Lorraine Cordeiro

Household Food Security Is Inversely Associated with Undernutrition among Adolescents from Kilosa, Tanzania

Household food insecurity contributes to poor nutritional health, with negative consequences on growth and development during childhood. Although early childhood nutrition needs have received much attention, another important nutritional phase is adolescence. In a sample of 670 adolescents from Kilosa District, Tanzania, this study used 3 approaches to better understand the relationship between food insecurity and undernutrition. First, this study examined the associations between 3 commonly used measures of household food security and undernutrition among 670 adolescents from Kilosa District, Tanzania. The measures of household food security, energy adequacy per adult equivalent, dietary diversity score, and coping strategies index, were strongly correlated with each other and household assets (P < 0.05). Second, this study measured the nutritional status of adolescents in this district, finding a high prevalence of undernutrition (21% with BMI-for-age <5th percentile of the National Center for Health Statistics/WHO reference). Third, this study measured the association between the log odds of undernutrition (as the dependent variable) and each of the 3 measures of household food security. In separate models, household energy adequacy per adult equivalent and household dietary diversity score were inversely associated with undernutrition after adjusting for gender, age, puberty, and the interaction between age and puberty. By contrast, a greater use of coping strategies was not associated with undernutrition. Strategies focused on increasing household energy intake and improving dietary diversity among the most vulnerable households could improve the nutritional health of adolescents.

Dietary Patterns and their Association with Hypertension Among Pakistani Urban Adults

Hypertension is one of the most common chronic diseases affecting more than 25% of adults worldwide. In Pakistan, 33% of the adult population suffers from hypertension. Numerous epidemiological studies have demonstrated the critical role of dietary patterns in the causation, prevention and management of hypertension. Theres a dearth of evidence from South Asia in this regard. The present study aimed to identify the association between dietary patterns and hypertension among 4304 low income urban adults who participated in the Control of Blood Pressure and Risk Attenuation (COBRA) study in Karachi, Pakistan. Dietary information was collected by a 33- item food frequency questionnaire and 3 unique dietary patterns namely; fat and sweet, fruit and vegetable, and seafood and yogurt patterns were derived using principal component factor analyses. We used univariate and multivariable logistic regression to examine the association between dietary patterns and hypertension. Men were more likely to have hypertension, while increase in age, and body mass index were also associated with hypertension (p<0.001). After adjusting for age, gender, education, marital status, body mass index, and tobacco use; the seafood and yogurt pattern was less likely (OR=0.78: 95% CI: 0.63, 0.98; p-value 0.03) to be associated with hypertension, whereas no significant associations were seen for other two dietary patterns. These findings suggest that certain dietary patterns may be associated with hypertension among Pakistani low income urban adults.

Dietary patterns of Pakistani adults and their associations with sociodemographic, anthropometric and life-style factors

Dietary pattern analysis is an epidemiological method designed to consider the complexity of food preferences and diet patterns of populations. Few studies from South Asia have used this methodology to describe population food intake. Our objective was to identify dietary patterns and understand their associations with sociodemographic, anthropometric and life-style factors among low-income Pakistani urban adults. Dietary information was collected by a thirty-three-item FFQ and dietary patterns were derived by principal component analyses in 5491 subjects enrolled in the Control of Blood Pressure and Risk Attenuation (COBRA) study. Three dietary patterns were identified: a fat and sweet pattern characterised by fried snacks/foods, desserts, organ meats, bakery products, Pakistani bread and food purchased from outside the home; a fruit and vegetable pattern including fruits, juices, raw and cooked vegetables, lean meat and low-fat milk; and a seafood and yogurt pattern identified by prawns, fish, potatoes and yogurt. The fat and sweet pattern scores were low among older subjects, those with high BMI and waist circumference but high among females and physically active participants. The fruit and vegetable pattern was associated with younger age, high BMI, education and non-tobacco use. The seafood and yogurt pattern was associated with high BMI, increased physical activity and non-tobacco use. In conclusion, distinct dietary patterns exist for the Pakistani population that may be related to some of the population characteristics and thus may have importance in suggesting dietary and life-style interventions in the prevention of chronic diseases.

Healthful, Cultural Foods and Safety Net Use Among Cambodian and Brazilian Immigrant Communities in Massachusetts

Declining health and food security status among low-income immigrants in the U.S. may result from limited access to healthful, cultural foods and safety net programs. We held focus group discussions with low-income Cambodian and Brazilian immigrants (11 groups, n = 84) living in Massachusetts. Cambodians and Brazilians valued healthful, cultural foods, emphasizing their beliefs that cultural foods are healthier and beneficial for weight management and aging. Although both groups could access these foods, some individuals had difficulty affording them. Cambodians reported that food quality decreased over the month due to inadequate resources. Cambodians relied on SNAP, WIC, families, and food pantries; however, Brazilians generally did not participate in safety net programs. Barriers to accessing and using safety nets appear to limit diet quality for some immigrant families. Targeted nutrition interventions should build on current knowledge of and desire for healthful, cultural foods in the context of available safety nets.

Household Dietary Diversity, Wild Edible Plants, and Diarrhea among Rural Households in Tanzania

Communities in Tanzania have an extensive history of using wild plants for nutritional and medicinal purposes. The high prevalence of food insecurity and infectious disease, combined with a lack of access to healthcare in rural areas, makes traditional plant sources of food and medical treatment a practical alternative for vulnerable households. In this study, the association between household consumption of wild edible plants and self-reported diarrhea across categories of household food security status was examined. Focus group discussions in four villages in Kilosa, Tanzania, were used to elicit coping strategies, including consumption of wild edible plants, employed during periods of food shortage. Data on household dietary diversity, food security, demographics, selfreported health, as well as socioeconomic status were collected using a structured survey administered to heads of households. The association between selfreported diarrhea and consumption of wild edible plants across categories of household food security status were determined using bivariate and multivariate statistical methods. Our results indicate that among the moderately food insecure, the odds of a household member having diarrhea was lower in consumers as compared to non-consumers of wild edible plants (OR 0.30 [0.12, 0.75], p <0.05). Consumption of wild edible plants appears to be a potential mediator of diarrheal diseases in food insecure populations, especially among the moderately food insecure. Further research on the contribution of wild edible plants to alleviation of food insecurity and related health outcomes in developing countries is needed. INTRODUCTION Diarrhea is one of the ten leading contributors to the global burden of disease (Lopez et al., 2006). In Sub Saharan Africa, more than 17 percent of children less than five years of age die from diarrheal diseases annually (UNICEF-WHO, 2009). Mortality from this health condition disproportionately targets individuals in lowand middle-income countries (Lopez et al., 2006), where food insecurity is highly prevalent (FAO, 2011). By definition, food security is attained when ‘all people, at all times, have physical and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active and healthy life’ (FAO, 2001). Household food insecurity has been associated with diarrhea (Perez-Escamilla et al., 2009) and other diseases (Perez-Escamilla et al., 2009; Weigel et al., 2007). The synergistic relationship between food insecurity and poor health is apparent when diets lacking appropriate nutrients reduce the bodys ability to resist disease, thus increasing susceptibility to pathogens in contaminated water or food that adversely impact health (Lonnerdal, 2000; Scrimshaw and SanGiovanni, 1997). Wild edible plants, many of which have nutritional (Weinberger and Msuya, 2004; Burlingame, et al., 2009) and medicinal benefits (Irungu et al., 2007; Johns and Chapman, 1995), are frequently underutilized as local solutions to food insecurity and associated health concerns (Flyman and Afolayan, 2006; Kaschula, 2008; Herforth, 2010). Consumption of wild edible plants has the potential to improve the health status of food insecure Cordeiro: Household Dietary Diversity, Wild Edible Plants, and Diarrhea amo