Evaluation of a rapid field tool for assessing household diet quality in Mozambique

Does government food demonstration intervention influence household dietary diversity in the Upper West Region of Ghana?

Dietary diversity is crucial in ensuring food and nutrition security. In low-middle-income countries, people frequently prioritize the quantity of food they consume over its quality due to a lack of availability and financial limitations. As a result, achieving dietary diversity is often overlooked in favor of ensuring adequate caloric intake. Through a social cognitive theory perspective, our study examines the relationship between food demonstrations and household dietary diversity in Ghana's Upper West Region utilizing cross-sectional survey data from 517 smallholder farmer households. The results from ordered logistic regression presented in odds ratio (OR) show that participating in food demonstrations (OR: 2.585, p<0.01), engaging in home gardening (OR: 1.932, p<0.001), having access to credit (OR: 1.609, p<0.01), self-rated good nutritional status (OR: 1.747, p<0.01), and Waala ethnicity (OR: 3.686, p<0.001) were all positively associated with high household dietary diversity. Conversely, living in the Wa West district was associated with lower dietary diversity (OR: 0.326, p<0.001). Our research findings suggest that policymakers may want to consider implementing community-based educational programs, such as home and school visits for food demonstrations and sensitizations, promoting mother-to-mother support groups for dietary diversity education, nutrition counseling services, and using role-play and local media. In addition, strengthening local agricultural policies through food banks, indigenous seed development, and mobile food markets and enhancing public-private partnerships like the Ghana Schools Feeding Programme and National Food Buffer Stock company could improve the supply chain and distribution networks for diverse food items. Implementing these interventions in the Upper West Region of Ghana could improve health, well-being, food security, and nutritional outcomes.

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.

Measuring Food Culture: a Tool for Public Health Practice

PURPOSE OF REVIEW

Food culture is a ubiquitous aspect of all societies. This review provides an overview of methods for measuring food culture, and emphasizes the importance of these measures not just for description, but also for strengthening public health practice, primarily through the development of better interventions; to monitor and evaluate changes in diet and nutrition; and for the development of strategies for sustainability and dissemination.

RECENT FINDINGS

Food culture measurement has enriched public health practice through its use of myriad approaches, including interviews, cultural domain analysis, visual methods, observation, time allocation studies, focus groups and community workshops, household studies, and textual analysis. Food culture measurement is essential for public health practice related to food and nutrition, and can lead to, among other outcomes, improved implementation research in nutrition, understanding household dynamics that impact nutritional outcomes, innovative textual analysis to identify food culture through language, and the selection of interventions conveyed through multiple strategies, including digital means, such as via social media.

International food group-based diet quality and risk of coronary heart disease in men and women

Background

Standard diet quality assessment tools, which measure micronutrient sufficiency and food consumption related to disease and applicable to different populations, are needed to track progress in meeting the Sustainable Development Goals related to hunger, food security, and nutrition. Diet quality scores have been constructed for high- and low-income countries, but none are simple to administer or applicable internationally.

Objective

We prospectively examined the association between the Food Group Index (FGI), the Minimal Diet Diversity Score for Women (MDDW), and a new Prime Diet Quality Score (PDQS), and the risk of ischemic heart disease (IHD) in 3 US cohorts.

Design

In total, 75,045 women (baseline age 43-63 y), 43,966 men (aged 40-75 y), and 93,131 younger women (aged 27-44 y) without a history of cardiovascular disease were followed up to 28 y. Diet was assessed multiple times using food frequency questionnaires and the 3 diet quality scores were computed for each individual. The association with IHD was modeled with Cox proportional hazard models, controlling for potential confounders.

Results

During follow-up, we ascertained 2908 incident IHD cases in the Nurses' Health Study, 3722 in the Health Professionals Follow-up Study, and 505 in the Nurses' Health Study II. The FGI was not associated with total IHD in any cohort. The PDQS was significantly associated with IHD in all 3 cohorts separately and the pooled RR for each SD increase was 0.89 (95% CI: 0.87, 0.91). This was significantly different than the pooled RR of 0.93 for MDDW (95% CI: 0.90, 0.96) and the RR of 0.98 for the FGI (95% CI: 0.95, 1.01). The association did not appear to differ by age.

Conclusion

We found that the PDQS with the most detailed differentiation of healthy and unhealthy foods was associated with a lower risk of IHD in a high-income country. On the other hand, diet quality scores that do not account for unhealthy foods had a limited association with IHD.

Associations of dietary diversity scores and micronutrient status in adolescent Mozambican girls

PURPOSE

In low-income settings, dietary diversity scores (DDSs) often predict the micronutrient adequacy of diets, but little is known about whether they predict levels of biochemical indicators of micronutrient status.

METHODS

In 2010, we studied two samples of non-pregnant 14- to 19-year-old girls in central Mozambique, the first in January-February ('hunger season'; n = 227) and the second in May-June (harvest season; n = 223). In this paper, we examined whether a low Women's Dietary Diversity Score (WDDS) predicts a low concentration of haemoglobin, serum ferritin, zinc, and folate, and plasma retinol in adolescent Mozambican girls. We constructed three scores: WDDS based on 24-h recalls, WDDS15g based on 24-h recall and employing a 15 g limit, and 7dWDDS based on 7-day food frequency questionnaires. Logistic regression models, stratified by season, were used to estimate the odds of having a low concentration of a status indicator (≤25th percentile of the season-specific distribution or cut-off from the literature) in those with a low score compared to those with a higher score.

RESULTS

In January-February, after adjusting for confounders, a low (≤3) WDDS and a low (≤5) 7dWDDS were each associated with higher odds of having low serum zinc compared to having a higher score, regardless of which of the two types of cut-offs for serum zinc was used. These associations were not present in May-June.

CONCLUSIONS

Our data from Mozambique suggest that dietary diversity is associated with serum zinc, but this association seems to be limited to the hunger season.

What are we assessing when we measure food security? A compendium and review of current metrics

The appropriate measurement of food security is critical for targeting food and economic aid; supporting early famine warning and global monitoring systems; evaluating nutrition, health, and development programs; and informing government policy across many sectors. This important work is complicated by the multiple approaches and tools for assessing food security. In response, we have prepared a compendium and review of food security assessment tools in which we review issues of terminology, measurement, and validation. We begin by describing the evolving definition of food security and use this discussion to frame a review of the current landscape of measurement tools available for assessing food security. We critically assess the purpose/s of these tools, the domains of food security assessed by each, the conceptualizations of food security that underpin each metric, as well as the approaches that have been used to validate these metrics. Specifically, we describe measurement tools that 1) provide national-level estimates of food security, 2) inform global monitoring and early warning systems, 3) assess household food access and acquisition, and 4) measure food consumption and utilization. After describing a number of outstanding measurement challenges that might be addressed in future research, we conclude by offering suggestions to guide the selection of appropriate food security metrics.

Child nutrition in Mozambique in 2003: the role of mother's schooling and nutrition knowledge

This paper is a study of the determinants of the anthropometric status of preschool children in Mozambique. Using the 2003 Demographic and Health Survey, we provide insights into two main explanatory factors: the mother's schooling and the mother's nutrition knowledge. Rather than treating the mother's schooling as a black box, we analyze its interaction with the mother's nutrition knowledge and household wealth in order to elucidate the mechanisms underlying their ultimate effect on child height. The estimates obtained through instrumental variable regression show that the direct effect of the mother's schooling is large but that the rate at which it increases declines as her educational level rises. Primary education seems to be a key to enhance the mothers' general knowledge, which then improves the allocation of resources in regard to children's well-being and the care for the child. A higher educational level attained by the mother is likely to play only a minimal and indirect role in her child's nutrition, by expanding her economic opportunities. This is because more educated mothers have also more qualified and time-consuming jobs, which reduces the time spent for childcare. Mothers with higher levels of nutrition knowledge, acquired primarily outside of school, are able to choose a more diversified diet for their children and, broadly speaking, to utilize food more effectively. Based on a second technique, the instrumental variable quantile regression, we are able to draw a double conclusion: that mothers' nutrition knowledge contributes to height increases among extremely deprived children, and that mothers' formal education and household wealth are slightly more important for relatively well-off children.

A comparative evaluation of dietary indicators used in food consumption assessments of at-risk populations

BACKGROUND

Easy-to-collect dietary indicators have been used increasingly for planning and evaluation of food security interventions. Various indicators have been employed, but rarely has a full set of indicators been compared using a common framework.

OBJECTIVE

This paper evaluates the performance of five dietary indicators for the assessment of household energy consumption using a common framework and recent data from Mozambique.

METHODS

Data were analyzed from a 2004 household survey, Current Vulnerability Analysis in Seven Provinces of Mozambique. Households (n = 4,358) were sampled from 42 rural districts using a two-stage design, and a quantitative 24-hour dietary recall was employed. Household energy intake ratios were calculated as the food energy consumed by household members divided by the sum of the members' recommended intakes. Five proxy indicators of household consumption in the previous day were developed: the number of meals, the number of food groups, the number of food items, a score based on a simple weighting of food groups consumed, and a predicted energy intake ratio based on weighting of food groups consumed with previously estimated regression coefficients. The performance of these indicators was assessed using correlations with energy intake, receiver operator characteristic analysis, efficiency of predictions, and prevalence estimate comparisons.

RESULTS

Although the predicted energy intake ratio performed best on all these performance criteria, and the simple food-group-weighted score performed second best, differences among the indicators on many of the criteria were relatively small.

CONCLUSIONS

New assessment systems could take full advantage of easy-to-collect information by using one of these best-scoring indicators, although established systems could continue to use some of the other indicators explored here, such as the food item count, without much loss in accuracy.

A comparison of weighed and recalled intakes for schoolchildren and mothers in rural Kenya

OBJECTIVE

To evaluate the relative validity of recalled intake among schoolchildren and mothers in rural Kenya.

DESIGN

Cross-sectional study. Mothers' recall of both the schoolchild's intake and her own intake on the previous day were compared with intakes that were weighed by an interviewer in the home.

SETTING

Karurumo location of Embu District in Kenya.

SUBJECTS

A total of forty-two sets of grade 1 students and their mothers.

RESULTS

Between 08.00 and 17.00 hours, when foods were both weighed and recalled, approximately 70 % of weighed food items were recalled the next day. Under-reporting of food amounts was seen across most food categories for the recall, with added sugars, sweets and fats being most affected. The recall underestimated energy intakes by approximately 6-9 % during this period. Correlation coefficients between nutrient intakes ranged from 0.43 to 0.65, while weighted kappa values ranged from 0.22 to 0.50. Higher levels of agreement were noted for nutrient densities, with correlation coefficients between 0.46 and 0.82 and weighted kappa values between 0.30 and 0.73.

CONCLUSIONS

Although the recall method provides an acceptable alternative to the more labour-intensive and expensive food-weighing method, there is need to further improve its performance in this population through more accurate recall of single foods, especially fruits, as well as added sugars, fats, dairy products and meats, which are often added in small amounts to mixed dishes.

Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy?

Objective

To assess whether a food variety score (FVS) and/or a dietary diversity score (DDS) are good indicators of nutrient adequacy of the diet of South African children.

Methods

Secondary data analyses were undertaken with nationally representative data of 1–8-year-old children (n = 2200) studied in the National Food Consumption Study in 1999. An average FVS (mean number of different food items consumed from all possible items eaten) and DDS (mean number of food groups out of nine possible groups) were calculated. A nutrient adequacy ratio (NAR) is the ratio of a subject's nutrient intake to the estimated average requirement calculated using the Food and Agriculture Organization/World Health Organization (2002) recommended nutrient intakes for children. The mean adequacy ratio (MAR) was calculated as the sum of NARs for all evaluated nutrients divided by the number of nutrients evaluated, expressed as a percentage. MAR was used as a composite indicator for micronutrient adequacy. Pearson correlation coefficients between FVS, DDS and MAR were calculated and also evaluated for sensitivity and specificity, with MAR taken as the ideal standard of adequate intake. The relationships between MAR and DDS and between anthropometric Z-scores and DDS were also evaluated.

Results

The children had a mean FVS of 5.5 (standard deviation (SD) 2.5) and a mean DDS of 3.6 (SD 1.4). The mean MAR (ideal = 100%) was 50%, and was lowest (45%) in the 7–8-year-old group. The items with the highest frequency of consumption were from the cereal, roots and tuber group (99.6%), followed by the ‘other group’ (87.6%) comprising items such as tea, sugar, jam and sweets. The dairy group was consumed by 55.8%, meat group by 54.1%, fats by 38.9%, other vegetables by 30.8%, vitamin-A-rich by 23.8%, other fruit by 22%, legumes and nuts by 19.7% and eggs by 13.3%. There was a high correlation between MAR and both FVS (r = 0.726; P < 0.0001) and DDS (r = 0.657; P < 0.0001), indicating that either FVS or DDS can be used as an indicator of the micronutrient adequacy of the diet. Furthermore, MAR, DDS and FVS showed significant correlations with height-for-age and weight-for-age Z-scores, indicating a strong relationship between dietary diversity and indicators of child growth. A DDS of 4 and an FVS of 6 were shown to be the best indicators of MAR less than 50%, since they provided the best sensitivity and specificity.

Conclusion

Either FVS or DDS can be used as a simple and quick indicator of the micronutrient adequacy of the diet.

Use of variety/diversity scores for diet quality measurement: relation with nutritional status of women in a rural area in Burkina Faso

OBJECTIVES

To develop scores for food variety and diversity to assess the overall dietary quality in an African rural area; and to study their relationship with the nutritional status of women of childbearing age.

DESIGN

Cross-sectional.

SETTING

Sahelian rural area in the North-East Burkina Faso (West Africa).

SUBJECTS

A total of 691 mothers with children below the age of 5 y, selected at random in 30 villages.

METHODS

A qualitative recall of women's food consumption during the previous 24 h made it possible to calculate a food variety score (FVS = count of food items consumed) and a dietary diversity score (DDS = count of food groups, among 14 groups). These scores were then divided into terciles. Body mass index (BMI), mid-upper arm circumference (MUAC) and body fat percentage (BFP) were used to determine the women's nutritional status.

RESULTS

The overall dietary quality was poor: mean FVS (s.d.) = 8.3 (2.9) food items; mean DDS = 5.1 (1.7) food groups. A clear relationship was shown between both FVS and DDS (in terciles) and most nutritional indices. Women with a FVS in the lowest tercile had a mean BMI of 20.1, while those in the highest tercile had a BMI of 20.9 (P = 0.009). Those in the lowest tercile of DDS had a 22.8% prevalence of underweight vs 9.8% in the highest tercile (P < 0.0001). The latter relationship remained significant even when the subjects' sociodemographic and economic characteristics were accounted for.

CONCLUSION

Dietary scores measured at the individual level are good proxies for overall dietary quality of women living in a poor rural African area. These scores were also shown to be linked with the nutritional status of women.

FINANCING

IRD financed the study with the assistance of UNICEF for the purchase of anthropometric equipment. The first author received a research allowance from the French Ministry of Research through the doctoral school 393 of Pierre and Marie Curie University (Paris VI).

Predictors of food variety and dietary diversity among older persons in Botswana

OBJECTIVE

We investigated whether food variety and diversity are associated with physical and cognitive functioning in older adults in Botswana and designed a simple set of screening questions that predict food variety in this population.

METHODS

Data were collected (1998) as a national household survey of 1085 subjects 60 y and older. A food variety score, based on a food frequency checklist, was calculated by summing the frequency of weekly intakes of 16 food items (0 to 66). A dietary diversity score was calculated as the number of food groups consumed weekly (0 to 5). A representative subsample (n = 393) was randomly selected for the clinical component of the survey, and measurements on dependency and cognitive function were conducted.

RESULTS

Low food variety was found: 35.2%, 59.3%, and 22.4% of subjects consumed no dairy products, fruits, and vegetables, respectively. A higher food variety score was associated with urban residence, ownership of cattle, higher education, and more frequent meals, and these indicators were used to construct a nutritional risk indicator. Higher food variety score was associated with better self-reported health and better cognitive function. Similarly, a higher score on the nutritional risk indicator screening tool was associated with desirable health outcomes.

CONCLUSION

A limited number of foods is consumed, leading to an overall pattern of poor food variety. Higher food variety was associated with improved physical and cognitive functions. A screening tool that predicts food variety in this population has been developed and is recommended to be incorporated at a primary care level to identify older adults most at risk of a poor quality diet.

Operationalizing Dietary Diversity: A Review of Measurement Issues and Research Priorities

Dietary diversity (DD) is universally recognized as a key component of healthy diets. There is still, however, a lack of consensus on how to measure and operationalize DD. This article reviews published literature on DD, with a focus on the conceptual and operational issues related to its measurement in developing countries. Findings from studies of the association between DD and individual nutrient adequacy, child growth and/or household socioeconomic factors are summarized. DD is usually measured using a simple count of foods or food groups over a given reference period, but a number of different groupings, classification systems and reference periods have been used. This limits comparability and generalizability of findings. The few studies that have validated DD against nutrient adequacy in developing countries confirm the well-documented positive association observed in developed countries. A consistent positive association between dietary diversity and child growth is also found in a number of countries. Evidence from a multicountry analysis suggests that household-level DD diversity is strongly associated with household per capita income and energy availability, suggesting that DD could be a useful indicator of food security. The nutritional contribution of animal foods to nutrient adequacy is indisputable, but the independent role of animal foods relative to overall dietary quality for child growth and nutrition remains poorly understood. DD is clearly a promising measurement tool, but additional research is required to improve and harmonize measurement approaches and indicators. Validation studies are also needed to test the usefulness of DD indicators for various purposes and in different contexts.