ABSTRACT
The study assessed the dietary diversity score and nutrient adequacy among adults in Umuahia North Local Government Area of Abia State. This cross - sectional study used simple random sampling techniques to select 429 adults from Afara and Amuzukwu communities in Umuahia North Local Government Area. The aim of the study was to calculate nutrient adequacy of the participants, determine the dietary diversity scores and to examine the relationship between dietary diversity score and nutrient adequacy ratio. Questionnaire was used to collect information on sociodemographic characteristics of the respondents. Food frequency questionnaire and 24- hours dietary recall were used to collect information on the nutrient intake and usual dietary pattern of the respondents which was converted into nutrient intake using Nutri-survey software. The anthropometric measurements of the respondents (weight, height, waist circumference and hip circumference) were taken using standard equipments and procedures and waist/hip ratio was calculated. Dietary Diversity Score (DDS) was created using 12-food group model. Nutrient intake was evaluated using Nutrient Adequacy Ratio (NAR). Mean adequacy ratio (MAR) was calculated as an indicator of nutrient intake. Statistical Package for Service solutions (SPSS) ( version 20) software was used for analysis of the data collected. More than half (56.4%) of the respondents had normal body weight, 15.2% were underweight while 21.2% were overweight and 7.2% were obese. Frequency and percentage, mean and standard deviation and correlation was used to analyze the data and level of significance was accepted at p<0.05. . Fruits, eggs and foods from milk and milk products were the least consumed. The mean DDS was 7.31±1.31. Majority (92.5%) of the respondents had high DDS, 7.5% had minimum DDS and 0.0% had low DDS. The MAR was 71.51±10.70; the intake of some nutrients such as carbohydrate(93.9%) vitamin C(70.2%), energy(50.2%), iron(93.1%), zinc(92%), magnesium(49.8%) and protein(76.9%) was above the recommended dietary intake but there was inadequate intake for some nutrients such as fat(51.9%), calcium(67.6%), sodium(79.0%) and potassium(19.5%) among the respondents. Consumption of foods from energy rich groups were found to be significantly related with nutrient intake adequacy as respondents with adequate intake of nutrients consumed more from energy dense food groups. DDS was significantly related With MAR for all nutrients. These results indicate that dietary diversity is an indicator of nutrient adequacy.
TABLE OF CONTENTS
Title page i
Certification ii
Dedication iii
Acknowledgement iv
Table of Contents v
List of Tables ix
Abstract x
CHAPTER 1:
INTRODUCTION
1.1 Statement of Problems 2
1.2 Objectives of The Study 7
1.2.1 General objectives 7
1.2.2 The specific objectives 7
1.3 Significance of The Study 8
CHAPTER 2:
LITERATURE REVIEW 9
2.1 Adults 9
2.2 Nutrient
Requirement for Adults 9
2.2.1 Protein 10
2.2.2 Carbohydrates 10
2.2.3 Fats
and Oil 10
2.2.4 Vitamins 11
2.2.5 Minerals 11
2.2.6 Water 11
2.3 The
Role of Nutrition in Adults 12
2.4
Effect of Inadequate Nutrition in
Adults 12
2.5 Socio-economic
Parameters 13
2.5.1 Socio-economic
and cultural factors affecting the nutritional status of adult 13
2.5.2 Other
factors affecting the nutritional status of adult 15
2.6 Dietary
Related Problems of Adult 16
2.6.1 Dietary
guidelines of adult 18
2.7 Nutrition and
Nutritional Status 19
2.7.1 Nutritional
assessment 20
2.7.2 Anthropometric
measurement 20
2.7.2.1 Height 20
2.7.2.2 Weight 21
2.7.2.3 Body mass index (BMI) 21
2.7.2.4 Skin fold measurement 22
2.7.2.5 Arm
circumference 23
2.7.2.6 Waist and
hip circumference measurement 23
2.7.2.7 Dietary
assessment 23
2.7.2.8 24-hour
dietary recall 24
2.7.2.9 Food
frequency questionnaires 24
2.7.2.10 Dietary diversity score 24
2.8 Diet 25
2.8.1 Dietary diversity
and food variety score 25
2.8.2 Types of dietary diversity 28
2.8.3 Measurement of dietary diversity 39
2.8.4 Importance and relevance of dietary diversity 31
2.8.5 Urbanization and diet 33
2.8.6 Assessment of dietary
diversity score 34
2.8.7 Nutritional
Knowledge and Food Choices 36
2.8.8 Food
price and diet cost 36
2.9 Outstanding Methodological Issues Related to the
Measurement
of Dietary Diversity 37
CHAPTE 3:
MATERIALS AND METHODS
3.1 Study
Design 42
3.2. Area
of Study 42
3.3 Population
of Study 43
3.4 Sampling
and Sampling Techniques 43
3.4.1 Sample size determination 43
3.4.2 Sampling procedure 43
3.5 Preliminary
Activities 44
3.5.1 Preliminary
Visit 44
3.5.2 Training
of Research Assistants 44
3.6 Data Collection 44
3.6.1 Questionnaire Administration 44
3.6.2 Anthropometric Measurement 45
3.7 Data Analysis 48
3.8 Statistical Analysis 49
CHAPTER 4:
RESULTS AND DISCUSSION
4.1 Socio-Demographic Characteristics 50
4.1.1 Socio-Demographic Data of Adults 50
CHAPTER FIVE: CONCLUSION
5.1 Conclusion 63
5.2 Recommendations 63
REFERENCES
APPENDIX
LIST OF TABLES
Table 3.1: Body Mass Index (BMI) Category 40
Table 3.2: Waist-hip ratio
classification 40
Table 3.3: Recommended
Nutrient Intake (RNI) 41
Table 3.4 : Categorization
of nutrient adequacy ratio of nutrients 41
Table 3.5: Dietary diversity
score classification 41
Table 4.1a:
Socio-demographic characteristics 43
Table 4.1b:
Socio-demographic characteristics continued 44
Table 4.1c:
Socio-demographic characteristics of the respondents (continued) 45
Table 4.2a: Mean
anthropometric status of the respondents 46
Table 4.2b: Anthropometric
status of the respondents 47
Table 4.3a : Frequency and
percentage consumption of food groups 49
Table 4.3b: Dietary
diversity score of the respondents 49
Table 4.3c: Dietary
diversity score categorization of respondents 50
Table 4.4: Food frequency
distribution of the respondents according to the food group 52
Table 4.5a: Nutrient Intake
of the respondents 53
Table 4.5b Nutrient adequacy
ratio (NAR) and mean adequacy ratio (MAR) distribution 54
Table 4.5: Relationship
between Dietary diversity score and nutrient adequacy 56
ratio (NAR) and (MAR)
CHAPTER 1
1.0 INTRODUCTION
A diet, which is sufficiently diverse, reflects
nutrient adequacy (Kennedy et al.,
2009). This is because there is no single food which contains all the nutrients
required for optimal health. The more varieties of foods from different food
groups are included in the daily diet, the greater the likelihood of meeting
nutrient requirements (WHO 2010). Since no single food can contains all
nutrients, the more food groups included the more it meets nutrient
requirements (Labadarios et al.,
2011). Dietary diversity score (DDS) is defined as a number of different food
or food groups consumed in the previous day (Hatloy et al., 2006). Dietary diversity is a qualitative measure of food
consumption that reflects household access to a variety of food and it is a
proxy of nutrient adequacy of the diet of individuals. Individual's dietary
diversty score aims to reflect nutrient adequacy (Hatloy et al., 2006). .
Nutrient adequacy can be defined as a sufficient
intake of essential nutrients needed to fulfil nutritional adequacy. It emerges
from the comparison between the nutrient requirement and the intake of certain
individual or population. (Ruel., 2003). Variation in an individual's diet is
associated with the intake of adequate energy and essential nutrient. That is
why increase variety in diets is recommended in most dietary guideline globally
(Ruel., 2003). The most common method of measuring dietary diversity for a
household or for an individual is by
assessing the varieties of different food groups consumed in specific recall
period. Dietary diversity can be measured at either at the household levels
or individual level and higher scores
represents a more diverse diet and increased economic access.( Seidell et al., 2011) Household dietary
diversity has been shown to be associated with caloric and protein adequacy and
household income (Hatloy et al.,
2006). The variability of nutrient content within each food group can be
another source of inconsistency (La vicchia et
al., 2001), despite the problem of standardization dietary diversity is
still been validated as a measure of nutritional adequacy .
Local and
international dietary recommendations promote increased dietary diversity but
limits saturated fats, refined sugar and salt (Ruel, 2003). Lack of dietary diversity is a major
nutritional concern among deprived people from the low income countries.
Changing from monotonous diet to one with varied food types has been shown to
improve energy and nutrient intakes in people from developing countries. The
demographic and economic transition that many developing countries are
undergoing is producing important changes in diet and lifestyle behaviors that
greatly impact on disease risk. (Jayawardena
et al., 2013)
Despite nutrient deficiencies being major concerns in
the developing countries, recent nutrition transition and changes in the
physical activity pattern, diet related metabolic problems has emerged as
alarming public health problems in many developing countries, especially among
urban dwellers. Nutritional status is considered as outcome of biological
processes that involve food utilization while dietary diversity ensures
adequate nutrient intakes among various social groups ( Steyn et all., 2006).
1.1 STATEMENT OF PROBLEM
The nutritional status of an adult is considered as a
measure of macro and micro nutrient adequacy irrespective of the level of food
intake (Theim et al., 1998). Global
nutrition transition has shifted dietary habits particularly in urban settings
(Bleiberg et al., 2001). Market system have been infiltrated with
modernized convenient food habits leading to excessive consumption of salts,
high consumption of these foods coupled with less physical activities greatly
contributes to rising lifestyle of chronic disease among adults (Hatloy et al., 2006).
Seasonality is recognized as key element of food
availability in many country particularly in Nigeria. Each year rural
population in Nigeria face a seasonal food shortage during the period between
the depletion of cereal stock and the next harvest, the shortage are
particularly harsh in areas where people depend on the annual harvest of the
staple crops after a single rainy season. This is also characterized by intense
agricultural work (Bleiberg et al.,
2001) and increased morbidity (Armonds et
al., 1995). The problem of not consuming food from diverse diet is really
alarming because a study has shown that over 300 billion people in Africa are
malnourished because of non-diverse diet and over 120 millions are micro-nutrient
deficient (WHO., 2006). Globally there is evidence that approximately 2billion
people are suffering from hidden hunger which has a devastating effect and
significantly contributes to global burden of disease (Kraemer, 2010). Adults
are faced with multiple challenges and more continues to emerge everyday which
includes excess workload, poverty, lack of time etc. This creates some problems
to adults like poor nutrients intake, obesity, wrong food choice, poor feeding
habit, food insecurity etc. Food affects the level of physical, mental, and
social wellbeing of individuals (Ajala,
2006). Recent data worldwide showed an absolute increase in the
prevalence of obesity in recent years; about 13% if the world's adult
population (11% of men and 15% of women) was obese in 2014 (WHO 2015 and
Cabllero, 2007). Studies carried out in developing countries by Natural
Nutrition survey (2002) indicates that people from a higher socio class tend to
have more diverse diet and more adequate nutrient than those from lower class.
One of the clearest intergenerational effect of low diverse diet is weak immune
system and higher risk of disease (National Nutrition Survey, 2002). Inadequate nutrient intake or nondiverse diet can lead to
reduced learning ability, increases reproductive and maternal health risk and
lowers productivity. This situation
contributes to an adult's diminished ability to access other assets later in life. People that are
undernourished are caught in a vicious cycle of poverty and under nutrition (Teller et
al., 2000).
Some dietary related
problems that makes dietary diversity score an area of concern are; overweight and obesity, cardiovascular diseases; diabetes milletus; hypertension,
diseases of the joint and bones are common
afflictions of the elderly. Osteoporosis and osteomalacia are associated with
reduction of bone mass in many persons in
their middle and later years of life and all these diseases are diet related.
Dietary diversity of
Nigeria diet was evaluated in six states representing the three Agro-ecological
zones, rural and urban sectors of Nigeria, in the study the mean DDD was 5.81
and 83% of the participants had medium DDS while 16.5% had low DDS which tells
us that dietary diversity is poor in Nigeria and effort to improve nutritional
status must first address the issue of dietary diversity (Ajania 2010)
1.2 OBJECTIVES OF THE STUDY
1.2.1 General
objectives
The general objective of this study was to determine
the relationship between dietary diversity score and nutrient adequacy among
adults in Umuahia North Local Government of Abia State.
1.2.2 Specific objectives
The specific objectives of this study are to:
i. access the respondents socio- economic status
ii. calculate nutrient adequacy of the participants.
iii. determine the dietary diversity score using
24hour recall and food frequency questionnaire.
iv. examine the relationship between dietary diversity
score and nutrient adequacy.
1.3 SIGNIFICANCE OF THE STUDY
In Nigeria, due to rapid urbanization, nutrition
problems namely undernutrition and overnutrition have been reported. Despite
the initiative implemented by the Government and other stakeholders, still
nutrition problems have declined only slightly (NBS, 2011). This will help to
expose the need for diverse diet and adequate nutrient intakes. The study will
provide information that will be relevant to policy makers, teachers, food
agencies, government, health professionals and program planners to build a
basic and stronger foundation for the design of appropriate and cost effective
interventions to improve the nutrient and health situation of the adult. This
study will enable the government to know the appropriate and necessary area to
channel their project and programmes so as to ensure a sustainable economic and
nutritional development of the area.
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