ABSTRACT
Nutritional adequacy is the key element for human growth and development. Inadequate or excess intake of the nutrients may result to poor nutritional status. However, Dietary diversity has been considered a potential 'proxy' indicator to reflect nutrient intake adequacy. This study aimed at assessing the Dietary Diversity and Nutrient Adequacy among adults in Rural Ikwuano Local Government of Abia State; calculate nutrient adequacy of the participants, determine the dietary diversity score and the relationship between dietary diversity score and nutrient adequacy. The respondents were selected using a simple random sampling technique involving 439 adults in Amawom and Amaoba, ikwuano L.G.A. The anthropometric measurements of the respondents were taken using standard equipment. A 24-hour dietary recall questionnaire was used to assess the food intake of the respondents, which was converted into nutrient intake using Nutri-survey software. Dietary Diversity Score (DDS) was created using a 16-food group model. Nutrient intake was evaluated using Nutrient Adequacy Ratio (NAR). Mean adequacy ratio (MAR) was calculated as an indicator of nutrient intake adequacy. Statistical Package for Social Sciences (SPSS) software was used for analysis of the data collected. More than half (56.4%) of the respondents had normal body weight, 4% were underweight, 23.8% were overweight and 15.9% were obese. The diet of the respondents consisted of food items mainly from food groups such as cereals, white roots and tubers, vitamin A-rich vegetables, spices, condiments and beverages. Fruits and foods from milk and milk products were the least consumed. The mean DDS was 9.11±1.79, 97.4% of the respondents had high DDS, 1.9% had medium DDS and 0.7% had low DDS. The MAR was lower in the female (64.39) than male (66.99). Zinc had an average NAR of at least 100%. Carbohydrate had an average NAR greater than 90%. The result revealed that protein and carbohydrate intakes were significantly higher in female participants (83.70± 35.92) and (91.82 ± 40.31) respectively than male participants (76.29 ± 34.16) and (82.66 ± 40.62) respectively. This study revealed that there was no significant relationship between nutrient adequacy ratio and dietary diversity score and no significant relationship between mean adequacy ratio and dietary diversity score.
TABLE OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv
TABLE OF CONTENTS v
LIST OF TABLES viii
ABSTRACT x
CHAPTER 1: INTRODUCTION
1.0 Background
Of The Study 1
I.1
Statement
Of Problem 4
I.2
Objective
Of The Study 6
1.2.1 General
objectives 6
1.2.2 Specific
objectives 6
I.3
Significance
Of The Study 7
CHAPTER
2: LITERATURE REVIEW 8
2.1 Dietary
Diversity 8
2.1.1
Measurement of dietary diversity 8
2.1.2
Relevance of dietary diversity 9
2.1.3 Socio-demographic
determinants of dietary diversity 10
2.1.4 FAO’s
dietary diversity guidelines 14
2.1.5 Dietary
assessment methods 15
2.2 Nutrient
Adequacy Assessment 17
2.3 Food
Choice 21
2.3.1 Sensory
appeal and food preferences 21
2.3.2 Price 21
2.3.3 Health
and wellbeing 22
2.3.4 Weight
control 22
2.3.5. Nutrition
knowledge 22
2.3.6 Life
stage 23
2.3.7 Culture
and religious beliefs 23
2.3.8 Lifestyle
choices 24
2.3.9. Habits,
routines and past experiences 25
2.3.10 Hunger
and appetite 25
2.3.11. Approaches to understanding food
choice 25
2.4 Adults 28
2.4.1 Nutrient needs
of adults 29
2.5. Dietary
Assessment 31
2.5.1. Nutritional
status assessment of adults 31
2.5.2 Anthropometry 31
2.5.3 Biochemical
assessment 32
2.5.4 Clinical assessment 32
CHAPTER 3: MATERIALS AND METHODS
3.1 Study
Design 33
3.2 Area
Of Study 33
3.3 Population
Of Study 33
3.4 Sampling
And Sampling Techniques 34
3.4.1 Sample
Size 34
3.4
Sampling Procedure 35
3.5 Preliminary
Activities 35
3.5.1 Preliminary
Visits 35
3.5.2 Training
Of Research Assistants 35
3.5.3 Ethical
Approval 36
3.6 Data
Collection 36
3.6.1 Questionnaire
Administration 36
3.6.2 Anthropometric
Measurements 36
3.6.3 Dietary
Measurement 38
3.7 Data
Analysis 41
3.8 Statistiscal
Analysis 42
CHAPTER 4: RESULTS AND DISCUSSION
4.1 Socio-Demographic Characteristics 44
4.2.1 Anthropometric characteristics of the participants 46
4.3 Dietary Diversity Scores Of Participants 48
4.3b Dietary diversity score of the respondents 50
4.3c: Dietary diversity score categorization of participants 51
4.4 Nutrient Adequacy Ratio Of Participants 53
4.5 Relationship Between Nutrient Adequacy
Ratio (Nar), Mean Adequacy
Ratio (Mar) And
Dietary Diversity Score (DSS) 55
CHAPTER 5: CONCLUSION AND RECOMMENDATION
5.1
Conclusion 58
5.2
Recommendation 58
REFERENCES
LIST OF
TABLES
Table 3.1: Body Mass Index Classification 42
Table 3.2:
Classification of Waist to Hip Ratio 42
Table 4.1: Socio-demographic
characteristics of the participants 45
Table 4.2: Anthropometric
indices of the participants 47
Table 4.3a:
Frequency consumption of food groups among the respondents 49
Table 4.3b: Dietary
diversity score of the respondents 51
Table 4.3c: Dietary diversity
score categorization of participants 52
Table 4.4: Mean
adequacy ratio (MAR), nutrient adequacy ratio (NAR), and
dietary diversity
score (DDS) of participants 54
Table4.5: Relationship Between
Nutrient Adequacy Ratio (Nar), Mean Adequacy Ratio
(Mar) And Dietary Diversity Score (DSS) 56
CHAPTER 1
INTRODUCTION
1.0 BACKGROUND OF THE STUDY
Dietary Diversity is
defined as the number of individual food items or food groups consumed over a
given period (Ruel, 2003). It can be measured at the household or individual
level through use of a questionnaire. Most often it is measured by counting the
number of food groups rather than food items consumed. The type and number of
food groups included in the questionnaire and subsequent analysis may vary,
depending on the intended purpose and level of measurement. At the household
level, dietary diversity is usually considered as a measure of access to food,
(e.g. of households’ capacity to access costly food groups), while at
individual level it reflects dietary quality, mainly micronutrient adequacy of
the diet. The reference period can vary but is most often the previous day or
week (Food and Agriculture Organization FAO, 2011; World Food Programme WFP,
2009).
As no single food
contains all necessary nutrients, diversity in dietary sources is needed to
ensure a balanced and healthy diet (Randall et
al., 1985). Consequently, dietary diversity score (DDS) which quantifies
the number of food groups in a diet consumed over a reference period emerged as
a potential indicator of nutritional adequacy (FAO, 2007). It is well
documented in developed countries that dietary diversity at different types of
sources is strongly associated with nutrient adequacy and is thus an essential
element of diet quality (Randall et al.,
1985).
Nutritional adequacy
is defined as the sufficient intake of essential nutrients, needed to fulfill
nutritional requirements for optimal health. According to the criterion of
adequacy defined, the requirement for a given nutrient may be at a lower or
higher intake amount. The criteria that are generally used to define adequacy
of intake are: the prevention of deficiency diseases, the prevention of chronic
diseases or the reduction of risk for diet associated diseases, subclinical
nutritional health conditions identified by specific biochemical or functional
measures, or requirements to maintain physiological balance (Dhonukshe-Rutten et al., 2013).
In
developing countries where the main concern is dietary deficit, nutrient
adequacy alone is often used to refer to dietary quality. However, quantifying
intake of nutrients is often expensive, time consuming and associated with
methodological challenges in developing countries (Ruel, 2002).
Although
dietary diversity and nutrient adequacy are related, they do not reflect the
exact same constructs. When using the simple content of food groups as
indicator of more complex nutrient adequacy, it is important to be aware of the
similarities and differences between the two (Torheim, 2004)
Dietary
diversity score is differentiated as household dietary diversity score (HDDS)
and individual dietary diversity score (IDDS), including child diversity score
(CDDS) and women dietary score (WDDS) (FANTA, 2006). Household dietary
diversity score is a proxy measure of the household access to food, or the
proxy measure of the socio-economic level of the household, whereas the
individual dietary diversity score is a proxy measure of the nutritional quality
of the individual’s diets, particularly that of micronutrient adequacy of a
diet (Vicchia et al., 2001). Two to
different arrays food groups formed the basis for quantifying DDS as indicator
of nutritional quality, most often 12 food groups are considered for household
dietary diversity (HDDS) and 8 or 9 food groups for individual dietary
diversity (IDDS) (Kennedy et al., 2007).
Dietary
diversity (DD) has been universally identified as a key element of high-quality
diets. As dietary factors are associated with increased risk of chronic
diseases and undernutrition, local and international dietary guidelines
recommend to improve the diversity of the diet. Macro and micro nutrient
deficiencies are public health concerns in most developing counties including
Sri Lanka, due to monotonous, cereal-based diet that lacks diversity (Ruel, 2003).
Furthermore, diverse diet reflects the nutrient adequacy of the diet (Mirmiran
et al., 2006). Several studies showed
that the overall nutritional quality of the diet is improved with diverse diet (Hatley
et al., 1998; Ogle et al., 2001; Torheim et al, 2003). Therefore, diversity in
the diet is important to meet the requirements for energy and other essential
nutrients especially for those who are in the risk of nutrition deficiencies (Mowe
et al., 1994).
Diverse diets have been shown to protect
against chronic diseases such as cancers (McCullough et al., 2002), as well as being associated with prolonged longevity
and improved health status (Kant et al., 1995).
Evidence suggests that nutrient intake
is influenced by many socio demographic attributes.
Income determines nutrition
and also provide an index of the purchasing capacity of adults. In a report stated
by World Bank in 1980 the serious and extensive nutritional deficiencies that
exist in almost all of these countries are “largely a reflection of poverty,
people do not have enough income for food”(World Bank, 1980)With the
improvement of household income, absolute expenditure on food is likely to go
up, as is the calorie and protein intake of the household, including adults (Gobalan
et al., 2012).
According to a study done by Galobardes et
al. in Geneva showed that lower education contributed to determining
differences in dietary habits and dietary intake (Galobardes et al., 2001).
1.1 STATEMENT OF PROBLEM
According to Ruel
(2002), lack of dietary diversity is a challenge for rural and urban communities
in developing countries. Household income, educational level and employment
status affects dietary pattern of adults in Nigeria especially the rural area,
thereby affecting the nutrient adequacy of their diet due to consumption of
non-diversified diet.
It has been clearly
stated that a non-diversified diet can have negative consequences on
individuals’ health, well-being and development, mainly by reducing physical
capacities and resistance to infection, but also by impairing cognitive
development, reproductive and even social capacities (Underwood, 1998).
Dietary Diversity of Nigerian diet was evaluated in six
states representing the three Agro- ecological zones, rural and urban sectors
of Nigeria. 1,472 women with a mean age (SD) of 27.9(6.2) years participated in
this study. Majority (97.1%) were married, occupation included traders (21.5%),
civil servants (23.9%), artisans (19.1%) and farmers (15.4%). Overall, mean
dietary diversity score (DDS) was 5.81 (1.4). This varied from 6.61 in Akwa-Ibom
state to 4.98 in Kaduna state. Overall 83% of the participants had
average/medium DDS (5-9) while 16.5% had low (1-4) DDS. These varied
significantly among the states. Low DDS (1-4) was 25% and 33% in the states in
the dry Savanna zone but 12.8% and 10% in the states in moist Savanna zone and
6.4 and 6.2 in humid forest. These differences are significant (p<0.05). In
conclusion dietary diversity is poor in Nigeria and efforts to improve
nutritional status must address the issue of dietary diversity (Ajani, 2010).
Practice of
non-diversified diet can lead to nutritional deficiency. Adults suffering from nutritional
deficiency may feel tired and find it difficult to work hard and may be prone
to poor health. This may make it difficult for them to provide for their
families. Poor diversification of diets in the household level and individuals
poses a threat to nutritional status of individuals which can cause very
chronic diseases and mortality rate increase. Similarly, adults who are very
overweight are more likely to have certain kinds of serious health problems.
Therefore, problems
of insufficient intake of vitamins and minerals such as vitamin A, B6, C,
Thiamin, riboflavin, niacin, calcium, iron and zinc as well as excessive
consumption of calories and fat especially in rural areas as may be influenced
by Poverty, ignorance, food insecurity, socio demographic characteristics
etc prompted and motivated this research study. Therefore, it was necessary to
investigate their dietary diversity and nutrient adequacy relating to their socio-demographic
characteristics.
I.2 OBJECTIVE OF THE STUDY
1.2.1 General objectives:
This work examines the relationship between dietary diversity score
(number of food items and food groups consumed), nutrient adequacy (the mean ratio
of intake to recommended intake) and socio-demographic parameters of adults in
a rural Ikwuano adult population.
1.2.2 Specific objectives:
The specific objectives include to:
I.
determine the socio-economic parameters among Ikwuano adult population.
II.
determine their dietary diversity
score.
III.
determine their nutritional
adequacy.
IV.
determine the relationship
between dietary diversity score, nutrient adequacy and socio-economic
parameters of the respondent.
I.6
SIGNIFICANCE OF THE STUDY
This research will help to motivate educators, as well as other
nutritionist educating families, adults etc on the benefits of dietary
diversity in the households. The success of this study will create awareness
and provide appropriate and adequate knowledge on proper dietary practice. It
will further provide convincing information to the government for use in
planning programmed and policies that will improve the nutritional adequacy as
well as nutritional status of adults in general.
This study can be used to make policies by
the government regarding fortification of food products in order to meet the
nutrient needs of adults.
In the education sector food based dietary
guidelines can be used to change the eating pattern of adults since dietary
pattern can be passed from adults in households to children.
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