• Applying the Food Multimix concept for sustainable and nutritious diets

      Zotor, Francis B.; Ellahi, Basma; Amuna, Paul; University of Health and Allied Sciences; University of Chester (Cambridge University Press, 2015-08-11)
      Background: Despite a rich and diverse ecosystem and biodiversity, worldwide, more than 2 billion people suffer from micronutrient malnutrition or hidden hunger. Of major concern are a degradation of our ecosystems and agricultural systems which are thought to be unsustainable thereby posing a challenge for the future food and nutrition security. Despite these challenges, nutrition security and ensuring well balanced diets depend on sound knowledge and appropriate food choices in a complex world of plenty and want. We have previously reported on how the food multimix (FMM) concept, a food-based and dietary diversification approach can be applied to meeting energy and micronutrient needs of vulnerable groups through an empirical process. Our objective in this article is to examine how the concept can be applied to improve nutrition in a sustainable way in otherwise poor and hard-to-reach communities. We have reviewed over 100 FMM food recipes formulated from combinations of commonly consumed traditional candidate food ingredients; on average five per recipe, and packaged as per 100 g powders from different countries including Ghana, Kenya, Botswana, Zimbabawe and Southern Africa, India, Mexico, Malaysia and United Kingdom; and for different age groups and conditions such as older infants and young children, pregnant women, HIV patients, diabetes and for nutrition rehabilitation. Candidate foods were examined for their nutrient strengths and nutrient content and nutrient density of recipes per 100 g were compared to reference nutrient intakes (RNIs) for the different population groups. We report on the nutrient profiles from our analysis of the pooled and age-matched data as well as sensory analysis and conclude that locally produced FMM foods can complement local diets and contribute significantly to meeting nutrient needs among vulnerable groups in food-insecure environments. Key words: food multimix, candidate foods, sustainable, food security, resource-poor, nutrition interventions.
    • Assessment of sodium and iodine intake among university students in Casablanca, Morocco

      Jafri, Ali; Elarbaoui, Maria; Elkardi, Younes; Makhlouki, Houria; Ellahi, Basma; Derouiche, Abdelfettah; Université Mohammed VI des Sciences de la Sante; University of Chester; Université Hassan II de Casablanca (Elsevier, 2021-07-08)
      Introduction. – Iodine deficiency is still a matter of public health concern despite salt fortification andespecially with global recommendations to lower salt intake, this is mainly due to dietary habits. Uni-versity students have a diet based on street food high in sodium and low in other micronutrients (i.e.iodine and potassium). In this study, we aim to measure sodium and iodine levels in university studentsto assess their risk of developing complications later in life.Methodology. – A sample of 120 students aged between 18 and 25 years old was recruited and asked tocollect their 24-hours urine samples in special containers containing. Samples were stored then analyzedfor sodium, potassium, iodine and creatinine levels.Results. – The average urinary excretion of sodium was 3066.8 ± 1196.0 mg/day. Overall, 72.6% of par-ticipants consume more than 2 g/day of sodium. Average potassium intake is 1805.9 ± 559.4 mg/day,and all participants consume less than the adequate amount. Daily urinary excretion of iodine is135.6 ± 88.9 mg/day, and 69.2% of participants consume less than the recommended amount. Sodium,potassium and iodine intakes were higher in male participants (P-values = 0.008; 0.044 and 0.003, respec-tively). The lowest average iodine intake was observed in underweight participants (119.4 ± 31.4) with87.5% of underweight participants and 80% of female participants below the recommended intake.Conclusion. – Sodium intake is high while iodine intake is low in this studied population, especially inwomen.
    • Association of apolipoprotein E gene polymorphisms with blood lipids and their interaction with dietary factors

      Shatwan, Israa M.; Winther, Kristian H.; Ellahi, Basma; Elwood, Peter; Ben-Shlomo, Yoav; Givens, Ian; Rayman, Margaret P.; Lovegrove, Julie A.; Vimaleswaran, Karani S.; University of Reading; King Abdulaziz University; University Hospital Denmark; University of Chester; University Hospital of Wales; University of Bristol; University of Surrey (BioMed Central, 2018-04-30)
      Background: Several candidate genes have been identified in relation to lipid metabolism, and among these, lipoprotein lipase (LPL) and apolipoprotein E (APOE) gene polymorphisms are major sources of genetically determined variation in lipid concentrations. This study investigated the association of two single nucleotide polymorphisms (SNPs) at LPL, seven tagging SNPs at the APOE gene, and a common APOE haplotype (two SNPs) with blood lipids, and examined the interaction of these SNPs with dietary factors. Methods: The population studied for this investigation included 660 individuals from the Prevention of Cancer by Intervention with Selenium (PRECISE) study who supplied baseline data. The findings of the PRECISE study were further replicated using 1238 individuals from the Caerphilly Prospective cohort (CaPS). Dietary intake was assessed using a validated food-frequency questionnaire (FFQ) in PRECISE and a validated semi-quantitative FFQ in the CaPS. Interaction analyses were performed by including the interaction term in the linear regression model adjusted for age, body mass index, sex and country. Results: There was no association between dietary factors and blood lipids after Bonferroni correction and adjustment for confounding factors in either cohort. In the PRECISE study, after correction for multiple testing, there was a statistically significant association of the APOE haplotype (rs7412 and rs429358; E2, E3, and E4) and APOE tagSNP rs445925 with total cholesterol (P = 4 × 10− 4 and P = 0.003, respectively). Carriers of the E2 allele had lower total cholesterol concentration (5.54 ± 0.97 mmol/L) than those with the E3 (5.98 ± 1.05 mmol/L) (P = 0.001) and E4 (6.09 ± 1.06 mmol/L) (P = 2 × 10− 4) alleles. The association of APOE haplotype (E2, E3, and E4) and APOE SNP rs445925 with total cholesterol (P = 2 × 10− 6 and P = 3 × 10− 4, respectively) was further replicated in the CaPS. Additionally, significant association was found between APOE haplotype and APOE SNP rs445925 with low density lipoprotein cholesterol in CaPS (P = 4 × 10− 4 and P = 0.001, respectively). After Bonferroni correction, none of the cohorts showed a statistically significant SNP-diet interaction on lipid outcomes. Conclusion: In summary, our findings from the two cohorts confirm that genetic variations at the APOE locus influence plasma total cholesterol concentrations, however, the gene-diet interactions on lipids require further investigation in larger cohorts.
    • Association of apolipoprotein E gene polymorphisms with blood lipids and their interaction with dietary factors

      Shatwan, Israa M.; Winther, Kristian H.; Ellahi, Basma; Elwood, Peter; Ben-Shlomo, Yoav; Givens, Ian; Rayman, Margaret P.; Lovegrove, Julie A.; Vimaleswaran, Karani S.; Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Reading, UK, RG6 6AP, UK; Food and Nutrition Department, Faculty of Home Economics, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Endocrinology and Metabolism Odense University Hospital Denmark; Faculty of Health and Social Care, University of Chester, Chester, CH1 1SL, UK; Department of Epidemiology, Statistics and Public Health, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK; Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK; Institute for Food, Nutrition and Health, University of Reading, Earley Gate, Reading RG6 6AR, UK; Department of Nutritional Sciences Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK. (BMC, 2018-04-30)
      Abstract Background: Several candidate genes have been identified in relation to lipid metabolism, and among these, lipoprotein lipase (LPL) and apolipoprotein E (APOE) gene polymorphisms are major sources of genetically determined variation in lipid concentrations. This study investigated the association of two single nucleotide polymorphisms (SNPs) at LPL, seven tagging SNPs at the APOE gene, and a common APOE haplotype (two SNPs) with blood lipids, and examined the interaction of these SNPs with dietary factors. Methods: The population studied for this investigation included 660 individuals from the Prevention of Cancer by Intervention with Selenium (PRECISE) study who supplied baseline data. The findings of the PRECISE study were further replicated using 1,238 individuals from the Caerphilly Prospective cohort (CaPS). Dietary intake was assessed using a validated food-frequency questionnaire (FFQ) in PRECISE and a validated semi-quantitative FFQ in the CaPS. Interaction analyses were performed by including the interaction term in the linear regression model adjusted for age, body mass index, sex and country. Results: There was no association between dietary factors and blood lipids after Bonferroni correction and adjustment for confounding factors in either cohort. In the PRECISE study, after correction for multiple testing, there was a statistically significant association of the APOE haplotype (rs7412 and rs429358; E2, E3, and E4) and APOE tagSNP rs445925 with total cholesterol (P=4x10-4 and P=0.003, respectively). Carriers of the E2 allele had lower total cholesterol concentration (5.54± 0.97 mmol/L) than those with the E3 (5.98± 1.05 mmol/L) (P=0.001) and E4 (6.09± 1.06 mmol/L) (P=2x10-4) alleles. The association of APOE haplotype (E2, E3, and E4) and APOE SNP rs445925 with total cholesterol (P=2x10-6 and P=3x10-4, respectively) was further replicated in the CaPS. Additionally, significant association was found between APOE haplotype and APOE SNP rs445925 with low density lipoprotein cholesterol in CaPS (P=4x10-4 and P=0.001, respectively). After Bonferroni correction, none of the cohorts showed a statistically significant SNP-diet interaction with lipid outcomes. Conclusion: In summary, our findings from the two cohorts confirm that genetic variations at the APOE locus influence plasma total cholesterol concentrations, however, the gene-diet interactions on lipids require further investigation in larger cohorts.
    • Building systemic capacity for Nutrition: Training towards a professionalised workforce for Africa.

      Ellahi, Basma; Annan, Reginald; Sarkar, Swrajit; Amuna, Paul; Jackson, Alan A.; University of Chester; University of Kumasi; University of Central Lancashire; University of Greenwich; University of Southampton (Cambridge University Press, 2015-06-15)
      The fundamental role played by good nutrition in enabling personal, social and economic development is now widely recognised as presenting a fundamental global challenge that has to be addressed if major national and international problems are to be resolved in the coming decades. The recent focus provided by the Millennium Development Goals and the Scaling-Up-Nutrition (SUN) Movement has been towards reducing the extent of nutrition-related malnutrition in high burden countries. This has served to emphasise that there is a problem of inadequate professional capacity in nutrition that is sufficiently widespread to severely limit all attempts at the effective delivery and sustainability of nutrition-related and nutrition-enabling interventions that have impact at scale. Many high burden countries are in sub-Saharan Africa where there is a high dependency on external technical support to address nutrition-related problems. We have sought to explore the nature and magnitude of the capacity needs with a particular focus on achieving levels of competency within standardised professional pre-service training which is fit for purpose to meet the objectives within the Scaling-Up-Nutrition movement in Africa. We review our experience of engaging with stakeholders through workshops and a gap analysis of the extent of the problem to be addressed, and a review of current efforts in Africa. We conclude that there are high aspirations but severely limited human resource and capacity for training that is fit-for-purpose at all skill levels in nutrition-related subjects in Africa. There are no structured or collaborative plans within professional groups to address the wide gap between what is currently available, the ongoing needs and the future expectations for meeting local technical and professional capability. Programmatic initiatives encouraged by agencies and other external players, will need to be matched by improved local capabilities to address the serious efforts required to meet the needs for sustained improvements related to Scaling-Up-Nutrition in high burden countries. Importantly, there are pockets of effort which need to be encouraged within a context in which experience can be shared and mutual support provided.
    • Considerations for evaluation of public health nutrition interventions in diverse communities

      Ellahi, Basma; University of Chester (Blackwell, 2017-06-02)
      Key messages Knowledge of ethnic groups and in particular their food habits is critical in evaluation Nutritionists should ensure they are culturally competent to work with diverse communities Evaluation of diverse groups requires consideration of language and cultural specific outcomes and literacy issues Identifying the factors that support successful nutrition interventions in diverse groups is challenging without the appropriate tools and measures
    • Decreasing physical activity levels across religious Sikh male South asian migrant population in Kent, UK: A public health concern

      Sarkar, Swrajit; Ellahi, Basma; Zotor, Francis B.; Amuna, Paul; Leeds Trinity University; University of Chester; University of Health and Allied Sciences; University of Greenwich (SAGE, 2017-10-09)
      Physical activity (PA) plays a crucial role in reducing the risk of non-communicable diseases (NCDs). We investigated intergenerational physical activity level (PAL) among first and second generation Sikh Punjabi male subjects (n=137), recruited from two Sikh temples in Medway, UK. Employing a cross sectional survey PA was quantified using the validated Global PA Questionnaire (GPAQ). Data were analysed using SPSS 20 and Epi Info software. 91% of the subjects were classified as overweight. Mean physical activity level (PAL) range was sedentary to low levels of PA (1.45 – 1.60). Comparisons between first and second generation Punjabi male subjects showed that the two groups are equally culpable in not engaging in work-related or recreational PA, but for the second generation this is significantly lower. Low PAL is a contributory factor to increased risk and prevalence of NCDs among this population and a public health concern. Efforts to increase PA in this group should continue.
    • Diet and eating habits of expectant parents and families in Ras Al Khaimah, Emirates: an exploratory study.

      Steen, Mary; Mottershead, Richard; Idriss, Johaina; Parletta, Natalie; Ellahi, Basma; Kumardhas, Vijaya; University of South Australia; Higher Colleges of Technology, Ras Al Khaimah; United Arab Emirates University; University of South Australia; University of Chester; RAK Medical and Health Sciences University (Royal College of Midwives, 2017-06-31)
      Background. Obesity is a problem that has reached epidemic proportions around the globe, attaining an alarming level in Arab Gulf countries. Poor diets and a lack of essential nutrients being consumed by pregnant women has been acknowledged, and it is recognised that parental eating habits and preferences can contribute to the development of unhealthy diets in children. However, there have been no studies exploring diet and eating habits that have targeted expectant parents and their families in the United Arab Emirates (UAE). Aim. To explore the diet and eating habits of expectant parents and their families during pregnancy and test the feasibility of introducing an EatWell Assist workshop and diary, to increase awareness of healthy eating to improve family diet and nutritional status. Method. Participants were recruited from three study sites in Ras Al Khaimah, UAE. Initially, a purposive sample of 20 expectant mothers and 10 expectant fathers were interviewed. Phase 2 of the study recruited 15 expectant mothers and five female family members or close friends to attend on e of three EatWell Assist workshops and complete a diary for four weeks. Thematic analysis of interview transcripts and simple analysis of the structured questionnaire was undertaken. Results. The thematic analysis identified seven main themes for expectant mothers’ current diets and eating habits. These were: knowledge and understanding, eating patterns, fast foods, using supplements, likes and dislikes, body image, influences. Five similar main themes emerged for expectant fathers but the theme, ‘no supplements’, was in contrast to expectant mothers’ ‘using supplements’, and ‘body image’ did not emerge. Overall, the findings demonstrated the workshop evaluations were positive and participants gained knowledge and valued the opportunity to attend. Completing an EatWell food diary enabled expectant mothers to improve their diets and eating habits. Conclusions. Expectant parents’ current diet and eating habits were significantly influenced by the availability of a Western diet as well as traditional foods and cultural eating preferences. There was some improvement in healthy eating behaviours after attending a healthy eating workshop and keeping a daily food diary. Expectant fathers’ work commitments and women’s preferences inhibited opportunities for them to receive healthy eating education. Strategies to engage with expectant fathers need to be implemented and online education options may be worth considering.
    • Dietary assessment in minority ethnic groups: A systematic review of portion size estimation instruments relevant for the UK

      Almiron-Roig, Eva; Aitken, Amanda; Galloway, Catherine; Ellahi, Basma; MRC Elsie Widdowson Laboratory, Cambridge, UK. Centre for Nutrition Research, University of Navarra, Pamplona, Spain. Faculty of Health and Social Care, University of Chester, Chester, UK (Oxford University Press, 2016-03-14)
      Context: Dietary assessment in minority ethnic groups is critical for surveillance programmes and for implementing effective interventions. A major challenge is the accurate estimation of portion sizes for traditional foods/dishes. Objective: To systematically review published records up to 2014 describing a portion size estimation element (PSEE) applicable to dietary assessment of UK-residing ethnic minorities. Data sources, selection, extraction: Electronic databases, internet sites, and theses repositories were searched generating 5683 titles from which 57 eligible full-text records were reviewed. Data analysis: Forty-two publications aimed at minority ethnic groups (n=20) or autochthonous populations (n=22) were included. The most common PSEE (47%) were combination tools (e.g. food models and portion size lists); followed by portion size lists in questionnaires/guides (19%); image-based and volumetric tools (17% each). Only 17% PSEE had been validated against weighed data. Conclusions: When developing ethnic-specific dietary assessment tools it is important to consider customary portion sizes by sex and age; traditional household utensil usage and population literacy levels. Combining multiple PSEE may increase accuracy but such tools need validating.
    • Dietary intake patterns of South Asian men attending mosques in Burnley, UK

      Ellahi, Basma; Chow, C.; Fitzgerald, Sarah; Dikmen, Derya; University of Chester ; University of Chester ; University of Chester ; Hacettepe University (Webmedcentral.com, 2014-10)
      Objective: To characterise the diet of South Asian males attending mosques in Burnley in order to focus intervention strategies to improve nutrition-related health in the community. Design: Cross sectional survey of Muslim men in Burnley, Lancashire UK. Muslim men (n=141) aged 15-67 years who consented were recruited. Subjects completed a food and health questionnaire and a 24 hour dietary recall (repeated) and provided self-reported anthropometric data. Results: Data revealed significant dietary under-reporting in the sample with a mean value of 78.0% of the estimated average intake (EAR) for energy specific to age group reported. Under-reporting was more likely as the body mass index (BMI) of subjects increased. Similar proportions of total energy were derived from protein but a greater percentage of energy was provided by total fat and a smaller proportion by total carbohydrate when compared with white British males. Saturated fatty acids constituted half the proportion of total food energy yet mono-unsaturated fatty acid intake was low in comparison. All (except the 46-67) year old age group consumed greater than 6g of salt a day. Conclusions: The study identifies several areas with the potential for health improvement. Subjects should reduce total fat intake and redistribute fat intake to more favourable proportions, with more emphasis on monounsaturated fat sources. Further dietary modifications include reducing salt intake and increasing non-starch polysaccharide consumption. Access to mosques for use as a health assessment and promotion environment is an important avenue for ensuring effective communication of messages for Muslims.
    • Exploring the health status of older persons in Sub Saharan Africa

      Audain, Keiron A.; Carr, Michelle; Dikmen, Derya; Zotor, Francis B.; Ellahi, Basma; University of Zambia; University of Chester; Hacettepe University; University of Health and Allied Science; University of Chester (Cambridge University Press, 2017-05-10)
      Sub-Saharan Africa has traditionally had a low life expectancy due to the onslaught of the HIV epidemic, high levels of chronic diseases, injuries, conflict and undernutrition. Therefore, research into public health concerns of older persons has largely been overlooked. With a growing population, the roll-out of antiretroviral treatment, and the effects of globalisation; Sub-Saharan Africa is experiencing an increase in the number of people over 50 years of age as well as an increase in the prevalence of non-communicable diseases. The aim of this review is to highlight available research on the health status of older persons in Sub-Saharan Africa, and to identify the current gaps that warrant further investigation. A literature search was conducted across multiple databases to identify studies in Sub-Saharan Africa on older persons (aged 50 years and older) related to health indicators including nutritional status, non-communicable diseases and HIV burden. Whilst it was concluded that older persons are at an increased risk of poor health, it was also determined that significant gaps exist in this particular area of research; namely nutrient deficiency prevalence. Resources should be directed towards identifying the health concerns of older persons and developing appropriate interventions.
    • Food supplementation among HIV-infected adults in Sub-Saharan Africa: Impact on treatment adherence and weight gain

      Audain, Keiron A.; Zotor, Francis B.; Amuna, Paul; Ellahi, Basma; University of KwaZulu Natal ; University of Health and Allied Sciences, Ghana ; University of Greenwich ; University of Chester (The Nutrition Society, 2015-03-12)
      Sub-Saharan Africa has the highest proportion of undernourished people in the world, along with the highest number of people living with HIV and AIDS. Thus, as a result of high levels of food insecurity many HIV patients are also undernourished. The synergism between HIV and undernutrition leads to poor treatment adherence and high mortality rates. Undernutrition has a debilitating effect on the immune system due to key nutrient deficiencies and the overproduction of reactive species (oxidative stress), which causes rapid HIV progression and the onset of AIDS. Therapeutic food supplementation used in the treatment of severe acute malnutrition is being applied to HIV palliative care; however, little biochemical data exist to highlight its impact on oxidative stress and immune recovery.
    • Fruit and vegetables on prescription: A brief intervention in primary care

      Buyuktuncer, Zehra; Kearney, Matt; Ryan, Christine L.; Thurston, Miranda; Ellahi, Basma; University of Chester/Haccettepe University, Turkey; Department of Health; University of Chester; University of Chester/Hedmark University College, Norway (Journal of Nutrition and Dietetics, 2014-05-07)
      Background Increasing fruit and vegetable consumption is a goal for the UK. Therefore, the effectiveness of a fruit and vegetable voucher scheme coupled with key ‘5-a-day’ consumption messages as a brief intervention in primary care consultations was assessed in this study. Methods 1188 vouchers as a prescription for fruits and vegetables were routinely distributed to patients attending a primary health care centre in a deprived area, and 124 volunteer patients routinely attending the centre were included. Telephone based questionnaires were used to examine changes in consumption in the short and medium term. Other key aspects assessed in the evaluation related to fruit and vegetable purchasing behaviour, knowledge relating to what constitutes a portion size, the relationship between food and health, and barriers to consumption. Results Although 76.2% of participants used the prescription vouchers when purchasing fruits and vegetables, a significant change in the consumption or purchasing behaviour was not observed (p0.05). Participants’ level of knowledge relating to number of portions recommended and the portion size of different fruits and vegetables showed moderate increase from baseline to short term and to medium term. The primary barriers to fruit and vegetable consumption were reported as ‘the quality of fresh fruits and vegetables’ and ‘the money available to spend on food’. Conclusion The use of “the fruit and vegetable on prescription” scheme was an effective method of engaging participants in improving awareness of key diet related health messages. However, further intervention is required to produce a significant impact on the actual behaviour change. Keywords fruit and vegetable prescription, mainstreaming prevention, health settings
    • FTO gene-lifestyle interactions on serum adiponectin concentrations and central obesity in a Turkish population

      Isgin-Atici, Kubra; Alsulami, Sooad; Turan-Demirci, Busra; Surendran, Shelini; Sendur, Suleyman Nahit; Lay5, Incilay; Karabulut, Erdem; Ellahi, Basma; Lovegrove, Julie; Alikasifoglu, Mehmet; et al.
      The aim of the study was to investigate whether lifestyle factors modify the association fat mass and obesity-associated (FTO) gene single nucleotide polymorphisms (SNPs) and obesity in a Turkish population. The study included 400 unrelated individuals, aged 24-50 years recruited in a hospital setting. Dietary intake and physical activity were assessed using 24-hour dietary recall and self-report questionnaire, respectively. A genetic risk score (GRS) was developed using FTO SNPs, rs9939609 and rs10163409. Body mass index and fat mass index were significantly associated with FTO SNP rs9939609 (P=0.001 and P=0.002, respectively) and GRS (P=0.002 and P=0.003, respectively). The interactions between SNP rs9939609 and physical activity on adiponectin concentrations, and SNP rs10163409 and dietary protein intake on increased waist circumference were statistically significant (Pinteraction=0.027 and Pinteraction=0.044, respectively). This study demonstrated that the association between FTO SNPs and central obesity might be modified by lifestyle factors in this Turkish population.
    • Household and market survey on availability of adequately iodized salt in the Volta region, Ghana

      Agbozo, Faith; Der, Joyce B.; Glover, Nutifafa J.; Ellahi, Basma; University of Health and Allied Sciences, Ho, Ghana; Volta Regional Health Directorate, Ghana Health Service; University of Chester (Taylor and Francis, 2016-10-27)
      Consumption of adequately iodized salt (AIS) ≥15ppm is one of the criteria for measuring progress towards universal salt iodization (USI) and sustainable elimination of iodine deficiency disorders. After series of health promotion activities, this survey was conducted to evaluate the extent to which USI was achieved. Cross-sectional survey was conducted in 1,961 households and 350 markets to estimate the iodine levels of salt consumed or sold. Three degrees of iodization were estimated from fine, coarse and granular texture salt using MBI rapid field test kits. Differences in iodization levels were determined using Bonferroni test in STATA. Determinants for household utilization of AIS were identified using regression analysis and reported as odds ratio (OR). Availability of AIS in households (24.5%) and markets (30.9%) was far below the 90% recommendation. No differences where observed in urban (26.8%) and rural (24.1%) households. Households that used fine-texture salt (OR: 40.13; CI: 30.1-53.4) or stored salt in original packs (OR: 8.02; CI: 6.01-10.70) were more likely to consume AIS. Across districts, highest household availability of AIS was 51.7% while the least was 7.5%. The district with the highest market availability of AIS was 85.7% while the least was 8.3%. Almost 32% of the traders were aware that selling non-iodized salt was unauthorized but out of this, only 12% sold AIS. Public education should emphasis appropriate handling and storage of salt throughout the supply chain. To ensure adequate salt fortification with iodine, improved surveillance of factories and mining sites is recommended.
    • Impact of type of child growth intervention program on caregivers’ child feeding knowledge and practices: A comparative study in Ga West Municipality, Ghana

      Agbozo, Faith; Colecraft, Esi; Ellahi, Basma; University of Ghana; University of Chester (Wiley, 2015-12-02)
      Community-Based Growth Promotion (CBGP) delivered by community volunteers aims at enhancing the traditional Growth Monitoring and Promotion (GMP) programme delivered by community health nurses through the promotion of optimum infant and young child feeding (IYCF) leading to improved child growth. This study compared IYCF knowledge and practices among caregiver-child pairs (0-24 months) receiving child welfare services from CBGP (n=124) and GMP (n=108) programmes. Semi-structured questionnaires were used to interview caregivers on IYCF knowledge/practices and validated food frequency questionnaire used to record infants’ food intakes. Group differences were determined using Chi-square and independent samples t-tests (p<0.05; 95% CI). Mean IYCF knowledge scores were similar (CBGP:10.84±1.69 vs. GMP:10.23±1.38, p=0.062). However, more CBGP caregivers (17%) were highly knowledgeable than their GMP counterparts (5%) (p=0.011). Early breastfeeding initiation (CBGP:54% vs. GMP:28%, p<0.0001), exclusive breastfeeding (CBGP:73% vs. GMP:56%, p=0.001) and timely complementary feeding (CBGP:72% vs. GMP:49%, p=0.014) were reportedly higher among CBGP caregivers. Underweight was 11% (CBGP:8% vs. GMP:14%, p=0.154. Mean dietary diversity scores (10 food groups) were similar (CBGP:4.49±1.89 vs. GMP:3.87±1.89, p=0.057) but more CBGP caregivers (77%) achieved minimum dietary diversity than their GMP counterparts (61%) (p=0.035). Few caregivers achieved minimum meal frequency (CBGP:31% vs. GMP:29%, p=0.486) and minimum acceptable diet (CBGP:23% vs. GMP:21%, p=0.464) indicators. Number of children under 5 years owned by caregiver (AOR: 0.405; 95% CI: 1.13-78.53, p=0.038), her educational level (AOR: 0.112; 95% CI: 0.02-0.90, p=0.040) and IYCF knowledge (AOR: 0.140; 95% CI: 0.03-0.79, p=0.026) significantly predicted optimum child feeding. Nutrition education on optimum complementary feeding and birth spacing strategies should intensify.
    • Interaction between Metabolic Genetic Risk Score and Dietary Fatty Acid Intake on Central Obesity in a Ghanaian Population

      Alsulami, Sooad; Nyakotey, David; Dudek, Kamila; Bawah, Abdul-Malik; Lovegrove, Julie; Annan, Reggie; Ellahi, Basma; Karani, Santhanakrishnan Vimaleswaran; University of Reading, University of Chester and Kumasi University (MDPI, 2020-07-27)
      Obesity is a multifactorial condition arising from the interaction between genetic and lifestyle factors. We aimed to assess the impact of lifestyle and genetic factors on obesity-related traits in 302 healthy Ghanaian adults. Dietary intake and physical activity were assessed using a 3 day repeated 24 h dietary recall and global physical activity questionnaire, respectively. Twelve single nucleotide polymorphisms (SNPs) were used to construct 4-SNP, 8-SNP and 12-SNP genetic risk scores (GRSs). The 4-SNP GRS showed significant interactions with dietary fat intakes on waist circumference (WC) (Total fat, Pinteraction = 0.01; saturated fatty acids (SFA), Pinteraction = 0.02; polyunsaturated fatty acids (PUFA), Pinteraction = 0.01 and monounsaturated fatty acids (MUFA), Pinteraction = 0.01). Among individuals with higher intakes of total fat (>47 g/d), SFA (>14 g/d), PUFA (>16 g/d) and MUFA (>16 g/d), individuals with ≥3 risk alleles had a significantly higher WC compared to those with <3 risk alleles. This is the first study of its kind in this population, suggesting that a higher consumption of dietary fatty acid may have the potential to increase the genetic susceptibility of becoming centrally obese. These results support the general dietary recommendations to decrease the intakes of total fat and SFA, to reduce the risk of obesity, particularly in individuals with a higher genetic predisposition to central obesity.
    • Interaction between TCF7L2 polymorphism and dietary fat intake on high density lipoprotein cholesterol

      Bodhini, Dhanasekaran; Gaal, Szilvia; Shatwan, Israa M.; Ramya, Kandaswamy; Ellahi, Basma; Surendran, Shelini; Sudha, Vasudevan; Anjana, Mohan R.; Mohan, Viswanathan; Lovegrove, Julie A.; et al. (Public Library of Science, 2017-11-28)
      Recent evidence suggests that lifestyle factors influence the association between the Melanocortin 4 receptor (MC4R) and Transcription Factor 7-Like 2 (TCF7L2) gene variants and cardio-metabolic traits in several populations; however, the available research is limited among the Asian Indian population. Hence, the present study examined whether the association between the MC4R single nucleotide polymorphism (SNP) (rs17782313) and two SNPs of the TCF7L2 gene (rs12255372 and rs7903146) and cardio-metabolic traits is modified by dietary factors and physical activity. This cross sectional study included a random sample of normal glucose tolerant (NGT) (n=821) and participants with type 2 diabetes (T2D) (n=861) recruited from the urban part of the Chennai Urban Rural Epidemiology Study (CURES). A validated food frequency questionnaire (FFQ) was used for dietary assessment and self-reported physical activity measures were collected. The threshold for significance was set at P=0.00023 based on Bonferroni correction for multiple testing [(0.05/210 (3 SNPs x 14 outcomes x 5 lifestyle factors)]. After Bonferroni correction, there was a significant interaction between the TCF7L2 rs12255372 SNP and fat intake (g/day) (Pinteraction=0.0001) on high-density lipoprotein cholesterol (HDL-C), where the ‘T’ allele carriers in the lowest tertile of total fat intake had higher HDL-C (P=0.008) and those in the highest tertile (P=0.017) had lower HDL-C compared to the GG homozygotes. In a secondary analysis of SNPs with the subtypes of fat, there was also a significant interaction between the SNP rs12255372 and polyunsaturated fatty acids (PUFA, g/day) (Pinteraction<0.0001) on HDL-C, where the minor allele carriers had higher HDL-C in the lowest PUFA tertile (P=0.024) and those in the highest PUFA tertile had lower HDL-C (P=0.028) than GG homozygotes. In addition, a significant interaction was also seen between TCF7L2 SNP rs12255372 and fibre intake (g/day) on HDL-C (Pinteraction<0.0001). None of the other interactions between the SNPs and lifestyle factors were statistically significant after correction for multiple testing. Our findings indicate that the association between TCF7L2 SNP rs12255372 and HDL-C may be modified by dietary fat intake in this Asian Indian population.
    • Knowledge and Determinants of Fruit and Vegetable Consumption among Adults in Hohoe Municipality, Ghana

      Awuni, Thomas K.; Kye-Duodu, Gideon; Duodu, Charles; Zotor, Francis B.; Ellahi, Basma; Ghana Health Service, Municipal Health Directorate, Elmina, Ghana 2 Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Ho, Ghana 3 Ghana Health Service, Volta Regional Health Directorate, Ho, Ghana 4 Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana 5 Faculty of Health and Social Care, University of Chester, Chester, UK (scholink, 2017-12-04)
      The World Health Organization (WHO) recommends that a person consumes at least 400g of Fruit and Vegetable (FV) daily to prevent chronic disease risk. We assessed knowledge of current WHO guidelines and other determinants of FV intake among adults (≥ 18 years, n = 397) in Hohoe Municipality, Ghana. Face-to-face interviews using a questionnaire adopted from WHO Risk Factor Surveillance System were undertaken. Knowledge of FV daily servings and determinants of intake were evaluated by descriptive statistics and binary logistic regression. There was a 99.2% response rate with approximately 9% of participants correctly stating the WHO daily recommended amount (P = .296). Most (54%) of respondents’ FV intake was affected by unavailability of desired choice (P = .050). Odd of inadequate consumption for persons aware of adequate amount was 1.97 (95% CI: 0.64, 6.05, P = .234) higher than persons without awareness. Participants with problems accessing their desired choice of FV had 0.59 odds (95% CI: 0.36, 0.95, P = .030) of consuming inadequate amount compared to those with easy access. Adequate FV intake depends on availability of consumer preference regardless of knowledge of recommendations. Individual FV cultivation is relevant for availability of preferred choice and adequate consumption for NCDs risk reductions among Ghanaians.
    • Maternal nutritional status, food intake and pregnancy weight gain in Nepal

      Acharya, Ojaswi; Zotor, Francis B.; Chaudhary, Pushpa; Amuna, Paul; Ellahi, Basma; Action Contre La Faim ; University of Health and Allied Sciences, Hohoe, Ghana ; Nepal Society of Obstetricians and Gynecologists ; University of Greenwich ; University of Chester (SAGE, 2016-03-07)
      Poor maternal nutrition during pregnancy may predispose to intrauterine growth restriction (IUGR), immunological and metabolic adaptations which manifest as low birth weight and increase the risk of adult non-communicable disease. This study examined the relationships between maternal nutritional status, food intake and pregnancy weight gain (PWG) which may account for risk of low birth weight (LBW) in Nepal.