Nutritional contribution of street foods to the diet of people in developing countries: a systematic review.

OBJECTIVE: To review studies examining the nutritional value of street foods and their contribution to the diet of consumers in developing countries. DESIGN: The electronic databases PubMed/MEDLINE, Web of Science, Cochrane Library, Proquest Health and Science Direct were searched for articles on street foods in developing countries that included findings on nutritional value. RESULTS: From a total of 639 articles, twenty-three studies were retained since they met the inclusion criteria. In summary, daily energy intake from street foods in adults ranged from 13 % to 50 % of energy and in children from 13 % to 40 % of energy. Although the amounts differed from place to place, even at the lowest values of the percentage of energy intake range, energy from street foods made a significant contribution to the diet. Furthermore, the majority of studies suggest that street foods contributed significantly to the daily intake of protein, often at 50 % of the RDA. The data on fat and carbohydrate intakes are of some concern because of the assumed high contribution of street foods to the total intakes of fat, trans-fat, salt and sugar in numerous studies and their possible role in the development of obesity and non-communicable diseases. Few studies have provided data on the intake of micronutrients, but these tended to be high for Fe and vitamin A while low for Ca and thiamin. CONCLUSIONS: Street foods make a significant contribution to energy and protein intakes of people in developing countries and their use should be encouraged if they are healthy traditional foods.

Food security in South Africa: a review of national surveys.

OBJECTIVE: To assess the status of food security--i.e., access to food, food availability and food utilization--in South Africa. METHODS: A systematic search of national surveys that used the Community Childhood Hunger Identification Project (CCHIP) index to measure food security in South Africa over a period of 10 years (1999-2008) was conducted. Anthropometric data for children aged 1-9 years were used to assess food utilization, and household food inventory data were used to assess food availability. FINDINGS: Only three national surveys had used the CCHIP index, namely, the 1999 and 2005 National Food Consumption Surveys (NFCS) and the 2008 South African Social Attitudes Survey. These surveys showed a relatively large decrease in food insecurity between 1999 and 2008. However, the consistent emerging trend indicated that in poorer households women were either feeding their children a poor diet or skipping meals so their children could eat. In terms of food access and availability, the 1999 NFCS showed that households that enjoyed food security consumed an average of 16 different food items over 24 hours, whereas poorer households spent less money on food and consumed fewer than 8 different food items. Moreover, children had low mean scores for dietary diversity (3.58; standard deviation, SD: ± 1.37) and dietary variety (5.52; SD: ± 2.54) scores. In terms of food utilization, the NFCS showed that stunting in children decreased from 21.6% in 1999 to 18% in 2005. CONCLUSION: The South African government must implement measures to improve the undesirably high level of food insecurity in poorer households.

How diverse is the diet of adult South Africans?

BACKGROUND: The objective of the current study was to measure dietary diversity in South Africans aged 16 years and older from all population groups as a proxy of food security. METHODS: A cross-sectional study representative of adults from all specified ages, provinces, geographic localities, and socio-economic strata in South Africa was used (n=3287). Trained interviewers visited participants at their homes during the survey. Dietary data was collected by means of a face validated 24 hour recall which was not quantified. A dietary diversity score (DDS) was calculated by counting each of 9 food groups. A DDS<4 was regarded as reflecting poor dietary diversity and poor food security. RESULTS: The provinces with the highest prevalence of poor dietary diversity (DDS<4) were Limpopo (61.8%) and the Eastern Cape (59.6%). By contrast, only 15.7% of participants in Western Cape had a low score. Participants in tribal areas (63.9%) and informal urban areas (55.7%) were by far the worst affected. There were significant differences in DDS by Living Standards Mean (LSM) analysis (p<0.05) with the lowest LSM group having the lowest mean DDS (2.93).The most commonly consumed food groups were cereals/roots; meat/fish; dairy and vegetables other than vitamin A rich. Eggs, legumes, and vitamin A rich fruit and vegetables were the least consumed. CONCLUSION: Overall the majority of South Africans consumed a diet low in dietary variety. The tribal areas and informal urban areas were worst affected and eggs, legumes and vitamin A rich fruit and vegetables, were the least consumed.

Which dietary diversity indicator is best to assess micronutrient adequacy in children 1 to 9 y?

OBJECTIVES: The aim of this study was to determine the best dietary diversity indicator to measure dietary diversity and micronutrient adequacy in children. METHODS: A national representative cross-sectional survey of children ages 1 to 9 y (N = 2,200) was undertaken in all ethnic groups in South Africa. A 24-h recall was done with the mother or caregiver of each child. A dietary diversity score (DDS), the number of food groups consumed at least once in a period of 24 h, was calculated for each child in accordance with 6-, 9-, 13-, and 21-food group (G) indicators and compared with a mean adequacy ratio (MAR). The nutrient adequacy ratio (NAR) was calculated for 11 micronutrients by comparing the distributions of estimated intakes with the Estimated Average Requirements for that micronutrient. The MAR was the average of all NARs. Correlations were done between MAR and DDS and sensitivity and specificity calculated for each group indicator. RESULTS: Pearson's correlations between food group indicators and MAR indicate that r values were all highly significant (P < 0.0001). There were no consistent or large differences found between the different group indicators although G13 and G21 appeared to be marginally better. Sensitivity and specificity values in the current study lay between DDS of 3 and 5, suggesting one of these as the best indication of (low) micronutrient adequacy. CONCLUSIONS: Overall results seem to indicate that any of the four G indicators can be used in dietary assessment studies on children, with G13 and G21 being marginally better. A cut-off DDS of 4 and 5, respectively, appear best.

What is the nutritional status of children of obese mothers in South Africa?

OBJECTIVE: To evaluate the anthropometric status of children of obese (body mass index [BMI] ≥30 kg/m2) mothers who participated during the 2005 National Food Consumption Study. METHODS: The survey population consisted of children 1-9 y of age and their mothers 16 to 35 y of age living in the same households (n = 1532). A national sample of households was drawn, representative of all nine provinces and urban and rural areas. Trained fieldworkers measured the heights and weights of participants at their homes. RESULTS: The prevalence of obesity was high in the mothers (27.9%), particularly in the 26- to 35-y-old (older) group (32.3%) and in urban areas (29.1%). Children of older mothers had a significantly (P < 0.05) higher mean height-for-age Z-score (-0.91) than those of younger mothers (16 to 25 y old, -1.06). Mean weight-for-age and weight-for-height Z-scores were significantly higher in children of obese women compared with those of non-obese women (BMI <30 kg/m2, P < 0.001). Furthermore, obese mothers had significantly more overweight children than non-obese mothers (P < 0.0001). Eighty-four percent of overweight children also had mothers with a BMI ≥25 kg/m2 and 52% had mothers with a BMI ≥30 kg/m2(∗ indicates statistical significance of confidence interval). Stunted mothers had a 1.5 times higher risk of being overweight (BMI ≥25 kg/m2, odds ratio 1.45, confidence interval 1.06-2.01). CONCLUSION: Overall, children of obese mothers had significantly higher mean Z-scores than those of mothers who were non-obese. Overweight and obese women were significantly less likely to have stunted or underweight children, whereas underweight women and stunted women were significantly more likely to have underweight and stunted children, respectively.

Secondary data analyses of dietary surveys undertaken in South Africa to determine usual food consumption of the population.

OBJECTIVE: The primary objective of this study was to generate a reference table of food items and average amounts of these items consumed by South Africans, for the Department of Health. The reference table was required to be representative of foods and beverages eaten frequently by children and adults from all age and ethnic groups in order for the Department of Health to test for contaminants in these foods. DESIGN: The National Food Consumption Survey (NFCS) served as a framework for compiling data on children since this was a national representative survey of 1-9-year-old children undertaken in South Africa in 1999. However, there has never been a national dietary survey on adults in South Africa. Consequently the data had to be extrapolated from existing isolated surveys on adults. Secondary data analysis was conducted on existing dietary databases (raw data) obtained from surveys undertaken on adults in South Africa between 1983 and 2000. Available datasets were regional and independent, and were not individually representative of the South African diet. It was therefore necessary to use different statistical methods, including factor analyses, weighting and correlations, to generate ethnic and geographic representative data for adults. Two methods were used: Method 1, which corresponded with results of the NFCS (over-sampled for low socio-economic status), and Method 2, which was based on ethnic proportions of the population. RESULTS: The secondary data analyses generated food items most commonly consumed by the South African adult population (Method 1) in descending frequency of usage and average (mean) amount per day: maize porridge (78%/848 g), white sugar (77%/27 g), tea (68%/456 g), brown bread (55%/165 g), white bread (28%/163 g), non-dairy creamer (25%/6 g), brick margarine (21%/19 g), chicken meat (19%/111 g), full-cream milk (19%/204 g) and green leaves (17%/182 g). In 6-9-year-olds, maize porridge (72%/426 g), sugar (76%/23 g), tea (51%/258 g), full-cream milk (35%/171 g) and white bread (33%/119 g) were eaten most frequently. Similarly, in 1-5-year-olds, the foods consumed most frequently were maize porridge (80%/426 g), sugar (76%/21 g), tea (44%/224 g), full-cream milk (39%/186 g) and white bread (24%/83 g). In order to evaluate the validity of the adult data generated, kilojoule values of the individual food items (per capita) were compared with food balance sheets (FBSs). The comparison was favourable except that the FBSs had a higher overall energy intake per capita of between 22 and 28%. CONCLUSION: Reference tables of commonly consumed foods and beverages were generated at minimal cost based on secondary data analyses of past dietary surveys in different South African populations.