Hidden hunger in adolescent Mozambican girls: dietary assessment, micronutrient status, and associations between dietary diversity and selected biomarkers
Year: 2016
Type: dissertation
Study design: Observational Study
Abstract: Poor micronutrient intake and status (also called hidden hunger ) may compromise the health and work capacity of adolescent girls. In Mozambique, a low-income country with a high rate of adolescent pregnancies, girls poor micronutrient status is also an important risk factor for maternal and child mortality, adverse birth outcomes such as low birth weight, and impaired cognitive performance of the child. The main aims of this thesis were to examine the diet and micronutrient status of adolescent girls in Central Mozambique and to study whether dietary diversity is associated with biomarkers of micronutrient status. The thesis also includes a methodological study assessing the validity of using food photographs in portion size estimation in adolescent Mozambican girls. The validity study on food photographs was conducted in 2009. Two local staple foods and three sauces were selected as test foods and photographs of three different portion sizes were produced for each of them. The participants (99 Mozambican girls aged 13-18 years) were served weighted food portions, and after eating their meal, they were interviewed and asked to estimate the size of their portions with the help of the food photographs. The findings of this study indicated a tendency towards under-estimation of portion sizes. On the group level, the results were acceptable, but large variation in the accuracy of individuals estimates was found. The ZANE Study was conducted in 2010. It was a population-based cross-sectional study on the diet and nutritional status of 14- to 19-year-old girls in Zambézia Province. The study regions included one urban area and two rural districts. Two separate samples of girls were recruited: the first in January-February ( hunger season , n=283) and the second in May-June (harvest season, n=268). A 24-hour dietary recall interview and a seven-day food frequency questionnaire interview were conducted for each participant. Blood and urine samples were collected and blood haemoglobin, serum ferritin, serum zinc, serum selenium, urinary iodine, plasma retinol and serum folate concentrations were analysed. The ZANE Study revealed a low median energy intake calculated from the 24-hour recalls [5.2 MJ/day, interquartile range: 3.6, 7.4 (calculated using sampling weights); n=543]. This is in line with the findings of the validity study and is at least partly explained by under-reporting. Low intakes of several micronutrients and relatively high phytate:zinc molar ratios, typical for diets in low-income settings, were found. Marked seasonal variation was noted for vitamin A intake. According to the World Health Organization definitions, anaemia was a severe public health problem and vitamin A deficiency a moderate public health problem. The serum ferritin concentrations indicated that iron depletion was prevalent in the population. The population was also found to have a risk of zinc deficiency. Folate status was considered to be generally adequate, but an exception to this was the low serum folate concentrations in the urban area in May-June. Mild to moderate iodine deficiency was found in the rural districts, whereas the iodine status of urban girls was adequate. Selenium status was considered adequate. In the last part of the thesis, associations between dietary diversity and low concentrations of haemoglobin and serum/plasma ferritin, zinc, retinol, and folate in non-pregnant girls (n=227 in January-February and n=223 in May-June) were examined in logistic regression models using three different dietary diversity scores. First, the Women s Dietary Diversity Score (WDDS), consisting of nine food groups was calculated from the 24-hour recalls according to instructions by the Food and Agriculture Organization of the United Nations. The second score employed a minimum portion size limit of 15 g (WDDS15g), and the third was based on the seven-day food frequency questionnaires (7dWDDS). The most consistent findings of this work were the associations observed for zinc. In January-February, after adjusting for confounders, a low (≤3) WDDS and a low (≤5) 7dWDDS were each associated with higher odds of having lowserum zinc (≤25th percentile of the season-specific distribution) compared with having a higher score. These associations were not present in May-June. In conclusion, using food photographs in portion size estimation in adolescent Mozambican girls showed an acceptable level of validity. There was, however, a tendency towards under-reporting. In the future, producing and testing more comprehensive sets of locally relevant food photographs will be useful for dietary studies in Sub-Saharan African settings. Hidden hunger was found to be a public health problem among adolescent girls in Central Mozambique. Actions are needed to prevent and control hidden hunger, especially with regard to low iron, zinc, iodine, and vitamin A status. Programmes may need to be tailored according to urban-rural differences in diet and micronutrient status. Some associations between dietary diversity and micronutrient status may exist, especially in the case of zinc. However, the associations seem to be season-specific, which may limit the practical application of dietary diversity scores as tools to identify populations at risk of low micronutrient status.
Source: Työväentutkimus Vuosikirja
Author: Liisa Korkalo
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2277109102