Monitoring population diet quality and nutrition status with household consumption and expenditure surveys: suggestions for a Bangladesh baseline

Using household economic survey data to assess food expenditure patterns and trends in a high-income country with notable health inequities

This study aimed to identify dietary trends in Aotearoa New Zealand (NZ) and whether inequities in dietary patterns are changing. We extracted data from the Household Economic Survey (HES), which was designed to provide information on impacts of policy-making in NZ, and performed descriptive analyses on food expenditures. Overall, total household food expenditure per capita increased by 0.38% annually over this period. Low-income households spent around three quarters of what high-income households spent on food per capita. High-income households experienced a greater increase in expenditure on nuts and seeds and a greater reduction in expenditure on processed meat. There was increased expenditure over time on fruit and vegetables nuts and seeds, and healthy foods in Māori (Indigenous) households with little variations in non-Māori households. But there was little change in processed meat expenditure for Māori households and expenditure on less healthy foods also increased over time. Routinely collected HES data were useful and cost-effective for understanding trends in food expenditure patterns to inform public health interventions, in the absence of nutrition survey data. Potentially positive expenditure trends for Māori were identified, however, food expenditure inequities in processed meat and less healthy foods by ethnicity and income continue to be substantial.

Tracing global flows of bioactive compounds from farm to fork in Nutrient Balance Sheets can help guide intervention towards healthier food supplies

Adequate supplies of healthy foods available in each country are a necessary but not sufficient condition for adequate intake by each individual. This study provides complete Nutrient Balance Sheets that account for all plant-based and animal-sourced food flows from farm production through trade to non-food uses and waste in 173 countries from 1961 to 2018. We track 36 bioactive compounds in all farm commodities recorded by the Food and Agriculture Organization of the United Nations, accounting for nutrient-specific losses in processing and cooking as well as bioavailability. We compare supply to requirements given each country's age-sex distribution and find that the adequacy of food supplies has increased but often remains below total needs, with even faster rise in energy levels and lower density of some nutrients per calorie. We use this nutrient accounting to show how gaps could be filled, either from food production and trade or from selected biofortification, fortification and supplementation scenarios for nutrients of concern such as vitamin A, iron and zinc.

Health promoting and demoting consumption: What accounts for budget share differentials by ethnicity in New Zealand

Background

Health demoting consumption of alcohol and tobacco are some of the most important risk factors for health loss worldwide, however there is limited information on these consumption risk factors in New Zealand (NZ) and whether inequities in the risk factors are ethnically patterned.

Methods

We used three nationally representative Household Economic Survey waves (2006/07, 2009/10, 2012/13) (n = 9030) in NZ to examine household expenditure for key health risk-related components of consumption by ethnicity, and its contributors to the differences using non-parametric, parametric and decomposition methods.

Results

Māori households (NZ indigenous population) were significantly poorer (25% less) than non-Māori households in terms of household per capita expenditure. However, our various econometric estimations suggested that, in relative terms, Māori spent more on tobacco and alcohol, and less on healthcare. The gaps become larger at upper quantiles of the budget share distributions; the composition effect (the gap due to differences in individual and household characteristics between Māori and non-Māori) explains most of the tobacco and alcohol budget share gap between the two groups, and less for healthcare. The structure effect (the gap due to returns to/or effect of individual and household characteristics) contributes very little to the budget share gap for tobacco and drink, but increasingly and predominantly when moving along the distribution of healthcare budget share.

The differences between Māori and non-Māori in household ownership, education, and income negatively affect budget share on these health demoting consumption (tobacco and alcohol). The household head's age, education, and employment contributed most to the structure effect.

Conclusions

Our study suggested ethnic inequities in the health risk consumption behaviour are evidenced in NZ. Interventions targeting education and employment that significantly affect household budget shares on risk factors (i.e., harmful consumption) for health loss may help narrow the gaps.

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Alcohol and tobacco are important risk factors for health loss worldwide.

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National Household Economic Survey data were analysed by ethnicity for New Zealand.

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Māori households spent more on tobacco and alcoholic drinks, and less on healthcare.

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The gap due to differences in household characteristics explains most of the budget share gap.

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Interventions targeting education and employment may help narrow the gaps.

Assessing Diet Quality Where Families Share Their Meals: Evidence from Malawi

BACKGROUND

Where families eat together from a common dish, the shared meal must be nutrient dense enough in each nutrient to meet the needs of the highest-need member.

OBJECTIVES

This study aimed to develop an aggregate household nutrient requirement benchmark that satisfies all members' needs in a context in which meals are shared and to illustrate how that metric could inform food and nutrition policy making.

METHODS

We merged nationally representative survey data for Malawi in 2010, 2013, and 2016-2017 with individual nutrient requirements and local food composition data to compute the adequacy of each household's aggregate consumption given its demographic composition and primary occupation. To meet each person's nutrient needs at any level of energy balance, the nutrient density of their shared diet needs to be within boundaries of the most restrictive member. We classified the adequacy of each household's diet using these energy-adjusted densities and examined differences by sociodemographic characteristics.

RESULTS

Accounting for meal sharing and nutrient density needs of the highest-need member, virtually all households' food consumption is insufficiently nutrient dense in riboflavin, selenium, lipids, and vitamin B-12, and most consumption is insufficiently nutrient dense in zinc and phosphorus as well. Meeting needs of women, adolescent girls, and young children using shared diets would on average require 145% more iron, 98% more zinc, and approximately 70% more phosphorus and vitamin C than if their needs were met with individualized diets.

CONCLUSIONS

Establishing shared nutrient requirements is feasible using existing survey data and can help set sufficiency criteria in settings in which families share meals. In Malawi, current diets and food composition are inadequate for many nutrients, especially in households with more women and adolescent girls. The results call for concerted investment to increase access to and use of more nutrient-dense foods.

Are Household Expenditures on Food Groups Associated with Children's Future Heights in Ethiopia, India, Peru, and Vietnam?

Household expenditure surveys, routinely conducted in low-and middle-income countries (LMICs), usually include questions pertaining to recent household expenditures on key food groups. When child anthropometrics are also available, such expenditure data can provide insights into household food purchasing patterns that are associated with subsequent child growth measures. We used data from 6993 children, born around 2001, from Ethiopia, India, Peru, and Vietnam, from the Young Lives younger cohort. We compared associations between two weeks of household food expenditures (in PPP-Purchasing Power Parity adjusted dollars) on food groups and child height-for-age-Z score (HAZ) at subsequent time points to assess longitudinal associations. Total food expenditures, rural/urban residence, maternal and paternal schooling, and child sex were included in our adjusted models because they may affect the relations between household food group expenditures and future child HAZ. In Ethiopia, India, and Peru every extra PPP$ spent on fats was associated with 0.02-0.07 higher future HAZ. In Vietnam every extra PPP$ spent on starches, was significantly associated with a 0.01 lower future HAZ. Across countries, different patterns of food expenditure and procurement may be differentially critical for predicting child HAZ. Our results demonstrate how expenditures on specific food groups can be associated with children's linear growth. This study provides additional evidence of the utility of longitudinal household food expenditure data in understanding child nutritional status.

Dietary Patterns and Determinants of Changing Diets in Bangladesh from 1985 to 2010

BACKGROUND

The government of Bangladesh has implemented multiple policies since 1971 to provide the population with more diverse and nutritious diets.

OBJECTIVE

The aim of this study was to examine the drivers of dietary change over time and the roles agriculture and economic development have played.

METHODS

We used principal component analysis to derive dietary patterns from 7 cross-sectional rounds of the Bangladesh Household [Income and] Expenditure Survey. We then used linear probability models to estimate associations of adherence to dietary patterns with socio-economic characteristics of households, and with agricultural production on the household and regional level. For dietary patterns that increased or decreased over time, Blinder-Oaxaca decomposition was used to assess factors associated with these changes.

RESULTS

Seven dietary patterns were identified: modern, traditional, festival, winter, summer, monotonous, and spices. All diets were present in all survey rounds. In 1985, over 40% of households had diets not associated with any identified pattern, which declined to 12% by 2010. The proportion of the population in households adhering to the modern, winter, summer, and monotonous diets increased over time, whereas the proportion adhering to the traditional diet decreased. Although many factors were associated with adherence to dietary patterns in the pooled sample, changes in observed factors only explained a limited proportion of change over time due to variation in coefficients between periods. Increased real per capita expenditure was the largest driver of elevated adherence to dietary patterns over time, whereas changes in the agricultural system increased adherence to less diverse dietary patterns.

CONCLUSIONS

These findings highlight the need for both diversified agricultural production and a continued reduction in poverty in order to drive dietary improvement. This study lays the groundwork for further analysis of the impact of changing diets on health and nutrition.