How dietary intake has been assessed in African countries? A systematic review

Dietary magnesium intakes among women of reproductive age in Ghana-A comparison of two dietary analysis programs

BACKGROUND

Despite the importance of magnesium to health and most importantly to women of reproductive age who are entering pregnancy, very few surveys have investigated the magnesium status of women of reproductive age, particularly in Africa. Additionally, the software and programs used to analyze dietary intake vary across countries in the region.

OBJECTIVE

To assess the dietary magnesium intake of women of reproductive age in Ghana and to compare the estimate of magnesium intake obtained from two commonly used dietary analysis programs.

METHODS

We collected magnesium intake from 63 Ghanaian women using a semiquantitative 150-item food frequency questionnaire. Dietary data was analyzed using two different dietary analysis programs, Nutrient Data Software for Research (NDSR) and the Elizabeth Stewart Hands and Associates (ESHA) Food Processor Nutrition Analysis software. We used the Wilcoxon signed rank test to compare the mean differences between the two dietary programs.

RESULTS

There were significant differences between the average dietary magnesium intake calculated by the two dietary programs, with ESHA estimating higher magnesium intake than NDSR (M±SE; ESHA: 200 ± 12 mg/day; NDSR: 168 ± 11 mg/day; p<0. 05). The ESHA database included some ethnic foods and was flexible in terms of searching for food items which we found to be more accurate in assessing the magnesium intake of women in Ghana. Using the ESHA software, 84% of the study women had intake below the recommended dietary allowances (RDA) of 320mg/day.

CONCLUSION

It is possible that the ESHA software provided an accurate estimate of magnesium in this population because it included specific ethnic foods. Concerted efforts such as magnesium supplementation and nutrition education should be considered to improve the magnesium intake of women of reproductive age in Ghana.

Nutritional intake and food sources in an adult urban Kenyan population

Urbanisation is hastening the transition from traditional food habits to less healthy diets, which are becoming more common among Kenyans. No up-to-date studies on usual dietary intake and the main food sources of adult Kenyans are available. The aim of the present study was to identify the main food sources of nutrients in the diet of urban adult Kenyans and explore potential associations with demographic variables including age, sex, level of education, occupation and body mass index. The study adopted a cross-sectional design. The dietary intake of 486 adult Kenyans from Nairobi was assessed using a validated, culture-sensitive, semi-quantitative food frequency questionnaire. Binary logistic regression models were used to evaluate associations between food sources and demographic variables. Macronutrient intakes as a proportion of total energy intake (TEI) were within international dietary guidelines. Cereals and grain products (34.0%), sugar, syrups, sweets and snacks (9.8%), fruits (9.7%) and meat and eggs (8.8%) were the major contributors to TEI. Cereals and grain products contributed 42.5% to carbohydrates, followed by fruits (12.4%) and sugar, syrups, sweets and snacks (10.6%). The most important sources of protein and total fat were cereals and grain products (23.3% and 19.7%, respectively) and meat and eggs (22.0% and 18.7%, respectively). Sex, age and level of education were associated with the choice of food groups. Although macronutrient intakes were within guidelines, the Kenyan diet was revealed to be high in sugars, salt and fibre, with differences in food sources according to demographic variables. These results can act as an incentive to national authorities to implement nutritional strategies aiming to raise awareness of healthier dietary patterns among Kenyans.

"Planeterranea": An attempt to broaden the beneficial effects of the Mediterranean diet worldwide

Non-communicable diseases (NCDs) lead to a dramatic burden on morbidity and mortality worldwide. Diet is a modifiable risk factor for NCDs, with Mediterranean Diet (MD) being one of the most effective dietary strategies to reduce diabetes, cardiovascular diseases, and cancer. Nevertheless, MD transferability to non-Mediterranean is challenging and requires a shared path between the scientific community and stakeholders. Therefore, the UNESCO Chair on Health Education and Sustainable Development is fostering a research project-"Planeterranea"-aiming to identify a healthy dietary pattern based on food products available in the different areas of the world with the nutritional properties of MD. This review aimed to collect information about eating habits and native crops in 5 macro-areas (North America, Latin America, Africa, Asia, and Australia). The information was used to develop specific "nutritional pyramids" based on the foods available in the macro-areas presenting the same nutritional properties and health benefits of MD.

Sensitivity of Food-Based Recommendations Developed Using Linear Programming to Model Input Data in Young Kenyan Children

Food-based recommendations (FBR) developed using linear programming generally use dietary intake and energy and nutrient requirement data. It is still unknown to what extent the availability and selection of these data affect the developed FBR and identified problem nutrients. We used 24 h dietary recalls of 62 Kenyan children (4-6 years of age) to analyse the sensitivity of the FBR and problem nutrients to (1) dietary intake data, (2) selection criteria applied to these data and (3) energy and nutrient requirement data, using linear programming (Optifood©), by comparing a reference scenario with eight alternative scenarios. Replacing reported by estimated consumption frequencies increased the recommended frequencies in the FBR for most food groups while folate was no longer identified as a problem nutrient. Using the 10-90th instead of the 5-95th percentile of distribution to define minimum and maximum frequencies/week decreased the recommended frequencies in the FBR and doubled the number of problem nutrients. Other alternative scenarios negligibly affected the FBR and identified problem nutrients. Our study shows the importance of consumption frequencies for developing FBR and identifying problem nutrients by linear programming. We recommend that reported consumption frequencies and the 5-95th percentiles of distribution of reported frequencies be used to define the minimum and maximum frequencies.

A culture-sensitive semi-quantitative FFQ for use among the adult population in Nairobi, Kenya: development, validity and reproducibility

OBJECTIVE

To develop a semi-quantitative FFQ and to evaluate its validity and reproducibility for the assessment of total dietary intake of Kenyan urban adult population, given its non-existence in Kenya.

DESIGN

The current study adopted a cross-sectional design. A culture-sensitive semi-quantitative FFQ was developed and its validity was tested relative to three non-consecutive 24-h recalls (24hR). Reproducibility was tested by the test-retest method, with a 3-week interval. Spearman's correlation coefficients and intra-class correlation coefficients were calculated for several macro- and micronutrients. Cross-classification into quartiles and Bland and Altman plots were analysed.

SETTING

Nairobi county (Dagoreti South and Starehe constituencies).

PARTICIPANTS

A convenient sample was recruited in three different clusters in Nairobi.

RESULTS

A culture-sensitive 123-food-item semi-quantitative FFQ showed higher nutrient intakes compared with the 24hR (total energy median 12543·632 v. 8501·888 kJ, P < 0·001). Energy-adjusted and deattenuated Spearman's correlations for macronutrients ranged between 0·21 (total fat) and 0·47 (protein). The agreement in the same quartile varied from 28 % (protein) to 41 % (carbohydrates). Including adjacent quartiles, the range increased: 76 % (protein and fat) to 81 % (carbohydrates). The extreme disagreement was low. The first FFQ application resulted in higher mean values for all nutrients compared with the second FFQ (total energy median 12459·952 v. 10485·104 kJ, P < 0·001). Energy-adjusted correlations for macronutrients ranged from 0·28 (carbohydrates) to 0·61 (protein). Intra-class correlation coefficients for macronutrients were moderate, between 0·6 and 0·7.

CONCLUSIONS

The developed semi-quantitative FFQ was shown to be a valid and reproducible tool for ranking urban adult Kenyans according to their dietary intake.

Soil and farm management effects on yield and nutrient concentrations of food crops in East Africa

Crops that grow on soils with higher fertility often have higher yields and higher tissue nutrient concentrations. Whether this is the case for all crops, and which soil and management factors, or combinations mostly affect yields and food nutrient concentrations however, is poorly understood. Here, the main aim was to evaluate effects of soil and management factors on crop yields and food nutrient concentrations in (i) grain, fruit and tuber crops, and (ii) between high and low soil fertility areas. Total elemental concentrations of Mg, P, S, K, Ca, Fe, Zn, Mn and Cu were measured using a portable X-Ray Fluorescence Spectrometer (pXRF) in maize grain (Zea mays; Teso South, Kenya: n = 31; Kapchorwa, Uganda n = 30), cassava tuber (Manihot esculenta; Teso South: n = 27), and matooke fruit (Musa acuminata; Kapchorwa, n = 54). Soil properties measured were eCEC, total N and C, pH, texture, and total elemental content. Farm management variables (fertilisation, distance to household, and crop diversity) were collected. Canonical Correspondence Analyses (CCA) with permutation rank tests identified driving factors of alterations in nutrient concentrations. Maize grain had higher correlations with soil factors (CCA > 80%), than cassava tuber (76%) or matooke fruit (39%). In contrast, corresponding correlations to management factors were much lower (8-39%). The main soil properties affecting food nutrients were organic matter and texture. Surprisingly, pH did not play an important role. A positive association of crop diversity with nutrient concentration and yield in lower fertility areas was observed. Considering, food nutrient composition, apart from yield, as response variables in agronomic trials (e.g. fertilisation or soil improvement strategies), would contribute towards discounting the notion that crops growing on fertile soils always produce healthy and high quality foods.

Dietary intake in undernourished adults living in Guinea-Bissau; a cross-sectional study

Background

Data on dietary intake in Guinea-Bissau is limited. The main purpose of this study was to compare mean daily energy intake (EI) with mean daily energy expenditure (EE) for a moderately active lifestyle in health-seeking individuals with a body mass index < 20.0 kg/m². Furthermore, dietary composition was evaluated by estimates of macronutrient energy distribution, individual dietary diversity scores, and the identification of frequently consumed food items, stratified by sex.

Methods

A cross-sectional dietary survey was conducted at the suburban health- and demographic surveillance site in Guinea-Bissau, West Africa, from May 2014–February 2015. Each participant answered one interviewer-administered 24-h dietary recall at baseline, from which dietary intake was assessed. Differences in dietary intake between men and women were analysed using the X² test or Fisher’s Exact test for categorical outcomes, and the Student’s t-test for continuous variables.

Results

Forty-three men and forty-eight women were included. Mean EI for men was 6326 kJ/d (sd 2104) and for women 6822 kJ/d (sd 2210). Mean EE for a moderately active lifestyle with a physical activity level of 1.75 was 10,479 kJ/d (sd 658) for men and 8729 kJ/d (sd 731) for women. Both men and women had a significantly lower mean EI compared with mean EE (p-values both < 0.001). Dietary diversity was low with a score of 3.5 (sd 1.0) for men and 4.0 (sd 1.3) for women, p-value 0.046. Macronutrient energy was distributed as 66% (sd 11) carbohydrate, 15% (sd 5) protein, and 19% (sd 9) fat, with no significant difference in distribution between men and women. Consumption of starchy and sugary carbohydrates accounted for two thirds of mean EI. Cereals were the main source of protein, in place of animal protein.

Conclusions

Both men and women in this study had low mean EI compared with mean EE for a moderately active lifestyle. Dietary intake was characterized by a seemingly low dietary diversity and imbalanced macronutrient energy distribution, comprising insufficient fat intake and excess carbohydrate intake. Cereals were the main source of protein.

Trial registration

PACTR2009110001673419. Registered 22 Oct 2009.