Objectives: Obesity is an increasing problem among women of reproductive age (WRA) in urban sub-Saharan Africa (SSA), yet population-specific information on dietary risk factors is limited. The objective of this study was to derive dietary patterns (DPs) among WRAs in urban SSA and to examine their association with overweight and obesity.
Methods: We used baseline data from two prospective studies conducted among WRAs in Accra, Ghana (n = 2307, year = 2008-9) and Lilongwe, Malawi (n = 103, year = 2017-18). Diet was assessed using locally adapted food frequency questionnaires. Overweight was defined as body mass index (BMI) ≥25 kg/m2 and BMI <30 kg/m2, and obesity as BMI ≥30 kg/m2. DPs were derived using principal components analysis, and their association with overweight and obesity was assessed using generalized linear models controlling for age, education and wealth. Socio-demographic characteristics were examined across ordered DP quartiles/quintiles using a non-parametric test for trends (significance: P < 0.05).
Results: Two DPs were identified in both Ghana and Malawi, explaining 34% and 42% of dietary variance, respectively. In both samples, a protein DP was identified characterized by high intake of cereals, pulses, eggs, meat and poultry in Ghana and dairy, eggs, poultry, fats and sugar-sweetened beverages in Malawi. In addition, a healthy DP in Ghana showed high intake of fruit, nuts and dark green leafy vegetables, and a modern DP in Malawi showed high intake of sweets, processed foods, tubers, nuts and fruit. In both countries, higher education and wealth were associated with higher protein, healthy and modern DPs. In Ghana, higher protein DP was also associated with lower age and lower prevalence of underweight. DPs were not significantly (all P > 0.05) associated with overweight or obesity in either Ghana or Malawi.
Conclusions: Healthy and protein DPs characterized diets of urban WRA in Ghana, and protein and modern DPs in Malawi. Higher education and wealth were associated with higher DP quartiles/quintiles in both samples. The healthy DP in Ghana may reflect an earlier stage of the nutrition transition compared to the modern DP in Malawi (data collected ten years apart), or different food cultures and food varieties in the two countries. Further research is needed to understand the lack of association between DPs and obesity among urban WRAs in SSA.
Funding Sources: None.
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