan, Ibadan, Nigeria
| | - Elise F. Talsma
- Department of Global Nutrition, Division of Human Nutrition and Health, Wageningen University and Research, 6700 AAWageningen, the Netherlands
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Nguyen PH, Sununtnasuk C, Christopher A, Ash D, Ireen S, Kabir R, Mahmud Z, Ali M, Forissier T, Escobar-DeMarco J, Frongillo EA, Menon P. Strengthening Nutrition Interventions during Antenatal Care Improved Maternal Dietary Diversity and Child Feeding Practices in Urban Bangladesh: Results of a Quasi-Experimental Evaluation Study. J Nutr 2023; 153:3068-3082. [PMID: 37354978 DOI: 10.1016/j.tjnut.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/03/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Bangladesh is urbanizing rapidly, facing challenges of malnutrition, low coverage and poor quality of urban nutrition services. OBJECTIVES We assessed the effect of integrating maternal, infant, and young child nutrition interventions, delivered at urban Maternal Neonatal and Child Health facilities, on maternal dietary diversity, iron and folic acid (IFA) and calcium consumption, and child feeding practices. METHODS We used a quasi-experimental design with a nonrandom assignment of 20 health care facilities in Dhaka to intensive and standard service arms. We conducted facility-based observations and community-based surveys at baseline (2020) and endline (2022) (n = 2455 observations and surveys with 1678 pregnant women [PW] or recently delivered women [RDW] at endline). We derived difference-in-difference (DID) estimates, adjusted for characteristics that differed at baseline or endline, and accounted for clustering. RESULTS Exposure to antenatal care (ANC) was similar in both arms: two-thirds of RDW received ANC during the first trimester and three-fourths received ≥4 ANC checkups. Compared to the standard arm, a higher proportion of PW in the intensive arm received counseling on dietary diversity (DID: 45 percentage points [pp]), and a higher proportion of RDW received IFA (25 pp) and calcium supplementation (19 pp), showed adequate weight gain (44 pp), and recorded appropriate child feeding (27 pp). Improvements were greater in the intensive than the standard arm for the number of food groups consumed (DID: 1.1 food groups) and minimum dietary diversity (23 pp); no effect was observed for IFA and calcium consumption during pregnancy. However, effects were observed for early initiation of (20 pp) and exclusive breastfeeding (45 pp), introduction of solid or semisolid foods (28 pp), and egg and/or flesh food consumption (33 pp) among children. Minimum dietary diversity and acceptable diet remained low in both arms. CONCLUSIONS Intensifying nutrition in government-aligned health care services delivered by experienced nongovernmental organization-run facilities is a feasible model to address the urban health gap, nutrition services coverage, and improve practices. The trial was registered at clinicaltrials.gov as NCT03882268.
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Affiliation(s)
- Phuong H Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States.
| | - Celeste Sununtnasuk
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | | | - Deborah Ash
- FHI Solutions, Washington, DC, United States
| | | | | | | | | | | | - Jessica Escobar-DeMarco
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, North Carolina, United States
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States
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Jenkins M, Jefferds MED, Aburto NJ, Ramakrishnan U, Martorell R, Addo OY. What Do United States Adolescents Eat? Food Group Consumption Patterns and Dietary Diversity from a Decade of Nationally Representative Data. Curr Dev Nutr 2023; 7:101968. [PMID: 37529118 PMCID: PMC10388726 DOI: 10.1016/j.cdnut.2023.101968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/09/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
Background Although the importance of adolescent nutrition has gained attention in the global nutrition community, there is a gap in research focused on adolescent dietary diversity and food group consumption. Objectives This study aimed to characterize population-level food group consumption patterns and quantify the extent of dietary diversity among United States adolescents using a large nationally representative sample of adolescents aged 10-19 y. Methods We used 24-h dietary recall data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 to construct the 10 food groups comprising the minimum dietary diversity for women (MDD-W) indicator and estimated the prevalence of intake of each food group. A composite metric adolescent dietary diversity score (ADDS) was derived for each adolescent where 1 point was awarded per food group. Both population scores and the distribution of individual scores were estimated. Differences in proportions of food groups consumed across sociodemographic categories were tested using the Rao-Scott χ2 test, and pairwise comparisons were expressed as population prevalence differences and prevalence ratios. Results Food group consumption patterns were very similar across 2 d of dietary recall but varied significantly by sex, race/ethnicity, and income status. The food groups with the highest prevalence of consumption were grains, white, roots, and tubers (∼99%), milk products (∼92%), and meat, poultry, and fish (∼85%), whereas <15% of adolescents consumed key micronutrient-dense foods, such as vitamin A-rich fruits and vegetables and dark green vegetables. The mean ADDS was 4.69, with modest variation across strata. Conclusions On average, United States youth consumed fewer than 5 food groups on a given day. The lack of dietary variety and relatively low prevalence of consumption of several micronutrient-rich plant-based foods could pose a risk for adolescents' ability to achieve micronutrient adequacy in the United States.
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Affiliation(s)
- Mica Jenkins
- International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Maria Elena D. Jefferds
- International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Nancy J. Aburto
- Food and Nutrition Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Usha Ramakrishnan
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Reynaldo Martorell
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - O. Yaw Addo
- International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Shamim AA, Hossain MM, Akter F, Urmy NJ, Hanif AAM, Hasan M, Khan MSA, Ullah MA, Bulbul MMI, Mridha MK. Unhealthy Foods and Sugar-Sweetened Beverages Consumption Among Bangladeshi Adolescents and Their Sociodemographic Determinants: Findings From a Nationally Representative Cross-Sectional Study. Cureus 2023; 15:e41262. [PMID: 37529825 PMCID: PMC10390030 DOI: 10.7759/cureus.41262] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Consumption of savory crispy or fried snacks (SCFS), sugary snacks (SS), and sugar-sweetened beverages (SSB) is associated with an increased prevalence of obesity and noncommunicable diseases. We aimed to estimate the consumption of SCFS, SS, and SSB among adolescent males and females in Bangladesh and to report the factors associated with their consumption using data from a nationwide cross-sectional survey. METHODS We interviewed 4,907 adolescent males and 4,865 females for the seven-day recall on intake of SCFS, SS, and SSB from 82 randomly selected clusters from rural, non-slum urban, and slum areas. Sociodemographic and anthropometry data were also collected. RESULTS Consumption of SCFS, SS, and SSB for ≥7 times per week was reported by 11.6%, 28.9%, and 25.6% of the males and 4.9%, 24.8%, and 20.7% of the females, respectively. The weekly mean frequency of SCFS, SS, and SSB intake increased after adjustment for potential confounders among females with higher maternal education and for SCFS and SSB among males with the highest level of father's education. Increased intake of SS and SSB for both males and females was associated with dwelling in a female-headed household. SCFS intake was higher among both males and females from the richest households. Nutritional status, both overweight and obesity, and underweight, was not associated with a more frequent intake of SCFS and SS among males and females; however, a lower frequency of intake of SSB was observed among overweight and obese males. Screen time (television viewing: none, up to 1 hour, and more than 1 hour) was not associated with consumption of SCFS and SSB among both males and females. CONCLUSION Consumption of unhealthy snacks and drinks is high among adolescents in Bangladesh and needs to be addressed through policy and program measures to abate the epidemic of obesity and associated NCD.
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Affiliation(s)
- Abu Ahmed Shamim
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Md Mokbul Hossain
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Fahmida Akter
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Nushrat Jahan Urmy
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Abu Abdullah Mohammad Hanif
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Mehedi Hasan
- James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Md Showkat Ali Khan
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Mohammad Aman Ullah
- Ministry of Health and Family Welfare, Bangladesh, National Nutrition Services (NNS), Dhaka, BGD
| | - Md Mafizul I Bulbul
- Ministry of Health and Family Welfare, Bangladesh, National Nutrition Services, Dhaka, BGD
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
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Dusingizimana T, Jones A, Vasanthakaalam H, Kjellqvist T. Household-Level Coverage of Iron-Biofortified Beans in the Northern Province of Rwanda. Curr Dev Nutr 2023; 7:100106. [PMID: 37396962 PMCID: PMC10314227 DOI: 10.1016/j.cdnut.2023.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Background Biofortification, the process of enhancing the micronutrient content of staple crops, is a nutrition-sensitive agricultural intervention with the potential to increase micronutrient intakes and improve health outcomes, especially among vulnerable populations. Although data are available on the number of farming households that grow biofortified crops, information on the coverage of biofortified foods in the general population is limited. Such information is critical to assess the performance of biofortification programs and guide decisions related to program implementation while ascertaining progress toward achieving expected impacts. Objective This study aimed to assess the household coverage of iron-biofortified beans (IBBs) in rural areas of the Northern Province of Rwanda. Methods We applied methods previously used to assess coverage in large-scale food fortification programs to develop coverage indicators for IBBs. These indicators were 1) consumption of beans in any form; 2) awareness of IBBs; 3) availability of IBBs; 4) consumption of IBBs (ever); and 5) consumption of IBBs (current). Results Of the 535 households surveyed, 98% consumed beans in any form and 79% were aware of IBBs. Among the 321 households that provided bean samples, only 40% of the samples were biofortified (as determined by a breeding specialist) and only 21% of respondents were able to correctly identify IBBs. Although 52% of households reported to be ever consuming biofortified beans, only 10% of households were currently consuming these beans. Conclusions Despite relatively high awareness of IBBs among surveyed households, a few households currently consume IBBs, highlighting the need to explore strategies to promote consumption. More research is also required to investigate factors hindering the consumption of IBBs.
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Affiliation(s)
- Theogene Dusingizimana
- Department of Food Science and Technology, College of Agriculture, Animal Sciences and Veterinary Medicine (CAVM), University of Rwanda, Kigali, Rwanda
| | - Andrew Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, MI, United States
| | - Hilda Vasanthakaalam
- Department of Food Science and Technology, College of Agriculture, Animal Sciences and Veterinary Medicine (CAVM), University of Rwanda, Kigali, Rwanda
| | - Tomas Kjellqvist
- School of Natural Sciences, Technology and Environmental Studies, Södertörn University, Huddinge, Sweden
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Mavragani A, Pallikadavath S, Ryder IH, Kandala N. The Effectiveness of a Web-Based Application for a Balanced Diet and Healthy Weight Among Indonesian Pregnant Women: Randomized Controlled Trial. JMIR Form Res 2023; 7:e38378. [PMID: 36716078 PMCID: PMC9926345 DOI: 10.2196/38378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/14/2022] [Accepted: 11/17/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Pregnant women have self-declared that they have difficulties in estimating nutrient intakes. The Nutrition Information System for Indonesian Pregnant Women (SISFORNUTRIMIL) application was created as a dietary assessment and calorie-counting tool to guide pregnant women to eat the right portion sizes for each meal. OBJECTIVE The study aimed to examine the effectiveness of the SISFORNUTRIMIL application in helping users achieve a balanced diet and healthy maternal weight gain in comparison to nonusers in Indonesia. METHODS First-pregnancy women in the second trimester aged 19-30 years (N=112) participated in the randomized controlled trial. Recruited women who were eligible and consented to participate in the study were allocated into the intervention group, or application user (n=56), and the control group, or application nonuser (n=56). The intervention recommended that pregnant women consume at least 5 food groups and calculate a recommended average portion size for 12 weeks. Both groups were self-monitored and recorded their intake in food records for 3 days every week. The dietary diversity consumed, macro- and micronutrient intake, and maternal weight gain were assessed pre- and postintervention. Data were collected three times during the intervention. Diversity food consumption was measured by the Minimum Dietary Diversity for Women of reproductive age. Furthermore, the Indonesian recommended dietary allowances were used to refer to and validate appropriate energy and nutrient amounts. Independent sample t test was used to compare differences between the intervention and control groups. RESULTS The mean dietary diversity score for the application user group (7.79, SD 1.20) was significantly greater than for the application nonuser group (7.02, SD 1.39; adjusted mean difference 0.77, 95% CI 0.28-1.25; d=0.28; P=.005). Macro- and micronutrient intake was significantly more in accordance with the dietary recommendations for the user group compared to the control group, including an energy daily intake of 156.88 kcal (95% CI 114.52-199.23; d=-1.39; P=.002), 102.43 g of carbohydrates (95% CI -125.2 to -79.60; d=-1.68; P=.02), 14.33 g of protein (95% CI 11.40-17.25; d=1.86; P<.001), and 10.96 g of fat (95% CI -13.71 to -8.20; d=-1.49; P<.001). Furthermore, there was a significantly higher intake of daily vitamins and minerals in the intervention group than in the control group. Other results showed that maternal weight gain in the intervention group was in accordance with the parameters of healthy weight gain. CONCLUSIONS Recording food intake using the application was significantly effective in improving the dietary diversity consumed, improving adequate energy and nutrient intake, and producing healthy maternal weight during pregnancy. TRIAL REGISTRATION ISRCTN Registry ISRCTN42690828; https://www.isrctn.com/ISRCTN42690828.
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Affiliation(s)
| | - Saseendran Pallikadavath
- Demography and Global Health, School of Health and Care Professions, University of Portsmouth, Portsmouth, United Kingdom
| | - Isobel Helen Ryder
- Faculty of Nursing, School of Health and Care Professions, University of Portsmouth, Portsmouth, United Kingdom
| | - Ngianga Kandala
- Faculty of Science, School of Health and Care Professions, University of Portsmouth, Portsmouth, United Kingdom
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The DQQ is a Valid Tool to Collect Population-Level Food Group Consumption Data: A Study Among Women in Ethiopia, Vietnam, and Solomon Islands. J Nutr 2023; 153:340-351. [PMID: 36913471 DOI: 10.1016/j.tjnut.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/09/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Diet Quality Questionnaire (DQQ) is a rapid dietary assessment tool designed to enable feasible measuring and monitoring of diet quality at population level in the general public. OBJECTIVES To evaluate validity of the DQQ for collecting population-level food group consumption data required for calculating diet quality indicators by comparing them with a multipass 24-h dietary recall (24hR) as the reference. METHODS Cross-sectional data were collected among female participants aged 15-49 y in Ethiopia (n = 488), 18-49 y in Vietnam (n = 200), and 19-69 y in Solomon Islands (n = 65) to compare DQQ and 24hR data in proportional differences in food group consumption prevalence, percentage of participants achieving Minimum Dietary Diversity for Women (MDD-W), percent agreement, percentage misreporting food group consumption, and diet quality scores of Food Group Diversity Score (FGDS), noncommunicable disease (NCD)-Protect, NCD-Risk, and the Global Dietary Recommendation (GDR) score using a nonparametric analysis. RESULTS The mean (standard deviation) percentage point difference between DQQ and 24hR in population prevalence of food group consumption was 0.6 (0.7), 2.4 (2.0), and 2.5 (2.7) in Ethiopia, Vietnam, and Solomon Islands, respectively. Percent agreement of food group consumption data ranged from 88.6% (10.1) in Solomon Islands to 96.3% (4.9) in Ethiopia. There was no significant difference between DQQ and 24hR in population prevalence of achieving MDD-W except for Ethiopia (DQQ 6.1 percentage points higher, P < 0.01). Median (25th-75th percentiles) scores of FGDS, NCD-Protect, NCD-Risk, and GDR score were comparable between the tools. CONCLUSIONS The DQQ is a suitable tool for collecting population-level food group consumption data for estimating diet quality with food group-based indicators such as the MDD-W, FGDS, NCD-Protect, NCD-Risk, and GDR score.
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12
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Merga G, Mideksa S, Dida N, Kennedy G. Dietary diversity and associated factors among women of reproductive age in Jeldu District, West Shoa Zone, Oromia Ethiopia. PLoS One 2022; 17:e0279223. [PMID: 36534691 PMCID: PMC9762567 DOI: 10.1371/journal.pone.0279223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Women of reproductive age are at a higher risk of insufficient micronutrient intake due to their low dietary diversity which has an impact on child growth and development, anemia and low birth weight. However, there are no information from the study area. Hence, the study aimed to assess dietary diversity and associated factors among reproductive-age women in Jeldu District, West Shoa Zone, Oromia Region, Ethiopia, 2018. METHODS A community-based cross-sectional study was undertaken among 634 women of reproductive age. The study participants were recruited using a systematic sampling method. The data were collected using a structured questionnaire based on 24-hour dietary recalls. The data were checked, coded, and entered into EpiData version 3.1 before being exported to SPSS Version 21 for analysis. Descriptive statistics like frequency standard deviation, mean and proportions were computed., both binary and multivariable logistic regressions were run at 95 percent confidence intervals. A P-value of <0.05 was used to declare a statistically significant association between dietary diversity and explanatory variables. RESULTS The proportions of women who consumed greater than or equal to five food groups were 81.9%. Agro-ecological zone of highland (AOR = 7.71: 95% CI: 3.72, 15.99), women who have a radio (AOR; 1.87: 95% CI; 1.17, 2.99) and women's decision-making power to purchase food for household (AOR; 3.93:95% CI; 2.3, 6.71) and having own mobile phone (AOR: 1.92 (1.74, 3.16)) were statistically associated with food dietary diversity. CONCLUSION The proportion of women who met the minimal standard for dietary variety requirements was high. The presence of radios, mobile phones, women's purchasing decision power, as well as possessing large cattle, and the agroecological zone of the participants were all important predictors of dietary variety among reproductive-age women. The local media, agriculture office, health office, and women, youth, and children office all need to pay more attention to the determinants of dietary variety in women.
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Affiliation(s)
- Gudisa Merga
- West Shewa Zonal Health Office, Ambo, Oromia, Ethiopia
| | - Samson Mideksa
- Ethiopian Public Health Research Institute, Addis Ababa, Ethiopia
| | - Nagasa Dida
- Public Health Department, College of Medicine and Health Sciences, Ambo University, Ambo, Oromia, Ethiopia
- * E-mail:
| | - Gina Kennedy
- Global Alliance for Improved Nutrition, Wageningen University, Wageningen, Netherlands
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Puwanant M, Boonrusmee S, Jaruratanasirikul S, Chimrung K, Sriplung H. Dietary diversity and micronutrient adequacy among women of reproductive age: a cross-sectional study in Southern Thailand. BMC Nutr 2022; 8:127. [PMCID: PMC9641308 DOI: 10.1186/s40795-022-00619-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Adequate nutritional intake of both macronutrients and micronutrients is essential for maintaining good health throughout life, particularly for women of reproductive age (WRA). The Minimum Dietary Diversity for WRA (MDD-W), or the sum of dietary diversity, is recommended as a simple indicator to identify at-risk WRA populations. However, there are no studies on the MDD-W among WRA in Thailand.
Objectives
To determine food group diversity, MDD-W, and micronutrient intake of WRA in Southern Thailand.
Participants
From December 2020 to November 2021, 120 healthy, young WRA (average age 33.2 ± 4.5 years) were enrolled.
Methods
A 24-h food record was used to quantitatively and qualitatively assess the food consumed. Dietary diversity was classified into ten food groups. The macronutrients and 15 micronutrients were calculated using the software program INMUCAL, which is the standard program for calculating nutrients in Thai food. The calculated intake of each micronutrient was transformed to the probability of adequacy (PA).
Results
The most common foods consumed were rice, followed by meat, eggs, fruits, and vegetables. Fewer than 40% of the participants consumed beans, dairy products, vitamin A-rich fruits and vegetables, dark green vegetables, and pulses. The average MDD-W score was 5 (range 2–8). The mean caloric intake (1,865 cal/day) was adequate for non-lactating WRA but was approximately 300 kcal/day lower than the recommendation for lactating WRA. Most WRA consumed lower amounts of micronutrients than those recommended. The mean PA (MPA) of the 15 micronutrients was 0.33 (range 0.0–0.9).
Conclusions
Non-pregnant WRA in Songkhla consumed adequate macronutrients but inadequate micronutrients. A nutritional education program regarding the importance of micronutrients should be provided to the public, with special attention to WRA.
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Zhong W, Zhao A, Lan H, Mao S, Li P, Jiang H, Wang P, Szeto IMY, Zhang Y. Dietary Diversity, Micronutrient Adequacy and Bone Status during Pregnancy: A Study in Urban China from 2019 to 2020. Nutrients 2022; 14:4690. [PMID: 36364952 PMCID: PMC9656709 DOI: 10.3390/nu14214690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Diet quality during reproduction is crucial to maternal and infant health. However, the association between dietary diversity and bone health of pregnant women remains unclear. We aimed to evaluate the dietary quality of Chinese urban gravidas using the dietary diversity score (DDS), and to explore the relationship of the DDS with micronutrient adequacy and bone health. In this cross-sectional study, we analyzed data from 775 pregnant women aged 18 years or older in urban China. Dietary diversity was assessed using the Minimum Dietary Diversity for Women (MDD-W) indicator. A 24-h dietary recall was used to collect diet data and to calculate the MDD-W and the nutrient intake. Bone health was measured using quantitative ultrasound and assessed by the speed of sound (SOS). Pearson's correlation coefficients between the DDS and the nutrient adequacy ratio (NAR) were calculated. A multivariable linear regression model was used to estimate the effect size of the DDS on the SOS. The mean DDS was 6.61 ± 1.53 points and 91.0% of participants reported the consumption of five or more food groups. Women in the diverse diet subgroup (DDS ≥ 7 points) were more likely to consume all kinds of food except starchy staples and had higher NARs. Pearson's correlation coefficients between the DDS and the NAR ranged from 0.161 to 0.484. For participants in the second trimester, those with a diverse diet had a higher SOS. A multivariable linear regression analysis showed that the DDS was positively and significantly associated with the SOS (β = 17.18, 95% CI = 5.97-28.39, p = 0.003), but this was not the case for women in the first and third trimesters. Urban Chinese women had good dietary diversity during pregnancy. A higher dietary diversity was associated with a higher NAR. From the point of view of bone, a diverse diet was positively correlated with better bone status, suggesting the importance of improving diet diversity for pregnant women, especially from mid-pregnancy.
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Affiliation(s)
- Wuxian Zhong
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Hanglian Lan
- Yili Maternal and Infant Nutrition Institute, Beijing 100071, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Shuai Mao
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Pin Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Hua Jiang
- School of Nursing, Peking University Health Science Center, Beijing 100191, China
| | - Peiyu Wang
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Ignatius Man-Yau Szeto
- Yili Maternal and Infant Nutrition Institute, Beijing 100071, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University Health Science Center, Beijing 100191, China
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Ludwig-Borycz EF, Wilson ML, Colecraft EK, Jones AD. A behavior change communication intervention, but not livelihood interventions, improves diet diversity and animal-source food consumption among Ghanaian women. Food Nutr Res 2022; 66:7570. [PMID: 35950103 PMCID: PMC9338446 DOI: 10.29219/fnr.v66.7570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 12/08/2021] [Accepted: 02/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background Women of reproductive age (WRA), especially in sub-Saharan Africa, are vulnerable to micronutrient deficiencies driven largely by poor quality diets. Intervening into food value chains, on which many households in low- and middle-income countries depend for their livelihood, may be a promising approach to improving diets in these contexts. Objective In this pilot-scale randomized trial, we evaluated whether a multisectoral, food value chain intervention improved the diet diversity and the consumption of animal-source foods (ASFs) among WRA in Ghana. Design Twelve fish-smoking communities in two regions of Ghana with 296 eligible women were randomly assigned to one of three 9-month treatment arms: 1) behavior change communication (BCC) to promote improved diet quality through twice-weekly audio messages and bi-weekly peer-to-peer learning sessions; 2) BCC with microcredit to increase women’s incomes; or 3) BCC with provision of new smoke-oven technology. We assessed baseline-endline and between-treatment arm differences using a 10-food group diet diversity score (DDS), the Minimum Dietary Diversity for Women (MDD-W) indicator, and 7-day frequency of ASF consumption. Results Among 118 participants (39 in both treatment arm 1 and treatment arm 3, and 40 in treatment arm 2, with no participant refusals), DDS increased from a mean (SD) of 4.0 (1.3) at baseline to 5.1 (0.9) at endline (P-value < 0.0001). The proportion of women achieving the MDD-W indicator nearly doubled from baseline (35.6%) to endline (69.5%) (P-value < 0.0001). Frequency of ASF consumption similarly increased for meat and poultry (2.7 (4.1) to 4.7 (5.3); P-value < 0.0001) and eggs (1.5 (3.1) to 2.3 (4.9); P-value = 0.02). Few differences in these outcomes were observed among treatment arms. Conclusions A BCC intervention improved diet diversity and consumption of ASFs among participants. However, neither a group-based microcredit nor improved smoke oven intervention, both of which increased women’s income, led to additional dietary improvements.
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Affiliation(s)
| | - Mark L. Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Esi K. Colecraft
- Nutrition and Food Science Department, University of Ghana, Accra, Ghana
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Andrew D. Jones, Department of Nutritional Sciences, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA. Tel.: 734-647-1881.
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Hanley-Cook GT, Argaw A, de Kok B, Toe LC, Dailey-Chwalibóg T, Ouédraogo M, Kolsteren P, Huybregts L, Lachat C. Seasonality and Day-to-Day Variability of Dietary Diversity: Longitudinal Study of Pregnant Women Enrolled in a Randomized Controlled Efficacy Trial in Rural Burkina Faso. J Nutr 2022; 152:2145-2154. [PMID: 35524695 PMCID: PMC9445846 DOI: 10.1093/jn/nxac104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Panel data indicate that nonpregnant women's dietary diversity fluctuates across climatic seasons in low- and middle-income countries. The natural day-to-day variability in food group consumption during gestation is unknown. OBJECTIVES A longitudinal study was conducted among pregnant women enrolled in the Micronutriments pour la Santé de la Mère et de l'Enfant study 3 randomized controlled efficacy trial [i.e., daily fortified balanced energy-protein supplement and an iron-folic acid (IFA) tablet compared with an IFA tablet only] to investigate the number of 24-hour recalls required to estimate usual prenatal food group (FG) diversity and the seasonality of pregnant women's dietary diversity in Houndé, Burkina Faso. METHODS FG consumption was assessed twice weekly by qualitative, list-based, 24-hour recalls among 1757 pregnant women (892 control, 865 intervention). The number of days needed to estimate a woman's usual prenatal 10-point FG diversity score was calculated using the within-subject coefficient of variation. Regression models, including truncated Fourier series, were fitted to assess seasonal variations in the FG diversity score and the probability of reaching Minimum Dietary Diversity for Women (MDD-W; i.e., ≥5 FGs). RESULTS The monthly mean FG scores (<5 FGs) and MDD-W prevalence (<45%) were low. Five list-based recalls allowed observed FG diversity to lie within 15% of the true mean in 90% of the estimations (mean ± SD, 40.4 ± 20.7 recalls per woman). Both the FG diversity score and prevalence achieving MDD-W showed responsiveness to seasonal variations, with peaks at the end of the dry season (i.e., April or May) and troughs in the rainy season (i.e., August). CONCLUSIONS Five list-based recalls are sufficient to estimate usual FG diversity during gestation, although intra-annual seasonal patterns did modestly affect the FG diversity score and MDD-W prevalence. Thus, timing of repeated dietary surveys is critical to ensure nonbiased inferences of change and trends in Burkina Faso. This trial was registered at clinicaltrials.gov as NCT03533712.
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Affiliation(s)
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Laeticia Celine Toe
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium,Institut de Recherche en Sciences de la Santé (IRSS), Unité Nutrition et Maladies Métaboliques, Bobo-Dioulasso, Burkina Faso
| | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | | | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium,Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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Ma S, Herforth AW, Vogliano C, Zou Z. Most Commonly-Consumed Food Items by Food Group, and by Province, in China: Implications for Diet Quality Monitoring. Nutrients 2022; 14:1754. [PMID: 35565720 PMCID: PMC9102302 DOI: 10.3390/nu14091754] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Dietary quality is of great significance to human health at all country income levels. However, low-cost and simple methods for population-level assessment and monitoring of diet quality are scarce. Within these contexts, our study aimed to identify the sentinel foods nationally and by province of 29 food groups to adapt the diet quality questionnaire (DQQ) for China, and validate the effectiveness of the DQQ using data from the China Health and Nutrition Survey (CHNS). The DQQ is a rapid dietary assessment tool with qualitative and quantitative analysis to determine appropriate sentinel foods to represent each of 29 food groups. Dietary data of 13,076 participants aged 15 years or older were obtained from wave 2011 of CHNS, and each food and non-alcoholic beverage was grouped into 29 food groups of the DQQ. The data were analyzed to determine the most commonly consumed food items in each food group, nationally and in each province. Key informant interviews of 25 individuals familiar with diets in diverse provinces were also conducted to identify food items that may be more common in specific provinces. China's DQQ was finalized based on identification of sentinel foods from the key informant interviews, and initial national results of the quantitative data. Consumption of sentinel foods accounted for over 95% of people who consumed any food item in each food group, at national levels and in all provinces for almost all food groups, indicating the reliability of the sentinel food approach. Food-group consumption data can be obtained through DQQ to analyze dietary diversity as well as compliance with WHO global dietary guidance on healthy diets, providing a low-burden, food-group-based and simple method for China to evaluate diet quality at the whole population level.
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Affiliation(s)
- Sheng Ma
- National Health Commission Key Laboratory of Reproductive Health, Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China;
| | - Anna W. Herforth
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | | | - Zhiyong Zou
- National Health Commission Key Laboratory of Reproductive Health, Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China;
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Baye K, Mekonnen D, Choufani J, Yimam S, Bryan E, Griffiths JK, Ringler C. Seasonal variation in maternal dietary diversity is reduced by small‐scale irrigation practices: A longitudinal study. MATERNAL & CHILD NUTRITION 2022; 18:e13297. [PMID: 34905655 PMCID: PMC8932846 DOI: 10.1111/mcn.13297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022]
Abstract
Some agricultural practices, such as irrigation, have the potential to buffer seasonal dietary gaps and through increased production and consumption improve diets, particularly of the rural poor relying on subsistence farming but also for rural and urban households purchasing irrigated produce on local markets. The study aimed to evaluate the effect of seasonality and irrigation on women's diet in rural Ethiopia. Using a longitudinal study design, three rounds of surveys were conducted among women of reproductive age (15–49 years). Data on socioeconomic status, food consumption and haemoglobin concentration was collected. Energy and nutrient intakes were estimated using an interviewer‐administered multiple‐pass 24‐h recall. Women's dietary diversity score (WDDS), the proportion of women meeting the minimum dietary diversity for women (MDDW), haemoglobin concentration, the prevalence of anaemia and energy and nutrients intakes were compared between irrigators and nonirrigators and by season. Associations between MDDW/WDDS and irrigation status were assessed using fixed‐effect models, after adjusting for covariates. WDDS was low (3–4 out of 10 food groups) and exhibited high seasonal variability (p < 0.05). Diets were predominantly cereal‐based, with little consumption of nutrient‐dense foods like fruits and animal source foods. High seasonal variability in energy, protein, vitamin C, calcium, iron and zinc intakes were observed (p < 0.01). Irrigators were more likely to meet the MDDW than women from non‐irrigating households (p < 0.05). No cases of malaria were reported from the three rounds of screening. There is a high seasonal variation in women's diet, but this could be partly offset by irrigation practices. Women's dietary diversity was low and exhibited high seasonal variation. The associations between season and diets were mediated by irrigation. Higher energy intakes were observed among women from households practising irrigation.
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Affiliation(s)
- Kaleab Baye
- Center for Food Science and Nutrition Addis Ababa University Addis Ababa Ethiopia
| | - Dawit Mekonnen
- Environment and Production Technology Division of the International Food Policy Research Institute Addis Ababa Ethiopia
| | - Jowel Choufani
- Environment and Production Technology Division of the International Food Policy Research Institute Washington District of Columbia USA
| | - Seid Yimam
- Environment and Production Technology Division of the International Food Policy Research Institute Addis Ababa Ethiopia
| | - Elizabeth Bryan
- Environment and Production Technology Division of the International Food Policy Research Institute Washington District of Columbia USA
| | - Jeffrey K. Griffiths
- Public Health and Community Medicine, Tufts University School of Medicine Tufts University Boston Massachusetts USA
| | - Claudia Ringler
- Environment and Production Technology Division of the International Food Policy Research Institute Washington District of Columbia USA
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Hanley-Cook GT, Daly AJ, Remans R, Jones AD, Murray KA, Huybrechts I, De Baets B, Lachat C. Food biodiversity: Quantifying the unquantifiable in human diets. Crit Rev Food Sci Nutr 2022; 63:7837-7851. [PMID: 35297716 DOI: 10.1080/10408398.2022.2051163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Dietary diversity is an established public health principle, and its measurement is essential for studies of diet quality and food security. However, conventional between food group scores fail to capture the nutritional variability and ecosystem services delivered by dietary richness and dissimilarity within food groups, or the relative distribution (i.e., evenness or moderation) of e.g., species or varieties across whole diets. Summarizing food biodiversity in an all-encompassing index is problematic. Therefore, various diversity indices have been proposed in ecology, yet these require methodological adaption for integration in dietary assessments. In this narrative review, we summarize the key conceptual issues underlying the measurement of food biodiversity at an edible species level, assess the ecological diversity indices previously applied to food consumption and food supply data, discuss their relative suitability, and potential amendments for use in (quantitative) dietary intake studies. Ecological diversity indices are often used without justification through the lens of nutrition. To illustrate: (i) dietary species richness fails to account for the distribution of foods across the diet or their functional traits; (ii) evenness indices, such as the Gini-Simpson index, require widely accepted relative abundance units (e.g., kcal, g, cups) and evidence-based moderation weighting factors; and (iii) functional dissimilarity indices are constructed based on an arbitrary selection of distance measures, cutoff criteria, and number of phylogenetic, nutritional, and morphological traits. Disregard for these limitations can lead to counterintuitive results and ambiguous or incorrect conclusions about the food biodiversity within diets or food systems. To ensure comparability and robustness of future research, we advocate food biodiversity indices that: (i) satisfy key axioms; (ii) can be extended to account for disparity between edible species; and (iii) are used in combination, rather than in isolation.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2022.2051163 .
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Affiliation(s)
- Giles T Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Aisling J Daly
- Department of Data Analysis and Mathematical Modelling, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Roseline Remans
- The Alliance of Bioversity International and International Centre for Tropical Agriculture, Geneva, Switzerland
| | - Andrew D Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Kris A Murray
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
- School of Hygiene & Tropical Medicine, MRC Unit The Gambia at London, Banjul, The Gambia
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Bernard De Baets
- Department of Data Analysis and Mathematical Modelling, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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Akter F, Hossain MM, Shamim AA, Khan MSA, Hasan M, Hanif AAM, Hossaine M, Urmy NJ, Ullah MA, Sarker SK, Rahman SMM, Mitra DK, Bulbul MMI, Mridha MK. Prevalence and socio-economic determinants of inadequate dietary diversity among adolescent girls and boys in Bangladesh: findings from a nationwide cross-sectional survey. J Nutr Sci 2021; 10:e103. [PMID: 35059184 PMCID: PMC8727722 DOI: 10.1017/jns.2021.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 01/05/2023] Open
Abstract
Malnutrition among adolescents is often associated with inadequate dietary diversity (DD). We aimed to explore the prevalence of inadequate DD and its socio-economic determinants among adolescent girls and boys in Bangladesh. A cross-sectional survey was conducted during the 2018-19 round of national nutrition surveillance in Bangladesh. Univariate and multivariable logistic regression was performed to identify the determinants of inadequate DD among adolescent girls and boys separately. This population-based survey covered eighty-two rural, non-slum urban and slum clusters from all divisions of Bangladesh. A total of 4865 adolescent girls and 4907 adolescent boys were interviewed. The overall prevalence of inadequate DD was higher among girls (55⋅4 %) than the boys (50⋅6 %). Moreover, compared to boys, the prevalence of inadequate DD was higher among the girls for almost all socio-economic categories. Poor educational attainment, poor maternal education, female-headed household, household food insecurity and poor household wealth were associated with increased chances of having inadequate DD in both sexes. In conclusion, more than half of the Bangladeshi adolescent girls and boys consumed an inadequately diversified diet. The socio-economic determinants of inadequate DD should be addressed through context-specific multisectoral interventions.
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Affiliation(s)
- Fahmida Akter
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Nushrat Jahan Urmy
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services, Institute of Public Health Nutrition, Dhaka, Bangladesh
| | - Samir Kanti Sarker
- National Nutrition Services, Institute of Public Health Nutrition, Dhaka, Bangladesh
| | | | - Dipak Kumar Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | - Malay Kanti Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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21
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Consumption of dietary folate estimates and its implication for reproductive outcome among women of reproductive age in Kersa: cross-sectional survey. BMC Nutr 2021; 7:69. [PMID: 34776012 PMCID: PMC8591879 DOI: 10.1186/s40795-021-00476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Dietary folate inadequacy is one the most common micronutrient deficiencies that cause neural tube defect (NTD) among infants in Sub-Saharan African countries. This study aims to determine the dietary intake of folate among women of reproductive age (WRA) of Kersa, Eastern Ethiopia. Methods A cross-sectional study took place among voluntary women that were selected from 1140 random households. Using a validated Food Frequency Questionnaire, participant’s weekly dietary intake history of Ethiopian foods and dietary folate intake was worked out. Statistical analysis was done at a 95% confidence interval. Modified Poisson regression was used to identify factors associated with dietary folate consumption. Result The estimated median usual intake of folate was 170 μg/d (IQR: 118.3; 252.2) and about 33% of WRA had low folate intake and 73.9% were at risk for folate inadequacy. From the reported food groups, Beans and Peas, Starchy staples, and Vitamin-A rich dark-green leafy vegetables were the top three ranked foods that contributed much of the dietary folate. The following conditions were statistically related to dietary folate inadequacy; women’s age, being in poor wealth index, low dietary diversity, having seasonal employment, and reliance on market food sources. Conclusions We found that women’s dietary intake of folate in Kersa is very low and cannot protect their offspring from the risk of having NTD. They could also potentially be predisposed to poor health outcomes. Diversifying and fortification of Ethiopian wheats and salts could decrease the burden of folate deficiency in the country.
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Bromage S, Batis C, Bhupathiraju SN, Fawzi WW, Fung TT, Li Y, Deitchler M, Angulo E, Birk N, Castellanos-Gutiérrez A, He Y, Fang Y, Matsuzaki M, Zhang Y, Moursi M, Kronsteiner-Gicevic S, Holmes MD, Isanaka S, Kinra S, Sachs SE, Stampfer MJ, Stern D, Willett WC. Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS). J Nutr 2021; 151:75S-92S. [PMID: 34689200 PMCID: PMC8542096 DOI: 10.1093/jn/nxab244] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups. OBJECTIVES We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings. METHODS Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics. RESULTS We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes). CONCLUSIONS The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application-based 24-h recall system developed as part of this project.
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Affiliation(s)
| | | | - Shilpa N Bhupathiraju
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Teresa T Fung
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Simmons University, Boston, MA, USA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Megan Deitchler
- Intake - Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Erick Angulo
- National Institute of Public Health, Cuernavaca, Mexico
| | - Nick Birk
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Yuna He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuehui Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mika Matsuzaki
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yiwen Zhang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mourad Moursi
- Intake - Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Selma Kronsteiner-Gicevic
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,London Centre for Integrative Research on Agriculture and Health, London, United Kingdom
| | - Michelle D Holmes
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sheila Isanaka
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sanjay Kinra
- London School of Hygiene and Tropical Disease, London, United Kingdom
| | - Sonia E Sachs
- Center for Sustainable Development, Columbia University, New York, NY, USA
| | - Meir J Stampfer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Dalia Stern
- National Institute of Public Health, Cuernavaca, Mexico
| | - Walter C Willett
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
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23
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Bromage S, Andersen CT, Tadesse AW, Passarelli S, Hemler EC, Fekadu H, Sudfeld CR, Worku A, Berhane H, Batis C, Bhupathiraju SN, Fung TT, Li Y, Stampfer MJ, Deitchler M, Willett WC, Fawzi WW. The Global Diet Quality Score is Associated with Higher Nutrient Adequacy, Midupper Arm Circumference, Venous Hemoglobin, and Serum Folate Among Urban and Rural Ethiopian Adults. J Nutr 2021; 151:130S-142S. [PMID: 34689198 PMCID: PMC8564694 DOI: 10.1093/jn/nxab264] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/18/2021] [Accepted: 07/20/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising. OBJECTIVES To evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults. METHODS We scored the GDQS and a suite of comparison metrics in secondary analyses of FFQ and 24-hour recall (24HR) data from a population-based cross-sectional survey of nonpregnant, nonlactating women of reproductive age and men (15-49 years) in Addis Ababa and 5 predominately rural regions. We evaluated Spearman correlations between metrics and energy-adjusted nutrient adequacy, and associations between metrics and anthropometric/biomarker outcomes in covariate-adjusted regression models. RESULTS In the FFQ analysis, correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy were 0.32 in men and 0.26 in women. GDQS scores were inversely associated with folate deficiency in men and women (GDQS Quintile 5 compared with Quintile 1 OR in women, 0.50; 95% CI: 0.31-0.79); inversely associated with underweight (OR, 0.63; 95% CI: 0.44-0.90), low midupper arm circumference (OR, 0.61; 95% CI: 0.45-0.84), and anemia (OR, 0.59; 95% CI: 0.38-0.91) in women; and positively associated with hypertension in men (OR: 1.77, 95% CI: 1.12-2.80). For comparison, the Minimum Dietary Diversity-Women (MDD-W) was associated more positively (P < 0.05) with overall nutrient adequacy in men and women, but also associated with low ferritin in men, overweight/obesity in women, and hypertension in men and women. In the 24HR analysis (restricted to women), the MDD-W was associated more positively (P < 0.05) with nutrient adequacy than the GDQS, but also associated with low ferritin, while the GDQS was associated inversely with anemia. CONCLUSIONS The GDQS performed capably in capturing nutrient adequacy-related outcomes in Ethiopian adults. Prospective studies are warranted to assess the GDQS' performance in capturing NCD outcomes in sub-Saharan Africa.
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Affiliation(s)
| | | | - Amare W Tadesse
- London School of Hygiene and Tropical Medicine, London, UK,Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | | | - Elena C Hemler
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Hanna Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Carolina Batis
- CONACYT—Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Shilpa N Bhupathiraju
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Teresa T Fung
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Simmons University, Boston, MA, USA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Megan Deitchler
- Intake–Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Walter C Willett
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Fung TT, Li Y, Bhupathiraju SN, Bromage S, Batis C, Holmes MD, Stampfer M, Hu FB, Deitchler M, Willett WC. Higher Global Diet Quality Score Is Inversely Associated with Risk of Type 2 Diabetes in US Women. J Nutr 2021; 151:168S-175S. [PMID: 34689196 PMCID: PMC8542093 DOI: 10.1093/jn/nxab195] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/29/2021] [Accepted: 05/25/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We have developed a diet quality metric intended for global use. To assess its utility in high-income settings, an evaluation of its ability to predict chronic disease is needed. OBJECTIVES We aimed to prospectively examine the ability of the Global Diet Quality Score (GDQS) to predict the risk of type 2 diabetes in the United States, examine potential differences of association by age, and compare the GDQS with other diet quality scores. METHODS Health, lifestyle, and diet information was collected from women (n = 88,520) in the Nurses' Health Study II aged 27-44 y at baseline through repeated questionnaires between 1991 and 2017. The overall GDQS consists of 25 food groups. Points are awarded for higher intake of healthy groups and lower intake of unhealthy groups (maximum of 49 points). Multivariable HRs were computed for confirmed type 2 diabetes using proportional hazards models. We also compared the GDQS with the Minimum Diet Diversity score for Women (MDD-W) and the Alternate Healthy Eating Index-2010 (AHEI-2010). RESULTS We ascertained 6305 incident cases of type 2 diabetes during follow-up. We observed a lower risk of diabetes with higher GDQS; the multivariable HR comparing extreme quintiles of the GDQS was 0.83 (95% CI: 0.76, 0.91; P-trend < 0.001). The magnitude of association was similar between women aged <50 y and those aged ≥50 y. An inverse association was observed with lower intake of unhealthy components (HR comparing extreme quintiles of the unhealthy submetric: 0.76; 95% CI: 0.69, 0.84; P-trend < 0.001) but was not with the healthy submetric. The inverse association for each 1-SD increase in the GDQS (HR: 0.93; 95% CI: 0.91, 0.96) was stronger (P < 0.001) than for the MDD-W (HR: 1.00; 95% CI: 0.94, 1.04) but was slightly weaker (P = 0.03) than for the AHEI-2010 (HR: 0.91; 95% CI: 0.88, 0.94). CONCLUSIONS A higher GDQS was inversely associated with type 2 diabetes risk in US women of reproductive age or older, mainly from lower intake of unhealthy foods. The GDQS performed nearly as well as the AHEI-2010.
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Affiliation(s)
- Teresa T Fung
- Department of Nutrition, Simmons University, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Yanping Li
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Shilpa N Bhupathiraju
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sabri Bromage
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Carolina Batis
- CONACYT—Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Michelle D Holmes
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Meir Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Megan Deitchler
- Intake—Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Walter C Willett
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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25
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He Y, Fang Y, Bromage S, Fung TT, Bhupathiraju SN, Batis C, Deitchler M, Fawzi W, Stampfer MJ, Hu FB, Willett WC, Li Y. Application of the Global Diet Quality Score in Chinese Adults to Evaluate the Double Burden of Nutrient Inadequacy and Metabolic Syndrome. J Nutr 2021; 151:93S-100S. [PMID: 34689199 PMCID: PMC8542094 DOI: 10.1093/jn/nxab162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/01/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The double burdens of under- and overnutrition are changing the health of individuals and the economic and disease burdens in China. Poor diet plays an important role; however, a valid and easily operationalized metric that could capture the full range of characteristics of the diet that are relevant to both under- and overnutrition is lacking in China. OBJECTIVES We aimed to examine the application of the Global Diet Quality Score (GDQS) to evaluate nutrient inadequacy and metabolic syndrome in different demographic groups of Chinese adults. METHODS A total of 35,146 individuals (men 14,978, women 20,168) aged >18 y from the 2010-2012 China National Nutrition and Health Survey were included. We scored the GDQS using average intakes of 25 food groups from 3 d of 24-h dietary recalls. Double burden was defined as coexisting metabolic syndrome and nutrient inadequacy. RESULTS Diet quality assessed by GDQS was significantly higher in urban than in rural residents (20.8 compared with 18.7), and increased with both educational level and household income (P-trends < 0.0001). A higher GDQS score was inversely associated with metabolic syndrome and nutrient inadequacy, or both (P-trends < 0.0001): multivariate adjusted ORs comparing extreme quintiles of GDQS were 0.79 (95% CI: 0.69, 0.91) for metabolic syndrome, 0.17 (95% CI: 0.14, 0.20) for nutrient inadequacy, and 0.59 (95% CI: 0.50, 0.69) for the double burden. These associations were consistent across different household income levels (P-interaction = 0.26), suggestively stronger in younger (<50 y), females, urban residents, and the more highly educated (P-interaction < 0.05) compared with their counterparts. CONCLUSIONS A higher GDQS was inversely associated with a double burden of nutrient inadequacy and metabolic syndrome across various subgroups of Chinese adults. The finding supports the use of the GDQS in different demographic groups of Chinese adults to assess diet quality and nutritional status.
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Affiliation(s)
- Yuna He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuehui Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sabri Bromage
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Teresa T Fung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Simmons University, Boston, MA, USA
| | - Shilpa N Bhupathiraju
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carolina Batis
- CONACYT—Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Megan Deitchler
- Intake – Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Wafaie Fawzi
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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26
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Castellanos-Gutiérrez A, Rodríguez-Ramírez S, Bromage S, Fung TT, Li Y, Bhupathiraju SN, Deitchler M, Willett W, Batis C. Performance of the Global Diet Quality Score with Nutrition and Health Outcomes in Mexico with 24-h Recall and FFQ Data. J Nutr 2021; 151:143S-151S. [PMID: 34689195 PMCID: PMC8542100 DOI: 10.1093/jn/nxab202] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/12/2021] [Accepted: 06/01/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Global Diet Quality Score (GDQS) is intended as a simple global diet quality metric feasible in low- and middle-income countries facing the double burden of malnutrition. OBJECTIVE The aim of this study was to evaluate the performance of the GDQS with markers of nutrient adequacy and chronic disease in nonpregnant nonlactating (NPNL) Mexican women of reproductive age and to compare it with the Alternate Healthy Eating Index-2010 (AHEI-2010) and the Minimum Dietary Diversity for Women (MDD-W). METHODS We included NPNL women aged 15 to 49 y from the Mexican National Health and Nutrition Surveys (2012 and 2016) with 24-h recall (n = 2542) or a FFQ (n = 4975) (separate samples). We evaluated the correlation of the GDQS with the energy-adjusted intake of several nutrients and evaluated its association with health parameters using covariate-adjusted linear regression models. RESULTS The GDQS was positively correlated with the intake of calcium, folate, iron, vitamin A, vitamin B-12, zinc, fiber, protein, and total fat (rho = 0.09 to 0.38, P < 0.05) and was inversely correlated with the intake of added sugar (rho = -0.37 and -0.38, P < 0.05) using both instruments, and with total fat, SFA, and MUFA only with 24-h recall data (rho = -0.06 to -0.16, P < 0.05). The GDQS was inversely associated with serum ferritin, BMI, waist circumference, and serum total and LDL cholesterol using FFQ data (P < 0.05), and was positively associated with serum folate using 24-h recall data (P < 0.05). Similar correlations and associations were observed with the MDD-W (only with micronutrients) and the AHEI-2010 (only with chronic disease-related nutrients and health markers). CONCLUSIONS In comparison to other diet metrics, the GDQS can capture both dimensions of nutrient adequacy and health markers related to the risk of chronic disease. The performance of the GDQS was satisfactory with either 24-h recall or FFQ.
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Affiliation(s)
| | - Sonia Rodríguez-Ramírez
- Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Sabri Bromage
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Teresa T Fung
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Simmons University, Boston, MA, USA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Megan Deitchler
- Intake – Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Walter Willett
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Carolina Batis
- CONACYT—Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
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Bromage S, Zhang Y, Holmes MD, Sachs SE, Fanzo J, Remans R, Sachs JD, Batis C, Bhupathiraju SN, Fung TT, Li Y, Stampfer MJ, Deitchler M, Willett WC, Fawzi WW. The Global Diet Quality Score Is Inversely Associated with Nutrient Inadequacy, Low Midupper Arm Circumference, and Anemia in Rural Adults in Ten Sub-Saharan African Countries. J Nutr 2021; 151:119S-129S. [PMID: 34689197 PMCID: PMC8542095 DOI: 10.1093/jn/nxab161] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden. OBJECTIVES We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDQS) against other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults. METHODS We scored the GDQS, Minimum Dietary Diversity-Women (MDD-W), and Alternative Healthy Eating Index-2010 (AHEI-2010) using FFQ data from rural men and nonpregnant, nonlactating women of reproductive age (15-49 y) in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models. RESULTS Correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% CI: 0.30, 0.38) in men and 0.37 (95% CI: 0.32, 0.41) in women. The GDQS was associated (P < 0.05) with lower odds of low MUAC [GDQS quintile (Q) 5 compared with Q1 OR in men: 0.44, 95% CI: 0.22, 0.85; women: 0.57, 95% CI: 0.31, 1.03] and anemia (Q5/Q1 OR in men: 0.56, 95% CI: 0.32, 0.98; women: 0.60, 95% CI: 0.35, 1.01). The MDD-W correlated better with some nutrient intakes, though associated marginally with low MUAC in men (P = 0.07). The AHEI-2010 correlated better with fatty acid intakes, though associated marginally with low MUAC (P = 0.06) and anemia (P = 0.14) in women. Overweight/obesity prevalence was low, and neither the GDQS, MDD-W, nor AHEI-2010 were predictive. CONCLUSIONS The GDQS performed comparably with the MDD-W in capturing nutrient adequacy-related outcomes in rural SSA. Given limited data on NCD outcomes and the cross-sectional study design, prospective studies are warranted to assess GDQS performance in capturing NCD outcomes in SSA.
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Affiliation(s)
- Sabri Bromage
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yiwen Zhang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michelle D Holmes
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Sonia E Sachs
- The Earth Institute, Columbia University, New York, NY, USA
| | - Jessica Fanzo
- Berman Institute of Bioethics, Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA
| | - Roseline Remans
- The Alliance of Biodiversity International and the International Center for Tropical Agriculture (CIAT), Geneva, Switzerland
| | | | - Carolina Batis
- CONACYT—Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Shilpa N Bhupathiraju
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Teresa T Fung
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Simmons University, Boston, MA, USA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Megan Deitchler
- Intake – Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Walter C Willett
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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28
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Lweno O, Hertzmark E, Darling AM, Noor R, Bakari L, Sudfeld C, Manji K, Fawzi W. The High Burden and Predictors of Anemia Among Infants Aged 6 to 12 Months in Dar es Salaam, Tanzania. Food Nutr Bull 2021; 43:68-83. [PMID: 34615387 DOI: 10.1177/03795721211007009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite several interventions, the prevalence of anemia and related complications remains high among infants in Tanzania. OBJECTIVE We sought to determine the predictors of iron-deficiency anemia (IDA) among infants of HIV-negative women in Dar es Salaam, Tanzania. METHODS Cross-sectional analysis of 2826 mother-infant pairs who participated in a trial of vitamins and perinatal outcomes in Dar es Salaam, Tanzania. Hemoglobin and mean corpuscular volume were used to determine the prevalence of anemia among infants at 6 and 12 months. Multiple logistic regression was used to determine the maternal and infant risk factors for anemia during infancy. RESULTS We found high prevalence of anemia (90%) and IDA (44.2%) among infants. Higher maternal education (odds ratio [OR] = 0.52), maternal normal hemoglobin at enrollment (OR = 0.68) and during the early postpartum period reduced the odds of IDA at 6 months (OR = 0.56). The odds of IDA at 6 months were higher among males (OR = 1.65), wealth score below median (OR = 1.35), low birth weight (LBW; OR = 1.75), and small for gestational age (SGA) infants below the third centile (OR = 1.95) or third to less than fifth centile (OR = 2.29). Higher maternal education lowered the odds of IDA at 12 months (OR = 0.25). Wealth score below median (OR = 1.44), preterm delivery (OR = 1.94), SGA (less than third centile; OR = 2.40), and LBW (OR = 2.89) increased the odds of IDA during infancy in the study population. Dietary diversity was low for infants and women in the study sample. CONCLUSION Interventions to reduce the risk of infant IDA should address women's education, improvement of wealth status, and optimal care for premature, SGA, and LBW infants.
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Affiliation(s)
- Omar Lweno
- Ifakara Health Institute, Bagamoyo Research and Training Center, Bagamoyo, Tanzania
| | - Ellen Hertzmark
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ramadhani Noor
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Leguma Bakari
- Ifakara Health Institute, Bagamoyo Research and Training Center, Bagamoyo, Tanzania
| | - Christopher Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karim Manji
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Performance of individual dietary diversity score to identify malnutrition among patients living with HIV in Ethiopia. Sci Rep 2021; 11:18681. [PMID: 34548547 PMCID: PMC8455526 DOI: 10.1038/s41598-021-98202-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
There is a lack of uniformity in developing and validating indicators of nutritional status among People Living with Human Immunodeficiency Virus (PLHIV). Experiences from low and middle-income countries are scant, and differences in methodological and analytical approaches affect the comparability and generalizability of findings. Therefore, this study investigated the performance of individual diversity score (IDDS) as a proxy indicator of nutritional status among PLHIV. We conducted a facility-based cross-sectional study among 423 PLHIV who were under Antiretroviral Treatment (ART) at clinics in Bahir-Dar, Ethiopia. We collected data on sociodemographic, dietary, clinical, and anthropometric measures. Dietary intake was assessed using 24-Hour dietary recall. Body Mass Index (BMI) was calculated to assess the nutritional status of study subjects. The receiver operating characteristic (ROC) curve analysis was used to assess the ability of the IDDS and Minimum Dietary Diversity for Women (MDD-W) to detect poor nutritional status. Furthermore, sensitivity, specificity, Predictive Values (PPs), and Likelihood Ratios (LRs) were calculated at different cut-off points. IDDS showed good reliability with Cronbach’s Alpha of 0.76. The Area Under the Curve (AUC) of IDDS was 78.5 (95%CI 73.9–83.4). At the IDDS cut-off of 4, the sensitivity and specificity of IDDS to indicate nutritional status were 88.0% (95%CI 81.0–93.0) and 71.0% (95%CI 66.0–76.0), respectively. The AUC of MDD-W was 74.1%, and at the cut-off of 4 the sensitivity and specificity of MDD-W to indicate undernutrition were 73.0% and 72.0%, respectively. Both IDDS and MDD-W have good accuracy as a proxy indicator for measuring the nutritional status of PLHIV. In the prevention of undernutrition among PLHIV especially in a resource-limited setting, IDDS and MDD-W can be used to assess nutritional status.
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30
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Household-level double burden of malnutrition in Ethiopia: a comparison of Addis Ababa and the rural district of Kersa. Public Health Nutr 2021; 24:6354-6368. [PMID: 34446127 DOI: 10.1017/s1368980021003700] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the prevalence of and factors associated with different forms of household-level double burden of malnutrition (DBM) in Ethiopia. DESIGN We defined DBM using anthropometric measures for adult overweight (BMI ≥ 25 kg/m2), child stunting (height-for-age Z-score <-2 sd) and overweight (weight-for-height Z-score ≥2 sd). We considered sixteen biological, environmental, behavioural and socio-demographic factors. Their association with DBM forms was assessed using generalised linear models. SETTING We used data from two cross-sectional studies in an urban (Addis Ababa, January-February 2018), and rural setting (Kersa District, June-September 2019). PARTICIPANTS Five hundred ninety-two urban and 862 rural households with an adult man, adult woman and child <5 years. RESULTS In Addis Ababa, overweight adult and stunted child was the most prevalent DBM form (9 % (95 % CI 7, 12)). Duration of residence in Addis Ababa (adjusted OR (aOR) 1·03 (95 % CI 1·00, 1·06)), Orthodox Christianity (aOR 1·97 (95 % CI 1·01, 3·85)) and household size (aOR 1·24 (95 % CI 1·01, 1·54)) were associated factors. In Kersa, concurrent child overweight and stunting was the most prevalent DBM form (11 % (95 % CI 9, 14)). Housing quality (aOR 0·33 (95 % CI 0·20, 0·53)), household wealth (aOR 1·92 (95 % CI 1·18, 3·11) and sanitation (aOR 2·08 (95 % CI 1·07, 4·04)) were associated factors. After adjusting for multiple comparisons, only housing quality remained a significant factor. CONCLUSIONS DBM prevalence was low among urban and rural Ethiopian households. Environmental, socio-economic and demographic factors emerged as potential associated factors. However, we observed no common associated factors among urban and rural households.
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Kim HS, Lee H, Provido SMP, Kang M, Chung GH, Hong S, Yu SH, Lee CB, Lee JE. Association Between Diet Quality and Prevalence of Obesity, Dyslipidemia, and Insulin Resistance Among Filipino Immigrant Women in Korea: The Filipino Women's Diet and Health Study. Front Public Health 2021; 9:647661. [PMID: 34277535 PMCID: PMC8281297 DOI: 10.3389/fpubh.2021.647661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/03/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives: Diet quality may be a key modifiable factor for the prevention of non-communicable disease. We aimed to investigate the association between diet quality and prevalence of obesity, dyslipidemia, and insulin resistance among Filipino immigrant women in Korea. Methods: A total of 413 participants from the 2014–2016 baseline population of the Filipino Women's Diet and Health Study (FiLWHEL) were examined. Individual dietary intakes were evaluated through 24-h recalls and then converted into two dietary quality assessments: Minimum Dietary Diversity for Women (MDD-W) developed by the Food and Agriculture Organization (FAO) and the Data Derived Inflammation Index (DDII) originally developed by our group. Fasting blood levels of triglycerides, high-density lipoprotein cholesterols, glucose, and insulin were measured. We used logistic regression models for odds ratios (ORs) with 95% confidence intervals (CIs). Results: We found a statistically significant association between MDD-W scores and decreased prevalence of abdominal obesity; ORs (95% CIs) of the 3rd vs. 1st tertiles were 0.58 (0.36–0.94; p for trend = 0.029). Increased DDII was associated with elevated prevalence of dyslipidemia and insulin resistance; ORs (95% CIs) of the 5th vs. 1–3rd quintiles were 6.44 (2.56–16.20) for triglycerides (TG), 3.90 (1.92–7.90) for low-density lipoprotein (LDL) cholesterol, 3.36 (1.81–6.24) for total cholesterol (TC), 6.25 (2.53–15.41) for abnormal TG/HDL ratios, 3.59 (1.96–6.59) for HbA1c, 2.61 (1.11–6.17) for fasting blood glucose levels, 9.67 (4.16–22.48) for insulin levels, and 9.73 (4.46–21.25) for homeostasis model assessment of insulin resistance (HOMA-IR) (p for trend <0.001 for all, except 0.033 for fasting blood glucose). Conclusions: Greater dietary diversity was inversely associated with the prevalence of abdominal obesity in Filipino immigrant women. Proinflammatory scores based on diet and lifestyle factors were associated with an increased prevalence of dyslipidemia and insulin resistance. Further, epidemiological studies on the relationship between dietary acculturation and chronic disease are warranted.
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Affiliation(s)
- Hee Sun Kim
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, South Korea
| | - Heejin Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, South Korea
| | | | - Minji Kang
- Research Institute of Human Ecology, Seoul National University, Seoul, South Korea.,BK21 FOUR Education and Research Team for Sustainable Food & Nutrition, Seoul, South Korea
| | - Grace H Chung
- Research Institute of Human Ecology, Seoul National University, Seoul, South Korea.,Department of Child Development and Family Studies, College of Human Ecology, Seoul National University, Seoul, South Korea
| | - Sangmo Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Sung Hoon Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Chang Beom Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, South Korea.,Research Institute of Human Ecology, Seoul National University, Seoul, South Korea
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Madzorera I, Jaacks L, Paarlberg R, Herforth A, Bromage S, Ghosh S, Myers SS, Masters WA, Fawzi WW. Food Systems as Drivers of Optimal Nutrition and Health: Complexities and Opportunities for Research and Implementation. Curr Dev Nutr 2021; 5:nzab062. [PMID: 34084996 PMCID: PMC8166275 DOI: 10.1093/cdn/nzab062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/17/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023] Open
Abstract
The Sustainable Development Goals (SDGs) are intricately linked to food systems. Addressing challenges in food systems is key to meeting the SDGs in Africa and South Asia, where undernutrition and micronutrient deficiencies persist, alongside increased nutrition transition, overweight and obesity, and related chronic diseases. Suboptimal diets are a key risk factor for mortality and 3 billion people cannot afford a healthy diet; in addition, food systems are not prioritizing environmental sustainability. Optimizing food systems and increasing agricultural productivity beyond calories, to nutrient-rich vegetables and fruits, legumes, and livestock, and sustainable fishing, are required. Strengthening of research around food systems-on pathways, value chains, and development and validation of metrics of diet quality-is required. The development of new technology in crop management and pest control and addressing natural resource degradation is key. Engaging with the public and private sectors, outreach to donors and policymakers, and strengthening cross-disciplinary collaborations are imperative to improving food systems.
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Affiliation(s)
- Isabel Madzorera
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Lindsay Jaacks
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Robert Paarlberg
- Harvard Kennedy School of Public Policy and Governance, Cambridge, MA, USA
| | - Anna Herforth
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Sabri Bromage
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Shibani Ghosh
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, MA, USA
| | - Samuel S Myers
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - William A Masters
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, MA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
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Kadiyala S, Harris-Fry H, Pradhan R, Mohanty S, Padhan S, Rath S, James P, Fivian E, Koniz-Booher P, Nair N, Haghparast-Bidgoli H, Mishra NK, Rath S, Beaumont E, Danton H, Krishnan S, Parida M, O'Hearn M, Kumar A, Upadhyay A, Tripathy P, Skordis J, Sturgess J, Elbourne D, Prost A, Allen E. Effect of nutrition-sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutritional outcomes in rural Odisha, India (UPAVAN trial): a four-arm, observer-blind, cluster-randomised controlled trial. Lancet Planet Health 2021; 5:e263-e276. [PMID: 33811818 PMCID: PMC8099729 DOI: 10.1016/s2542-5196(21)00001-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Almost a quarter of the world's undernourished people live in India. We tested the effects of three nutrition-sensitive agriculture (NSA) interventions on maternal and child nutrition in India. METHODS We did a parallel, four-arm, observer-blind, cluster-randomised trial in Keonjhar district, Odisha, India. A cluster was one or more villages with a combined minimum population of 800 residents. The clusters were allocated 1:1:1:1 to a control group or an intervention group of fortnightly women's groups meetings and household visits over 32 months using: NSA videos (AGRI group); NSA and nutrition-specific videos (AGRI-NUT group); or NSA videos and a nutrition-specific participatory learning and action (PLA) cycle meetings and videos (AGRI-NUT+PLA group). Primary outcomes were the proportion of children aged 6-23 months consuming at least four of seven food groups the previous day and mean maternal body-mass index (BMI). Secondary outcomes were proportion of mothers consuming at least five of ten food groups and child wasting (proportion of children with weight-for-height Z score SD <-2). Outcomes were assessed in children and mothers through cross-sectional surveys at baseline and at endline, 36 months later. Analyses were by intention to treat. Participants and intervention facilitators were not blinded to allocation; the research team were. This trial is registered at ISRCTN, ISRCTN65922679. FINDINGS 148 of 162 clusters assessed for eligibility were enrolled and randomly allocated to trial groups (37 clusters per group). Baseline surveys took place from Nov 24, 2016, to Jan 24, 2017; clusters were randomised from December, 2016, to January, 2017; and interventions were implemented from March 20, 2017, to Oct 31, 2019, and endline surveys done from Nov 19, 2019, to Jan 12, 2020, in an average of 32 households per cluster. All clusters were included in the analyses. There was an increase in the proportion of children consuming at least four of seven food groups in the AGRI-NUT (adjusted relative risk [RR] 1·19, 95% CI 1·03 to 1·37, p=0·02) and AGRI-NUT+PLA (1·27, 1·11 to 1·46, p=0·001) groups, but not AGRI (1·06, 0·91 to 1·23, p=0·44), compared with the control group. We found no effects on mean maternal BMI (adjusted mean differences vs control, AGRI -0·05, -0·34 to 0·24; AGRI-NUT 0·04, -0·26 to 0·33; AGRI-NUT+PLA -0·03, -0·3 to 0·23). An increase in the proportion of mothers consuming at least five of ten food groups was seen in the AGRI (adjusted RR 1·21, 1·01 to 1·45) and AGRI-NUT+PLA (1·30, 1·10 to 1·53) groups compared with the control group, but not in AGRI-NUT (1·16, 0·98 to 1·38). We found no effects on child wasting (adjusted RR vs control, AGRI 0·95, 0·73 to 1·24; AGRI-NUT 0·96, 0·72 to 1·29; AGRI-NUT+PLA 0·96, 0·73 to 1·26). INTERPRETATION Women's groups using combinations of NSA videos, nutrition-specific videos, and PLA cycle meetings improved maternal and child diet quality in rural Odisha, India. These components have been implemented separately in several low-income settings; effects could be increased by scaling up together. FUNDING Bill & Melinda Gates Foundation, UK AID from the UK Government, and US Agency for International Development.
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Affiliation(s)
- Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Shibanath Padhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Kendrapara, India
| | | | - Philip James
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Fivian
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Naba Kishor Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Kendrapara, India
| | | | - Emma Beaumont
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sneha Krishnan
- Environment, Technology and Community Health Consultancy Service, Mumbai, India; Jindal School of Environment and Sustainability, Jindal Global University, Haryana, India
| | | | - Meghan O'Hearn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | | | | | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
| | - Joanna Sturgess
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
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Dietary diversity and associated factors among HIV-positive adults attending the anti-retroviral therapy clinic at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia: a cross-sectional study. J Nutr Sci 2021; 10:e18. [PMID: 33889401 PMCID: PMC8057398 DOI: 10.1017/jns.2021.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/24/2022] Open
Abstract
The aim of the study was to assess dietary diversity (DD) and associated factors among human immune deficiency virus (HIV)-positive adults attending the anti-retroviral therapy (ART) clinic at Felege Hiwot Comprehensive Specialized Hospital (FHCSH) in Northwest Ethiopia. An institution-based cross-sectional study was conducted at FHCSH in 2019. A systematic random sampling technique was employed to select 352 study subjects. Data were collected using an interviewer-administered questionnaire and chart review. Statistical Package for the Social Science version 26 was used for analysis. A simple and multivariable binary logistic regression was used to determine associated factors. Two hundred and nine (59⋅4 %) adults had consumed a diversified diet. The mean individual DD score was 3⋅86 ± 1⋅18. Self-employment status (adjusted odd ratio (AOR): 4⋅60; 95 % confidence interval (CI): 1⋅72, 12⋅27), quintiles of wealth index (the second (AOR: 4⋅33; 95 % CI: 1⋅72, 10⋅89), middle (AOR: 4⋅40; 95 % CI: 1⋅71, 11⋅31), fourth (AOR: 6⋅60; 95 % CI: 2⋅36, 18⋅48) and the highest quintiles (AOR: 9⋅45: 95 % CI: 3⋅34, 26⋅77), the last CD4 count 200–349 cells/mm3 (AOR: 8⋅08; 95 % CI: 2⋅93, 22⋅23), those who took first-line ART regimen drugs (AOR: 4⋅49; 95 % CI: 2⋅19, 9⋅21), subjects who did not take co-trimoxazole prophylaxis (AOR: 6⋅36; 95 % CI: 2⋅54, 15⋅88), those who had nutritional counselling at a health institution (AOR: 2⋅36; 95 % CI: 1⋅08, 5⋅16), had no food preference (AOR: 2⋅42; 95 % CI: 1⋅14, 5⋅13) and a food-secure household (AOR: 3⋅51; 95 % CI: 1⋅85, 6⋅67) were associated factors of DD among adults on ART. This study exhibited that the DD status among adults attending the ART clinic was below two-thirds. Health institutions and health professionals working at ART clinics shall strengthen their efforts to sustain the nutritional counselling service and ART adherence at health institutions and encourage the patients to avoid food preference for their meal. It is vital to ensure the household food security of adults on ART.
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The Influence of Eating at Home on Dietary Diversity and Airway Inflammation in Portuguese School-Aged Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052646. [PMID: 33808006 PMCID: PMC7967357 DOI: 10.3390/ijerph18052646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
Considering the negative impact of a lack of dietary diversity on children’s nutritional status, we aimed to describe dietary variety according to eating at home frequency and assessed its association with respiratory outcomes in school-aged children. This cross-sectional study included 590 children (49% girls) aged 7 to 12 years from 20 public schools located in city of Porto, Portugal. Daily frequency of eating at home groups were calculated and dietary diversity was calculated using a 10-food group score from a 24 h recall questionnaire. Spirometry and exhaled nitric oxide levels (eNO; <35 and ≥35 ppb) were assessed. The comparison of diet diversity according to the groups was performed by ANOVA and ANCOVA. The association between dietary diversity and respiratory outcomes was examined using regression models. In multivariate analysis, children in the highest group of eating at home episodes (≥4 occasions) obtained the lowest dietary diversity mean score, while the lowest group (<2) had the highest mean score (p-value 0.026). After adjustment for confounders, higher diet diversity (≥5 food groups) significantly decreased the odds of having an eNO ≥35. Diet diversity might decrease the chance of airway inflammation among children. However, having more eating episodes at home could be a barrier to a more diverse diet.
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Seiermann AU, Al-Mufti H, Waid JL, Wendt AS, Sobhan S, Gabrysch S. Women's fasting habits and dietary diversity during Ramadan in rural Bangladesh. MATERNAL AND CHILD NUTRITION 2021; 17:e13135. [PMID: 33522117 PMCID: PMC8189200 DOI: 10.1111/mcn.13135] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 01/01/2023]
Abstract
Little is known about fasting practices and dietary changes during Ramadan in low‐ and lower‐middle‐income countries. Although pregnant women are exempt from fasting, they may still fast. This is of interest as dietary habits during pregnancy may affect the development of the unborn child. In a community‐based sample of young women in rural Sylhet division, Bangladesh, we described fasting practices and beliefs (n = 852). We also examined reported food group consumption and minimally adequate dietary diversity for women (MDD‐W) by Ramadan occurrence (n = 1,895) and by fasting adherence (n = 558) using logistic regression with Hindu women as a seasonal control. During Ramadan in 2018, 78% of pregnant Muslim women fasted every day. Over 80% of Muslim women believe that they should fast during pregnancy and over 50% expect positive health effects on the mother and the unborn child. We found strong evidence that Muslim women have more diverse diets during Ramadan, with higher odds of MDD‐W (OR [95% CI]: 5.0 [3.6, 6.9]) and increased consumption of pulses, dairy, fruit, and large fish. Dietary diversity increased to a lesser extent on non‐fasting days during Ramadan. Ramadan appears to improve dietary quality in both fasting and non‐fasting Muslim women in a rural population in Bangladesh. These results help to interpret findings from studies on Ramadan during pregnancy on later‐life outcomes and thus contribute to a better understanding of intrauterine influences of maternal nutrition on healthy child development.
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Affiliation(s)
- Andrea U Seiermann
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hudaalrahman Al-Mufti
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Nineveh Directorate of Health, Ministry of Health, Nineveh, Iraq
| | - Jillian L Waid
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh.,Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Amanda S Wendt
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Shafinaz Sobhan
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany.,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Gabrysch
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany.,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Linkages between dietary diversity and indicators of agricultural biodiversity in Burkina Faso. Food Secur 2021. [DOI: 10.1007/s12571-020-01137-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ghosh‐Jerath S, Kapoor R, Singh A, Nilima, Downs S, Goldberg G, Fanzo J. Agroforestry diversity, indigenous food consumption and nutritional outcomes in Sauria Paharia tribal women of Jharkhand, India. MATERNAL & CHILD NUTRITION 2021; 17:e13052. [PMID: 32720415 PMCID: PMC7729651 DOI: 10.1111/mcn.13052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 01/24/2023]
Abstract
Like several indigenous populations, Sauria Paharias, a vulnerable indigenous tribal group residing in a biodiverse environment of Jharkhand, India, have high levels of undernutrition. We assessed agroforestry and dietary diversity, food consumption especially indigenous food (IF) intake and nutritional status of Sauria Paharia women through a cross-sectional study conducted in 18 villages of Godda district, Jharkhand. Household level information was elicited through household surveys including a dietary survey and a food frequency questionnaire. Twenty-four-hour dietary recalls (24 HDR) and anthropometric assessments were taken on one randomly selected woman per household. An index, Food Accessed Diversity Index (FADI) created to measure agroforestry diversity, showed a low mean score of 0.21 ± 0.15 and range: 0, 0.85. Fifty-nine percent of women consumed any IF during 24 HDR. Median minimum dietary diversity score for women (MDD-W) was 3 (acceptable score ≥5). More than 96% of women had intakes below estimated average requirements for all nutrients studied (energy; vitamins A, C, thiamine, riboflavin, niacin, pyridoxine; folate; iron; calcium and zinc) except protein; 41% women were underweight. IF consumption was independently associated with calcium and vitamin A intake. Decision trees developed for micronutrient consumption at different levels of MDD-W score and IF consumption scenarios revealed 1.3 to 2.9 times higher consumption of micronutrients among women with MDD-W ≥ 3 or 4. Strategies like agricultural extension programmes promoting indigenous varieties and nutrition education for increasing dietary diversity with IFs have potential to address undernutrition in Sauria Paharia women.
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Affiliation(s)
- Suparna Ghosh‐Jerath
- Indian Institute of Public Health‐DelhiPublic Health Foundation of IndiaGurgaonIndia
| | - Ridhima Kapoor
- Indian Institute of Public Health‐DelhiPublic Health Foundation of IndiaGurgaonIndia
| | - Archna Singh
- Department of BiochemistryAll India Institute of Medical SciencesNew DelhiIndia
| | - Nilima
- Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia
| | - Shauna Downs
- Department of Urban‐Global Public HealthRutgers School of Public HealthNewarkNew JerseyUSA
| | - Gail Goldberg
- Nutrition and Bone Health Research Group, MRC Human Nutrition ResearchElsie Widdowson LaboratoryCambridgeUK
| | - Jessica Fanzo
- Berman Institute of Bioethics, Johns Hopkins Nitze School of Advanced International Studies, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Bai Y, Naumova EN, Masters WA. Seasonality of diet costs reveals food system performance in East Africa. SCIENCE ADVANCES 2020; 6:6/49/eabc2162. [PMID: 33277248 PMCID: PMC7821891 DOI: 10.1126/sciadv.abc2162] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 10/22/2020] [Indexed: 05/27/2023]
Abstract
Seasonal fluctuations in food prices reflect interactions between climate and society, measuring the degree to which predictable patterns of crop growth and harvest are offset by storage and trade. Previous research on seasonality in food systems has focused on specific commodities. This study accounts for substitution between items to meet nutritional needs, computing seasonal variation in local food environments using monthly retail prices for 191 items across Ethiopia, Malawi, and Tanzania from 2002 through 2016. We computed over 25,000 least-cost diets meeting nutrient requirements at each market every month and then measured the magnitude and timing of seasonality in diet costs. We found significant intensity in Malawi, Tanzania, and Ethiopia (10.0, 6.3, and 4.0%, respectively), driven primarily by synchronized price rises for nutrient-dense foods. Results provide a metric to map nutritional security, pointing to opportunities for more targeted investments to improve the year-round delivery of nutrients.
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Affiliation(s)
- Yan Bai
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Elena N Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - William A Masters
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
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Herforth AW, Wiesmann D, Martínez-Steele E, Andrade G, Monteiro CA. Introducing a Suite of Low-Burden Diet Quality Indicators That Reflect Healthy Diet Patterns at Population Level. Curr Dev Nutr 2020; 4:nzaa168. [PMID: 33344879 PMCID: PMC7723758 DOI: 10.1093/cdn/nzaa168] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Few low-burden indicators of diet quality exist to track trends over time at low cost and with low technical expertise requirements. OBJECTIVE The aim was to develop and validate a suite of low-burden indicators to reflect adherence to global dietary recommendations. METHODS Using nationally representative, cross-sectional, quantitative dietary intake datasets from Brazil and the United States, we tested the association of food-group scores with quantitative consumption aligned with 11 global dietary recommendations. We updated the Healthy Diet Indicator (HDI) to include current quantifiable recommendations of the WHO (HDI-2020). We developed 3 food-group-based scores-an overall Global Dietary Recommendations (GDR) score as an indicator of all 11 recommendations composed of 2 subcomponents: GDR-Healthy, an indicator of the recommendations on "healthy" foods, and GDR-Limit, an indicator of the recommendations on dietary components to limit. We tested associations between these scores and the HDI-2020 and its respective subcomponents. We developed 9 dichotomous food-group-based indicators to reflect adherence to the global recommendations for fruits and vegetables, dietary fiber, free sugars, saturated fat, total fat, legumes, nuts and seeds, whole grains, and processed meats. We conducted receiver operating characteristic and sensitivity-specificity analyses to determine whether the dichotomous indicators were valid to predict adherence to the recommendations in both countries. RESULTS The GDR score and its subcomponents were moderately to strongly associated with the HDI-2020 and its respective subcomponents (absolute values of rank correlation coefficients ranged from 0.55 to 0.66). Of the 9 dichotomous indicators, 8 largely met the criteria for predicting individual global dietary recommendations in both countries; 1 indicator (total fat) did not perform satisfactorily. CONCLUSIONS Food-group consumption data can be used to indicate adherence to quantitative global dietary recommendations at population level. These indicators may be used to track progress of countries and populations toward meeting WHO guidance on healthy diets.
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Affiliation(s)
- Anna W Herforth
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | | | - Giovanna Andrade
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carlos A Monteiro
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
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Hawkes C, Fox E, Downs SM, Fanzo J, Neve K. Child-centered food systems: Reorienting food systems towards healthy diets for children. GLOBAL FOOD SECURITY 2020. [DOI: 10.1016/j.gfs.2020.100414] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Blakstad MM, Mosha D, Bellows AL, Canavan CR, Chen JT, Mlalama K, Noor RA, Kinabo J, Masanja H, Fawzi WW. Home gardening improves dietary diversity, a cluster-randomized controlled trial among Tanzanian women. MATERNAL AND CHILD NUTRITION 2020; 17:e13096. [PMID: 33241924 PMCID: PMC7988851 DOI: 10.1111/mcn.13096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/17/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022]
Abstract
Homestead food production (HFP) programmes improve the availability of vegetables by providing training in growing nutrient-dense crops. In rural Tanzania, most foods consumed are carbohydrate-rich staples with low micronutrient concentrations. This cluster-randomized controlled trial investigated whether women growing home gardens have higher dietary diversity, household food security or probability of consuming nutrient-rich food groups than women in a control group. We enrolled 1,006 women of reproductive age in 10 villages in Pwani Region in eastern Tanzania, split between intervention (INT) and control (CON) groups. INT received (a) agricultural training and inputs to promote HFP and dietary diversity and (b) nutrition and public health counselling from agricultural extension workers and community health workers. CON received standard services provided by agriculture and health workers. Results were analysed using linear regression models with propensity weighting adjusting for individual-level confounders and differential loss to follow up. Women in INT consumed 0.50 (95% CI [0.20, 0.80], p = 0.001) more food groups per day than women in CON. Women in INT were also 14 percentage points (95% CI [6, 22], p = 0.001) more likely to consume at least five food groups per day, and INT households were 6 percentage points (95% CI [-13, 0], p = 0.059) less likely to experience moderate-to-severe food insecurity compared with CON. This home gardening intervention had positive effects on diet quality and food security after 1 year. Future research should explore whether impact is sustained over time as well as the effects of home garden interventions on additional measures of nutritional status.
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Affiliation(s)
- Mia M Blakstad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Alexandra L Bellows
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Chelsey R Canavan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Ramadhani A Noor
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joyce Kinabo
- Department of Food Science Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | | | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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Madzorera I, Blakstad MM, Bellows AL, Canavan CR, Mosha D, Bromage S, Noor RA, Webb P, Ghosh S, Kinabo J, Masanja H, Fawzi WW. Food Crop Diversity, Women's Income-Earning Activities, and Distance to Markets in Relation to Maternal Dietary Quality in Tanzania. J Nutr 2020; 151:186-196. [PMID: 33244605 PMCID: PMC7779231 DOI: 10.1093/jn/nxaa329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Women's dietary diversity and quality are limited in low- and middle-income countries (LMICs). Nutrition-sensitive interventions that promote food crop diversity and women's access to income could improve diets and address the double burden of malnutrition in LMICs. OBJECTIVES We examined the associations among food crop diversity and women's income-earning activities with women's diet quality, as well as effect modification by access to markets, in the context of small-holder food production in rural Tanzania. METHODS Data from a cross-sectional study of 880 women from Rufiji, Tanzania, were analyzed. Women's dietary intake was assessed using a food frequency questionnaire. The prime diet quality score (PDQS; 21 food groups; range, 0-42), a unique diet-quality metric for women that captures the healthy and unhealthy aspects of diet, was computed. Generalized estimating equation linear models were used to evaluate the associations of food crop diversity and women's income-earning activities with PDQS, while controlling for socio-economic factors. RESULTS Maternal overweight (24.3%) and obesity (13.1%) were high. The median PDQS was 19 (IQR, 17-21). Households produced 2.0 food crops (SD ± 1.0) yearly. Food crop diversity was positively associated with PDQS (P < 0.001), but the association was strengthened by proximity to markets (P for interaction = 0.02). For women living close (<1.1 km) to markets, producing 1 additional food crop was associated with a 0.67 (95% CI, 0.22-1.12) increase in PDQS, versus a 0.40 (95% CI, 0.24-0.57) increase for women living farther away. The PDQS increased with women's salaried employment (estimate, 0.96; 95% CI, 0.26-1.67). CONCLUSIONS Household food production may interact with access to markets for sales and purchases, while nonfarm income also improves women's diet quality in rural Tanzania. Programs to improve women's diet quality should consider improving market access and women's access to income (source of empowerment), in addition to diversifying production.
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Affiliation(s)
| | - Mia M Blakstad
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Alexandra L Bellows
- Department of International Health (Human Nutrition), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chelsey R Canavan
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Sabri Bromage
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ramadhani A Noor
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Joyce Kinabo
- Department of Food Science Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | | | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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Nsereko E, Uwase A, Muvunyi CM, Rulisa S, Ntirushwa D, Moreland P, Corwin EJ, Santos N, Lin J, Chen JL, Nzayirambaho M, Wojcicki JM. Association between micronutrients and maternal leukocyte telomere length in early pregnancy in Rwanda. BMC Pregnancy Childbirth 2020; 20:692. [PMID: 33187486 PMCID: PMC7664098 DOI: 10.1186/s12884-020-03330-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Exposure to environmental stressors can lead to shorter leukocyte telomere length and increase the risk of chronic diseases. Preservation of leukocyte telomere length by reducing oxidative stress exposure and reinforcing immunity may be a mechanism by which nutritional factors delay or prevent chronic disease development. METHODS Healthy pregnant women (aged 18-45 years) at 9-15 weeks of gestation living in Gasabo District, Kigali, Rwanda, were recruited from 10 health centers for a prospective, longitudinal study from September to October 2017 to determine possible associations between nutrition health, infectious disease and leukocyte telomere length. Anthropometric and laboratory measurements were performed using standard procedures; sociodemographic parameters and health histories were assessed via surveys, and leukocyte telomere length was assessed using quantitative PCR expressed as the ratio of a telomeric product to a single-copy gene product (T/S). RESULTS Mean gestational age of participants (n = 297) at enrollment was 13.04 ± 3.50 weeks, age was 28.16 ± 6.10 years and leukocyte telomere length was 1.16 ± 0.22 (T/S). Younger age; no schooling vs. primary schooling; and lower levels of ferritin, soluble transferrin receptors and retinol-binding protein were independent predictors of longer telomere length in multivariable models. CONCLUSIONS Leukocyte telomere length is an indicator of biological aging in pregnant Rwandan women. Maternal micronutrient status, specifically lower ferritin, soluble transferrin receptor levels, and retinol-binding protein levels were associated with longer maternal telomere length in contrast with some studies from North America and Europe. There were no associations between inflammation and infectious disease status and maternal leukocyte telomere length. Further studies are needed to enhance our understanding of the interplay between maternal nutritional status and infectious disease in relation to leukocyte telomere length in developing countries.
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Affiliation(s)
- Etienne Nsereko
- College of Medicine and Health Sciences School of Health Sciences, University of Rwanda, P.O. Box: 3538, Kigali, Rwanda.
| | - Aline Uwase
- College of Medicine and Health Sciences School of Health Sciences, University of Rwanda, P.O. Box: 3538, Kigali, Rwanda
| | - Claude Mambo Muvunyi
- College of Medicine and Health Sciences School of Medicine and Pharmacy, University of Rwanda, P.O. Box: 3538, Kigali, Rwanda
| | - Stephen Rulisa
- College of Medicine and Health Sciences School of Medicine and Pharmacy, University of Rwanda, P.O. Box: 3538, Kigali, Rwanda
| | - David Ntirushwa
- College of Medicine and Health Sciences School of Medicine and Pharmacy, University of Rwanda, P.O. Box: 3538, Kigali, Rwanda
| | - Patricia Moreland
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
| | | | - Nicole Santos
- University of California San Francisco, Institute for Global Health Sciences, San Francisco, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, USA
| | - Jyu-Lin Chen
- Departmentof Family Health Care Nursing, University of California San Francisco, San Francisco, USA
| | - Manasse Nzayirambaho
- University of Rwanda College of Medicine and Health Sciences School of Public Health, P.O. Box: 3538, Kigali, Rwanda
| | - Janet M Wojcicki
- Department of Pediatrics, University of California San Francisco, San Francisco, USA.
- Department of Epidemiology and Biostatistics, University of California, 550 16th Street, San Francisco, CA, 941558, USA.
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Briaux J, Martin-Prevel Y, Carles S, Fortin S, Kameli Y, Adubra L, Renk A, Agboka Y, Romedenne M, Mukantambara F, Van Dyck J, Boko J, Becquet R, Savy M. Evaluation of an unconditional cash transfer program targeting children's first-1,000-days linear growth in rural Togo: A cluster-randomized controlled trial. PLoS Med 2020; 17:e1003388. [PMID: 33201927 PMCID: PMC7671539 DOI: 10.1371/journal.pmed.1003388] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2014, the government of Togo implemented a pilot unconditional cash transfer (UCT) program in rural villages that aimed at improving children's nutrition, health, and protection. It combined monthly UCTs (approximately US$8.40 /month) with a package of community activities (including behavior change communication [BCC] sessions, home visits, and integrated community case management of childhood illnesses and acute malnutrition [ICCM-Nut]) delivered to mother-child pairs during the first "1,000 days" of life. We primarily investigated program impact at population level on children's height-for-age z-scores (HAZs) and secondarily on stunting (HAZ < -2) and intermediary outcomes including household's food insecurity, mother-child pairs' diet and health, delivery in a health facility and low birth weight (LBW), women's knowledge, and physical intimate partner violence (IPV). METHODS AND FINDINGS We implemented a parallel-cluster-randomized controlled trial, in which 162 villages were randomized into either an intervention arm (UCTs + package of community activities, n = 82) or a control arm (package of community activities only, n = 80). Two different representative samples of children aged 6-29 months and their mothers were surveyed in each arm, one before the intervention in 2014 (control: n = 1,301, intervention: n = 1,357), the other 2 years afterwards in 2016 (control: n = 996, intervention: n = 1,035). Difference-in-differences (DD) estimates of impact were calculated, adjusting for clustering. Children's average age was 17.4 (± 0.24 SE) months in the control arm and 17.6 (± 0.19 SE) months in the intervention arm at baseline. UCTs had a protective effect on HAZ (DD = +0.25 z-scores, 95% confidence interval [CI]: 0.01-0.50, p = 0.039), which deteriorated in the control arm while remaining stable in the intervention arm, but had no impact on stunting (DD = -6.2 percentage points [pp], relative odds ratio [ROR]: 0.74, 95% CI: 0.51-1.06, p = 0.097). UCTs positively impacted both mothers' and children's (18-23 months) consumption of animal source foods (ASFs) (respectively, DD = +4.5 pp, ROR: 2.24, 95% CI: 1.09-4.61, p = 0.029 and DD = +9.1 pp, ROR: 2.65, 95% CI: 1.01-6.98, p = 0.048) and household food insecurity (DD = -10.7 pp, ROR: 0.63, 95% CI: 0.43-0.91, p = 0.016). UCTs did not impact on reported child morbidity 2 week's prior to report (DD = -3.5 pp, ROR: 0.80, 95% CI: 0.56-1.14, p = 0.214) but reduced the financial barrier to seeking healthcare for sick children (DD = -26.4 pp, ROR: 0.23, 95% CI: 0.08-0.66, p = 0.006). Women who received cash had higher odds of delivering in a health facility (DD = +10.6 pp, ROR: 1.53, 95% CI: 1.10-2.13, p = 0.012) and lower odds of giving birth to babies with birth weights (BWs) <2,500 g (DD = -11.8, ROR: 0.29, 95% CI: 0.10-0.82, p = 0.020). Positive effects were also found on women's knowledge (DD = +14.8, ROR: 1.86, 95% CI: 1.32-2.62, p < 0.001) and physical IPV (DD = -7.9 pp, ROR: 0.60, 95% CI: 0.36-0.99, p = 0.048). Study limitations included the short evaluation period (24 months) and the low coverage of UCTs, which might have reduced the program's impact. CONCLUSIONS UCTs targeting the first "1,000 days" had a protective effect on child's linear growth in rural areas of Togo. Their simultaneous positive effects on various immediate, underlying, and basic causes of malnutrition certainly contributed to this ultimate impact. The positive impacts observed on pregnancy- and birth-related outcomes call for further attention to the conception period in nutrition-sensitive programs. TRIAL REGISTRATION ISRCTN Registry ISRCTN83330970.
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Affiliation(s)
- Justine Briaux
- NUTRIPASS, French National Research Institute for Sustainable Development–University of Montpellier-Montpellier SupAgro, Montpellier, France
- University of Bordeaux, Inserm, Institut de Recherche pour le Développement, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, Bordeaux, France
| | - Yves Martin-Prevel
- NUTRIPASS, French National Research Institute for Sustainable Development–University of Montpellier-Montpellier SupAgro, Montpellier, France
| | - Sophie Carles
- NUTRIPASS, French National Research Institute for Sustainable Development–University of Montpellier-Montpellier SupAgro, Montpellier, France
| | - Sonia Fortin
- NUTRIPASS, French National Research Institute for Sustainable Development–University of Montpellier-Montpellier SupAgro, Montpellier, France
| | - Yves Kameli
- NUTRIPASS, French National Research Institute for Sustainable Development–University of Montpellier-Montpellier SupAgro, Montpellier, France
| | - Laura Adubra
- NUTRIPASS, French National Research Institute for Sustainable Development–University of Montpellier-Montpellier SupAgro, Montpellier, France
| | - Andréa Renk
- Paris School of Economics, UMR 8545, Paris, France
| | - Yawavi Agboka
- Projet de Développement Communautaire et Filets Sociaux, Ministère du Développement à la Base, Lomé, Togo
| | | | | | - John Van Dyck
- The World Bank, Social Protection and Labor Global Practice, Washington, District of Columbia, United States of America
| | - Joachim Boko
- The World Bank, Social Protection and Labor Global Practice, Country Office of Cotonou, Benin
| | - Renaud Becquet
- University of Bordeaux, Inserm, Institut de Recherche pour le Développement, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, Bordeaux, France
| | - Mathilde Savy
- NUTRIPASS, French National Research Institute for Sustainable Development–University of Montpellier-Montpellier SupAgro, Montpellier, France
- * E-mail:
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Food Sources and Dietary Quality in Small Island Developing States: Development of Methods and Policy Relevant Novel Survey Data from the Pacific and Caribbean. Nutrients 2020; 12:nu12113350. [PMID: 33143309 PMCID: PMC7692177 DOI: 10.3390/nu12113350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 12/29/2022] Open
Abstract
Small Island Developing States (SIDS) have high and increasing rates of diet-related diseases. This situation is associated with a loss of food sovereignty and an increasing reliance on nutritionally poor food imports. A policy goal, therefore, is to improve local diets through improved local production of nutritious foods. Our aim in this study was to develop methods and collect preliminary data on the relationships between where people source their food, their socio-demographic characteristics and dietary quality in Fiji and Saint Vincent and the Grenadines (SVG) in order to inform further work towards this policy goal. We developed a toolkit of methods to collect individual-level data, including measures of dietary intake, food sources, socio-demographic and health indicators. Individuals aged ≥15 years were eligible to participate. From purposively sampled urban and rural areas, we recruited 186 individuals from 95 households in Fiji, and 147 individuals from 86 households in SVG. Descriptive statistics and multiple linear regression were used to investigate associations. The mean dietary diversity score, out of 10, was 3.7 (SD1.4) in Fiji and 3.8 (SD1.5) in SVG. In both settings, purchasing was the most common way of sourcing food. However, 68% (Fiji) and 45% (SVG) of participants regularly (>weekly) consumed their own produce, and 5% (Fiji) and 33% (SVG) regularly consumed borrowed/exchanged/bartered food. In regression models, independent positive associations with dietary diversity (DD) were: borrowing/exchanging/bartering food (β = 0.73 (0.21, 1.25)); age (0.01 (0.00, 0.03)); and greater than primary education (0.44 (0.06, 0.82)). DD was negatively associated with small shop purchasing (-0.52 (95% CIs -0.91, -0.12)) and rural residence (-0.46 (-0.92, 0.00)). The findings highlight associations between dietary diversity and food sources and indicate avenues for further research to inform policy actions aimed at improving local food production and diet.
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EAT- Lancet diet score requires minimum intake values to predict higher micronutrient adequacy of diets in rural women of reproductive age from five low- and middle-income countries. Br J Nutr 2020; 126:92-100. [PMID: 32993824 DOI: 10.1017/s0007114520003864] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The EAT-Lancet Commission promulgated a universal reference diet. Subsequently, researchers constructed an EAT-Lancet diet score (0-14 points), with minimum intake values for various dietary components set at 0 g/d, and reported inverse associations with risks of major health outcomes in a high-income population. We assessed associations between EAT-Lancet diet scores, without or with lower bound values, and the mean probability of micronutrient adequacy (MPA) among nutrition-insecure women of reproductive age (WRA) from low- and middle-income countries (LMIC). We analysed single 24-h diet recall data (n 1950) from studies in rural DRC, Ecuador, Kenya, Sri Lanka and Vietnam. Associations between EAT-Lancet diet scores and MPA were assessed by fitting linear mixed-effects models. Mean EAT-Lancet diet scores were 8·8 (SD 1·3) and 1·9 (SD 1·1) without or with minimum intake values, respectively. Pooled MPA was 0·58 (SD 0·22) and energy intake was 10·5 (SD 4·6) MJ/d. A one-point increase in the EAT-Lancet diet score, without minimum intake values, was associated with a 2·6 (SD 0·7) percentage points decrease in MPA (P < 0·001). In contrast, the EAT-Lancet diet score, with minimum intake values, was associated with a 2·4 (SD 1·3) percentage points increase in MPA (P = 0·07). Further analysis indicated positive associations between EAT-Lancet diet scores and MPA adjusted for energy intake (P < 0·05). Our findings indicate that the EAT-Lancet diet score requires minimum intake values for nutrient-dense dietary components to avoid positively scoring non-consumption of food groups and subsequently predicting lower MPA of diets, when applied to rural WRA in LMIC.
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Hanley-Cook GT, Tung JYA, Sattamini IF, Marinda PA, Thong K, Zerfu D, Kolsteren PW, Tuazon MAG, Lachat CK. Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) Data Collection: Validity of the List-Based and Open Recall Methods as Compared to Weighed Food Record. Nutrients 2020; 12:E2039. [PMID: 32659995 PMCID: PMC7400839 DOI: 10.3390/nu12072039] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/24/2020] [Accepted: 07/08/2020] [Indexed: 12/14/2022] Open
Abstract
Minimum dietary diversity for women of reproductive age (MDD-W) was validated as a population-level proxy of micronutrient adequacy, with indicator data collection proposed as either list-based or open recall. No study has assessed the validity of these two non-quantitative proxy methods against weighed food records (WFR). We assessed the measurement agreement of list-based and open recall methods as compared to WFR (i.e., reference method of individual quantitative dietary assessment) for achieving MDD-W and an ordinal food group diversity score. Applying a non-inferiority design, data were collected from non-pregnant women of reproductive age in Cambodia (n = 430), Ethiopia (n = 431), and Zambia (n = 476). For the pooled sample (n = 1337), proportions achieving MDD-W from both proxy methods were compared to WFR proportion by McNemar's chi-square tests, Cohen's kappa, and receiver operating characteristic (ROC) analysis. Ordinal food group diversity (0-10) was compared by Wilcoxon matched-pairs signed-rank tests, intraclass correlation coefficients (ICC), and weighted kappa. MDD-W food groups that were most frequently misreported (i.e., type I and II errors) by the proxy methods were determined. Our findings indicate statistically significant differences in proportions achieving MDD-W, ordinal food group diversity scores, and ROC curves between both proxy methods and WFR (p < 0.001). List-based and open recall methods overreported women achieving MDD-W by 16 and 10 percentage points, respectively, as compared to WFR (proportion achieving MDD-W: 30%). ICC values between list-based or open recall and WFR were 0.50 and 0.55, respectively. Simple and weighted kappa values both indicated moderate agreement between list-based or open recall against WFR. Food groups most likely to be misreported using proxy methods were beans and peas, dark green leafy vegetables, vitamin A-rich fruit and vegetables, and other fruits. Our study provides statistical evidence for overreporting of both list-based and open recall methods for assessing prevalence of MDD-W or ordinal food group diversity score in women of reproductive age in low- and middle-income countries. Operationalizing MDD-W through qualitative recall methods should consider potential trade-offs between accuracy and simplicity.
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Affiliation(s)
- Giles T. Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (G.T.H.-C.); (P.W.K.)
| | - Ji Yen A. Tung
- Nutrition and Food Systems Division (ESN), Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (J.Y.A.T.); (I.F.S.); (M.A.G.T.)
| | - Isabela F. Sattamini
- Nutrition and Food Systems Division (ESN), Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (J.Y.A.T.); (I.F.S.); (M.A.G.T.)
| | - Pamela A. Marinda
- Department of Food Science and Nutrition, School of Agricultural Sciences, University of Zambia, P.O. Box 32379 Lusaka, Zambia;
| | - Kong Thong
- Department of Food Science, Faculty of Agro-Industry, Royal University of Agriculture, P.O. Box 2696 Phnom Penh, Cambodia;
| | - Dilnesaw Zerfu
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, P.O. Box 1242 Addis Ababa, Ethiopia;
| | - Patrick W. Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (G.T.H.-C.); (P.W.K.)
| | - Maria Antonia G. Tuazon
- Nutrition and Food Systems Division (ESN), Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (J.Y.A.T.); (I.F.S.); (M.A.G.T.)
| | - Carl K. Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (G.T.H.-C.); (P.W.K.)
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Gómez G, Nogueira Previdelli Á, Fisberg RM, Kovalskys I, Fisberg M, Herrera-Cuenca M, Cortés Sanabria LY, Yépez García MC, Rigotti A, Liria-Domínguez MR, Guajardo V, Quesada D, Murillo AG, Brenes JC. Dietary Diversity and Micronutrients Adequacy in Women of Childbearing Age: Results from ELANS Study. Nutrients 2020; 12:E1994. [PMID: 32635544 PMCID: PMC7400493 DOI: 10.3390/nu12071994] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 12/18/2022] Open
Abstract
Dietary diversity, an important component of diet quality, is associated with an increased probability of adequate micronutrient intake. Women of childbearing age (WCA) are particularly vulnerable to micronutrient inadequacy. The Minimum Dietary Diversity for Women (MDD-W) has been used widely as a proxy measurement of micronutrient adequacy. This study aimed to assess the association between MDD-W and nutrients adequacy among WCA of eight Latin American countries. Nutrient intakes from 3704 WCA were analyzed with two 24-hour dietary recalls. Dietary diversity was calculated based on ten food groups with a cut-off point of intake ≥5 groups. The mean dietary diversity score was 4.72 points, and 57.7% of WCA achieved MDD-W. Vitamin D and E showed a mean Nutrient Adequacy Ratio (NAR) of 0.03 and 0.38, respectively. WCA with a diverse diet (MDD-W > 5) reported a significantly higher intake of most micronutrients and healthy food groups with less consumption of red and processed meats and sugar-sweetened beverages. MDD-W was significantly associated with the mean adequacy ratio (MAR) of 18 micronutrients evaluated. Nevertheless, even those women with a diverse diet fell short of meeting the Estimated Average Requirements (EAR) for vitamins D and E. MDD-W is an appropriate tool to evaluate micronutrients adequacy in WCA from Latin America, showing that women who achieved the MDD-W reported higher adequacy ratios for most micronutrients and an overall healthier diet.
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Affiliation(s)
- Georgina Gómez
- Departamento de Bioquimica, Escuela de Medicina, Universidad de Costa Rica, San Jose 94088, Costa Rica; (D.Q.); (A.G.M.)
| | | | - Regina Mara Fisberg
- Departamento de Nutriçao, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo 01000, Brazil;
| | - Irina Kovalskys
- Committee of Nutrition and Wellbeing, International Life Science Institute (ILSI-Argentina), Buenos Aires C1059ABF, Argentina; (I.K.); (V.G.)
- Pontificia Universidad Catolica de Argentina, Facultad de Medicina, Buenos Aires B1675, Argentina
| | - Mauro Fisberg
- Instituto Pensi, Fundaçao Jose Egydio Setubal, Sabara Hospital Infantil, Sao Paulo 01239-040, Brazil;
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo 04023-062, Brazil
| | | | | | | | - Attilio Rigotti
- Centro de Nutricion Molecular y Enfermedades Cronicas, Departamento de Nutricion, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Catolica, Santiago 833-0024, Chile;
| | | | - Viviana Guajardo
- Committee of Nutrition and Wellbeing, International Life Science Institute (ILSI-Argentina), Buenos Aires C1059ABF, Argentina; (I.K.); (V.G.)
| | - Dayana Quesada
- Departamento de Bioquimica, Escuela de Medicina, Universidad de Costa Rica, San Jose 94088, Costa Rica; (D.Q.); (A.G.M.)
| | - Ana Gabriela Murillo
- Departamento de Bioquimica, Escuela de Medicina, Universidad de Costa Rica, San Jose 94088, Costa Rica; (D.Q.); (A.G.M.)
| | - Juan Carlos Brenes
- Instituto de Investigaciones Psicologicas & Centro de Investigacion en Neurociencias, Universidad de Costa Rica, San Jose 11501, Costa Rica;
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50
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Delimont N, Nickel S. Food Pattern Modeling as an Alternative Assessment Method to Multiday Dietary Recalls for Iron-Related Nutrients: A Proof-of-Concept Study. Nutrients 2020; 12:E1911. [PMID: 32605218 PMCID: PMC7401284 DOI: 10.3390/nu12071911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 12/03/2022] Open
Abstract
There are barriers to in-depth memory-based dietary assessment techniques in community-based research. Food pattern modeling may be an alternative method to traditional assessment techniques. The objective of this study was to pilot a comparison of food pattern modeling to 24 h diet recalls for predicting hematological outcomes of iron status. Data from 3-24 h dietary recalls in 27 women were analyzed by two methods: mean dietary intake estimates or food pattern modeling. Food pattern modeling was used to determine the total inventory of foods consumed with iron, phytate, or ascorbic acid or iron-phytate ratios. Each variable was analyzed for its relationship to hemoglobin, ferritin, and acute iron absorption from a meal challenge study by creating receiver operating characteristic (ROC) curves. There were no differences in ROC curves or diagnostic accuracies between food pattern modeling or mean dietary intake estimates for iron, vitamin C, phytate, or phytate-iron ratios for estimating hemoglobin or ferritin values (p > 0.05). Food pattern modeling was inferior to mean dietary estimates for acute iron absorption, suggesting that more detailed methods may be necessary for studies with sensitive or acute dietary measurement outcomes. Food pattern modeling for total iron, vitamin C, phytate, and phytate-iron ratios may be comparable to detailed memory-based recalls for larger studies assessing the impact of foods on iron status.
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Affiliation(s)
- Nicole Delimont
- School of Nursing, Wichita State University, Wichita KS 67260, USA
| | - Sarah Nickel
- Department of Medical Laboratory Sciences, Wichita State University, Wichita, KS 67260, USA;
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