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Korkalo L.,University of Helsinki | Erkkola M.,University of Helsinki | Heinonen A.E.,University of Helsinki | Freese R.,University of Helsinki | And 2 more authors.
European Journal of Nutrition | Year: 2016

Purpose: In low-income settings, dietary diversity scores (DDSs) often predict the micronutrient adequacy of diets, but little is known about whether they predict levels of biochemical indicators of micronutrient status. Methods: In 2010, we studied two samples of non-pregnant 14- to 19-year-old girls in central Mozambique, the first in January–February (‘hunger season’; n = 227) and the second in May–June (harvest season; n = 223). In this paper, we examined whether a low Women’s Dietary Diversity Score (WDDS) predicts a low concentration of haemoglobin, serum ferritin, zinc, and folate, and plasma retinol in adolescent Mozambican girls. We constructed three scores: WDDS based on 24-h recalls, WDDS15g based on 24-h recall and employing a 15 g limit, and 7dWDDS based on 7-day food frequency questionnaires. Logistic regression models, stratified by season, were used to estimate the odds of having a low concentration of a status indicator (≤25th percentile of the season-specific distribution or cut-off from the literature) in those with a low score compared to those with a higher score. Results: In January–February, after adjusting for confounders, a low (≤3) WDDS and a low (≤5) 7dWDDS were each associated with higher odds of having low serum zinc compared to having a higher score, regardless of which of the two types of cut-offs for serum zinc was used. These associations were not present in May–June. Conclusions: Our data from Mozambique suggest that dietary diversity is associated with serum zinc, but this association seems to be limited to the hunger season. © 2016 Springer-Verlag Berlin Heidelberg

Korkalo L.,University of Helsinki | Erkkola M.,University of Helsinki | Fidalgo L.,Food Security and Nutrition Association ANSA | Nevalainen J.,University of Turku | Mutanen M.,University of Helsinki
Public Health Nutrition | Year: 2013

Objective To assess the validity of food photographs in portion size estimation among adolescent girls in Mozambique. The study was carried out in preparation for the larger ZANE study, which used the 24 h dietary recall method. Design Life-sized photographs of three portion sizes of two staple foods and three sauces were produced. Participants ate weighed portions of one staple food and one sauce. After the meal, they were asked to estimate the amount of food with the aid of the food photographs. Setting Zambezia Province, Mozambique. Subjects Ninety-nine girls aged 13-18 years. Results The mean differences between estimated and actual portion sizes relative to the actual portion size ranged from -19 % to 8 % for different foods. The respective mean difference for all foods combined was -5 % (95 % CI -12, 2 %). Especially larger portions of the staple foods were often underestimated. For the staple foods, between 62 % and 64 % of the participants were classified into the same thirds of the distribution of estimated and actual food consumption and for sauces, the percentages ranged from 38 % to 63 %. Bland-Altman plots showed wide limits of agreement. Conclusions Using life-sized food photographs among adolescent Mozambican girls resulted in a rather large variation in the accuracy of individuals' estimates. The ability to rank individuals according to their consumption was, however, satisfactory for most foods. There seems to be a need to further develop and test food photographs used in different populations in Sub-Saharan Africa to improve the accuracy of portion size estimates. Copyright © The Authors 2012.

Korkalo L.,University of Helsinki | Freese R.,University of Helsinki | Alfthan G.,Finnish National Institute for Health and Welfare | Fidalgo L.,Food Security and Nutrition Association ANSA | Mutanen M.,University of Helsinki
Nutrition Research | Year: 2015

Micronutrient deficiencies can damage the health of adolescent girls and their offspring. There is a lack of population-based data on the micronutrient status of adolescents in Sub-Saharan Africa. We conducted a cross-sectional, population-based study to examine the biochemical status, prevalence of deficiency, dietary intake, and food sources of selected micronutrients among adolescent girls in Central Mozambique. Separate groups of study participants were recruited in 2 seasons in 2010. The participants were girls between 14 and 19 years of age (n = 551) from 1 urban area and 2 rural districts. Micronutrient status indicators were analyzed from blood and urine samples. Twenty-four-hour dietary recalls were also carried out. The overall prevalence with 95% confidence interval (calculated using sampling weights) among nonpregnant girls was 42.4% (37.2%-47.8%; n = 466) for anemia, 27.4% (23.1%-32.2%; n = 427) for low serum ferritin, 32.7% (27.7%-38.1%; n = 423) for low serum zinc, 14.7% (11.2%-19.0%; n = 426) for low plasma retinol, and 4.1% (2.9%-5.8%; n = 448) for low serum folate. The selenium status was considered sufficient. Mild to moderate iodine deficiency was found in the rural districts, whereas the iodine status of urban girls was adequate. Significantly lower serum folate concentrations were found in the urban area compared to the rural districts. The seasonal differences in vitamin A intake were significant. The intakes of micronutrients from animal source foods were small. In summary, adolescent Mozambican girls are at risk of several micronutrient deficiencies. This raises concern especially because adolescent motherhood is common in the region. Actions need to be taken to prevent and control micronutrient deficiencies. © 2015 Elsevier Inc.

Korkalo L.,University of Helsinki | Freese R.,University of Helsinki | Fidalgo L.,Food Security and Nutrition Association ANSA | Selvester K.,Food Security and Nutrition Association ANSA | And 2 more authors.
Journal of Medical Internet Research | Year: 2014

Background: There is very little published work on dietary intake and nutritional status of Mozambicans. We conducted a population-based cross-sectional study on the diet and nutritional status of adolescent girls in different types of communities in Zambézia Province, Central Mozambique, in two distinct seasons. Objective: The purpose of this paper is to present the design, methods, and study population characteristics of the Estudo do Estado Nutricional e da Dieta em Raparigas Adolescentes na Zambézia (the ZANE Study). Methods: Data was collected in January-February 2010 ("hunger season") and in May-June 2010 ("harvest season"). A total of 551 girls in the age group 14-19 years old were recruited from one urban area and two districts (district towns and rural villages). The study protocol included a background interview, a 24-hour dietary recall interview, a food frequency questionnaire, anthropometric measurements, bioimpedance, hemoglobin measurement, and venous blood, urine, buccal cell, and fecal sampling. Results: Adolescent motherhood was common in all study regions. Stunting prevalence for the total study population as a weighted percentage was 17.8% (95/549; 95% CI 14.3-22.0) with no regional differences. Overweight was found mainly in the urban area where the prevalence was 12.6% (20/159; 95% CI 7.5-17.6), thinness was rare. There were regional differences in the prevalence of malaria parasitemia and intestinal helminth infestation, but not human immunodeficiency virus. Conclusions: The fully analyzed data from the ZANE Study will yield results useful for setting priorities in nutrition policy and further research on the diet and nutritional status in Mozambique and other countries with similar nutritional problems. Trial Registration: ClinicalTrials.gov: NCT01944891; http://www.clinicaltrials.gov/ct2/show/NCT01944891 (Archived by WebCite at http://www.webcitation.org/6L9OUrsq8). © Holly O Witteman.

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