The Global Diet Quality Score is Associated with Higher Nutrient Adequacy, Midupper Arm Circumference, Venous Hemoglobin, and Serum Folate Among Urban and Rural Ethiopian Adults

Abstract

Background Nutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising. Objectives To evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults. Methods We scored the GDQS and a suite of comparison metrics in secondary analyses of FFQ and 24-hour recall (24HR) data from a population-based cross-sectional survey of nonpregnant, nonlactating women of reproductive age and men (15–49 years) in Addis Ababa and 5 predominately rural regions. We evaluated Spearman correlations between metrics and energy-adjusted nutrient adequacy, and associations between metrics and anthropometric/biomarker outcomes in covariate-adjusted regression models. Results In the FFQ analysis, correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy were 0.32 in men and 0.26 in women. GDQS scores were inversely associated with folate deficiency in men and women (GDQS Quintile 5 compared with Quintile 1 OR in women, 0.50; 95% CI: 0.31–0.79); inversely associated with underweight (OR, 0.63; 95% CI: 0.44–0.90), low midupper arm circumference (OR, 0.61; 95% CI: 0.45–0.84), and anemia (OR, 0.59; 95% CI: 0.38–0.91) in women; and positively associated with hypertension in men (OR: 1.77, 95% CI: 1.12–2.80). For comparison, the Minimum Dietary Diversity–Women (MDD-W) was associated more positively (P < 0.05) with overall nutrient adequacy in men and women, but also associated with low ferritin in men, overweight/obesity in women, and hypertension in men and women. In the 24HR analysis (restricted to women), the MDD-W was associated more positively (P < 0.05) with nutrient adequacy than the GDQS, but also associated with low ferritin, while the GDQS was associated inversely with anemia. Conclusions The GDQS performed capably in capturing nutrient adequacy–related outcomes in Ethiopian adults. Prospective studies are warranted to assess the GDQS’ performance in capturing NCD outcomes in sub-Saharan Africa.

Stunting and thinness in school-attending adolescents in Addis Ababa

“…The GDQS was designed for non-pregnant, non-lactating women of reproductive age in low- and middle-income countries (LMICs) [ 23 – 25 ]. The method was tested for mothers but has not been tested for adolescents [ 20 , 22 , 26 , 27 ]. Focusing on adolescents’ populations will benefit present and future generations in terms of health and development.…”

Folate deficiency among women of reproductive age in Ethiopia: A systematic review and meta-analysis

“…Among the studies, nine [ 4 , 10 , 27 – 32 , 52 ] were cross-sectional studies, and one was a case-control [ 51 ]. Regarding the study setting, six of the studies [ 4 , 27 , 28 , 30 , 31 , 52 ] were done at the community level, while the other four [ 10 , 29 , 32 , 51 ] were institutional-based. Three studies [ 4 , 28 , 30 ] were conducted at a national level, whereas the other seven were conducted at the sub-national/local level—three in Oromia Region [ 29 , 32 , 52 ], one in Amhara Region [ 31 ], one in Sidama Region [ 27 ], and two in Addis Ababa City Administration [ 10 , 51 ].…”

“…Six studies [ 10 , 27 , 29 , 32 , 51 , 52 ] were conducted among pregnant women, and two were [ 28 , 30 ] done among non-pregnant/non-lactating women. However, two studies [ 4 , 31 ] were performed generally in WRA without specifying the physiological status of the women.…”

“…However, two studies [ 4 , 31 ] were performed generally in WRA without specifying the physiological status of the women. Five studies [ 4 , 28 , 30 , 31 , 52 ] applied probability sampling techniques, while the other five [ 10 , 27 , 29 , 32 , 51 ] used non-probability sampling. The sample size of the studies ranged from 99 [ 27 ] to 1647 [ 30 ], with response rates ranging from 89.5% [ 31 ] to 100% [ 4 , 28 , 29 , 32 , 51 ].…”

“…Five studies [ 4 , 28 , 30 , 31 , 52 ] applied probability sampling techniques, while the other five [ 10 , 27 , 29 , 32 , 51 ] used non-probability sampling. The sample size of the studies ranged from 99 [ 27 ] to 1647 [ 30 ], with response rates ranging from 89.5% [ 31 ] to 100% [ 4 , 28 , 29 , 32 , 51 ]. Nine of the studies [ 4 , 10 , 27 , 29 – 32 , 51 , 52 ] reported mean (+ SD) age of the WRA, ranging from 24.5 (+ 5.0) [ 32 ] to 33.1 (+ 7.2) [ 31 ] years.…”