What Can Dietary Patterns Tell Us about the Nutrition Transition and Environmental Sustainability of Diets in Uganda?

Exploring the relationship between dietary patterns and obesity among Nigerian adults: a cross-sectional study

BACKGROUND/OBJECTIVE

No previous study has investigated the association between dietary pattern and both general and abdominal obesity risk among adults in Nigeria. This study aimed to evaluate the associations between dietary patterns and the risk of obesity among adult age 18 and above in Ekiti State, Southwestern Nigeria.

METHODS AND STUDY DESIGNS

A total of 1003 adults were included in this cross-sectional study (males = 558; females = 445). Body mass index (BMI) and waist-to-hip (WHR) were used to assess general and abdominal obesity respectively and they were categorized using WHO recommendation. Partial correlation analyses were performed to assess the associations of dietary patterns with BMI and WHR. Prevalence ratio between dietary pattern and both general and abdominal obesity were calculated using Robust Poisson Regression.

RESULTS

The prevalence of general obesity among adults was 15.9%, (11.6% among men and 20.2% among women); abdominal obesity was 32.3% (28.9% among males and 44.5% among females). Four dietary patterns were identified; diversified traditional pattern; typical traditional pattern; milk and bread pattern and egg and fish pattern. Diversified traditional pattern was negatively associated with BMI (PR = 0.571, 95%CI: 0.360 ~ 0.905, p = 0.017), and typical traditional pattern was positively associated with BMI (PR = 1.561, 95% CI: 1.043 ~ 2.339, p = 0.031) and WHR in females (PR = 1.849, 95% CI: 1.256 ~ 2.721, p = 0.005). In comparison to those in the lowest quartile, adults with the highest quartile of the typical traditional pattern had a higher risk for abdominal obesity (PR = 1.849, 95%CI = 1.256 ~ 2.721, p = 0.020).

CONCLUSION

This study reports an alarming increase in Obesity prevalence among Nigeria adults which is greatly influence by their lifestyle and eating pattern. We found out that a typical traditional food pattern was associated with a higher risk of both general and abdominal obesity, but a diverse traditional food pattern was associated to a reduced risk of general obesity.

Dietary patterns and their socio-demographic correlates in the context of migration and urbanisation demonstrate nutrition transitions in South Africa

This paper investigates the demographic and socio-economic correlates of dietary patterns in South Africa, drawing on a sample of young adults experiencing internal migration and urbanisation. We use data from the 2018 baseline survey of the Migrant Health Follow-Up Study, an original longitudinal cohort study consisting of 3,087 internal migrants and rural residents aged 18-40 nested within the Agincourt Health and socio-Demographic Surveillance System in rural northeast South Africa. We employ principal components analysis to identify dietary patterns from food frequency questionnaires and ordinary least squares regression to assess whether migration and other socio-economic characteristics correlate with specific dietary patterns at baseline. We observe five distinct dietary patterns characterised by frequent consumption of processed foods, red meat, fruits and vegetables, diverse foods, and high sugar/fat foods. We find migration to be significantly associated with more frequent consumption of both processed foods and fruits and vegetables; we also find the association between migration status and dietary patterns to be heterogenous depending on migrants' destinations. This paper extends current understanding of changing dietary patterns in the context of nutrition transitions with attention to dynamic migration processes rather than static rural-urban differences.

Socio-demographic characteristics and dietary pattern of community-dwelling adults in Abia State, Nigeria

Objective

Identification of dietary patterns and their association with socio-demographic factors.

Design

Community-based cross-sectional study design.

Setting

Urban and rural communities in Abia State, Nigeria.

Participants

Eight hundred and sixty-eight (868) male and female adults aged 20 to 59 years.

Methods

Identification of Dietary patterns (DP) by Principal Component Analysis (PCA) based on the consumption of 10 food groups, assessed using a 7-day qualitative food frequency questionnaire. Bivariate and multivariate logistic regression analyses evaluated the association between identified patterns and socio-economic factors.

Results

Two dietary patterns 'traditional and convenience DPs were identified, explaining 52% of the total variance. The traditional DP was loaded with starchy staples, vegetable soups/sauces, and animal proteins. The convenience DP was characterised by high factor loading of processed cereals, carbonated drinks and alcoholic beverages. Larger households (>3) had lower odds of adhering to high traditional DP [AOR =0.633; 95% CI (0.429-0.934); p = 0.021]. Females [AOR =1.586; 95% CI (1.104-2.279); p = 0.013] and middle-aged adults (AOR = 1.750; 95% CI (1.075-2.848);p = 0.024] were more likely to adhere to the convenience DP, whereas, the odds of adhering to the convenience pattern was lower among adults residing in rural areas [AOR =0.3161.586; 95% CI (0.219-0.456); p = 0.001].

Conclusion

Socio-economic variables (age, gender, household size and place of residence) were associated with dietary patterns among community dwellers in Nigeria.

Funding

None declared.

Food Insecurity and Dietary Deprivation: Migrant Households in Nairobi, Kenya

The current study focuses on food consumption and dietary diversity among internal migrant households in Kenya using data from a city-wide household survey of Nairobi conducted in 2018. The paper examined whether migrant households are more likely to experience inferior diets, low dietary diversity, and increased dietary deprivation than their local counterparts. Second, it assesses whether some migrant households experience greater dietary deprivation than others. Third, it analyses whether rural-urban links play a role in boosting dietary diversity among migrant households. Length of stay in the city, the strength of rural-urban links, and food transfers do not show a significant relationship with greater dietary diversity. Better predictors of whether a household is able to escape dietary deprivation include education, employment, and household income. Food price increases also decrease dietary diversity as migrant households adjust their purchasing and consumption patterns. The analysis shows that food security and dietary diversity have a strong relationship with one another: food insecure households also experience the lowest levels of dietary diversity, and food secure households the highest.

Impact of healthy food and diet information on household food security: A randomized control trial in Kampala, Uganda

Healthy diets are unaffordable for almost 3.1 billion people worldwide, and in 2018, already 43% of the African population were urban dwellers. Our food systems are changing rapidly, coupled with rising dietary aspirations. What are healthy diets and how can healthy diets be reached and increased in an urban context was the question of project NOURICITY. Looking into different information channels to deliver information on healthy diets in a low-income area in urban Kampala, Uganda, two packages of interventions were developed based on information on the selected focus group discussions with parish representatives. The first package consisted of a flier including graphic information on healthy diets and three food groups (treatment group 1). The second included the same flier plus interactive voice responses (IVRs) as a phone call to deliver the flier information in a different format (treatment group 2). For the study, we targeted 450 randomly selected households, which were randomly assigned into three groups (control, treatment group 1, and treatment group 2). Respondents from Kanyanya (a low-income parish of Kampala city) were randomly selected. They were visited two times in March as well as in December of the year 2021, while the intervention was rolled out in the period from September to November 2021. Healthy diets are measured using the Household Dietary Diversity Score and the food variety score is based on a 7-day food consumption recall, while dietary quality is measured for a subsample of women and the minimum dietary diversity for all of the selected women. The results indicated statistically significant changes per group at household food consumption in March 2021 compared to December 2021. However, the results of the difference-in-difference method between the control and the treatment groups did not display any significant difference at the household level. However, increased dairy and meat consumption in the treatment groups was observed. Over 90% of the households in treatment group 2 listened to any type of IVR message. Although no significant treatment effects were found, almost all households receiving intervention package 2 mentioned that the IVR calls were easy to follow, while almost 80% indicated sharing the information with their neighbors and 92% enjoyed receiving the message. However, the intervention has potential but needs to be improved upon.

Carbon dioxide (CO2) emissions and adherence to Mediterranean diet in an adult population: the Mediterranean diet index as a pollution level index

BACKGROUND

Research related to sustainable diets is is highly relevant to provide better understanding of the impact of dietary intake on the health and the environment.

AIM

To assess the association between the adherence to an energy-restricted Mediterranean diet and the amount of CO₂ emitted in an older adult population.

DESIGN AND POPULATION

Using a cross-sectional design, the association between the adherence to an energy-reduced Mediterranean Diet (erMedDiet) score and dietary CO₂ emissions in 6646 participants was assessed.

METHODS

Food intake and adherence to the erMedDiet was assessed using validated food frequency questionnaire and 17-item Mediterranean questionnaire. Sociodemographic characteristics were documented. Environmental impact was calculated through greenhouse gas emissions estimations, specifically CO₂ emissions of each participant diet per day, using a European database. Participants were distributed in quartiles according to their estimated CO₂ emissions expressed in kg/day: Q1 (≤2.01 kg CO₂), Q2 (2.02-2.34 kg CO₂), Q3 (2.35-2.79 kg CO₂) and Q4 (≥2.80 kg CO₂).

RESULTS

More men than women induced higher dietary levels of CO₂ emissions. Participants reporting higher consumption of vegetables, fruits, legumes, nuts, whole cereals, preferring white meat, and having less consumption of red meat were mostly emitting less kg of CO₂ through diet. Participants with higher adherence to the Mediterranean Diet showed lower odds for dietary CO₂ emissions: Q2 (OR 0.87; 95%CI: 0.76-1.00), Q3 (OR 0.69; 95%CI: 0.69-0.79) and Q4 (OR 0.48; 95%CI: 0.42-0.55) vs Q1 (reference).

CONCLUSIONS

The Mediterranean diet can be environmentally protective since the higher the adherence to the Mediterranean diet, the lower total dietary CO₂ emissions. Mediterranean Diet index may be used as a pollution level index.

From Ampesie to French fries: systematising the characteristics, drivers and impacts of diet change in rapidly urbanising Accra

Sub-Saharan Africa (SSA) is urbanising rapidly. One of the most visible outcomes of this urbanisation process is the change in the diets of urban residents. However, diet change in the context of rapid urbanisation is a complex and multi-dimensional phenomenon that encompasses multiple intersecting historical, environmental, socioeconomic, and political aspects. This study aims to unravel and systematise the characteristics, drivers and impacts of diet changes in Accra, through the interviews of multiple stakeholders and Causal Loop Diagrams. Diet change is characterised by the increased consumption of certain foodstuff such as rice, chicken, fish, vegetable oil, sugar, and ultra-processed food (UPF), and the decreased consumption of traditional foodstuff such as roots, tubers, and some cereals such as millet. These changes are driven by multiple factors, including among others, changes in income, sociocultural practices, energy access, and policy and trade regimes, as well as the proliferation of supermarkets and food vendors. Collectively, these diet changes have a series of environmental, socioeconomic, and health/nutrition-related impacts. Our results highlight the need to understand in a comprehensive manner the complex processes shaping diet change in the context of urbanisation, as a means of identifying effective interventions to promote healthy and sustainable urban diets in SSA. The development of such intervention should embrace a multi-stakeholder perspective, considering that the relevant urban actors have radically different perspectives and interests at this interface of urbanisation and diet change.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11625-022-01195-y.

Sustainable Development Practices of Restaurants in Romania and Changes during the COVID-19 Pandemic

Sustainable development is a constant and a necessity of daily life in the restaurant industry. The restaurant industry has high consumptions of energy, water, detergents, and consumables, together with tremendous food waste. The COVID-19 pandemic highlighted many acute sustainable development problems. In this context, this article analyzes the practices identified by restaurant managers that define their responsible behavior, and the significant changes made towards sustainability during the COVID-19 pandemic. This article presents the results obtained through qualitative research, carried out by semi-directive in-depth interviews, conducted with 56 restaurant managers from Romania. The answers obtained are based on five topics of discussion highlighting the managers’ growing interest in finding solutions to counteract negative effects on the environment, to ensure the wellbeing of customers and employees, and to increase the profitability of their company. The results obtained from the research reflect the thoughts and actions of restaurant managers in Romania, contributing to the body of knowledge in the understanding of sustainability practices in the foodservice sector.

Food consumption in Tunisian university students and its association with sociodemographic characteristics and lifestyle behaviours

OBJECTIVE

This study aimed to characterise food consumption among students at the University of Carthage (Tunisia), assessing quality of diet and main dietary patterns, and their association with potential conditioning factors.

DESIGN

Cross-sectional study. Participants self-reported food consumption in two 24-h recalls and information about sociodemographic, anthropometric and lifestyle characteristics such as BMI, birthplace, physical activity, eating places or kitchen appliances. Mediterranean Diet Score (MDS) and the Nutrient Rich Foods (NRF) index (NRF9.3) were used to assess diet quality. Exploratory factor analysis was conducted to identify eating patterns. Linear regression models were used to test the association of dietary patterns with the diet quality markers.

SETTING

Students at the University of Carthage, Tunisia.

PARTICIPANTS

132 students.

RESULTS

Almost 96 % of participants need shifts towards healthier food. Four main food patterns were identified 'Traditional food', 'Transitional food', 'European breakfast' and 'Western food'. 'Traditional food' was the first dietary model, positively associated with MDS and NRF9.3. Women showed higher adherence to 'European breakfast' and higher quality of diet by NRF9.3. Students eating out of home showed higher adherence to 'Western food', those who never kept a regular schedule of meals consumed lower amount of vegetables and tubers, and sedentary or low active students had a higher intake of ready-to-eat products.

CONCLUSIONS

Diet quality of the participating Tunisian students is inadequate, but traditional Mediterranean diet remains the main pattern in spite of the advanced transitional nutrition. Some lifestyle risk behaviours affecting quality of diet were identified in this work, which supports the youth's particular vulnerability.

Dietary Patterns as Characterized by Food Processing Levels and Their Association with the Health Outcomes of Rural Women in East Africa

Overweight and obesity are rapidly rising in Sub-Saharan Africa including in rural areas. However, most studies focus on urban centers, and have attributed this epidemic to the consumption of processed foods without their clear characterization. This study investigated food intake patterns defined by food processing levels and their association with overweight/obesity in rural areas. Four 24-h dietary recalls, anthropometric measurements, and socio-demographic characteristics were collected from 1152 women in Kenya, Tanzania, and Uganda. The PCA method was used to extract patterns characterized by food processing levels. The association between patterns and overweight/obesity was ascertained with regression models. The overweight/obesity rate was 47%, 42%, 26%, and 38% in Kenya, Tanzania, Uganda, and East Africa (as pooled data), respectively. Several patterns were identified, yet a "plant-based pattern" largely characterized by unprocessed and minimally processed foods and a "purchase pattern" mainly distinguished by highly processed foods were dominant. The "plant-based pattern" was inversely or not associated with overweight/obesity, while the "purchase pattern" had a positive association or no association. A clear distinction on processed foods as healthy and unhealthy should be made based on their nutrient provision to avoid their mischaracterization as unhealthy. Policies to reverse consumption of unhealthy processed foods while promoting healthy ones should be pursued.

Food Waste on Foodservice: An Overview through the Perspective of Sustainable Dimensions

Food waste (FW) is a current, complex, and widely debated issue in various spheres of society. Globally, about 2.6 trillion dollars per year is lost because of wasted food. Part of FW is preventable, and it is necessary to identify where it occurs. In most cases, FW occurs at the end of the production chain (meal preparation and distribution). Identifying the main food service failures on FW is important for developing efficient strategies for reducing them. Therefore, this study aimed to perform a narrative review of the impacts caused by FW in food services considering the three dimensions of sustainability (social, economic, or environmental). Multiple reasons were identified in this review that impacts those three dimensions, such as the cost of wasted raw material, use of cleaning material, the energy consumption, salary of food handlers, the water footprint, the amounts of rest-intake, production waste, energy density wasted, use of organic food, and food donation. Identifying these aspects can contribute to reduce FW impacts for better sustainable development, develop tools to measure FW, and assist food service managers in minimizing FW.

Caribbean nutrition transition: what can we learn from dietary patterns in the French West Indies?

PURPOSE

Despite the urgency regarding increasing rates of obesity and chronic diseases in the Caribbean, few studies described the nutrition transition. We aimed to provide such information by identifying dietary patterns in the French West Indies and their characteristics.

METHODS

This cross-sectional analysis included 1144 Guadeloupeans and Martinicans from a multistage sampling survey conducted on a representative sample. Dietary patterns were identified using principal component analysis followed by a clustering procedure, and described using multivariable regression models.

RESULTS

Four patterns were identified: (i) a "prudent" pattern characterized by high intakes of fruits, vegetables, legumes, seafood and yogurts, low intakes of fatty and sweet products, and a high Diet Quality Index-International (DQI-I); (ii) a "traditional" pattern characterized by high intakes of fruits, vegetables, tubers and fish, low intakes of red and processed meat, snacks, fast foods, and sweetened beverages, with a high DQI-I, mostly shaped by women and older persons; (iii) a "convenient" pattern characterized by high intakes of sweetened beverages, snacks, and fast foods, with the lowest DQI-I, principally shaped by young participants; (iv) a "transitioning" pattern characterized by high consumptions of bread, processed meat, sauces, alcoholic and sweetened beverages, but also high intakes of tubers, legumes, and fish, mainly shaped by men, middle aged, of whom 35% had metabolic syndrome.

CONCLUSION

The co-existing dietary patterns in the French West Indies, marked by a generational contrast, seem to reflect different steps in dietary change as described in the literature, suggesting an ongoing nutrition transition.

Environmental, Social and Economic Sustainability Indicators Applied to Food Services: A Systematic Review

Sustainability is the integration of actions focused on three pillars: environmental, social, and economical. Implementing sustainable development ranges from the pursuit of quality of life, and from environmental balance to break with the current pattern of development. Therefore, the objective of this work was to understand and analyze the sustainability indicators implemented in the production of meals in food services. The authors developed specific search strategies for Scopus, Web of Science, Pubmed, Lilacs, Google Scholar, and ProQuest Dissertations & Theses Global to perform the systematic review. The authors evaluated the methodological quality of the included studies using the Meta-analysis Statistical Assessment and Review Instrument (MASTARI). A total of 31 cross-sectional studies were analyzed. Twenty four (77.41%) of the studies had activities that covered the three indicators (environmental, social, and economic); 22.59% (n = 7) used two indicators in which 12.90% (n = 4) presented environmental and economic indicators and 9.67% (n = 3) with environmental and social indicators. This research indicates that the studies in food services are seeking to insert indicators that cover the three pillars of sustainable meal production. It is worth mentioning that in the literature, many works encompasses the importance of sustainability, but few explore which indicators are most applied or detail their implementation in food services. More studies are needed to estimate better the indicators being applied in food services.

Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study

PURPOSE

To derive dietary patterns (DPs) of Lebanese adolescents (10-18 years) and evaluate associations between identified DPs and household food insecurity (HFI).

METHODS

Data on adolescents (n = 693) were drawn from a national survey conducted in 2015 on a representative sample of Lebanese households with children. In addition to a sociodemographic questionnaire, data collection included the validated Arabic-version of the Household Food Insecurity Access Scale, used to evaluate HFI. Dietary intake was assessed using a 187-item validated food frequency questionnaire. Associations between HFI scores and DPs were examined using multiple linear regressions.

RESULTS

HFI was observed in 55.2% of the study sample. Two DPs were derived among adolescents: Western and Lebanese-Mediterranean (LM). The Western DP was characterized by higher consumption of sweetened beverages, fast foods, sweets, and refined grains, whereas the LM DP was characterized by higher intakes of fruits, vegetables, dairy products, and whole grains. Scores of the Western DP were negatively associated with fiber, calcium, iron, and vitamins A and D, while the LM DP scores were positively correlated with fiber, proteins, iron, calcium, and vitamins A and D (p < 0.01). LM DP scores were also negatively correlated with total fat, saturated and polyunsaturated fats, p < 0.05. After adjustment for sociodemographics, multiple linear regression showed that higher HFI scores were associated with lower adherence to LM DP among adolescents (β = - 0.026, 95% CI - 0.046, - 0.006).

CONCLUSIONS

HFI was associated with lower adherence to the Mediterranean pattern among Lebanese adolescents. Preventive strategies are needed to promote better diet quality among food-insecure youth.