Assessing diet quality and its determinants among adults in two Southern Nigerian States
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Submitted
January 13, 2024
Published
July 21, 2024
Abstract
Background: Adherence to high-quality dietary patterns is crucial for preventing diet-related chronic diseases. However, global dietary shifts towards energy-dense, nutrient-poor foods are prevalent.
Aim: This study aimed to assess diet quality (DQ) among adults in two States – Akwa Ibom State (AKS) and Cross River State (CRS) in southern Nigeria.
Methods: Diet quality was evaluated using the Diet Quality Index-International (DQI-I), comprising components of food variety, adequacy, moderation, and balance. Binary logistic regression was employed to examine factors associated with low diet quality.
Results. Among 1,188 adults (mean age: 35.47 ± 11.2 years), the mean DQI-I score was 56.08 ± 7.3. Mean scores for DQI-I components were 11.24 ± 3.9, 24.43 ± 4.8, 19.70 ± 5.8, and 0.70 ± 1.5 for total food variety, dietary adequacy, moderation, and overall balance, respectively. Low diet quality was significantly more prevalent among adults in AKS (p = 0.001), females (p = 0.034), and rural dwellers (p = 0.003). Further analyses revealed that, rural dwellers [Adjusted Odd Ratio (AOR): 0.72; 95% Confidence Interval (CI): (0.55 – 0.93); p = 0.014] and females [AOR: 0.76; CI: (0.60 – 1.00); p = 0.028] were less likely to adopt moderate-to-high DQ, when compared to their respective counterparts.
Conclusion: This study revealed suboptimal diet quality among adults in Akwa Ibom and Cross River States in southern Nigeria. Dietary intakes were characterized by dietary adequacy, moderation and appreciably, food variety. Targeted interventions addressing all aspects of diet quality are necessary to improve dietary patterns and reduce the burden of diet-related diseases.
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References
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Bivoltsis, A., Trapp, G., Knuiman, M., Hooper, P., & Ambrosini, G. (2018). Can a simple dietary index derived from a sub-set of questionnaire items assess diet quality in a sample of Australian adults? Nutrients, 10(4), 486. https://doi.org/10.3390/nu10040486
Blair, S. N., Kohl, H. W., 3rd, Paffenbarger, R. S., Jr, Clark, D. G., Cooper, K. H., & Gibbons, L. W. (1989). Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA, 262(17), 2395–2401. https://doi.org/10.1001/jama.262.17.2395
Bollyky, T. J., Templin, T., Cohen, M., & Dieleman, J. L. (2017). Lower-income countries that face the most rapid shift in noncommunicable disease burden are also the least prepared. Health Affairs (Project Hope), 36(11), 1866–1875. https://doi.org/10.1377/hlthaff.2017.0708
Chiaka, J. C., Zhen, L., & Xiao, Y. (2022). Changing food consumption patterns and land requirements for food in the six geopolitical zones in Nigeria. Foods (Basel, Switzerland), 11(2), 150. https://doi.org/10.3390/foods11020150
Chukwuonye, I. I., Chuku, A., John, C., Ohagwu, K. A., Imoh, M. E., Isa, S. E., Ogah, O. S., & Oviasu, E. (2013). Prevalence of overweight and obesity in adult Nigerians - A systematic review. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 6, 43–47. https://doi.org/10.2147/dmso.s38626
Chukwuonye, I. I., Ohagwu, K. A., Ogah, O. S., John, C., Oviasu, E., Anyabolu, E. N., Ezeani, I. U., Iloh, G. U. P., Chukwuonye, M. E., Raphael, C. O., Onwuchekwa, U., Okafor, U. H., Oladele, C., Obi, E. C., Okwuonu, C. G., Iheji, O., Nwabuko, O. C., Nnoli, M. A., & Okpechi, I. G. (2022). Prevalence of overweight and obesity in Nigeria: Systematic review and meta-analysis of population-based studies. PLOS Global Public Health, 2(6), e0000515. https://doi.org/10.1371/journal.pgph.0000515
Dasi, T., Selvaraj, K., Pullakhandam, R., & Kulkarni, B. (2019). Animal source foods for the alleviation of double burden of malnutrition in countries undergoing nutrition transition. Animal Frontiers, 9(4), 32–38. https://doi.org/10.1093/af/vfz031
Ekerette, N., Udo, A. U., Ayandele, I. A., Udom, G. N., Effiong, G. O., Etuk, U. R., Ekpo, I. E., Inyang, U. G., Edet, G. E., & Moffat, I. (2023). Emerging Food Environments and Implications for Attaining Sustainable Development Goals in Africa. Nyaudoh, 401–409.
Federal Ministry of Health. (2001). Food-based dietary guidelines – Nigeria. Food and Agriculture Organization of the United Nations. Retrieved from: https://www.fao.org/nutrition/education/fooddietaryguidelines/regions/countries/nigeria/en/
Gibson, R. S. (2023). Principles of Nutritional Assessment: Introduction. (3rd Edition). [Online chapter]. Retrieved from https://nutritionalassessment.org/#intro/.
Gibson, R. S., & Ferguson, E. L. (2008). An interactive 24-hour recall for assessing the adequacy of iron and zinc intakes in developing countries. Washington, DC: International Food Policy Research Institute (IFPRI) and International Center for Tropical Agriculture (CIAT). Retrieved from https://www.ifpri.org/publication/interactive-24-hour-recall-assessing-adequacy-iron-and-zinc-intakes-developing-countries [Last accessed on December 26, 2022]
Gil, Á., Victoria, E. M. De, & Olza, J. (2015). Indicators for the evaluation of diet quality. Nutrición Hospitalaria, 31(3), 128–144. https://doi.org/10.3305/nh.2015.31.sup3.8761
Haileselassie, M., Redae, G., Berhe, G., Henry, C. J., Nickerson, M. T., Tyler, B., & Mulugeta, A. (2020). Why are animal source foods rarely consumed by 6-23 months old children in rural communities of Northern Ethiopia? A qualitative study. PloS One, 15(1), e0225707. https://doi.org/10.1371/journal.pone.0225707
Institute of Medicine. (2005). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies Press. Available from: https://doi.org/10.17226/10490
Kabir, A., Miah, S., & Islam, A. (2018). Factors influencing eating behavior and dietary intake among resident students in a public university in Bangladesh: A qualitative study. PloS One, 13(6), e0198801. https://doi.org/10.1371/journal.pone.0198801
Kim, S., Haines, P. S., Siega-Riz, A. M., & Popkin, B. M. (2003). The diet quality index-international (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. The Journal of Nutrition, 133(11), 3476–3484. https://doi.org/10.1093/jn/133.11.3476
Lee, E., Choi, J., Ahn, A., Oh, E., Kweon, H., & Cho, D. (2015). Acceptable macronutrient distribution ranges and hypertension. Clinical and Experimental Hypertension (New York, N.Y.: 1993), 37(6), 463–467. https://doi.org/10.3109/10641963.2015.1013116
Martin, J. C., Moran, L. J., Teede, H. J., Ranasinha, S., Lombard, C. B., & Harrison, C. L. (2017). Exploring diet quality between urban and rural dwelling women of reproductive age. Nutrients, 9, 586. https://doi.org/10.3390/nu9060586
Mediratta, S., & Mathur, P. (2023). The quality of Indian diets: A comparison of two indices to predict risk of dietary inadequacies linked to non-communicable diseases. World Nutrition, 14(3), 36–47. https://doi.org/10.26596/wn.202314336-47
Mekonnen, D. A., Trijsburg, L., Achterbosch, T., Brouwer, I. D., Kennedy, G., Linderhof, V., Ruben, R., Talsma, E. F., & Béné, C. (2021). Food consumption patterns, nutrient adequacy, and the food systems in Nigeria. Agricultural Systems, 191(103136), 1–14. https://doi.org/10.1016/j.agsy.2021.103136
Müller, A. M., & Koh, D. (2016). Effectiveness of active learning methods in health professional education: A systematic review. Journal of Nursing Education, 55(5), 282–288. https://doi.org/10.3928/01484834-20160414-06
National Institute of Diabetes and Digestive and Kidney Diseases. (2022). Body Composition. What Is It, and What Are Its Risks?. [National Institutes of Health (.gov)]. Retrieved from https://www.niddk.nih.gov/health-information/weight-management/body-composition.
National Population Commission (NPC) [Nigeria] and ICF. (2019). Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF.
Nielsen, S. J., & Popkin, B. M. (2003). Patterns and trends in food portion sizes, 1977–1998. JAMA, 289(4), 450–453. https://doi.org/10.1001/jama.289.4.450
Omonona, B. T. (2009). Quantitative analysis of rural poverty in Nigeria (NSSP Report 9). Nigeria Strategy Support Program (NSSP), International Food Policy Research Institute (IFPRI). Retrieved from: http://www.ifpri.org/publication/quantitative-analysis-rural-poverty-nigeria
Ruel, M. T. (2003). Operationalizing dietary diversity: A review of measurement issues and research priorities. The Journal of Nutrition, 133(11 Suppl 2), 3911S–3926S. https://doi.org/10.1093/jn/133.11.3911S
Sanusi, R. A., & Owolabi, O. O. (2022). Household Food Security Status, Food Consumption Pattern and Nutritional Status of Households in a Semi-urban Area of Nigeria. Pakistan Journal of Nutrition, 21, 91–100. https://doi.org/10.3923/pjn.2022.91.100
Shamah-Levy, T., Mundo-Rosas, V., & Villalpando-Hernández, S. (2013). Dietary intake and micronutrient status among Mexican women of reproductive age. Nutrition Reviews, 71(10), 680–690. https://doi.org/10.1111/nure.12073
Smith, L. C., & Haddad, L. (2015). Reducing child undernutrition: Past drivers and priorities for the post-MDG era. World Development, 68, 180–204. https://doi.org/10.1016/j.worlddev.2014.11.014
United Nations Department of Economic and Social Affairs. (2019). World Population Prospects 2019: Highlights. Retrieved from https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf
United Nations Development Programme (UNDP). (2020). Human Development Report 2020. Retrieved from: http://hdr.undp.org/en/2020-report
World Health Organization (WHO). (2015). Healthy Diet. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/healthy-diet
World Health Organization (WHO). (2018). WHO | Healthy Diet. Retrieved from: http://www.who.int/nutrition/publications/nutrientrequirements/healthydiet_factsheet/en/
World Health Organization (WHO). (2020). Noncommunicable Diseases. Retrieved from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
Ahmed, A. E., & Salih, O. A. (2019). Assessment of the Minimum Dietary Diversity of Reproductive Women in Saudi Arabia. Pakistan Journal of Nutrition, 18, 615–622. https://doi.org/10.3923/pjn.2019.615.622
Akwa Ibom State Government. (2014). Projected Population 2007-2015: Ministry of Economic Development, Uyo, Akwa Ibom State. Retrieved from: http://www.nigerianstat.gov.ng/pdfuploads/Population.pdf
Arganini, C., Saba, A., Comitato, R., Virgili, F., & Turrini, A. (2012). Gender Differences in Food Choice and Dietary Intake in Modern Western Societies. Public Health - Social and Behavioral Health, 83–102. https://doi.org/10.5772/37886
Bivoltsis, A., Trapp, G., Knuiman, M., Hooper, P., & Ambrosini, G. (2018). Can a simple dietary index derived from a sub-set of questionnaire items assess diet quality in a sample of Australian adults? Nutrients, 10(4), 486. https://doi.org/10.3390/nu10040486
Blair, S. N., Kohl, H. W., 3rd, Paffenbarger, R. S., Jr, Clark, D. G., Cooper, K. H., & Gibbons, L. W. (1989). Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA, 262(17), 2395–2401. https://doi.org/10.1001/jama.262.17.2395
Bollyky, T. J., Templin, T., Cohen, M., & Dieleman, J. L. (2017). Lower-income countries that face the most rapid shift in noncommunicable disease burden are also the least prepared. Health Affairs (Project Hope), 36(11), 1866–1875. https://doi.org/10.1377/hlthaff.2017.0708
Chiaka, J. C., Zhen, L., & Xiao, Y. (2022). Changing food consumption patterns and land requirements for food in the six geopolitical zones in Nigeria. Foods (Basel, Switzerland), 11(2), 150. https://doi.org/10.3390/foods11020150
Chukwuonye, I. I., Chuku, A., John, C., Ohagwu, K. A., Imoh, M. E., Isa, S. E., Ogah, O. S., & Oviasu, E. (2013). Prevalence of overweight and obesity in adult Nigerians - A systematic review. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 6, 43–47. https://doi.org/10.2147/dmso.s38626
Chukwuonye, I. I., Ohagwu, K. A., Ogah, O. S., John, C., Oviasu, E., Anyabolu, E. N., Ezeani, I. U., Iloh, G. U. P., Chukwuonye, M. E., Raphael, C. O., Onwuchekwa, U., Okafor, U. H., Oladele, C., Obi, E. C., Okwuonu, C. G., Iheji, O., Nwabuko, O. C., Nnoli, M. A., & Okpechi, I. G. (2022). Prevalence of overweight and obesity in Nigeria: Systematic review and meta-analysis of population-based studies. PLOS Global Public Health, 2(6), e0000515. https://doi.org/10.1371/journal.pgph.0000515
Dasi, T., Selvaraj, K., Pullakhandam, R., & Kulkarni, B. (2019). Animal source foods for the alleviation of double burden of malnutrition in countries undergoing nutrition transition. Animal Frontiers, 9(4), 32–38. https://doi.org/10.1093/af/vfz031
Ekerette, N., Udo, A. U., Ayandele, I. A., Udom, G. N., Effiong, G. O., Etuk, U. R., Ekpo, I. E., Inyang, U. G., Edet, G. E., & Moffat, I. (2023). Emerging Food Environments and Implications for Attaining Sustainable Development Goals in Africa. Nyaudoh, 401–409.
Federal Ministry of Health. (2001). Food-based dietary guidelines – Nigeria. Food and Agriculture Organization of the United Nations. Retrieved from: https://www.fao.org/nutrition/education/fooddietaryguidelines/regions/countries/nigeria/en/
Gibson, R. S. (2023). Principles of Nutritional Assessment: Introduction. (3rd Edition). [Online chapter]. Retrieved from https://nutritionalassessment.org/#intro/.
Gibson, R. S., & Ferguson, E. L. (2008). An interactive 24-hour recall for assessing the adequacy of iron and zinc intakes in developing countries. Washington, DC: International Food Policy Research Institute (IFPRI) and International Center for Tropical Agriculture (CIAT). Retrieved from https://www.ifpri.org/publication/interactive-24-hour-recall-assessing-adequacy-iron-and-zinc-intakes-developing-countries [Last accessed on December 26, 2022]
Gil, Á., Victoria, E. M. De, & Olza, J. (2015). Indicators for the evaluation of diet quality. Nutrición Hospitalaria, 31(3), 128–144. https://doi.org/10.3305/nh.2015.31.sup3.8761
Haileselassie, M., Redae, G., Berhe, G., Henry, C. J., Nickerson, M. T., Tyler, B., & Mulugeta, A. (2020). Why are animal source foods rarely consumed by 6-23 months old children in rural communities of Northern Ethiopia? A qualitative study. PloS One, 15(1), e0225707. https://doi.org/10.1371/journal.pone.0225707
Institute of Medicine. (2005). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies Press. Available from: https://doi.org/10.17226/10490
Kabir, A., Miah, S., & Islam, A. (2018). Factors influencing eating behavior and dietary intake among resident students in a public university in Bangladesh: A qualitative study. PloS One, 13(6), e0198801. https://doi.org/10.1371/journal.pone.0198801
Kim, S., Haines, P. S., Siega-Riz, A. M., & Popkin, B. M. (2003). The diet quality index-international (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. The Journal of Nutrition, 133(11), 3476–3484. https://doi.org/10.1093/jn/133.11.3476
Lee, E., Choi, J., Ahn, A., Oh, E., Kweon, H., & Cho, D. (2015). Acceptable macronutrient distribution ranges and hypertension. Clinical and Experimental Hypertension (New York, N.Y.: 1993), 37(6), 463–467. https://doi.org/10.3109/10641963.2015.1013116
Martin, J. C., Moran, L. J., Teede, H. J., Ranasinha, S., Lombard, C. B., & Harrison, C. L. (2017). Exploring diet quality between urban and rural dwelling women of reproductive age. Nutrients, 9, 586. https://doi.org/10.3390/nu9060586
Mediratta, S., & Mathur, P. (2023). The quality of Indian diets: A comparison of two indices to predict risk of dietary inadequacies linked to non-communicable diseases. World Nutrition, 14(3), 36–47. https://doi.org/10.26596/wn.202314336-47
Mekonnen, D. A., Trijsburg, L., Achterbosch, T., Brouwer, I. D., Kennedy, G., Linderhof, V., Ruben, R., Talsma, E. F., & Béné, C. (2021). Food consumption patterns, nutrient adequacy, and the food systems in Nigeria. Agricultural Systems, 191(103136), 1–14. https://doi.org/10.1016/j.agsy.2021.103136
Müller, A. M., & Koh, D. (2016). Effectiveness of active learning methods in health professional education: A systematic review. Journal of Nursing Education, 55(5), 282–288. https://doi.org/10.3928/01484834-20160414-06
National Institute of Diabetes and Digestive and Kidney Diseases. (2022). Body Composition. What Is It, and What Are Its Risks?. [National Institutes of Health (.gov)]. Retrieved from https://www.niddk.nih.gov/health-information/weight-management/body-composition.
National Population Commission (NPC) [Nigeria] and ICF. (2019). Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF.
Nielsen, S. J., & Popkin, B. M. (2003). Patterns and trends in food portion sizes, 1977–1998. JAMA, 289(4), 450–453. https://doi.org/10.1001/jama.289.4.450
Omonona, B. T. (2009). Quantitative analysis of rural poverty in Nigeria (NSSP Report 9). Nigeria Strategy Support Program (NSSP), International Food Policy Research Institute (IFPRI). Retrieved from: http://www.ifpri.org/publication/quantitative-analysis-rural-poverty-nigeria
Ruel, M. T. (2003). Operationalizing dietary diversity: A review of measurement issues and research priorities. The Journal of Nutrition, 133(11 Suppl 2), 3911S–3926S. https://doi.org/10.1093/jn/133.11.3911S
Sanusi, R. A., & Owolabi, O. O. (2022). Household Food Security Status, Food Consumption Pattern and Nutritional Status of Households in a Semi-urban Area of Nigeria. Pakistan Journal of Nutrition, 21, 91–100. https://doi.org/10.3923/pjn.2022.91.100
Shamah-Levy, T., Mundo-Rosas, V., & Villalpando-Hernández, S. (2013). Dietary intake and micronutrient status among Mexican women of reproductive age. Nutrition Reviews, 71(10), 680–690. https://doi.org/10.1111/nure.12073
Smith, L. C., & Haddad, L. (2015). Reducing child undernutrition: Past drivers and priorities for the post-MDG era. World Development, 68, 180–204. https://doi.org/10.1016/j.worlddev.2014.11.014
United Nations Department of Economic and Social Affairs. (2019). World Population Prospects 2019: Highlights. Retrieved from https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf
United Nations Development Programme (UNDP). (2020). Human Development Report 2020. Retrieved from: http://hdr.undp.org/en/2020-report
World Health Organization (WHO). (2015). Healthy Diet. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/healthy-diet
World Health Organization (WHO). (2018). WHO | Healthy Diet. Retrieved from: http://www.who.int/nutrition/publications/nutrientrequirements/healthydiet_factsheet/en/
World Health Organization (WHO). (2020). Noncommunicable Diseases. Retrieved from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
Authors
Ekerette , N. N., & Sanusi , R. A. (2024). Assessing diet quality and its determinants among adults in two Southern Nigerian States. The North African Journal of Food and Nutrition Research, 8(18), 9–18. https://doi.org/10.51745/najfnr.8.18.9-18
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