Healthy Diets from Sustainable Food Systems: Calculating the WISH Scores for Women in Rural East Africa.

Diets should be healthy for the benefits of both humans and the environment. The World Index for Sustainability and Health (WISH) was developed to assess both diets' healthiness and environmental sustainability, and the index was applied in this study. Food intake quantities for single foods were calculated based on the data collected from four 24-h recalls during two seasons in 2019/2020 with women of reproductive age in two rural areas each in Kenya, Tanzania and Uganda (n = 1152). Single foods were grouped into 13 food groups, and the amount of each food group consumed was converted to an overall WISH score and four sub-scores. The food groups with a low WISH score were fruits, vegetables, dairy foods, fish, unsaturated oils and nuts, meaning that their consumption was outside the recommended range for a healthy and sustainable diet. Contrariwise, the intake of red meat and poultry was partly above the recommended intake for those women who consumed them. The overall WISH score and sub-scores showed that the consumption of "protective" food groups needed to increase in the study population, while the consumption of "limiting" food groups was sufficient or should decrease. For future application, we recommend dividing food groups that are critical for nutrition, e.g., vegetables, into sub-groups to further understand their contribution to this index.

Are processed fruits and vegetables able to reduce diet costs and address micronutrient deficiencies? Evidence from rural Tanzania.

OBJECTIVE: To assess the impact of integrating processed fruits and vegetables (FV) into diets in terms of diet cost reduction and ensuring nutritional adequacy year-round. DESIGN: Market surveys were conducted to record foods. Focus group discussions (FGD) and 24-h dietary assessments - from children and women - were carried out to determine culturally accepted dietary habits. Six processed FV were considered for addition to diets. Using the Cost of Diet linear programming tool, standards diets were first modelled, and subsequently, the processed FV were included to analyse their impact. SETTING: Rural Tanzania: Mtwara and Morogoro. PARTICIPANTS: Market survey: 50 traders; FGD: 40 women; 24-h recalls: 36 infants aged 6-23 months, 52 children aged 6-13 years and 292 women. RESULTS: The standard diet costs between TZS 232 and 2368 (USD 0·3-3) daily for infants. For children aged 6-13 years, it costs between TZS 1711 and 7199 (USD 2·2-9·1) daily and the cost for the women was between TZS 2793 and 10 449 (USD 3·5-13·2). Addition of the processed FV reduced diet costs by up to 61 %, 48 % and 49 % for children aged 12-23 months, children aged 6-13 years and women, respectively. However, for infants aged 6-11 months, costs rose by up to 127 %. The processed FV addressed all micronutrient gaps in the diets except for infants aged 6-11 months, where some micronutrient intakes were unfulfilled. CONCLUSIONS: Processed FV could provide a feasible option to ensure availability of nutritious but cheap diets year-round. Hence, interventions to process FV into nutritious and affordable products should extensively be pursued.

Nutrition integrated agricultural extension-a case study in Western Kenya.

Integrating nutrition communication in agricultural intervention programs aimed at increased food availability and accessibility in resource-poor areas is crucial. To enhance the sustainability and scalability of nutrition communication, the present study piloted the approach of 'nutrition integrated agricultural extension' and tested nutrition-related outcomes with two types of nutrition messages (specific vs. sensitive) and two delivery channels (public sector vs. private sector). The study intervention comprised (i) vegetable seed kit distribution, (ii) ongoing agricultural extension activities by public or private sectors and (iii) nutrition communication with two different messages. The intervention was tested with three treatment arms and reached 454 farmers (>65% female) in rural Kakamega County, Western Kenya. Pre-/post-surveys measured outcome variables focused on farmers' nutrition-related knowledge, attitudes and practices in vegetable production and consumption, and household dietary diversity score. Results showed that all treatments increased nutrition knowledge (p < 0.05). Nutrition-specific communication was more effective than nutrition-sensitive communication. Nutrition communication through either the public or the private agricultural sector was both effective. Before the study intervention, many participants believed that vegetable consumption was beneficial and wanted to increase intake. After the intervention, the number of participants who felt eating more vegetables was challenging decreased slightly. Nutrition communication was found to be especially important in conveying recommended food amounts and promoting increased vegetable consumption. Seasonality affected on-farm crop diversity and vegetable consumption results in this study.

Changes in Vegetable Consumption in Times of COVID-19-First Findings From an International Civil Science Project.

The crisis related to the COVID-19 pandemic influenced food security and nutrition through both direct and indirect pathways. This ranged from short-term to long-term impacts, not only on health but also on food systems and thus on nutrition. This study aimed to identify how the observed constraints affected the food intake of populations across the globe. Here, special attention was paid to the consumption of vegetables and legumes and the diversity within these food groups. An online survey on Food and COVID-19 was conducted using a semi-structured questionnaire translated into several languages. Binary logistic regression models and Poisson regression models were calculated to evaluate changes in consumption patterns and to test potential determinants for the changes. For more detailed information on reasons for changes open ended questions were analysed qualitatively. Time spend at home, working from home, and mental stress were important drivers for changes in dietary intake according to the 1,042 respondents included in this analysis. The participants observed a change in food quantity (38%) and vegetable intake (27%). No changes were observed for the number of vegetable groups consumed, while significant reductions in diversity were detected within all vegetable groups. Moreover, associations between the number of consumed vegetable types during the COVID-19 pandemic and income regions as well as gender were found. The regression analysis showed that the level of decrease in vegetable diversity in the different vegetable groups were often depending on educational and occupational status, gender and household environment. Changes in food prices were related to changes in vegetable intake per se, overall vegetable diversity, and diversity within the provitamin A rich vegetable group. Food systems are not static and are transitioning quickly as could be observed during the Covid-19 pandemic. There is a need for a nutrition strategy to strengthen the resilience of vulnerable households to consume a diverse diet in adequate amount even in times of a pandemic.

Dietary Patterns as Characterized by Food Processing Levels and Their Association with the Health Outcomes of Rural Women in East Africa.

Overweight and obesity are rapidly rising in Sub-Saharan Africa including in rural areas. However, most studies focus on urban centers, and have attributed this epidemic to the consumption of processed foods without their clear characterization. This study investigated food intake patterns defined by food processing levels and their association with overweight/obesity in rural areas. Four 24-h dietary recalls, anthropometric measurements, and socio-demographic characteristics were collected from 1152 women in Kenya, Tanzania, and Uganda. The PCA method was used to extract patterns characterized by food processing levels. The association between patterns and overweight/obesity was ascertained with regression models. The overweight/obesity rate was 47%, 42%, 26%, and 38% in Kenya, Tanzania, Uganda, and East Africa (as pooled data), respectively. Several patterns were identified, yet a "plant-based pattern" largely characterized by unprocessed and minimally processed foods and a "purchase pattern" mainly distinguished by highly processed foods were dominant. The "plant-based pattern" was inversely or not associated with overweight/obesity, while the "purchase pattern" had a positive association or no association. A clear distinction on processed foods as healthy and unhealthy should be made based on their nutrient provision to avoid their mischaracterization as unhealthy. Policies to reverse consumption of unhealthy processed foods while promoting healthy ones should be pursued.

Seasonal Variations in Dietary Diversity and Nutrient Intakes of Women and Their Children (6-23 Months) in Western Kenya.

Seasonal variations in food availability and access contributes to inadequate nutrient intakes, particularly in low income countries. This study assessed the effect of seasonality on dietary diversity (DD) and nutrient intakes of women and children aged 6-23 months in a rural setting in Western Kenya. A longitudinal study was conducted among 426 mother-child pairs during the harvest and post-harvest seasons in 2012. Dietary intakes were assessed using 24-h dietary recalls and dietary diversity scores (DDS) and nutrient intakes calculated for both seasons. Effect of seasonality on women dietary diversity scores (WDDS) and children's dietary diversity scores (CDDS) were assessed using generalised linear mixed models (GLMM). The proportion of women consuming diets with high DDS (>4 out of 9 food groups) increased from 36.4 to 52.4% between the two seasons, with mean WDDS being significantly higher in November compared to July/August (4.62 ± 1.43 vs. 4.16 ± 1.14, P < 0.001). A significantly higher proportion of children consumed foods from ≥4 out of 7 food groups in November compared to July/August (62.4 vs. 52.6%, P = 0.004). Mean CDDS (3.91 vs. 3.61, P = 0.004) was low but significantly higher in November compared to July/August. Estimated marginal mean WDDS increased from 4.17 to 4.38, and decreased for CDDS from 3.73 to 3.60 between the seasons. Seasonality had a small but significant effect on WDDS, P = 0.008 but not on CDDS, P = 0.293. Increase in CDDS in November was due to age and not seasonal effect. Higher women education and household food security were associated with higher WDDS and CDDS. Intakes of iron, calcium and vitamin E were higher among women in November and significantly different between the seasons. Agro-ecological zone, ethnic group and home gardening influenced nutrient intakes of the women. Seasonality had an effect on the DD of women but not of children, thus other factors apart from food availability influence the quality of children's diets during the complementary feeding period. With increasing age and transition to family foods, children's DD is expected to be affected by seasonality. Integrated interventions to alleviate seasonal food insecurity and strengthen rural households' resilience against seasonal deterioration in diet quality are recommended.

The Impact of Local Agrobiodiversity and Food Interventions on Cost, Nutritional Adequacy, and Affordability of Women and Children's Diet in Northern Kenya: A Modeling Exercise.

Wild plant species are often excellent sources of micronutrients and have the potential to promote healthy living, yet they are under-exploited. Distribution of micronutrient powders as diet supplements can play an effective role in reducing micronutrient deficiencies among infants and young children. However, assessing their effects in ensuring a nutritious diet at low cost have been limited. This study assessed the impact of including wild plant species and micronutrient powders in modeled optimized lowest-cost diets for women and children in rural Kenya. Market surveys, focus group discussions in six villages and a 24-h dietary intake recall were used to collect data that were subsequently entered in the cost of diet linear programming tool to model lowest-cost nutritious diets for women and children in Turkana County, Kenya. Three wild vegetables, three wild fruits, and micronutrient powder were added to the models to assess their impact on the cost and the nutrient adequacy of the diets. A locally adapted cost optimized nutritious diet without any intervention costs between 50 and 119 Kenyan shillings (KES) daily ($0.5 to $1.2) for children between 6 and 23 months and 173 to 305 KES ($1.8 to $2.9) for women. Addition of the three wild vegetables resulted in cost reductions between 30 and 71% as well as making up for iron and zinc gaps. The micronutrient powder had an insignificant effect on diet cost and filling nutrient gaps. Edible wild plant species, specifically wild vegetables, can reduce diet costs in considerable proportions while filling nutrient gaps year-round. However, affordability of a nutritious diet remains a major challenge in Turkana County, irrespective of the wealth group.

Contribution of Nutrient Diversity and Food Perceptions to Food and Nutrition Security Among Smallholder Farming Households in Western Kenya: A Case Study.

BACKGROUND: Sub-Saharan Africa is the only region in the world where hunger is prevalent in over one-third of the population, with smallholder farming households, producers of over 80% of Africa's food, facing both calorie and micronutrient deficiencies. With agricultural systems serving as the main source of all nutrients, little is known about the extent to which agricultural diversity in different seasons can meet macro- and micronutrient needs in rural Africa. OBJECTIVE: Linkages between nutrient diversity and food species were investigated. METHODS: A case study was conducted in Western Kenya to assess the seasonal nutrient diversity, seasonal nutrient accessibility levels, and food perceptions in 30 smallholder farms, 7 markets, and among 97 focus group discussion participants, respectively. All present food plant and animal species were inventoried and assigned to 1 of the 7 major Food and Agriculture Organization-defined food groups. Based on 2 macronutrients and 5 micronutrients, dendrogram-based nutrient functional diversity metrics were calculated. RESULTS: On-farm and market food species offered all 7 macro- and micronutrients under investigation, regardless of seasonal variation in species numbers. Although there were varying seasonal nutrient accessibility levels in markets, farms were especially effective in readily availing 4 of the 7 nutrients. However, the main food shortage months coincided only with maize shortage, but a diversity of local foods, deemed to be of low cultural and culinary preferences, were available. CONCLUSIONS: Nutrition education on the importance of a diversity of local foods in meeting dietary needs, thus stimulating the demand side, can contribute to achieving year-round household food security.

Influence of Seasonal On-Farm Diversity on Dietary Diversity: A Case Study of Smallholder Farming Households in Western Kenya.

This study explored the associations between dietary patterns and farm diversity as well as socioeconomic variables during two seasons in rural Western Kenya. As a mean of two surveys, the average dietary diversity scores (DDS) of households and women were low, implying low household economic access to food and low women's dietary quality. The Food Consumption Score (FCS) showed that acceptable levels of food consumption were realized over seven consecutive days in the 2014 survey by the majority of households (83%) and women (90%). While there was no strong association between the food scores and seven farm diversity indicators, both food scores were significantly associated with the household's wealth status, ethnicity of both the household head and the spouse, and the education level of the spouse. For holistic household food and nutrition security approaches, we suggest a shift from a focus on farm production factors to incorporating easily overlooked socioeconomic factors such as household decision-making power and ethnicity.

Community-based educational intervention improved the diversity of complementary diets in western Kenya: results from a randomized controlled trial.

OBJECTIVE: Lack of diversity is a major factor contributing to inadequate nutrient intakes among children during the complementary feeding period in many rural areas in developing countries. This has been attributed to inadequate feeding practices and nutrition knowledge among their caregivers. The aim of the present study was to assess the effect of an educational intervention on children's dietary diversity and nutrition knowledge of caregivers. DESIGN: Cluster randomization was applied and twenty matched village pairs were randomly assigned to the intervention or control group. The nutrition education intervention consisted of four sessions comprising of group trainings and cooking demonstrations that were conducted over a period of 5 months. SETTING: Households in rural communities in Bondo and Teso South sub-counties, western Kenya. SUBJECTS: Caregivers with children aged 6-17 months receiving nutrition education. RESULTS: The children's dietary diversity scores (CDDS) and nutrition knowledge scores of the caregivers improved significantly in the intervention group at endline. The treatment effect on CDDS was positive and significant (P=0.001). The CDDS rate of the children in the intervention group was 27% larger than it would have been without the treatment effect. The intervention also had a significant effect on the caregivers' nutrition knowledge scores (incidence rate ratio=2.05; P<0.001). However, the nutrition knowledge of the caregivers did not have a significant effect on CDDS (P=0.731). CONCLUSIONS: The nutrition education intervention led to improvements in children's dietary diversity and nutrition knowledge of the caregivers.

Obesity as a public health problem among adult women in rural Tanzania.

BACKGROUND: For many developing countries, obesity and its sequelae have become a challenge of a magnitude similar to hunger and undernutrition. The main objective of this study was, therefore, to investigate the weight status of women in rural Tanzania with reference to season as well as the link between women's weight, food consumption, and attitudes toward obesity. METHODS: Three cross-sectional surveys in 3 different seasons within 1 year interviewed the same 210 women, ages 17-45 years, from 3 rural districts of northeastern and central Tanzania. These surveys assessed body mass index (BMI), food intake, and dietary diversity through 24-hour recalls, women's attitudes toward obesity, vegetable production, and socioeconomic status. RESULTS: Although 71% of the women had a normal BMI, 7% were underweight, 16% overweight, and 6% obese. The BMI was correlated with the Dietary Diversity Score (DDS), the Food Variety Score (FVS), with the consumption of foods from the food groups "bread/cakes," "sugar," and "tea," and with the production of exotic vegetables. In a multiple regression model, FVS was directly associated with BMI. When asked to describe the typical characteristics of an obese person, women mentioned more negative than positive characteristics. CONCLUSION: The prevalence of overweight and obesity was 3 times higher than that of underweight. Apparently, even in rural areas of Tanzania, a nutrition transition is underway. No direct association was identified between vegetable consumption and BMI. Although this study did not assess behavioral factors, such behavioral factors as activity levels as well as attitudes need to be considered, even in rural settings, to address all facets of malnutrition.

Dietary patterns and nutritional health of women: the nutrition transition in rural Tanzania.

BACKGROUND: Many developing countries are experiencing a rapid nutrition transition in urban areas. OBJECTIVE: To investigate whether a nutrition transition was occurring in a rural area by examining the dietary patterns of women in rural Tanzania. METHODS: A total of 252 women aged 16 to 45 years from three districts of northeastern and central Tanzania participated. During three different seasons in 2006-2007, the women were interviewed with the use of a structured, interviewer-administered questionnaire, including a 24-hour dietary recall. From these recalls, the mean intakes of 12 main food groups were calculated and used to establish five dietary patterns by principal component analysis. Data were also obtained on attitudes toward obesity, body mass index (BMI), hemoglobin level, and measures of socioeconomic status and analyzed for associations with dietary patterns. RESULTS: The five dietary patterns were "traditional-coast," characterized by fruits, nuts, starchy plants, and fish; "traditional-inland," characterized by cereals, oils and fats, and vegetables; "purchase," characterized by bread and cakes (usually fried in oil), sugar, and black tea; "pulses," characterized mainly by pulses, with few or no vegetables; and "animal products," characterized by a high consumption of meat, eggs, and/or milk. Significant positive associations were found, among others, between the purchase pattern and BMI (p = 0.192, p = .005) and between the animal products pattern and wealth (p = 0.168, p = .002). CONCLUSIONS: Differences between traditional and modern nutritional food patterns were evident. This study found the"traditional-inland" pattern to be the most healthy, while the "purchase" food pattern was the most prevalent. The purchase pattern, in particular, may provide some evidence for early stages of the nutrition transition in rural Tanzania.

Bitter gourd (Momordica Charantia): A dietary approach to hyperglycemia.

Bitter gourd (Momordica charantia) is a vegetable with pantropical distribution. It contains substances with antidiabetic properties such as charantin, vicine, and polypeptide-p, as well as other unspecific bioactive components such as antioxidants. Metabolic and hypoglycemic effects of bitter gourd extracts have been demonstrated in cell culture, animal, and human studies. The mechanism of action, whether it is via regulation of insulin release or altered glucose metabolism and its insulin-like effect, is still under debate. Adverse effects are also known. Nevertheless, bitter gourd has the potential to become a component of the diet or a dietary supplement for diabetic and prediabetic patients. Well-designed interdisciplinary research by nutritionists, medical doctors, and agronomists is needed before a dietary recommendation can be given and a product brought to the market.