Determining minimum food intake amounts for diet diversity scores to maximize associations with nutrient adequacy: an analysis of schoolchildren's diets in rural Kenya

Immunonutrition: Diet Diversity, Gut Microbiome and Prevention of Allergic Diseases

Allergic diseases are increasing both in morbidity and mortality. Genetic, environmental, and dietary factors may all be involved in this increase. Nutrition during pregnancy, breastfeeding, and early life may play a particularly important role in preventing allergic diseases. Based on current systematic reviews, the intake of specific nutrients has failed to prevent allergic disease. Prevention strategies have shifted their focus to the overall diet which can be described using diet diversity. Infant and maternal diet diversity in pregnancy has been associated with reduced allergy outcomes in childhood. Overall, diet also seems to have a marked effect on the microbiome compared to single foods. Factors that may negate the allergy-preventative effect of overall diet diversity include the addition of emulsifiers, advanced glycation end-product content, and overuse of commercial baby foods. There is a need to perform randomized controlled trials using overall dietary intake to support international food allergy guidelines. These studies should ideally be conducted by multi-professional teams.

Assessing rural household's food groups-and-sources and dietary diversity pattern in Malaita Province

Access to and availability of various food sources is not an issue in rural communities. However, there is no guarantee that households are not affected by nutritional inadequacy, which is still a problem in most underdeveloped nations. A mixed-methods study was conducted to determine the HDDS through the snowballing method for the last 12 months' food groups-and-sources and the 48-h diet recall. Ninety-eight households in two rural communities surrounding Sikwafta (zone one) and Malu'u (zone two) participated in the interview between April and May 2019. The results were then analyzed through SPSS and QDA MINER. The aim is to analyze the household dietary patterns of the communities between the two zones. The study also hypothesizes that the dietary pattern of households has not changed. Results showed that a total of nine food groups were consumed: grain, white roots, tubers, plantains, oils/fats (95.90%), condiments (83.70%), and meat/poultry/sea foods (77.60%). The majority of the food consumed comes from the gardens, followed by other food sources, which make up the average HDDS of five. A correlation analysis found a statistically significant relationship between HDDS and total meal (0.504*), with no relationships between demographics. When comparing 48-h food sources-and-groups to the previous year, there was little to no difference in accessibility and availability. This implies that the majority of households are likely to achieve their nutritional needs within the parameters of their dietary trend. Even though households have adequate access to food, there is a significant need to improve their nutritional needs, even if they consume the average amount of the required food groups.

Food allergy prevention: Where are we in 2023?

Food allergy prevention involves recommendations to the maternal diet during pregnancy and breast feeding, early life feeding and introduction of solid foods. Pregnant and breastfeeding women are not recommended to exclude any food allergens from their diet, but data are lacking to support active consumption of food allergens for prevention of food allergy. Breastfeeding is recommended for the many health benefits to the mother and child but has not shown any association with reduction in childhood food allergies. There is currently no recommendation regarding the use of any infant formula for allergy prevention, including the use of partially or extensively hydrolyzed formulas. Once the introduction of solid food commences, based on randomized controlled trials, it is advised to actively introduce peanuts and egg early into the infant diet and continue with consumption of these. Although there are limited data with respect to other major food allergens and whether early introduction may prevent allergy development, there is no need to delay the introduction of these allergens into the infant diet. Interpreting food allergen consumption in the context of cultural food practices has not been studied, but it makes sense to introduce the infant to family foods by 1 year of age. Consumption of foods typical of the Western diet and foods high in advanced glycation end products may be associated with an increase in food allergies. Similarly, intake of micronutrients, such as vitamin D and omega-3 fatty acids in both the maternal and infant diet, needs further clarification in the context of food allergy prevention.

Using Household Consumption Data to Flag Low Nutrient Access

BACKGROUND

Information on food consumption, dietary diversity, and nutrient inadequacies are key for informing food security and nutrition programming. Household- and individual-level data together provide the most complete information, but individual dietary modules are not always feasible in humanitarian contexts due to cost and time constraints.

OBJECTIVE

This article asks to what extent it is possible to use food consumption data which is commonly collected at household level through food security and vulnerability surveys, to assess the household's access to vitamin A and iron.

METHODS

The validation analysis uses household food consumption and expenditure surveys from Guatemala, Honduras, Nepal, and Uganda and the adult male equivalent approach for calculating nutrient access.

RESULTS

The results show a positive significant correlation between the frequency of consumption and adequacy as estimated from comprehensive household food consumption modules, with correlation in the range of 0.4 to 0.7. Frequency thresholds for distinguishing between adequate and inadequate nutrient access, based on how often foods rich in the relevant nutrient are eaten during 1 week, mostly fulfill standard sensitivity and specificity criteria.

CONCLUSIONS

The article concludes that in humanitarian contexts, a frequency-based proxy for nutrient access based on household data commonly collected in emergency assessments and through monitoring systems can be used and can support this particular data gap. As a rule of thumb, a frequency threshold of 7 should be used for vitamin A and of 12 for iron.

Global Trends in the Availability of Dietary Data in Low and Middle-Income Countries

Individual-level quantitative dietary data can provide suitably disaggregated information to identify the needs of all population sub-groups, which can in turn inform agricultural, nutrition, food safety, and environmental policies and programs. The purpose of this discussion paper is to provide an overview of dietary surveys conducted in low- and middle-income countries (LMICs) from 1980 to 2019, analyzing their key characteristics to understand the trends in dietary data collection across time. The present study analyzes the information gathered by the Food and Agriculture Organization of the United Nations/World Health Organization Global Individual Food consumption data Tool (FAO/WHO GIFT). FAO/WHO GIFT is a growing repository of individual-level dietary data and contains information about dietary surveys from around the world, collected through published survey results, literature reviews, and direct contact with data owners. The analysis indicates an important increase in the number of dietary surveys conducted in LMICs in the past four decades and a notable increase in the number of national dietary surveys. It is hoped that this trend continues, together with associated efforts to validate and standardize the dietary methods used. The regular implementation of dietary surveys in LMICs is key to support evidence-based policies for improved nutrition.

Drivers of Pigeon Pea Consumption Among School-Aged Children in Central Tanzania

Background: Protein energy malnutrition (PEM) and iron deficiencies (ID) are of major public health concern in Tanzania including among school-aged children. PEM and ID in early childhood have serious, long-term consequences because they impede motor, sensory, social and emotional development, growth retardation, poor cognitive development, learning disability of children, lowered resistance to infectious diseases, and reduced physical work capacity. The objective of this study was to elucidate the drivers of pigeon pea consumption among school-aged children in Dodoma district, Central Tanzania. Understanding these drivers would be useful in promoting pigeon pea consumption among school-aged children as one of the strategies to increase dietary protein and iron intake.

Methods: This study was a cross-sectional study in which data were collected using a questionnaire based on a combination of the Theory of Planned Behavior and Health Belief Model. The data were collected from caregivers (n = 138) in four villages in Kongwa district, Dodoma region, Central Tanzania. We used correlations and multiple regressions to assess associations between constructs and identify predictive constructs. Mann–Whitney U tests were used for score comparisons with a significant p-value set at <0.10.

Results: Health value was significantly correlated with health behavior identity (rs = 0.63, p < 0.001) and also significantly predicted health behavior identity (rs = 0.49, p = 0.001). The constructs cues to action and control belief were significantly associated with intention (β = −0.41, p = 0.059 and β = 0.06, p = 0.019 respectively). Finally, we observed that intention was a significant predictor of behavior (β = 1.38, p = 0.001). We also observed a significant negative interaction between perceived barriers and intention to consume pigeon pea (β = −0.04, p = 0.006), indicating that perceived barriers limit intention to consume pigeon pea.

Conclusion and Implication: Our findings indicate that when the caregiver places increased importance on preventing her school-aged child from being iron or protein deficient or indeed anemic (health value), it results in a positive evaluation of the effectiveness of giving pigeon pea to address these nutrient deficiencies. Programs and efforts aimed at promoting pigeon pea consumption should focus on educating caregivers on iron and protein deficiency and the role that pigeon pea could play in addressing these. However, perceived barriers such as pest infestation during storage need to be addressed to increase pigeon pea consumption. The involvement of post-harvest management specialists is therefore crucial. Along with this, increasing productivity and crop management is also crucial to ensure year-round affordable supply of pigeon pea.

Methodological Aspects of Diet Quality Indicators in Childhood: A Mapping Review

Diet quality indicators (DQIns) are tools that aim to assess an individual's overall diet quality. Previous reviews focused mainly on health-related outcomes but did not provide detailed information about components, assessment variables, or important methodological issues for the development and application of DQIns in the pediatric age. The current mapping review aims to provide comprehensive guidance regarding DQIns developed through a priori methodology in children aged ≤14 y that have been applied worldwide. A mapping review was conducted, whereby 1665 original articles describing the development, modifications, and updates of DQIns, published up to June 26, 2020, in English and Spanish, were retrieved. A total of 139 articles were identified and classified into 13 subgroups. There were 10 overall DQIns: Healthy Eating Indexes (n = 25), Dietary Diversity Scores (n = 20), Diet Quality Indexes (n = 16), Food Variety Scores (n = 11), Healthy and Unhealthy Scores (n = 11), Feeding and Eating Indexes (n = 10), Diet Quality Scores (n = 5), Nutritional Adequacy and Micronutrients Indexes (n = 5), Dietary Guidelines Indexes (n = 5), and Other Healthy Diet Indexes (n = 13). Three additional subgroups of dietary and lifestyle indicators found were Mediterranean Diet Indexes (n = 10), Diet-Lifestyle Indexes (n = 5), and Breakfast Quality Indexes (n = 3). This compilation of DQIns will help researchers select the most appropriate tool for future epidemiological studies by considering a careful selection of information about the assessment components, scoring methods, and key methodological issues. The main limitations of this review are that, due to its nature, a risk-of-bias assessment was not performed and the article screening was completed in 2 databases (PubMed/MEDLINE and Scopus). More research is needed to identify health-related outcomes associated with DQIns in the pediatric population, using clearer and more standardized methodological criteria.

Qualitative exploration of feasibility and acceptability of the modified Atkins diet therapy for children with drug resistant epilepsy in Kenya

PURPOSE

Approximately one-third of children with epilepsy have clinical syndromes characterized by drug resistance. Modified Atkins dietary therapy (MADT) can reduce seizures and improve health outcomes for these children. This intervention is yet to be consistently offered as standard of care in sub-Saharan Africa.

OBJECTIVES

This study aimed to assess feasibility and acceptability of MADT for children with drug-resistant epilepsy and identify enabling strategies for implementation and adherence to the MADT.

METHODS

This qualitative inquiry utilized in-depth interviews with purposively selected caregivers and adolescent patients having used MADT for drug-resistant epilepsy. A qualified team consisting of a social scientist and an interviewer carried out the interviews with consenting participants. Thematic analysis was done independent of the clinicians.

RESULTS

This study enrolled 17 participants including 14 caregivers of children aged 1-17 years, and three adolescents. Caregivers were predominantly trained professionals living in urban areas who had attended the epilepsy clinic for at least one year. Duration of continuous MADT use ranged from two weeks to two years. Among participants who indicated that they could afford to provide the MADT, it was less costly to provide for younger children and for those living in rural areas. At the time of the study, majority of the caregivers had ceased administration of the MADT, more than half of whom reported barriers including cost of food, child refusal of foods, and inconsistent dietician support. Social support was a key enabler to successful implementation and continuation of the diet. Majority of the participants considered MADT to be an effective and acceptable intervention for management of epilepsy.

CONCLUSIONS

Among participants in this focused Kenyan group, implementation of MADT was found to be feasible particularly for younger children living in rural areas. Majority of participants evaluated MADT to be an effective and acceptable intervention for management of epilepsy. Cultural factors did not influence feasibility or acceptability of MADT in this study.

Nutritional Inadequacy: Unraveling the Methodological Challenges for the Application of the Probability Approach or the EAR Cut-Point Method-A Pregnancy Perspective

The aim of this study was to unravel the methodological challenges when exploring nutritional inadequacy, involving 608 healthy pregnant women. The usual intake of twenty-one nutrients was recorded by employing a validated FFQ. Simulated datasets of usual intake were generated, with randomly imposed uncertainty. The comparison between the usual intake and the EAR was accomplished with the probability approach and the EAR cut-point method. Point estimates were accompanied by bootstrap confidence intervals. Bootstrap intervals applied on the risk of inadequacy for raw and simulated data tended in most cases to overlap. A detailed statistical analysis, aiming to predict the level of inadequacy, as well as the application of the EAR cut-point method, along with bootstrap intervals, could effectively be used to assess nutrient inadequacy. However, the final decision for the method used depends on the distribution of nutrient-intake under evaluation. Irrespective of the applied methodology, moderate to high levels of inadequacy, calculated from FFQ were identified for certain nutrients (e.g., vitamins C, B6, magnesium, vitamin A), while the highest were recorded for folate and iron. Considering that micronutrient-poor, obesogenic diets are becoming more common, the underlying rationale may help towards unraveling the complexity characterizing nutritional inadequacies, especially in vulnerable populations.

Magnitude of Anemia and Associated Factors among HIV-Infected Children Receiving Antiretroviral Therapy in Pastoral Community, Ethiopia: A Retrospective Cross-Sectional Study

Background

The two major comrbidities (anemia and poor nutrition) are common manifestations of HIV-infected children, which threaten their lives. In Ethiopia, there is limited information on the magnitude and factors associated with anemia among HIV-infected children. Thus, this study was aimed to determine the magnitude and factors associated with anemia among HIV-infected children receiving antiretroviral therapy in the Afar region, Ethiopia.

Methods

A cross-sectional retrospective record review was conducted on a sample size of 102 HIV-infected children aged 6 months to < 15 years in selected ART sites of the Afar region from May 1 to 25, 2018. Patient cards from 2009 to 2017 with the required information were considered. A paired sample t-test was used to assess whether there is a significant difference in the hemoglobin level before and after the HAART regimen. Multivariable logistic regression was used to determine predictors of anemia. Statistical significance was determined atp value < 0.05.

Result

At baseline, 53.9% of study participants were anemic, from which 8.7%, 36.3%, and 9.8% were mild, moderate, and severe, respectively. There was a statistically significant improvement of hemoglobin level following the one-year course of ART treatment from 10.67 ± 1.82 to 11.5 ± 1.5 (p value ≤ 0.001): an improvement of 0.83 ± 1.74. Children who were moderately and severely stunted were more than five (AOR = 5.16, 95% CI (1.71, 15.56)) and more than twelve (AOR = 12.45, 95% CI (2.62, 59.21)) times more likely to be anemic than children who were not stunted, respectively. Children whose mothers had not attended ANC follow-up were more than three (AOR = 3.68, 95% CI (1.38, 9.81)) times more likely to be anemic than children whose mothers attended ANC. Children who were in clinical stages 3 and 4 were more than five (AOR = 5.07, 95% CI (1.79, 14.37)) times more likely to be anemic than children who were in clinical stage 1 and 2.

Conclusion

The magnitude of anemia among HIV-infected children was found to be high, which is 53.9%. Nutritional status (stunting), WHO clinical stage, and history of ANC follow-up were the predictors significantly associated with childhood anemia. Thus, interventions for HIV-infected children should consider those factors.

Dietary diversity scores, nutrient intakes and biomarkers vitamin B12, folate and Hb in rural youth from the Pune Maternal Nutrition Study

Hidden hunger is widespread in India. Individual dietary diversity score (IDDS) is a measure of the nutrient adequacy of the diet. The FAO has set guidelines for the measurement of dietary diversity: the IDDS and the minimum dietary diversity score for women (MDD-W) to assess nutritional deficiency, but validation against nutritional biomarkers is required. Using available data among rural youth (17 years) from the Pune Maternal Nutrition Study, the validity of DDS was assessed to measure deficiencies of vitamin B12, folate and Hb. Of the 355 boys and 305 girls, 19 % were classified as underweight, 57 % as vitamin B12 deficient (<150 pmol/l) and 22 % as anaemic (<120/130 g/l). Cereals, legumes and 'other-vegetables' were the most frequently consumed foods. More boys than girls consumed milk, flesh, eggs and micronutrient-dense foods. Median IDDS of 4 (interquartile range (IQR) 3-4) and MDD-W of 6 (IQR 5-7) were low. Youth with vitamin B12 deficiency had a higher likelihood of an IDDS ≤ 4 (1·89; 95 % CI 1·24, 2·87) or an MDD-W ≤ 5 (1·40; 95 % CI 1·02, 1·94). Youth with anaemia were more likely to have an IDDS ≤ 4 (1·76; 95 % CI 1·01, 3·14) adjusted for socio-economic scores, BMI, energy intake and sex. Folate deficiency was low (3 %) and was not associated with either score. Youth with lowest plasma vitamin B12 and Hb infrequently or never consumed dairy products/non-vegetarian foods. These rural Indian youth were underweight, had low DDS and consumed foods low in good-quality proteins and micronutrients. Associations of DDS with circulating micronutrients indicate that DDS is a valid measure to predict vitamin B12 deficiency and anaemia.

Associations of dietary diversity with anaemia and iron status among 5- to 12-year-old schoolchildren in South Africa

OBJECTIVE

To examine the associations of dietary diversity with anaemia and iron status among primary school-aged children in South Africa.

DESIGN

An analysis was conducted with pooled individual data from the baseline surveys from three previously conducted independent intervention studies. Two different dietary diversity scores (DDS) were calculated based on data from 1-day (1-d) and 3-day (3-d) dietary recall periods, respectively. Logistic regression analysis was performed to examine the associations of dietary diversity with anaemia and iron status.

SETTING

KwaZulu-Natal and North West provinces, South Africa.

PARTICIPANTS

Children (n 578) 5- to 12-year-old.

RESULTS

A DDS ≤ 4 was associated with higher odds of being anaemic (1-d P = 0·001; 3-d P = 0·006) and being iron deficient (ID) (3-d P < 0·001). For both recall periods, consumption of 'vegetables and fruits other than vitamin A-rich' and 'animal-source foods (ASF)' was associated with lower odds of being anaemic (both P = 0·002), and 'organ meats' with lower odds of being ID (1-d P = 0·045; 3-d P < 0·001). Consumption of 'meat, chicken and fish' was associated with lower odds of being anaemic (P = 0·045), and 'vegetables and fruits other than vitamin A-rich', 'legumes, nuts and seeds' and 'ASF' with lower odds of being ID for the 3-d recall period only (P = 0·038, P = 0·020 and P = 0·003, respectively).

CONCLUSION

In order to improve anaemia and iron status among primary school-aged children, dietary diversification, with emphasis on consumption of vegetables, fruits and ASF (including organ meats), should be promoted.

Meat, fruit, and vegetable consumption in sub-Saharan Africa: a systematic review and meta-regression analysis

CONTEXT

The dietary choices people make affect personal health and have consequences for the environment, both of which have serious implications for the 2030 Sustainable Development Agenda. In global reviews, the literature on meat, fruit, and vegetable consumption in sub-Saharan Africa (SSA) is limited.

OBJECTIVE

This systematic review set out to quantify meat, fruit, and vegetable consumption in SSA populations and to answer the following question: How much meat, fruit, and/or vegetables are being consumed daily by which individuals in SSA over the years?

DATA SOURCES

Following the PRISMA guidelines, the authors systematically searched the MEDLINE, EMBASE, ASSIA CINAHL, Web of Science, POPLINE, and Google Scholar databases to identify 47 (out of 5922 search results) studies reporting meat, fruit, and/or vegetable consumption in SSA populations.

DATA EXTRACTION

Three independent investigators extracted data on year of data collection, study country, study population and geographical context, and population intake of meat, fruit, and/or vegetables.

DATA ANALYSIS

Using STATA SE version 15 software, random-effects meta-regression analyses were used to test the effect of year of data collection and method of data collection on population meat, fruit, and vegetable consumption. The analyses also tested any association between age, sex, rural/urban residence, or a country's economic development and population intake of meat, fruits, and/or vegetables. The review was started in 2017 and completed in 2019.

RESULTS

Richer SSA countries were likely to consume more meat (ß = 36.76, P = 0.04) and vegetables (ß =43.49, P  = 0.00) than poorer countries. Vegetable intake has increased dramatically over the last 3 decades from ≈10 g to ≈110 g (ß = 4.43, P  = 0.00). Vegetable (ß= -25.48, P  = 0.00) consumption was higher in rural than in urban residents. Although the trend of meat consumption has risen (≈25 g to ≈75 g), the trend is nonsignificant (ß = 0.63, N.S.). Daily average per capita meat consumption was 98 g - above the 70 g recommendation - while fruit and vegetable intake (268 g) remain below the World Health Organization's recommendation (400 g).

CONCLUSIONS

Given the low intake of plant-based foods, it is likely that SSA populations may be deficient in high-quality protein and micronutrients as suggested by the EAT-Lancet Commission. There is a need to promote both an adequate supply and demand of plant-based protein and micronutrients, including fruit, vegetables, nuts, seeds, and legumes, in SSA countries. While dietary changes in SSA may offer large absolute benefits, consideration of the magnitude of dietary change, particularly increasing or reducing meat consumption, will need to occur in a way that ensures that policy and interventions support the reduction of undernutrition and micronutrient deficiencies without worsening the prevalence and environmental impacts of noncommunicable diseases. There is also the need for preventive action that ensures that SSA populations do not increase their meat consumption as disposable incomes increase and countries' economic development rises, as is seen in most countries undergoing economic transformation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42018090497.

EAACI position paper on diet diversity in pregnancy, infancy and childhood: Novel concepts and implications for studies in allergy and asthma

To fully understand the role of diet diversity on allergy outcomes and to set standards for conducting research in this field, the European Academy of Allergy and Clinical Immunology Task Force on Diet and Immunomodulation has systematically explored the association between diet diversity and allergy outcomes. In addition, a detailed narrative review of information on diet quality and diet patterns as they pertain to allergic outcomes is presented. Overall, we recommend that infants of any risk category for allergic disease should have a diverse diet, given no evidence of harm and some potential association of benefit in the prevention of particular allergic outcomes. In order to harmonize methods for future data collection and reporting, the task force members propose relevant definitions and important factors for consideration, when measuring diet diversity in the context of allergy. Consensus was achieved on practice points through the Delphi method. It is hoped that the definitions and considerations described herein will also enable better comparison of future studies and improve mechanistic studies and pathway analysis to understand how diet diversity modulates allergic outcomes.

Assessing Dietary Diversity in Pregnant Women: Relative Validity of the List-Based and Open Recall Methods

BACKGROUND

The Minimum Dietary Diversity for Women (MMD-W) was validated as a proxy of micronutrient adequacy for nonpregnant women, with proposed data collection being either a list-based or a qualitative open recall method. Few studies have compared the performance of these 2 methods.

OBJECTIVES

We compared performance in predicting micronutrient adequacy of food group indicators (FGIs) measured by the list-based and the quantitative open recall methods using varying quantity cut-offs. We also examined the agreement between list-based and open recall FGIs.

METHODS

Data were collected in Bangladesh (n = 600 pregnant women) and India (n = 655). The performance of different indicators to predict micronutrient adequacy was compared using receiver operating characteristic (ROC) analysis. Correlations between list-based and open recall FGIs were calculated using Spearman's rank test; agreement was assessed by the intraclass correlation coefficient (ICC) and kappa statistics. Food groups that were most often misreported by the list-based method were identified.

RESULTS

There were no statistically significant differences in ROC curves between list-based and open recall FGIs in either country. In Bangladesh, correlations between list-based and open recall FGIs varied between 0.6 and 0.8; ICC values were 0.43-0.75; kappa values were 0.51-0.53 when using a cut-off of any quantity or 15 g for open recall, but were lower (k = 0.24) with the cut-off of 1 portion. In India, these values were lower: ∼0.4 for correlation, 0.32-0.37 for ICCs, and 0.17-0.22 for kappas. Food groups most susceptible to misreporting using the list-based method were beans/peas in Bangladesh and other vegetables in India.

CONCLUSIONS

Our study provides initial support for the use of list-based questionnaires in assessing food group diversity or prevalence of MDD-W in pregnant women. Additional and context-specific work may be required to understand the potential of simple methodologies to assess consumption of specific food groups. This trial was registered at clinicaltrials.gov as NCT02745249 (Bangladesh) and NCT03378141 (India).

Exploring agrobiodiversity for nutrition: Household on-farm agrobiodiversity is associated with improved quality of diet of young children in Vihiga, Kenya

Due to their limited access to the external productive inputs and the dependency on rain-fed agricultural production, small scale farmers in sub-Saharan Africa have continued to face undernutrition despite the significant advancements in agriculture. They however often live in areas endowed with high agrobiodiversity which could contribute, if explored, to improved diets and nutrition. Few studies have linked the contribution of agrobiodiversity to the micronutrient adequacy of the diets of young children among smallholder farmers. The study explored this relationship and contributes to the growing body of literature linking agrobiodiversity to nutrition of young children. Two cross-sectional surveys were conducted as part of baseline assessment for an intervention study, one in the lean and a second in the plenty season in Vihiga county, Kenya. Household level interviews were administered to 634 households with children 12–23 months. Agrobiodiversity was defined as the number of crop species cultivated or harvested from the wild and the number of livestock maintained by the household across two agricultural seasons. Dietary data were collected using two-non-consecutive quantitative 24-hour recalls and analyzed using Lucille software. Diet quality was assessed using dietary diversity score based on seven food groups and mean probability of micronutrient adequacy computed for eleven micronutrients. A total of 80 species were maintained or harvested from the wild by the households. Mean household species richness was 9.9 ± 4.3. One in every four children did not meet the minimum dietary diversity score. The average mean probability of micronutrient adequacy was 68.11 ± 16.08 in plenty season compared to 56.37± 19.5% in the lean season. Iron, zinc and calcium were most limiting micronutrients in the diet, with less than 30% average probability of adequacy in both seasons. Household agrobiodiversity was positively associated with both dietary diversity score (r = 0.09, p = 0.029) and micronutrient adequacy (r = 0.15, p<0.000) in the pooled sample. One unit increase in species diversity was associated with 12.7% improvement in micronutrient adequacy. Despite the rich agrobiodiversity in the study area the diets were low in diversity and there is an unrealized opportunity to improve micronutrient intake through greater promotion and consumption of locally available agrobiodiversity.

The role of dietary diversity in the response to treatment of uncomplicated severe acute malnutrition among children in Niger: a prospective study

Background

Community-based treatment of severe acute malnutrition (SAM) has proven to be safe and cost-effective, although identifying additional factors that can increase recovery and decrease treatment failure may improve program effectiveness. We examine the association of dietary diversity and clinical and program treatment outcomes among children treated for uncomplicated SAM in Niger.

Methods

Two thousand four hundred twelve children were enrolled in a randomized trial of routine amoxicillin in the treatment of uncomplicated SAM from 2012 to 2014. All children received ready to use therapeutic food (RUTF) and standard clinical care. Child dietary diversity was assessed using a 7-day food frequency questionnaire and 8-food group diet diversity score. We assessed the association of dietary diversity at admission with nutritional recovery, hospitalization, and death at program discharge and 12 weeks, and weight and height gain.

Results

Food groups most commonly consumed by children in seven days preceding SAM treatment were cereals, roots and tubers (N = 2364, 99.5%) and vitamin A rich fruits and vegetables (N = 2253, 94.8%). Egg (N = 472, 19.9%) and dairy (N = 659, 27.7%) consumption was low. Mean (SD) diet diversity score was significantly lower in the lean vs. non-lean season [2.7 (1.1) vs. 2.9 (1.0)]. There was no evidence that dietary diversity increased nutritional recovery at discharge (RR: 1.02, 95% CI: 1.00, 1.04) or 12 weeks (RR: 0.98, 95%CI: 0.94, 1.02). No significant association was found with risk of hospitalization or death, or weight and height gain. Egg consumption was protective against death at discharge (RR: 0.53, 95% CI: 0.39, 0.70) and 12 weeks (RR: 0.66, 95% CI: 0.45, 0.96). Vitamin A rich fruits and vegetable consumption was associated with greater risk of mortality in children at discharge (RR: 1.30, 95% CI: 1.08, 1.56) and 12 weeks (RR: 1.19, 95% CI: 1.03, 1.36).

Conclusions

We did not find evidence that dietary diversity influenced nutrition recovery or response to treatment for children with uncomplicated SAM in Niger. It is feasible consumption of nutrient-dense foods like eggs may be important for recovery from SAM. There is need for continued research to further elucidate drivers of nutritional recovery from acute malnutrition in different settings.

Trial registration

Trial registration number: ClinicalTrials.gov NCT01613547. Registered May 26, 2012.

Caregivers' nutritional knowledge and attitudes mediate seasonal shifts in children's diets

Smallholder farmers dependent on rain‐fed agriculture experience seasonal variations in food and nutrient availability occasioned by seasonality of production patterns. This results in periods of nutrient abundance in the plenty seasons followed closely by periods of nutrient inadequacies and malnutrition. This pattern contributes to a cycle of deteriorating health and nutrition status and deprives children of their ability to realize full developmental potential. This study investigates the role of caregiver's nutritional knowledge and attitudes in mediating effects of seasonality on children's diets. Repeated cross‐sectional surveys were conducted on 151 randomly selected households in the plenty and lean seasons to collect dietary data using two non‐consecutive quantitative 24‐hr recalls and caregiver's nutritional knowledge and attitudes assessed using interviewer administered questionnaire. Sixty‐five percent of the caregivers had attained a primary level education or less. There was a positive modest correlation between caregivers' nutritional knowledge and their attitudes (r = 0.3, P < 0.000, α = 0.01). Children's mean adequacy ratio was significantly higher in the plenty season than in the lean season (0.84 vs. 0.80, P < 0.000). A two‐block hierarchical regression to predict the seasonal changes in dietary quality of children using caregiver's nutritional knowledge and attitude scores while controlling for the effect of sociodemographics and mean adequacy ratio at first season (plenty) found that caregiver's nutritional knowledge (ß = −0.007, SE = 0.003, P = 0.027, 95% CI [−0.013, −0.001] ŋ² = 0.034) but not attitudes had significant contribution to the prediction. Maternal nutritional knowledge mediates seasonal variation in child nutrient intakes.

Do Chinese Preschool Children Eat a Sufficiently Diverse Diet? A Cross-Sectional Study in China

BACKGROUND

This study aimed to comprehensively evaluate dietary diversity and its associated factors in Chinese preschoolers and explore whether the daily food consumption of children with different dietary diversity-associated characteristics met recommended dietary amounts.

METHODS

A cross-sectional study covering seven cities and two villages was conducted and included 697 preschool children aged 3⁻7 years old. Dietary diversity score (DDS) and DDS 10 were calculated based on 24-h dietary recall. The food-intake differences among children with different DDS 10 predictors were examined.

RESULTS

The mean DDS and DDS 10 in Chinese preschool children were 7.4 ± 1.5 (ranged from 3 to 9) and 7.0 ± 3 (ranged from 3 to 9) respectively. Positive predictors of dietary diversity included residing in an urban environment, a higher household expenditure on children’s food, and a higher frequency of eating outside. Food-intake differences existed among the predictors.

CONCLUSIONS

Education and intervention should be strengthened to improve the dietary diversity of preschool children, especially in rural areas. The overall dietary pattern of children requires attention, which means not only increasing dietary diversity but also avoiding an unbalanced diet.

Usual nutrient intake adequacy among young, rural Zambian children

Inadequate nutrient intakes put children at risk for impaired growth and development. We described diet, usual intakes of energy and macro- and micronutrients and prevalence of nutrient intake adequacies among 4–8-year-old Zambian children. Children not yet in school and living in Mkushi District, Central Province, Zambia were enrolled into an efficacy trial of pro-vitamin A biofortified maize. Children in the non-intervened arm were included in this analysis (n 202). Dietary intake data were collected by tablet-based 24-h recall on a monthly basis over the 6-month trial. Observed nutrient intakes were derived from reported food quantities, standard recipes and food composition tables. Usual nutrient intake distributions were modelled based on observed intakes. Prevalence of inadequacy was estimated by comparing the usual nutrient intake distribution to the nutrient requirement distribution. Frequency and quantity of consumption of commonly reported foods were described and key sources of energy and nutrients were identified. Median usual energy intake was 6422 kJ/d (1535 kcal/d). Most childrens’ macronutrient intakes fell within recommended ranges (74–98 %). Estimated prevalences of inadequate intakes of Fe, folate, vitamin B12 and Ca were 25, 57, 76 and >99 %, respectively. Estimated prevalences of inadequacy for other micronutrients were low (0·1–2·2 %). Commonly consumed foods included maize, vegetable oil, tomatoes, rape leaves and small fish (>0·6 servings/d), whereas meat, eggs or dairy were rarely eaten (<0·2 servings/d). These findings suggest that the heavily plant-based diet of rural Zambian children provides inadequate Ca, folate, vitamin B12 and Fe to meet recommended nutrient intakes.

Seasonality affects dietary diversity of school-age children in northern Ghana

BACKGROUND AND OBJECTIVES

Dietary diversity score (DDS) is relatively easy to measure and is shown to be a very useful indicator of the probability of adequate micronutrient intake. Dietary diversity, however, is usually assessed during a single period and little is known about the effect of seasonality on it. This study investigates whether dietary diversity is influenced by seasonality.

METHODS

Two cross-sectional surveys were conducted in two different seasons-dry season (October 2010) and rainy season (May 2011) among the same school-age children (SAC) in two rural schools in northern Ghana. The study population consisted of 228 school-age children. A qualitative 24-hour dietary recall was conducted in both seasons. Based on 13 food groups, a score of 1 was given if a child consumed a food item belonging to a particular food group, else 0. Individual scores were aggregated into DDS for each child. Differences in mean DDS between seasons were compared using linear mixed model analysis.

RESULTS

The dietary pattern of the SAC was commonly plant foods with poor consumption of animal source foods. The mean DDS was significantly higher (P < 0.001) in the rainy season (6.95 ± 0.55) compared to the dry season (6.44 ± 0.55) after adjusting for potential confounders such as age, sex, occupation (household head and mother) and education of household head. The difference in mean DDS between dry and rainy seasons was mainly due to the difference in the consumption of Vitamin A-rich fruits and vegetables between the seasons. While vitamin A-rich fruits (64.0% vs. 0.9%; P < 0.0001) and vitamin A rich dark green leafy vegetables (52.6% vs. 23.3%, P < .0001) were consumed more during the rainy season than the dry season, more children consumed vitamin A-rich deep yellow, orange and red vegetables during the dry season than during the rainy season (73.7% vs. 36.4%, P <0.001).

CONCLUSION

Seasonality has an effect on DDS and may affect the quality of dietary intake of SAC; in such a context, it would be useful to measure DDS in different seasons. Since DDS is a proxy indicator of micronutrient intake, the difference in DDS may reflect in seasonal differences in dietary adequacy and further studies are needed to establish this.

Temporal changes and determinants of childhood nutritional status in Kenya and Zambia

BACKGROUND

The prevalence of undernutrition is decreasing in many parts of the developing world, but challenges remain in many countries. The objective of this study was to determine factors influencing childhood nutrition status in Kenya and Zambia. The objective of this study is to determine factors associated with temporal changes in childhood nutritional status in two countries in sub-Saharan Africa.

METHODS

Data from national demographic and health surveys from the World Bank for Kenya (1998-2009) and Zambia (1996-2014) were used to select the youngest child of each household with complete data for all variables studied. Multiple linear regression analyses were used for data from 2902 and 11,335 children from Kenya and Zambia, respectively, in each year to determine the relationship between social and economic factors and measures of nutritional status, including wasting, stunting, and overweight.

RESULTS

There was a decreased prevalence of stunting (35% in Kenya and 40% in Zambia), while the prevalence of wasting was unchanged (6-8% in both countries). From 1998 to 2009, there was a protective effect against stunting for wealthier families and households with electricity, for both countries. Finally, better educated mothers were less likely to have stunted children and girls were less likely to be stunted than boys.

CONCLUSIONS

Based on the data analyzed, there was a higher risk of stunting in both Kenya and Zambia, for those with lower literacy, less education, no electricity, living in rural areas, no formal toilet, no car ownership, and those with an overall lower wealth index. Improving the education of mothers was also a significant determinant in improving the nutritional status of children in Kenya and Zambia. More broad-based efforts to reduce the prevalence of undernutrition need to focus on reducing the prevalence of undernutrition without promoting excess weight gain. Future economic advances need to consider integrated approaches to improving economic standings of households without increasing the risk for overnutrition.

Nutrient Intake Is Insufficient among Senegalese Urban School Children and Adolescents: Results from Two 24 h Recalls in State Primary Schools in Dakar

Due to rapid urbanization and high food prices and in the absence of nutrition programs, school children from urban areas in West Africa often have insufficient and inadequate diet leading to nutrient deficiencies that affect their health and schooling performance. Acute malnutrition and micronutrient deficiencies are prevalent in children from primary state schools of Dakar (Senegal). The objectives of the present study were to assess the overall diet of these children, to report insufficient/excessive energy and nutrient intakes and to investigate association between insufficient nutrient intake and micronutrient deficiencies. Children attending urban state primary schools in the Dakar area were selected through a two-stage random cluster sampling (30 schools × 20 children). Dietary intake data were obtained from two 24 h recalls and blood samples were collected from 545 children (aged 5-17 years, 45% < 10 years, 53% girls) and adjusted for intra-individual variability to estimate nutrient usual intakes. Energy intake was insufficient and unbalanced with insufficient contribution of protein and excessive contribution of fat to global energy intake in one third of the children. Proportions of children with insufficient intake were: 100% for calcium, 100% for folic acid, 79% for vitamin A, 69% for zinc, 53% for vitamin C and 46% for iron. Insufficient iron and protein intake were risk factors for iron deficiency (odds ratio, OR 1.5, 2.2). Insufficient zinc intake and energy intake from protein were risk factors for zinc deficiency (OR 1.8, 3.0, 1.7, 2.9). Insufficient iron and vitamin C intake, and insufficient energy intake from protein were risk factors for marginal vitamin A status (OR 1.8, 1.8, 3.3). To address nutritional deficiencies associated with a diet deficient in energy, protein and micronutrients, nutrition education or school feeding programs are needed in urban primary schools of Senegal.

Food-Based Interventions to Modify Diet Quality and Diversity to Address Multiple Micronutrient Deficiency

Global data indicate a high prevalence of hidden hunger among population. Deficiencies of certain micronutrients such as folic acid, iodine, iron, and vitamin A have long lasting effects on growth and development and therefore have been a National priority from many decades. The strategy implemented so far limits to the use of supplemental sources or fortified foods in alleviating the burden of deficiencies. These approaches however undermine the food-based strategies involving dietary diversification as the long-term sustainable strategy. There is lack of understanding on the level of evidence needed to implement such strategies and the level of monitoring required for impact evaluation. Dietary diversity concerns how to ensure access for each individual to a quality and safe diet with adequate macro- and micronutrients. The key to success in using dietary diversity as a strategy to tackle hidden hunger is in integrating it with the principles of bioavailability, translated to efficient food synergies with due emphasis on food accessibility, affordability, and outdoor physical activity/life style modifications. Promoting enabling environment and sustainable agriculture is crucial for practicing dietary diversification with behavior change communication as an integral segment. It can be concluded that food-based strategies require careful understanding of the factors associated with it and moderate it to form an effective strategy for controlling multiple micronutrient deficiencies.

Dietary intake of schoolchildren and adolescents in developing countries

School age and adolescence is a dynamic period of growth and development forming a strong foundation for good health and productive adult life. Appropriate dietary intake is critical for forming good eating habits and provides the much needed nutrients for growth, long-term health, cognition and educational achievements. A large proportion of the population globally is in the school age or adolescence, with more than three quarters of these groups living in developing countries. An up-to-date review and discussion of the dietary intake of schoolchildren and adolescents in developing countries is suitable to provide recent data on patterns of dietary intake, adequacy of nutrient intake and their implications for public health and nutrition issues of concern. This review is based on literature published from 2000 to 2014 on dietary intake of schoolchildren and adolescents aged 6-19 years. A total of 50 studies from 42 countries reporting on dietary intake of schoolchildren and adolescents were included. The dietary intake of schoolchildren and adolescents in developing countries is limited in diversity, mainly comprising plant-based food sources, but with limited intake of fruits and vegetables. There is a low energy intake and insufficient micronutrient intake. At the same time, the available data indicate an emerging trend of consumption of high-energy snacks and beverages, particularly in urban areas. The existence of a negative and positive energy balance in the same population points to the dual burden of malnutrition and highlights the emerging nutrition transition in developing countries. This observation is important for planning public health nutrition approaches that address the concerns of the two ends of the nutrition divide.