Trends in energy and nutrient supply in Ethiopia: a perspective from FAO food balance sheets.

BACKGROUND: Ethiopia is the second-most populous country in Africa. Although most people still live in rural areas, the urban population is increasing. Generally, urbanisation is associated with a nutrition transition and an increase in risk factors for non-communicable diseases (NCDs). The objective of this study was to determine how the nutritional composition of the Ethiopian food supply has changed over the last 50 years and whether there is evidence of a nutrition transition. METHODS: Food balance sheets for Ethiopia from 1961 to 2011 were downloaded from the FAOSTAT database and daily per capita supply for 17 commodity groupings was calculated. After appropriate coding, per capita energy and nutrient supplies were determined. RESULTS: Per capita energy supply was 1710 kcal/d in 1961, fell to 1403 kcal/d by 1973, and increased to 2111 kcal/d in 2011. Carbohydrate was by far the greatest energy source throughout the period, ranging from 72% of energy in 1968 to 79% in 1998; however, this was mostly provided by complex carbohydrates as the contribution of sugars to energy only varied between 4.7% in 1994 and 6.7% in 2011. Energy from fat was low, ranging from 14% of energy in 1970 to 10% in 1998. Energy from protein ranged from 14% in 1962 to 11% in 1994. Per capita supplies of calcium, vitamin A, C, D, folate and other B-vitamins were insufficient and there was a low supply of animal foods. CONCLUSIONS: The Ethiopian food supply is still remarkably high in complex carbohydrates and low in sugars, fat, protein, and micronutrients. There is little evidence yet of changes that are usually associated with a nutrition transition.

Is vitamin D deficiency a public health concern for low middle income countries? A systematic literature review.

PURPOSE: Vitamin D deficiency has been receiving increasing attention as a potential public health concern in low and lower-middle income countries (LMICs), of which there are currently 83. We aimed to conduct a comprehensive systematic literature review (SLR) of available data on vitamin D status and prevalence of vitamin D deficiency in all 83 LMICs. METHODS: We followed the general methodology for SLRs in the area of serum 25-hydroxyvitamin D. Highest priority was placed on identifying relevant population-based studies, followed by cross-sectional studies, and to a lesser extent case-control studies. We adopted the public health convention that a prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D < 25/30 nmol/L) at > 20% in the entire population and/or at-risk population subgroups (infants, children, women of child-bearing age, pregnancy) constitutes a public health issue that may warrant intervention. RESULTS: Our SLR revealed that of the 83 LMICs, 65% (n = 54 countries) had no published studies with vitamin D data suitable for inclusion. Using data from the remaining third, a number of LMICs had evidence of excess burden of vitamin D deficiency in one or more population subgroup(s) using the above convention (Afghanistan, Pakistan, India, Tunisia and Mongolia) as well as possibly other LMICs, albeit with much more limited data. Several LMICs had no evidence of excess burden. CONCLUSION: Vitamin D deficiency is a public health issue in some, but certainly not all, LMICs. There is a clear need for targeting public health strategies for prevention of vitamin D deficiency in those LMICs with excess burden.

Food and Nutrient Intake in African American Children and Adolescents Aged 5 to 16 Years in Baltimore City.

OBJECTIVE: This study aimed to describe food and nutrient intake for low-income, urban African American children and adolescents, to highlight the need for further nutrition intervention programs and appropriate tools to address overweight and obesity. METHODS: This was a cross-sectional study using interviewer-administered single 24-hour dietary recalls. Participants were low-income African American boys and girls aged 5-16 years or their caregivers in Baltimore City. Frequency of food consumption and dietary intakes were analyzed by gender and age groups. RESULTS: Eighty-one participants were included for analysis. Mean daily energy intakes exceeded Dietary Reference Intakes (DRIs) from 10% to 71% across all gender-age groups: 2304 kcal for children aged 5-8 years; 2429 kcal and 2732 kcal for boys and girls aged 9-13 years, respectively; and 3339 kcal and 2846 kcal for boys and girls aged 14-16 years, respectively. The most frequently reported consumed foods were sweetened drinks, chips, candies, and milk across all age groups. The majority of participants (79-100%) did not meet the DRIs for dietary fiber and vitamin E across all gender-age groups. Milk accounted for 14%, 17%, and 21% of energy, fat, and protein intake, respectively, among children 5-8 years of age, while pizza was the top source of energy, fat, and protein (11%, 13%, and 18%, respectively) among 14-to 16-year-old adolescents. Sweetened drinks and sweetened juices were major sources of sugar, contributing 33% for 5-8 year olds, 29% for 9-13 year olds, and 35% for 14-16 year olds. CONCLUSIONS: Mean daily energy intake exceeded dietary recommendations across all gender-age groups. This study has provided previously unavailable information on diet and highlights foods to be targeted in nutrition intervention programs.

Traditional food consumption is associated with better diet quality and adequacy among Inuit adults in Nunavut, Canada.

The Inuit population is undergoing a rapid nutrition transition as a result of reduced consumption of traditional foods. This study aims to describe the differences in dietary adequacy between non-traditional and traditional eaters among Inuit populations in Nunavut, Canada. A cross-sectional survey was conducted using a culturally appropriate quantitative food frequency questionnaire. Participants included 208 Inuit adults from three isolated communities in Nunavut. Traditional eaters consumed a more nutrient-dense diet and achieved better dietary adequacy than non-traditional eaters. Traditional foods accounted for 7 and 27% of energy intake among non-traditional and traditional eaters, respectively. Non-nutrient-dense foods accounted for a greater proportion of energy intake in non-traditional eaters; however, these were consumed in significant amounts by both the groups (36 and 27% of total energy). Consumption of traditional foods is associated with greater diet quality and dietary adequacy. Efforts should be made to promote traditional and non-traditional foods of high-nutritional quality.

Changing dietary patterns in the Canadian Arctic: frequency of consumption of foods and beverages by inuit in three Nunavut communities.

BACKGROUND: Inuit in Arctic regions are experiencing a rapid diet and lifestyle transition. There are limited data on food consumption patterns among this unique population, raising concerns about assessing the risk for the development of diet-related chronic diseases. OBJECTIVE: To assess the current frequency of consumption of foods and beverages among Inuit in Nunavut, Arctic Canada. METHODS: A cross-sectional dietary study was conducted among randomly selected Inuit adults from three communities in Nunavut using a validated quantitative food frequency questionnaire. The participants were 175 women and 36 men with median (IQR) ages of 41.0 (32.5-48.5) and 40.1 (30.0-50.0) years, respectively. The mean and median frequencies of consumption over a 30-day period were computed for 147 individual food items and grouped as foods or beverages. RESULTS: The 30 most frequently consumed foods were identified. Non-nutrient-dense foods (i.e., high-fat and high-sugar foods) were the most frequently consumed food group (median intake, 3.4 times/day), followed by grains (2.0 times/day) and traditional meats (1.7 times/day). The frequency of consumption of fruits (0.7 times/day) and vegetables (0.4 times/day) was low. The median values for the three most frequently consumed food items were sugar or honey (once/day), butter (0.71 times/day), and Coffee-mate (0.71 times/day). Apart from water, coffee, and tea, the most frequently consumed beverages were sweetened juices (0.71 times/day) and regular pop (soft drinks) (0.36 times/day). This study showed that non-nutrient-dense foods are consumed most frequently in these Inuit communities. CONCLUSIONS: The results have implications for dietary quality and provide useful information on current dietary practices to guide nutritional intervention programs.

Assessment of dietary intake among Inuvialuit in Arctic Canada using a locally developed quantitative food frequency questionnaire.

OBJECTIVE: Inuvialuit in Arctic Canada are experiencing a nutritional and lifestyle transition, characterized by a declining consumption of traditional foods, increased consumption of non-nutrient-dense store-bought foods (NNDF), and reduced levels of physical activity with a concurrent rise in chronic diseases. The aim of the present study was to determine dietary intake of Inuvialuit adults in the Northwest Territories, Canada, using a culturally specific, validated quantitative food frequency questionnaire (QFFQ). METHODS: A cross-sectional dietary survey of 213 randomly selected adults (≥19 years) was conducted in 3 remote communities in the Northwest Territories. Nonparametric analysis was used to compare mean nutrient intake, dietary inadequacy, and differences in nutrient density among men and women. Data were also analyzed to determine the top food groups contributing to energy and selected nutrients. RESULTS: With response rates of 65% to 85%, 43 men (mean age 43.2 ± 12.8) and 170 women (mean age 44.7 ± 13.9) completed the QFFQ. Mean daily energy intakes for men were 3478 ± 1474 kcal and for women they were 3299 ± 1653 kcal. For both sexes, protein, carbohydrates, and fat provided approximately 16%, 47%, and 28% of energy intake, respectively. NNDFs were the top contributors to energy (39%), fat (40%), carbohydrate (54%), sugar (74%), and sodium (23%) intake. Total traditional foods from the land, sea, and sky such as polar bear and wild birds contributed 11% of energy and 41% of protein intake. Most participants' daily intakes were below recommended levels for dietary fiber; vitamins A, E, and D; potassium; and magnesium. Mean daily energy, saturated fat, and sodium intakes exceeded recommendations. CONCLUSIONS: We identified nutrient inadequacies and characterized food consumption among Inuvialuit. These data support nutritional interventions that encourage consumption of traditional foods. The cultural and ethnic differences in Canadian Arctic populations require specific tailoring of public health interventions and policy using population specific tools to meet local needs.

Food expenditure patterns in the Canadian Arctic show cause for concern for obesity and chronic disease.

BACKGROUND: Little is understood about the economic factors that have influenced the nutrition transition from traditional to store-bought foods that are typically high in fat and sugar amongst people living in the Canadian Arctic. This study aims to determine the pattern of household food expenditure in the Canadian Arctic. METHOD: Local food prices were collected over 12 months in six communities in Nunavut and the Northwest Territories. Dietary intake data were collected from 441 adults using a validated quantitative food frequency questionnaire. Money spent on six food groups was calculated along with the cost of energy and selected nutrients per person. RESULTS: Participants spent approximately 10% of total food expenditure on each of the food groups of fruit/vegetables, grains and potatoes, and dairy, 17% on traditional meats (e.g. caribou, goose, char, and seal liver), and 20% on non-traditional meats (e.g. beef, pork, chicken, fish, and processed meats). Non-nutrient-dense foods (NNDF) accounted for 34% of food expenditure. Younger participants (<30 years) spent more on NNDF and less on traditional meats compared with the older age groups. Participants with higher levels of formal education spent more on fruit and vegetables and less on traditional meats, when compared with participants with lower levels of formal education. CONCLUSIONS: Participants spent most household income on NNDF, a possible consequence of generation discrepancy between younger and older participants. The tendency toward NNDF, particularly among youth, should be addressed with an assessment of predictive factors and the development of targeted approaches to population-based interventions.

Dietary adequacy of vitamin D and calcium among Inuit and Inuvialuit women of child-bearing age in Arctic Canada: a growing concern.

BACKGROUND: Arctic populations are at an increased risk of vitamin D inadequacy due to geographic latitude and a nutrition transition. This study aimed to assess the adequacy of dietary vitamin D and calcium among women of child-bearing age in Arctic Canada. METHODS: This study collected data from 203 randomly selected women of child-bearing age (19-44 years) in Nunavut and the Northwest Territories of Arctic Canada. Cross-sectional surveys using a validated quantitative food frequency questionnaire were analysed to determine the dietary adequacy of vitamin D and calcium and summarize the top foods contributing to vitamin D and calcium intake among traditional food eaters (TFE) and non-traditional food eaters (NTFE). RESULTS: The response rate was between 69-93% depending on the community sampled. Mean BMIs for both TFE and NTFE were above the normal range. Traditional food eaters had a significantly higher median vitamin D intake compared with non-traditional eaters (TFE=5.13 ± 5.34 µg/day; NTFE=3.5 ± 3.22 µg/day, p=0·004). The majority of women (87%) were below the Estimated Average Requirements (EAR) for vitamin D. Despite adequate median daily calcium intake in both TFE (1,299 ± 798 mg/day) and NTFE (992 ± 704 mg/day; p=0.0005), 27% of the study population fell below the EAR for calcium. Dairy products contributed the most to intake of vitamin D (TFE=30.7%; NTFE=39.1%) and calcium (TFE=25.5%; NTFE=34.5%). CONCLUSIONS: Inadequate dietary vitamin D intake is evident among Inuit and Inuvialuit women of child-bearing age in Arctic Canada. Promotion of nutrient-rich sources of traditional foods, supplementation protocols and/or expanded food fortification should be considered to address this nutrition concern.

Eating habits of a population undergoing a rapid dietary transition: portion sizes of traditional and non-traditional foods and beverages consumed by Inuit adults in Nunavut, Canada.

BACKGROUND: To determine the portion sizes of traditional and non-traditional foods being consumed by Inuit adults in three remote communities in Nunavut, Canada. METHODS: A cross-sectional study was carried out between June and October, 2008. Trained field workers collected dietary data using a culturally appropriate, validated quantitative food frequency questionnaire (QFFQ) developed specifically for the study population. RESULTS: Caribou, muktuk (whale blubber and skin) and Arctic char (salmon family), were the most commonly consumed traditional foods; mean portion sizes for traditional foods ranged from 10 g for fermented seal fat to 424 g for fried caribou. Fried bannock and white bread were consumed by >85% of participants; mean portion sizes for these foods were 189 g and 70 g, respectively. Sugar-sweetened beverages and energy-dense, nutrient-poor foods were also widely consumed. Mean portion sizes for regular pop and sweetened juices with added sugar were 663 g and 572 g, respectively. Mean portion sizes for potato chips, pilot biscuits, cakes, chocolate and cookies were 59 g, 59 g, 106 g, 59 g, and 46 g, respectively. CONCLUSIONS: The present study provides further evidence of the nutrition transition that is occurring among Inuit in the Canadian Arctic. It also highlights a number of foods and beverages that could be targeted in future nutritional intervention programs aimed at obesity and diet-related chronic disease prevention in these and other Inuit communities.

Ethnic differences in grains consumption and their contribution to intake of B-vitamins: results of the Multiethnic Cohort Study.

BACKGROUND: Research indicates that a diet rich in whole grains may reduce the risk of prevalent chronic diseases, including cardiovascular disease, diabetes, and some cancers, and that risk for these diseases varies by ethnicity. The objective of the current study was to identify major dietary sources of grains and describe their contribution to B vitamins in five ethnic groups. METHODS: A cross-sectional mail survey was used to collect data from participants in the Multiethnic Cohort Study in Hawaii and Los Angeles County, United States, from 1993 to 1996. Dietary intake data collected using a quantitative food frequency questionnaire was available for 186,916 participants representing five ethnic groups (African American, Latino, Japanese American, Native Hawaiian and Caucasian) aged 45-75 years. The top sources of grain foods were determined, and their contribution to thiamin, riboflavin, niacin, vitamin B6, and folic acid intakes were analyzed. RESULTS: The top source of whole grains was whole wheat/rye bread for all ethnic-sex groups, followed by popcorn and cooked cereals, except for Native Hawaiian men and Japanese Americans, for whom brown/wild rice was the second top source; major contributors of refined grains were white rice and white bread, except for Latinos. Refined grain foods contributed more to grain consumption (27.1-55.6%) than whole grain foods (7.4-30.8%) among all ethnic-sex groups, except African American women. Grain foods made an important contribution to the intakes of thiamin (30.2-45.9%), riboflavin (23.1-29.2%), niacin (27.1-35.8%), vitamin B6 (22.9-27.5%), and folic acid (23.3-27.7%). CONCLUSIONS: This is the first study to document consumption of different grain sources and their contribution to B vitamins in five ethnic groups in the U.S. Findings can be used to assess unhealthful food choices, to guide dietary recommendations, and to help reduce risk of chronic diseases in these populations.

Smoking and dietary inadequacy among Inuvialuit women of child bearing age in the Northwest Territories, Canada.

OBJECTIVE: The prevalence of smoking in Aboriginal Canadians is higher than non-Aboriginal Canadians, a behavior that also tends to alter dietary patterns. Compared with the general Canadian population, maternal smoking rates are almost twice as high. The aim of this study was to compare dietary adequacy of Inuvialuit women of childbearing age comparing smokers versus non-smokers. RESEARCH METHODS & PROCEDURES: A cross-sectional study, where participants completed a culturally specific quantitative food frequency questionnaire. Non-parametric analysis was used to compare mean nutrient intake, dietary inadequacy and differences in nutrient density among smokers and non-smokers. Multiple logistic regression analyses were performed for key nutrients inadequacy and smoking status. Data was collected from three communities in the Beaufort Delta region of the Northwest Territories, Canada from randomly selected Inuvialuit women of childbearing age (19-44 years). RESULTS: Of 92 participants, 75% reported being smokers. There were no significant differences in age, BMI, marital status, education, number of people in household working and/or number of self employed, and physical activity between smokers and non-smokers. Non-parametric analysis showed no differences in nutrient intake between smokers and non-smokers. Logistic regression however revealed there was a positive association between smoking and inadequacies of vitamin C (OR = 2.91, 95% CI, 1.17-5.25), iron (OR = 3.16, 95% CI, 1.27-5.90), and zinc (OR = 2.78, 95% CI, 1.12-4.94). A high percentage of women (>60%), regardless of smoking status, did not meet the dietary recommendations for fiber, vitamin D, E and potassium. CONCLUSIONS: This study provides evidence of inadequate dietary intake among Inuvialuit of childbearing age regardless of smoking behavior.

Trends in energy and nutrient supply in Trinidad and Tobago from 1961 to 2007 using FAO food balance sheets.

OBJECTIVE: Trinidad and Tobago has experienced an epidemiological transition over recent decades characterised by reduced rates of communicable diseases but rapidly increasing rates of obesity and non-communicable chronic diseases. The objective of the present study was to investigate the changes in energy and nutrient supply that have taken place in Trinidad and Tobago between 1961 and 2007. DESIGN: Food balance sheets for each year between 1961 and 2007 were downloaded from the FAOSTAT database and daily per capita supply for seventeen food commodity groupings was calculated. After appropriate coding, energy and nutrient supply were determined using dietary analysis software. SETTING: FAO food balance sheets for Trinidad and Tobago from 1961 to 2007. SUBJECTS: None. RESULTS: The food supply in 2007 provided an extra 1561 kJ (373 kcal)/capita per d than it did in 1961. Energy from carbohydrate as a percentage of total energy fell from 62% in 1961 to 57% in 2007, whereas energy from fat as a percentage of total energy increased from 26% to over 30% and now lies at the upper end of WHO recommendations. Sugars increased from 20% to over 26% of total energy and are well above WHO recommendations. When expressed on a nutrient density basis, supplies of vitamin A, folate and Ca are lower than WHO recommendations. CONCLUSIONS: Nutritional imbalances in the Trinidadian food supply need to be addressed to combat the rise in nutrition-related chronic disease that is projected to cause increased disability and premature death in the country in the coming years.

Frequency of consumption of foods and beverages by Inuvialuit adults in Northwest Territories, Arctic Canada.

Limited data exist regarding nutrient intakes and overall dietary quality in Canadian Arctic populations. This cross-sectional study determined the frequency of consumption of traditional meats (e.g. caribou, polar bear, seal, char and whale) and non-traditional store-bought foods including non-traditional meats (e.g. beef, pork and chicken), grains, dairy, fruits, vegetables and non-nutrient dense foods (NNDFs) (e.g. butter, chocolate, chips, candy and pop) by Inuvialuit adults (175 women, mean age 44 ± 14 years; 55 men, mean age 41 ± 13 years) in three remote communities in the Northwest Territories. Using a validated quantitative food frequency questionnaire, frequency of consumption over a 30-day period was determined for 141 commonly reported foods. Mean consumption of traditional meats (1.6 times/day), fruits (1 time/day) and vegetables (0.6 times/day) was less frequent than that of NNDFs (5.0 times/day). Nutritional intervention strategies are needed to promote more frequent consumption of nutrient-rich foods and less frequent consumption of NNDFs in these Arctic communities.

Vitamin D deficiency and disease risk among aboriginal Arctic populations.

Aboriginal populations living above the Arctic Circle are at particularly high risk of vitamin D deficiency due to limited ultraviolet B exposure (related to geographic latitude) and inadequate dietary intake (recently related to decreased traditional food consumption). Major changes in diet and lifestyle over the past 50 years in these populations have coincided with increased prevalence rates of rickets, cancer, diabetes, and obesity, each of which may be associated with vitamin D inadequacy. This review examines the risk factors for vitamin D inadequacy, the associations between vitamin D and disease risk at high geographic latitudes, and the recommendations for improving vitamin D status particularly among aboriginal Arctic populations. Traditional foods, such as fatty fish and marine mammals, are rich sources of vitamin D and should continue to be promoted to improve dietary vitamin D intake. Supplementation protocols may also be necessary to ensure adequate vitamin D status in the Arctic.

The nutrition transition in the Republic of Ireland: trends in energy and nutrient supply from 1961 to 2007 using Food and Agriculture Organization food balance sheets.

Over the course of the last 50 years the Republic of Ireland has gone from being one of the poorest countries in Europe to one of the richest; however, it is now experiencing increasing rates of obesity and non-communicable chronic disease. Although several national nutrition surveys have been carried out in Ireland since 1990, there is little information on the Irish diet before then. We analysed the FAO food balance sheets for Ireland from 1961 to 2007 in order to characterise the changes in energy and nutrient supply that took place during that period. Food balance sheets were downloaded from the FAOSTAT database and per capita supply of commodities was analysed using dietary analysis software. Energy from carbohydrate as a percentage of total energy fell from 55 % in 1961 to 46 % in 2007, whereas energy from fat increased from 29 % to 34 %; these values are well outside WHO recommendations for the prevention of chronic disease. Energy from alcohol as a percentage of total energy has doubled within the last 20 years. On a nutrient-density basis, vitamins and minerals met or exceeded WHO recommendations, apart from vitamin D, folate, Ca and Fe. Although there are methodological limitations associated with the use of food balance sheets, the present results demonstrate that the current imbalances in the Irish diet were already evident several decades ago. Because they are so long established, they will be difficult to reverse unless major public health nutrition interventions are implemented.

Use of FAO food balance sheets to estimate the potential ability of novel folate-enriched eggs to increase the folate supply in European Union countries.

OBJECTIVE: European governments have yet to introduce mandatory folic acid fortification of foods for neural tube defect prevention because of uncertainty about the long-term safety of high intake of folic acid. Novel folate-enriched eggs have been proposed as offering a practical way of increasing intake of natural folates, which do not have the same safety concerns as synthetic folic acid. Our objective was to estimate the potential increase in folate supply that could occur in European Union (EU) countries if normal eggs were replaced by folate-enriched eggs. DESIGN: FAOSTAT data on daily per capita availability of eggs were linked to mean folate concentrations of un-enriched and folate-enriched eggs from three representative feeding trials from the recent literature. SETTING: Data were collated in Microsoft Excel. SUBJECTS: The study used food balance sheets for Europe for 1961-2003 and for twenty-six individual EU countries for 2003. RESULTS: There has been little variation in egg supply in Europe over the past 40 years, with eggs providing only about 1·3-1·6 % of total energy. In 2003, the average per capita egg supply across twenty-six EU countries was 32·8 g/d, equivalent to a little over half an egg. Even if the folate concentrations of all eggs across the EU were increased two- to threefold, per capita folate supply would increase only by about 25 µg/d. CONCLUSIONS: At current enrichment levels, the availability of novel folate-enriched eggs will have little impact on folate supply in EU countries. In the absence of mandatory fortification, additional natural folate sources are needed urgently.