Are Malawian diets changing? An assessment of nutrient consumption and dietary patterns using household-level evidence from 2010/11 and 2016/17

Gilbert, Rachel; Benson, Todd; Ecker, Olivier

doi:10.2499/p15738coll2.133522

Cited by 12 publications

(14 citation statements)

References 10 publications

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“…This review demonstrates that estimating nutrient supply from HCES data may help identify populations at risk of nutrient deficiencies due to poor diets. The literature identified in this review used HCES data to disaggregate nutrient supply results by well-documented social factors affecting diets, such as wealth (41,48,49) , education (50,51) , geography (49,52) , and ruralness (41,53,54) .…”

Section: Discussionmentioning

confidence: 99%

“…Households differ in size and composition across and within countries and regions, so the majority of publications attempted to convert nutrient supply estimated at the household level to estimates of individual-level apparent intake (41) using one of two approaches: per capita or AME. While the use of the per capita approach is simpler, it does not account for any difference in nutrient intakes between household members, which will skew estimates between households of different composition, especially those with large families.…”

Section: Discussionmentioning

confidence: 99%

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Systematic review of metrics used to characterise dietary nutrient supply from household consumption and expenditure surveys

Tang

Adams

Ferguson

et al. 2022

Public Health Nutr.

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Objective: To review existing publications using Household Consumption & Expenditure Survey (HCES) data to estimate household dietary nutrient supply to (1) describe scope of available literature, (2) identify the metrics reported and parameters used to construct these metrics, (3) summarize comparisons between estimates derived from HCES and individual dietary assessment data, and (4) explore the demographic and socioeconomic sub-groups used to characterize risks of nutrient inadequacy. Design: This study is a systematic review of publications identified from online databases published between 2000 to 2019 that used HCES food consumption data to estimate household dietary nutrient supply. Further publications were identified by “snowballing” the references of included database-identified publications. Setting: Publications using data from low- and lower middle income countries Results: In total, 58 publications were included. Three metrics were reported that characterized household dietary nutrient supply: apparent nutrient intake per adult-male equivalent per day (n=35), apparent nutrient intake per capita per day (n=24), and nutrient density (n=5). Nutrient intakes were generally overestimated using HCES food consumption data, with several studies finding sizeable discrepancies compared to intake estimates based on individual dietary assessment methods. Sub-group analyses predominantly focused on measuring variation in household dietary nutrient supply according to socioeconomic position and geography. Conclusion: HCES data are increasingly being used to assess diets across populations. More research is needed to inform the development of a framework to guide the use of and qualified interpretation of dietary assessments based on these data.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic review of metrics used to characterise dietary nutrient supply from household consumption and expenditure surveys

Tang

Adams

Ferguson

et al. 2022

Public Health Nutr.

View full text Add to dashboard Cite

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“…However, in Malawi, this was not the case with uptake of vitamin A capsules in PSC in the six months preceding the MNS of 71% [ 23 ]. Furthermore, previous data have shown that most households in Malawi did not meet their vitamin A dietary requirements in the year 2016–2017 [ 60 ], that there was, in fact, a decrease in consumption of vitamin A at this point compared to 2010–2011. Considering the likelihood of widespread dietary shortfalls of vitamin A, and the incomplete coverage of supplements, it is likely that some VAD occurs in Malawi.…”

Section: Discussionmentioning

confidence: 99%

Re-Defining the Population-Specific Cut-Off Mark for Vitamin A Deficiency in Pre-School Children of Malawi

et al. 2021

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Retinol Binding Protein (RBP) is responsible for the transport of serum retinol (SR) to target tissue in the body. Since RBP is relatively easy and cheap to measure, it is widely used in national Micronutrient Surveys (MNS) as a proxy for SR to determine vitamin A status. By regressing RBP concentration against SR concentration measured in a subset of the survey population, one can define a population-specific threshold concentration of RBP that indicates vitamin A deficiency (VAD). However, the relationship between RBP and SR concentrations is affected by various factors including inflammation. This study, therefore, aimed to re-define the population-specific cut-off for VAD by examining the influence of inflammation on RBP and SR, among pre-school children (PSC) from the 2015–16 Malawi MNS. The initial association between RBP and SR concentrations was poor, and this remained the case despite applying various methods to correct for inflammation. The World Health Organization (WHO) recommends the threshold of 0.7 µmol/L to define VAD for SR concentrations. Applying this threshold to the RBP concentrations gave a VAD prevalence of 24%, which reduced to 10% after inflammation adjustments following methods developed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA). Further research is required to identify why SR and RBP were poorly associated in this population. Future MNS will need to account for the effect of inflammation on RBP to measure the prevalence of VAD in Malawi.

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“…14 In Malawi, the diets of its near 19 million inhabitants depend on cereals, roots/tubers, and vegetables to supply a large proportion of micronutrient needs. 15 Low consumption of micronutrient dense foods (e.g., animal-sourced foods) and seasonal variation in the availability of certain fruits, vegetables, and root/tubers suggest that risks for dietary micronutrient inadequacy may be high and fluctuate throughout the year. 6 The Malawian government has enacted the mandatory fortification of several fortification vehicles, which, when implemented together, are intended to fill micronutrient gaps throughout the population resulting from poor quality diets.…”

Section: Introductionmentioning

confidence: 99%

Modeling food fortification contributions to micronutrient requirements in Malawi using Household Consumption and Expenditure Surveys

Tang

Adams

Ferguson

et al. 2021

Annals of the New York Academy of Sciences

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Large-scale food fortification may be a cost-effective intervention to increase micronutrient supplies in the food system when implemented under appropriate conditions, yet it is unclear if current strategies can equitably benefit populations with the greatest micronutrient needs. This study developed a mathematical modeling framework for comparing fortification scenarios across different contexts. It was applied to model the potential contributions of three fortification vehicles (oil, sugar, and wheat flour) toward meeting dietary micronutrient requirements in Malawi through secondary data analyses of a Household Consumption and Expenditure Survey. We estimated fortification vehicle coverage, micronutrient density of the diet, and apparent intake of nonpregnant, nonlactating women for nine different micronutrients, under three food fortification scenarios and stratified by subpopulations across seasons. Oil and sugar had high coverage and apparent consumption that, when combined, were predicted to improve the vitamin A adequacy of the diet. Wheat flour contributed little to estimated dietary micronutrient supplies due to low apparent consumption. Potential contributions of all fortification vehicles were low in rural populations of the lowest socioeconomic position. While the model predicted large-scale food fortification would contribute to reducing vitamin A inadequacies, other interventions are necessary to meet other micronutrient requirements, especially for the rural poor.

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Are Malawian diets changing? An assessment of nutrient consumption and dietary patterns using household-level evidence from 2010/11 and 2016/17

Cited by 12 publications

References 10 publications

Systematic review of metrics used to characterise dietary nutrient supply from household consumption and expenditure surveys

Systematic review of metrics used to characterise dietary nutrient supply from household consumption and expenditure surveys

Re-Defining the Population-Specific Cut-Off Mark for Vitamin A Deficiency in Pre-School Children of Malawi

Modeling food fortification contributions to micronutrient requirements in Malawi using Household Consumption and Expenditure Surveys

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