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.
Wild plant species are often excellent sources of micronutrients and have the potential to promote healthy living, yet they are under-exploited. Distribution of micronutrient powders as diet supplements can play an effective role in reducing micronutrient deficiencies among infants and young children. However, assessing their effects in ensuring a nutritious diet at low cost have been limited. This study assessed the impact of including wild plant species and micronutrient powders in modeled optimized lowest-cost diets for women and children in rural Kenya. Market surveys, focus group discussions in six villages and a 24-h dietary intake recall were used to collect data that were subsequently entered in the cost of diet linear programming tool to model lowest-cost nutritious diets for women and children in Turkana County, Kenya. Three wild vegetables, three wild fruits, and micronutrient powder were added to the models to assess their impact on the cost and the nutrient adequacy of the diets. A locally adapted cost optimized nutritious diet without any intervention costs between 50 and 119 Kenyan shillings (KES) daily
Objective: To assess the impact of integrating processed fruits and vegetables (FVs) into diets in terms of diet cost reduction and ensuring nutritional adequacy year-round. Design: Market surveys were conducted to record foods. Focus group discussions (FGDs) and 24-hour dietary assessments – from children and women – were carried out to determine culturally accepted dietary habits. Six processed FVs were considered for addition to diets. Using the Cost of Diet linear programming tool, standards diets were first modeled, and subsequently, the processed FVs were included to analyze their impact. Setting: Rural Tanzania: Mtwara and Morogoro Participants: Market survey: 50 traders; FGDs: 40 women; 24-hour recalls: 36 infants 6-23 months, 52 children 6-13 years and 292 women. Results: The standard diet costs between TZS 232 – 2,368 (USD 0.3 – 3) daily for infants. For children 6-13 years, it costs between TZS 1,711 – 7,199 (USD 2.2 – 9.1) daily, and the cost for the women was between TZS 2,793 – 10,449 (USD 3.5 – 13.2). Addition of the processed FVs reduced diet costs by up to 61%, 48%, and 49% for children 12-23 months, 6-13 years, and women, respectively. However, for infants 6-11 months, costs rose by up to 127%. The processed FVs addressed all micronutrient gaps in the diets except for infants 6-11 months, where some micronutrient intakes were unfulfilled. Conclusions: Processed FVs could provide a feasible option to ensure availability of nutritious but cheap diets year-round. Hence, interventions to process FVs into nutritious and affordable products should extensively be pursued.
High post-harvest losses of fruits and vegetables (FVs) limit their supply and availability for year-round consumption. Hence, processing innovations at their production areas could help address this constraint, which requires the need to assess people's perceptions in these areas. Therefore, this study gauged the knowledge, attitude, and practices towards FV processing and consumption and its relationship with actual FV consumption. Surveys were conducted with women in six study sites – three fruit and three vegetable production areas – in Kenya, Tanzania, and Uganda. Quantitative 24-h dietary and 7-day FV recalls were collected across two seasons. Open and closed-ended questions were constructed to assess the women's knowledge, attitude, and practices towards FV processing and consumption. The fruit and vegetable sites included 584 and 732 women, respectively. Average fruit consumption was 4-135 g/day in the plenty season and 4-106 g/day in the lean season. Vegetable consumption was 112-146 g/day and 84-180 g/day in the plenty and lean season, respectively. There were significant consumption differences across seasons. Most women expressed high knowledge of FV processing and consumption benefits and showed a positive attitude towards FV processing and consumption. Yet, in practice, a small number of women process FVs largely due to limited processing know-how and equipment. The relationship between knowledge and attitude and FV consumption was negative or none. The high knowledge and positive attitude expressed, yet the limited processing know-how and equipment should be a basis for interventions to increase FV processing into nutritious products for better nutrition and to ensure their availability year-round.
Diets should be healthy for the benefits of both humans and the environment. The World Index for Sustainability and Health (WISH) was developed to assess both diets’ healthiness and environmental sustainability, and the index was applied in this study. Food intake quantities for single foods were calculated based on the data collected from four 24-h recalls during two seasons in 2019/2020 with women of reproductive age in two rural areas each in Kenya, Tanzania and Uganda (n = 1152). Single foods were grouped into 13 food groups, and the amount of each food group consumed was converted to an overall WISH score and four sub-scores. The food groups with a low WISH score were fruits, vegetables, dairy foods, fish, unsaturated oils and nuts, meaning that their consumption was outside the recommended range for a healthy and sustainable diet. Contrariwise, the intake of red meat and poultry was partly above the recommended intake for those women who consumed them. The overall WISH score and sub-scores showed that the consumption of “protective” food groups needed to increase in the study population, while the consumption of “limiting” food groups was sufficient or should decrease. For future application, we recommend dividing food groups that are critical for nutrition, e.g., vegetables, into sub-groups to further understand their contribution to this index.
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