Background: This scoping review aims to describe the body of nutrition intervention and dietary assessment research undertaken with Khmer populations in Cambodia, as well as summarise the nutrition knowledge base and highlight priority areas for future research. Methods: Five databases and the grey literature were searched, following PRISMA-ScR guidelines. Studies involving dietary assessment or nutrition interventions published after 1992 were identified using specific search terms and extracted to a customised data extraction table for categorisation and analysis. Study participants were Khmer people of any age and gender, living in rural or urban Cambodia. Results: Of the 100 included studies, 58 were dietary assessment only studies, 24 were nutrition interventions only, and 18 studies involved both assessment of intake and an intervention. Sixty-eight percent of study populations were mothers and young children, of which 52 studies focused on children aged under 5 years. Nineteen interventions involved supplementation and six trialled fortification of rice or fish sauce. Anaemia was the most common nutrition condition studied (n = 17), followed by malnutrition (n = 15) and malnutrition risk factors (n = 11). General nutrition status was explored in 25 studies, and individual micronutrients that were studied included iron (n = 27), zinc (n = 6), vitamin A (n = 4) and thiamine (n = 3). Conclusions: Diet-related research in Khmer populations in Cambodia has predominantly focused on dietary assessment or evaluation of interventions aimed at reducing malnutrition and resolving micronutrient deficiencies. Areas identified as emerging needs included non-communicable diseases, the ageing population and non-iron deficiency anaemia. Highlights• Previous research involving nutrition interventions and/or dietary assessment research among Khmer populations living in Cambodia has largely focused on malnutrition and anaemia. • Populations studied have been predominantly maternal and young children, addressing Sustainable Development Goals. • Supplementation and fortification interventions are prominent. • Wide variety of study outcomes involving dietary assessment, e.g., health behaviours, food security, intervention effectiveness and oral health, across different population groups.

Background: Despite economic growth, Cambodia continues to have high rates of malnutrition, anaemia and nutrition-related deficiencies. Government policies promote nutrition strategies, although dietary intake data is limited. A detailed synthesis of existing intake data is needed to inform nutrition policy and practice change. This review aims to characterise and assess quality of dietary assessment methods and outcomes from individual-level 'whole diet' studies of Khmer people living in Cambodia. Methods: Searches were conducted using PRISMA-ScR guidelines. Included papers reported dietary intake at an individual level for 'whole diet'. Studies using secondary data or lacking dietary assessment details were excluded. Extracted data included dietary assessment features, nutrient/food group intakes and database. Results: Nineteen publications (15 studies) were included, with nine carried out among children under 5 years and six among women. Eleven studies reported intake by food groups and four by nutrients, prominently energy, protein, vitamin A, iron, calcium and zinc. Inconsistent intakes, food groupings and reporting of study characteristics limited data synthesis. All but one study used 24-h recalls. Trained local fieldworkers used traditional interview-administered data collection and varied portion estimation tools. Food composition databases for analysis were not tailored to the Cambodian diet. Overall quality was rated as 'good'. Conclusions: We recommend the development of a best-practice protocol for conducting dietary assessment, a Cambodia-specific food composition database and a competent trained workforce of nutrition professionals, with global support of expertise and funding for future dietary assessment studies conducted in Cambodia. K E Y W O R D SCambodia, dietary assessment, dietary intake, food composition database, review Key points• Fifteen studies with highly variable intake data included in the review.• The food composition databases used were not specific to Cambodian diet.• Minimum reporting standards and best practice protocols recommended, including in-country nutrition training. • Lack of whole population dietary intake data indicates the need for a national survey.

High rates of under-and over-nutrition, anaemia and nutrition-related deficiencies persist in Cambodia despite recent economic growth in this low-middle-income country. (1) While the Cambodian government promotes nutrition strategies and programs to meet global Sustainable Development Goals, their effectiveness remains unclear. (2) Cambodian's communal eating style makes dietary assessment challenging. This review set included an initial scoping review to characterise nutrition interventions and dietary assessment studies conducted in Cambodia since 1993, followed by a systematic review of individual studies evaluating whole diet intake. Both reviews followed PRISMA guidelines. Five databases and grey literature from government, non-government and global health websites were searched for the scoping review. Eligible studies involved Cambodian people living in Cambodia of any age, gender or province, reported on nutritional interventions and/or used dietary assessment methods of any kind. One hundred studies were included; 76 reported on dietary assessment methods, 42 were nutrition interventions, and 18 assessed intakes within a nutrition intervention. The most reported nutrition variables were iron status (n = 27), malnutrition (n = 26), and anaemia (n = 17). All interventions involved women and/or children, largely evaluating supplements (n = 19) or fortification (n = 6). Most common dietary assessments methods were 24-hour recalls (n = 40) and food frequency questionnaires (n = 34), with over 80% collecting intake of selected food items only. Dietary assessment studies focused on infant feeding (n = 16), nutrient deficiencies (n = 8) or food security (n = 8). From the 100 papers in the scoping review, we then screened for studies that collected individual-level, complete dietary intakes. Fifteen studies were included; nine with children under five years and six with women. Six studies collected nutrient intake and eleven collected food intakes. Pooling nutrient and/or food group intakes was not possible due to the small representation within each subgroup and variability in reporting. All but one study used 24-hour recalls, mostly utilising pen-and-paper methods administered by local Khmer fieldworkers. Only two studies reported using a validated tool to assess dietary intakes. Food composition databases used for nutrient analysis were not tailored to the Cambodian food supply. Both reviews reflect the strong focus of nutrition studies towards addressing Cambodia's poor maternal and child health status. These reviews confirmed the absence of research addressing emerging needs of non-communicable diseases, ageing population groups and non-iron deficiency anaemia. Improvements to dietary assessment studies in Cambodia requires a best-practice protocol, a Cambodia-specific food composition database and a trained nutrition local Khmer workforce. Regular national nutrition surveys could facilitate monitoring of national dietary nutritional adequacy and nutritional status to better inform future nutrition policies a...

Despite recent economic improvements, Cambodian women of reproductive age carry the triple burden of malnutrition. Both underweight (14%) and overweight (18%) coexist with anaemia (44%), and other micronutrient deficiencies such as folic acid (19%), (1) with differences in nutritional status thought to be worse with rural versus urban Cambodian population samples. (1) Only three studies have collected individual-level, whole diet intakes from Khmer women living in Cambodia, and none have compared rural and urban localities or assessed diets of breastfeeding mothers. (2) The current study aimed to determine the nutritional adequacy of dietary intakes of Cambodian mothers, by breastfeeding status in rural, semi-rural and urban localities. Dietary assessment was conducted using imagevoice two x three-day food records (up to 6 non-consecutive days total) captured on a smartphone application. Participants were mothers recruited from rural, semi-rural and urban locations in Siem Reap province, Cambodia in 2019-2020. Demographic and anthropometric data were collected, then mothers were trained to use the app to collect intake. Data were analysed by Dietitians using a semi-automated process in a web platform using a tailored food composition database of Cambodian foods and mixed dishes. Adequate intake was determined by proportion of participants over the Estimated Average Requirement. (3) Data were analysed for 119 participants, of whom 58% were breastfeeding. for each nutrient. Protein, carbohydrate, vitamin B12, iron, phosphorus and sodium were adequate for over 65% of mothers. Less than 10% of mothers were consuming adequate vitamin A, vitamin C, thiamine, calcium, zinc and potassium. Median intakes for energy (1510 kcal and 1117 kcal respectively, p = 0.009) and all nutrients except fat and vitamin C were significantly higher for breastfeeding compared to non-breastfeeding mothers, but higher requirements meant that a lower proportion of breastfeeding mothers had adequate intakes of protein, carbohydrate, vitamin A, thiamine and zinc. Differences between rural, semi-rural and urban localities included higher intake of carbohydrate, dietary fibre and calcium by rural mothers and a lower proportion of urban mothers with adequate folate intakes. The very low percentage of breastfeeding mothers with adequate intakes of vitamin A, thiamine, calcium and zinc is inconsistent with low deficiency rates that have been reported for Cambodian women. Conversely, the 84% of breastfeeding women reporting adequate iron intakes contrasts with high anaemia prevalence of 55% for breastfeeding women in Cambodia. (1) These findings support recent Cambodian research suggesting that anaemia is multifactorial. (4) Data from this novel image-voice dietary assessment suggest that the dietary intake of Cambodian mothers is nutritionally inadequate, which is consistent with previous research. Validation of this method may facilitate improved dietary assessment to inform appropriate nutritional interventions and policies in Cambodia to improve ...