Department of Public Health Sciences, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
Nutr J. 2018 Jan 29;17(1):14. doi: 10.1186/s12937-018-0316-3.
Identifying dietary patterns that consider the overall eating habits, rather than focusing on individual foods or simple counts of consumed foods, better helps to understand the combined effects of dietary components. Therefore, this study aimed to use dietary patterns, as an alternative method to dietary diversity scores (DDSs), and investigate their associations with childhood stunting in Ethiopia.
Mothers and their children aged under 5 years (n = 3788) were recruited using a two-stage random cluster sampling technique in two regions of Ethiopia. Socio-demographic, dietary and anthropometric data were collected. Dietary intake was assessed using standardized dietary diversity tools. Household, maternal and child DDSs were calculated and dietary patterns were identified by tetrachoric (factor) analysis. Multilevel linear and Poisson regression analyses were applied to assess the association of DDSs and dietary patterns with height-for-age z score (HAZ) and stunting, respectively.
The overall prevalence of stunting among children under-five was 38.5% (n = 1459). We identified three dietary patterns each, for households ("fish, meat and miscellaneous", "egg, meat, poultry and legume" and "dairy, vegetable and fruit"), mothers ("plant-based", "egg, meat, poultry and legume" and "dairy, vegetable and fruit" and children ("grain based", "egg, meat, poultry and legume" and "dairy, vegetable and fruit"). Children in the third tertile of the household "dairy, vegetable and fruit" pattern had a 0.16 (β = 0.16; 95% CI: 0.02, 0.30) increase in HAZ compared to those in the first tertile. A 0.22 (β = 0.22; 95% CI: 0.06, 0.39) and 0.19 (β = 0.19; 0.04, 0.33) increase in HAZ was found for those in the third tertiles of "dairy, vegetable and fruit" patterns of children 24-59 months and 6-59 months, respectively. Those children in the second (β = -0.17; 95% CI: -0.31, -0.04) and third (β = -0.16; 95% CI: -0.30, -0.02) tertiles of maternal "egg, meat, poultry and legume" pattern had a significantly lower HAZ compared to those in the first tertile. No significant associations between the household and child "egg, meat, poultry and legume" dietary patterns with HAZ and stunting were found. Statistically non-significant associations were found between household, maternal and child DDSs, and HAZ and stunting.
A higher adherence to a "dairy, vegetable and fruit" dietary pattern is associated with increased HAZ and reduced risk of stunting. Dietary pattern analysis methods, using routinely collected dietary data, can be an alternative approach to DDSs in low resource settings, to measure dietary quality and in determining associations of overall dietary intake with stunting.
与关注单一食物或摄入食物的简单计数相比，识别综合饮食习惯的饮食模式更有助于理解饮食成分的综合影响。因此，本研究旨在使用饮食模式作为饮食多样性评分（DDS）的替代方法，并调查其与埃塞俄比亚儿童发育迟缓的关系。
在埃塞俄比亚的两个地区，采用两阶段随机聚类抽样技术招募了母亲及其 5 岁以下儿童（n=3788）。收集了社会人口统计学、饮食和人体测量数据。使用标准化饮食多样性工具评估饮食摄入。通过四次（因子）分析确定家庭、母亲和儿童的 DDS 和饮食模式。应用多水平线性和泊松回归分析分别评估 DDS 和饮食模式与身高年龄 z 评分（HAZ）和发育迟缓的关系。
5 岁以下儿童发育迟缓的总患病率为 38.5%（n=1459）。我们分别为家庭（“鱼、肉和杂项”、“蛋、肉、家禽和豆类”和“乳制品、蔬菜和水果”）、母亲（“植物性”、“蛋、肉、家禽和豆类”和“乳制品、蔬菜和水果”和儿童（“谷物为主”、“蛋、肉、家禽和豆类”和“乳制品、蔬菜和水果”）确定了三种饮食模式。与处于第一三分位的家庭“乳制品、蔬菜和水果”模式的儿童相比，处于第三三分位的儿童 HAZ 增加了 0.16（β=0.16；95%CI：0.02，0.30）。处于第三三分位的儿童 24-59 个月和 6-59 个月 HAZ 分别增加了 0.22（β=0.22；95%CI：0.06，0.39）和 0.19（β=0.19；0.04，0.33）。与处于第一三分位的儿童相比，处于第二（β=-0.17；95%CI：-0.31，-0.04）和第三（β=-0.16；95%CI：-0.30，-0.02）三分位的母亲“蛋、肉、家禽和豆类”模式的儿童 HAZ 显著降低。家庭和儿童“蛋、肉、家禽和豆类”饮食模式与 HAZ 和发育迟缓之间无显著关联。家庭、母亲和儿童的 DDS 与 HAZ 和发育迟缓之间也未发现统计学上显著的关联。
较高的“乳制品、蔬菜和水果”饮食模式依从性与 HAZ 增加和发育迟缓风险降低有关。使用常规收集的饮食数据的饮食模式分析方法可以作为 DDS 的替代方法，用于衡量饮食质量和确定整体饮食摄入与发育迟缓的关系。
