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Adams KP, Vosti SA, Becher E, Ishaya F, Engle-Stone R. Bouillon fortification as a strategy to address inequities in micronutrient adequacy of diets in Nigeria. Ann N Y Acad Sci 2024. [PMID: 39255239 DOI: 10.1111/nyas.15207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
Bouillon is a widely consumed condiment in many West African countries, including Nigeria. Although Nigeria has mandatory fortification standards for multiple food vehicles, bouillon fortification could help address remaining gaps in micronutrient intake. Using household food consumption data, we used the nutrient density method to model the additional contribution of bouillon fortified with vitamin A (40-250 µg/g bouillon), folic acid (20-120 µg/g), vitamin B12 (0.2-2 µg/g), iron (0.6-5 mg/g), and zinc (0.6-5 mg/g) for meeting micronutrient requirements of women of reproductive age (WRA) and children aged 6-59 months. Accounting for existing fortification programs, our results showed that, except for iron, the prevalence of inadequacy was substantially higher among WRA and children living in poorer and rural households. Given the ubiquity of bouillon consumption, bouillon fortification has the potential to virtually eliminate vitamin A, folate, and vitamin B12 inadequacy, reduce the prevalence of zinc inadequacy by over 20 percentage points, and improve equity in the micronutrient adequacy of diets across socioeconomic strata and urban and rural residence. Our results also suggested that designing a bouillon fortification program would require careful planning to balance reductions in inadequacy with the risk of high intakes. This evidence provides important input into decisions around bouillon fortification in Nigeria.
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Affiliation(s)
- Katherine P Adams
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
| | - Stephen A Vosti
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California, USA
| | - Emily Becher
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
| | | | - Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
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Hassan R, Ali M, Saha S, Akhter S, Amin MR. Geospatial variation in dietary patterns and their association with heart disease in Bangladeshi population: Evidence from a nationwide survey. PLoS One 2024; 19:e0307507. [PMID: 39024333 PMCID: PMC11257343 DOI: 10.1371/journal.pone.0307507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/07/2024] [Indexed: 07/20/2024] Open
Abstract
Heart disease is a significant public health threat, and its burden is increasing worldwide. Recent evidence suggests that dietary pattern is a key modifiable factor for heart disease. Research regarding dietary patterns and heart disease in Bangladesh with their spatial variability is limited. In this study, the spatial variation and relationship between dietary patterns and heart disease among Bangladeshi people was investigated. The country-representative Household Income and Expenditure Survey 2016 dataset was used, and a total of 77,207 participants aged 30 years and over were included. A principal component analysis was conducted to derive the dietary patterns. Both statistical and spatial analyses were performed. The overall prevalence of heart disease was 3.6%, with a variation of 0.6% to 10.4% across districts of Bangladesh. Three major dietary patterns, named "festival pattern", "pickles and fast foods pattern", and "rice and vegetable pattern" were identified, accounting for 25.2% of the total dietary variance. Both the dietary pattern and heart disease rate varied across the region. A higher risk of heart disease was persistent in the western-south, southern, central, and eastern regions, as was greater adherence to the "festival pattern" and "pickles and fast foods pattern." After adjusting for confounders, participants with the highest adherence to the "rice and vegetable pattern" were associated with a lower likelihood of developing heart disease (AOR: 0.78, 95% CI: 0.64-0.95, p <0.05), while the highest adherence to the "pickles and fast foods pattern" was associated with a higher likelihood of developing heart disease (AOR: 1.50, 95% CI: 1.27-1.76, p <0.001). The spatial disparities in the prevalence of heart disease and dietary patterns underscore the significance of prioritizing intervention at the district level, especially in the western-south, southern, central, and eastern regions, to control the rising heart disease trends in Bangladesh.
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Affiliation(s)
- Rafid Hassan
- Institute of Nutrition and Food Sciences, University of Dhaka, Dhaka, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Masum Ali
- International Food Policy Research Institute (IFPRI), Dhaka, Bangladesh
| | - Sanjib Saha
- Department of Clinical Science (Malmö), Health Economics Unit, Lund University, Lund, Sweden
| | - Sadika Akhter
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Faculty of Health, School of Health and Social Development, Deakin University, Burwood, Australia
| | - Md. Ruhul Amin
- Institute of Nutrition and Food Sciences, University of Dhaka, Dhaka, Bangladesh
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Adams KP, Vosti SA, Tarini A, Beye M, Pachón H, Kiselova S, Engle-Stone R. The potential contributions of bouillon fortification to meeting micronutrient requirements among women and preschool children in Senegal: A modeling study using household consumption and expenditure survey data. Ann N Y Acad Sci 2024; 1537:98-112. [PMID: 38973341 DOI: 10.1111/nyas.15156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
To reduce micronutrient deficiencies, Senegal mandates the fortification of refined oil with vitamin A and wheat flour with iron and folic acid. Expanding Senegal's large-scale food fortification programs to include fortified bouillon could help fill the remaining gaps in dietary micronutrient requirements. Using 7-day household food consumption data collected between 2018 and 2019, we assessed the potential contributions of bouillon fortified with vitamin A (40-250 μg/g bouillon), folic acid (20-120 μg/g), vitamin B12 (0.2-2 μg/g), iron (0.6-5 mg/g), and zinc (0.6-5 mg/g) for meeting micronutrient requirements of women of reproductive age (WRA; 15-49 years old) and children (6-59 months old). Most households (90%) reported consuming bouillon, including poor and rural households. At modeled fortification levels, bouillon fortification reduced the national prevalence of inadequacy by up to ∼20 percentage points (pp) for vitamin A, 34 pp (WRA) and 20 pp (children) for folate, 20 pp for vitamin B12, 38 pp (WRA) and 30 pp (children) for zinc, and ∼8 pp for iron. Predicted reductions in inadequacy were generally larger among poor and rural populations, especially for vitamins A and B12. Our modeling suggests that bouillon fortification has the potential to substantially reduce dietary inadequacy of multiple micronutrients and could also help address inequities in dietary micronutrient inadequacies in Senegal.
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Affiliation(s)
- Katherine P Adams
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
| | - Stephen A Vosti
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California, USA
| | - Ann Tarini
- Independent Consultant, Laval, Quebec, Canada
| | | | - Helena Pachón
- Food Fortification Initiative, Atlanta, Georgia, USA
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Sophia Kiselova
- The Swiss Federal Institute of Technology in Lausanne (EPFL), Lausanne, Switzerland
| | - Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
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Grieve E, Mamun AA, de Roos B, Barman BK, Ara G, Roos N, Pounds A, Sneddon AA, Murray F, Ahmed T, Little DC. Adolescent girls in aquaculture ecozones at risk of nutrient deficiency in Bangladesh development and validation of an integrated metric. BMC Public Health 2023; 23:405. [PMID: 36855076 PMCID: PMC9972605 DOI: 10.1186/s12889-023-15175-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/31/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND This study developed and validated an integrated metric that enhances understanding of linkages between agro-ecological and socio-economic factors that are important for explaining nutritional wellbeing in relation to fish consumption; especially among adolescent girls who are at risk of nutritional deficiency in Bangladesh. Currently, there is no metric that takes account of environmental, cultural and economic contexts when considering fish consumption and dietary health from a policy perspective. METHODS The study was designed as a bi-seasonal survey, repeated in the same population of adolescent girls recruited during the dry and wet seasons. Sampling was stratified by five settings (four aqua-agroecological zones and one processing plant community), with 60 girls recruited in each. Associations between candidate predictors (salinity, diet diversity, religion, socio-economic status and women's autonomy score) and dependent variables representing nutritional outcomes (anthropometry, omega-3 index and micronutrient levels) were explored in multivariable regressions. The fitted model with its predictors was validated, and a risk score derived from responses to a few short questions on religion, salinity zone, female autonomy, diet diversity and tilapia consumption. RESULTS The omega-3 index showed the clearest distinction between seasons, by salinity and religion. Higher female autonomy, religion (being Hindu rather than Muslim), geographical location (living in a high or mid-saline area), and a higher dietary diversity were the strongest predictors of whole blood omega-3 index. The c-index for the prognostic model was 0.83 and 0.76 in the wet and dry season respectively, indicating good predictive accuracy. There appeared to be a clear trend in risk scores differentiating between those 'chronically at risk' and those 'never at risk'. CONCLUSIONS Observational data on different aquaculture-ecozones defined by salinity enabled us to establish linkages between seasonal fish intake, religion, diet diversity, female autonomy and nutritional wellbeing. The purpose of the metric is to reveal these specific linkages in practice. This tool should improve targeting of timely, preventative and cost-effective nutritional interventions to adolescent girls most at-risk from low omega-3 levels in communities where seafood is produced.
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Affiliation(s)
- Eleanor Grieve
- 1 Lilybank Gardens, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ UK
| | - Abdullah-Al Mamun
- Department of Fisheries and Marine Science, Noakhali Science and Technology University, University Road, Noakhali, 3814 Bangladesh
| | - Baukje de Roos
- The Rowett Institute, University of Aberdeen, Ashgrove Road W, Aberdeen, AB25 2ZD UK
| | - Benoy K. Barman
- WorldFish, Bangladesh and South Asia, House 355/A Rd 114, Dhaka, 1212 Bangladesh
| | - Gulshan Ara
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, GPO Box 128, Dhaka, 1000 Bangladesh
| | - Nanna Roos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, 2200 Copenhagen, Denmark
| | - Alexandra Pounds
- Institute of Aquaculture, University of Stirling, Stirling, FK9 4LA UK
| | - Alan A. Sneddon
- The Rowett Institute, University of Aberdeen, Ashgrove Road W, Aberdeen, AB25 2ZD UK
| | - Francis Murray
- Institute of Aquaculture, University of Stirling, Stirling, FK9 4LA UK
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, GPO Box 128, Dhaka, 1000 Bangladesh
| | - David C. Little
- Institute of Aquaculture, University of Stirling, Stirling, FK9 4LA UK
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Ebrahimi S, Leech RM, McNaughton SA, Abdollahi M, Houshiarrad A, Livingstone KM. Dietary patterns derived using principal component analysis and associations with sociodemographic characteristics and overweight and obesity: A cross-sectional analysis of Iranian adults. Front Nutr 2023; 10:1091555. [PMID: 37139453 PMCID: PMC10149977 DOI: 10.3389/fnut.2023.1091555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/21/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction This study examined the cross-sectional association between household dietary patterns and sociodemographic characteristics and BMI in a nationally representative sample of Iranian adults. Methods Data on 6,833 households (n = 17,824 adults) from the National Comprehensive Study on Household Food Consumption Pattern and Nutritional Status 2001-2003 were used. Principal component analysis (PCA) was used to extract dietary patterns from three household 24-h dietary recalls. Linear regression analyses were used to examine associations between dietary patterns and sociodemographic characteristics and BMI. Results Three dietary patterns were identified: the first was characterized by high citrus fruit intake, the second by high hydrogenated fats intake and the third by high non-leafy vegetables intake. The first and third patterns were associated with household heads with higher education and living in urban areas, while the second was associated with household heads with lower education and living in rural areas. All dietary patterns were positively associated with BMI. The strongest association was found with the first dietary pattern (β: 0.49, 95% CI: 0.43, 0.55). Discussion While all three dietary patterns were positively associated with BMI, the sociodemographic characteristics of Iranian adults who consumed them differed. These findings inform the design of population-level dietary interventions to address rising obesity rates in Iran.
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Affiliation(s)
- Sara Ebrahimi
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
- *Correspondence: Sara Ebrahimi,
| | - Rebecca M. Leech
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Sarah A. McNaughton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Morteza Abdollahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Nutrition Research, School of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Houshiarrad
- Department of Nutrition Research, School of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Katherine M. Livingstone
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Adams KP, Vosti SA, Mbuya MNN, Friesen VM, Engle-Stone R. Update on Analytical Methods and Research Gaps in the Use of Household Consumption and Expenditure Survey Data to Inform the Design of Food-Fortification Programs. Adv Nutr 2022; 13:953-969. [PMID: 35254392 PMCID: PMC9156391 DOI: 10.1093/advances/nmac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/17/2021] [Accepted: 02/28/2022] [Indexed: 11/14/2022] Open
Abstract
The lack of nationally representative, individual-level dietary intake data has led researchers to increasingly turn to household-level data on food acquisitions and/or consumption to inform the design of food-fortification programs in low- and middle-income countries (LMICs). These nationally representative, household-level data come from household consumption and expenditure surveys (HCESs), which are collected regularly in many LMICs and are often made publicly available. Our objectives were to examine the utility of HCES data to inform the design of food-fortification programs and to identify best-practice methods for analyzing HCES data for this purpose. To this end, we summarized information needed to design fortification programs and assessed the extent to which HCES data can provide corresponding indicators. We concluded that HCES data are well suited to guide the selection of appropriate food vehicles, but because individual-level estimates of apparent nutrient intakes rely on assumptions about the intrahousehold distribution of food, more caution is advised when using HCES data to select the target micronutrient content of fortified foods. We also developed a checklist to guide analysts through the use of HCES data and, where possible, identified research-based, best-practice analytical methods for analyzing HCES data, including selecting the number of days of recall data to include in the analysis and converting reported units to standard units. More research is needed on how best to deal with composite foods, foods consumed away from home, and extreme values, as well as the best methods for assessing the adequacy of apparent intakes. Ultimately, we recommend sensitivity analyses around key model parameters, and the continual triangulation of HCES-based results with other national and subnational data on food availability, dietary intake, and nutritional status when designing food-fortification programs.
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Affiliation(s)
- Katherine P Adams
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA, USA
| | | | | | - Reina Engle-Stone
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
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7
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Adams KP, Luo H, Vosti SA, Kagin J, Ngnie‐Teta I, Ndjebayi A, Assiene JG, Engle‐Stone R. Comparing estimated cost-effectiveness of micronutrient intervention programs using primary and secondary data: evidence from Cameroon. Ann N Y Acad Sci 2022; 1510:100-120. [PMID: 34888885 PMCID: PMC9299899 DOI: 10.1111/nyas.14726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/14/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
Designing a cost-effective portfolio of micronutrient intervention programs is complex and generally undertaken with limited data. We developed the MINIMOD-Secondary Data (MINIMOD-SD) tool, which uses household consumption and expenditure survey data and other secondary data to estimate apparent nutrient intakes and model the effectiveness and cost-effectiveness of micronutrient intervention programs. We present the SD tool methodology and results in the context of Cameroon, with a particular focus on vitamin A (VA) for children and folate for women of reproductive age (WRA). We compared the MINIMOD-SD tool estimates with those of the full MINIMOD tool, which uses 24-h dietary recall data. The SD tool consistently underestimated folate intake among women (median (IQR): 230 (143,352) versus 303 (244,367) μg dietary folate equivalents (DFEs)/day) and especially VA among children (141 (64,279) versus 227 (102,369)). Qualitatively, however, the two tools were generally consistent in predicted subnational patterns of micronutrient adequacy and identification of effective and cost-effective (cost per child/WRA moving from inadequate to adequate intake) interventions. Secondary data and the MINIMOD-SD tool can provide policymakers with information to qualitatively assess deficiency risks and identify cost-effective interventions. However, accurately quantifying individual-level deficiency or dietary inadequacy and intervention effectiveness and cost-effectiveness will likely require individual-level dietary data and biomarker measurements.
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Affiliation(s)
- Katherine P. Adams
- Institute for Global NutritionDepartment of NutritionUniversity of CaliforniaDavisDavisCalifornia
| | - Hanqi Luo
- Institute for Global NutritionDepartment of NutritionUniversity of CaliforniaDavisDavisCalifornia
- Hubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlantaGeorgia
| | - Stephen A. Vosti
- Department of Agricultural and Resource EconomicsUniversity of CaliforniaDavisDavisCalifornia
| | | | | | | | | | - Reina Engle‐Stone
- Institute for Global NutritionDepartment of NutritionUniversity of CaliforniaDavisDavisCalifornia
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Gurugubelli VS, Fang H, Shikany JM, Balkus SV, Rumbut J, Ngo H, Wang H, Allison JJ, Steffen LM. A review of harmonization methods for studying dietary patterns. SMART HEALTH (AMSTERDAM, NETHERLANDS) 2022; 23:100263. [PMID: 35252528 PMCID: PMC8896407 DOI: 10.1016/j.smhl.2021.100263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Data harmonization is the process by which each of the variables from different research studies are standardized to similar units resulting in comparable datasets. These data may be integrated for more powerful and accurate examination and prediction of outcomes for use in the intelligent and smart electronic health software programs and systems. Prospective harmonization is performed when researchers create guidelines for gathering and managing the data before data collection begins. In contrast, retrospective harmonization is performed by pooling previously collected data from various studies using expert domain knowledge to identify and translate variables. In nutritional epidemiology, dietary data harmonization is often necessary to construct the nutrient and food databases necessary to answer complex research questions and develop effective public health policy. In this paper, we review methods for effective data harmonization, including developing a harmonization plan, which common standards already exist for harmonization, and defining variables needed to harmonize datasets. Currently, several large-scale studies maintain harmonized nutrient databases, especially in Europe, and steps have been proposed to inform the retrospective harmonization process. As an example, data harmonization methods are applied to several U.S longitudinal diet datasets. Based on our review, considerations for future dietary data harmonization include user agreements for sharing private data among participating studies, defining variables and data dictionaries that accurately map variables among studies, and the use of secure data storage servers to maintain privacy. These considerations establish necessary components of harmonized data for smart health applications which can promote healthier eating and provide greater insights into the effect of dietary patterns on health.
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Affiliation(s)
| | - Hua Fang
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, 01655, Massachusetts, USA
- Corresponding author. Tel.: +0-508-910-6411;
| | - James M Shikany
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, 35294, Alabama, USA
| | - Salvador V Balkus
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
| | - Joshua Rumbut
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, 01655, Massachusetts, USA
| | - Hieu Ngo
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
| | - Honggang Wang
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
| | - Jeroan J Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, 01655, Massachusetts, USA
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, 55455, Minnesota, USA
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Knight F, Woldt M, Sethuraman K, Bergeron G, Ferguson E. Household-level consumption data can be redistributed for individual-level Optifood diet modeling: analysis from four countries. Ann N Y Acad Sci 2022; 1509:145-160. [PMID: 34850396 PMCID: PMC9299870 DOI: 10.1111/nyas.14709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 12/05/2022]
Abstract
A barrier to using Optifood linear programming (LP), which identifies nutrient gaps and supports population-specific food-based recommendation (FBR) development, is the requirement for dietary intake data. We investigated whether Household Consumption and Expenditure Surveys (HCESs) could be used instead of individual-level 24-h recalls (24HRs). The 24HR data from 12- to 23-month-old breastfeeding children in rural Kenya, Uganda, Guatemala, and Bangladesh were paired with HCES food consumption data from similar areas (n = 8) and time periods. HCES food intakes (g/week) were estimated using adult male equivalents, adjusted for breastfeeding. Paired HCES- and 24HR-defined LP inputs and outputs were compared using percentage agreement. Mean overall percentage agreements were 42%, 63%, and 80%, for food, food subgroup, and food-group model parameters, respectively. HCES food lists were on average 1.3 times longer than 24HR. Similar nutrient gaps (77-100% agreement), food sources of nutrients (71-100% agreement), and FBRs (80-100% agreement) were identified. The results suggest that HCES data can be used in Optifood analyses for 12- to 23-month-old children, despite recognized challenges of using it to estimate dietary intakes of young children compared with older age groups. Further analyses, however, are required for different age groups and locations to confirm expectations that it would perform equally well.
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Affiliation(s)
- Frances Knight
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
- United Nations World Food ProgrammeRomeItaly
| | - Monica Woldt
- Helen Keller InternationalWashingtonDistrict of Columbia
- Formerly with the Food and Nutrition Technical Assistance Project (FANTA)WashingtonDistrict of Columbia
- USAID Advancing NutritionArlingtonVirginia
| | - Kavita Sethuraman
- Formerly with the Food and Nutrition Technical Assistance Project (FANTA)WashingtonDistrict of Columbia
| | - Gilles Bergeron
- Formerly with the Food and Nutrition Technical Assistance Project (FANTA)WashingtonDistrict of Columbia
- New York Academy of SciencesNew YorkNew York
| | - Elaine Ferguson
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
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10
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Ebrahimi S, Leech RM, McNaughton SA, Abdollahi M, Houshiarrad A, Livingstone KM. Associations between diet quality and obesity in a nationally representative sample of Iranian households: A cross-sectional study. Obes Sci Pract 2022; 8:12-20. [PMID: 35127119 PMCID: PMC8804934 DOI: 10.1002/osp4.536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/12/2021] [Accepted: 05/23/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Research examining associations between diet quality and obesity in Iranian adults is limited by small and non-representative samples. This study examined associations between two diet quality indices and obesity risk in a nationally representative sample of Iranian adults and interactions by sex and area of residence. METHODS Data on 18,307 adults (mean age 37 [SD 15.2] years) were used from the Iranian National Survey 2001-2003. Two diet quality indices (Healthy Eating Index 2015, HEI-2015, and Diet Quality Index International, DQI-I) were calculated from household 24-h dietary recalls. Multi-level regression analyses were used to examine the association between household diet quality and individual-level obesity risk, with interaction terms for sex and area of residence. RESULTS Higher household HEI-2015 and DQI-I were associated with higher risk of obesity (HEI-2015: relative risk ratio: 1.04, 95% CI: 1.03, 1.05; DQI-I: relative risk ratio: 1.02, 95% CI: 1.01, 1.02), with stronger effect sizes in adults living in rural areas. CONCLUSIONS Higher diet quality (HEI-2015 and DQI-I) was associated with higher obesity risk, which was stronger in adults living in rural areas. Due to the complexity of examining these associations in a Middle Eastern country undergoing a nutrition transition, longitudinal research is needed to confirm these findings.
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Affiliation(s)
- Sara Ebrahimi
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
| | - Rebecca M. Leech
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
| | - Sarah A. McNaughton
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
| | - Morteza Abdollahi
- Social Determinants of Health Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Department of Nutrition ResearchNational Nutrition and Food Technology Research InstituteSchool of Nutrition Sciences and Food TechnologyShahid Beheshti University of Medical SciencesTehranIran
| | - Anahita Houshiarrad
- Department of Nutrition ResearchNational Nutrition and Food Technology Research InstituteSchool of Nutrition Sciences and Food TechnologyShahid Beheshti University of Medical SciencesTehranIran
| | - Katherine M. Livingstone
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
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11
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Tang K, Adams KP, Ferguson EL, Woldt M, Yourkavitch J, Pedersen S, Broadley MR, Dary O, Ander EL, Joy EJM. Systematic review of metrics used to characterise dietary nutrient supply from household consumption and expenditure surveys. Public Health Nutr 2022; 25:1-13. [PMID: 35022103 PMCID: PMC9991734 DOI: 10.1017/s1368980022000118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 11/22/2021] [Accepted: 01/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To review existing publications using Household Consumption and Expenditure Survey (HCES) data to estimate household dietary nutrient supply to (1) describe scope of available literature, (2) identify the metrics reported and parameters used to construct these metrics, (3) summarise comparisons between estimates derived from HCES and individual dietary assessment data and (4) explore the demographic and socio-economic sub-groups used to characterise risks of nutrient inadequacy. DESIGN This study is a systematic review of publications identified from online databases published between 2000 to 2019 that used HCES food consumption data to estimate household dietary nutrient supply. Further publications were identified by 'snowballing' the references of included database-identified publications. SETTING Publications using data from low- and lower-middle income countries. RESULTS In total, fifty-eight publications were included. Three metrics were reported that characterised household dietary nutrient supply: apparent nutrient intake per adult-male equivalent per day (n 35), apparent nutrient intake per capita per day (n 24) and nutrient density (n 5). Nutrient intakes were generally overestimated using HCES food consumption data, with several studies finding sizeable discrepancies compared with intake estimates based on individual dietary assessment methods. Sub-group analyses predominantly focused on measuring variation in household dietary nutrient supply according to socio-economic position and geography. CONCLUSION HCES data are increasingly being used to assess diets across populations. More research is needed to inform the development of a framework to guide the use of and qualified interpretation of dietary assessments based on these data.
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Affiliation(s)
- Kevin Tang
- Department of Population Health, London School of Hygiene & Tropical Medicine, LondonWC1E 7HT, UK
- USAID Advancing Nutrition, 4th Floor, 2733 Crystal Drive, Arlington, VA22202, USA
| | - Katherine P Adams
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - Elaine L Ferguson
- Department of Population Health, London School of Hygiene & Tropical Medicine, LondonWC1E 7HT, UK
| | - Monica Woldt
- USAID Advancing Nutrition, 4th Floor, 2733 Crystal Drive, Arlington, VA22202, USA
- Helen Keller International, Washington, DC, USA
| | - Jennifer Yourkavitch
- USAID Advancing Nutrition, 4th Floor, 2733 Crystal Drive, Arlington, VA22202, USA
- Results for Development, Washington, DC, USA
| | - Sarah Pedersen
- USAID, Bureau for Resilience and Food Security, Washington, DC, USA
| | - Martin R Broadley
- School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, UK
| | - Omar Dary
- USAID, Bureau for Global Health, Washington, DC, USA
| | - E Louise Ander
- School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, UK
- Centre for Environmental Geochemistry, British Geological Survey, Keyworth, Nottingham, UK
| | - Edward JM Joy
- Department of Population Health, London School of Hygiene & Tropical Medicine, LondonWC1E 7HT, UK
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Bandyopadhyay A, Haile B, Azzarri C, Somé J. Analyzing the Drivers of Household Dietary Diversity: Evidence from Burkina Faso. Food Nutr Bull 2021; 42:530-550. [PMID: 34467801 PMCID: PMC8637355 DOI: 10.1177/03795721211029092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The diets of millions of poor individuals lack adequate amount of essential nutrients. OBJECTIVE To examine the determinants of household dietary diversity in Burkina Faso and assess whether the choice of a diversity metric matters. METHODS Using survey data from 2014, we construct 3 metrics-Household Dietary Diversity Score (HDDS), Berry Index (BI), and Healthy Food Diversity Index (HFDI). Unlike the oft-used HDDS, the BI captures the quantity distribution of food items while the HFDI captures all 3 aspects of a healthy diet-count, quantity distribution, and health value. We fit linear (for BI and HFDI) and Poisson (for HDDS) models controlling for several socioeconomic and climatic covariates. RESULTS Some parameter estimates are sensitive to the diversity metric with fewer significant covariates observed in the HFDI model. Overall, diets are more diverse for households in urban areas, with female or better educated heads, with higher asset-based wealth and with more diverse on-farm production, while remoteness reduces dietary diversity. Higher precipitation seems to reduce diversity, potentially driven by the spatial heterogeneity in precipitation and on-farm production diversity. CONCLUSIONS The sensitivity of estimates to the metric used underscores potentially more complex interactions that determine the quantity distribution of food items consumed. Policies that enhance on-farm production diversity, market access, and women's empowerment may help improve dietary diversity and subsequent nutritional benefits. Efforts should be made to compile health value data that are relevant to developing countries facing nutrition transition.
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Affiliation(s)
| | - Beliyou Haile
- International Food Policy Research Institute, Washington, DC, USA
| | - Carlo Azzarri
- International Food Policy Research Institute, Washington, DC, USA
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13
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Moltedo A, Jiménez S, Álvarez-Sánchez C, Manyani T, Ramos MP, Custodio E. Raw versus cooked food matching: Nutrient intake using the 2015/16 Kenya Integrated Household Budget Survey. J Food Compost Anal 2021; 102:103879. [PMID: 34483479 PMCID: PMC8356072 DOI: 10.1016/j.jfca.2021.103879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/20/2022]
Abstract
Dietary energy assessment does not require matching foods in cooked form. Macronutrient dietary assessment does not require matching foods in cooked form. Vitamin and mineral dietary assessment requires matching foods in cooked form.
In many countries, statistics from household consumption and expenditure surveys are increasingly being used to inform policies and programs. In household surveys, foods are typically reported as they are acquired (the majority are raw). However, the micronutrient content of some foods diminishes during processing and cooking. Using food consumption data from the 2015/16 Kenya Integrated Household Budget Survey, this study analyzes whether mean consumption estimates of dietary energy, macronutrients, and eight micronutrients are equivalent (applying a two-side paired equivalence test) when matching foods: (1) considering the nutrient content in raw foods (as reported in the survey), and (2) considering the nutrient content in foods as typically consumed, thus applying yield and retention factors as needed. Both food matching approaches rendered statistically equivalent mean consumption estimates, at national and county levels, for dietary energy, protein, fats, available carbohydrates, total fiber, calcium and zinc. Non-equivalent means were found for iron, vitamins A, B1, B2, B12, and C. The higher differences between the means were, in percentage change, for vitamin C (47 %), B1 (34 %) and B12 (26 %).
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Affiliation(s)
- Ana Moltedo
- Statistics Division, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153, Rome, Italy
| | - Sofía Jiménez
- Joint Research Centre, Sustainable Resources, Economics of Agriculture, European Commission, Joint Research Centre, C/Inca Garcilaso s/n, Sevilla, E-41092, Spain
| | - Cristina Álvarez-Sánchez
- Statistics Division, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153, Rome, Italy
| | - Talent Manyani
- Statistics Division, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153, Rome, Italy
| | - María Priscila Ramos
- Universidad de Buenos Aires. Facultad de Ciencias Económicas. Departamento de Economía, Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Instituto Interdisciplinario de Economía Política de Buenos Aires (IIEP-Baires), Avenida Córdoba 2122 - 2do Piso, C1120AAQ, Ciudad Autónoma de Buenos Aires, Argentina.,Centre d'Etudes Prospectives et d'Information Internationale (CEPII), 20 avenue de Ségur, 75334, Paris cedex 07, France
| | - Estefanía Custodio
- Joint Research Centre, Sustainable Resources, Economics of Agriculture, European Commission, Joint Research Centre, C/Inca Garcilaso s/n, Sevilla, E-41092, Spain
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Moltedo A, Álvarez-Sánchez C, Grande F, Charrondiere UR. The complexity of producing and interpreting dietary vitamin A statistics. J Food Compost Anal 2021; 100:103926. [PMID: 34219918 PMCID: PMC8140404 DOI: 10.1016/j.jfca.2021.103926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
38 of 90 food composition tables reviewed report total vitamin A values poorly. Only 9 tables provide total vitamin A values expressed in both RE and RAE. 25 tables provide enough information to calculate total vitamin A in RE and RAE. Consensus on the conversion of pro-vitamin A carotenoids to retinol is needed. Vitamin A adequacy ratios vary with the unit of intake and source of requirements.
Producing, reporting, and interpreting vitamin A statistics present multiple challenges largely attributable to the systems of equivalence used to convert pro-vitamin A carotenoids into retinol equivalents, and to the criteria used by institutions to set recommendations. This study describes the information on total vitamin A, retinol and provitamin A carotenoids available in 90 food composition tables/databases (FCTs/FCDBs). It also evaluates the effect of the definition of vitamin A intake (Retinol Equivalents [RE] or Retinol Activity Equivalents [RAE]) and the source of requirements on the potential contribution of dietary intake to the population’s requirements. We found that 43 percent of the FCTs/FCDBs reviewed, many of them from high-income countries, do not provide total vitamin A or sufficient information for computing it, or present inconsistencies between the metadata and the published values; 9 percent publish total vitamin A in RE and RAE; and 28 percent provide information on retinol and provitamin A carotenoids that enables calculating total vitamin A in both definitions. Vitamin A adequacy ratios are lowest when the consumption unit is RAE and the source of requirements is the US Health and Medicine Division. When the consumption definition is RE, adequacy ratios are higher using FAO/WHO than EFSA requirements. It is imperative to reach consensus on the system of conversion of provitamin A carotenoids into retinol equivalents.
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Affiliation(s)
- Ana Moltedo
- Statistics Division, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153, Rome, Italy
| | - Cristina Álvarez-Sánchez
- Statistics Division, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153, Rome, Italy
| | - Fernanda Grande
- Food and Nutrition Division, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153, Rome, Italy
| | - U Ruth Charrondiere
- Food and Nutrition Division, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153, Rome, Italy
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Palacios C, Hofmeyr GJ, Cormick G, Garcia‐Casal MN, Peña‐Rosas JP, Betrán AP. Current calcium fortification experiences: a review. Ann N Y Acad Sci 2021; 1484:55-73. [PMID: 32949062 PMCID: PMC8246751 DOI: 10.1111/nyas.14481] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
Low dietary calcium is very common in many populations, contributing to nutritional rickets/osteomalacia in children/adults and increasing the risk of several health problems. Calcium is a nutrient of concern as the recommended nutrient requirements are difficult to meet in the absence of dairy products. The provision of culturally acceptable calcium-fortified foods may improve calcium intake when it is a feasible and cost-effective strategy in a particular setting. This landscape review was conducted in 2019 and describes current calcium fortification efforts and lessons learned from these experiences. Worldwide, the United Kingdom is the only country where calcium fortification of wheat flour is mandatory. It is estimated that this fortified staple ingredient contributes to 13-14% of calcium intake of the British population. Other items voluntary fortified with calcium include maize flour, rice, and water. Current calcium fortification programs may lack qualified personnel/training, clear guidelines on implementation, regulation, monitoring/evaluation, and functional indicators. Also, the cost of calcium premix is high and the target groups may be hard to reach. There is a lack of rigorous evaluation, particularly in settings with multiple micronutrient programs implemented simultaneously, with low quality of the evidence. Further research is needed to assess the impact of calcium fortification programs.
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Affiliation(s)
- Cristina Palacios
- Department of Dietetics and NutritionStempel School of Public HealthFlorida International UniversityMiamiFlorida
| | - G. Justus Hofmeyr
- Effective Care Research UnitEastern Cape Department of HealthUniversities of the Witwatersrand and Fort HareEast LondonSouth Africa
| | - Gabriela Cormick
- Department of Mother and Child Health ResearchInstitute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Buenos AiresArgentina
- Departamento de SaludUniversidad Nacional de La MatanzaSan JustoArgentina
| | | | | | - Ana Pilar Betrán
- WHO–World Bank Special Programme of ResearchDevelopmentand Research Training in Human ReproductionDepartment of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
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Ebrahimi S, McNaughton SA, Leech RM, Abdollahi M, Houshiarrad A, Livingstone KM. A comparison of diet quality indices in a nationally representative cross-sectional study of Iranian households. Nutr J 2020; 19:132. [PMID: 33278876 PMCID: PMC7719237 DOI: 10.1186/s12937-020-00646-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/18/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Iranian diet quality has been evaluated using indices that have not been created based on Iranian dietary guidelines. This study aimed to examine the applicability of two diet quality indices by examining their associations with nutrient adequacy, nutrient intakes and sociodemographics. METHODS Dietary data were collected using three 24-h dietary recalls from Iranian households. Nutrient adequacy was assessed using World Health Organization/Food and Agriculture Organization 2002 (WHO/FAO) cut points. Household diet quality was calculated using the Healthy Eating Index (HEI) and Diet Quality Index-International (DQI-I). Sociodemographics of the household members were assessed. Regression analyses were used to examine associations between diet quality and nutrient adequacy, and between sociodemographics and diet quality. RESULTS A total of 6935 households were included in the analysis. Higher household diet quality was associated with adequate intake of calcium (HEI: OR 1.11, 95% CI: 1.10, 1.13; DQI-I: OR 1.14, 95% CI: 1.13, 1.16), vitamin C (HEI: OR 1.19, 95% CI: 1.17, 1.20; DQI-I: OR 1.12, 95% CI: 1.11, 1.12) and protein (HEI: OR 1.01, 95% CI: 1.00, 1.02; DQI-I: OR 1.09, 95% CI: 1.08, 1.09). Higher household diet quality was associated with household heads who were older (> 56 years old) (HEI: β 2.06, 95% CI: 1.63, 2.50; DQI-I β 2.90, 95% CI: 2.34, 3.45), higher educated (college/university completed) (HEI: β 4.54, 95% CI: 4.02, 5.06; DQI-I: β 2.11, 95% CI: 1.45, 2.77) and living in urban areas (HEI: β 2.85, 95% CI: 2.54, 3.16; DQI-I: β 0.72, 95% CI: 0.32, 1.12). CONCLUSIONS Based on associations with nutrient adequacy and sociodemographics, the applicability of two diet quality indices for assessing the diet quality of Iranian households was demonstrated. Results also indicated DQI-I may be more applicable than HEI for evaluating Iranian nutrient adequacy. Findings have implications for the design and assessment of diet quality in Iranian populations. Future research should examine the link between these diet quality indices and health outcomes.
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Affiliation(s)
- Sara Ebrahimi
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220 Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Victoria 3125 Australia
| | - Sarah A. McNaughton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220 Australia
| | - Rebecca M. Leech
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220 Australia
| | - Morteza Abdollahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Houshiarrad
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Katherine M. Livingstone
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220 Australia
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